Tag Archives: empathy

Physician heal thyself…

And nurses, counselors, therapists, caregivers, social workers, case managers, community health workers, teachers, first responders, peer outreach… in short any person who spends their time (work or volunteer) opening themselves to the experiences of others’ suffering. In a recent continuing education exercise, I was asked to examine myself for resilience and potential risk of compassion fatigue. The simple act of participating in the exercise and completing the assignments for the course reminded me of the very great risk that people in caring roles face of suffering from the “cost of caring.” Amy Cunningham speaks of this beautifully and concisely in a Ted Talk, describing what this cost can be and toll it takes (link in the credits below, totally worth the viewing).

Many of us who work and volunteer in roles of service have adopted the philosophy that self-denial in pursuit of career, advancement, and the care of others is to be admired. Self-sacrifice is applauded and rewarded. Going above and beyond is the expectation. Adding insult to the expected self-injury is that we are frequently also required to be above the consequences or be able to physic our own resulting ailments. To a certain extent, I can agree with admiring dedication and industry. A good work ethic is absolutely to be admired. However, there is a fine line between a good work ethic and good self-care. I occasionally use that line as a jump rope (more about that later). For those of you in the caring professions, and a few of you who are not,  you have likely heard the term “compassion fatigue.” You may also have heard this described as secondary traumatization or vicarious trauma. What many people think of when folks talk about stress related to caring for others is burnout. I want to tell you now, that these are different concepts, related but decidedly not the same.

As caring professionals, we frequently are exposed to the traumatic experiences and information that can be shocking, depressing, or even devastating just being exposed to it, hearing it, visualizing it, and empathizing with the victims in our care. Empathy is one of the most important tools of the caring professions, but there is a cost involved in being empathic day after day. Repeated exposure or even just one event that triggers some recognition or identification becomes a lived sensory experience that transports the care giver into the realm of the victim. Some professionals begin experiencing symptoms of traumatic stress, much like those of the people who have been involved in critical incidents or crises. Different than counter-transference where the experience mirrors or parallels experiences from their own lives or triggers emotional reactivity in the part of the caregiver because of personal history, they respond with stress related symptoms purely out of empathy for the situation of those they assist. The frequency or intensity of just experiencing the trauma through the eyes of the individual they are helping is sufficient to trigger signs and symptoms. This is compassion fatigue. It is not my intent in this post to give all the specific signs and symptoms of traumatic stress, but in broad strokes, it has physical, cognitive, behavioral, emotional, and spiritual impact. It can impact relationships. It can impact efficacy as a professional.

Ok… I hear you saying, “but that sounds a lot like burnout.” Here is the most significant difference: Victims of burnout have gotten to the point that they just want to give up. They have nothing left to give, no space to absorb. They have exhausted their energy, empathy, and passion, like a bulb that was used until failure or a battery run past minimum charge. The way most experts in this topic differentiate between compassion fatigue and burnout is that people who have gotten to the point of burnout frequently no longer want to practice their profession or calling. While compassion fatigue results in risks for the professional and their clients due to potential boundary concerns and difficulty managing the stress they experience, burnout can lead to the loss of empathy and resentment towards those for whom they once cared. Professionals and volunteers with burnout can become callous and appear uncaring or harsh. It can result in errors of omission in services rendered and potential harm to patients or clients.

The important piece of this puzzle is that neither of these conditions are unavoidable. Taking the appropriate actions in self-care, consultation, and support can provide preventative measures to avoid the pitfalls of vicarious trauma and even help bring caring professionals back from the brink of burnout.

Insight into your own needs and responses can be the best preventative measure. Watch for your own signs of drowning: Irritability, sleeplessness, dread going on shift, numbness to any and all emotional content (personal or professional), rumination and inability to let go at the end of the day, fatigue, isolation, using (or abusing) alcohol or drugs… You know your own signs best. Self-awareness is the best primary defense, but when we fail to see our own symptoms, it is good to have the buddy system. Friends, family, colleagues are often great at noticing when you are “not yourself.”

Over the years, I have gotten to be much better at spotting my own particular signs of distress (and knowing how to combat these signs). When my natural defense system is on emotional overload, I fall back on my introversion and a combination of task and avoidance oriented coping (You thought task and avoidance would be mutually exclusive, didn’t you?). When I start running a tad low, I tend to become more task-oriented, workaholic, and isolating. I avoid situations and people that require my emotional presence. I tend to shut people out if it isn’t work related, and I let things go that are my best forms of self-care: Running, gym time, sleep, meditation, and play… yes play. Adult or not, we all need recreation. It helps us rejuvenate our cognitive processes. But when I’m overdrawing my emotional and empathic accounts due to work or personal stressors, these self-care processes always seem to be the first to go. I know myself well enough (after, the unspecified number of years I will admit to being on the planet) that I recognize when things in my life have gotten out of hand and I have reached that aggregate limit. When this happens, I try to fill my time and avoid any activities that might let my mind drift to the very topics or memories that hurt… and yet theses topics and memories are likely the very ones that probably need most to be taken out, examined, and processed. With that self-awareness, I also know that timing is key. If I push myself too soon, it doesn’t serve the best purpose, but if I leave it too long, my self imposed exile becomes way to comfortable and I won’t want to rejoin the world. This is where that support network comes in handy. Friends and colleagues who know me best are also the best at dragging me back out of any caves I might crawl into and encouraging the self-care I’ve probably been neglecting.

For you, my readers, I encourage an honest self examination and evaluation. Be ruthless. Be thorough, and try to recall how you handle critical events and times of intense stress. Evaluate time and outcome. How did it work? List the coping strategies that you have in your toolbox, and objectively determine whether they are truly helpful or maybe not so much.

Prevention is a keystone to good health and good mental health. Restorative and preventative exercises can divert compassion fatigue from become burnout. It is important to get rest, exercise, nutrition, and time away from constant exposure to shared trauma and the histories that recount horrific occurrences. Most jobs and deployments have leave or paid time away. It is there for a reason. Take a break. Use that time. Most importantly, it is crucial to have appropriate training, refresher courses, supervision, and/or consultation. Carrying the burden can get extra heavy, and consultation (or supervision) provides ethical opportunities to identify and address challenging aspects of situations that may trigger stress. It is important to employ your ethical decision making model and engage with colleagues who can be objective and provide good clinical counterpoint. Professional colleagues can often provide support to each other and offer insight when we get overwhelmed in our own empathic response.

Lastly, I would encourage those of you out there caring for others to remember your own natural supports: Family and friends. We often have to be concerned with confidentiality, and we also wish to protect the ones we love from some of the things we see, hear, and experience. However, don’t shut them out. You need not share details of information gained under the cloak of privacy and confidentiality (or when the story is just too terrible), but you can share your own feelings and fears. You can explain your own reactions without having to give details of the stimuli. Stay connected to humanity, especially your own. That can give you a life jacket to prevent drowning in empathy, and regardless of the proverbial command in the title, it is completely unnecessary to heal yourself.

Amy Cunningham presents on Ted Talks, Drowning in Empathy. http://edu.ava360.com/drowning-in-empathy-the-cost-of-vicarious-trauma-amy-cunningham-tedxsanantonio_d7a4359c8.html


Empathy, Sympathy, and Apathy walk into a bar…


…It took a moment to get the feel of the place.

Three words, all with similar word origins and roots, but oh the difference. People throw words around these days with little regard of what is really going on behind them.

For most people it is those first two words that they get all tangled up. As a therapist, empathy is one of the tools of the trade, but too many in the field confuse sympathy with empathy. Too many clients expect sympathy and don’t understand when they get empathy… and vice versa. I can understand the confusion, honestly. It’s all about definitions. Empathy has one, but sympathy has two… and that second definition is just close enough to empathy to create the difficulty.

Before we drop down that rabbit hole, let’s take a look at where all these words came from…

Well, that’s simple. Greek. Pathos. The word that literally means emotion and feeling. What becomes important then is the prefix added to it. The ’em’ from empathy literally means ‘in.’ So, empathy becomes ‘in feeling.’ The ‘sym’ of sympathy actually comes from a different prefix ‘sun’ meaning ‘with.’ Sympathy is actually ‘with feeling.’ (For like two seconds I wanted to say “Once more…”) You see the difference? Maybe not… I’ll ramble on a bit further.

You see, I’ve actually been playing around with this post or the concept of it for a while. Observing various roles of the health and mental health fields, you garner a lot of information about how different people approach interactions with patients (clients, consumers, members… whatever the title for the people who need care). I’ve watched fledgling therapists, social workers, psychologists, and counselors struggle with the concept of empathy. I’ve seen nurses and doctors approach bedside manner with a sledgehammer draped in sympathetic camouflage. It is meant to convey to a patient that the provider cares about what is going on with them, but what ends up actually occurring is a sense of pity. That the provider maybe feels sorry for them… even if they really don’t.

So, why is that even a problem? Well, as I heard it said very well recently, the difference between empathy and sympathy is that empathy draws people together and sympathy distances people from each other.

To have empathy for a person, you have to actually let your guard down. You have to let your self actually feel or experience some part of what the other is feeling. You have to get into their feelings with them. “But how can I do that if I’ve never experienced what they have?” Well… that’s the trick about empathy. You don’t have to experience the exact same circumstances to recognize pain, sadness, or even joy and happiness. You can go to your own chest of emotional memories and realize that it might be something like what that other person is feeling. Why is that hard? Well, it makes us vulnerable. It creates a sense of shared experience that can almost be intimate (No, not sexual, pull your mind out of the gutter). I mean that exposing rawness of emotion to anyone and becoming vulnerable, even for a little while can be just a little scary.

So, what is wrong with sympathy? It’s the right thing to do, isn’t it? We send sympathy cards, and we express our sympathy… It isn’t really that it is wrong, but when sympathy is offered, it is from the outside looking in or from the sidelines. It is me standing over here well apart from you and what you are going through and saying “I’m sorry,” but without being there with you or providing any other support. So, instead it can come across more as “Wow, sucks to be you. Glad I’m way over here.” Sympathy often accompanies the strong urge to “fix it” as well, and while there may be opportunities for solution-focused approaches, this isn’t generally what is needed immediately… and definitely not from someone who hasn’t shown an understanding for what is happening. The jump to solving a problem without understanding just feels like dismissal to someone in pain. It can feel like the equivalent of a person on a luxury yacht coming along side a person treading water trying not to drown and critiquing their technique from the boatdeck. It doesn’t really help and highlights the differences between you.

Not everyone can get to a place of empathy. It just isn’t in their wheelhouse. Most people today are so stuck in their own heads they are blind to the emotions of others around them, even those near and dear. Sometimes, sympathy is a good enough approximation if it is given with authenticity and without the “Mr. Fix-it” approach. This is where that other definition comes into the picture. Symppathy can also mean a common understanding between people. Sounds a lot like how empathy was defined. The subtle difference is the lack of emotional content. While empathy feels with the person, sympathy sorta intellectually acknowledges understanding of what they are going through. It’s subtle, but the difference is there, but again, sometimes that is all you can muster, and that is ok. Certainly it is better than apathy… and so we come to the mean girl (or douchebag) of the trio.

This one’s etymology should be pretty easy for most: “A-“, when not performing as the initial letter of the alphabet or a guest star on Sesame Street, means “not” or “without” in Greek. So, a- plus pathos is “without feeling.” Being apathetic means you don’t care. Now, I misspoke saying it is the mean girl or douchebag implying it is somehow entirely negative. That really isn’t true. You can have no strong feeling about something without that being a particularly bad thing. However, in our modern, hyperbolic, social-media (and media in general) fueled society, apathy has come to mean something very negative. It has come to represent people who would stand by and watch while others are violated. It has come to mean people who let injustice reign out of the “Meh, it doesn’t really matter to me” attitude. Or it is a symptom of depression and other mental disorders… no, literally, it is a descriptor of affect that is sometimes found on mental status exams. The word is often used when we want to illustrate someone that has “given up.” Apathy has become associated with defeat or disinterest… or worse yet a dismissal and dislike of something (or someone) to the point of “not caring” if it (they) cease to exist. That, honestly, is taking apathy to a way more active level than the word originally started out to be. But are we just giving poor apathy a bad rep? Do we really need to have heightened passions about every blessed thing and in every circumstance? Honestly, I’m not sure. I think that we’ve come too far in the evolution of vocabulary to start changing anyone’s mind about it now, but I think that we need to be more specific when we say “I don’t really have feelings one way or another,” and make sure that we don’t mean “I actually have very strong feelings about that in a negative way and I wish you would shut up about it.”

And… that pretty much covers our three friends walking into a bar. Maybe some of you (or most of you) already understood the difference. Maybe you are apathetic to the whole issue. Maybe you can empathize or at least share some sympathy for my irritation when people misuse the words. Hopefully you won’t get them confused if you run into them at that bar.