Risks and Solutions for Compassion Fatigue

Perhaps nothing more than compassion fatigue causes more helpers to prematurely exit their fields.  First responders are generally seen as the most at risk for compassion fatigue (and possibly PTSD), followed by emergency room medical staff. A third group, medical and clinical staff working with high risk terminally-prone patients is also highly impacted. The risk increases as the age and observed suffering of the clinical population decreases.

Clinicians (psychologists, clinical social workers, addictions counselor, mental health counselors, and art therapists) are negatively impacted by both the serious suffering they “witness” in their psychotherapy sessions, suicide and homicide risks,  increasing liability problems, AND by relatively poor funding for the needed services they provide.  As a norm behavioral health funding lags far behind medical funding in person-hours of services delivered. This ever-present dearth of adequate financial supports translates into these helpers spending more time doing the ever-growing bureaucratic demands of health care. I have always been amazed at what I call “organic bureaucracy”  in health care services.  Apparently, there is enough new money for more administrators, clerks and software reporting/tracking/auditing programs, but not enough to make the jobs of clinicians more efficient and practical.  The more time clinicians are required by funders and regulators to work on paper and EMRs, the less time they have to help their clients CHANGE. When clients change they tend to use less health care services, thus saving money. For example, many studies have documented that effective substance abuse treatment services save more money for states/governments than they cost to deliver – and yes these studies have been replicated. One would think that with the epidemic of mass-killings by gunfire in the United States and the out-of-control addictions here (5% of the world’s population using 60-70% of the world’s opioids), that funding sources would increase resources in this important psychological-health area – but it is not happening. Lots of big talk, but very little big action.

What is Compassion Fatigue?

Let’s take a look at what companion fatigue is and some of the known causes. Along with vicarious and secondary traumatic stress, compassion fatigue eats up the emotional and physical energies required to do this difficult psychological work.  Work dread and tired irritability slowly replace the inner joy that once came with the work.  Sadness, powerlessness, anxiety and depression may eventually occur in the exhausted helper. Where once their was high reinforcement and sympathetic joy to do the job, now there is more disappointment and resentment.  As the worker enters compassion fatigue, his/her error rate increases; as one’s error rate increases there is more job stress, job insecurity and client risk/liability. Clinical supervisors, who once helped to shield their supervisees from the administrative and emotional “trauma” of doing this relatively-lower paid job, are now also caught up in the BIG machine of utilization and documentation requirements. Some less than effective supervisors actually become the primary source of clinician stress on the job. It all becomes one ball of pain and suffering with its own feedback loops.

What are Some of the Causes of Compassion Fatigue?

I will simply list some well-known causes here:

1. Personal inability to leave the emotions of the job at work;
2. Over-exposure to clients’ traumatic experiences, especially if the helper has unresolved trauma;
3. Short-staffing patterns due to funding realities;
4. Longer hours at the job, especially in non-clinical work duties;
5. Lack of human validation experiences and personal power at work;
6. Weak personal boundaries with clients, which cause client experiences to be internalized more;
7. Emotional triggering of one’s own suffering in life (people, places, things, senses, object relations, etc.);
8. Taking on more work – not taking breaks, not eating lunch in a healthy way, adding shifts, etc.;
9. Weak self-care practices, and an inability to apply them mindfully;
10. Mindlessness in the pressure and rush of it all;
11. Excessive guilt for not being able to reduce a client’s suffering as much as you had wished to;
12. Repeating automatic negative thoughts and feelings related to work roles and duties;
13. Over-identification with client stories and emotions, perhaps stimulating your own attachment reality;
14. Dehumanization of clients or black humor about clients – a sure sign of coming or present burnout;
15. Experiencing more psycho-physical symptoms of stress reactivity, thus causing more stress;
16. Self-medication behaviors as an effort to reduce your own emotional suffering; etc. etc.

What Can be Done to Reduce Compassion Fatigue?

I will simply lost some well-known supports and possible solutions here:

1. Always apply more self-compassion (if you do not know how to, get help to learn how to);
2. Practice boundary-making rituals when you leave your work location;
3. Become more active advocating for improved behavioral health funding (state and national);
4. Learn self-validating skills, and actively validate and emotionally-support co-workers;
5. Perhaps practice anonymous random acts of kindness at work;
6. Try not to overload yourself with high-trauma clients, and get help for yourself if necessary;
7. Practice “enough is enough” by not taking on additional voluntary work;
8. Get very serious about implementing self-care practices – and be mindful about it, schedule it;
9. Learn and practice mindfulness skills (breathing, stretching, meditation, yoga, mindful walking)
10. Do more regular, daily exercise;
11. Use disputation skills from cognitive therapy for auto-pilot negative thinking;
12. Be aware of devaluation of clients, and catch yourself mindfully BEFORE you engage in it;
13. Try to notice something positive in every client you work with – include co-workers;
14. Spend more time in nature;
15. Share your feelings with a trusted colleague or friend;
16. Transform your experience into personal writing, journaling, poetry, art, etc.
17. Practice mindfulness-based stress reductions skills often (meditation, yoga, etc.);
18. Obtain professional help with your stress reactivity and, especially, with self-medication behaviors; and,
19. Begin to value yourself more – like and love yourself as much as possible.

By Anthony R. Quintiliani, PhD., LADC

From the Eleanor R. Liebman Center for Secular Meditation in Monkton, Vermont

Author of Mindful Happiness  

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