What is Compassion Fatigue? This week on OnTopic with Empathia, host Kelly Parbs introduces herself and her guest, psychotherapist and author Philip Chard, to explain just how Compassion Fatigue begins to affect caregivers in all walks of life, both personal and professional, and reveal a few ways you can identify susceptibility and avoid what he calls the dreaded ‘rain-barrel’ effect.
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00;00;09;01 – 00;01;20;28
Welcome to OnTopic with Empathia! I’m your host, Kelly Parbs. I’m a licensed clinical social worker with over 35 years of working at Empathia, supporting individuals and organizations across the globe. Today on the show, we’re talking about compassion fatigue. Our guest today is Philip Chard. He is a practicing psychotherapist with over 35 years of experience in the field. In addition to having retired as CEO and President of Empathia, he has written an award winning weekly column titled ‘Out of My Mind’. As part of Phil’s experience in Mental Health, he has a great deal of knowledge on addressing compassion fatigue. Given it is such a hot topic today across the country, we will be providing insights as to how to identify and address compassion fatigue. I have to be honest with our listeners – Phil and I have known each other for many years and I’ve always been in awe of your depth of knowledge and your ability to share it with simplicity and then back it up with current research. Hello Phil, and thanks again for joining us!
00;01;21;03 – 00;01;23;08
Thanks, Kelly. I’ll do my best today.
00;01;23;16 – 00;01;27;28
Can you give our listeners an idea about what is compassion fatigue?
00;01;28;00 – 00;03;19;08
Sure. The term itself was initially researched by Charles Figley, who’s a physician, and he came up with his own kind of definition about it. And, you know, I’m just going to quote to you what he said. He said, “Compassion fatigue is a state that’s experienced by people who are helping other people or animals in distress. It’s an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.” And there’s a couple of essential words in there. And one of those or terms, rather, and one of those is secondary traumatic stress, because that’s really essentially what compassion fatigue is. You’re being traumatized emotionally by your exposure to suffering in others or in other animals as well. You know, but I to kind of give a I think a more a simpler kind of definition of it. I’d also like to quote Rachel Naomi Remen, who’s a physician. She actually wrote an interesting book called Kitchen Table Wisdom. And the way she defined compassion fatigue sort of was by saying that, you know, the idea that we can be immersed in emotional suffering and loss daily and not be touched by it is as unrealistic as expecting to walk through water without getting wet. So really, what happens with compassion fatigue is the individual who is in the helping or caregiving role and working with someone who’s, you know, distressed or suffering is going to begin to absorb into themselves, if you will, more and more of that emotionality and that over time, the compassion that they feel and extend to that other person can begin to wane and really reach the point where it’s gone altogether.
00;03;19;20 – 00;03;33;26
I really appreciate that- that definition. It makes it… it just makes it real, right? How- how can someone be exposed to suffering daily, like you said, and not be impacted? It kind of just gives people permission to be human.
00;03;34;05 – 00;04;25;25
Exactly. To go back to that term, secondary traumatic distress, that helps us to get a better sense of what this condition really is. You know, everybody’s heard about post-traumatic stress disorder or what we refer to as PTSD. And, you know, these two conditions, compassion, fatigue and PTSD do bear some similarities in the symptoms that they create in people. And also the fact that they’re both connected to emotional trauma. That’s their genesis. The difference, however, is that with PTSD, one has been the victim or a direct witness to the trauma inducing event, where with compassion fatigue, one has witnessed suffering in others rather than the event or happening that caused that suffering. So maybe that’s a helpful way to look at it as well.
00;04;26;00 – 00;04;39;25
Absolutely. So how can we be on the lookout for someone with compassion fatigue, maybe a coworker, maybe a loved one, maybe even ourselves? What are some of the common symptoms of this condition?
00;04;39;29 – 00;09;12;19
Well, is true in a lot of areas related to mental well-being. Symptoms often overlap. You know that you can see the same kinds of symptoms arising in people with different conditions. And as a result of that, it can be kind of difficult sometimes to figure out what it is that’s really going on with that individual. They may find it difficult to figure that out themselves. But we see the kind of symptoms that arise from compassion fatigue in what we call four domains of wounding, if you will. And those domains, in other words, where these symptoms show up, is in the body. The mind or how we think our cognitive experience, then our emotions and also our spiritual life. So some of the symptoms that we tend to see is, as you might expect with compassion fatigue, as your available capacity for that attribute, compassion begins to diminish. You start to lose the ability to extend it to others or even to care for others. And that can be a kind of a numbing, emotional, numbing that occurs where the person begins to feel less and less affected, if you will, because they’re protecting themselves from more and more of that negativity. Sometimes in people with compassion fatigue, we also see they become kind of preoccupied with the people that they’re trying to help. They’ll find themselves ruminating and thinking about those people, even when they’re not with them, and kind of rolling that over in their head. Many of them report feeling a kind of mental and sometimes even an accompanying physical exhaustion that goes with it. Hence the term fatigue. Many of them display a kind of angry and irritable demeanor at times kind of moodiness. And we do know that one of the symptoms of compassion fatigue is often depression. And depression often shows up as anger or irritability, particularly in males. We also know that people with this condition can have intrusive thoughts. They may kind of replay some of these interactions they have with people who are suffering. And those thoughts can sort of trigger more and more of these symptoms. Many report sleep problems. Some even feel that they get a kind of a startle response, sort of a jumpiness sometimes, which we also tend to see in folks with PTSD. So there’s one of those areas of overlap I was referring to. When it gets further on, you know, more serious, they may feel certain hopelessness about the work they’re doing. You know, like I’m not really making that much of a difference. There’s still all this suffering and I haven’t put a dent in it. Some of them start to avoid certain activities or situations or people that might trigger them or they sometimes feel a general withdrawal like people are, you know, tough for them to deal with. And they’re- they’re kind of- I’ve had one of them say to me, I’m really tired of hearing sad stories. So that individual starts to protect themselves from those stories by avoiding other people. Some folks also feel kind of like a failure as a helper. You know, I haven’t really made a difference. As I referred to, their productivity at work may go down. They might start feeling more and more of that emotional numbness that I was referring to. And this the ability to separate for themselves their personal life and their professional life blurred is that already is these days by technology becomes even more blurred and they seem to carry what happens at work into their personal life and have a lot of difficulty putting it, you know, off to the side and reengaging with their personal life independent of that sometimes, unfortunately, they also start to try different dysfunctional coping behaviors, you know, self-medicating, for example, with alcohol would be an example of that or overeating or other kinds of behaviors that are meant to soothe us. But in the long run, undermine our well-being. So those kind of things are very common symptoms We see, along with what you would expect with just a person who’s feeling increasingly disconnected from others and more and more withdrawn into themselves. Those are what we tend to see the most.
00;09;12;22 – 00;09;36;07
Gosh, I would imagine that that would be pretty scary. If you’re a person who had such passion for, you know, let’s say, nursing or some kind of helping profession, and then over time you find yourself not having that passion or or feeling that emotional numbness and having some of those symptoms that you mentioned. I would imagine that’s pretty scary and surprising for people to go through.
00;09;36;20 – 00;10;07;15
Good point. And many people, of course, in the helping professions are folks who hold that value very high. You know, that value being I want to be a force for good. I want to help other people. I want to relieve suffering. And when their efforts appear to be failing, at least in their minds in that regard, then it can be a real blow to them in terms of their whole value system and their sense of purpose in life and in their work.
00;10;07;23 – 00;10;13;03
So what kind of situations or activities might lead to compassion fatigue?
00;10;13;11 – 00;12;18;07
Well, we see it’s most common, you know, among those who are in the helping and caregiving professions or even roles. You don’t have to be a professional caregiver to get compassion fatigue by any means. But, you know, the kind of activities we tend to see occur in the work lives of health care professionals and and first responders, family caregivers is another area, veterinarians and other animal helpers. And even folks who are involved in social and environmental justice movements, you know, which I’m going to talk a little bit about later. But in most instances, these individuals are witnessing and engaged with the suffering in other people or animals. So consider physicians and nurses and other allied health professionals who work almost exclusively with people who are chronically or seriously ill or or whose conditions cause deep physical or emotional suffering. That’s a kind of situation where we see a high prevalence of compassion fatigue, or it could be a family member, you know, who’s caring for a loved one who is in pain or despair, or perhaps there’s a little hope of improvement in that person’s condition. Could be a, you know, a rescue worker who’s exposed to the suffering of animals who are victimized by cruelty and abuse. Or it could even be another example of a situation might be a social worker who’s in Child Protective Services, who witnesses neglect and abuse of children. So there are lots and lots of situations that can trigger compassion fatigue in people, whether they’re professionals or they’re just family members who are in the caregiving role. And unfortunately, then there are very many examples of these situations. Any situation basically that involves a significant amount of human suffering, both emotional suffering, physical suffering, or both has the capacity. When we witness it, when we engage with these people? It has that ability to induce compassion fatigue.
00;12;18;17 – 00;12;48;13
I’m sure we have listeners who are saying, uh-oh, I’m definitely on that list of people who are at risk for developing compassion fatigue. I mean, okay, I’ll be honest, as a counselor who responds to trauma, I’m- I’m on that list! I want to make sure that we spend some time on how to protect ourselves from being vulnerable. So I’ll be sure to come back to that. But first, I’m wondering, how is compassion fatigue different from burnout or just general fatigue?
00;12;48;16 – 00;14;37;18
Well, there is a difference for sure. I mean, burnout results from basically, you know, too much to do and too little time to do it. It’s task overload, time crunch kind of condition. And as a result of that, the individual begins to feel like I just have too much to do. I don’t have enough time or energy to get it done and things back up, and then they begin to feel like their energy is gone for handling all this stuff. And so burnout can occur in tandem with compassion fatigue. But these two conditions are distinct. Compassion fatigue can co-mingle sometimes with another condition that we call moral injury. This issue arises when someone feels kind of compelled, if you will, to work in ways that are not consistent with their moral values. The way they feel people should be treated. For example, maybe they’re working in a system that makes it difficult for them to devote the time and attention to someone who is suffering. And because, you know, relieving suffering is one of their values, they begin to feel almost like they don’t have integrity around what they’re doing. That often leads to cynicism and withdrawal. So an example of moral injury might be a physician, for example, who’s highly dedicated to delivering excellent patient care. But because there are certain kind of institutional constraints or scheduling issues, that person lacks the capacity to meet their own standard of care in this regard. And we call that moral injury because they feel like I’m not really being true to my values in my work. So burnout and moral injury are kind of related in some ways to compassion fatigue, but they also are different in a fairly distinct way.
00;14;37;26 – 00;15;26;04
I really appreciate you talking about moral injury. That’s a term that I’ve heard come up a lot, especially in the- in the past couple of years. And I’m relating so much to what you’re seeing. I’ve worked with a lot of nurses and doctors who are exposed, of course, to so much suffering, but they don’t necessarily have the staff or enough hours in the day to ease all of that suffering. And- and I’ve had nurses in my office crying saying I feel so guilty because I know how to help. I have the skills to help. I just I don’t have enough hours in the day and I just really need time to sleep or time to be away from my job and away from my family or with I’m sorry, with my family. And so that’s such a conflict for them.
00;15;26;12 – 00;15;52;04
Yes, it is. And that has prompted some health care organizations to take a hard look at their practice design, meaning how people are organized and the systems are organized for the work they’re doing, and trying to create an environment where people like the nurses you’re referring to really do have the time and energy to attend to the emotional as well as the physical needs of their patients.
00;15;52;10 – 00;16;11;09
The symptoms of compassion fatigue seem very similar, as you mentioned to those of depression and anxiety, for example, difficulty with sleep, difficulty with concentration. Can compassion fatigue lead to more serious mental health issues such as depression or anxiety?
00;16;11;11 – 00;21;04;23
It definitely can, and I think maybe this would be a good place to talk about people who are risk for developing compassion fatigue more than others. There are certain individuals that are at higher risk in this regard based on elements of their own personality even. And those people are most at risk for compassion fatigue, leading to some kind of more serious mental health issue. So it’s kind of as a preamble to answering that question. I’d like to just real quickly touch on those risk factors. And one of them is if the individual themselves has had a history of emotional trauma in their own lives, we refer to childhood trauma these days with a kind of euphemistic phrase which is adverse childhood experiences or events. But if you’ve had a history of trauma as a child or at any point in your life, really, then part of what can happen when you’re dealing with somebody else who’s been emotionally traumatized is it can trigger and reconnect you, if you will, with that prior trauma of your own. The other people that seem to be at high risk are what we call highly sensitive persons, or some people call them HSP’s. And we think this is roughly about 15 to 20% of the population. These people are sometimes referred to as empaths because they have such a pronounced capacity for empathy. And as a result of that, highly sensitive people tend to absorb a lot of the emotions of the people around them. And we know that a significant number of HSP’s end up in helping and serving professions. And so you what you’ve got is this combination of a lot of really sensitive people working in an environment where that sensitivity can sometimes backfire on them if they’re, again, dealing with compassion fatigue. The other thing is, if the people are dealing with what we call a no win scenario, that means that despite their efforts, the individual they’re working with isn’t really going to improve or there’s not going to be a good outcome. And so those no win kind of situations and we see that sometimes with family caregivers who are caring for someone in the family, maybe who has Alzheimer’s would be an example of that. It’s not going to get better. There’s not necessarily going to be a happy ending. And yet they have to continue to do their best. A couple other risk factors Low social supports, one of them. So if this individual doesn’t have good, strong social connections that help them with their own emotional issues, then that can be a risk factor as well as perfectionism. You know, this idea of it’s never good enough can really get in the way of what we often say, which is you got to have a good enough mentality sometimes when you’re working with folks again who are not necessarily going to improve. And the other thing we see that’s a risk factor and we’ll get into this as well is diminished self care. So if somebody is sacrificing their personal well-being and the things that they do to maintain that in order to care for others and you see this a lot in home caregiving situations, that’s also definitely a risk factor for developing those. So to go from those risk factors to, you know, can compassion fatigue lead to a serious mental health issue? Again, the answer is clearly, yes, it can and it does. You know, even folks who, you know, might otherwise not be at risk of a mental disorder could develop one if they experience compassion fatigue too intensely and for too- too long a period of time. And then, of course, those who are already suffer a preexisting mental or emotional issue, you know, often find it significantly aggravated when they get into a secondary traumatic distress kind of situation. So, you know, we all have limits. And, you know, in mental health, we sometimes we call it the rain barrel effect, you know, as the rain barrel slowly fills with water, you know, the barrel can still hold the water in place. But a point reached where the water level is poised at the top, you know, right on the rim. And it only takes one more drop, you know, to send it cascading down the sides of the barrel. So this can kind of occur in folks who have compassion fatigue that they leave untreated and unaddressed. You know, they may be feeling I maintaining I’m, you know, holding. I’m guy I got it under control. And then one more event comes along that negatively impacts them. And you know that at that point over they go and the mental break can lead to really debilitating impacts, sometimes even suicide.
00;21;05;03 – 00;21;31;10
This information highlights how very important it is for us to… to stop and take a look and take inventory of ourselves and- and check ourselves to see are we vulnerable or at risk for compassion fatigue; do we have any of these symptoms? And so, Phil, for some people, compassion fatigue shows up in their relationships. How might compassion fatigue impact personal relationships and overall well-being?
00;21;31;16 – 00;24;02;13
Yeah, it very much often shows up in our relationships, not just the ones at work if we’re in a professional capacity, but also, you know, at home and friendships and so on. Those impacts can be profound sometimes and very destabilizing to relationships. You know, try as they may and want to spouses and sometimes, you know, other family, friends, whatever, They really cannot grasp what someone with compassion fatigue is going through unless, of course, they’ve experienced it themselves or, you know, at work in an environment where they are exposed to it. So that’s why folks with this condition often turn to colleagues for sharing and support, because the people that they work with do get it. You know, they’re going through the same kinds of experiences. But when they go home sometimes or what they do with their friends and they start talking about it, they can sense that it’s really not getting across. These people can’t, even if they want to really grasp what’s going on with the individual who’s suffering this kind of fatigue. So when they’re talking to their colleagues or people at work who do get it, then the person doesn’t have to struggle, you know, to explain what’s going on because their coworkers get it. They can almost talk in code about it and understand each other. So the net effect on other relationships then can be emotional distancing, you know, withdrawal, feeling misunderstood. And so on. And that can increase a person’s sense of isolation. Like I’m in this all on my own. You know, it’s- it’s all on me, which is a contributing factor to intensifying the fatigue experience. The other thing to be aware of is that compassion fatigue seems to be what we call a whole person wound, if you will, meaning it impacts us individually on the level of our physical well-being and our mental well-being, emotional and spiritual as well. So it has this really powerful capacity to undermine our well-being at all these levels. You know, we feel it in our bodies. We can sense it in the way we think and how our minds are working and the attitude and perspectives that we endorse, we can feel in our emotional responses to things. And then it also has an impact on our sense of spirituality or faith or life philosophy. So the impact on well-being can be profound.
00;24;03;00 – 00;24;09;04
Phil, how has the pandemic and its associated stressors contributed to compassion fatigue?
00;24;09;10 – 00;25;30;19
Sadly, a great deal. You know, we know that the population wide rates of like anxiety and depression have more than tripled since the onset of the COVID pandemic. And there’s some evidence that these already high levels of distress are even greater among helping professionals and family caregivers. So the COVID pandemic has had a tremendous impact in that it’s caused more widespread suffering and death and generated basically more settings and situations that kind of lend themselves to inflicting compassion fatigue on caregivers. There’s just more suffering out there. So unfortunately, there’s more situations that can create this condition in helpers. So health care and mental health professionals, you know, in particular during the pandemic have been exposed to a lot greater incidence, if you will, of suffering than they saw and experienced prior to the onset of the pandemic. So this in part kind of accounts for- for many of these caregivers leaving their professions or particular job roles because, you know, they simply can’t handle the impacts that compassion fatigue is having on their lives and their well-being.
00;25;30;23 – 00;26;04;15
You’re reminding me of a doctor that I worked with maybe a year ago, and she said to me that working through the pandemic felt like she was chipping away at her soul. All this work was chipping away at her soul. And I thought that was such powerful language and really highlighted how difficult the pandemic has been for her professionally and personally. How does compassion fatigue affect professionals and helping roles specifically such as health care workers, social workers and counselors?
00;26;04;18 – 00;28;48;19
Yeah, good question. And I’ll get to that in a second. But I want to go back to what you just said about chipping away at my soul. A very powerful element of compassion fatigue is how it can change an individual’s sense of their life philosophy, their faith, their spirituality, and lead them towards a kind of cynicism. You know, it just doesn’t matter, what’s the use, why try kind of thinking. What’s it all about? I don’t get it. It doesn’t make sense to me anymore. Those kinds of feelings in people sort of represent that crossover zone, if you will, between compassion fatigue and what we were referring to earlier as moral injury. So we know that in addition to its, you know, mental and physical and emotional impacts, compassion fatigue can have a profound impact on the way we look at life and the way we look at ourselves in life. So the example you gave is- is very much appropriate to this point. To go back to your question, though, how does compassion fatigue affect professionals helping roles? These are among the most affected professional groups like health care workers, social workers, counselors. And I also would add people who are in veterinary services and animal welfare are also group where we see a lot of compassion fatigue. In addition to kind of messing with the mental health of these individuals, their physical well-being and their relationships also suffer. And sometimes it compels them again to leave their job or even the profession altogether. There’s been some interesting data coming out where they were asking physicians who’ve suffered during the COVID pandemic and the compassion fatigue that came from that. They asked them if you had to do it all over again, would you go into medicine? And a shocking percentage of them said no. So you can see the how that impact occurs in these kinds of folks, in these helping roles and, you know, this turnover or leaving the profession altogether, you know, in response to a wave of compassion fatigue due to COVID is really hobbled many helping organizations. And they’ve been, you know, really hard pressed to staff up to a level that is efficient and that, as we talked about before, can also cause compassion fatigue. So you can see how this is a vicious cycle as more people leave, the people who are left have less time and energy to care for their patients or family members, whomever it is that they’re working with. And as a result of that, it becomes a kind of vicious cycle.
00;28;49;01 – 00;29;45;11
Phil, you’re reminding me of a situation that I personally went through as a counselor. I was supporting an organization and many individuals. I probably served over 100 individuals over the course of the week following a fatal helicopter crash. Of course, it was terribly sad, but I left with a sense of satisfaction that I had helped people, and I actually felt pretty good about it. Good about the work that I had done. So then while I was on the airplane heading home, I leaned my head back with that sigh of relief. After a long job, and out of nowhere I felt tears just streaming down my face. And it was a surprise to me because I really wasn’t feeling particularly sad. But there are those tears were. And looking back, you know, I wonder if that was compassion fatigue, sneaking up on me a bit, you know, What do you think was happening there, Phil?
00;29;45;21 – 00;32;23;05
Well, you know, much of our mental processing in our emotional processing occurs initially outside of our conscious awareness and sort of lives in the so-called subconscious mind, or we know the majority of that processing occurs outside of our awareness. And so sometimes when we’re engaged in something like you were, you know, your focus is on these affected individuals and how you can help them. And so you are taking your own emotional responses to the situation and compartmentalizing. You’re sort of putting them off to the side in a box, if you will, a mental box and saying, I’ll deal with that later. I got something else here I need to do, help these people. And so then when you’re out of that situation, you have time to actually hit the pause button, as it were. Then that compartmentalization can cease. You reconnect with your own feelings about what you went through, and then you have your own emotional response. That’s not necessarily indicative of compassion fatigue. But if those kind of things happened over and over and you’re not practicing adequate self-care and you’re getting too much exposure, it could certainly lead to it. You know, there’s something else interesting, what you said there. People in the helping professions, again, as we talked about, I many of them are highly sensitive people. They’re empathic, they absorb the feelings of others. They work a lot, obviously, with people were suffering is common, but they also are responsive to something that you referred to that we call compassion satisfaction. This kind of means that people like yourself and many others in the helping professions, they feel a sense of satisfaction and in personal fulfillment, you know, when they’re able to show compassion for those in distress, and even if just in a small way relieve the suffering of those people. So they’re a little bit like the proverbial moth alert to the flame, as you well know, this desire to help and the satisfaction that comes from being able to do it is what draws people into that kind of work. And so that’s the happy side of this. This whole discussion is that feeling of why I made a difference, which is what you had after you had that caregiving experience with the folks from the crash. So compassion satisfaction is why is sort of the impetus bitwise between why we do this work sometimes. But when we lose that, when the satisfaction starts to go away, then we know we may be getting into a danger zone.
00;32;23;11 – 00;33;45;12
Phil, thank you so much for joining us today to talk about this with our listeners. We really appreciate it. This episode is part one of my conversation with Philip Chard. Come back next time for part two, when Phil and I will discuss evidence based strategies on addressing and prevention of compassion fatigue. To hear that episode and other episodes of OnTopic with Empathia, visit our website, empathia.com. Follow us on social media at Empathia and subscribe to OnTopic with Empathia to hear new episodes as soon as they go live. I’m Kelly Parbs. Thanks for listening to OnTopic with Empathia.