Introduction
Compassion Fatigue – also known as secondary traumatic stress and vicarious trauma – is pervasive in the helping profession; particularly with care giving professionals who have a high degree of exposure to patients who are experiencing some form of psychological, medical or social trauma and who are trauma survivors themselves.
In a 2004 article called “Compassion Fatigue Following the September 11th Terrorist Attacks: A Study of Secondary Trauma Among New York City Social Workers,” it is noted that “…[M]ental health professionals working with traumatized clients were at greater risk for CF, controlling for demographic factors, personal trauma history, social support and work environment factors…We suggest that the important variables in predicting CF include degree of exposure, personal history, social support, and work environment factors.”
While this article focuses on the mental health professional, I believe compassion fatigue is not exclusive to mental health professionals and is found in virtually every healthcare specialty, particularly those who engage in helping others.
Degree of Exposure
Degree of exposure to another person’s trauma may be a little more difficult to estimate than one might think. How many of our patients are trauma survivors? Which diagnostic categories are most associated with trauma? Is trauma limited to clients with a formal diagnosis of PTSD or is trauma present in other diagnostic categories such as depression, family violence, marital discord, personality disorders and substance abuse to name a few? What about social and medical trauma?
Degree of exposure may also include the nature, length, frequency and intensity of contact with trauma survivors. I recently gave a workshop on compassion fatigue to counselors working in a correctional facility. In this closed environment where the frequency and intensity of contact was high, these counselors experienced frequent symptoms that are associated with vicarious trauma such as abuse of chemicals, spending less time with clients, tardiness and absenteeism, making professional errors, being critical of others and depersonalizing clients.
Personal History
One of the questions I almost always ask in my workshops is: How many of us in the counseling profession have experienced personal trauma? The answer I hear back most often is 85%, which is actually higher than the 66% for psychotherapists as estimated by Pearlman and Saakvitne in their book “Trauma and the Therapist,” which focuses on countertransference issues in psychotherapy with incest survivors. How can a personal history of trauma place a counselor at higher risk for compassion fatigue?
In “The Body Bears the Burden” by Dr. Robert Scaer, the concept of “emotional kindling” is introduced which he describes as a: “self-sustaining feedback circuit” to explain a type of emotional “spontaneous combustion.” Those of us with a personal history of trauma may be more susceptible to spontaneous emotional combustion when working with trauma survivors, whether that is in the form of an explosion or implosion, because we have a built in, emotional hyper-sensitivity to traumatic stress; particularly if our patient’s trauma is similar to what we have experienced in our own past personal history.
Social Support
One of the first jobs I had right out of graduate school was working as a crisis counselor in a very busy inner-city emergency room. I can still recall trying to explain to my family and friends some of the experiences I had working with acutely traumatized patients and the blank look that would come over their faces or the outright exclamation that I must be mistaken or exaggerating. After a while I stopped trying to explain my experiences and would spend most of my leisure time either alone or with co-workers, as we would descend at times into dark humor about our patients.
Isolation and withdrawal from our support network is a telling sign of compassion fatigue. As we begin to unconsciously internalize the traumatic experiences of our clients, our frame of reference begins to change, from inclusion to exclusion. In a workshop I gave for outreach crisis workers that was co-sponsored by the police department, one of the officers shared that over a period of time police officers would often experience a progressive sense of isolation excluding everyone else from their circle of trust except other officers. The same is often true for care givers.
Work Environment Factors
Are there certain conditions at work that can either contribute to or help ameliorate compassion fatigue? In an unpublished report called “Vicarious Traumatization and Burnout Survey Report” Mary Louise Gould, Med., author and consultant states: “Wherever trauma work is happening, the setting itself is another crucial variable. This is true for the professional as well as for the survivor, both of whom need to feel safe and supported within the work environment.”
How often are survivor counselors attracted to work environments that may (unconsciously) resemble their family of origin? Freud said: “You will repeat instead of remember.” As I look back now I realize I should have been somewhat alarmed at the ease in which I slipped into the chaotic, unpredictable and at times even dangerous conditions that accompanied my role as a crisis counselor in an inner-city emergency department; a perfect fit for a survivor of physical and emotional abuse. My awareness was limited only by my willingness and ability to be honest with myself, to accept ownership for my thoughts, feelings and behavior and to express who I deeply felt myself to be.
Three Principles for Healing
From the forward of my book, “Breath of Relief: Transforming Compassion Fatigue into Flow,” I outline three principles that I believe are essential for healing and transformation. They are: Self-honesty, personal responsibility and self-expression. These principles will be the subject of my next article: Compassion Fatigue: Principles for Transformation.
Karl D. LaRowe M.A., LCSW is a licensed clinical social worker who learned about compassion fatigue from his experience burning out as a crisis counselor in a busy inner city emergency room. He has written a book: “Breath of Relief: Transforming Compassion Fatigue into Flow and developed numerous mind/body techniques based on Qigong he learned from a master in Singapore. He now presents talks, workshops and consultations on how to transform compassion fatigue into positive energy flow. His website is: www.compassionstrengths.com.
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