Compassion Fatigue

What is the cost of caring?

Our clinician Richard Zhang asks our industry what we are doing to protect ourselves from compassion fatigue and secondary traumatisation. Providing some crucial strategies to support both the professional and personal self, Richard builds our knowledge of self-care and capacity to self-support.

Compassion fatigue comes from the repeated and continual exposure to hearing others discuss traumatic events and the sufferings in their lives. Not only do we hear about traumatic stories in our day-to-day work, but we also experience indirect exposure to traumatic events through television and the internet. With this in mind, what’s the cost of caring? Even more so, how do we draw the line of protecting ourselves from ongoing compassion fatigue and secondary traumatisation while continuing to remain compassionately engaged each time when we see our clients and/or hear another disclosure of a traumatic event?

The cost of caring… awareness of risks and costs of one-way caring relationships

We often feel a sense of obligation and sometimes even a sense of personal commitment to help the children and families we work with. We want to provide assistance and support to the children we work with and the children in need. Having said that, when we work with vulnerable children and children who have experienced trauma, we can personally experience different reactions that reflect how difficult such work can be. The work in the trauma space demands a large capacity for compassion, empathy and commitment, and without the capacity to employ different methods to emotionally distance ourselves and regulate our feelings, our ability to provide empathic responses can be significantly taxed.

In the book ‘Supporting Traumatised Children and Teenagers’, the author Atle Dyregrov described several reactions among those who work with traumatised children and how those reactions affect our ability to remain compassionately engaged in the trauma space. For example, feelings of helplessness can quickly evolve when we know that there is nothing we can do to reverse the traumatic situation. We can often feel a sense of helplessness in addition to feelings like shame, guilt, and self-criticism, especially when we dwell on what more we could have done or what we could have done differently for the children and family we’ve worked with.

Our ability to provide compassionate response may also be jeopardised when our protective strategy such as the illusion of invulnerability falls apart, and the feelings of fear and anxiety that something bad will happen to ourselves or our own loved ones can increase. This change and increase in our own fear, anxiety and vulnerability, a consequence of hearing recurring traumatic stories, can hijack our capacity to provide compassionate responses. For some, that fear and anxiety can become so great and problematic it can begin to interfere with our life (e.g. continually needing to monitor and check up on our loved ones for no apparent reason).

The heavy trauma work can also shift our inner cognitions and expectations of the world, damaging our own feelings, beliefs, self-esteem, confidence and sense of safety. We can become cynical and pessimistic as we absorb the trauma through the eyes and ears of our clients.

It is also not uncommon that we suppress our emotions when we are repeatedly exposed to traumatic stories while working with clients in the trauma space. We often learn and prefer not to think about our feelings at work when we are on the go, but uncomfortable emotions such as anger, grief, and pain can surge when we come home to our safe space. Not only that, but listening to the painful accounts of traumatised children can also produce intrusive images and memories as if though we are reliving the events based on the accounts we’ve heard.

It is also important to recognise that our own trauma history, being in the early career stage paired with a high degree of trauma work, and insufficient self-care can also predispose us to compassion fatigue.

Staying alive personally and professionally

When we are not mindful of the consistent need for self-care, other-care may suffer. The term self-care is broad. It should mean different things to different people, but it’s a human requisite, and an ethical imperative. It should be viewed as an ongoing preventative activity and a priority of all professionals, especially for those working with, and constantly hearing stories from clients, that are saturated with themes of daily stress, grief, loss, anxiety, depression, and traumatic stress.

In the book ‘The resilient practitioner – burnout and compassion fatigue prevention and self-care strategies for the helping professions’, the authors discuss self-care from a professional and personal standpoint.

Supporting the professional self

Set limits

With work and information overload, it can seem like there is always too much to do. We can easily find ourselves working overtime, working weekends, constantly being on the phone, emails, meetings, and of course, the disappearance of boundaries. We must set the boundaries, and to do that, we must set realistic expectations and learn to say no.

Support from colleagues

Colleagues can be an important source of support. Have several colleagues that you can turn to for support and advice. Debriefing with colleagues can be an opportunity to talk about our thoughts, feelings, and reactions. Remember confidentiality does not prevent us from speaking about our own experiences.

Celebrate small wins

Too easily and too often we can get caught up in wanting to make big change and big difference for ourselves. And often this actually makes us feel more ambivalent and resistance about change and makes improvement less possible. Reducing expectations and focusing on small steps and celebrate small successes can be more empowering.

Long term development

Build professional care into a long term adventure of your career. Be open and nondefensive to new information and feedback. Find out ways for ongoing development. This can be done through professional development or self-development through reading, reflection, professional supervision from a senior or a mentor or a combination of these.

Focus on the controllable

Sometimes the work we do may not always be appreciated or recognised, and we may begin to wonder about the meaning of our work. It is important that we continue to reflect on our own expert knowledge and the working alliance that we can develop with our clients because they are the two dimensions we have control over.

Supporting the personal self

Self-compassion

Being kind and understanding towards ourselves in instances of hardships or failure rather than being self-critical. The practice of self-compassion promotes the ability to forgive ourselves and understand that imperfection is a part of human experience. It allows us to hold uncomfortable feelings and thoughts in mind, taking them just as thoughts or string of words rather than over-identifying with them.

Nurturing our values

Our values reflect what we find meaningful in life. They are what we care about and what we consider to be important. They can change over time, and they reflect how we want to engage with the world, and with people around us, and with ourselves. Consider what your values are, and think about what helps you feel connected with meaning and values. Knowing what our values are allows us to focus on action planning so that we can live a life that is guided by and aligned with our core values.

Supporting the recreational self

Explore and participate in hobbies, interests, and do the things that you find enjoyable. This is not a narcissistic luxury; it’s about replenishing our personal self, enhancing our mood, and reducing stress levels.

There are many other ways to self-care, and most of us will be familiar with the physical and the social self-care components such as eating well, getting enough sleeping, looking after our physical wellbeing, making sure we schedule in time for our friends, etc.

Remember we can’t pour from an empty cup! We must fill our own cups before we can fill the cups of the clients with work with.

Richard Zhang

Psychologist

Australian Childhood Trauma Group