Compassion Fatigue in the Caring Professions
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Burnout, though possible in all careers, is something that caring professionals like therapists and social workers may need to take extra care over
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Therapist Veena Ganapathy offers her insight into compassion fatigue and how to protect against it
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If you are experiencing secondary traumatic stress or compassion fatigue, find a therapist here
Empathy and compassion may be considered desirable, even essential, attributes in those of us working within the caring professions. A responsive and attentive approach can be therapeutically beneficial in supporting individuals experiencing emotional distress. Here, though, I will consider the impact on practitioners as we attempt to offer an emotionally-attuned, compassionate and client-centred response.
There is a growing conversation about the potential for compassion fatigue (also known as secondary traumatic stress) in those who support others through psychological or physical injury or ill-health. Burnout can be experienced in any job but research suggests those in helping professions can be particularly at risk. Characterised by apathy, a sense of detachment or hopelessness and a compromised capacity to meet the demands of work, burnout can be powerfully impactful on the emotional and mental wellbeing of those working in helping roles.
My perspective comes from my current work as a psychotherapist and my previous role as a psychiatric social worker. As a therapist, I am invited to attend and help give meaning to – and hopefully, release from - the trauma the people with whom I work have experienced or currently face. I work by being emotionally available as clients engage with their internal struggles and hope that together, we can find words to give shape to their internal narratives and allow healing and growth to take the place of suffering. It is a privilege to be entrusted with bearing witness to what is both unique and universal, personal and shared.
The reality in the consulting room, nevertheless, is that often our clients and we are in touch with the torment, the pain, the wordless anguish of what it means to be human. The therapy space can be – and indeed often is - the only one in which individuals may feel safe or supported enough to be in touch with these aspects of their inner self. As an NHS social worker, I supported adults experiencing serious psychiatric symptoms such as hallucinations and paranoia, who self-harmed and made suicide attempts and who were often unable or unwilling to engage with services. I witnessed first-hand the budget cuts and woefully limited resources that exacerbated the enormous pressures my colleagues and I were under.
The themes of loss, death and endings in particular are ever-present when working with relationships and the human condition. As a therapist, social worker and in a previous role as Cruse Bereavement Care counsellor, I am and often was in the presence of raw and visceral emotions. Issues of death, loss and mortality can connect people to the very core of themselves. Therapists and other caring professionals are not exempt from these experiences.
It is not difficult to imagine the levels of work-related stress, apathy or despondency many professionals can experience, and the self-destructive coping strategies that can be compelling. A clinical consideration for me, then, is how to balance being therapeutically responsive without feeling entirely overwhelmed in the presence of emotional distress and other intense feeling.
In an attempt to respond, and at the risk of playing into the cliche of therapists answering questions with further questions, I find myself formulating more queries, not answers. Perhaps we have a professional responsibility to ask ourselves these difficult questions and continually add to our thinking in response to what emerges.
- How do we as practitioners in the helping professions contribute meaningfully to people’s mental, physical and psychological recovery without experiencing compassion fatigue or a feeling of overwhelm and disillusionment?
- How do we protect ourselves from the effects of vicarious trauma, when we are working so intimately with people who are themselves traumatised?
- How can we meet our professional responsibilities without feeling wholly or overly responsible?
As a therapist working to the ethical and professional guidance of member organisations such as the UK Council for Psychotherapy (UKCP) and the British Association for Counselling and Psychotherapy (BACP), there are clear guidelines and recommendations on practising care of self and fostering adequate resilience and resources to be able to carry out our duties. Counsellors and therapists are also required to be engaged with regular clinical supervision to ensure that the work being done is ethical, boundaried and promotes the wellbeing of our clients. I consider these stipulations and recommendations part of the therapy framework; ways of keeping client and therapist safe and supported.
Given the potential to feel adversely affected, I also think it is necessary to find our own ways to manage the demands of the work. Given the isolation and intensity that so often accompany working in the caring professions, creativity is key. With issues of confidentiality and sensitivity rightly at the forefront, ‘water-cooler conversations’ or a chat with family or friends about our day at work can be minimal. It can often be professionally and personally bolstering to engage in peer support, or to reach out to online and in-person groups. Engagement at events, conferences and workshops can, as well as inform of latest thinking on therapeutic matters, also remind us of our connectedness to a professional community. Many therapists complement client work with teaching, supervising, even writing.
A commitment to personal therapy is part of the requirements of most counselling and therapy trainings. This deeper engagement with the self hopefully allows us as practitioners to understand ourselves better and also reflect on what we may be feeling in our work. This enables us to separate out what may be arising in us that is our clients’ material and what may be evoked in relation to our own areas of distress or pain. This self-reflection can be profoundly helpful both in keeping our therapeutic engagement focused on our clients, and in helping us process our own emotional responses. It can strengthen our capacity to bear what is felt to be unbearable, both in the people we see and in ourselves. When our resilience and robustness can be nurtured in these ways, it is less likely that we may turn to unhealthy coping methods or find our emotional or physical health being compromised. Alongside recognising what our clients may be needing, we can be mindful of what we as professionals might also be requiring. This creates the possibility of finding ways to meet those deeper needs and wishes in healthy, conscious ways that safe-guard our clients whilst also protecting our integrity, health and capacity for this work.
Engaging in activities that feed different aspects of us can also build our resilience and capacity to cope. It may be that a physical activity, for example, can ‘take us out of our heads’ and give relief from embodied pain. (Apparently, psychotherapists and counsellors often suffer back and neck pain because of all that sitting in ‘active-listening’ positions!). Mindfulness and meditation practices can have profound effects on wellbeing and enhance our tolerance for bearing difficult feelings in ourselves and in those we work with. Finding what feeds the spirit and soothes the soul can build up our ‘internal resources’ and replenish our professional capabilities. As the old saying goes, ‘You cannot serve from an empty vessel.’
Additionally, all of us who work in the caring professions also exist as members of wider communities, as citizens both local and global. We are embedded in the social and cultural fabric of our surroundings, just as the people with whom we work are. We, like our clients, feel the powerful collective forces that shape political, environmental and societal climates. Just as it is with our client’s inner worlds, however, the challenge then is to remain open without being overwhelmed.
So, as we consider how to keep ourselves responsive and resilient so we can continue to do the work that we do, perhaps it is fitting that even as we seek clarity and answers, we raise questions. Perhaps we can allow the possibility of a more fluid exploration that better reflects the complexities of the therapeutic and wider world we live in, and consider this a place from which to move forward rather than a destination arrived at.
Veena Ganapathy is a verified welldoing.org therapist in SE1, London
