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.

Why working in the caring professions can lead to burnout

The reality in the consulting room 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?