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Caring Professions and Compassion Fatigue by Tycee Belcastro, M.A. LMFT & Dr. Katrina Katen, Psy.D

Prolonged exposure to other people’s trauma in a professional setting can result in secondary (or “vicarious”) trauma. This is compassion fatigue. Professionals in the caring fields are at high risk for experiencing the devastating mental and physical effects of this secondary trauma. Compassion fatigue is different than burnout. While both are related to stressful workloads and vocational environments, the key difference is that compassion fatigue results from being exposed to other people’s trauma. Warning signs can include a wide range of mental and physical symptoms such as: substance abuse, anger, depression, sleep disturbance, hypertension, immunity suppression, headaches, sadness, lack of drive, workaholism, social isolation, etc. Factors that increase the likelihood of developing compassion fatigue include: high stress levels, poor coping skills, lack of social support, insufficient self-care, a personal history of trauma, and poor interpersonal/emotional boundaries.

Burn Out Vs Compassion Fatigue: Burnout happens when you are over-working, and/or experiencing occupational stress. When you work very long hours in demanding work settings, potentially within systems that don’t work well, or fit with your personal value system, you are risk of burn-out. This can occur even when you love your work. Symptoms of burnout build slowly and add to normal life stressors. These symptoms bleed over into other aspects of life, impacting relationships, physical health, and mood. Burn out creates physical and emotional exhaustion, heightened feelings of pressure, and less overall life satisfaction. This can happen within any profession or occupation, leading to a loss of motivation, disinterest and low energy. Often, burn out can be helped by rest and rejuvenation, like taking a vacation, getting some rest, or receiving new training that re-energizes you.

Compassion Fatigue is a slightly different animal. Compassion Fatigue is caused by the consistent exposure to the suffering of others and to caring for these people. When your system is overwhelmed by input, and you feel out-of-control and helpless, PTSD symptoms can come on suddenly or at least appear to come on suddenly. With Compassion Fatigue, the symptoms of burnout are compounded with secondary traumatic stress. Not dealing with this can lead to lacking empathy and a robotic, detached, desensitized approach to your life and your work. Just as the “whole person” can be affected by compassion fatigue, the solution and the preventive measures also must encompass the whole self. In other words, attention and intention must be given to the mind, body, spirit, and heart.

Mind: Our thought process serves as a “filter.” Our thoughts reflect our conscious and unconscious, beliefs and programming. This programming underlies behavioral choices and impacts how we feel. Unconscious patterns of behavior can emerge in times of high stress (any time really) but certainly, you are more inclined toward to reactive, auto-pilot behavior in times of stress. Becoming self-aware is essential. Cognitive Behavioral Therapy (CBT) is an excellent way to become aware of and challenge faulty thinking and beliefs that no longer serve us.

Body: We all know that eating well, hydrating, exercising, and sleeping are essential to healthy functioning. However, too often we believe that if someone is not engaging in these healthy habits, they must lack self-discipline. This is often not the case. For most people, poor health habits are a signal of an underlying emotional issue. So, while changing health habits can be helpful, the greatest change comes when we examine why we were engaging in the unhealthy habit in the first place.

Spirit: Spirit, in this context, refers to an individual’s faith and connection to their bigger meaning. In caring professions, staying connected to our own personal “why” is essential. What is your “why”? When did you know that you wanted to be a nurse, counselor, doctor, first responder, a caregiver? Never forget…your “why” really does matter!

Heart: The emotional experience of a caregiving professional is a key contributor to compassion fatigue. In the moment of responding to others’ needs or managing a crisis, there is not time (nor are our brains wired) to pause for emotional reflection. So, we pack away emotions and put them on the shelf to deal with later. The key is that we must deal with them later. There is a book title that says it all: “Feelings Buried Alive Never Die” (by Karol K. Truman). It is essential that we find a way to process through and understand our emotions.

Strategies and Resources If you or someone you know is experiencing compassion fatigue, here is a list of things that can truly help:

The Mind:

• Reading

• Education and classes

• Meditation

• Learning to center yourself during a crisis without engaging in denial and dissociation

• Cognitive Behavioral Therapy (CBT)

• Morning pages (mind dump)

• Positive reinforcement

• Core routine

• Planning ahead

• Money management

• Studying Martial Arts

• Workshops and trainings

The Body

• Exercise

• Enjoyable activity

• Healthy diet

• Elimination of toxins

• Meditation

• Healthy sleep

• Healthy sexuality (massively stress relieving)

• Healthy posture

• Self-care habits and practices

The Spirit

• Spiritual and/or religious practice

• Connection to significant others

• Community and cooperation

• Participating in something greater than yourself

• Meditation

• Reading spiritual and inspirational work

• Creating or appreciation of art and beauty

• Time in nature

• Prayer

• Finding joy and play

• Connection to meaning and hope

• Yoga practice

The Heart

• Consistent individual therapy practice

• Group therapy

• Support and debriefing groups and opportunities

• Developing healthy and supportive friend relationships

• Developing healthy and supportive relationships with colleague

• Identifying your true values

• Journal practice

• Reading

• Identification of and learning to deal with your personal issues

• Offering support and nurturance to others - caring without taking on responsibility for others

• Learning to identify and understand healthy limits of responsibility

• Setting appropriate limits and boundaries

• Creating emotional safety with self and other

• Relationship skills

In addition, below are some resources that you may find beneficial:

• Man’s Search For Meaning, by Viktor Frankl

• On Death and Dying, Elisabeth Kübler-Ross

• Real Self-Care, by Pooja Lakshmin, MD

• The Relaxation Response, by Herbert Benson MD

• The Shocking Link Between Kindness & Illness!, YouTube presentation by Gabor Mate

• The Body Keeps The Score, by Bessel van der Kolk

• The Five Why’s Technique, Taiichi Ohno

• Loyalty To Your Soul, Ron and Mary Hulnick

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