Are the problems of clients, family members, or congregation members weighing you down so that you are finding normal life difficult? You may have compassion fatigue. Compassion fatigue is a relatively new construct first used by Joinson (1992) in Nursing magazine to describe the condition of nurses who were exhausted from their daily care of patients in an emergency department. Additional concepts of compassion fatigue were later expounded upon by Figley (1995) as he noted the impact of trauma on the families of veterans. Figley (1995) labeled this as secondary traumatic stress and defined it as “the stress resulting from helping or wanting to help a traumatized or suffering person” (p. 7). The term secondary traumatic stress is often used synonymously with compassion fatigue.

Compassion fatigue results from efforts of the caregiver to be compassionate and empathetic with those who are suffering and as such place themselves at risk for becoming traumatized in the process. The symptoms of compassion fatigue often show up without any warning creating a sense of helplessness, shock, and confusion along with a sense of isolation in the midst of the process (Figley, 2007). Additional factors manifesting themselves in the caregiver are prolonged working hours, sacrifice of self, and poor self-care. Clearly there is a “cost” in caregiving and secondary suffering can be a result.

Symptoms

Because caregivers lean on the emotions of compassion and empathy, they are likely to carry the trauma of the person cared for into other areas of their lives. The symptoms of compassion fatigue are:

• decreased concentration
• decreased self-esteem
• disorientation
• apathy
• rigidity
• perfectionism
• preoccupation with the traumatic material of those cared for

There may also be irritability, mood swings, withdrawal behaviors, sleep disturbances, elevated startle responses, and hypervigilance. Emotional symptoms associated with compassion fatigue vary from increased anxiety, guilt, powerlessness, anger, rage, numbness, fear, helplessness and sadness (Dutton & Rubinstein, 1995). Somatic symptoms vary from shock, sweating, rapid heartbeat, breathing difficulties, and dizziness to increased medical problems. Caregivers may become withdrawn from personal relationships, have decreased interests in intimacy and sex, abuse drugs, display mistrust, complain of loneliness or increased personal conflicts (Beaton & Murphy, 1995). In the work setting, others may observe low worker morale, low motivation, avoidance of work tasks, apathy, negativity, increased absenteeism, exhaustion, irritability, and increased withdrawal from colleagues. The impact of trauma on the spiritual realm causes one to question the meaning of life as the caregiver experiences a loss of purpose, experiences anger at God, questions prior religious beliefs and shows a greater skepticism about their religion while trying to find meaning in the midst of their traumatic experience (Lahad, 2000; Pearlman & Saakvitne, 1995).

Compassion Satisfaction

Not all who care for others are negatively affected. Stamm (2005) introduced the term compassion satisfaction to describe “the pleasure you derive from being able to do your work well” (p. 5). The joy and satisfaction gained from helping others grants the caregiver a special ability “to be sustained in the face of potentially distressing work” (Stamm & Figley, 2002). Those who have compassion satisfaction have lower rates of compassion fatigue.

Compassion Fatigue Prevention Strategies

All caregivers will be affected in some manner by the care that they give. As such, the importance of self-care cannot be underestimated. The following are some suggestions for the prevention of compassion fatigue from Gentry (2002):

• Become more informed about compassion fatigue.
• Join a traumatic stress study group.
• Begin an exercise program.
• Teach your friends and peers how to support you.
• Develop your spiritual connections.
• Bring your life into balance.
• Develop an artistic or sporting hobby.
• Be kind to yourself.
• Seek short-term treatment from a qualified mental health provider or a trained pastoral counselor (Gentry, 2002, pp. 37-61).

Treatment Strategies

For counselors who work with those who may be suffering from compassion fatigue the first place to start would be to assess for compassion fatigue symptoms in the caregiver. The Professional Quality of Life Scale: Compassion Satisfaction and Subscales – Revision IV (ProQOL) is available at: www.isu.edu/~bhstamm/tests.htm.  The ProQOL and its scoring sheet is free and can give the counselor valuable feedback in assessing for compassion fatigue in the client. An examination of the history of the caregiver is a critical step in treating compassion fatigue as researchers have found that a personal history of a traumatic experience can contribute to the experience of compassion fatigue (Meyers & Cornille, 2002). Counselors can assist helpers to examine the role that their previous traumatic material has on making them vulnerable to the experience of compassion fatigue. Supportive environments go a long way in the treatment of and prevention of compassion fatigue. Therapists can encourage workers towards individual therapy, work-support groups for debriefing, and compassion fatigue support groups. Care should also be given to the management of stress and maintenance of balance in the caregiver’s life. Finally, counselees should be encouraged towards incorporating the word “no” more into their vocabulary. Those who care for others are often called upon because of their caring gift. An occasional “no” may go a long way in providing the caregiver the time necessary for self-care; in turn, they will have energy to care for others in the future without incorporating the risk of compassion fatigue into their lives.
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References

Beaton, R. D., & Murphy, S. A. (1995). Working with people in crisis: Research implications.
In C. R. Figley (Ed.). Compassion fatigue: Secondary traumatic stress in helpers (pp.51-81). New York: Brunner/Mazel.

Dutton, M. A., & Rubinstein, F. L. (1995). Working with people with PTSD: Research 
implications. In C. R. Figley (Ed.), Compassion fatigue: Secondary traumatic stress
disorder in helpers. (pp. 82-100). New York: Brunner/Mazel.

Figley, C. R. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in
 those who treat the traumatized. New York: Brunner/Mazel.

Figley, C. R. (2007). The art and science of caring for others without forgetting self-care. Article
retrieved 5/5/2008 at http://www.giftfromwithin.org/html/artscien.html.

Gentry, J. E. (2002). Compassion fatigue: The crucible of transformation. The Journal of
 Traumatic Stress, 1(3-4), 37-61.

Joinson, C. (1992). Coping with compassion fatigue. Nursing, 22(4), 116-122.
Lahad, M. (2000). Darkness over the abyss: Supervising crisis intervention teams following
disaster. Traumatology, 6, 273-293.

Meyers, T. W., & Cornille. (2002). The work of working with traumatized children. In C. R.
Figley (Ed.), (2002). Treating compassion fatigue. New York: Brunner/Mazel.

Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist. New York: Norton.

Stamm, B. H. (2005). The ProQOL Manual: The professional quality of life scale: Compassion
satisfaction, burnout, and compassion fatigue/secondary trauma scales. Lutherville, MD:
Sidran Press.

Stamm, B. H. (2002). Measuring Compassion Satisfaction as Well as Fatigue: Developmental
History of the Compassion Fatigue and Satisfaction Test. In C.R. Figley (Ed.). (pp.107-
119). Treating compassion fatigue. New York: Brunner Mazel.

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Merrill Reese is a student in the Doctoral Program in Counselor Education & Supervision at Regent University. He has spent the past year as an instructor in the master’s program in counseling at Regent and will assume a faculty role as an Assistant Professor commencing Fall 2008. His areas of specialization include loss and bereavement, stress and trauma, and grief. You can reach Mr. Reese at merrree@regent.edu.

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