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 Caregivers may become withdrawn from personal relationships,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.________________________________________________________________________________
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.
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.


