It has been recognised for some time now that people working in the helping professions are almost inevitably affected by the work that they do. This is particularly the case for those whose job it is to hear stories of high distress, disadvantage and trauma. Over time, workers can find themselves responding in ways that are not helpful to themselves or their clients. This can look very different for different workers and different contexts, but commonly workers report either losing their compassion for clients, or getting over-involved and losing a sense of boundary between work and personal life. Practitioners can even develop some of the trauma symptoms that their clients are experiencing. However, it is not all bad news: apart from research about what tends to be called compassion fatigue and vicarious trauma, there has emerged more recently some evidence that there can be positive effects of the work as well. Practitioners report being inspired by their clients’ resilience, developing a new appreciation of what is available to them in their own lives, and having a refreshed belief in the work that they do. This has been referred to as ‘Compassion Satisfaction’. Further, it has become clearer that one can both enjoy and feel committed to their work at the same time as experiencing some negative impacts of the work. So that Compassion Fatigue and Compassion Satisfaction can co-exist. This distinguishes it from the phenomenon of ‘Burnout’, which involves an experience of complete emptiness and exhaustion.
So how is it that some practitioners can work for years with highly distressed and traumatised clients and not show any apparent signs of compassion fatigue, while others of us find ourselves thinking about our clients over the weekends, dreading seeing particular clients, experiencing physical symptoms, having worrying work-related dreams, doing less of what is good for us, etc.? What leads to sustainability in our clinical work, and what is more likely to have us feel that we have reached our ‘use-by’ date?
The answer to this question is complex, involving a number of factors at various levels – personal, professional and organisational. In other words, our own personal resources, the client groups we work with and our professional practices, and resources available to us within the organisations we work for all contribute to the impacts, both positive and negative, of the work that we do. An important thing to remember is that this work can affect any one of us, from those new to the work to those who have been in it for years. It is not about weakness or being in the wrong job: it is about being human, and wanting to do more than it is often possible to do. One researcher, Charles Figley, refers to Compassion Fatigue as “the cost of caring”. Paradoxically, the very things that make us good at our jobs can also leave us vulnerable to being negatively impacted by the work.
How does worker self-care fit into this picture?
This is one very active contribution that practitioners can make to their own professional life, in such a way that they experience not just ‘surviving’ but ‘thriving’ in the work over time. Self-care is much more than that general plan we all have in our heads about what we need to do in the future to feel better, less exhausted, less stressed at work (which usually involves New Year-type resolutions like drinking less, exercising more, getting to bed earlier, spending more time with the family…..). It involves a review of our relationship to every aspect of our working life, as well as the balance between this and our personal life.
There are some things in our work that we have no control over, but in the sections that follow, we will look at some things that are possible to do to enhance your sustainability and optimise the resources that you bring to your work (which has to be better both for you and for your clients!)
Firstly, some definitions
Compassion Fatigue - Charles Figley used this term to describe the natural array of experiences that can arise from this type of work. Also known as Secondary Traumatic Stress, compassion fatigue is a natural response to being a caring, empathic worker and is likely to be experienced to varying degrees by most of us at some stage in our careers. Compassion Fatigue can affect almost every aspect of your well-being: there can be
- Nervous system arousal
- Sleep disturbance
- An increase in emotionality
- A decrease in cognitive functioning
- Behavioural and judgment impairment
- A decreased sense of trust, and a loss of hope
- Spiritual and social impacts (for example, isolation and loss of morale)
Vicarious Traumatisation – has been defined as “the transformation that occurs in the inner experience of the therapist (or worker) that comes about as a result of empathic engagement with clients’ trauma material” (Pearlman and Saakvitne, 1995). That is, when another person experiences symptoms of traumatic stress as if the trauma was their own. For example, workers who bear witness to their clients’ stories of trauma may experience nightmares, intrusive images, or obsessive thoughts, or disruption to previously held assumptions and beliefs about the world.
Compassion fatigue tends to have a more gradual onset, or builds over time, whereas Vicarious Traumatisation is usually are more rapid onset in response to a particular event.
Burnout - this has three dimensions: emotional exhaustion, depersonalisation (a negative attitude toward clients, a personal detachment, or loss of ideals) and reduced personal accomplishment and commitment to the profession (Maslach, 1993). Workers experiencing burnout usually describe themselves as “having nothing left”, “empty”, or “completely exhausted.” Burnout can affect workers in many areas, not just in the helping professions.
From this point, we will use the term Compassion Fatigue to summarise the normal, negative effects that our work can have on us.