Compassion Fatigue and Vicarious/Secondary Trauma in the Helping Profession

Medicine Moves Movement Psychotherapy and Counselling Services

Victoria, BC

The helping professions, including counsellors, social workers, nurses, police officers, paramedics, correctional workers, mental health workers, teachers and many others, are not without significant risks to the helper.  The nature of the work can be quite challenging as well as rewarding and can often result in profound psychological, social, emotional and spiritual change for the helper.  It is in how this change is processed that puts a counsellor or helper at risk for impairment.

Helper/counsellor impairment has yet to be precisely defined but the terms burnout, compassion fatigue and vicarious or secondary trauma are commonly used.  Burnout and compassion fatigue:

My candle burns at both ends;

It will not last the night;

But ahh my foes, and oh my friends, it gives a lovely light!

(Edna St. Vincent Millay)

Burnout and Compassion Fatigue:

That which once shone so brightly no more illuminates the world around it, and the shadows cast by the dimming are long and deep and dark.  Where once there was enthusiasm, conviction and compassion for helping others, only frustration, apathy and terrible loneliness remain. Paradoxically, the need to reach out and help is still there, but it is mired in a personal sense of reduced motivation, low energy and an overwhelming sense of futility and fraud (Kesler).

Burnout and compassion fatigue describe a phenomenon that shows symptoms of emotional depletion and a loss of motivation and commitment to one’s work.   It is a multidimensional concept that includes exhaustion, depersonalization of people we help and a felt sense of a lack of personal accomplishment.  Emotional exhaustion includes feelings of being overextended and depleted of one’s emotional resources.  Depersonalization describes a negative, callous or excessively detached response to other people.  Personal accomplishment refers to a decline in one’s feeling of competence and successful achievement in one’s work.  Simply put – burnout and compassion fatigue is a physical, mental and emotional exhaustion caused by long-term involvement with people in situations that are emotionally draining.

Specific symptoms of burnout and compassion fatigue can include depression, cynicism, detachment, loss of vitality, insomnia, loss of intimacy (social and sexual), impatience, anger at people we help, many somatic symptoms including tension and headaches, susceptibility to illness, apathy, substance abuse, self-harm, lower productivity, absenteeism and a decrease in client care.

Burnout and compassion fatigue progresses through four distinct stages, starting with a period of excessive enthusiasm wherein the counsellor/helper over identifies with, and is too available for, the client. Next, the helper starts to stagnate where their expectations decrease to more normal levels and personal dissatisfaction starts to surface from the undercurrents.  Helpers can become frustrated, their difficulties seem to multiply and they begin to withdraw from their clients emotionally and empathically.  Finally, counsellors can become apathetic, wherein depression and listlessness begins.

Burnout is mostly caused by external situational factors outside of the counsellor’s environmental control and that these are outside the range of normal human experiences.

There are certain situational factors that put a counsellor at increased risk for compassion fatigue.  Counsellors who have little social support, which acts as a buffer against stress, are more likely to be affected by this condition.  Helpers whose workload is excessive, not under their control and exposed to high levels of stress and emotional volatility from others are also at higher risk for impairment.

Specifically for counsellors, people who worked in a community agency or clinic were more likely to experience burnout than those in private practice.  Ultimately, it seems that the more control one has in the work place in setting the conditions of their work, the less likely they are to be affected by compassion fatigue and its resulting impairment.

The severity of the client’s problems, working with chronic clients, time limitations, job instability and long-term employment in the helping field were risk factors.  Specific to counsellors, working with resistant, coerced, traumatized and long-term clients in a time limited mental health clinic/agency, would be a recipe for severe burnout.

Some personal/internal factors can also influence the onset and severity of this condition with helpers.  Some helpers with high self esteem, or those who actively work to improve theirs, can minimize the external risk factors for impairment without necessarily having to leave their work environment.

It may also be that something about the helper’s “helper persona” can affect how/if compassion fatigue manifests itself.  If helpers infuse most or all of their identity in being a ‘helper” they put themselves at risk for not asking for help and support themselves when they most need it.  An individual’s beliefs, attitudes and behavior also affect the likelihood of burnout.  If they need to make the client feel better, do not like the clients they work with, isolate themselves from other professionals, over identify with clients, expect to receive gestures of gratitude from clients, setting exceptionally high goals for clients or possess perfectionist tendencies, they are more likely to experience compassion fatigue.

The process of compassion fatigue is from sustained and intense stressors couple with internal personal factors.  From a body and movement counselling perspective, looking at how the body reacts to stress would be helpful.  When the body senses emotional threat, the alarm reaction is automatically triggered as a survival response.  The pupils of the eyes dilate, the blood rushes to the extremities/limbs to fight or flee and the heart beats faster as adrenalin is released.  If the stress does not disappear, the body enters the resistance stage to recover from the initial bout of stress and to endure the stress to come.  This chronic stage continues to deplete physical and psychological resources.  If there is no relief and the individual cannot manage the stress, she or he enters exhaustion.  Exhaustion signals a depletion of all internal resources, despite old and new sources of stress confronting the system.  Adrenal burnout can be a co-occurring disorder.

Vicarious or Secondary Trauma:

Vicarious or secondary trauma is related to yet different than compassion fatigue.  It has the same symptoms as post-traumatic stress disorder (PTSD), depression and anxiety.  It disrupts the counsellor/helper’s self-protective beliefs about safety, control and predictability in the world.  It also includes the helper being a helpless witness to a client’s repetitive and harmful behavior and the onset of cynicism, despair and the loss of hope by the helper.

PTSD is said to occur when an individual experiences a traumatic event(s); reacts with intense fear, helplessness or horror and develops symptoms that last for at least a month.  The symptoms of PTSD include: recurrent and intrusive distressing recollections of the event such as dreams or feelings that the event was recurring and intense psychological distress at exposure to symbolic or similar stimuli of the traumatic event (i.e. if one was viciously attacked by a dog, the sound of a dog barking in the distance may trigger an intense response).  Other symptoms include persistent avoidance of any stimuli that reminds the person of the traumatic event; increased arousal such as insomnia; poor concentration/memory, hyper-vigilance or an exaggerated startle response.  Other problems that often co-occur with PTSD are substance abuse, depression, psychosomatic disorders, adjustment disorders and anti-social behavior.

While counsellors/helpers may not directly witness or experience the traumatic event(s) of their clients, vicarious traumatic experience is a normal response to empathic engagement with these clients and that the cause of this condition is in the nature of working with others who are directly traumatized.

McCann and Pearlman, who have done extensive research in this area, believe that all helpers who work with traumatized individuals will experience lasting changes in how they see and feel the world around them and that this will have a significant impact on their emotions, relationships and life in general.  The harm that these changes affect is dependent on what support and treatment the helper receives (just as the people they help) in  integrating and transforming these traumatic experience (direct or vicarious).

That transformation and integration includes the titrated, gentle and contained discharge of traumatic energy from the body while simultaneously helping the person work through the apparent incongruence between the traumatic event(s) and some core beliefs that most people hold as true:  a belief in personal invulnerability, the perception of the world and life as being meaningful and understandable and the view of the “self” in a positive way. Traumatic events directly confront some or all of these beliefs and until resolution and integration occurs, that same traumatic energy is perpetuated over and over in the body as is the traumatic event held in active memory – ruminating and obsessing – waiting and wanting release and resolution.

Recovery and healing takes time, patience and perseverance.  If impairment is severe, the best course of action a helper can take is to eliminate or drastically reduce the external stressors in the work place.  This may require a leave of absence, a modified return to work or in some cases leaving the work place permanently.  Psychotherapeutic treatment along with a comprehensive wellness plan are key components to manifest the long term and sustainable return to health, vitality and happiness.  Body/movement psychotherapies are especially effective in treating traumatic stress. They access the traumatic energy directly, allow for a healing release and/or transform the energetic holding patterns in the body into more healthy patterns of movement  while providing the psychological and emotional tools required to prevent the recurrence of habitual traumatic patterns of thinking, feeling and behaving to return to the self.

On a personal note I spent a significant amount of time and energy researching this topic during my graduate degree in counselling.  I have also experienced this debilitating and unfortunate condition as a result of working with highly impaired and wounded clients over many years in an unsupportive and unhealthy work environment(s).  Through a sustained treatment and healing process I have moved with, through and past that professional “dark night of the soul”  and have come to a place of health, vitality and joyfulness even in the face of an unjust and at times cruel world.

For those of us in the helping professions (emergency response workers, paramedics, mental health workers, counsellors, nurses, teachers, social workers, child protection workers, police officers, correctional/parole/probation officers etc.) where we are constant witness to the pain, suffering and cruelty of the human condition in the modern world we are at risk for compassion fatigue and/or vicarious/secondary trauma.  We are also, in some ways, the least likely to ask for help until things are very severe – we are supposed to be the helpers right!  Ultimately, despite our best efforts, we are of no real, meaningful or sustainable service to others when we do not honor our own health first.  Reach out for help if you need it.

Jim Kragtwyk M. Ed

Registered Clinical Counsellor (RCC)

Internationally Certified Addictions Counsellor (ICADC)

Victoria, BC

(250)-896-6683

jim@medicinemoves.ca

Category : Counselling Posted on October 13, 2010

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