During the pandemic, providers across healthcare fields were struggling to remain motivated and hopeful. There were increased talks of compassion fatigue, burn-out, secondary stress (review my blog on this here), moral injury, and self-care. But what do these terms really mean? How do we differentiate between them? And what do we do to cope? In this blog, I’ll be tackling compassion fatigue. I’ll discuss moral injury and burn-out in the future.

What is Compassion Fatigue?

Sinclair et al., (2017) conducted a meta-narrative review of healthcare literature focused on compassion fatigue. The analysis found that the definition of compassion fatigue has significantly changed over time and is overused. As such, there is no consensus on what it means. And what meaning it does hold, has been diluted. In turn, there is little research on compassion fatigue in health care generally and even less in mental health care. As a result, we don’t really know all that much about it, how to prevent it, and how to cope once we have it. Interestingly, they also found that the primary measure of compassion fatigue, the Professional Quality of Life Scale, doesn’t directly measure constructs of compassion.

Definitions

Compassion fatigue was first studied among nurses. It was defined as having difficulty providing compassionate care because of the impact of working with traumatized persons.  Later definitions clarified that compassion fatigue stemmed from “feeling overwhelmed” by the work. This was distinguished from “being afraid” of the work, which was deemed more of an indication of secondary-stress or burn-out. And being afraid or having secondary stress or burn-out, could in turn cause compassion fatigue. It’s a bit of a snake eating its tail situation.

Dowling (2018), in work with veterinarians, argued that compassion can’t fatigue.  Rather, clinicians experience “empathetic distress.” Empathetic distress occurs when there is an overidentification with a client’s suffering. The clinician then desires to pull away from that suffering for self-perseveration.

Symptoms

Symptoms of compassion fatigue occur on physical, social, cognitive, and emotional levels. It looks a lot like depression, anxiety, grief, and trauma. Thus, according to Stoewen (2020; another veterinarian medicine researcher), compassion fatigue disturbs the ability to think clearly, modulate emotions, feel effective and maintain hope. 

Meaning

Chan (2023) applied Victor Frankel’s logotherapy to social work education and training. These efforts addressed the relationship between our sense of meaning in life and our sense of efficacy, and meaning, in our work. The greater a sense of meaning, the more resilient we are to burn-out and compassion fatigue. Conversely, our sense of meaning in our work can be jeopardized when we are overwhelmed by the suffering we face.

A New Definition

Chan’s work got me thinking. 

What if compassion fatigue is about losing connection to the meaning of our work? And in turn, struggling with the existential suffering this disconnect creates? 

My Experience

Christmas 2019, I had my first experience with compassion fatigue. Amidst the celebrations, I felt intensely overwhelmed by the vast suffering of the world, including my own.

The last few years of my personal life had been particularly difficult.  Most significantly, my father died from a rare lung disease. My first day back from work after his death, I learned that during my time off, a client’s close family member, who helped raise them, had died. I coped by showing up for my client as best I could.  I kept my grief to myself. I was in not state to be regulated and effective with such a disclosure. To share would detract from her time and the care she deserved to receive. I counted down the minutes until the session was over, took a few minutes to cry, gather myself, and then started my next appointment.

At that point in my career, I had been a staff psychologist in the outpatient mental health clinic at the VA for about a year and half. The three years prior I worked on the VA inpatient unit. In both settings, I specialized in working with folks struggling with active suicidal ideation and chronic self-harm who had survived multiple traumas across their lifetimes. I was passionate about this work and skilled at navigating the emotional intensities that the job required. My clients often couldn’t see their way through their pain. It was my job to guide them there and to hold the hope for healing. And while I firmly believed that healing was possible, to maintain this hope in the face of so much suffering, took its toll. I also knew that I couldn’t help everyone. This is a difficult reality to face, and accept, for anyone in healing professions.

The Starfish Analogy   

That Christmas, my friend shared with me the Starfish Analogy. Coincidently, another friend had shared this same analogy just weeks prior. The analogy goes like this. Imagine you are along a beach littered with starfish that have washed ashore.  You bring as many back to the ocean as you can.  You stop, becoming overwhelmed and hopeless by how many more starfish there are to save.  Instead of giving up, you appreciate the power and importance of being able to save the ones you can.  For those individual starfish, being brought back to the ocean was everything. 

This analogy was, and remains, an anchor for me. When I started my private practice, one of those same friends gifted me a glass starfish as decoration for my new office. It is a daily reminder to stay grounded in what I can do, and to remember how significant that is.

How do we cope with Compassion Fatigue?

Compassion fatigue doesn’t come out of know where. And it rarely exists in a vacuum. My compassion fatigue was absolutely correlated to and influenced by my grief. I was confronted by what I couldn’t control and who I couldn’t help. And I had to, by my own stubbornness and value system, remain hopeful for my clients , even when I struggled to see the light at the end of the tunnel. No one thing got me through that period. And probably no one thing will do the trick for you. We often need a combination of self-reflection and compassion, grace and patience, support and community, movement, and connecting to who we are outside our role as healers.

This list is not exhaustive. Take what works for you. Leave what doesn’t. Add your own ideas.

• Find the metaphors, symbols, quotes, song lyrics., etc. that work for you (and know they will not be the end all be all).
• Celebrate the wins.
• Utilize consultation and supervision. 
• Let yourself feel.  Cry and rant when you need to. Talk to a supportive friend.
• Journal. Ask yourself the tough questions – Check out The Resilient Clinician for a list of self-reflection prompts.
• Move and get the stress out of your body.
• Remember who you are outside of work.
• Take a social media break. 
• Go to therapy.
• Make a change in your work setting; the population you serve, etc.
• Seek Community Care. We are not meant to do this alone. Consider We Heal Together for inspiration.

For Clinicians: If you are struggling with compassion fatigue, I see you. You didn’t do anything wrong to get here. It happens. And it is essential to take this seriously. I hope this blog helped you recognize the signs and gave you some inspiration for what you can do.

For Those Seeking Healing: As I discussed in my secondary stress blog, I hope what you’ve read here doesn’t scare you away from getting your needs met in therapy. It is not your responsibility to assess, manage, or try to influence you’re provider’s well-being. Share your concerns. Talk it out.