A View From the Watchroom
Barry K. Wyrick, MS, MBA
Chief Operating Officer
Compassion Fatigue (10/25/13)
For those of us who work in the helping professions, the very fact that we touch intense pain on a daily basis can take a devastating toll on our own lives. Let me share one of my poems from my book of poetry, Of Rats and Rhinos .
West Chester Counseling Center
The phone rings—
A mother praying for her son,
A wife crying through blackened eyes,
A teacher holding a child’s bruised hand.
At nine Monday
Her thoughts are frantic,
today crowds tomorrow,
self-hate steals success.
She takes my mind—
arranging, restating, achieving.
At one Wednesday
A couple cries together,
words bitten off in anger,
dreams dashed on broken promises.
They take my heart—
caring, holding, loving again.
At four Thursday
He talks of self-destruction,
help flees in panic,
hope slips through undecided fingers.
He takes my soul—
believing, planning, finding meaning.
At five Friday
I clean my desk,
service reports to the in-box,
appointment book to the briefcase.
Home to my own life—
mindless, heartless, without soul.
Last post I talked about the fact that if counselors did not take care of their businesses, they were not good to anyone because they would go out of business. Today, I am talking about another reason that counselors can end up being no good to anyone—compassion fatigue. Compassion fatigue has been defined in the helping services field as the gradual lessening of compassion over time. It is caused by the long-term exposure to intense pain and suffering. It is differentiated from burnout in that burnout is usually an interplay between interpersonal and organizational factors, while compassion fatigue is an interpersonal risk for those in the helping professions.
Those of us in the counseling profession deal with intense pain and suffering on a daily basis. When our clients walk through our door, they bring their pain with them. Regardless of our theoretical approach to working with our clients, touching this much pain on a routine basis eventually starts to hurt. If we work from a self-psychology model, we allow our clients to borrow a portion of our ego strength to repair their lives; but just like library books that are borrowed, we never get all of it back. If we work from a client-centered approach, we “hold hands” with our clients while they experience a journey of self-discovery and growth; but holding hands with someone in pain breaks our heart a little each day. Even if we work from a cognitive-behavioral model where we help our clients examine their thoughts and behaviors that contribute to their pain, we still get our hands dirty working with that pain. Ultimately, caring hurts. And while we do our best to practice empathy in our clinical work, who of us hasn’t found that small tear of sympathy filling our eyes at some time?
Compassion fatigue is the end result of a long process of coming into routine contact with pain. In order to emotionally and mentally survive, the counselor begins to protect him or herself gradually over time, and this protection takes the form of caring a little less each time. If we don’t protect ourselves, we will find ourselves screaming at God and the universe, “OK, just how many dead babies do you expect me to deal with!?!” The end result is that we become hardened to the pain of others, we are more excited when our clients don’t show up than when they do, or we are unable to maintain the therapeutic neutrality that is necessary for our work. Some counselors continue to work in the field but not as effectively as they once were. Others have to leave the field to save themselves. All of us in the helping services field must be aware of the effects of compassion fatigue and how it is affecting us.
What to do, what to do??? Everywhere that you read about compassion fatigue, the writers are going to express the importance of self-care. Yes, you need to take good care of yourself—emotionally and physically. You need to have somewhere to release the intensity of emotions that you experience in working with your clients. You need to have someone to be able to talk to about your experience (even experienced counselors need supervision!). But at the end of the day, all of this advice starts to sound like Charlie Brown’s school teacher—“Wha, wha, wha, wha.” All of us know what we need to do to take care of ourselves; whether we are consistent in doing it or not is another question. None of us needs another sermon about self-care, so I won’t give you one.
The only strategies that I have found useful in the management of compassion fatigue come from two of the axioms of Choice Theory, developed by Dr. William Glasser. First, Glasser suggests that the only person whose behavior we can control is our own. We need to rigorously maintain our therapeutic boundary when working with our clients’ pain. The moment that we become responsible for what our clients choose to do or the outcome of the therapeutic process, we have crossed the boundary, we have taken responsibility for our clients, and the pain becomes our own. If you find yourself thinking about (other than designing your next therapeutic intervention) or worrying about your clients between sessions, you have crossed the therapeutic boundary and the clients’ pain is beginning to affect you. Second, Glasser states that what happened in the past that was painful has a great deal to do with what we are today, but revisiting this painful past can contribute little or nothing to what we need to do now. Ouch!!—Glasser is a little stiff on that past versus the present thing! But think about this idea—when our clients come to us with painful experiences in their past, we have a tendency to want them to describe whatever the trauma was to us in detail. We want to get to the depth of the emotions they have experienced, but all that we are really doing at that point is re-traumatizing our clients and traumatizing ourselves. Our clients come to us because they are experiencing problems in the present. It may be a past event that is affecting them, but it is causing problems in the present, because if it wasn’t, they wouldn’t be in your office. They are coming to the counseling relationship because they want to change something in their current lives—because, deep down, our clients understand that we do not have the magic needed to change the past. And so, the focus on what our clients need to change in the present helps to insulate us as counselors from the enormity of the pain that our clients have experienced in the past.
I’m going to say it again—caring hurts. We can do what we can to keep the pain from hurting us, but sometimes it is not enough. Sometimes we need to walk away to prevent our lives from being destroyed. Sometimes we need to change what we do so that we don’t deal with as much pain. Sometimes we just have to accept how incredibly sad and painful the work that we do is. So I will end with one of my favorite television quotes, from Michael Conrad as Sgt. Phil Esterhaus on Hill Street Blues, “Let’s be careful out there.”