personal, social change

On compassion fatigue, vicarious trauma & burn out

Recently, I participated in an amazing training to become a domestic violence advocate for immigrant women in the D.C. area. One area which we focused on was burnout, compassion fatigue, and self-care.

A recent article in the NY Times highlighted the sadly common phenomenon of compassion fatigue among not just those of us who work in the social change field, but also the general public — who are increasingly tiring of being deluged by information about war, famine, disaster and violence — while simultaneously feeling powerless to stop these atrocities from happening. But compassion fatigue often hits those in social work and caregiving professions the hardest:

Those in the so-called helping professions know as much about the limits of empathy as they do about its merits. Studies of oncology nurses, trauma workers and even marriage counselors, among others, have documented a common “compassion fatigue” that seems directly related to the amount of emotion shared. “In particular, listening to people who are suffering and not being able to do enough for them puts a tremendous weight” on caregivers, said Dr. Charles Figley, a psychologist at Tulane University.

Sadly, I’ve felt the effects of compassion fatigue too. After hearing traumatic, difficult stories from the homeless, mentally ill, prisoners, refugees, and domestic violence survivors, it is hard not to feel hopeless. Certainly, the people I’ve spoken to display resilience and strength. At the same time, my own ability to change things sometimes seems hopelessly limited. Compassion fatigue, for me, results in feelings of hopelessness — of not being able to affect any change in the grand scheme of things. I’m sure many of you have felt this way too.

What are some signs/symptoms of compassion fatigue?

  • Increased isolation from others
  • Apathy, sadness, no longer finding activities pleasurable
  • Feels that colleagues and friends simply don’t understand
  • Can’t recover quickly after association with a traumatic event
  • Affected deeply by stress of clients
  • Lost sense of hopefulness and optimism; cynicism and pessimism
  • Difficulty concentrating on anything
  • Mentally and physically tired
  • Nightmares or flashbacks of traumatic event
  • Substance abuse used to mask feelings
  • Compulsive behaviors such as overspending, overeating, gambling, addictions
    (Source: 1, 2)

A similar phenomenon is known as “vicarious traumatization.” By repeatedly hearing stories of clients or learning about threats, harm, destruction, injury, or death that has affected a client or someone close to you can be traumatizing for the caregiver or social worker. There are emotional and even physical indicators of vicarious trauma. Anger, sadness, grief, and depression can be the result. Nightmares, flashbacks, hypervigilance too. It is a by-product of empathy that we have with our clients or those we are hoping to help.

The danger of compassion fatigue & vicarious trauma is not only to one’s individual health and well-being, but also when it results in such intense burn-out, cynicism, and hopelessness that it becomes apathy. It can lead to such intense feelings of powerlessness and apathy about social change that it causes people to drop out of the social justice field altogether. This is burn-out. Burn-out develops over time, when one starts to believe he/she is not meant for this work, or is being ineffective.

In the past, I never thought too deeply about self-care. Me? Needing self-care? I thought I didn’t need it, that I could keep on chugging endlessly. But when you start dealing with particularly heavy topics, everyone needs self-care. As I increasingly consider the option of a social work career, or at least a career where I am involved with issues such as gender-based violence and human rights violations, I realize that thinking about such difficult issues– and hearing the stories of clients and others who have experienced deep trauma–day in and day out can be tiring and deeply mentally unsettling. After immersion in these topics, I become overwhelmed by learning about the worst faces of humanity.

At the same time, the solution is not to shut away your empathy and become totally detached. I don’t think I ever want to become numb to the plight of those who are suffering. I want to continue empathizing, because it is part of what it means to be human. Still, I realize that this is where self-care comes in. I realize that I need a break to enjoy myself, spend time with friends & family, pursue hobbies such as photography, take care of myself through cooking & yoga & exercise, and take time to be energized.

And most importantly, the foundation that helps me keep going is the reminder of all those inspiring folks: grassroots and community leaders, social innovators and entrepreneurs, and thought leaders pioneering new paths to compassion and social change. I remain inspired by those I see around me working endlessly to further human rights and social movements, and this gives me balance to counteract the dark side of humanity that too often shows its face in my work. It gives me hope for the future of our world, and faith that I am doing the right work for the right reasons.

Have you experienced vicarious trauma, burn out, or compassion fatigue? How do you deal with these feelings and keep yourself inspired to continue social justice work?

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23 thoughts on “On compassion fatigue, vicarious trauma & burn out”

  1. Tatiana says:

    While I haven’t gotten the opportunity to work with people or animals directly, I experience compassion fatigue when dealing with people who don’t GET IT on an intellectual and emotional level in conversations and on blogs. I definitely believe that patience and compassion are necessary survival tools for dealing with people who are uninformed about many of the problems we face as a species (and more so with people who simply don’t care). 

    How do you deal with people who don’t care about the rain forest, or about injustice committed against other living things? How do you talk to someone who doesn’t care about anything until it personally effects them? There’s a lot of disconnect we experience as a species from each other and definitely between the other organisms we share the planet with. 

    I haven’t all the answers, but the one thing I try to do is ignore those people. Hah. While I think it’s important to engage everyone – at least to a certain extent – some people just don’t care. So it’s easier to focus attentions on ourselves, and the reasons why we do the work that we want to do. Some people may not be open to animal and plant rights, but that doesn’t mean I should stop caring or stop talking about it. 

    1. Akhila says:

      That’s interesting– I am not sure this is the same as compassion fatigue which I mention in the post, as that is something documented by psychologists as an effect of working directly with those in need especially in roles as social workers. Perhaps what you are experiencing is frustration with those who don’t seem to care — and there are a lot of them. I think it is important to take that frustration and put it to positive use. Keep a positive outlook by finding a community of like minded people. And as to the rest, you don’t necessarily have to ignore them– but you can find some common ground with them, explain your views and why your beliefs are important, and encourage them in whatever way possible to care, contribute. It is not easy. Frequently I ask my friends to read articles, donate, etc but few of them actually do it — not that they’re not good people, but they just don’t have the same interest. But I try not to let it get to me and instead, try to keep bringing these topics up gently because I care about them!

  2. AlmostClever says:

    You already know how I feel about this topic Akhila 🙂  🙂  but I just wanted to add that self-care really does help, and I don’t know too many people who have not had brushes with fatigue and burn-out in this field.  

    I think one excellent thing I always remember in my area of work is that the client is the one who should be working the hardest.. If I am working harder than the client then I know I need to check myself because I am crossing that boundary.  My supervisor always gives me little nuggets of wisdom, and one that stuck with me when I was feeling the burn was “we cannot save our clients, but we can work with them so they can save themselves.”  She told me going into our work with the concept of helping or saving is us saying we are the experts, that we know the answers – and it creates a hierarchy placing us above our clients.  I never have and never will forget that.  It has helped me immensely in how I approach this field.  

    I also seriously think blogging is a form of self-care, especially when we are either blogging about our hobbies, or blogging about our field and then receiving feedback and support.  Also, having a support network that understands the work has made all the difference in my self-care.  I need other social workers I can go out to dinner with and talk about what we are going through.  I need people I can talk to about traumatic sexual abuse issues without jaws dropping and subjects being changed..  This has made such a huge difference for me.  I have made it a point to meet with social workers socially at least once or twice a month.  

    Great post, as always sweetie.  I hope you got a lot from your domestic violence training.  

    1. Akhila says:

      Thank you Sarah! You are my favorite blogger expert on this topic of dealing with trauma and self care especially due to your experience with the social work field directly.

      That is a great point, that the client should be working hardest. We shouldn’t be doing everything for them, but participating in a process of empowerment by encouraging them to take control of things in their own lives. That is so true that it creates a hierarchy and an unequal/unhealthy power dynamic, and this is something I will remember from domestic violence training as well. Paying attention to the power dynamics is so important because you want to stay on the same level as much as possible.

      That’s a great point about blogging as well- I am so thankful to have an outlet to talk about my interests, feelings & passions, and to find a community of like minded people. The feeling of community, knowing you’re not alone in this, is SO important to me.

  3. Marianne says:

    Wonderful, important post Akhila – as you know I’m passionate about this subject myself and learned the hard way the perils of neglecting my own self-care while working in Afghanistan. Thank you for writing about this. 

    1. Akhila says:

      Thank you for reading Marianne — I always love your posts and writing on this subject and think you have so much of value to add to this discussion. I haven’t truly considered the topic in depth for myself until more recently, and I see its importance now!

  4. Pace says:

    Thanks for posting about this, Akhila.

    The ways that I heal from burnout are:
     – severely limiting my intake of trauma that I can’t do anything about (no TV, no news)
     – reminding myself that I am not alone by surrounding myself with other world-changers
     – daily spiritual practice, to give me strength and courage and to remind me to be of service

    1. Akhila says:

      Thank you for posting how you deal with burnout, Pace! Those are some great tips and sometimes, there’s nothing better than getting away from media consumption and the deluge of information around us, and just focusing inwards to heal from burnout.

  5. Sara BB says:

    Holy crap, this is my life right now.

    I’ve been trying to get back into the habit of doing things that make me happy, like photography and cooking, but mustering the energy to do these things is sometimes beyond my reach.

    A quick backstory: I’m currently living and working in the South Pacific nation of Kiribati with the Ministry of Environment, Land and Agriculture and also conducting my thesis research on the issues related to climate change adaptation.

    The feelings of complete and utter hopelessness that have found their way into my life since arriving to this tiny atoll nation in the clutch of eventual disrepair show little sign of abating. I see glimmers of hope, but they quickly disappear when I witness the ineffectual implementation of initiatives. There is a general understanding of the issues by the people – issues that are far more basic and pervasive than ‘the environmental effects of climate change’ – but it recognizing problems and effecting change are two very different processes. Every problem can be traced back to an even larger problem and this never ending string of bigger and bigger issues seem daunting and imposible.

    It doesn’t help that I have no support on the ground here, as I am not working through any international organization or donor-mandated project. I’m here alone; a loneliness that is oppressive  There are other expats living here, of course, but their situation doesn’t seem (from my perspective) to parallel mine. They are funded and pampered or at least provided with a support network so that if they run into any trouble, they have somewhere to turn.

    A logical response on my part would be to band together with these individuals to create my own network, but the prospect of doing that feels like too much effort. Sometimes I just feel like I don’t care enough (about my social network) to make an effort anymore. I keep thinking, if I dig myself a nice little hole and hide in it for long enough my time here will come to an end, I will have some data for my research and I will have helped in whatever tiny way I can (even if I have little faith that what I do will actually create positive ripples).

    So, thank you for posting this and for giving me pause to think about how I’m treating myself. Although I recognized the problem from the outset, I didn’t have the words to describe it. I have to build the psychological first rung to be able to begin to climb out of this rut. How I will do that remains to be seen.

    1. Akhila says:

      Sara, thanks for your thoughtful comment and for reading! I admire the work you’re doing and it sounds important and impactful. I am sorry you have to deal with such feelings of hopelessness; it’s difficult doing development work and I have a feeling a lot of aid workers who are dealing with seemingly impossible social problems and challenges, without seeing extremely effective methods or programs dealing with these issues, share a lot of similar sentiments with you.

      I think the idea of joining with other individuals is a great idea– I really do think that finding community where you can talk about these issues and feelings, share a common experience, and have a common mission/passion can REALLY help and be energizing.

      And sometimes, trying to simply work towards a solution that you think might address some of the problems you’re seeing can do wonders to make you feel like you’re doing something positive, that might have an impact. We all need some success stories to keep going, and you can try and play a small role in that. And finally, self-care is important to take some time to enjoy life, do the things you love, and rejuvenate yourself when times are bad.

  6. Weh Yeoh says:

    For me, the key to getting over my malaise was to spend some time processing exactly how I felt. After getting back from a particularly tough trip, I experienced some of those feelings you listed. After processing my thoughts for a month, I came to the conclusion that yeah ok, the world is a fucked up place, and there’s probably nothing that I’m going to be able to do about it to reverse that. I probably won’t be ending wars, preventing famine or disease. But for me, knowing that there is so much suffering only leads to one logical response – and that’s to do whatever I can to help, even if it is just a little.

    After all, I think acknowledging and reflecting on your own feelings is vital, but after a while, the empathy that you feel for others can quickly turn into self-pity, and that’s no longer constructive. Acknowledge how you feel, try and reflect and heal, and then move on to do what is logical. Oh, and also, do lots and lots of running.

    1. Akhila says:

      Totally agree– spot on that sometimes empathy can turn into self-pity. In the end, if we constantly feel hopeless/depressed/powerless we’re not going to be of value in ANY way in our daily work and lives. I think your reaction was very logical but something we all reach at some point. The realization that as individuals, we’re not going to singlehandedly eradicate poverty or violence, but the fact is that we are trying our best on a daily basis to attack these problems, and our contributions are positive – and valuable – nonetheless. Even if we make a small impact, it’s still undoubtedly positive.

  7. Mindfulness for NGOs says:

    Thanks for this important post, we can move beyond the shame mentality in aid and speak out about emotions and how we feel. I see this happening more and more, and I take it as a sign that we are coming to see that we cannot take part in the process of healing others if we neglect ourselves. An effective self-care practice is mindfulness, and as a psychologist using this approach I’m happy to offer advice to aid workers if appropriate (I’ve been there too as an aid worker, so know how though it is).

    1. Akhila says:

      Completely agree– we have to care for ourselves before we can care for others. If we ourselves are not in a good mental state, how can we work with others in a positive, productive manner? Our inner emotions would come out and the results would not be positive. I am glad more and more people are realizing the importance of self-care because it makes us more effective in our daily work.

  8. Gia Ghani says:

    Really really great post Akhila. I think it’s very normal to feel fatigue on some level but you’re right in suggesting that the best way to temper that is to find activities that energize your spirit. It’s really easy to get discouraged by all the heartbreaking in the world and it requires a stronger personality to combat that and focus on the uplifting. That’s so obviously you. 🙂

    When Pakistan experienced the massive flood a couple summers ago, I was filled with so much sadness about the lack of aid from others. My family and I put together several fundraisers and some were incredibly successful while others were not. We realized that even if someone else isn’t willing to help, you can’t let that damper you spirit or ignore the calling that you feel inspired to chase after.

    I’ve devoted a lot of volunteer time in women’s shelters etc and it’s very discouraging but I think it takes one really great survival story for me to continue to feel motivated. I hold on to that and it helps me get through my bouts of despair.

    Again, really great post. 🙂

    1. Akhila says:

      Thanks, Gia, for sharing! I completely agree with you– sometimes it can certainly be quite discouraging, but you have to keep yourself inspired and motivated. Reminding yourself of the success and survival stories is one great way to remind yourself of the strength of the human spirit, and the beauty of the work we are doing. We have to keep these stories in mind in those depressing moments because it is the way we can keep doing important work and keep our spirit energized.

  9. Roxanne says:

    Truly wonderful and much-needed post, Akhila. I have experienced a lot of what you are describing. One of my own strategies for healing is coupling mindfulness with mindlessness. Dancing in the living room, browsing on Pinterest, walking down the street with music blasting… All of that helps clear my head and allows me to re-energize so I can dive back into my work. Practicing compassion and empathy is my goal regardless of whether I am at work or at home, but – as you and these articles discuss here – it is much easier to extend compassion and empathy when our own container is filled and when we bring self-care to our own lives.

    1. Akhila says:

      Thank you Roxanne, I know you have experienced a lot of this firsthand and I know your work must be heavy at times, though highly inspiring at others. I love your idea of mindfulness and mindlessness! Sometimes we just need to relax and stop thinking about our work and the people we are serving; sometimes we need a break. I completely agree with you and thanks for sharing your experiences.

  10. Nikita T. Mitchell says:

    As usual, I feel as though you are so in tune with my life. I started writing my second post on my experience as a rape crisis counselor almost two weeks ago. Last week I sat down again to try to finish it with no luck. Then on my way into work toward the end of the week, I read this post. 

    Let me just say that you’ve inspired me to sit down and write it despite how hard it is. 

    I had big melt down last month after a particularly tough call for the Rape Crisis Center. I mean hysterical tears on a corner at 1am trying to hail a cab after leaving the hospital… that kinda melt down. The worst part about the situation – now that I look back at it – is the amount of shame I felt for breaking down the way that I did. I’m forever thankful for the DCRCC staff, esp the volunteer coordinator who gave me the space I needed to get myself together but made it clear that she was there for me when I wanted/needed to speak (which, of course, I needed but I was ashamed to explain what I was feeling). 

    It has only been a year since I’ve been doing this work, and I’m still trying to figure out how to bring what is likely my best quality for this work (my “bleeding heart”) into it without letting it eat me alive at the same time. I need to learn to empathize without allowing the sense of helplessness to wear me down the way that it can…. I apologize for what is still a bunch of random trains of thoughts lumped together. My struggle with this is still fairly fresh, and I’ve yet to clearly articulate it all. So I thank you for this post and for reminding me why it’s important that I do find a way to get it out.

    1. Akhila says:

      Thanks Nikita. I know that working with domestic violence/rape/sexual assault survivors can be extremely emotionally difficult, draining and tiring especially as you are exposed to difficult topics on a daily basis, and making a difference turns out to be very hard. It can really have a emotional impact. I am sorry it took such a toll on you, because when we ourselves are overwhelmed and at the break point clearly we cannot be good advocates or be of service. I hope you are able to find time to rejuvenate, clear your mind, and refresh from all the challenges of your work so you can get back into it with renewed optimism. Keep up the amazing work. I am so glad you’re doing this, despite it’s difficulty and challenges! More people like you are needed in the social justice movement 🙂

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