Compassion Fatigue- Who is Helping the Helpers?

WRITTEN BY AMY ROLLO, M.A., LSSP, LPA, LPC-S
OWNER, HEIGHTS FAMILY COUNSELING 

A few years ago I wrote a blog on compassion fatigue for therapists and got more comments on it than any previous blog. I wanted to go back to it, as helpers just navigated lockdowns, a pandemic, and limited resources while giving to their clients. This seems more relevant than ever before.

I feel like therapists are expected to have an unlimited amount of compassion, and I’m not sure if that is really a reality.” These words came from a colleague in the field as we chatted during coffee. We both let the words hang in the air for a bit because we sensed the guilt, but truth that came with them. Being in the helping field means that most therapists (hopefully all) truly care for other humans. Our days are consumed holding our client’s pains, sorrows, traumas, disappointments, and frustrations. So much so, that we sometimes ignore our own human needs in that moment like hunger, thirst, needing to go to the restroom, the need to daydream, or even fatigue. A full day of compassion can be difficult for many therapists, and many successful therapists practice 30 clinical hours a week for decades. Compassion fatigue becomes very real, even when we aren’t in a pandemic.

We are currently in an environment setting us up for burnout. In fact, 52% of people surveyed recently reported experiencing burnout in 2021. Further 67% reported that their burnout has worsened during the pandemic. Now let’s look at mental health field data right now. It’s even more alarming. Half of all psychotherapists are reporting burnout and 78% of psychiatrists report a high-level of burnout, with over 15 % reporting symptoms of depression. It leaves me wondering, who is helping the helpers?

When the pandemic hit, I immediately lost all my support systems. I no longer had childcare, no school for the kids- we were in charge, no family to call for support, and a full staff and client load that felt the same. We were all weathering the same storm the best we could. As the months continued, clients from the past were coming back and needing help. This meant that my client load went from an intentional manageable level to sometimes working 9 client hours a day and working on case notes and managing the business in the evening. In the height of the pandemic, we lost all our coping resources to deal with high stress. For instance, there were no date nights, girls’ night out, or vacations to ease the burden. It was a hamster wheel of survival.

At the same time, we started learning about Zoom fatigue. It was an “aha” moment, as the migraines, exhaustion, and unable to keep up with demands suddenly made sense. I also started noticing something different in clients. As their stress and anxiety increased during the pandemic, the expectations of me increased for some, as their own emotional burdens were at capacity. Suddenly logging in slightly late due to an emergency or taking a sick day was triggering for some, as everyone’s nervous system was activated. When this happens, humans as a whole, tend to interpret even neutral events as negative, meaning us therapists rarely get the benefit of the doubt during this pandemic. As therapists, we get it. We have a special role we play in helping and healing others. We know it’s a gift to do this, but it also means we are aware that our relationship with clients can be triggering. Previous trauma, abandonment, betrayal, attachment wounds, etc. can all be activated when a therapist isn’t available physically or emotionally. We must be on, at all times. Our clients’ healing depends on this.

Compassion fatigue is often described as a loss of caring about clients, often to a degree of feeling irritated by their problems (Brown, 2017). A person-centered approach is often noted as the foundation for any therapeutic relationship. A person-centered approach includes having unconditional positive regard, empathy, and congruence for a client. Compassion fatigue and person-centered therapy simply cannot go together. In fact, most experts would agree that the therapeutic relationship is the most important indicator for the likelihood of success in treatment.

How can therapists continue to pour while their cup feels empty? Read some of the tips below to care for yourself and, in turn, your clients.

One of the first ways to reduce compassion fatigue is varying your efforts. Think about what you can really withstand as a counselor? Are you able to do 8 60-minute session back-to-back? Not for long and especially not during this period where burnout is so susceptible. Are you able to return home after a full day of sessions and return emails? Most likely not long term. This means that in order to truly be a good therapist, you need to get rid of the notion that you have to be a perfect therapist. You cannot do everything for your client.

One of the first things I do when I become susceptible to burnout is to be mindful of the time. During normal times, I’m okay with doing 55-60 minute sessions. In fact, I enjoy the longer sessions, as so many things emerge the last few minutes of a session. However, when I’m reaching capacity, I’m mindful of ending right at the 50 minute mark. Think about, if you see 6 clients a day, that’s an extra hour you just gave to yourself for self-care and replenishing your needs.

The next thing I do is manage expectations. I have put up an away message on my email that says that I will be slow to respond, and it could take up to a week for a response in order to care for myself. I do skim through to look for emergencies, but I also direct my clients where to go if it’s an emergency. Yes, therapists are allowed to take evenings off. In fact, we should. This is vital and a perfect example of self-care.

            I’m a therapist, a dog owner, and a mom, which means I’m the perfect combo of too much compassion, giving, and generosity. I love the field and love helping humans. It’s seriously the best job in the world. So, this next one is hard for me. It’s “boundaried generosity.” The term means having a boundary of time, and a boundary of compassion. Think of it as a protective shield of burnout that allows you to continue to pour into your clients. This means that you allow yourself to go home and relax instead of worrying about clients that evening. It means going every 2 weeks instead of weekly if your calendar is full. It means saying no to evening or early morning appointments if the schedule is draining you, even if it’s more convenient for the client. Man, it’s hard to have boundaried generosity, but it’s actually a gift to clients, as they will continue to receive your empathy and compassion, while you protect yourself from compassion fatigue and burnout.

Compassion fatigue and burnout are similar but different. While all humans are susceptible to burnout, only helping professionals experience compassion fatigue. Further, individuals in the helping profession who experience burnout are even more susceptible to compassion fatigue. Subsequently, by understanding the signs of burnout, a therapist can begin to create necessary changes to prevent compassion fatigue. Burnout is defined as a state of chronic stress which can lead to physical and emotional exhaustion.

One of the best ways to prevent or treat burnout is daily self-care. Self-care is changing as the pandemic changes. For me, it used to be a daily walk after sessions when we were still isolated and not going out. Then, after vaccinations, it became a weekly date night with the husband or time with my friends. As covid ramps up again, we are figuring out how to include self-care while feeling safe from covid. We are learning to bend and adapt in order to not break.

Being in the helping profession takes a toll on everyone. Burnout and compassion fatigue are real. In fact, the statement of “I feel like therapists are expected to have an unlimited amount of compassion, and I’m not sure if that is really a reality” is absolutely true! Therapists are humans and humans have a limited amount of compassion. There are steps to take to prevent this. Listen to your needs, practice being good enough, set boundaries, including boundaried generosity, and practice daily self-care. It might be necessary to cancel a day’s worth of clients when burnout symptoms appear to truly be available for the client the following week. And never forget that to truly be a good therapist, you need to get rid of the notion that you have to be a perfect therapist.

If you are a therapist or helper needing help with compassion fatigue, coaching, or burnout, reach out. We have your back.

Consider Work Burnout Counseling:

We specialize in high achievers, including those in the health field.

Our team of skilled therapists is passionate about helping you build the life you want. We are value-driven and help people navigate life to make sense of their stories. Together, we ensure they are creating meaning and purpose in their lives. We would love to work with you. Follow these steps to begin counseling in Houston, TX, or our new San Antonio office, or online therapy in Texas:

1.    Contact our counseling clinic to set up a free phone consultation

2.    Meet with one of our  therapists

3.    Begin work burnout counseling