Thread by @drlouisehansen

Compassion fatigue, vicarious trauma and burnout: “These three terms are complementary and yet different from one another. Compassion Fatigue refers to the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate. 1/23

The term vicarious trauma was coined by Pearlman & Saakvitne (1995) to describe the profound shift in world view that occurs in helping professionals when they work with clients who have experienced trauma. 2/23

Helpers notice that their fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material. Burnout is a term that has been used since the early 1980s describe the physical and emotional exhaustion 3/23

that workers can experience when they have low job satisfaction and feel powerless and overwhelmed at work. However, burnout does not necessarily mean that our view of the world has been damaged, or that we have lost the ability to feel compassion for others. 4/23

Example: If my job as an administrative assistant to a parole officer is to read the files of violent sex offenders, I may be secondarily traumatised and deeply disturbed by the content of what I read. 5/23

This may, in turn, affect my sex life, my feelings of safety for my children or my ability to watch television (vicarious trauma). However, I may not necessarily feel too tired to talk to my friend who is going through a difficult time at home, and I may not find that 6/23

this has caused me to feel deeply exhausted in my interaction with colleagues. But then again I may experience all of the above (vicarious trauma and compassion fatigue). 7/23

If I work as a nurse in palliative care, helping patients who are dying of cancer, I may feel incredibly drained, fatigued, unable to give any more and/or unable to stop thinking about my patients when I go home (compassion fatigue). 8/23

I may also find that I have become very preoccupied with death, dying and end of life issues. Over time, these may affect my world view and beliefs about ageing, cancer or similar issues (vicarious trauma). 9/23

Compassion fatigue and vicarious trauma are much more complicated than just being tired and overworked. They are often caused by a conflict between our deepest values and the work that we are required to do, a phenomenon which is called ‘moral distress’. 10/23

What are some of the signs of compassion fatigue and vicarious trauma? Researchers have discovered that helpers, when overtaxed by the nature of their work, begin to show symptoms that are very similar to their traumatised clients: 11/23

Difficulty concentrating; Intrusive imagery; Feeling discouraged about the world; Hopelessness; Exhaustion and irritability; High attrition (helpers leaving the field); Negative outcomes (dispirited, cynical workers remaining in the field, boundary violations). 12/23

What factors contribute to compassion fatigue, vicarious trauma and burnout? There are many reasons. The Individual: Your current life circumstances, history, coping style and personality type can all affect you. Most helpers also have other life stressors to deal with. 13/23

The Situation: Helpers often do work that other people don’t want to hear about. They spend their time caring for people who are not valued or understood in our society. This may include individuals who are homeless, abused, incarcerated or chronically ill. 14/23

Furthermore, working environments are often stressful and fraught with workplace negativity. The work itself is also very stressful. Finally, we live in a society that glamorises violence and does not adequately fund efforts to reduce or prevent violence in our society. 15/23

What can be done? Organisational health researchers have been busy studying the most effective strategies to reduce, mitigate and prevent compassion fatigue and vicarious trauma and in helping professionals. Here is what has been shown to be most effective. 16/23

Working in a Healthy Organisation: Studies show that “who you work for” is one of the biggest determinants of employee wellness. This includes: Access to a supportive, flexible manager who is open to regular workload assessments in order to reduce trauma exposure; 17/23

Leadership from a manager who encourages staff to attend ongoing professional education and who provides timely and good quality supervision as needed; Employees who had more control over their schedule reported a higher rate of job satisfaction overall. 18/23

Personal Strategies: Developing and maintaining a strong social support both at home and at work; Increased self awareness: mindfulness, meditation, journaling, etc; Regular self care (often an afterthought for busy helping professionals). 19/23

What if those strategies aren’t enough? Talk to your GP about options such as counselling. Unfortunately, with a main focus on self-care and work-life balance as the sole solutions to compassion fatigue, some helpers have felt blamed for their compassion fatigue. 20/23

They have received a strong (and incorrect) message from their workplace –  “If you feel burnt out, it means you are not taking good enough care of yourself”. This can further silence people in pain and it is actually not true. 21/23

The biggest contributors to compassion fatigue are where you work, your workload, your working conditions and the amount of high quality training you have received in trauma-related areas – not the amount of kale you eat and yoga you practice (although great as well!).” 22/23

Françoise Mathieu (2019). Early drafts co-developed with Robin Cameron. Mathieu, F., (2007) Running on Empty: Compassion Fatigue in Health Professionals. Rehab & Community Care Medicine, Spring. & Mathieu, F., (2012) The Compassion Fatigue Workbook. New York: Routledge. 23/23