Compassion fatigue: Psychotherapists’ chronic lack of self care.

“Therapists commonly experience “compassion fatigue” (Figley, 2002; Weiss, 2004) due to the emotional labor that is often a part of therapeutic work (Mann, 2004).”

“As Figley (2002a) has noted, “it is, therefore, up to all of us to elevate these issues to a greater level of awareness in the helping professions.”

“For example, studies were excluded if they had a PTSD or stress-related outcome measure, measures of general psychosocial functioning, or well-being scales that have not been established in the literature as valid indicators of CF.”

“Being overly sensitive to other people's pain could thus be detrimental and cause a host of serious deleterious effects such as compassion fatigue or burnout in this population (Figley, 2002).”

“Empathy may thus be viewed as a double-edged sword, facilitating caring and compassion but at the same time leaving the physician vulnerable (Figley, 2002; Sabo, 2006).”

“Studies have shown how, despite being an important component in providing effective care, empathy also creates vulnerability for stress related conditions such as compassion fatigue and professional emotional exhaustion (Figley, 2002; Rothschild, 2006).”

“Figley's causal compassion stress and fatigue model ( 1995 2002a 2002b ) points to the influence of nine variables implicated in the development of compassion fatigue, including those related to traumatic material exposure and clinicians' capacity for empathic engagement.”

“…reduced capacity or interest in being empathic or bearing the suffering of clients and (is) the behavioural and emotional state that results from knowing about a traumatizing event experienced by another person’ (Figley, 1995, 2002; Adams et al.,, 2006, p. 2; Boscarino et al., 2010, p. 2).”

“In the present study, we use the umbrella term secondary traumatic stress to discuss such effects of secondary exposure as secondary PTSD (Bride et al., 2004), vicarious traumatization (McCann & Pearlman, 1990), and the STS aspect of compassion fatigue (Figley, 2002).”

“Figley (2002b) states: ‘‘. . .we cannot avoid our compassion and empathy.”

“In the past two decades, clinical observations and empirical reports have established that indirect exposure to traumatic material is associated with high rates of posttraumatic stress disorder symptoms among social workers (Bride, 2007) and those working with child maltreatment (Bride, Jones, & MacMaster, 2007), and…”

“Figley (1995, 1996, 2002a, 2002b) later coined the term compassion fatigue to describe the cognitive emotional behavioral changes that caregivers experience from indirect exposure to trauma survivors.”

“Theoretical models and potential predictors of ofessional quality of life Figley (1995) first described empathy as a risk factor for rses’ compassion fatigue; in the Multi-factor Model of mpassion Fatigue (Figley, 2002), he elaborated that being pathic could predict compassion fatigue.”

“Canfield, J. (2005). Secondary traumatization, burnout, and vicarious traumatization.”

“In some cases, caring for others comes at the expense of caring for the self, and often this continued self-sacrifice can lead to compassion fatigue among helping professionals, especially those exposed to pain, suffering, or trauma (Figley, 2002; Sabo, 2011).”

“Furthermore, stress and burnout among psychology graduate students can have a negative impact on their ability to provide adequate clinical care (Figley, 2002; Wicks, 2008).”

“Risk of CF was operationalized with the ProQOL, as evidenced by a process by which score ranges could be categorized into minimum (<7), moderate (8-17), and high (>18) levels for CF risk.”

“At the same time, continuous work with people in mental distress commonly leads to symptoms of psychological distress in clinicians, which may lead to burnout (Figley 2002; Hannigan et al. 2004).”

“The signs and symptoms of compassion fatigue and secondary traumatic stress have been well documented (Collins & Long, 2003b; Figley, 2002; Maytum et al., 2004; Pfifferling & Gilley, 2000); however, it appears that limited research has been done on the affect that compassion fatigue may have on the…”

“The cumulative effects of emotional, mental, and physical burnout thus can lead to professional impairment in the provision of services (Figley 2002).”

“The usual definition of empathy, according to which empathy consists in sharing the emotions of others, rather refers to sympathy than empathy.”

“Compassion fatigue can be defined as secondary traumatic stress resulting from knowing about a traumatizing event experienced by a significant traumatized or suffering person (Figley, 1995, 2002).”

“…been variously described using several well-known concepts, including vicarious traumatization (McCann and Pearlman 1990; Pearlman and MacIan 1995; Pearlman and Saakvitne 1995), compassion fatigue (Figley 1995, 2002), secondary traumatic stress (Stamm 2002), and burnout (Leiter and Maslach 1988).”

“, regular exercise, yoga, eating well and getting enough sleep, spending time with friends, establishing boundaries between one’s personal and professional life, and making time for fun activities) are critical to the wounded healer’s psychological health (Figley, 2002; Pearlman, 1995; Wright et al., 2012).”

“Some investigators have argued that personal features of the therapist’s environment could place him or her at risk for vicarious trauma (Anderson, 2000; Figley, 2002b).”

“…describe the impact of secondary trauma exposure onmental health professionals, researchers have proposed a number of constructs including secondary traumatic stress (Figley, 1995), vicarious traumatization (McCann & Pearlman, 1990), compassion fatigue (Figley, 2002), and burnout (Maslach, 1982).”

“The “fatigue etiological” perspective, based in work by Figley (2002), is an extension of the resiliency approach in that it describes the process of empathy-based stress responses.”

“Psychologists and allied mental health professionals are also subject to a number of work related health impairments, including compassion fatigue (Figley, 2002) secondary traumatization (Canfield, 2005) and vicarious traumatization (Dunkley and Whelan, 2006).”

“Due to the experience of CF, caregiving professionals may themselves need assistance to cope with the effects of helping others resolve their traumatic experiences (Figley, 1995, 2002; Gentry, 2002; Gentry, Baranowsky, & Dunning, 1997, 2002; Pearlman & Saakvitne, 1995; Saakvitne, 1996).”

“Kulkarni, Bell, Hartman, and Herman-Smith (2013) found that commitment and greater time invested in self-care is associated with lower levels of STS.”

“CF is likely to result in problems such as misjudgements, clinical errors, poor treatment planning, all serious issues for effective care (Figley, 2002a; Bride et al., 2007; Adams et al., 2008).”

“Being overly sensitive to patients’ suffering can lead to deleterious effects, such as burnout or compassion fatigue (Figley, 2002; 2012), especially if one lacks adequate emotional regulation and control (Decety et al.”

“Compassion fatigue is often thought of as the caregiver’s cost of caring and results when health professionals are exposed to repeated interactions requiring high levels of empathic engagement with distressed patients, although compassion fatigue can be a significant contributing factor in health professional burnout.…”

“Many of the symptoms identified in patients with PSTD, such as intrusive thoughts, sleep disturbances, avoidance, anxiety, distressing emotions, and hyperarousal, are also present in some individuals with CF (Figley, 2002; Gentry et al., 2010).”

“emotional self-care needs of employees and students, including assessing and enhancing the social support networks of human service professionals (Figley, 2002).”

“arise from practicing empathy and compassion (Figley, 2002; Newell & Nelson-Gardell, 2014; Stamm, 2010), and that would appear to relate to the emotional exhaustion component of burnout.”

“Correspondingly, as much research emphasizes the importance of the therapeutic relationship (Figley, 2002; Raab, 2014), shorter (Held et al., 2018) or workbook-based interventions (Held & Owens, 2015) may miss this proven active ingredient.”

“Empathy, Emotional Separation, and STS Empathy has been theoretically assigned an important role as a conduit for STS reactions ( Figley, 1995, 2002; Pearlman & Mac Ian, 1995).”

“All of these characteristics were reported by Figley (1995, 2002a) as integral in the development of CF; however, the assessment measures developed thus far for CF do not reflect these supposedly important elements.”

“With development of healthy self-care routines, nurses can continue to successfully provide compassionate care to others (Figley, 1995, 2002).”

“Because empathy is a valuable form of intense listening that should be facilitated by the trauma counselor (Jackson, 1992), the helper unconsciously makes him or herself available to the absorption of the client’s traumatic story (Figley, 2002).”

“The significance of self-awareness and adequate self-care in response to the stresses induced by professional practice has been noted (e.g., Baker, 2003; Figley, 2002; Mahoney, 1997; Norcross, 2000).”

“The findings seem to corroborate Figley’s theory which implicates empathy in the development of compassion fatigue (Figley, 2002).”

“More broadly, and beyond the specific domain of PTSD treatment, compassion fatigue denotes a state of emotional exhaustion that can occur as a result of intensive empathic involvement with people who are in distress (Figley, 2002).”

“Compassion fatigue compromises one’s empathic ability to recognize pain in others, motivation to respond to it, and the psychotherapist’s ability to experience the painful emotions of the client (Figley, 2002).”

“As Figley (2002) notes, “Compassion fatigue, like any other kind of fatigue, reduces our capacity or our interest of bearing the suffering of others” (p. 1434).”

“Compassion stress is defined as the distress that results from the pressures of helping a traumatized or suffering client and is one of the most common forms of job stress experienced by helping practitioners (Figley, 2002).”

“Researchers have demonstrated that practitioners can also be indirectly traumatized as they empathically engage with trauma survivors (Figley, 2002; Pearlman & Saakvitne, 1995).”

“…to increase the risk of developing compassion fatigue include: continued exposure to patients’ stories and heightened emotions of family members; burnout and stress; failure to maintain self-care; and practitioners’ empathy levels (Collins & Long 2003a,b, Fox & Carey 1999; Figley 1995, 2002a).”

“to engage in the helping professions may result in increased stress for the helper (Figley, 2002).”

“Empathy has been viewed as essential to effective helping but is potentially a “doubleedged sword” (Decety, 2011; Figley, 2002a), placing social workers and other helping professionals at risk for burnout and compassion fatigue.”

“…to the mental health of health professionals (4-7) , is defined as “the natural, consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person” (8) .”

“Many caregivers experience high levels of stress and “compassion fatigue,” and may be especially hard on themselves (Figley, 2002).”

“However, with prolonged exposure, traumatic memories that elicit an emotional response, and other degrees of life disruptions, the caregiver is destined to develop compassion fatigue (Figley, 2002).”

“STS (see Figley 2002a ), but little research has been conducted on this topic.”

“But the prescription for compassion fatigue, which Figley (2002a) refers to as Jane’s problem, would be neither supervision nor psychotherapy.”

“Tending to the needs of others on a continuous basis can skew perceptions of how compassion should be prioritized, such that compassion for others overrides much needed compassion for the self.(65,66) Moreover, the unique demands of health care workers may have made it more challenging to practice and enhance self-com…”

“emotional impact of the work (Figley, 2002; Guy et al., 2008), effective supervisors”

“Likewise, Figley (2002) suggests this kind of disengagement is preventative of the emotional exhaustion of burnout and purports a worker must make ‘‘a conscious, rational effort to recognize that she or he must let go of the thoughts, feelings, and sensations associated with the sessions with the…”

“Finally, Figley (2002) suggested that the ability to empathize is the critical component in both caring for those who are suffering and being susceptible to the costs of caring.”

“…been suggested that self-compassion is associated with better outcomes because more self-compassionate individuals manage stress more effectively such that burnout exhausts less of their capacity to be caring and compassionate towards others (Alkema et al., 2008; Figley, 2002; Vigna et al., 2017).”

“Citing concerns that the secondary trauma label might be considered derogatory by some professionals, Figley (2002b) began using the term compassion fatigue, which he believed to be less stigmatizing.”

“…the potential impact of working with traumatised individuals, such as a reduction in the capacity or interest in bearing the suffering of others (Figley, 2002), physical and emotional exhaustion and a pronounced reduction in the ability to feel empathy and compassion for others (Elwood et al.,…”

“Figley (Figley, 2002, Figley, 1995) created a theoretical model based on adaptive or maladaptive responses to stress, establishing four determining factors: capacity to empathize, behaviour t ward the victim, difficulty in distancing oneself from work, and satisfaction from caregiving.”

“For emerging social work practitioners, setting aside personal needs may be easier said than done and, according to Figley (2002), even seasoned helping professionals may pay high costs for the strategic use of compassion.”

“Burnout also may be the result of secondary experiencing of traumatic events (Figley, 2002; Stamm, 2010) or may be, among school counselors, due to the ongoing empathetic position they hold with their students (Maslach, 2003; Stebnicki, 2008).”

“…since it has been proposed that cumulative stress from years of caregiving may result in more negative outcomes such as caregiver burden and compassion fatigue (Bainbridge, Krueger, Lohfeld, & Brazil, 2009; Coetzee & Klopper, 2010; Figley, 1995, 2002; Savundranayagam, Montgomery, & Kosloski, 2011).”