All About Compassion Fatigue

  Image by talented  Shain Blum Photography  in San Francisco. ©2018 All Rights Reserved.

Image by talented Shain Blum Photography in San Francisco. ©2018 All Rights Reserved.

“All of us who attempt to heal the wounds of others will ourselves be wounded; it is, after all, inherent in the relationship.” David Hilfiker

If your heart is big, mission strong and you are committed to healing others and society, this message is for you. Compassion and empathy are finite resources that we as human beings must learn to preserve and replenish if we wish to continue giving to others throughout our lifetime. There is no unending well of compassion; its regeneration is cyclical and requires the giver to receive before they give again. 

DEFINITION OF COMPASSION FATIGUE

Compassion fatigue is often referred to as “the cost of caring,” a phrase coined by Dr. Charles Figley. It was Babette Rothschild that simply stated “Compassion Fatigue is a general term applied to anyone who suffers as a result of serving in a helping capacity.” Whether it’s referred to as compassion fatigue, secondary traumatic stress, empathy fatigue or empathic strain - the exhaustion, pain, and suffering run bone deep. 
 

HOW DOES COMPASSION FATIGUE DEVELOP?

Secondary traumatic stress develops through empathetically relating to others who are enduring suffering. Hearing details and witnessing someone suffer from the effects of trauma can cause symptoms of PTSD to arise in the empathetic helper. The social worker, teacher, lawyer, advocate or nurse that is there to help can sometimes experience immediate or long-term discomfort from their professional role. 
 

PROFESSIONALS ARE TAXED AND RUNDOWN

We know that symptoms can arise after one instance of helping another individual in crisis; consider professionals who are required to serve hundreds or thousands of individuals a year and tens of thousands of people over a lifetime. The results of prolonged exposure to secondary trauma can be devastating when left unattended too. Compassion fatigue is a public health crisis that is not only affecting professionals and their wellbeing, but also the recipients of services, organizations and communities.

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WHAT ARE THE SYMPTOMS OF COMPASSION FATIGUE?

If you are exhausted, irritable, pessimistic, depleted or ill and you spend your days helping, protecting or serving others you could be suffering from compassion fatigue. Other common symptoms include apathy, excessive tiredness, agitation, trouble sleeping, trouble concentrating, disorganization, lack of motivation, anxiety, hyper-vigilance, difficulty making decisions, tardiness, stubbornness and social isolation.

It’s additionally been noted that increased avoidance of certain people or situations signals a wish to distance one’s self from a client as well as reminders of the client's trauma as a way of coping with secondary traumatic stress.

SUBTLE SYMPTOMS OF COMPASSION FATIGUE

It’s easier to spot some of the major symptoms but there are also subtle changes in lifestyle such as normalizing trauma-centric thinking patterns, seeing and talking about trauma all the time, experiencing relationship difficulties, decreased social activity and having few or no personal relationships that don’t involve work or work-related conversations. 

ISN'T COMPASSION FATIGUE JUST BURN OUT?

No. Compassion fatigue and burnout are uniquely different in their manifestation and recovery process. Compassion fatigue can arise with little warning and cannot be remedied by merely taking a break from work, unlike burnout that can often be addressed by changing one's position or place of work, getting sufficient rest and activating basic self-care. Numerous studies have reported on the importance of having different treatment protocols for secondary traumatic stress and burnout.

COMPASSION FATIGUE AND THE LINK TO PERSONAL TRAUMA

Furthermore, there is a relationship between compassion fatigue and one’s own personal history with traumaOften people are called to meaningful work due to unresolved traumatic experiences. This personal history provides them with great insight into the specifics of particular types of sufferings and can be an opportunity for them to find deeper healing for themselves. J. Eric Gentry found that addressing the individual’s primary trauma is often necessary before attempting to work through his/her secondary trauma. 
 

BEWARE OF "THEIR PAIN IS WORSE THAN MINE!"

Be on the lookout for what we've coined the “hierarchy of pain” - the voice that says “their pain is worse, mine doesn’t matter.” All pain matters; your wise self knows this but the constellation of societal conditioning, professional pressure, ego, unconscious pain, internalized oppression and past harm have tricked you into believing certain types of pain are more deserving of a compassionate response than others. It is simply not true. Your pain, discomfort, and worries are valid too. It is important that you continue to process and grow through your own life challenges as often there is a tendency to ignore your own problems because they don’t feel as severe as those you serve. 
 

THE "HIERARCHY OF PAIN" AND SELF-COMPASSION

This “hierarchy of pain” is a master trickster because the same voice that condemns your own pain as not worthy of attention and support is the same voice that condemns the pain of people who are suffering “just a little bit” - those you deem to have more privilege and smaller problems. It judges them for being too sensitive or overreacting to their life challenges. When we activate self-compassion we can in-turn let go of the voice of judgment towards others and meet them where they are. 
 

I AM SO ANGRY, I CAN'T GIVE ANYMORE!

It can be frustrating to feel tapped out and unable to move forward with grace. You came in with so much energy, optimism and have given your all. We get it. It’s important to understand that big-hearted people with big missions are who compassion fatigue effects the most. You get depleted because you care and that is nothing to be ashamed of. If you didn’t care and want things to be better there is less of a chance of being affected. 

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UNDERSTANDING INFINITE NEED VS. FINITE CAPACITY

Perspective is everything. We live in a world where human need is infinite - more than any one person, organization or country can heal. At the same time, our individual human capacity to care is finite. We are living in a fundamental crux. It’s imperative to begin making conscious choices on how to replenish and distribute our personal emotional resources as compassion and empathy are internal supplies which can get drained or depleted. Receiving support and nourishing ourselves before we give again must become our default, rather than an exception. Additionally, organizations must acknowledge this truth and provide safeguards for employees. 

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PERSONAL LIMITS

We understand that each individual has physical strength limits. We know that a person can lift 30, 50 or 100 pounds on a regular basis with the right support, but it’d be unrealistic to lift limitless amounts of weight all the time. Using this analogy, you can begin to understand that people also have emotional limits in regards to the amount of suffering one person can bare witness to in a given time frame. Each human has a limit to the amount of traumatic material they can process while still maintaining their health and well-being. 
 

CLARIFYING POINTS

1.) Many in the helping, healing and protecting professions confuse an increased personal capacity to face the darkness with a limitless capacity to do so. 
2.) Providing high-quality response does not necessarily equate to a higher quantity container. 
3.) Having a larger and more skilled capacity to interact with trauma - more than the general public - does not make one immune to the effects of serving.
 

THERE IS A WAY THROUGH

While the effects of compassion fatigue may seem dire when you experience them, there is a way through. Healing and thriving while continuing to contribute to the greater good is possible.  
 

HERE IS WHAT HEALING CAN LOOK LIKE

Imagine waking up and having the energy to invest in yourself first. Sense what it’s like to consciously decide how and where you’d like to invest your emotional energy and that it is both nourishing and beneficial to yourself and others. Then when you enter your professional role for the day, you are able to bring your full self and deep presence to the work. There is a renewed clarity about the power of holding witness versus the pull to fix someone. Your boundaries remain intact, you feel safe in your body and are able to self-monitor and process material that comes forth at a pace that is healthy for you. When your workday is over, you are able to know you’ve done all that you can and trust that your colleagues, locally and around the world, will continue the work while you rest and replenish. You are able to receive joy, pleasure, laugh and play in your downtime without guilt. Your personal life is a full life - one filled with friends, loved ones, diverse interests, health and wellness routines and rest. You’ve moved beyond a self-sacrifice paradigm and into a full, rewarding and meaningful life.

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HEALING COMPASSION FATIGUE

Most literature written about the healing of compassion fatigue includes a list of basic self-help tools. At Forest Hughes & Associates we believe that professionals on the front lines are some of the most intelligent, resourceful human beings who know the ins and outs of healing. If the solution was simple self-care practices, professionals would have done them already. While baths, exercise, healthy eating, spirituality, and meditation may be great for your overall health and well-being they are simply not enough to address compassion fatigue particularly because they are solitary experiences. 
 

COMPREHENSIVE HEALING

There are numerous elements and components necessary for full recovery from compassion fatigue. Additional elements include identifying personal resources, cultivating mindfulness, tending to your nervous system, creating a sustainable and personal program that will continue to support you in the future. As painful as the symptoms are, the remedies are quite nourishing, easily accessible and fun to explore. The relief, vitally, health and renewed vigor are worth every moment you invest.
 

MEANINGFUL JOURNEY

This multi-layered approach of being called to healing work in the world, to experience the pain of serving others which ultimately leads to professionals towards getting the necessary healing for themselves, is a path of deep meaning. We do not exist in isolation nor can we heal in solitude. Relationships are the duality that both cause and cure elements of emotional pain. We are ultimately called to connect further to ourselves and for the sake of others. 
 

SELF-MONITORING

It’s imperative that we know ourselves and our values. Once you identify your personal baseline it’s easier to notice when things change. Take some time to reflect on your values, thoughts, behaviors and reactions at various points in your life to begin to notice what has often been true for you.  Journaling is an accessible way to start this process. 
 

IDENTIFYING CHANGES AND THE FIRST SIGNS OF COMPASSION FATIGUE

Once you’ve completed a baseline assessment of yourself you can begin to note any changes that have occurred recently or overtime. Have you given up hope that real change can happen? Are you withdrawing from co-workers or society? Does anger happen more frequently? Forest Hughes & Associates provides a free symptom tracker to assist you in this process.
 

COMPARE AND ASSESS

Once you’ve received and completed a baseline review and symptom tracker assessment, set aside some time to reflect on what's different. If the results are concerning or troubling to you it’s time to take action. Know that compassion fatigue and the symptoms are something that can be resolved and it is possible to experience, not just relief, but joyful living. Forest Hughes & Associates provides a comprehensive 12-week foundational healing program for compassion fatigue which includes daily exercises and weekly one-on-one support for the full twelve weeks. The aim is to assess, educate, witness, support, guide and assist in creating a sustainable healing program for each individual given the specifics of their personal and professional lives. 

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STEP ONE IS AWARENESS

Learning about compassion fatigue, secondary traumatic stress, vicarious trauma, effective self-care and resources for support are first steps. Wellness starts with knowing when we are unwell; from there we can begin to take action to move towards optimal health where you have access to your vital life energy once again. 
 

CONNECTION HEALS

One of the key elements of healing compassion fatigue is connection; deep connection to one’s self, as well as a personal and professional support network. There are limited opportunities for professionals to speak about the impact their professional role has on their life. Engaging in discussion and reflection can lead to the uncovering of the extent to which one is being affected and can provide discoveries needed for the healing process. 

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UNDERSTANDING THE COLLECTIVE EXPERIENCE: UNVEILING THE MYSTERY

Going it alone cuts us off from much-needed support, resources, and clarity. There are millions of professionals living through similar experiences. Engaging in conversations about compassion fatigue and how it’s affecting you breaks the silence and activates the healing. If there is no direct professional support at your workplace, Forest Hughes and Associates can help. Locally, we can arrange regular programming at your work. Worldwide we can support you through guest workshops and our online programming.
 

UNCOVERING AND REDISCOVERING SELF

Self with a capital “S,” is central to shifting the paradigm. What are your interests outside of work? What elements of your personality are most intriguing and inspiring? What are your true likes and dislikes? Chances are there are more than a few elements of Self that have moved to the background on your professional journey of moving others into the forefront. It’s time to remember and resurrect all those details that make you - you! 
 

RECONNECTING WITH WHERE YOU STARTED

Connect with your purpose and who you are when you started your career. What were your hopes and dreams? How have those matured or shifted over time? Become curious about your past internal motivation. Question if it’s still true. That can help you orient decisions in the present. The present moment is where we have the power to choose and direct our lives with the most power and clarity. Chances are you have grown, matured, changed and have a more balanced view of what you need and how you’d like to contribute at this stage in your life. 
 

GENDER-SPECIFIC LENS

Women must work through an additional layer of social conditioning that stems from their gendered upbringing in modern culture. Emotional labor and the expectation to give, care, love, sacrifice and show unlimited compassion and empathy are common unspoken agreements. It’s important to address both the professional pressure and internalized pressure to give beyond what we can. 

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WHAT IF IF DON'T START THE HEALING PROCESS NOW?

Compassion fatigue can compound and develop into vicarious trauma where it extends beyond the symptoms we spoke of and starts to shift the foundation of your life: your core beliefs, identity and spiritual frameworks such as from where you derive hope, meaning, and purpose. 
 

IMPACT ON CAREER AND REPUTATION

As compassion fatigue progresses, individuals start to react and behave in ways that don’t represent who they are at their core nor who they were when they began this work. One who used to be viewed as calm, centered and compassionate may come across as short, impatient, rude or irresponsible. Procrastination and tardiness may set-in, as well as a lack of cooperation. These symptoms, and others, if not remedied, will eventually impact a truly compassionate worker’s reputation and limit their career trajectory.
 

IMPACT ON ORGANIZATIONS

When employees do not receive support and preventative care for compassion fatigue, the bottom line will be affected. The organization will experience decreased productivity, motivation, willingness, capacity, and cooperation; increased errors, turnover, absence, disproportionate reactions and elevated risk for lawsuits and liability claims. It is imperative that agencies, hospitals, schools, and nonprofits provide ongoing, in-house programs for compassion fatigue. 

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HOPE

Post-traumatic growth refers to a positive change that occurs as a result of the struggles and challenges we face from interacting with trauma. It’s the growth that is called forth in the toughest of times, which later rewards us with integrated resources that can continue to serve us through the rest of our lives. We may become more resilient, centered, wiser or experience a sense of knowing that runs deep. It can also show us a renewed appreciation for life, increased level of gratitude or ability to live in the present moment. 
 

THE UPSIDE OF OFFERING COMPASSION

Besides allowing yourself to have an empathic human response to human needs that heals and helps, studies show that compassion is contagious and it can spread. Compassion also lengthens our life, strengthens our immune and cardiovascular systems. It’s literally good for our health. The message here is to continue to live compassionate and empathic lives with the knowledge of how to self-monitor, receive and replenish. 
 

THE FUTURE

One day society will look back and wonder why we did not take better care of the people that spend their lives helping, serving and protecting others. In the future, we at Forest Hughes & Associates believe that someday soon targeted compassion fatigue support services will be available to all medical, mental health and legal professionals, officers, activists, charity workers, researchers, journalists and educators. Anyone who sees, hears about or interacts with other people’s suffering need to receive mandatory support services, both ongoing and post workplace crisis. To leave workers without necessary knowledge, tools and support is unethical and is something we are committed to changing. 

© 2018 Forest Hughes & Associates ALL RIGHTS RESERVED
*Article originally published on March 8th, 2018 coining term and concept "hierarchy of pain."
All reproduction and distribution of material without consent will be pursued to the fullest extent of the law. You may not copy, alter, modify, enhance or use excerpts or concepts from this material or www.foresthughes.com as it is the intellectual property of Forest Hughes & Associates LLC. 

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Trauma-Informed Care: 7 Reasons Employee Support is the First Step

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The Oprah effect has also been sparked with this month’s expose on childhood trauma which highlighted St. A, an organization that serves orphaned children through trauma-informed care. Many schools, hospitals and clinics are eager to provide the same level of service. Given that St. A has been attuned to trauma since it’s inception 168 years ago, what does it mean for institutions taking their first steps today? Where can you begin?
 

WHAT IS TRAUMA INFORMED CARE?

Trauma-informed care is a framework that emphasizes recognizing and responding appropriately to trauma and it's impact on individuals. Organizations who are interested in transforming their services and practices to a trauma-informed care model can work with consultants and trauma professionals to assess, review and revise their policies, procedures and services. 
 

IT'S A PROCESS:

Transforming an organization to a trauma-informed care model is a multi-year process that requires a full community overhaul. Transitioning requires a full commitment from leadership on all levels and an understanding of why this is a worthy mission. 

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YOU ARE NOT BEING ASKED TO HEAL TRAUMA:

Any organization can choose to offer trauma-informed care whether or not their services are directly related to mental health or development. This does not mean that institutions are expected to heal survivors' trauma. It does mean that there is an awareness, sensitivity and ability to respond without causing harm and that there is a strong referral system to community resources with qualified mental health professionals trained in trauma. 
 

A COMMON THEME AMONGST TIC MODELS:

Many trauma-informed care models cite the necessity of providing preventative and supportive care for staff’s exposure to secondary trauma. It's noted that this should be a beginning foundational step for the process.  

WHY IS STAFF SUPPORT FOR SECONDARY TRAUMA THE FIRST STEP TOWARDS PROVIDING TIC? 

1.) DO NO HARM

The ethics of trauma treatment always includes the guiding principle of “do no harm.” The harm that is spoken of refers to the intentional, subtle and unconscious harm we could possibly cause when interacting with all people - not just survivors of trauma. Unsupported employees are increasingly likely to unintentionally cause harm. Providing on-going programming that increases awareness, manages stress and provides balance for their nervous systems will allow workers to drastically minimize their potential to cause unintended harm.  
 

2.) HEALTHY BOUNDARIES

 When an organization chooses to be trauma-informed the expectation that employees will be able to respond appropriately to a person suffering increases and so does the frequency of individuals revealing their traumatic pasts. Most people want to help others, particularly those who are suffering; employees are no different. When faced with serious situations many goodhearted people will get pulled-in over their head with very little tools or support. Providing employees with support, guidance and tools on how to maintain their professional boundaries and make sense of the magnitude of suffering is imperative to limit liability and protect employees from vicarious trauma.
 

3.) PRIMARY TRAUMA

Professionals are humans too. Often times the people who work in helping, serving or protecting professions are drawn to this work because of their own unresolved pain. It’s not uncommon for someone to consciously or unconsciously hope to help others in the similar situations they once were in themselves. That is natural. It becomes a challenge is when the person “fails” to be able to “save” someone or they are overwhelmed by the sheer amount of pain shared by students, patients or clients and project their own situation onto others. Sitting with coworkers in regularly held circles for the purpose of support is a necessary program for all entities. 


4.) BALANCED CARE

Trauma-informed organizations are not asked to provide healing for trauma but they are asked to respond effectively, reliably and compassionately. They are required to find the right balance between too little a response and too much. Too little a response and people are neglected and not connected with proper care while too much of a response can bring undo attention, over-involvement, control or excessive force. When professionals are consistently supported with a place to reflect upon and process their role, they will respond in a more balanced fashion. 

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5.) SELF-UNDERSTANDING BEFORE UNDERSTANDING OTHERS

PTSD, triggers, and the after effects of trauma can be mysterious and confusing to both the individual and professionals. Each person has a very specific constellation of responses and triggers that are unique to them. Likewise, the elements that soothe them are unique as well. When employees are offered courses to explore their own life, experiences and responses it provides a healthy beginning point for them to better understand the people they serve which increases their level of empathy, ability to relate and understand.
 

6.) COMPASSION FATIGUE IS REAL

Big-hearted people on a mission to help, serve and protect others will inevitably, at some point, experience various symptoms of secondary traumatic stress otherwise known as compassion fatigue. Symptoms can range from irritability, absenteeism, tardiness, decreased empathy, disorganization, anger, insomnia and lack of cooperation. These arise because workers care, listen and empathetically feel what people are going through. This can happen in as little as one time of hearing about someone’s suffering. Considering how many stories one professional sees or hears each week, month or year it is understandable how compassion fatigue needs to be a primary concern for every organization serving the public. 

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7.) INREASED EMPLOYEE RETENTION

Professionals who dedicate their lives to serving others are often not in it for the money. They come to organizations and leave organizations depending on how motivated, supported and able to to do the work they are. Offering a program that tends to their specific needs and targets the development of skills that will grow them as human beings and have a positive impact on their entire life, is an organization people will be loyal to. On a larger scale, providing employees with support and protection from compassion fatigue will keep them being able to work in their beloved profession longer. 
 

WHAT STUDIES SHOW:

Research confirms the prevalence of compassion fatigue across professional sectors, from judgesto doctors, social workers, teachers and nonprofits workers. Studies also outline preventative and ongoing support for secondary traumatic stress as being the starting point for organizations wishing to adopt a trauma-informed care model.
 

GOOD NEWS:

The good news is there are solutions that work which employees enjoy. Forest Hughes & Associates offers a 12 module program that has been developed to address compassion fatiguein professionals who are exposed to secondary trauma. The model can be offered in various formats which makes it accessible for organizations as well as individuals. We have an online version to reach workers in need nationally and internationally. 

© 2018 Forest Hughes & Associates ALL RIGHTS RESERVED
All reproduction and distribution of material without consent will be pursued to the fullest extent of the law. You may not copy, alter, modify, enhance or use excerpts or concepts from this material or www.foresthughes.com as it is the intellectual property of Forest Hughes & Associates LLC. 

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How Much Can You Hold? Our Finite Capacity in the Face of Infinite Need

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It's ok to not be ok. It's ok to take a break. A life of service, paid or unpaid, is a life-long marathon where the end goal is to finish the race with our hearts wide-open, sweat in the game and hope on the horizon.

HOPE / REALITY

We can simultaneously hope for and work towards a better future while realizing the collective change we strive for may not be achieved in our lifetime. We can actively contribute to change in the world and care for ourselves and our loved ones. We can speak up and take time for silence. We can work hard and rest completely. What we can't do is - live solely on one side of the paradigm as both sides are needed. 

GRAPPLING WITH PERSONAL LIMITS VS. COLLECTIVE NEED

We live in a world where human need is infinite - more than any one person, organization or country can heal. At the same time, our individual human capacity is finite. This is the crux. Given our dilemma, it’s imperative to make conscious choices about how to replenish and distribute our personal and emotional resources so that we are fully present both action and rest. 

PERSONAL LIMITS

Each individual has physical strength limits. We know that a person can lift 30, 50 or 100 pounds on a regular basis with the right support, but it’d be unrealistic to lift limitless amounts of weight all the time. Using this analogy, you can begin to understand that people also have emotional limits in regards to the amount of suffering one person can bear witness to and service in a given time frame. Each human has a limit to the amount of traumatic material they can process while still maintaining their health and well-being. It's ok to not be ok. You may have reached your limit for now. 

THE QUESTION

How much can you hold?
How much can you hold right now?
How much can you hold today?
How much can you hold this week?
How much can you hold this year?
How much can you hold in your life? 

THE ANSWER

Your answer is valid.
Respect it.
Set boundaries around it.
Take steps to honor it. 

IF YOU CAN'T STOP SERVING EVEN WHEN YOU ARE FRIED...

Exhausted, irritable, pessimistic, cranky and not who you know yourself to be as a result of serving? You could be living in a trauma triggered state that tells you it's "never enough", you "can't stop," "no one else can do it" but you.

The truth is the need will always exist until the end of time and there are millions of people taking action to help during the exact moment you are getting a solid nights sleep, so rest dear one, tomorrow is another day. Your life and health matter too.