I sound like a horrible daughter, don’t I? Maybe. Maybe not. I’m one of three daughters who don’t talk to or only very rarely talk to my mom. I won’t speak for my sisters, but I have many reasons for hoarding my words and time. As the eldest, and only 18 years younger than my mom, I filled her “best friend” role for most of my life.  As an adult, that role sometimes translated to positive experiences together, but other times, in not-so-healthy ways, like becoming drinking buddies.

When I was a kid, Mom most often called me her best friend when she sobbed in my arms. I remember one time, when I was about 12 or 13 years old, wrapping her in my arms on the kitchen floor. She cried heavy, barking sobs into my chest. As I sat on the floor in the middle of the night, helpless and confused, Mom insisted again that I was her best friend. I’d just wrestled a kitchen knife out of her hands that she’d threatened to stab herself with. (This might explain why I also long struggled in the friendship department–it took me a while to learn what true friendship looks like.)

Now, at only 61 years old, my mom has been put into assisted living. She can’t take care of herself anymore. In my opinion, she never has…taken care of herself, I mean. Despite this, I feel profound grief for her situation. All our situations, really. Because my mom is more than alcoholism, mental illness, and a disease ultimately created through the combination of those things. My mom was also one of the smartest, sharpest, and most tenacious people I’ve ever met. Many of the good things I value in myself wouldn’t have flourished if not for her. In some ways, those things grew in me because she planted and nurtured the seeds in ways she could. In other ways, I thrived just to prove I could, and because I was determined to never need anyone the way she needed me. I didn’t want to drain anyone of their vitality the way I felt stripped of mine.

I’m writing this article because it really pisses me off when people assume that children who cut off parents do so with ease and callousness. There is nothing easy about this. I love my mom. I care about her. I have compassion for her. And…I just can’t do it anymore. As I heal, the emotion that rises to the top again and again and again is grief.  I’ve mourned my mom from many angles, many times, in many ways. I’ve mourned for a childhood where I felt safe and loved without conditions. I mourned for a relationship with my mom where I didn’t have to also calculate the cost of her affection and attention.

I’ve mourned on her behalf for all the things she missed out on because she couldn’t be present in the ways we–and she—deserved. Now I mourn a future she will never have because the chains of the past have permanently bound her.

Like me, Mom grew up in someone else’s nightmare. She never escaped but instead created new scenes. Not all of them were horrific or tragic. Some of them were heroic. She got her GED a few years after dropping out of high school, pregnant with me. In her early twenties, with four kids under the age of seven, she started college. She was the first in her family to earn a college degree. She did it with honors.

In some ways, she set solid examples and, at times, I truly did feel her love in strong and powerful ways. In other moments where I offered consolation and comfort, I felt a profound sadness and the deepest well of hopelessness one can imagine emanating from her. I know my mom did not want these things for herself. Or her kids.

She always said, “I want to do better for you than was done for me.” I think she succeeded and failed because here we are, repeating the same cycle. Throughout most of my childhood, my mom didn’t talk to her mom. When we mentioned Grandma, Mom shut us down and couldn’t conceal her strong negative feelings. Eventually, they reconciled, but Mom rejected her mom throughout most of her adult life. I wish it were not this way, but I feel like the only way I can make sure that this isn’t repeated with my daughter is for me to heal. I can’t heal when I’m locked in caretaker mode. My mom doesn’t know how to see me any other way. The only way to resign from that role was to walk away completely. So, I did.

I’m afraid to watch someone I once saw such tenacity and intelligence in flounder to perform basic daily functions. I don’t want to see her that way, which is interesting because, in some ways, that intelligence and willpower allowed her to manipulate me and situations in ways that crushed me. I don’t know who she is without them in her arsenal. As much as those parts of her hurt me, I’m sad that she lost the things that gave her some sense of control in a chaotic life. I understand why she wielded them; they were self-protective. And…they tended to hurt those in her wake, me included.

My mom’s mental decline happened to coincide with the long-overdue resurrection of myself. I’ve been in therapy for over two years, and sometimes, between individual, couples, and group therapy, I attend up to five hours of therapy a week. I work hard between sessions to practice new coping strategies, assert boundaries, and engage in self-care. It’s working because I’m working so hard to heal. Sometimes it pisses me off that I have to bust my ass to come out the other end of this thing and that I can’t have the kind of relationship with my mom that I longed for.  I’m enraged that I have to work this hard to feel safe, secure, and happy.

This self-restoration has brought piping red, long-submerged anger to the surface, but there’s more than that.  I’m devastated for her. As much as I know it was out of her control–essentially two diseases, alcoholism and mental illness, paved the way to another disease, WKS–I’m so angry that it took her down. I’m furious with her for not fighting harder. I’m pissed at myself for not “saving” her. Sometimes I don’t know where to put all that anger.

I don’t want to fight my mom because it’s not a fair battle. Once again, there’s an unbalanced power dynamic. This time I’m in “power.” I could potentially use it to pulverize the final shreds of her. I don’t want to. Not even a little bit. So, I’m going to keep walking the other way. The anger, for now, keeps me safe.

Beyond the anger, though, I’m so damn sad. I don’t want to see my mom suffer. That young child in me, who soothed her so many times, wishes she could save Mom just one more time. But that little girl in me can’t. I can’t. So, my mom’s house stands vacant and for sale. I never visited. Not once. Now, she lives somewhere where strangers will do the things that I can’t. Not because I don’t want to, but because I just can’t. Not anymore. This choice doesn’t feel like a choice at all, but it’s what I must do for now. I must continue to move on.

Photo Credit: Unsplash

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Fortunately, we are a little wiser now. Much research has been carried out on clinicians whose work brings them into daily contact with those who have suffered trauma.

Compassion fatigue is characterised by physical and emotional exhaustion and a decrease in the ability to empathise. It is a form of secondary Post Traumatic Stress Disorder (PTSD), with the stress occurring as a result of helping, or wanting to help, those who are in need. It is often referred to as ‘the cost of caring’ for others who are in physical or emotional pain.

While it is not uncommon to hear compassion fatigue referred to as burnout, the conditions are not the same. Compassion fatigue is more treatable than burnout and I believe it is the early warning sign of a dysregulated Autonomic Nervous System (ANS), telling us it is in danger of developing burnout. Burnout signifies adrenal fatigue and, eventually, adrenal failure.

Some years ago I took early retirement from medicine as a practising GP and Gestalt Psychotherapist and set about exploring alternative healing methods — other ways to heal people mentally and emotionally. I created a modality, QEC, that works with the subconscious mind to heal past traumas and change limiting beliefs permanently.

QEC has always taught that the emphasis of clinical practice needs to be on self-care and addressing one’s own needs first.

Compassion Fatigue Research

Research found in ‘Helping till it hurts?’ by Kyle D Killian [1] shows that clinicians in the helping professions who are regularly exposed to traumatic compassion fatigue in their work, do best when they have access to social support and the protective function of supervision to process the secondary trauma of their own work. It indicated that a lack of awareness of stress led to more serious burnout and that education and advice on self-care was crucial.

Stress factors identified in this study – from most common down:

1. High caseload demands and/or ‘workaholism’
2. Personal history of trauma
3. Lack of regular access to supervision
4. Lack of control in the working environment
5. Lack of a supportive social network, social isolation
6. Worldview e.g. overabundance of optimism, or cynicism. Those with a spiritual belief system did best
7. Ability to recognise and meet one’s own needs – having self-awareness

Compassion Fatigue in Practitioners

How can we best prevent compassion fatigue and burnout?

The emphasis of clinical practice needs to be on self-care and addressing one’s own needs first. At this time, in particular, it seems that an abundance of people accessing therapeutic help are traumatised.

Many are severely traumatised, and some are even suicidal. It behooves us therefore to be most vigilant, at this time, with our own mental health, so that we are able to be fully present with challenging clients. We need to know the signs and symptoms of overwhelm in ourselves to become aware and to engage in timely prevention of burnout.

Signs and Symptoms of Compassion Fatigue leading to Burnout:

• Chronic exhaustion (emotional, physical, or both)
• Reduced feelings of sympathy or empathy
• Dreading working for or taking care of another, and feeling guilty as a result
• Feelings of irritability, anger, or anxiety
• Depersonalisation – i.e. ANS freeze – feeling disconnected and numb
• Hypersensitivity or complete insensitivity to emotional material
• Problems in personal relationships
• Poor work-life balance
• Physical symptoms such as:
• Headaches
• Trouble sleeping
• Weight loss or weight gain
• Impaired decision-making ability

Compassion Fatigue: Overwork

Some of us may be overworking, some even proudly consider ourselves ‘workaholics’. This is usually related to an inability to set healthy boundaries, maybe stemming from past, usually childhood, trauma. We must therefore look at our boundaries, both external and internal if we are suffering from compassion fatigue.

External boundaries:

Questions you could ask yourself:

“Do I have …”

• Good time management e.g. do I take time off between sessions?
• Regulating caseload – do I know when ‘too much’ really is too much?
• Am I able to say NO?
• Do I believe that my needs come first?
• Am I able to maintain a balance between work and rest?
• Do I feel guilty if I take time out from work?
• Do I allow myself to have regular social connections and support?
• Do I attend regular supervision and am I willing to be vulnerable and process my challenges?
• Do I have sufficient control over your work environment?
• Am I doing more than one job?

“If all you are using is emotional empathy, eventually you will run out of this emotion when empathising day after day, hour after hour. It is like an electric pump running without water, eventually, it burns out. You need to bring much wider and different energy to your connection – love and compassion from the heart.” – Matthieu Riccard, Buddhist monk

Internal Boundaries

What is my internal experience when I’m faced with immense suffering in my client?

The challenge here is to remain empathetic, and supportive of others without becoming overly involved in taking on another’s pain. Setting emotional boundaries helps you maintain a connection while still remembering and honouring the fact that you are a separate person, with your own needs.

Resilience

Bouncing back is always an indicator of internal resilience. We now know that resilience is a factor in how healthy and balanced our ANS is. It is vital then if you feel overwhelmed, that you immediately seek help and therapeutically return to optimal neurological balance.

This is something I teach my QEC practitioners; to attend sessions with a fellow practitioner to return to an optimal neurological balance rather than push on in a state of overwhelm.

Remember that your ANS has become overwhelmed for a reason – meaning that it’s likely that you’ve been triggered by your own unhealed trauma. The only way you can remain with a balanced ANS is to work on your trauma, release it, returning your ANS to optimal balance once more. Once more you will be able to have compassion for yourself and your clients.

Remember: seeking therapeutic help is the best strategy we have!

Footnote:

1. Traumatology Vol 14. No 2 June 2008. Ref. Self-Care in Physicians Working with Trauma Survivors

Additional resources:

Why do we work with the subconscious mind?

I recently sat down with Guy Macpherson, host of The Trauma Therapist Project podcast, for an in-depth discussion on treating trauma:

• A look at the traditional way we treat mental health and trauma – what is and isn’t working
• How working with the subconscious actually works: an explanation of the QEC process – technique, results, length of process – from start to finish
• How and why QEC was created – my 40-year career in medicine as a GP, Gestalt Psychotherapist, TRE trainer and trauma specialist

Watch the interview here.

Prefer to listen? You can do so here.

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