When I was a medical doctor, I suffered burnout three times. This was in the 1990s and few people, least of all me, had any idea what was wrong when overwhelming fatigue took over and we had to stop working for a while. I had not been taught about self-care and knew nothing of compassion fatigue. On these occasions I thought I was just ‘sick and weak’ and so returned to work immediately after my time out, determined to work harder and longer, to prove I was up to it.
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:
- High caseload demands and/or ‘workaholism’
- Personal history of trauma
- Lack of regular access to supervision
- Lack of control in the working environment
- Lack of a supportive social network, social isolation
- Worldview e.g. overabundance of optimism, or cynicism. Those with a spiritual belief system did best
- 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:
- 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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Medical doctor, Gestalt psychotherapist, TRE trainer, trauma specialist and teacher, I have committed my life to the exploration and practice of healing.
During my 40 years in medicine, I became increasingly frustrated with the limited ability for pharmaceutical drugs to treat the cause of health issues including psycho-emotional conditions in my patients. To me, it became clear that these problems were related to a dysfunctional nervous system caused by unresolved and unhealed trauma. This understanding led me to leave medicine to seek out a better way.
In 2008 I found it. Combining the best from many modalities including Gestalt psychotherapy, neuroscience, and epigenetics – drawing inspiration from both the traditional and modern – I created Quantum Energy Coaching (QEC), revolutionising the way we approach healing. A simple, yet profoundly effective method that works with the subconscious mind, QEC is a clinically usable tool that heals the effects of past trauma and changes limiting beliefs rapidly and safely.
Following early success, QEC soon established a global following, inspiring me to offer training in the methodology and to build a team of practitioners who today, use it to heal thousands all around the world from the most traumatised to those simply wanting to live their fullest lives.
My debut autobiography, There Has to Be Another Way, is available to buy at all good online retailers.
