I was working as a mental health professional for about two years when I was seeing a client who had an extensive history of trauma. I found myself wanting to do everything I could for this young girl. I listened to her stories that involved years of abuse and mistreatment at the hands of the individuals who should have protected her. Even though I found myself moved by her resilience, she was in therapy with me because still had a long way to go. There were a lot of scars, and a lot of poor choices, shaped by the dysfunctional thinking that developed from the years of abuse. I wanted to do everything I could to help this young woman because I knew that when these things happened to her as a girl, she had no control over it. I began seeing her in therapy at least twice a week, and made myself available to her in emergency situations (and there were many). That’s when I noticed a change. Not with her. With me. I was angry and irritable with many close friends and colleagues, I had trouble staying focused at work, was having strange dreams, and noticed that my scalp was sore in certain areas where I had picked at my hair, causing it to fall out. It wasn’t until much later that I was able to accurately label what was happening. It was my first experience with a concept commonly known as compassion fatigue.
Compassion fatigue occurs when there is countertransference, or in other words, an emotional reaction to your patient’s experiences. It’s a phrase used by mental health professionals, but it originated in 1992 when researchers noted among nurses “the loss of the ability to nurture”. What researchers noticed is that nurses were not only responding to more demanding workloads, but also to their patients’ experiences of pain, trauma, and emotional distress. The effects left nurses feeling angry, tired, depressed, apathetic, detached and ineffective. Unfortunately, compassion fatigue was not just a “phase” in the 90’s, but is also common among today’s health care professionals.
Nurses are more susceptible to compassion fatigue than other healthcare professionals. Nurses are not just an observer, but a partner with someone on their journey back to health. Nurses walk into a room when the patient is at their most vulnerable, and they get a front row seat into the intricate unsavory details of their patients’ lives. It’s not easy to “turn off” the images of the discoloration that occurs in the extremities of your diabetic patients, or the emotional anguish you witness in families when they lose a loved one. For nurses, these memories can creep in at inopportune times when you are trying to enjoy your own family. If these symptoms sound all too familiar, don’t worry. You are not alone, and you can reverse these symptoms.
To fight off compassion fatigue, the first step is learning to identify it. This can be difficult, because compassion fatigue stems from an emotional response. For health care workers, we are trained to exude professionalism always, meaning that we tend to stuff our emotions to do our jobs. Compassion fatigue is much different than burnout, although they may have similar symptoms. Burnout arises when you have identified goals that have not been met. Compassion fatigue comes about when caretaking attempts have been unsuccessful. Individuals who have a compulsive sensitivity to the needs of others, and are emotionally responsive, are most at risk for developing compassion fatigue. Unfortunately, these are also the qualities of some of the best healthcare professionals.
The most desirable outcome of course, is to prevent compassion fatigue and to head off these symptoms before they start. This is done by taking care of YOU first.