In the demanding world of therapy and counselling, professionals walk a tightrope between empathy and self-preservation.
The emotional labor inherent in this work can lead to a sense of depletion, often described by terms like “burnout,” “compassion fatigue,” and “vicarious trauma.”
This blog post for therapists aims to provide clarity on these definitions, helping you better understand your own experiences and navigate the path toward greater well-being as a helping professional.
Defining Key Terms
When researching for this blog, I realised that we have quite a few different ways to describe the occupational impact that can come within our work. Understanding these terms seems like a good place to start the exploration.
Burnout
The World Health Organization (WHO) classifies burnout as an occupational phenomenon characterized by three dimensions:
- Exhaustion: A feeling of profound emotional and physical depletion.
- Cynicism: Development of a negative or detached attitude towards one’s work.
- Reduced Efficacy: A diminished sense of competence and accomplishment in one’s role.
Compassion Fatigue
Coined by Charles Figley, compassion fatigue refers specifically to the emotional strain experienced by those who work with people suffering from trauma.
It is defined as a form of emotional and physical exhaustion that can affect individuals who care for people who are suffering from trauma or stress over an extended period of time.
Vicarious Trauma
The term vicarious trauma was coined by Irene Lisa McCann and Laurie Anne Pearlman to describe how work with traumatized clients affects trauma therapists.
Vicarious trauma refers to the profound changes a therapist experiences as a result of empathetic engagement and exposure to graphic, traumatizing material from clients over time.
Secondary Traumatic Stress
Another term believed to be originally used by Charles Figley that has a similar meaning to vicarious trauma. It is used to describe the emotional duress that results when an individual hears about the firsthand trauma experiences of another.
Moral Injury
Moral injury can occur among healthcare professionals, like counsellors and psychotherapists, when systemic constraints prevent them from providing patients with the level or quality of care they feel is ethically required. This may lead to symptoms of guilt, shame, anger and psychological distress over time if left unaddressed.
Signs and Symptoms
Counsellors and psychotherapists grappling with burnout, compassion fatigue, vicarious trauma, or related conditions often exhibit a similar set of symptoms.
Being aware of these signs can be really helpful because burnout and compassion fatigue can have a significant impact on both your wellbeing and your ability to provide effective care to your clients.
Common indicators include emotional exhaustion, emotional numbing or feeling ‘flat’, irritability, a sense of hopelessness or helplessness, and difficulty finding joy outside of work.
Therapists might also experience cognitive difficulties, such as intrusive thoughts about clients’ experiences, problems with concentration, and nightmares. Shifts in one’s beliefs about the world and people, or a more negative outlook, can also be present.
Behavioural signs can include social withdrawal or increased isolation, turning to substances to manage difficult feelings, changes in attendance at work, difficulties in maintaining boundaries with clients (which can lead to over-involvement or emotional entanglement), and alterations in sleeping or eating patterns.
Physical symptoms may include headaches, trouble sleeping, digestive problems, and feeling more prone to illness.
Recognising these signs early on is important, as they can worsen over time and impact your ability to function effectively as a therapist.
A summary of the potential signs and symptoms
- Emotional: Exhaustion, emotional numbing or feeling ‘flat’, irritability, a sense of hopelessness or helplessness, difficulty finding joy outside of work.
- Cognitive: Intrusive thoughts about clients’ experiences, problems with concentration, nightmares, shifts in one’s beliefs about the world and people.
- Behavioural: Social withdrawal or increased isolation, turning to substances to manage difficult feelings, changes in attendance at work, difficulties in maintaining boundaries with clients, alterations in sleeping or eating patterns.
- Physical: Headaches, trouble sleeping, digestive problems, feeling more prone to illness.
Risk Factors
Some of us are more prone to being affected by compassion fatigue than others. The Office for Victims of Crime in the USA have produced a comprehensive guide to vicarious trauma.
Understanding the factors that increase your vulnerability to burnout, compassion fatigue, and vicarious trauma is crucial for prevention and seeking the right support. Risk factors include:
- Personal History of Trauma: Therapists who have experienced trauma themselves may be more susceptible to vicarious trauma or re-activation of their own trauma responses.
- High Levels of Empathy: While essential for therapeutic work, high empathy can make a therapist more prone to compassion fatigue. (A study suggests higher empathy levels are found in those who experienced childhood trauam)
- Perfectionism and Difficulty Setting Boundaries: The pressure to always give 100% and difficulty saying “no” contribute significantly to the risk of burnout.
- Heavy Caseloads: Consistently carrying a high volume of clients, particularly those with complex needs, puts a strain on a therapist’s resources.
- Exposure to Severe Trauma: Frequent work with clients who have experienced severe or repeated trauma increases the risk of vicarious traumatisation.
- Lack of Organizational Support: Working in environments lacking sufficient supervision and peer support leaves therapists more vulnerable – this is particularly true for independent practitioners.
- Insufficient or Poorly Integrated Training: Therapists who haven’t received adequate preparation for navigating the emotional complexities of the work.
- Poor Self-Care: Neglecting basic physical and emotional needs compromises a therapist’s resilience, making them more vulnerable to occupational strains.
Experiencing distress due to these risk factors isn’t a personal failing. It’s a consequence of the emotionally demanding nature of therapy.
Strategies for Management & Prevention
Recognising the signs and understanding the risks of burnout, compassion fatigue, and vicarious trauma is the first step.
Now, let’s turn our attention to practical strategies for managing these conditions and safeguarding your wellbeing as a counsellor or psychotherapist. While there’s no single solution that fits everyone, have a think about some of these areas.
Self-Awareness
Cultivating awareness of your own early warning signs is crucial. Regularly check in with yourself emotionally, physically, and mentally. Journalling, mindful reflection, and honest conversations within supervision can all facilitate this process.
Compassionate Self-Care
How often do we have to convince clients that self-care isn’t an indulgence; it’s a necessity. So you too should think about how to sustain yourself within the profession. Prioritise activities that nourish you, such as spending time in nature, engaging in hobbies, exercising, pursuing creative outlets, or simply getting sufficient sleep and eating well. Remember, you can’t pour from an empty cup, and that oxygen mask goes on you first!
Boundaries
Establishing healthy boundaries between your work life and personal life is crucial. This might involve setting limits on your availability outside of work hours, learning to say “no” when your caseload is full, and actively disengaging from work during your off-time.
Think about whether you have clearler defined how and when you will refer clients to more suitable support, if you feel their needs are outside of your areas of competence.
Supervision & Support
Utilise supervision to process difficult emotions, gain insight into your blind spots, and receive guidance tailored to your unique circumstances. Consider peer support groups where you can connect with colleagues who understand the specific challenges of the profession.
Personal Therapy
Walk the walk and talk the talk. See a therapist and give yourself the opportunity to receive the same care an attention you provide to your clients. Don’t wait for a supervisor or colleague to suggest you do it.
Conclusion
Burnout, compassion fatigue, and related conditions present real challenges for dedicated counsellors and psychotherapists. However, remember that you are not alone, and these challenges can be overcome. If you recognise the signs, don’t hesitate to seek support – speak to trusted colleagues, find a therapist who understands the unique stresses of your profession, and always share this with your supervisor.
Seeking help is a sign of strength and a commitment to both your own well-being and the quality of care you provide.
