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Compassion Fatigue & Vicarious Trauma Therapy For Mental Health Therapists

Canh Tran

Common Issues For Therapists & Social Workers

  • Compassion fatigue

  • Vicarious trauma

  • Burn out

  • Personal history of trauma

  • Healthy boundaries

  • Stress management

  • Seeking a space to process issues personal in nature that aren’t fit for consultation/supervision

  • Seeking a space to learn more about oneself through development, awareness, insight, and understanding

Compassion Fatigue, unlike burnout, refers to overcommitment, over invested, and/or doing too much.

What is Compassion Fatigue?

  • Usually resulted from working with trauma, intense issues/concerns, and more challenging populations

  • Not burned out, but being overcommitted and overinvested and over empathy with clients

  • Compassion fatigue is a combination of physical, emotional, and spiritual depletion associated with caring for others who are in significant emotional pain and physical distress.

Who is More Prone to Compassion Fatigue?

  • Those with unresolved trauma

  • Reactivation of past trauma

  • Working with children

  • Working with survivors of trauma (torture, refugees, sexual assault, rape, abuse, neglect, etc.)

  • Working in higher levels of care including: IOP, PHP, and IP

  • Working with chronic and ongoing suicidality

  • Working with serious and persistent mental health issues

  • And more

Symptoms of Compassion Fatigue

  • Making assumptions about clients

    • Rather than asking and expressing curiosity

  • Persistent feelings the client’s stress is also the clinician’s stress

    • Taking on

  • Believing no one can help them except for the clinician

    • Skepticism and mistrust of the world and society

  • Believing they must be accessible to clients

    • A greater need to be needed than served

  • Porous boundaries

  • Rigid boundaries

  • Disassociation or numbing out when hearing trauma opening old wounds

  • Being overly invested in the outcome for their lives

  • Feeling overly responsible or guilty when clients don’t get better

What is Compassion Satisfaction?

  • Compassion satisfaction refers to the pleasure derived from work, including feeling positively about the meaningfulness of one's contribution to the work and/or to the greater good of society.

What is Vicarious Trauma?

  • Vicarious trauma (VT) was coined by Pearlman & Saakvitne (1995) to describe the profound shift in worldview that occurs in helping professionals when they work with clients who have experienced trauma.

  • Vicarious trauma is an expected result of exposure to other people’s trauma over a long period of time.

  • Helpers notice that their fundamental beliefs about the world are altered and possibly damaged by being repeatedly exposed to traumatic material.

  • Vicarious trauma is an occupational challenge for people working and volunteering in the fields of victim services, law enforcement, emergency medical services, fire services, and other allied professions, due to their continuous exposure to victims of trauma and violence.

  • Exposure to the trauma of others has been shown to change the world-view of these responders and can put people and organizations at risk for a range of negative consequences.

Vicarious trauma is the transformation of the clinician’s experience and worldviews

  • This work is going to change us

  • The work is expected to change us

  • I do not see the world the same way since I began this work X amount of years ago

Focuses on external factors such as burn out and internal factors such as compassion fatigue, but is a mix of these two

What is Vicarious Resilience?

  • Vicarious resilience is a process of learning about overcoming adversity from a trauma survivor and the resulting positive transformation and empowerment experienced through witnessing the survivor's empathy and interaction.

What is Burn Out?

Burn-out is defined in ICD-11 as follows:

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

  1. Feelings of energy depletion or exhaustion;

  2. Increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and

  3. Reduced professional efficacy.

Physical Symptoms of Burnout (Khalil, 1988)

  • Fatigue

  • Depletion

  • Exhaustion

  • Sleep difficulties

  • Somatic issues like headaches, stomachaches, gastrointestinal issues, etc.

Emotional Symptoms of Burn out (Kahill, 1988)

  • Irritability

  • Anxiety

Behavioral Issues Of Burnout

  • Anger

  • Aggression

  • Pessimism

  • Defensiveness

  • Cynicism

  • Substance use

  • Avoidance tactics

  • Overeating or undereating

  • Work-related symptoms of Burnout

  • Quitting job

  • Poor work performance

  • Being late

  • Not coming to work

Interpersonal Symptoms of Burn Out

  • Overfocus on clients

  • Poor boundaries

  • Enmeshment

  • Wanting to save or caregiver clients

  • Withdrawal from clients

  • Disassociation

  • Not being able to connect with clients

  • Inability to concentrate

  • Intellectualizing clients

  • Treating clients like a case or object rather than a person

Who Is More Prone Burn Out & Compassion Fatigue?

  • Healthcare workers

  • Education like teachers

  • Those working in non profit

  • Helpers and healers like social workers, therapists, psychologists

  • First responders like fre, law enforcement, and emergency medical personnel

  • Those working in the realm of grief, trauma, loss, violence, and abuse

  • Victim service providers who work with survivors of violence

  • Highly Sensitive People & Burn Out

  • Wounded Healers & Burn Out

Challenging Unhelpful Beliefs

  • I do not have to be successful with my clients all the time

  • I don’t have to be perfect

  • I have to be admired, liked, and respected by all my clients

  • My clients need to work hard in sessions (improve, growth, change, transformation)

  • I have to do everything

  • My clients are helpless

  • I need to enjoy my work 100% of the time

  • My job is a job that I find meaning in and it doesn’t have to define me solely as a person

  • I have my own boundaries and the client has their own boundaries

  • I do not have to take on my client’s feelings of helplessness

  • I can give my client their dignity by respecting their agency, choice, and independence rather than assuming or expecting things from them

  • I can give myself my own dignity by respecting my agency, choice, and independence

  • I should make the system work for the client all the time since I am in a position of authority in the therapy room

  • And more

What Protects Against Burn Out, Compassion Fatigue & Vicarious Trauma?

  • Hardiness —>

  • Altruism —> helping others without expecting a reward or outcome

  • Resiliency —>

  • Humor

  • Creativity

  • Integrity

  • Hope

  • Problem solving

Questions To Ask Yourself

  • Are you reaching out for help when you need it?

  • What are your professional boundaries? What are your personal boundaries? Is there a stark difference or similarity?

  • Are your boundaries honest and nourish you? Do your boundaries deplete you?

  • Do you spend time with friends, family, and community? Social engagement is connection is crucial.

  • Do you do things that are mentally stimulating outside of work?

  • Do you do things that are relaxing and resting outside of work?

  • Do you engage in activities that recharge and energize you?

  • What are your hobbies outside of your job? How often do you engage in them? If you don’t have hobbies, what did you previously engage in or what would you like to engage in?

  • Do you have rituals before and after work to leave work at work?

  • Do you have healthy ways to process your emotions?

Value Of Therapy For Therapists

  • Therapy can be a tool for therapists. Other tools can include: 1) Exercise/movement, 2) Nutrition, 3) Sleep, 4) Decreasing stress, 5) Social connections and engagements, 6) Decreasing substance use, 7) Relaxation techniques, 8) Spirituality, 9) Faith/religion, and 10) Expressive arts.

  • Tools should used be in tandem with one another rather than alone as part of a comprehensive plan. Notice how you feel when you engage in your plan regularly. Notice how you feel when you skip using certain tools. Keep editing your plan as needed because life changes constantly due to adjustments and transitions (separation, divorce, loss, grief, death, moving, starting a new job, stressors, illness, etc.).

  • Being a therapist is a lifestyle requiring active choices and a wellness plan in order to combat the occupational hazards of our job.

Is Personal Psychotherapy Required?

  • No

  • According to Macron & Shapiro (1998): “Whilst the majority of therapists feel that they have benefited professionally from personal therapy there is very little empirical evidence that it has any measurable effect on client outcome. However, there is some evidence that personal therapy has a positive effect on those therapist qualities often cited as constructive to client change (e.g. empathy, warmth, genuineness).”

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