Care for the caregiver: Dealing with compassion fatigue
Prof Wentzel Coetzer from North West University specialises in the field of trauma counselling. His topic at the SAAP open day on 15 May 2010 was “Care for the Caregiver”. He addressed compassion fatigue and secondary trauma (“medelye-moegheid” in Afrikaans).
Caregivers can easily be traumatized through their work without actually being physically harmed or threatened with harm. It happens when another person’s pain triggers the counsellor’s own long-forgotten pain.
Compassion fatigue is not identical to burn-out. It refers to the situation where the counsellor associates to such an extent with the pain and hurt of others that his own body and spirit are affected and that he is touched in his innermost feelings.
Everyone caring for others may from time to time suffer from this dilemma. Christians are quite vulnerable as they cannot easily say “no” to helping others.
We find the topic in Scripture in Mark 6:31 when Jesus told his disciples to find a place to be alone and get some rest – he accurately observed the red lights.
In Luke 8:14 in the parable of the seeds Jesus observed that some of the young plants were chocked by the cares, anxieties and worries of this life (also in Luke 21:34).
The depth of compassion is well depicted in: “Who is weak, and I do not feel his weakness? Who is made to stumble and fall and have his faith hurt, and I am not on fire with sorrow or indignation?” (2 Cor 11:29, Ampl)
The trauma lens
The person entering a counselling career must realise that it can profoundly change his world - the caregiver can often be wounded by his work. It is as if you are a spectator of the trauma of the victim – you experience it as if it happened in front of your own eyes.
The counsellor must guard against viewing the world through a trauma lens. An example is counselling work with a flood victim that may change the counsellor’s attitude to being near a river.
We are more severely affected if the trauma happens to the significant people in our lives, such as death in the family.
The role of the counsellor’s unresolved trauma
The mirroring effect of secondary trauma means that the counsellor must ensure that the big issues in his own life have been sorted out.
The human brain is remarkable; day-to-day memories may be forgotten, but traumatic memory never fades.
Our natural reaction is to try and block traumatic memory, but a big trauma can trigger the memory and, even after 60 years, it will be right there in front of you.
Due to the counsellor’s past experiences he can become more vulnerable, be aware of the fragility of life and be easily overwhelmed by feelings of helplessness, depression or hopelessness.
The eventual result of unresolved trauma is depression. Minirth and Meier reports that more than 80% of depression cases can be traced to unresolved grieving processes, due to bottling up of emotions after trauma.
Counter-transference reactions
Transference occurs in the client where his attitudes and feelings that involve important figures in the past are unconsciously re-enacted in the counselling situation in the present.
Counter-transference refers to a similar, but reversed process: It is the counsellor’s reaction to the person being counselled.
With regard to trauma counsellors there are especially two types of counter transference reactions.
The first is the avoidance of pain by denial, distortion, and minimising the counsellee’s story. The counsellor moves out of the empathic role and cannot help the client.
Secondly, by overidentification with the counsellee, the counsellor’s needs are addressed through the counsellee.
Physical identification
We may also experience physical symptoms in our bodies as reaction to the stories presented to us (“body memory”).
A nurse working at a clinic that counselled women through abortion experienced similar pain in her lower back as the patients. She had to resolve her physical pain by working through the emotional pain connected to her career.
The counsellor that focuses on chronic suicidal and destructive behaviour may experience intense anxiety, rage, exhaustion, hopelessness, and deep inner insecurity after he has listened to so many bad stories. He may even question his own beliefs and ask “Where is God?”.
Sometimes a counsellor can be so overwhelmed by the pain and trauma of others that he is no longer able to listen. Counsellors are especially vulnerable to this problem when the traumatic experiences of the counsellee reminds him of unresolved trauma in his own past.
Danger signs and symptoms
The counsellor/worker...
- sees too many clients, spends too many hours counselling;
- fails to establish reasonable limits and boundaries for themselves;
- assumes too much responsibility for the client’s problems and treatments;
- experiences rage, sudden tears, overwhelming emotions;
- may have sleep difficulties, eating problems, and/or distressing dreams;
- is anxious, drained, exhausted, confused;
- is depressed, has longings to die, is overwhelmed with feelings of helplessness and hopelessness; or
- has a pattern of physical problems.
Combating compassion fatigue
It was found in the USA that counsellors were more effective when they worked in a team and rotated to different areas to avoid overexposure to specific types of pain.
Prospective counsellors had to attend a healing retreat where their issues were systematically worked through.
In debriefing sessions counsellors also pray for each other to ensure that no undue baggage is taken with after counselling.
The people closest to the counsellor are part of the solution. They can assist with monitoring him and relating his emotions after counselling.
Supervision is important. Debriefing is required from time to time. Find a mentor or accountability partner to help keep you on track. This can take place in a conversation once every few months in which you frankly discuss how you are coping, the level of your spirituality and quiet time, if you take vacations and if hobbies help you to relax.
An important point to discuss is if you are still excited about the calling of the Lord and if you are fulfilling your deepest passion. “Compassion satisfaction” refers to having fulfilment as counsellor – this helps avoid fatigue.
What is a manageable workload for the counsellor? It depends on age. Usually a maximum of 5 people should be counselled per day. Some counsellors find that seeing 6 or 7 clients per day affects them and that they may need 2 days to recover. Give yourself a 15 minute break between sessions. Listen to your body – have sufficient rest and take vacations.
“Co-dependence” refers to the unhealthy pattern of being dependent on a sick situation. The counsellor must be wary of becoming dependent on the counselling situation or the client in an unhealthy way. A counsellor’s history of unresolved trauma may unconsciously lead him into the trap.
Guidelines for preventing compassion fatigue
The risk with novice therapists is that in youthful enthusiasm they feel they must help everyone. They are vulnerable to compassion fatigue because of a lack of experience, rescue fantasies, intense pre-occupation with clients, and exceeding their emotional limits too often (the saviour syndrome).
“There is a cost to caring”
This is the introductory statement in the first chapter of the pioneering publication, Compassion Fatigue, by Charles Figley, professor of Sociology at the Florida State University, USA. Figley gives some excellent guidelines to counsellors:
- They must know when to rest, put something aside, try again later, or move on to the next person, couple or group.
- They must examine their own problems - talk or write honestly about experiences, thoughts, feelings, wants, and fears. They do not pretend to have it all together.
- They must avoid isolation – they join professional organizations and small support groups.
- They must have a colleague or supervisor to consult with regularly.
- They must care deeply, but stay objective and healthy and lovingly detach from others, their problems and pain.
- They must write down goals and stay focused on what’s important.
- They must set boundaries between work and home.
- They must establish an accountability system for responsible self-care.
- They must go through a healing process first, or risk that some of their own pain may be transferred to the client, doing more damage than healing.
- If their own pain is not resolved, they cannot effectively help others. They first have to put down their own emotional baggage.
Counsellors must establish priorities, balance and moderation in their lives. Priorities are rest, sleep, meditation and work. We tend to make work the highest priority and only rest when there is time, which is not a healthy pattern. To be of more use to God, we should actually focus on the first three!
Organisations should have someone on call for helping workers deal with stress and compassion fatigue. They should use retreats to allow counsellors to refresh, heal, motivate, recommit, and seek God.
Jesus said: "Are you tired? Worn out? Burned out on religion? Come to me. Get away with me and you'll recover your life. I'll show you how to take a real rest. Walk with me and work with me—watch how I do it. Learn the unforced rhythms of grace. I won't lay anything heavy or ill-fitting on you. Keep company with me and you'll learn to live freely and lightly." (Matt 11:28-30, The Message)
