INTRO
Compassion fatigue, what it is, what it isn’t, and how to best address it. That was the focus of this webinar led by Lisa Rowe, Licensed Clinical Social Worker in private practice, a co-author of Unraveled Roots and the former CEO and current volunteer with Support After Abortion.
Lisa’s many years of experience as both a therapist and manager have allowed her to hone her understanding of this issue and how to best support those who find themselves dealing with compassion fatigue.
The issue of compassion fatigue is an important one. As Lisa observed, “Don’t leave yourself out to dry. So many people in our industry do that. They think that they have to bear all the weight on their shoulders. They have to take one for the team all the time, and they have to be the one that’s all knowing and all powerful. But the reality is that’s not who we are.”
Kylee Heap, Executive Director, kicked off the webinar by having attendees take an online self-assessment, the Professional Quality of Life Measure. The automated survey results provided each with a personalized score for compassion satisfaction, burnout, and secondary traumatic stress.
WHAT IS COMPASSION FATIGUE?
Lisa then discussed these three areas – compassion fatigue, burnout, and secondary trauma. She stated, “My hope is that I can differentiate that for you today and help us really understand.”
Lisa stated, “I hope to bring a personal connection to this for you so that when you’re sitting across from a client or you’re on the phone with someone, maybe a family member even, you can identify what that thing is that’s going on inside of you. If we can catch when we’re starting to feel irked or upset or having a difficult moment with a client and start to process that out loud.” She then stated she believes it is possible to stay ahead of compassion fatigue if there is enough awareness of the issue.
COMPASSION VS. EMPATHY
“Empathy is a big word to describe, I can personally relate to your experience,” Lisa said. The hallmarks of empathy are common experiences, and can be recognized by thoughts such as, “I know exactly what that feels like. Or I remember when,” and prompts you to reach back into your own story and draw parallels. Lisa then cautioned, “We want to be careful to have boundaries as we draw from our empathy.”
Meanwhile, compassion does not require our own intimate understanding of the issue at hand, but simply the ability to feel for a person going through hardship, even if that hardship is unknown to us. Compassion carries with it a desire to help the person suffering.
Lisa summed up the difference by saying, “So we got empathy, which is I can personally connect to it and we have compassion, Man, that’s a hard situation. I want to be able to help you.” She added, “Compassion is I want to help somebody. That word fatigue speaks for itself. I’m tired, right? I’m growing weary.”
Without boundaries around their empathy and compassion, providers will find themselves taking more and more of their clients’ “junk” home with them, which leads to fatigue.
BURNOUT VS. COMPASSION FATIGUE
Lisa then described the difference between burnout and compassion fatigue, stating, “Burnout is, I can no longer work in this hospital setting anymore. I worked three 12 hour shifts and I am being asked to do overtime left and right. I’m not getting any time to sleep. I am burnt out. Where compassion fatigue is, I don’t have anything in me left to hear one more person’s story. I don’t care about one more person’s story. I don’t want to hear another person tell me that they need financial support.”
Key to burnout is the feeling that the provider can no longer do this work physically, and the feeling of I can’t do this, whereas the heart of compassion fatigue is, I don’t want to do this.
SECONDARY TRAUMA
Lisa used the example of soldiers coming home from war, saying, “And the first encounter after they’ve been at war, they’re dropping all of that pain, all of the need that they have after returning from war on these helpers. And you do that long enough, you hear the stories long enough, you can grow that compassion fatigue, you can have secondary trauma.” She added that helpers can become “inundated with that experience.”
While it is not unusual to suffer secondary trauma when absorbing such heavy doses of trauma from a client, Lisa noted, “When you’re in front of that client, and you’re having that internal reaction or internal dialogue with yourself, you can name what’s going on, so you know how to walk that path forward.”
RECOGNIZING COMPASSION FATIGUE IN YOURSELF AND OTHERS
In this key section, Lisa let attendees know that she would be describing recognizing compassion fatigue in yourself and others “in a really playful way.” Lisa then introduced the metaphor of a sponge and compared the way we absorb what is exchanged in conversation with the way a sponge absorbs water.
“As people begin to share their hopes, their dreams, their heartaches, their pains, whatever it is, there’s this essence of this exchange where our sponge begins to absorb whatever those experiences are,” she said. “When compassion fatigue sets in is when that sponge is smelly, it’s been sitting in the sink. It has not been wrung out, and it just keeps absorbing, and it never wrings out.”
Lisa cautioned, “This isn’t a matter of not leaning into our clients. This isn’t a matter of disconnecting from them. Yes, we’re going to sit and have that natural exchange, but what do we do afterwards?”
To give attendees a strong sense of what compassion fatigue looks like, Lisa quoted Reddit users describing their personal compassion fatigue. “One woman said, I can’t even take a deep breath. Another one said, My ‘give a crap’ meter. It’s gone. I’m like absent when I enter a room with a client.”
Lisa then said, “And I’m going to begin to create what I see happening within us as we start to say these things. I feel absent because I’ve absorbed everybody’s pain. And so now I’ve started to take on the look of someone else. And I start to become someone else. I feel like I’m being separated from the rest of the world.”
She continued, stating, “Well, yeah, you are because you’re starting to clown around with other people’s behaviors. When I start to see long-term care as a human warehousing. Yeah. I’m not even myself anymore. I’m absorbing everybody else’s pain.”
As Lisa read these quotes and commented upon them, she put on a clown wig, tie, hat, and nose, to create a clown costume illustrating the impact of compassion fatigue. Once in her clown costume, Lisa said, “we become something we don’t even recognize.”
Importantly, Lisa commented on our inability to properly show up for and be present for clients when we are “putting on a fake face and doing the fake little show when inside we have nothing left.” She added, “that’s an indicator light you’ve lost your way. And we’ve got to get help for that.”
ADDRESSING & RESOLVING COMPASSION FATIGUE
Lisa then moved on to discuss what should be done to address compassion fatigue and noted that it is often the case that people jump to the idea of self-care as exercising or taking time to get a facial. She explained that while there is nothing wrong with this sort of self-care and that it certainly has its place, these sorts of actions are only treating the symptoms. To truly wring out the sponge requires getting to the root of the compassion fatigue.
To stress the significance of this task, Lisa noted the lengths to which people will go to avoid addressing the root causes of their compassion fatigue, some going so far as to leave their job. As difficult as it might be to resolve compassion fatigue, Lisa strongly encouraged attendees to do so.
“If any of this resonates, or you know somebody that’s operating in this space, shows up to work sarcastic every day, makes jokes about what clients are saying, can’t process with their clients anymore, doesn’t want to lead a group anymore… We want to get to the root of what’s driving that. What created that space inside of them that they no longer want to help because they’re fatigued. That space they once held that they wanted to help people so desperately, they’re running far from it,” she said.
In addition to those avoidant behaviors, she also mentioned the propensity of codependent practitioners to put on the clown costume and deny what is really going on within themselves.
To stay ahead of compassion fatigue, Lisa recommended Client Care Meetings, and stressed the importance of these meetings for new clinicians. “It’s not just to talk about the clients,” she said. “It’s to talk about what’s going on inside of us. When I have a clinician bring to me, I’m having a really hard time with this client. I’m asking them what is coming up inside of you first and foremost, not what’s coming up with the client, not how to solve the client’s problem, but what’s coming up inside of you that we need to be in touch with. That doesn’t seem like the way that you’ve always shown up for other clients. What’s different about this client? What’s different about you? “
Lisa extended this advice to those who are leading groups or otherwise working intensely with clients, saying they should have a “mechanism built in” where they are checking in with “somebody they trust and value.” The purpose of these check-ins is to assess what is accumulating, and to wring out the sponge.
“We’ve had all these experiences, and we get a whole lot of energy from helping other people,” Lisa said. “And we want to do the best that we can. And so it is really hard for us to admit that we’re in a place that we can’t help people the way that we once did. Or we actually have negative feelings towards our clients or negative feelings towards people.”
Having that trusted confidante is a key piece of addressing compassion fatigue, because a safe space is needed to explore feelings, be vulnerable, and stay humble. Lisa encouraged attendees who do not have that sort of resource to reach out to Support After Abortion.
Q&A
As the webinar moved from Lisa’s presentation to the Q&A, she stated, “I am so interested in how compassion fatigue has showed up for you, how it’s shown up in the people that you work with, how you’ve worked through it, how you’re struggling with it right now.” With that, Kylee thanked Lisa for the fruitful conversation and said many comments and questions had come through the chat.
Q: How do you trust the person you share with?
A: Lisa recommended sharing with someone who has more experience, who has journeyed further down the same or similar road and is someone you admire, with an emphasis on respecting the actions they have taken in life, as opposed to simply what they say.
She then acknowledged that sometimes this sort of person is not available to us, in which case we should seek a trusted peer, while using appropriate filters. Lisa stated that these sort of check-ins are not appropriate for those with less experience. “I’m not reaching down for support in these conversations,” she said.
Q: How do you address compassion fatigue in a team setting without singling out an individual or making them feel like they are not doing enough?
A: Lisa remarked that it is possible to bring unnecessary compassion fatigue onto yourself by “tiptoeing around.” Having a direct conversation with love and compassion is one of the most important things providers can do. She commented that she often hears people say that they know they were being talked about, but no one was willing to have a direct conversation with them. “I would say as a leader, I always go directly to what’s going on. And it has always served me to be able to have that direct and loving conversation.”
Q: I sometimes wonder if compassion fatigue can be directed to a particular client or story, like, we just don’t have the capacity to give any more toward that at one circumstance, yet we can still be available for another client who’s in a different situation. Is this something that I should pay attention to?
A: Lisa heartily agreed and said, “Absolutely.” She then directed the questioner to return to the empathy versus compassion discussion and challenged the viewers to consider why a particular client or story is difficult for them. Lisa cited her own frustration with clients who do not move forward in their journey because she is someone who is very focused on growth.
So when a client repeatedly complains about the same problem without doing the homework to address it, she can find herself getting “irked” and that “I need to make sure that that stays a client thing, not a me thing.”
If a provider finds it impossible to wring out their sponge with a certain client, Lisa suggested that it may be best “to give that relationship away to somebody that maybe can help in a different way.”
Q: When should someone dealing with compassion fatigue talk to her supervisor about it?
A: Lisa recommended that someone in that situation clear out her emotional fog with her therapist before having a conversation with her supervisor, stating, “We always want to have conversations with people that are in supervisor roles or business conversation type settings without emotion, as much as we can. We want to have as much objectivity as possible.”
She continued, suggesting that whether a person is resigning, asking for a lighter caseload, or requesting a different caseload, clarity is required before the conversation with the supervisor. Otherwise, the supervisor will solve the problem without your clear input and the solution may not be agreeable.
Q: If a staff or volunteer is showing signs of compassion fatigue, should we require them to take time off or provide some type of leave?
A: While Lisa recommended checking in with the person and having the person check in with themselves through the Likert Scale, she added, “But if we’re super far down the line, absolutely. You want to protect and keep our clients as safe as possible from people that can’t get out of their own way right now. If they’re showing up like a clown, and they don’t know it, get those clients into a safe space. And absolutely protect those clients from somebody who needs some more support and needs some rest.”
Kylee then shifted gears, mentioning two resources available at Support After Abortion. The first is a Quarterly Facilitator Training, which “brings facilitators of all sorts of curriculums together for training…it’s an opportunity to collaborate with others and to be nourished, not only from an educational space, but also from an emotional space.”
The second resource from Support After Abortion is a coaching program led by “seasoned facilitators who can walk with you as you facilitate groups, like Keys to Hope and Healing and Unraveled Roots.”
Q: How frequently should we be assessing ourselves?
A: Lisa replied that as a mother of teenagers, she is checking in with her 14-year-old high school freshman daily, but that six months from now it would probably be weekly. She used this example to illustrate how the frequency of assessment shifts in accordance with maturity and longevity, with new clinicians needing much more support than a fully mature veteran.
Q: Can you model what such a conversation should look like?
A: Lisa prefaced the modeled conversation with the caveat that all relationships are like bank accounts. We make deposits and withdrawals, and that we should be mindful of where our relationship equity stands prior to making a withdrawal.
Lisa then suggested a multi-step process when dealing with someone who may be suffering from compassion fatigue. She recommended first letting the person know there is an issue, by saying, “I’d like to have a conversation. I’m noticing some differences in your behavior, and I’d like to have a conversation as soon as possible.” This is crucially important because blindsiding someone is the worst thing you can do in such a situation, she said. By letting the person know what the conversation will be about, they can come in prepared. This sets the conversation up for success.
Once the meeting begins, Lisa recommended stating gratitude for the presence of the other person and asking questions designed to take their pulse and find out where they are mentally.
Importantly, Lisa recommended against using I feel like or I think you should language. Instead, supervisors should be very direct and objective, and present concrete observations of actions taken or statements said by the person suffering compassion fatigue. The hope is then to facilitate a deep dive conversation into what is behind these outward symptoms of compassion fatigue, concluding with actionable steps that can be taken to resolve the issue.
Q: What kind of language should we avoid in these conversations?
A: “I think. I feel. We don’t want to be subjective,” Lisa said. “If we can, we want to bring as much objectivity to a conversation like this. And we also want to be super direct. We don’t want to dance around things because people can sense that inauthenticity. Everything I said is something I’ve already said to people, and they usually walk away knowing that they can trust me because I’ve been my honest self with them.”
Lisa also said to avoid “why” questions, instead going with “what” or “how.” She explained, “I don’t want to hear the question why. Why goes backwards. Why looks to personalize it. What happened here? How can you get better? What do you need from me? How can we work on this together? What did your clients need? How can you improve this? Instead of saying, Why did you do that? Why do you think that happened? Stay away from that.”
Q: How does the conversation change when it is peer-to-peer?
A: “I think it’s the same,” Lisa replied. “I think that maybe it will feel a little bit softer. There’s a little bit of a safer place to land because there isn’t that power differential, but still just naming that, “Hey, Susie, I wanted to talk to you today. I noticed something and I’m worried about you.’”
CLOSING
Kylee then moved to wrap up the webinar, citing how many attendees had words of praise and gratitude for Lisa’s presentation. Kylee quoted Jane Abate who said, “I so appreciate Lisa, how clear, specific and direct you approach conversations.”
Kylee closed the webinar by saying, “What a joy it has been to have this reunion of sorts together with you today and have an opportunity to really focus on this important topic.”
NEXT STEPS
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