Compassion fatigue in therapists

Compassion fatigue therapists experience can be a source of stress and therapist burnout.

In SimplePractice’s 2023 Therapist well-being report, over half of therapists (54%) reported compassion fatigue as a major factor contributing to therapist burnout.

This article will outline the symptoms of compassion fatigue therapists may have, how it develops, and how to manage it.

What is compassion fatigue therapists are experiencing?

Charles Figley, MD, who coined the term in the 1980s, described compassion fatigue as “the cost of caring.” Symptoms of compassion fatigue are wide-ranging and can affect clinicians on many levels.

According to the Canadian Medical Association (CMA), the emotional symptoms of compassion fatigue therapists and other clinicians experience include emotional exhaustion, feeling detached and numb with reduced empathy, and decreased sensitivity toward others.

Compassion fatigue can manifest in physical symptoms such as headaches, nausea, or dizziness. Cognitive issues can include sleep disturbance, nightmares, and difficulty concentrating or making decisions.

Therapist burnout can lead to the compassion fatigue therapists report when they  neglect their own self-care, succumb to social withdrawal and isolation, and resort to unhealthy coping mechanisms.

Compassion fatigue is a type of burnout unique to those who care for others, especially those who have experienced trauma.

Indirect trauma, an occupational hazard

“Compassion fatigue,” “vicarious trauma,” and “secondary traumatic stress” are often used interchangeably, but according to experts, they are different forms of indirect trauma.

Carolyn Knight, MSW, PhD, who trains clinical supervisors in trauma-informed supervision, treats them as three distinct manifestations of indirect trauma, which can overlap.

Indirect trauma is a very real occupational hazard for therapists. According to the International Society for Trauma Stress Studies (ISTSS), it’s an “inevitable byproduct of working with trauma survivors.” It’s also a leading cause of therapist burnout, and must be recognized by clinicians and supervisors alike so it can be managed appropriately.

Vicarious trauma 

Vicarious trauma is an adverse change in a clinician’s thoughts and beliefs that develops in response to exposure to others’ trauma.

Here are examples of vicarious trauma:

• A therapist working with a rape victim might subconsciously develop a sense that the world is inherently a dangerous place.
• A therapist with a caseload of children in foster care may begin to assume that all parents abuse their children.

Secondary traumatic stress

Secondary traumatic stress manifests in symptoms nearly identical to PTSD, including flashbacks, nightmares, hyperarousal, and/or avoidance of someone else’s trauma. Secondary traumatic stress is distinct from a therapist’s own personal trauma, in that the disturbing symptoms occur as a result of exposure to a client’s trauma.

Compassion fatigue

When experiencing compassion fatigue, therapists and other clinicians may find themselves emotionally exhausted, which can result in reduced empathy, patience, and connection toward clients, and can extend to others in the therapist’s personal life and even to themselves.

Some examples of compassion fatigue are:

• A therapist might become irritable and impatient with a client who makes a destructive decision such as returning to an abusive partner.
• A therapist may become irritated or even enraged by their teenage child’s immature choices.
• When experiencing compassion fatigue, therapists may also begin judging themselves harshly and isolate themselves from loved ones or from opportunities within their professional community that would provide support.

Therapist burnout

Burnout is somewhat distinct from the kind of compassion fatigue therapists may develop, as it develops as a result of general work stress like administrative workload, long hours, and low pay. It can be exacerbated by indirect trauma, but is not necessarily caused by it.

If you suspect you might be experiencing compassion fatigue or therapist burnout, you can take the Professional Quality of Life Measure (ProQOL 5.0) to assess your levels of compassion satisfaction (a low score indicates compassion fatigue), as well as burnout and secondary traumatic stress.

What causes compassion fatigue?

Most compassion fatigue therapists experience results from exposure to clients’ trauma without opportunities to process their feelings about what they’ve witnessed.

Here are some compassion fatigue examples that affect various types of therapists: 

Trauma specialists 

While all therapists act as a compassionate witnesses to their clients’ pain, those who specialize in treating trauma are more likely to witness disturbing material on a regular basis.

Without opportunities to process their own feelings about what they’ve witnessed, this traumatic material can pile up. Lack of proper support leaves clinicians more susceptible to developing compassion fatigue.

New therapists

Newer therapists might not feel that they can share their irritability or overwhelm with their supervisors.

In fact, some pre-licensed clinicians state that supervisors have mistaken their compassion fatigue for a lack of professional boundaries or fitness for the job.

Veteran therapists 

Veteran therapists might experience compassion fatigue if they don’t avail themselves of opportunities to talk about their feelings in consultation, personal therapy, or collegial connections.

Complicating factors such as a heavy caseload, overwhelming administrative tasks, and poor boundaries can wear down therapists’ resilience and exacerbate symptoms of compassion fatigue therapists face.

Managing compassion fatigue and therapist burnout

Remember, compassion fatigue therapists and other clinicians face is a very common occurrence.

If you notice that you’re starting to develop signs such as cynicism, irritability, emotional exhaustion, or reduced empathy, you’re far from alone.

It’s important to recognize these symptoms as early as possible so that you can get appropriate support.

Take care of yourself

Ask yourself if you’re taking proper therapist self-care measures: Are you sleeping well? Have you been exercising? Are you eating nourishing, healthy food?

Prioritize self-care practices to ensure that you have access to your full measure of resilience.

Practice mindfulness

Stay mindful of your thoughts, feelings, and physical sensations. If you notice a significant shift in your emotional state at work or in regards to work, pay attention. Your body and mind are giving you important information.

Set boundaries

You might consider changing your work schedule to see fewer clients per day or to include more breaks. Consider limiting communication with clients outside of work hours by telling your clients you will no longer respond to texts on weekends, for example.

Seek support

Find someone to talk to about your feelings. Remember that therapists can benefit from their own personal therapy—whether that’s in an individual or group setting.

Peer consultation groups can also be an excellent source of support to normalize your experience and benefit from an abundance of ideas for how to recover your resilience and emotional well-being.

Sources

• Barron, J. (2023) Therapists are burning out—here’s why, what the impact is, and how to help. Pollen by SimplePractice.
• (2020) Compassion fatigue: Signs, symptoms, and how to cope. Canadian Medical Association website.
• Knight, C. (2013). Indirect trauma: implications for self-care, supervision, the organization, and the academic institution.

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