Are you experiencing

compassion fatigue
As psychologists continue to help those
suffering from the impact of COVID-19,
they should watch for signs of their own
distress or burnout
By Rebecca A. Clay
Date created: June 11, 202

Clay, R. A. (2020, June 11). Are you experiencing compassion

fatigue? http://www.apa.org/topics/covid-19/compassion-fatigue

Psychologist Heidi Allespach, PhD, of the University of

Miami’s Miller School of Medicine, knows that the big
hearts that propel people into psychology and other
caregiving careers also put them at risk of developing
compassion fatigue. Ironically, she explains, caregivers
can become so over-empathic that they nd themselves
growing numb to their patients’ suffering. That’s why she
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urges the medical residents she teaches to develop what

she calls a “semi-permeable membrane” around their
hearts. “Without enough of a shield, everything just comes
in,” says Allespach. “And being overwhelmed with the
feelings of others can feel like drowning.
Now Allespach and other psychologists are worried that
psychologists are facing increased risks of compassion
fatigue as the COVID-19 pandemic stretches on
Compassion fatigue occurs when psychologists or others
take on the suffering of patients who have experienced
extreme stress or trauma, explains Charles R. Figley, PhD,
founder of the Traumatology Institute at Tulane University.
It is an occupational hazard of “any professionals who use
their emotions, their heart,” he says, and represents the
psychological cost of healing others. “It’s like a dark cloud
that hangs over your head, goes wherever you go and
invades your thoughts,” he says
Compassion fatigue doesn’t just make it dif cult to feel
empathy for your patients, says Kerry A. Schwanz, PhD, of
Coastal Carolina University. One component of the
condition is burnout, which is associated with too much
work and not enough resources to do that work well.
Burnout can result in depression and anxiety, physical and
emotional exhaustion, less enjoyment of work, and more
arguing. Another component of compassion fatigue is
secondary traumatic stress, or indirect exposure to trauma
via helping others. “I sometimes refer to this component as
‘empathy overload,’” says Schwanz, adding that
symptoms include anxiety, intrusive thoughts,
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 hypervigilance, numbness or feelings of having nothing left

to give
To keep compassion fatigue from developing or to address
it if it does, compassion fatigue experts suggest that
psychologists do the following
Recognize the sign
“Psychologists and other people in helping roles really do
forget that they’re vulnerable,” says Schwanz, explaining
that psychologists are trained to be empathic but also to
put their own emotions aside. If psychologists suspect
they are experiencing compassion fatigue, Schwanz
recommends they assess themselves with the free
Professional Quality of Life measure developed by
psychologist Beth Hudnall Stamm, PhD. This self-report
tool covers symptoms, such as loss of productivity,
depression, intrusive thoughts, jumpiness, tiredness,
feelings of being on edge or trapped, or inability to
separate personal and professional life. The measure also
assesses compassion satisfaction—the positive emotions
associated with helping others, such as happiness, pride
and satisfaction
Make self-care part of a routin
Psychologists should adopt the mantra of ight attendants:
“Put your own oxygen mask on before helping others,”
says psychologist Amy M. Williams, PhD, of the Henry
Ford Health System. Good self-care means developing a
routine that makes each day predictable and that includes
what Williams calls the big ve of self-care: adequate
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sleep, healthy nutrition, physical activity, relaxation and

socializing. The schedule should also include ve minutes
for a self check-in each morning to assess tension in the
body and worries in the mind. “Don’t do it 10 minutes
before bed, when the mind spins off into worry,” she
suggests
Examine beliefs about self-car
It’s not enough to just go through the motions of self-care,
emphasizes Schwanz. It needs to be a legitimate attempt.
“In our society, we applaud people who work themselves
to death, who neglect their own self-care to help others,”
says Schwanz. “We rarely applaud people for taking the
day off.” Psychologists may have internalized this
message, viewing self-care as sel sh, says Schwanz, who
is studying such beliefs’ relationship with compassion
fatigue. As a result, psychologists may not reap the bene t
of any self-care efforts they make, because they engage in
behaviors such as worrying about work on a day off. And
psychologists shouldn’t feel guilty about taking time for fun
and laughter during this sad, anxious time, adds Thomas
Skovholt, PhD, of the University of Minnesota. Playing
games, watching funny movies and the like can replenish
the energy needed to help others, he says. Even a tiny
dose of positive emotion, such as noticing owers
blooming, can help
Practice self-compassio
Psychologists are having a hard time along with everyone
else, says Allespach, and that’s unusual. Most
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 psychologists are now experiencing the same problems
their patients are experiencing—worries about safety,
uncertainty, nancial concerns and disrupted routines.
“Psychologists are usually the rocks in the river of life’s
uncertainty for our patients, but right now, we’re in that
river with them,” she says. “For those of us in the helping
professions, we’re trying to help our patients make sense
of this strange new reality while doing that ourselves.” That
unusual situation can increase psychologists’ stress, says
Allespach. But so can psychologists’ own tendencies, says
psychologist Anna Baranowsky, PhD, founder of Toronto’s
Traumatology Institute, who says psychologists tend to be
“over-copers.” “They are capable of working really hard
and delivering great results,” says Baranowsky. “But they
are very self-demanding and very focused on the
perfection of what they’re delivering, until the point of total
exhaustion.” It’s important for psychologists to take time to
re ect—alone, with a trusted colleague, religious leader, or
therapist—on any wounds that are surfacing during this
uncertain time, she says. “You want to really respect the
fact that you’re human, too,” she says. “Bearing witness to
another person’s suffering ignites things within ourselves.”
Create communit
Connecting with like-minded others is another strategy
that can help prevent compassion fatigue. “It may not
sound fancy or sophisticated, but building community is
the most powerful thing you can do,” says Geoffry White,
PhD, a private practitioner in Los Angeles who has worked
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 to prevent compassion fatigue in mental health

practitioners responding after terrorism and war. In
addition to staying connected with family and friends,
psychologists could set up Zoom consultation or
supervision groups to check in with each other and
prevent and address signs of compassion fatigue.
“Compared with other societies, the United States has a
very mind-your-own business culture, prizing
independence and self-reliance over community” says
White. “But anything that takes away from that isolation—
peer support—will help.
Help colleague
The pandemic is exacerbating what was already a crisis of
burnout for health-care providers, say researchers and
medical professionals at Texas A&M University and
Houston Methodist Hospital. They found that intensive
care unit workers are facing longer shifts, increased
patient deaths, lack of personal protective equipment and
nancial fears among other stressors (Sasangohar, F., et
al., Anesthesia and Analgesia, published online ahead of
publication, 2020). Those stressors can also lead to
compassion fatigue. If psychologists see signs that a
colleague, whether another psychologist or a health-care
professional, is developing compassion fatigue, they
should check in, says Schwanz. Psychologists and trusted
colleagues can give each other permission to point out
potential problems and keep at it despite attempts to
de ect or deny, says Schwanz. Schwanz herself has a
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 self-care buddy. They text each other to check in on each

other’s stress levels and to report daily acts of self-care,
such as taking breaks and drinking enough water to stay
hydrated
It’s also important to normalize compassion fatigue, adds
Williams. “You could say, ‘These are crazy times, and I’m
struggling,’” she says. “Then ask, ‘Is that something you’re
going through, too?’” In the support groups she runs, for
example, participants often admit that they didn’t realize
compassion fatigue is normal, and so they were hesitant
to ask for help. Once they realize that feeling this way is
normal for others, she says, they are more willing to talk
about their struggles and to accept help.
Focus on compassion
satisfactio
Psychologists should celebrate the positives of helping
others. “There can be terrible things going on, but focus on
the wins,” suggests Schwanz, citing the celebrations
health-care providers hold when patients come off
ventilators. Focusing on gratitude can also help, she says
Additional informatio
To learn more about compassion fatigue, read
“Compassion Fatigue Resilience” or The Resilient
Practitioner: Burnout and Compassion Fatigue Prevention
and Self-care Strategies for the Helping Professions.
There is also a special issue of the journal Traumatology
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devoted to secondary traumatic stress, compassion

fatigue and vicarious trauma
Toronto’s Traumatology Institute offers online compassion
fatigue specialist training and other resources. The
institute also offers an entry-level online compassion
fatigue resiliency and recovery training for students and
community members
Get more tips on self-care by reading about how to take
care of yourself and avoid burnout. Or listen to a podcast
on self-care. To earn continuing education credit, read the
Monitor article “Are you burned out? Here are signs and
what to do about them.”
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