Compassion Fatigue: When the Helping Well Runs Dry

Editor’s Note: This text is a transcript of the course, Compassion Fatigue: When the Helping Well Runs Dry, presented by Kim Anderson, PhD, MSSW, LCSW.

Learning Outcomes

After this course, participants will be able to: 

• Recognize the differences between compassion fatigue and burnout.
• Identify the symptoms of compassion fatigue and burnout.
• Identify strategies to impact compassion fatigue and burnout.

Introduction

This course is actually based on a chapter I wrote in my book, "Enhancing Resilience in Survivors of Family Violence". The point of putting this together is when we're talking about compassion fatigue, it's very different from burnout. I notice quite often that with the students I teach or the professionals that I interact with, they would talk a lot about burnout. But when they started to explain more about their experiences and their processes, it wasn’t something that burnout could have contributed to. It was really something more along the lines of compassion fatigue or what's also called “secondary traumatic stress”. It's very unique in the sense that it is something specific to working in areas of high trauma or high needs such as clients who are suffering and you are empathizing with them and taking that on. So this course is really about looking at compassion fatigue and the difference between it and burnout. 

Compassion fatigue and burnout differ in that there are different sources for them. That then means there are different solutions depending on if you're experiencing compassion fatigue or burnout. I also just want to put a caveat out there that there are professionals who don't experience either one.  It doesn't necessarily mean that if you go into social work you will experience burnout or compassion fatigue.  However, my students always say their number one concern is burnout.  So, let’s talk about strategies that can help prepare us for the work so that our compassion satisfaction balances that compassion fatigue. 

Compassion Fatigue vs. Burnout

Differences

We want to recognize the differences as far as the source of what's causing either compassion fatigue or burnout. We want to find strategies that can impact compassion fatigue and burnout. A lot of times when we talk about strategies, we talk about taking deep breaths, walking, and exercise, et cetera, which are all very helpful. However, I also want to discuss strategies related to some research that's been done on what's called Master Therapist.  There are some individuals who have been in the field for a long time and they have found that there are different areas in their lives that are really strong and that helps them to navigate those tougher waters in the practice arena. So, we'll learn from the experts and I'll talk more about that. 

Let's first look at the cost of empathy for compassion fatigue. What happens in our work is that, obviously, our best feature is being compassionate to the people that we work with. That can take a toll.  We are human and we share in the suffering with the people that we work with. We experience some of the same kinds of feelings that our clients feel and experience. That is really different than burnout. 

Burnout is really about the generalized stress of working with difficult clients and difficult situations. Anyone can experience burnout. Meaning, whether you're working at McDonald's, you are a faculty member at a university, or you have a client caseload. Anyone can be overwhelmed with stress from their job and also the challenges of that. That tends to be more related to the environment that is causing the burnout, whether that's too many caseloads or not enough support, etc. 

Compassion fatigue is different in that it comes from within the individual and is just about “the cost of empathy”. It's the cost of caring. When that well starts to dry up, it's hard to keep going back to it then. We feel a lack of connection or a lack of impact in energy in our work. 

Compassion fatigue is a specific reaction to working with the trauma history of survivors. It is about working with individuals who have suffered, and therefore their suffering we also witness. As witnesses, it can take a toll on us. As I said, burnout occurs in any profession, but compassion fatigue is really about the specialized work that we do. 

With burnout, we feel overloaded. Oftentimes, there's too much, too many tasks, too much to do, and not enough time.  Burnout is about the work and trying to get the work done. 

Burnout progresses gradually. It's not something that comes on suddenly like compassion fatigue. Compassion fatigue comes on maybe because you have a large number of survivors in trauma and you are witnessing their experiences and their stories and their reactions.  Suddenly you have a reaction to it. You may be experiencing that secondary trauma, which is not being able to stop thinking about a client or their situation, not being able to separate yourself from those emotions and feelings. You actually end up being anxious in situations or settings where there is not a trigger. 

Burnout includes emotional exhaustion. But with compassion fatigue, it’s not just emotional exhaustion, it’s emotional depletion. In some sense, it also leads to a different view or perspective on how we see things in our lives. It leads to changes in trust. For example, if we're working with rape survivors, we may lose trust and that could impact our relationships, feelings of control, intimacy issues, safety concerns, intrusive imagery. So even though you may not have experienced what your clients have experienced, you might have images of when you're talking about their experiences of what that was like. That may come on suddenly or at times when you’re not even thinking about it. 

Compassion fatigue also impacts how we look at things. Suddenly in your world, all you see is trauma, whether you're out shopping or if you're attending a religious service, etc. You may start to see people as predators or potential abusers. It really feels unsafe. Whereas in burnout it doesn't necessarily lead to changes associated with your personal life. It can be bothersome, like if you come home and displace your frustration on your partner or something of that sort. But it's not impacting the way you view your relationships with your partner or others. 

Commonalities

Now let's talk about the commonalities. Sometimes it’s difficult at times to distinguish between compassion fatigue and burnout because there are similarities.  However, as I said, it's that source of where it’s coming from that's different. 

Commonalities include physical symptoms, behavioral symptoms, work-related issues, interpersonal problems, a decrease in concern and esteem for clients, and a decline in quality of care. These symptoms might provide you some insight into whether you or a co-worker may have something going on.  When I started working, I thought that if I had any kind of negative reaction to a client or a feeling about them, that was not good for relationships. I thought I had to be perfect and not ever have any negative thoughts or feelings about it.  Then I realized over time that you're human and that's going to happen. It's actually good to pay attention to transference or countertransference. When you are feeling something in relation to your client, then that countertransference is telling you something, and it means we probably need to pay attention to something in ourselves or in that relationship. 

Physical symptoms.  There's the fatigue, that overall physical exhaustion. Even if you get enough sleep, it never really feels like you are as alert as you want to be. You're always feeling this underlying fatigue. Then, of course, there are sleep difficulties. Similar to depression, what often happens is you can fall asleep rather easily but then you wake up and can't get back to sleep. There is anxiety that goes with sleep difficulties, which often means you can't fall asleep. You're up and it feels more like insomnia. There are many somatic problems which is when you have physical symptoms with no physical cause. It might be due to stress whether it’s headaches, abdominal pain, muscle weakness or muscle tension, sore back, sore neck. A lot of times this is when we have that mind-body connection where we might think we're doing okay but our body is saying, "Hey, let's look at what's going on here. There's something that is not right.” 

Emotional symptoms.  This is really about irritability. When we talk about this, we have coworkers who are irritable, just like our clients, that means that obviously something's going on with that person. This ends up distancing them from others. When you're irritable towards others, then they don't want to be around you. It becomes very distancing when people are acting in an irritable manner. But, often, it’s the opposite of what they want.  They're pushing people away but they actually want support. The idea is if I complain enough, I will get support but what ends up happening is you want to distance yourself from that person. 

Anxiety is the anxiousness that you have about work.  For example, you might be very anxious about clients coming in or getting things done. Depression is kind of related to not getting things done, not feeling you can be there for your clients, and feeling shut down. Guilt is an interesting symptom because as you hear your clients' stories, you start thinking, “I haven't been through that," or "My life's pretty good." So you start to feel guilty for not having the experiences that clients have or you feel guilty that your life experiences are not impacted in that same way. 

Finally, there's a sense of helplessness. This is that overwhelming feeling of, “Where do I go from here? What do I do with this client?” For example,  a client comes in and you're doing the assessment. They tell their story of childhood abuse and sexual assault in adulthood. They're talking about this and you're thinking, "Oh, goodness, this person has been through so much. Where do we even begin?" So, you start feeling helpless or overwhelmed, which is perhaps what the client is feeling also. But you also could be feeling that sense of helplessness because you have a lot of cases that are similar in that regard, where there's a lot of trauma and difficulty that people are having. You feel responsible. 

I know I had the most challenges with compassion fatigue when I was working with children and particularly in child sexual abuse. The first job that I took, they did what most agencies do and they loaded me up with all the difficult cases. I had probably 15 to 20 cases of child sexual abuse. That became extremely overwhelming for me, particularly this sense of helplessness, especially when testifying in court and judgments would go against what I thought was in the best interest of a child. There was just that sense of helplessness. What really was necessary during that was having a good supervisor, good peer support, and also the belief in the resiliency of children and families - not to invalidate any trauma that they'd gone through. 

Other times that I had challenges with compassion fatigue were when I had worked with a young client and we had worked really hard. Then a year later, that same client would come in and would have been sexually abused again. That’s when things became really challenging for me. Eventually, I did change client populations and the next part of my career really focusing on adults, where that child sexual abuse, et cetera was something that occurred in the past, it still affected them but it wasn't happening right then at the time. 

Behavioral symptoms. This includes aggression which can be seen from coworkers or yourself being verbally aggressive. Callousness, especially from coworkers, can really feel condescending when they are either callous about you and your work or callous about their clients and treating them in that way. So, these behaviors are not just in the coworkers' environment but they can also become aggressive with their clients. 

There is also pessimism. I've been in this field for 30 years and have had the pleasure of working with many different coworkers, clients, et cetera. What I always have a hard time with is the pessimism. When you try to create solutions and the person shuts it down and says, "Nope, we've done that before. "That didn't work." I always tell students who are doing their internships that they will bring something up and staff will tell them, "Oh, you'll learn. You'll learn, you're naive, wait till you learn." I always talk to the students and say, "That's not the case. It's actually just a different paradigm." They operate in a paradigm that looks at things as problems, and you're coming in with a paradigm that looks at solutions. You're saying people can change, and they're saying they can't. I always say if you're told you're naive that's actually a good thing. It means you believe that people can change and that there's a solution or many solutions to this case. 

Another behavioral symptom is defensiveness. You say something to a coworker and they react strongly as if it's an affront on them. But there's also the defensiveness with clients. For example, a client might say, "I don't feel this is helping me." The social worker might become very defensive and say, "Well, what are you doing to help yourself?"  Again, there are those aspects that come forth either in relationships at work or with clients. 

Cynicism occurs when you or a coworker thinks that people don’t change.  For example, a coworker reads a file and says, "Oh no, they've been here. We've seen these people before. We've seen these clients and here they are again. They don't change," This is very different than thinking from more of a solution focus which would be, "So they've been here before and they must have done well. They were able to get their kids back." for example, if it was an abusive situation. "I wonder how they did that? Maybe what worked then we could try again," A cynical view would be, "You know what, they just shouldn’t be parents." 

There is also the avoidance of clients. Avoidance of clients happens in many different ways but some examples are: not answering phone calls from them, not making home visits or not scheduling visits with clients. With avoidance there is this feeling that it’s just too much, there are people that are depending on us too much.  So, there is this avoidance of doing the work related to that, such as writing up notes about the client and their situation. 

Substance abuse is another behavioral symptom. This is the idea of dealing with the stress and frustration, and feeling overwhelmed by substance abuse. It can be brought into the work environment which is a pretty significant situation and one that needs to be confronted quickly.  We want to support that person to get the help that they need. 

Finally, there's physically or verbally acting out. This is very significant.  No one should have to go to work and be verbally or physically abused in their environment. If that's happening, it needs to stop immediately with leadership doing something about it. 

Work-related symptoms. Work-related symptoms can occur when you reach a point where you're saying, "I just can't do this anymore” and you quit your job.  That's where I see a lot of turnover particularly in areas where somebody is new or they're early in their career. It's just like what happened to me with getting some of the hardest cases, some of the most difficult cases, and didn't have a lot of variety. Then we don't get the support we need and oftentimes we don't get financially compensated in a way that I think we should in our work. That leads practitioners to quit their job. 

Work-related symptoms can also include poor work performance. If you're avoiding clients, that means you're not meeting with them. That means that you're also not providing direct service or perhaps billable service. But even when you do provide that, if the work is not helpful or it's negative, then you become a person who is always having a problem with the client. However, you feel it is always the client's fault, not yours. 

There is also absenteeism where the person is absent from meetings or not going to appointments. They are always late and say, "Oh, well, that's just how I am." Generally, there's something more to it. I also see this when I work with students who are always late to class.  When I ask them about that and other parts of their life, they say, "Well, I won't do it in practicum." I always say to co-workers and students that we don't generally change dramatically from situation to situation.  So, it's good to work on those skills now especially with students before they're in a practicum in order to impact some of those behaviors and enhance professionalism. 

Constantly seeking avoidance of work is another work-related symptom. This is the individual who spends all of their energy avoiding work rather than just doing the work.  (Avoidance and procrastination are anxiety-based.)  As a result, the work builds up, and then it becomes all the more overwhelming. Then the person shuts down even more.  And then you even shut down more. 

There is also risk-taking.  For example, let's say you go out after work with coworkers and you start talking about clients and saying names, etc. Breaking that confidentiality is a job-ender. You can have your job terminated for that. But then there's also the risk-taking of making home visits late at night. Those types of things. 

Interpersonal symptoms. This includes symptoms like perfunctory communication. All you do is respond “yes”, “no”, “sounds good”, etc.  It's cutting people off in conversation which of course is not positive relationship building. 

It also includes the inability to concentrate and focus.  There is social withdrawal that isolates you from other people.  

A lack of a sense of humor or humor at the expense of clients is also an interpersonal symptom. I see this happening in very negative work environments. I have gone into certain facilities to do a training or work with folks and the employees are making fun of clients and telling jokes about them.  There's never a reason for that.  Humor is a good thing, but not at the expense of anyone else. 

Finally, there are poor client interactions. As I said before, it this idea of having a lot of problems with clients but they're the ones causing the problem. You just always have the caseload with the most problematic clients but yet that doesn't change. You don't look at anything that perhaps you're doing in the relationship to cause that. I always say that I don't have problematic clients; I have clients with problems.  I say this with teaching too. So many times, we stop looking at clients and their whole picture. We start focusing on their faults and don't see anything else, which makes it very difficult to impact any type of change. 

Definition of Compassion Fatigue

Let’s move on to the definitions of the sources of compassion fatigue and burnout, what causes it, and how to impact it. Compassion fatigue is that state of tension and preoccupation with traumatized clients. It can be reexperiencing the traumatic events, which, again, doesn't mean that you experienced it directly, but you are reexperiencing it and thinking about it, dreaming about it, processing it, and not being able to let go of it. There can be avoidance/numbing of reminders. Similar to symptoms, this is avoiding clients or avoiding a topic or situation that the client wants to discuss because the social worker can’t handle it or deal with it anymore.  Of course, that is coupled with the persistent arousal which is part of that anxiety. 

These symptom clusters are very similar to posttraumatic stress disorder. What that means is helpers can have that, too, as secondary trauma.  You might think that it's something related to being burned out, but in reality, it's related to that tension and working with clients who are suffering. 

The Compassion Trap

The compassion trap is the inability to let go of thoughts, feelings, and emotions that are useful in helping another, long after they're useful.  What that means is oftentimes our brains have to work through and process these experiences of what people have been through; these often inhumane, awful, terrible experiences that they've been through. Your brain has tried to make sense to that and how to process that.  So, it continues to work in that realm of thinking about how to impact that.  You have to have a way to be able to debrief and let go for that to happen. And that may happen in different ways. It’s actually very helpful to process the experience, just like we tell our clients to do.  We tell them to process the experience, to talk about it, and to discuss it.  Your brain is going to do that just that.  However, when your brain can't shut that off and you keep thinking about it and obsessing about it and having those thoughts over and over, that is when it's not as useful. 

Compassion Fatigue is Characterized by:

Compassion fatigue it's characterized by a set of symptoms that are sometimes disconnected from real causes. For example, the trauma didn't happen to you directly. Even if you have had that type of trauma in your background, it doesn't necessarily mean that it's triggering it.  Most often the symptoms are related to the work that you're doing, they’re not about your own personal experiences. That being said, if it is triggering, that's something then you need to be able to look at, address it, and get the help that's necessary. 

Compassion fatigue is also a set of symptoms triggered by other experiences. And once it's noted, it's highly treatable. So, once you recognize that this is compassion fatigue, not burnout, there's something that you can do about it.  Although it comes on suddenly, it can also be resolved quickly too. 

Definition of Burnout

Burnout, defined, is a state of extreme dissatisfaction with one's work. Dr. Christine Maslach is a researcher who has done a significant amount of research in this area and has survey instruments on burnout. She talks about the “work-climate view” and says that burnout is not a problem of the people themselves but of the social environment in which they work. It is the negative work culture that is impacting a person's satisfaction level with what they do and where they work. 

Key Work Dimensions

There are some key work dimensions related to burnout. Think about your own work environment and the differences between these two categories: 

Fully Engaged                       versus                                    Burned Out

Energy                                                                                   Exhaustion

Involvement                                                                          Cynicism

Efficacy                                                                                  Ineffectiveness

If we look at key work dimensions that positively impact the work environment and therefore lessen or decrease burnout significantly, it's a work culture where people are fully engaged. They're fully engaged in the work that they do and thinking about the work environment.  It’s not this sense of not doing the work and just kind of “hanging out”.  It's contributing and wanting our work environment to be positive and for people to do their best and do that on behalf of their clients. 

That is different than the negative work environment, where people are burned out about the work. They feel no matter what they do, it doesn't make a difference anyway. Everybody kind of feeds off each other in that regard with negativity. 

If we look at highly engaged work environments, people have a lot of energy and there's an excitement about it. They are coming up with new ideas and solutions versus the exhaustion of people feeling that they're not having an impact and can't make a difference. 

In a positive work environment, people are highly involved in their work, as opposed to the cynicism that is seen in negative work cultures that contribute to burnout. There is also a sense of efficacy. There is a sense of, "What I do can make a difference." You are not trying to fix people but you are thinking that you can help people with strategies and tools to help them fix themselves. There is meaningfulness in that. When we have burnout there is an overwhelming feeling of ineffectiveness, which goes back to that helplessness. 

There are three points that I really want to make clear in work environments. A client cannot function psychologically at a higher level than the helper. That means that as the helper, you have to have your life areas and your impacts fairly managed. I've worked with clients who have had different workers and they come in and say, “He/She needs to have therapy,” meaning the worker themselves. They tell me about some of the things that have been said to them, and I understand their frustration. However, that negative language, or verbal abuse, those types of things are not only unnecessary but damaging. So, we really have to take care of ourselves because it comes across in our work. 

In a parallel fashion, it's hard for a worker to function at a higher level than the boss. If you have a boss who is disrespectful or not acknowledging the work people are doing, it's hard for a worker to continue to function at a level that is higher than that or different than that to try and rise above it. 

Lastly, only energized people can continually care for others in need and do it over and over again. We all got into the helping profession for a reason. Ultimately, it is to help others. We cannot do that if we don't feel energized and we're not taking care of ourselves. We're human and there are times when I have messed up with a client or I've said something to a client. But, I have found that people really acknowledge and respond to apologies. For example, if I had been short with the client or if I have a client that says, "You look like you have a lot going on" because my facial features many times show more than I realize. And I apologize and say, "Oh, you know, I do. I'm sorry, but I'm here for you. Thank you for acknowledging it and you're correct. I do have a lot going on." I want to honor their insights, but I also want to apologize and make sure that they know that I'm there for them. 

Six Work Environment Sources of Burnout

Let's look at the environment and the sources of burnout: 

1. Work overload vs. Sustainable workload - We have way too many cases. A lot of times, in the direct practice world we have to book more cases than what's manageable because not everybody shows. But when they do, it is very challenging.
2. Lack of control vs. Feelings of choice/control - A lack of control is feeling that things are always changing, and you don't have any input in impacting that environment. 
3. Insufficient reward vs. Recognition/reward - You don't feel that you're rewarded. It's not only financially but it's also about not being recognized.
4. Unfairness vs. Fairness, respect, justice -  There's unfairness that's happening. The supervisor treats some workers different than others and that feels unjust, disrespectful
5. Breakdown of Community vs. A sense of community - There's a breakdown of community versus that sense of community
6. Value conflict vs. Meaningful, valued work - Feeling that you are operating in an environment that conflicts with your personal, and not personal but perhaps, but most importantly your professional values. In that case, the work then doesn't feel meaningful, doesn't feel value.

Negative Work Culture

Negativity is easy to catch.  It’s as if everybody wants some catharsis. Everybody wants to let loose, but the problem is that negativity doesn't lead to solutions. It generally builds on itself and often isn’t directed to what the real underlying issue is. So, negativity is seductive. At first, you feel better when one gets it. Venting helps initially, but it leads to more venting and not solutions. It's difficult to offer hope to your clients if you're not seeing solutions. It's difficult to do that in a working environment and keeping compassion when we're in this cynical work environment. For example, with burnout and a negative work culture, one of the solutions might be using an external consultant to look at the work environment and culture and how to impact it. I've done a lot of external consulting for agencies and what I find is it really starts with leadership. It's about that leader's positivity and how they impact their workers in the work environment. That’s not to say that as workers we can't find solutions and contribute also, but it really helps to have a leader on the page of wanting a positive work culture. 

Creating a Positive Work Structure Within the Organization

Creating competent and committed leadership promotes a healthy work environment.  But there is also mentor and peer support that is critical, particularly for those in their first two years of a job. It is essential to be checking in with coworkers and to assist them when stressors exist. 

Workers also need to have ongoing enriching peer relationships. I've been very fortunate to have had a lot of good relationships with social workers. Many of my friends are social workers. But I also had a lot of friends and relationships with folks that have nothing to do with social work. It is so helpful in the work environment to have ongoing positive peer relationships. 

Workers also need to be involved in creating health-promoting work environments. 

You need to have your input but also make that difference. As I said previously, you can't just leave it up to leadership, you also have to take responsibility in making an impact. 

Protective Factors for Workers

Some other protective factors for workers with burnout would include workers directly engaging in highly stressful professional dilemmas. Meaning, instead of avoiding highly stressful professional dilemmas,  we're actually working on directly engaging in them. Other protective factors include workers confronting and resolving personal issues, and being highly engaged in learning. That's a powerful source of renewal for them. 

These protective factors can be helpful for both burnout or compassion fatigue. We need those professional development experiences, but we also need to be able to confront and resolve personal issues. That will help us to engage rather than avoid. 

Characteristics of Master or Well-Regarded Practitioners 
that Avoid Burnout and Compassion Fatigue

I want to talk more about the research conducted looking at the characteristics of master or well-regarded practitioners who avoid burnout and compassion fatigue.  Essentially, practitioners were asked to nominate someone they feel has been in the business for a long time but is still excited about their work, satisfied with their work, et cetera. If a person received three to four nominations, they became a part of the study. The study then asked those individuals to describe how they have managed and navigated 20 to 30 years of work they do in this highly specialized area of trauma, et cetera. How do they do this work and still have a sense of wanting to make a difference every single day?  How is there still a high level of satisfaction?  

Cognitive Domain

The researchers found that cognitively, these master therapists were voracious learners and insatiably curious. It wasn't just about reading about social work practice, it was also about reading about other areas in life such as history or other types of literature. 

Their accumulated experiences were significant and they had brought wisdom to their work. That was a major resource. What's different about their accumulated experiences is that they used that wisdom to make a positive impact as opposed to shutting down experiences and saying, "Oh, we can't try that." 

I had a coworker who had worked 30 years and she retired. When I asked her what she's going to do in retirement she said, "You know, I think I'm going to learn Vietnamese. I would like to try to learn that language. I've always had a lot of interest in the area." Her answer did not surprise me. She's always going to be learning and using that language because there were several families that were Vietnamese in her church that she wanted to build relationships with. 

These master practitioners were also found to value cognitive complexity and are okay with the ambiguity of the human condition. This means that problems really don't overwhelm. In fact, they usually want to figure things out. “How can I work with the person and figure this out.” It's a profound understanding and acceptance of the human condition. I really like that aspect because it's not judging.  It doesn’t judge people and it’s realizing that everybody has a story. We don't always know what that story is but our role is to help in our clients figure out what story it is that they want to create for themselves. 

Emotional Domain

Emotionally, master practitioners are very receptive.  This characteristic is so significant. They're defined as being self-aware, reflective, non-defensive, and open to feedback. Some of these are in direct opposition to the characteristics we talked about in regard to the symptoms of burnout or compassion fatigue. 

They are not only able to accept feedback but they seek it out. How am I doing? What could I do differently? That's not only from coworkers and supervisors but from their clients too. They're mentally healthy and tend to their own emotional wellbeing. They are human. They know they have issues; we all have them, but they do something about it, so it doesn't feed into their work. They're aware of how important it is to be emotionally healthy and provide that to their relationships with their clients and coworkers. 

There's also a deep acceptance of self. There's this acceptance that I don't know all the answers, but that doesn't mean that we can't search for those and find that. I'm not perfect.  A good example is when a coworker or client says something that they disliked about what I did or said, I can accept that and acknowledge it but also take responsibility. 

There is also an intense will to grow no matter how long they've been in business. They want to grow personally and/or professionally, and just really enjoy life.

Relational Domain

In regards to relationships, master practitioners possess strong relationship skills. They're able to engage others and do it in a way that's very comfortable, and it doesn't matter who that person is. 

Well-regarded practitioners have strong working alliances with clients. That doesn't mean their clients don’t have conflicts with them, but they have a positive relationship because they believe in the client's ability to change and their ability to self-heal. It's also related to their helping paradigm, which is often centered around a solution-focused, strengths orientation. They see that people are always in progress and that change is inevitable and can happen. They just might not have the right tools at the moment. But we can figure out different tools. 

These practitioners also have a strength of character and personal power that enables them to face tough issues and challenge clients when needed. No one likes confrontation. However, characteristic of these therapists is that they see the importance of confrontation when it is needed for helping clients along their healing journey. Also, conflict in any type of meaningful relationship is going to happen.  It will also happen in our relationships with our clients. 

Nurturing Self through Solitude and Relationships

The participants in the study seemed to nurture themselves through solitude and relationships. There's a balance of looking at that aspect of reflection, taking time for self, but also being connected to others and connected in those relationships. They foster a professional stability by nurturing their personal life. I think that's why we see them as often cool, calm, and collected. That's really based on a strong personal life. 

The participants also invest in a broad array of restorative activities. It's not just physical activity but also mental activity or creative activity. There's a broad range of activities they enjoy which makes sense because they are truly curious and interested. There is always something new to do. 

They construct fortifying personal relationships. It doesn't mean there has to be a large quantity of them. It can be the quality of them as well. They have a really good support system which helps them in their professional life too.  The participants were also found to value an internal focus. They value being able to look inward and process and do it in a way that is not obsessive. It's about figuring out problems and issues, whether it's personally or professionally, to make a positive impact. 

Professional Quality of Life Scale (Pro-Qol)

If you're wondering if you have burnout or compassion fatigue, there is a free scale called the Professional Quality of Life Scale, Pro-Qol.  I highly recommend that you take this scale to not only see where you are at now but retake it every three to six months to see how it changes. 

There are three sub-scales: compassion satisfaction, burnout, and compassion fatigue. 

Compassion satisfaction is the positive feeling you get from the work that you do. The higher the number, the higher the satisfaction.  A score of 41 or higher means you're in the top tier of compassion satisfaction. A score from 37 to 40 would be average satisfaction and score of 32 or lower indicates less compassion satisfaction.  

For the burnout subscale, there are characteristics of the work environment. It asks questions about workload, etc.  Higher numbers mean higher burnout. 

The compassion fatigue subscale asks about the relationship aspects of your cases, such as do you take your work home with you mentally, emotionally, et cetera. Again, higher numbers mean that you have higher compassion fatigue.  It is possible to have high compassion fatigue and also have high compassion satisfaction. They don't cancel each other out but they can balance each other out. Similarly, you can have high burn out but high compassion satisfaction. This can happen when you love your job even though the work environment isn’t what you would like it to be. 

With that, I want to thank you all for doing work that you do and ultimately taking care of yourselves so you can keep doing that work. 

References

Anderson, K. M. (2010).  Enhancing resilience in survivors of family violence.  New York:  Springer Publishing Company. ISBN: 9780826111395

Brown, A.R., Walters, J.E., & Jones, A. E. (2019). Pathways to retention: Job satisfaction, burnout, & organizational commitment among social workers. Journal of Evidence-Based Social Work, 16(6), 577-594. doi:10.1080/26402066.2019.1652006

Brown, M.-E. (2020). Hazards of Our Helping Profession: A Practical Self-Care Model for Community Practice. Social Work, 65(1), 38–44.  

Cuartero, M. E., & Campos-Vidal, J. F. (2019). Self-care behaviours and their relationship with Satisfaction and Compassion Fatigue levels among social workers. Social work in health care, 58(3), 274-290.

Figley, C. (2002).  Treating Compassion Fatigue. New York:  Brunner-Routledge.

Fox, M. (2019). Compassion Fatigue and Vicarious Trauma in Everyday Hospital Social Work: A Personal Narrative of Practitioner–Researcher Identity Transition. Social Sciences, 8(11), 313.

Newell, J. M. (2020). An Ecological Systems Framework for Professional Resilience in Social Work     Practice. Social Work, 65(1), 65–73. 

Skovholt, T. (2001).  The Resilient Practitioner:  Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals.  Boston:  Allyn & Bacon.

Skovholt, T., & Jennings, L. (2004).  Master Therapists:  Exploring Expertise in Therapy and Counseling.  Boston:  Pearson.

Stamm, B.H. (2010). The Concise ProQOL Manual, 2nd Ed. Pocatello, ID: ProQOL.org.

Summary

Katrinna Matthews: Thank you so much, Dr. Anderson, for sharing your expertise with us. Having a working knowledge of the differences between compassion fatigue and burnout, being able to identify the symptoms associated with each and ultimately being able to identify and implement strategies to alleviate and/or reduce compassion fatigue and burnout is essential to effective social work practice, especially if social workers wish to remain mentally and physically healthy and able to provide their clients with the best social work services possible. We, social workers, must remember that it is impossible to pour from an empty cup or fetch water from a dry well. Again, thank you for joining us on Social Work at continued.com.