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How to Deal with Compassion Fatigue Among Therapists

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All of us in the human services feel the impetus to give, empathise with our clients, and invest our creative energy into the clinical process. Well, after years of giving, empathising, and emotional investment in our clients, sometimes in very stressful situations, we feel it.

Call it early fatigue, or burnout, whatever the definition is, I hear it often from other therapists: ‘I give give give, and sometimes, I just get tired…’ or ‘He (my client) is stuck and no matter what I do, they don’t budge from their situation and move on.’ The fact is, we therapists are doing something wrong if we experience these sometimes very visceral and troublesome warning signs.

We can run out of empathy. Imagine all you have to offer your clients in one physiological space. For my own purposes, I imagine a well in a countryside meadow or a reservoir of water.

This is our emotional tank. Inside this tank is what’s left of our capacity to provide transference-free empathy uninhibited by our own ‘stuff’. What I mean is that, when our empathy well runs dry, the likelihood of keeping our day-to-day drama, concerns, and personal problems from infiltrating and polluting our capacity to give to others is put at risk.

Have you ever had a really bad day, riddled with personal problems, and go to work as a therapist and try to provide counselling? How did you fare? I would hazard to say not very well. Sure, you might have made it through the day, but did you really provide transference, or countertransference, free therapy without inserting your personal biases and judgement. I know, personally, and from speaking with other therapists in the field, when he has on an individual basis been struggling, either through personal plight or an unfortunate turn in circumstances, that it truly reflects in the quality and provision of their services.

You probably observed this in your day-to-day work. Have you ever witnessed a colleague spiral out due to personal problems, either bad self-care, lack of attention to their own mental health, or maybe even physical complaints that went unaddressed?

You have probably also observed its defect in the quality of their work. Either client complaints, a rise in the number of incidents on their caseload, or even incidents in the office, due to lack of attention into warning signs, or red flags in their client’s clinical picture, sometimes session content, which can unfold into emergency services making an appearance at your practice or clinic.

Believe it or not, these situations happen all the time. Why? Well, there are several contributing factors which can cause a therapist’s empathy well to run dry:

  • Poor or inadequate face to face supervision
  • An unreasonable increase in work or productivity requirements
  • Poor or insufficient self-care
  • Medical or psychiatric issues gone unaddressed
  • The collision of unfortunate life circumstances

Sure, we all need to take care of ourselves. As therapists, we know that we have an increased responsibility to model good self-care, and personal, professional practices to avoid this pitfall early on in our careers.

I recommend, without further delay, speaking with your supervisor about the status of your empathy well. Make sure to talk about it weekly at supervision. If you don’t have an immediate supervisor, reflect, as often as possible, where you stand in your capacity to provide wholly and purely empathic counselling without hitting the bottom of your reservoir.

At every one of the lectures that I give at the university, and weekly as a supervisor in a fast-paced community clinic which sees its share of trauma, I know to take time to reflect with my students and those I supervise about how to avoid this overlooked aspect of the clinical process.

It goes deeper than just personal reflection and self-awareness. Without question, and for the reasons listed earlier on, the status of our empathy wells is connected to how we practice as clinicians and what our clients are experiencing.

Thus, the level and intensity of trauma we hear about in session and have the potential to experience, vicariously, are all impacted and interlinked to the nature of the disorders we treat.

So, if you’re treating depression, you will need a different breadth of skills and be attentive to a different set of warning signs, than if you are treating psychosis or personality disorders.

Since these disorders all impact clients differently, depending on their particular circumstances such as resilience and strength, the odds are that your empathy well will also be impacted differently, depending on the nature and composition of your caseload.

This is why good supervision will go a long way in terms of identifying early drainage of your reservoir and be just as vital in terms of preserving a good healthy balance to working in this field and maintaining good emotional health. So, be reflective as much a possible, and pay closer attention to your well at all times, because it not only impacts your health but the health and wellness of those you serve and treat as clinicians in the helping profession.

Max E. Guttman, LCSW  is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.


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