If you have been on the front lines providing public services, juggling the complexities of maintaining work and family obligations during COVID-19, caring for ill or high-risk loved ones, coping with your own mental and physical needs in times of notable social isolation, and/or struggling to see the light at the end of the tunnel, this message is for you. You are not alone. Despite these very likely human struggles, others may be depending on us for mental health services and our expertise. Despite our own best intentions, we can be pushed to limits that can impact our ability to effectively and ethically serve others.

Compassion fatigue is defined as decreased ability or interest in empathically caring for clients (Rossi et al., 2012). Similar to burnout, which is defined by cumulated emotional exhaustion, compassion fatigue is characterized by holding the stressful experiences of others. It differs depending on the intensity of the stressor and its onset becomes a secondary trauma in a helping professional (Duarte & Pinto-Gouveia, 2017), characterized by increased tension, emotional numbing or avoiding, hypervigilance, and irritability (Rossi et al., 2012). Harmful to clinical work, compassion fatigue impairs clinical judgement and treatment and increases instances of errors (Rossi et al., 2012).

Mental health professionals across the board have the potential to be affected by compassion fatigue and burnout, including trainees and professionals who have been in the field for years. Unsurprisingly, students and trainees are at risk of compassion fatigue as they encounter their first clients (Beaumont et al., 2016; Can & Watson, 2019; Knight, 2011). For each year spent working in a community-based mental health setting, the risk of burnout and compassion fatigue increases (Rossi et al., 2012). This has also been observed in other helping professions (Fahy, 2007; Fontin et al., 2020) and may be, in part, credited to evidence-based buffers against compassion fatigue being only relatively recent studied (Fahy, 2007).

One identified risk factor for greater levels of compassion fatigue includes having experienced at least one negative event in the prior year (Rossi et al., 2012), putting all mental health professionals working during the pandemic at a greater risk. The COVID-19 pandemic is both conceptualized as a single and a series of negative events, subject to individual experience and perception. Yet, previous research suggests the risk of compassion fatigue is more strongly related to minimal negative events in the past 12 months, versus the risk of burnout, which is more strongly related to multiple negative experiences (Rossi et al., 2012). Present applications may suggest that, while we may see high rates of compassion fatigue now, we may see an increasing rate of burnout among mental health providers as the pandemic surges.

We are in this together, and the following ways may help us all to reduce the risk of both compassion fatigue and burnout.

Find value in your work

Compassion satisfaction, which means finding value and satisfaction in  helping others, appears to protect against compassion fatigue (Duarte & Pinto-Gouveia, 2017; Rossi et al., 2012). Psychological distress among mental health care workers is associated with lower levels of compassion satisfaction and higher levels of compassion fatigue (Rossi et al., 2012). To antidote such fatigue, consider enhancing gratitude practice, focusing on the things that bring you more joy in your work, and/or reducing the things that result in less satisfaction.

Foster self-compassion

A greater sense of self-compassion is related to greater resiliency against others’ distress (Beaumont et al., 2016), demonstrated by neural activity observed in those who complete compassion training (Klimecki et al., 2012). Seemingly counterintuitive by name, increased self-compassion, such as practicing mindfulness and meeting your own needs, will build resiliency needed to care for others.

Set boundaries (especially from home)

Working from home in the era of COVID-19 brings on another challenge when work is helping in nature. Work-life imbalance contributes to burnout (Yester, 2019); however, mental health professionals working from home no longer have the walls of an office or other external workplace to set natural boundaries. Rather, the spaces associated with self-care, such as home, family, relaxation, etc., are now blurred with clinical work. Change your environment in ways you may have not considered before with sensory tools and exercise, or even consulting with an occupational therapist. Above all else, practice self-compassion.

Build and model practices for trainees

While a strong supervisory alliance is an important aspect of clinical training, the alliance alone does not appear to buffer against compassion fatigue (Can & Watson, 2019). Rather, clinical supervisors might encourage wellness and self-care practices for trainees as part of their training, integrating protective factors early in trainees’ clinical careers. Open discussions around risk factors and symptoms of compassion fatigue might foster preventative practices and awareness for trainees to incorporate into their professional careers.

References

Beaumont, E., Durkin, M., Martin, C. J. H., & Carson, J. (2016).
          Measuring relationships between self-compassion, compassion fatigue, burnout,
          and well-being in student counsellors and student cognitive behavioural psychotherapists:
          A quantitative survey.
          Counselling and Psychotherapy Research, 16(1), 15-23. 
          https://self-compassion.org/wp-content/uploads/2016/06/Beaumont_2015.pdf

Can, N., & Watson, J. C. (2019).
          Individual and relationship predictors of compassion fatigue among counselors-in-training.
          The Professional Counselor, 9(4), 285-297. https://tpcjournal.nbcc.org/wp-content/uploads/2019/11/Pages_285-297-Can-Individual_and_Relational_Predictors_of_Compassion_Fatigue_in_CITs.pdf

Duarte, J., & Pinto-Gouveia, J. (2017).
          The role of psychological factors in oncology nurses’ burnout and compassion fatigue symptoms.
          European Journal of Oncology Nursing, 28, 114-121.
https://doi.org/10.1016/j.ejon.2017.04.002

Fahy, A. (2007). The unbearable fatigue of compassion:
          Notes from a substance abuse counselor who dream of working at Starbucks.
          Clinical Social Work Journal, 35, 199-205.
https://psycnet.apa.org/doi/10.1007/s10615-007-0094-4

Fontin, F. M. B., Pino, E. C., Hang, J., & Dugan, E. (2020)
          Compassion satisfaction and compassion fatigue among violence intervention caseworkers.
          Journal of Social Service Research.
https://doi.org/10.1080/01488376.2020.1839628

Klimecki, O., Leiberg, S., Lamm, C., & Singer, T. (2012).
          Functional neural plasticity and associated changes in positive affect after compassion training.
          Cerebral Cortex, 23(7), 1552-1561.
https://doi.org/10.1093/cercor/bhs142

Knight, C. (2011). Indirect trauma in the field practicum:
          Secondary traumatic stress, vicarious trauma, and compassion fatigue among social work
          students and their field instructors.
          Journal of Baccalaureate Social Work, 15(1), 31-52.
https://doi.org/10.5555/basw.15.1.l568283x21397357

Rossi, A., Cetrano, G., Pertile, R., Rabbi, L., Donisi, V., Grigoletti, L., Curtelo, C., Tansella, M., Thornicraft, G., & Amaddeo, F.(2012).
          Burnout, compassion fatigue, and compassion satisfaction among staff in community-based
          mental health services.
          Psychiatry Research, 200(2-3), 933-938.
https://doi.org/10.1016/j.psychres.2012.07.029

Yester, M. (2019). Work-life balance, burnout, and physician wellness.
          The Health Care Manager, 38(3), 239-246.
https://doi.org/10.1097/hcm.0000000000000277