Compassion Fatigue: Overcoming a Common Challenge for People Who Help Others

October 23, 2020 Mark Wilhelm

Any type of work that puts people under large amounts of stress for extended periods of time can lead to burnout. Burnout is often identified by feelings of physical and emotional exhaustion, a reduced sense of accomplishment, and loss of personal identity. High-stress professions such as law enforcement, nursing and legal work are notorious for high rates of burnout, which can also lead to high employee turnover.

However, individuals who work in the “helping professions”—such as nurses, physicians, educators, social workers and counselors—may also experience a special type of burnout known as compassion fatigue. With this type of burnout, a helping professional may feel overwhelmed by the struggles and challenges of their clients, which can create emotional distress in their own lives.

Rachele Love, one of our life skills specialists, has personal experience with the challenges that can come with working in a helping profession. Consider Rachele’s story about her close brush with compassion fatigue when she first joined our team in Putnam County.

Rachele Love’s Story of Professional Stress and Adaptation

Before she joined Cummins, Rachele Love already had a wealth of experience working in the helping professions. She previously spent 17 years working as a paraeducator, assisting school-aged children and teens who had mild, moderate and severe disabilities. In addition, she also served five years active duty in the U.S. Army, which instilled her with a strong sense of duty and personal achievement. “When you’re a soldier, you’re given a directive, and you don’t just meet it—you exceed it. That’s just what’s been ingrained in my life,” Rachele says.

When Rachele joined our team at Cummins, she knew she wanted to continue her work with children, so she became a school-based life skills specialist (or LSS) at Cloverdale middle school and high school. Although the work was different than it had been in a special education environment, Rachele took to it quickly. Many of the youths she counseled had behavioral problems rather than mental illnesses or developmental disabilities, but Rachele had little difficulty connecting with them. “The rapport and relationship with all of my kids was great,” she says.

However, scheduling appointments with her consumers soon became an issue. Rachele was only permitted to pull students from non-core classes such as computers, physical education, art and music, but she also needed to rotate through these electives so her students didn’t miss any one class too many times. Despite her best efforts, these restrictions caused her to start falling short of her counseling expectations. “My position was productivity-based,” Rachele explains. “The expectation was 25 hours of direct clinical care each week, and I was struggling to meet that. It was a huge problem for me.”

Rachele’s supervisors, for their part, were very supportive. They encouraged her not to worry about her hours and just focus on providing high-quality care for her students. But even with this reassurance, Rachele had trouble accepting her own perceived shortcomings. “I was definitely stressed out about it, and I would say a little bit depressed as well, because it’s really a punch in the gut when I can’t meet an expectation,” she says. “I felt like I was letting myself and everyone else down.”

Rachele was struggling, and she knew that the situation would only get worse if it continued. Clearly, something needed to change.

Shelby Rusk on the What, Why and How of Compassion Fatigue

Rachele’s story is not a textbook example of compassion fatigue, but it does bear many similarities. As mentioned above, compassion fatigue is a sort of burnout caused by repeated exposure to people who are experiencing difficult life circumstances. The psychologist Charles Figley, the so-called “Father of Compassion Fatigue,” has described it as “vicarious traumatization”—a phenomenon that occurs when therapists and other helping professionals personally experience the trauma felt by the people they are helping.

“Compassion fatigue is very similar to burnout, but it can affect us faster,” says Shelby Rusk, a Youth Therapist at our Montgomery County office. “We take on the suffering of our consumers, and we start to feel what our consumers feel. Having intrusive thoughts, having trouble sleeping, maybe being irritable, withdrawing from our supports or not wanting to do things that previously brought us joy— these would definitely be some things to look for.”

According to the American Institute of Stress, some other common symptoms of compassion fatigue include:

More intense emotions
Diminished cognitive abilities
Feelings of isolation
Depression and post-traumatic stress
Loss of self-worth
Loss of hope and personal sense of meaning
Anger toward people or situations that have caused harm to others

Why does compassion fatigue happen in the first place? As human beings, it is natural for us to feel concern when we witness another person suffering. Those who work in the helping professions encounter suffering much more often than the average person—and perhaps more than our brains are equipped to handle. “Every hour is a new traumatic story, and hearing all these traumatic stories can really wear on a person,” Shelby says.

In addition, Shelby speculates that individuals who join the helping professions may be especially sensitive to other people’s suffering. “I think people who come into these fields just naturally want to help others. A lot of times, we want to fix problems, so we take on a lot of responsibilities for our consumers,” she says.

Returning from the Brink of Exhaustion

If compassion fatigue is caused by overexposure to other people’s suffering, then it can be prevented by limiting this exposure and focusing more energy on ourselves. But how is this possible for someone whose entire profession revolves around helping others?

It begins with basic self-care routines like getting plenty of sleep, exercising regularly, eating a healthy diet, and practicing mindfulness whenever possible. According to Shelby, it’s also important to focus on positive outcomes and situations when working in the helping professions, which is where gratitude exercises can come in handy. “You are going to see more challenges with people than not, so it’s important to focus on the positives and the successes you had,” she says.

However, it’s also crucial that helping professionals have access to good support systems both inside and outside of work. Shelby says, “Having a positive support system at work is huge. Ideally, we need co-workers who can help us have fun and not get stuck in negative ruts, and we also need leaders who can give us guidance. But that support system outside of work is very important, as well, to help you separate your two lives. You have to separate them, and it can be hard when you live and breathe work.”

Having said that, let’s return now to Rachele’s story. Was she able to find balance in her work and turn back from the brink of burnout and compassion fatigue? Fortunately, she was.

“I have to give credit to Anna Harmless,” Rachele says. “She was my team lead, and she was just so helpful, and just incredible. I met with Anna and I told her, ‘We have to talk, because this isn’t working for me. But I love this company and I don’t want to leave.’ “ For Rachele, the solution was not to change her line of work, but to change her assignment within the organization. She left the school-based environment and started working as an LSS at Green Willows, a supported group living home operated by Cummins. “Green Willows sounded perfect for me, because it was very close to what I had done for three years prior to joining Cummins,” she says.

Today, Rachele’s story shows that it is possible to recover from the stress and fatigue that sometimes afflicts those who work in the helping professions. “It’s been awesome. I’m just so happy here,” she says.

For more information about challenges that helping professionals may face in their line of work, we recommend our blog posts on multitasking and the Imposter Syndrome below!

How Motivational Interviewing Helps Create Positive Life Change During Counseling

October 9, 2020 Mark Wilhelm

“Everything changes and nothing stands still.” — Hereclitus of Ephesus, ancient Greek philosopher

Change is one of the few things about life that never changes. No matter who we are or how old we get, the circumstances of our lives never stay the same forever. Sometimes change is unplanned, unexpected, or outside of our control—we may lose our job or be offered a new job, meet a new friend or lose an old one, live through a natural disaster or be gifted a large sum of money. Other times, change occurs because of actions we take to create it.

As we’ve discussed in a previous post, any change that we make to our own lives follows a predictable pattern known as the Stages of Change. First comes precontemplation, the stage in which we haven’t even begun to consider the change we’d like to make. Next come contemplation and preparation, when we begin to consider and make plans for the upcoming change. Then we reach the action stage, where we take the necessary steps to implement our change, and finally maintenance, where we work to continue whatever behaviors brought about the change.

However, it’s impossible to make a conscious change to our life if we don’t know what we want to change. With all the daily duties and distractions that occupy our thoughts, we may sometimes find it difficult to envision how we’d like to improve our lives. We can become stuck in the precontemplative stage of behavior change, in need of a spark to ignite positive change like a rocket taking off from its launch pad.

Motivational interviewing is a counseling method that can help with this indecision. By focusing on the consumer’s values and life goals, a counselor using motivational interviewing (or MI) can help someone discover their internal source of inspiration, providing that much needed spark to jump start the process of change. In this blog post, Cummins’ Tracy Waible and Tim Grzeskiewicz explain what principles motivational interviewing is based upon, what it looks like in practice, and why it’s a highly effective tool for eliciting positive life change.

Principles of Motivational Interviewing: “A Dance, Not a Wrestling Match”

To understand motivational interviewing, it helps if we recognize how it is different from other forms of counseling.

In traditional counseling or therapy, the care provider’s job is to impart knowledge and guidance to the recipient. The assumption is that the person in counseling has a problem that only the counselor knows how to solve. We can see this even in the definition of the word “counsel,” which means to advise. By contrast, to “interview” someone means to question or talk with (them) to get information. In motivational interviewing, the counselor does not tell the consumer how they should change, but rather asks them if and how they would like to change.

“When you’re using MI, the provider is focused on the thoughts, values and goals of the person coming in for services,” says Tracy Waible. “It’s not about what I think is best for you or how I think you need to go about changing, but rather, what do you think? How do you think you can get there? What are your reasons for change?”

When working with a consumer using motivational interviewing, care providers utilize a set of person-centered skills known as “OARS+A”:

Open-ended questions: Instead of asking simple “yes or no” questions, the provider poses questions that prompt the consumer to elaborate. E.g. “How do you feel about that?” or “What do you want to do about it?”
Affirmations: The provider comments positively on the consumer’s intentions and efforts to change, which helps build confidence in their ability to change. E.g. “I think you’re making great progress toward your goal, well done.”
Reflections: The provider repeats back the consumer’s thoughts and feelings to let them know they’re being heard and understood. E.g. “It sounds like you feel frustrated about this aspect of your life.”
Summaries: The provider connects the dots between the consumer’s thoughts to help them better understand their own feelings and desires. E.g. “You’ve told me that you always feel stressed at work, you dread getting up in the morning, and you would quit your job if you could. It sounds to me like you aren’t very happy in your current line of work. Does that sound right to you?”
+ Advice with permission: If the consumer is open to suggestions, the provider may offer advice about what they should do next. E.g. “Based on what I’ve heard, I think you should consider changing your sleep habits.”

According to Tracy, motivational interviewing is ultimately about collaborating with the consumer to help them make the changes they want to make in their life. “Motivational interviewing views people as very values-driven. For any behavior that’s happening, there’s a value or an emotion behind it,” she says. “Our job as providers is to tap into that. A lot of therapy techniques are very confrontational or directive, where the provider just asks people a bunch of questions and they don’t really feel a part of the process. MI is more like a partnership. It should feel like a dance versus a wrestling match.”

Motivational Interviewing in Practice: Continuously Increasing Insight

As we’ve explained, the goal of motivational interviewing is to help consumers discover why and how they want to change their lives. But how does this translate into a typical counseling session?

According to Tim Grzeskiewicz, who uses MI in his work treating individuals with substance use disorder, it all begins with the initial assessment for services. “Let’s say someone has gone through the intake assessment, they’ve been identified as needing IOT, and they’re ambivalent or arguably resistant,” he says. “They come to my office, and I just kind of lay it out there. I say, ‘You’re in my office because somewhere along the line, somebody said you have a substance use problem. What do you think?’ “

Depending on how the consumer responds, Tim begins to determine their willingness to change and how to proceed with counseling. “There’s a great tool that I like to use called ‘branching,’ “ he explains. “You ask that first open-ended question, and then you continually branch questions down from there. If the response is, ‘Yeah, obviously I’ve been using a little more than I should, that’s why I’m here,’ there’s a different question that follows that versus if the response was, ‘Yeah, my wife’s a little worried. It’s not a problem for me, but it is for her.’ “

No matter what a consumer believes or how open they are to change, the ultimate goal of motivational interviewing is to continuously build insight regarding potential problems in their life. As Tim explains, this is the best way to help a consumer identify opportunities for change:

“As people, we aren’t stupid, we just have blind spots. We don’t want to think that we’re making bad decisions, but when we hear them out loud, we might realize they aren’t healthy for us. That’s the whole thing with motivational interviewing: it leads people to their own insights. Because I could tell you, ‘You need to change. Look at the scores on this assessment. You have a problem.’ If I do that, you’re probably not going to make a change. But if I lead you to the discovery, now you’re thinking about it, so I just helped you move from precontemplation to contemplation. Then you might say, ‘Wow, do I need to change something?’ and I would say, ‘I don’t know, let’s talk about that.’ And then we would be moving toward preparation and planning.”

Even after a person has successfully made a change to their life, the usefulness of motivational interviewing doesn’t end. “Therapeutically, I’m always using MI,” says Tim Grzeskiewicz. “If I’m in session with someone I’ve been seeing for two years, and we’re exploring whatever’s happening in their personal life, I’m still asking open-ended questions so they can develop insight into areas of their life that they may want to change.”

At Cummins Behavioral Health, motivational interviewing is one of the primary tools our providers use to help consumers achieve their behavioral health goals. As Tracy Waible says, “Our view at Cummins is that MI is the lining in any hat you’re wearing. Even if we’re using other treatment modalities, we can always embody the spirit of MI.”

Looking for inspiration for your next positive life change? Our blogs posts on nutrition, exercise, sleep and mindfulness might provide you with a few interesting ideas!