Health Care Dialogue
Kim S. Hwang, PsyD
August 17, 2012
Dear Dr. Hwang:
“Have you ever heard of compassion fatigue?”
Yes, I am familiar with the term, “Compassion Fatigue.” Compassion fatigue is a concept used to describe an experience that some psychological researchers describe as a result of overwhelming feelings of distress and fatigue, due to caring. It was coined by psychologists to describe a feeling of being burnt out or subsequently displaying too much compassion to the point of physical, mental and emotional fatigue. Moreover, compassion fatigue suggests that a therapist is so heavily influenced by a client’s emotional turmoil that they are inevitably drawn down into an overwhelming state of emotional and sometimes chronic fatigue. A variety of research identifies compassion fatigue as a phenomenon that occurs as a direct result of working with people or clients with complex, intense and ongoing mental health issues or diagnosis.
However, I see compassion fatigue differently. I believe that compassion fatigue is a direct result of a therapist or mental health provider having complex mental health and psychological issues who have been unable to recognize signs of fatigue to such a point where it draws them down to a diagnostic state of, “Compassion Fatigue.” Justifying a professional’s inability to maintain positive mental health, engage in self-care and provide ethical supportive care beyond one’s breaking point should not be assigned a label in which we detach responsibility from the mental health provider, therapist or psychologist (terms which I will use interchangeably). A cognitive psychologist may suggest that wrongly assigning responsibility fatigue to the client versus the therapist as displacement. Inaccurately placing the responsibility of therapist’s emotional state onto a client implies that the pathology of the client is the problem versus the inability of the therapist to care for oneself as the problem. Inadvertently, the two words together may ignore possible pathology of the provider. The term has an underlying tone of blame and depersonalization. Caring psychologists consider themselves in as much as they care for those they serve. Compassion should not be married to the term fatigue in a professional role. It goes against the whole premise of, “At least do no harm.”
Does this happen? Yes. Otherwise there would not be a multitude of research available giving umpteen examples where clients have been harmed due to a therapist’s negligence of burn out. Is it the client’s fault? Absolutely not!
When vulnerable people seek supportive therapy, they should be able to assume that their provider is highly capable, caring and competent. But, this is not always the case. If you feel that the person you are seeking help from may be burnt out, it is okay to openly make inquiries about your concerns because obtaining help from a mentally exhausted therapist is likely counterintuitive and will have the opposite experience you are seeking to achieve. I would hope that your therapist in this case would welcome your feedback and invite you to tell them about your expectations of therapy. Some therapists have inflated ideas of what they should offer and mean well existentially. And, there are deep flaws in every system, which make it difficult to provide the kind of optimal mental health services most mental health providers wish to generously sustain and maintain. At the same time, it is not your responsibility as the client to worry about the (compassion) + fatigue of your therapist, the term or if it is in play. Most ambitious therapists are expected to help people thrive and grow without feeling they are struggling to express empathy, kindness, care or concern. Clients should not have to grow tolerant of health care submerged in unproductive work. This vicious cycle can create a rhythm of frustration, which is not appropriate for treatment.
Longitudinal studies suggest that burn out is high among most caring professions. People who move into these roles do so with the best of intentions and sometimes, altruistic goals. Some studies have shown that across cultures other countries may fair better because there is more of an emphasis on human beings versus productivity and profit. Profit becomes a threat to existential goals of helping and caring for others. Just as therapy is an interruption in your week and offers you time and a space free from chaos, therapists also need these types of interruptions in their lives, free from chaos as well. But, it is their responsibility to know this. When you are in communication with them, your time is your interruption, which allows you to return to your sometimes, chaotic life better able to cope.
While it is also important to have reasonable expectations of your therapist, it is up to your therapist to manage their fatigue and ensure that compassion is abundant and plentiful. You deserve a restorative experience, which is healing and forward moving. Paradoxically, what’s perceived as efficiency by some therapists is leading to inefficiency. Therefore, it may be unintentionally drawing down some psychologist’s emotional energy towards substandard services, which may not be in the best interest of the client.
Bottom line, it’s a professional relationship first. And, it is also a human relationship. There are times when it is, “perfectly perfect,” to cut each other some slack within reason and ethical guidelines. Moreover, in session, as a therapy recipient, converting to compassion fatigue likely means it’s time to move on to a person who can regulate their fatigue towards providing compassion.