What is Compassion Fatigue?

Why talk about compassion fatigue when we are talking about childhood trauma?

Working with children and their families is tremendously rewarding, but engaging with the chronic traumas children experience in their families can be stressful, overwhelming and engender hopelessness. Given the knowledge and training gap most physicians have about addressing developmental trauma, as well as the high stakes and complexity of the cases they are managing, the conditions are in place for the development of compassion fatigue. Over time pleasure and pride in our clinical work can evaporate, our energy seeps away and an irritable pessimism can start to take over.  A negative cost of caring for these complex children and families has emerged. 

There are various terms used to describe this cost of caring: compassion fatigue, burnout, secondary traumatic stress, vicarious traumatisation, negative counter transference and others. Distinguishing between these terms is important for the clinician self-assessing compassion and clinical engagement.

Burnout can happen to anyone - not just health professionals. It is the gradual onset of physical and emotional exhaustion which accumulates over time when work pressure does not diminish, high output is required, and an unsupportive work environment give rise to a feeling of powerlessness to change the situation.  The feelings of hopelessness, irritation, and a loss of pleasure and interest can persist.  But it doesn't necessarily mean the loss of the ability to feel compassion for others.  It's a problem with the system - a change in jobs or a change in work pressure organization and support can resolve burnout.

Compassion Fatigue: Compassion fatigue often develops as a result of chronic, repeated demands on our time and energy. Over time, when we do not have a chance to replenish, we can witness a shift in our ability to empathically engage with individuals in need and patients, colleagues and even our loved ones. It may be related to a single case (someone who is chronically in crisis and never seems to improve) or a large volume of cases, often very similar in nature (seeing many patients with the same complaint.) We are attracted to the healthcare profession because we want to relieve distress in others.  Compassion provides the motivation and pleasure to work with kids and their caregivers, and when it ebbs away it hits at a core sense of professional identity; leaving a sense of being ineffective and less capable. We may reduce our clinical efforts and withdraw from our patients, and feel irritated and blaming of them.  We lose who we were when we came into the profession.

Secondary Traumatic Stress or Vicarious Traumatization specifically refers to a health care professionalism response to hearing about patients' experiences of trauma or hearing colleagues share graphic details of a tragic or traumatic events. This secondary exposure to extremely stressful events can reawaken old traumas in the physician or create new ones and include Post traumatic type symptoms like feeling afraid, trouble sleeping, unwanted re-experiencing of the feared event, or significant avoidance of reminders of such an event. Symptoms can mirror the patient's symptoms. Belief about the world and the self may be negatively affected by repeated exposure to traumatic material.