Bringing you Caregiving Stories from the CaregiverAsia Community

Compassion Fatigue

Compassion Fatigue is pervasive in the helping profession; particularly among caregiving professionals who have a high degree of exposure to patients who are experiencing some form of psychological, medical or social trauma and who are trauma survivors themselves. Since the Covid-19 pandemic, Compassion Fatigue is becoming one of the leading, yet unidentified causes of burnout and costly staff turnover.

Healthcare providers, especially those working with Covid-19 patients are more susceptible to experiencing Compassion Fatigue which is characterised by: “exhaustion, anger and irritability, negative coping behaviours including alcohol and drug abuse, reduced ability to feel sympathy and empathy, a diminished sense of enjoyment or satisfaction with work, increased absenteeism, and an impaired ability to make decisions and care for patients.”

Some of the specific symptoms of Compassion Fatigue include:

• Sleep disturbances
• Depression (hopelessness, helplessness)
• Difficulty concentrating
• Increase in illness and absenteeism
• Decrease in work satisfaction
• Not feeling effective as a helper; loss of purpose, meaning
• Feeling burdened by client problems
• Preoccupation with client stories/issues
• Psychosomatic symptoms (chest pains, muscle tension, gastrointestinal distress, headaches)
• Increased irritability with others, ourselves
• Low tolerance for others’ problems/emotions
• Physically drained
• Increased isolation from others
• Feeling “numb” or emotionally disconnected
• Anxiety 

To test your level of Compassion Fatigue visit: http://www.compassionstrengths.com/Compassion_Fatigue_Test.html

The Caregiving Personality

Yet, despite our greater vulnerability to Compassion Fatigue caregivers are often surprisingly resistant to learning and practising effective self-care. As I stated in my previous book Breath of Relief: Transforming Compassion Fatigue into Flow: “Some of the personality traits that attracted us to caregiving as a profession are the very same traits that can render us vulnerable to stress, burnout and depression.”

Some of these traits include the tendency to put other people’s concerns ahead of our own and/or downplay what we need; to minimise our own internal distress; to over-estimate how much we can and should be able to do. We are very good at taking care of other people, not quite as good at taking care of ourselves.

You Are Good Enough!

One of the first things we must change to take better care of ourselves is our self-perception. Many of us, myself included, share the belief that in order to be a good doctor, nurse, social worker, etc., we should never show any signs of weakness or vulnerability that we believe may interfere with caring for our patients. Too often this, unfortunately, translates into: “I shouldn’t need to practice self-care, I am a healthcare professional.” One of the most unfortunate beliefs I hear over and over again in my coaching can be stated as:

“As a healthcare professional I should have no emotional problems myself and should feel guilty and ashamed if I do. I should not have to ask for advice or support either professionally or personally.”

In order to really take care of ourselves, we need to release this unrealistic and inaccurate belief and know in our hearts that we are just as deserving of the care and concern we provide for others.

Self-Compassion

Self-compassion is the act of treating ourselves with kindness, understanding and forgiveness rather than self-judgment and criticism. As self-compassion researcher Dr Kirsten Neff states:

“Instead of mercilessly judging and criticising yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings…”

Although the philosophy of self-compassion is ancient, recent research on the practice of self-compassion has shown that people who regularly practise self-compassion are less likely to be depressed, anxious and stressed. As a result, they are more likely to be happy, resilient and optimistic about the future. In the end, those who are self-compassionate experience better mental health. This is especially important when we are facing down high levels of stress and uncertainty every day which, by default, will trigger our negative thinking and emotional patterns. Self-compassion is the science behind how to support ourselves especially during times of stress and uncertainty.

“With self-compassion we mindfully accept that the moment is painful, and embrace ourselves with kindness and care in response, remembering that imperfection is part of the shared human experience. This allows us to hold ourselves in love and connection, giving ourselves the support and comfort needed to bear the pain, while providing the optimal conditions for growth and transformation.”

Practising Self-Compassion

The best time to practice self-compassion is when you are being harsh, judgmental and critical of yourself for not doing or being “good enough.” We are harshest with ourselves when we don’t fulfil our self-expectations. Most of us have internalised a critical inner voice that believes our personal value is based upon what we do rather than who we are. When we are confronted with situations in which we feel we are not doing (good) enough, we whip ourselves with our inner-critic that who we are isn’t good enough.

We will often say horrible, insulting things to ourselves such as: “You stupid #!* you can’t do anything right! What’s wrong with you?! How could you? Why didn’t you? (and much, much more). In addition to the harsh critical self-talk, we may be experiencing feelings of guilt, shame, anger, self-loathing and disgust. There may also be sensations of hurt and heaviness in your chest, around your heart or in your stomach. You may literally feel “sick with yourself.”

When you first notice this reaction: Pause! Breathe. Relax.

The most important thing you can do right away is to ease this negative reaction of setting yourself on fire. Each time you can pause this highly energised automatic reaction the more you are taking control of your emotions and your reactions. Catching yourself in this automatic reaction and then finding the will to do something different maybe the hardest part. It requires coming to the understanding within yourself that viscously beating yourself up will not and cannot make you better at your job or feel better about yourself.

You can never hold yourself up by knocking yourself down.

When you do catch yourself, and are able to, pause, breathe and relax, it is useful to discharge the residual stress in your neck and shoulders. When you can, do a couple of stress-relieving shoulder rotations as shown on this video: https://youtu.be/G71OvpnZMyE.

If you are in a place where you don’t feel comfortable doing the shoulder rotation, then take a couple of long, slow, deep breaths and let the air out very slowly.

After a couple of deep breaths bring your attention inside yourself; simply focus your awareness inside your body, around your heart. To the best of your ability visualise that you can surround your heart with feelings of kindness and compassion. Visualise a warm soothing sensation surrounding and penetrating your heart. Affirm to yourself that you are your most important resource in being able to help others. Develop an affirmation such as: “I am good enough,” or “I accept myself as I am.” Repeat your affirmation several times with as much feeling of self-compassion as you can. Allow yourself to accept and internalise this affirmative compassion.

To watch a video on how to do self-compassion click on: https://youtu.be/tuRK9aRZnqI

Conclusion

The Chinese character for Crisis is Danger and Opportunity.

The danger is clear and present. The opportunity however can be hidden. In my experience of 40 years in mental health, I am always amazed at the strength and resilience demonstrated by caregivers. It is truly our superpower. We will survive this crisis as well. But maybe, we can do more than just survive. Possibly, even with the immensity of the task set before us, we can discover that at our core, who we truly are, is stronger, kinder, more compassionate and courageous than we ever imagined.