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Why Don’t I Care Anymore? Clinicians’ Struggles with Burnout and Compassion Fatigue

Scenario: Is it burnout or compassion fatigue?

Imagine you are a clinician. You have 25 clients on your caseload, but your maximum caseload is 22. Your supervisor/manager is detailed oriented requiring articulate and accurate treatment plans and progress notes. Your workplace is highly organized, and expectations are set high. Despite having three extra clients you are still required to meet all deadlines and office expectations. Within your caseload you have four clients who have trauma histories, and they are seeking treatment for post traumatic stress disorder (PTSD). After weeks of having more clients on your caseload than you should you’re finding yourself exhausted. You don’t feel like dealing with the clients’ issues anymore, especially the individuals with trauma histories. Your work performance begins to decline, and you find yourself struggling to meet expectations. Are you experiencing compassion fatigue or burnout? Which is it?

What is burnout?

Burnout is the adverse result of prolonged and repeated exposure to workplace (environmental) stressors that have not been successfully managed. The following are symptoms of burnout.

  • Weariness, exhaustion, apathy, loss of energy, and fatigue
  • Resentment, frustration, irritability, cynicism
  • Negativity, distrust, pessimism about work
  • Disconnecting from your job
  • Reduced productivity, poor performance, low morale, and inability to cope at work

What is Compassion Fatigue?

Compassion fatigue (CF), also known as vicarious traumatization (VT) and secondary traumatic stress (STS), refers to a “clinician’s exposure to traumatic events through their clients’ stories and vivid imagery whereby the indirect exposure to trauma involves an inherent risk of significant emotional, cognitive, and behavioral changes in the clinician” (Bride et al., 2007, p. 155).

  • Emotional: negative changes in emotional wellbeing including anxiety, depression/sadness, irritability, and loss of happiness.
  • Cognitive: negative changes in attention and memory, difficulty concentrating, nightmares, flashbacks, and recurrent negative thoughts.
  • Behavioral: changes in daily routine, withdrawing from social and workplace environments, low motivation, decrease in productivity, and increased vigilance.
  • Physical: negative physiological changes including difficulty sleeping, headaches, stomachaches, nausea, muscle tension, hypertension, lightheadedness, pain in the body, blurred vision, and changes in bowel movements.

Compassion Fatigue vs. Burnout

Discussion around compassion fatigue and burnout benefits from clearly differentiating between the two. While sharing similarities, they are uniquely different. These terms have been erroneously used interchangeably which is a grave mistake. The fundamental component of CF is that there is a change in a clinician’s wellbeing as a result of indirect exposure to trauma. Both indirect trauma exposure and a change in the clinician’s wellbeing must be present. While repeated exposure to clients’ trauma events is often at play for CF to occur, it can also result from a single incidence. Burnout on the other hand is inherently the result of exposure to prolonged and repeated environmental stressors. Burnout can be understood as the negative changes to one’s wellbeing because of workplace environmental factors and results in a decrease in work performance. Thus, CF uniquely requires indirect exposure to trauma and may occur after a single incidence while burnout requires repeated exposure to environmental stressors in the workplace.

Which is it? The Scenario Answered

In the example in the introduction, the clinician may be experiencing both CF and burnout. The workplace demands are high resulting in prolonged and repeated exposure to environmental stressors. This would be a clear indicator of burnout. However, the clinician also has four clients diagnosed with PTSD. The indirect exposure that the clinician is experiencing could result in secondary trauma stress, or CF. Thus, there are contributing factors in this example that illustrate the unique components of both CF and burnout. As such, while both CF and burnout are unique, they may co-occur.

Identifying Causes of CF or Burnout

Helping professionals may experience both CF and/or burnout. Often unnoticed, CF may be overlooked for long periods of time because the given type of work requires exposure to people’s problems. In some instances, there may be a very clear case whereby a clinician can identify it as triggering of CF or troublesome. Yet in other instances it may be the culmination of a handful of cases that leads to CF. The impact of indirect exposure to trauma is often misunderstood and overlooked. In these occurrences, the contributing factors to CF are unclear and not easy to define. On the other hand, employees experiencing burnout are often highly aware of the workplace stressors causing their distress. They may even be discussed or complained about regularly. These stressors are easily identifiable and often experienced daily or weekly. Henceforth, factors contributing to CF are much more difficult to identify.

Locus of Control

Significantly driving the two concepts further apart is the understanding of locus of control. Helping professionals, particularly clinicians, are often in a position where they do not get to choose whether they are indirectly exposed to trauma events. It happens and they are put in a position of having to respond. While helping professionals, namely clinicians, have specialties and areas of expertise that may limit the type of people they work with, when a client recalls a traumatic event, the clinician has an ethical responsibility to listen to the client and provide the best direction of care for the individual. The helping professional does not have the ability to control what their clients decide to share with them. As such, CF often is the product of environmental factors that are outside of the locus of control of the clinician. However, these factors are also outside the control of the business.

Burnout on the other hand is controlled by the leaders of the business or organization. Leaders within a business are responsible for creating the workplace culture. Curating their workplace environment, leaders control the factors that drive burnout. Demands placed by managers, requirements of contracting agencies, or clients’ needs create expectations that must be fulfilled. How these expectations are regulated, how these demands are managed, all lie within the locus of control of the organization and its leaders. Moreover, how these requirements are communicated create a workplace culture that can lead to burnout or an environment that leads to productivity. Managing workplace responsibilities and overseeing employees requires an intricate harmony between the two. The harmonious balance must empower employees to feel confident, competent, and capable of being able to complete required tasks effectively. Failure to empower employees to be successful in their roles will inevitably lead to burnout. An inability to manage workplace demands will inherently lead to burnout. Not having the capacity to meet clients’ needs will ultimately lead to burnout. Leaders in a business can control workplace stressors that lead to burnout, and thus they can cultivate a workplace environment that leads to productivity instead.

Synopsis of CF & Burnout

  • CF requires indirect exposure to trauma (once or repeatedly)
  • Burnout results from prolonged and repeated exposure to workplace stressors
  • Burnout and CF result in negative changes to helping professionals’ / clinicians’ wellbeing
  • Helping professionals / clinicians may experience BOTH CF and burnout
  • CF is outside the locus of control of helping professionals / clinicians
  • Burnout is within the control of employees and leaders of an organization

Beat Burnout and Fire Up Your Life

As Sonnentag (2015) describes, “job stressors and job resources [are] the core predictors of job-related well-being and burnout… personality variables can also explain individual differences in job-related well-being and burnout” (p. 538). Because employees are often unable to control the job stressors and job resources (aka workplace stressors), loss of control of these stressors and burnout become closely associated. In fact, workplace stressors are the highest rated reason for employee burnout (Kron, 2016; Sonnentag, 2015). Leaders within an organization therefore have the responsibility to minimize workplace stressors to not only avoid burnout, but to ensure productivity. Employees also have the responsibility to communicate factors that are contributing to burnout symptoms.

Tips to Avoid Burnout for Leaders and Employees

  • Foster an environment with open dialogue and cooperation (vs. competition)
  • Monthly townhall meetings – discussion between leaders and employees (communication is everything)
  • Utilize an employee assistance program (EAP)
  • Conduct research/surveys to establish sources of chronic stress for employees and then minimize or eliminate these stressors
  • Implement a workplace wellness program or wellness team
  • Develop strong working professional relationships
  • Establish a mentor program
  • Maintain a work calendar that includes all position responsibilities with due dates
  • Break things up into small measurable objectives
  • Move around physically and also your work location (move to a different area)
  • Decline additional workloads – It’s ok to say NO!
  • Re-evaluate work goals and objectives and track your progress

Crush Compassion Fatigue and Blossom

It is possible to avoid CF. In businesses that employ intake screening, client/case assignment con be conducted to ensure trauma trained clinicians receive clients requiring trauma work while clinicians that are not trauma trained receive appropriate clients related to their training. This method is not 100% effective however as it is dependent upon intake information. This method also does not work for therapists working in an individual practice.

              More realistically, instead of trying to run away from CF there are some tips clinicians can employ to help minimize CF. Ultimately, these tips relate to self-care and self-evaluation.

Tips to Minimize Symptoms of Compassion Fatigue

  • Self-evaluation: Honestly reflect on your experiences and evaluate your cognitions and emotions at the end of the workday. Identify areas of distress or risk factors you might have experienced and address areas of distress. Do not ignore or avoid them. Early detection is always best!
  • Self-care: Maintain an adequate sleep schedule, participate in some form of weekly exercise, eat 3 healthy meals a day (do not skip meals!)
  • Educate yourself to become a trauma-informed clinician
  • Engage in a hobby or some practice of a creative activity (art, music, poetry, gardening, etc.)
  • Schedule social events with friends or family and go to them!
  • Balance your work/home life schedule
  • Identify your strengths and areas of improvement
  • Consider referring clients out if necessary
  • Talk to a therapist yourself if necessary

References

Bride, B. E., Radey, M., & Figley, C. R. (2007). Measuring compassion fatigue. Clinical Social Work Journal35(3), 155-163. https://link.springer.com/content/pdf/10.1007/s10615-007-0091-7.pdf

Kron, R. (2016). Manufacturing employee’s ratings on risk factors for burnout [Unpublished raw data].

Sonnentag, S. (2015). Wellbeing and burnout in the workplace: Organizational causes and consequences. International Encyclopedia of the Social & Behavioral Sciences25(2), 537-540. http://english.8n8.ir/upload/document/wet.pdf

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