In this quote, Vicktor Frankl eloquently and succinctly summarizes the dilemma of compassion fatigue for every caregiver.
We have all volunteered to be givers of light. In making this effort, we are all going to burn. It hurts to work with the
population of clients with whom we provide care. It is not a pleasant thing to see track marks in the arm of a 17 year old
prostitute nor bear witness to the stories of rape and torture that occur millions of times daily to children in the “war
zones” of middle-class American homes. It challenges our views of an ordered world, a benevolent God and makes our heart hurt.
I have watched many excellent caregivers during my 23 years of work in this field say “enough,” and either move into
administrative positions or simply leave the field completely burned out. It’s easy, and often even rewarded; to remain
in denial about the effects of secondary traumatic stress and burnout (and primary trauma in the life of the caregiver)
and believe those falling around me are “weak” while we cling to my “it’ll never happen to me” mantra. In devoting most
of my research and clinical efforts during the past seven years to studying and treating compassion fatigue, I have come
away with a few “truths.” The first one is that no one is immune to the effects of secondary traumatic stress—some cope
better than others and some hide it better than others—no one remain unaffected. If we simply refuse to address the
issues of self-care and tend to our own resiliency, we may be lucky and “catch on fire” quickly, have our crises and make
these necessary adjustments in our life. For those who are less fortunate, they get the slow burn. They get to watch
their relationships slowly disintegrate because they can no longer tolerate intimacy, or witness their effectiveness as a
caregiver dwindle because they are unable to hear one more story of abuse, or experience somatic symptoms (including weight
gain, alcohol/drug usage) so intense that they can no longer find comfort inside their own skin. I have some experience
with this last category, both as a caregiver who has lived through it and as a clinician who treats other caregivers who
are at various stages in this downward spiral. This leads me to the second “truth” I have uncovered in this work…
This “truth” is that for all the pain, these symptoms are a blessing. They point out to caregivers that their life is out
of balance and needing intervention. My work with compassion fatigue has drawn heavily from the work of David Schnarch
(1991) who works with couples’ sexuality. His deeply evocative approach holds that couples reach “gridlock” in their marital
relationships because they have not yet matured to self-validated intimacy and are unable to self-regulate the anxieties of
abandonment and engulfment that are naturally occurring in every committed relationship. As the individuals in a marriage
“grow up” and are no longer in need of their partner’s approval, they are able to tolerate higher levels of intimacy and
eroticism. As I became progressively fascinated with his theory and treatment, I began seeing that for many caregivers the
most significant relationship they have, outside their marriage, is with their career. I further noticed that the more
dependent that the caregiver was upon her work to provide her with feelings of worth and adequacy, the less resilient she was
to the deleterious effects of helping (e.g., burnout). This understanding has become the theoretical engine that has driven
the development and implementation of the Accelerated Recovery Program for Compassion Fatigue [2002, Gentry, Baranowsky, &
Dunning in C. Figley (Ed.) Treating Compassion Fatigue] Discussing this phenomenon with the many caregivers that I have treated
has led to the distillation of two key and critical ingredients for the prevention and treatment of compassion fatigue. These
are the development and maintenance of a non-anxious presence and self-validated caregiving. It is my strong bias, borne out
by the reports from several seasoned and thoroughly compassion-fatigued whom I have treated, that attention to maintaining
these two important areas, along with good self-care renders the caregiver 100% resilient to the negative effects of caregiving.
They still experience pain, maybe even more so, however this pain no longer diminishes them because they have found that to
maintain their non-anxious presence and self-validation they must “re-fill” themselves with nurturing and active experiences.
As it turns out, the best treatment and prevention for compassion fatigue is to live a good life.
In my work with the Accelerated Recovery Program, I have had the good fortune to train the mental health professionals of the
FBI (who have adopted the ARP), helping professionals who have provided ongoing relief services to the survivors of the OKC
bombing many care providers who provided help to the survivors of 9/11, along with hundreds of other clinicians from all over
the world. With each of these caregivers, I have been blessed to witness them make their own transformations and come into
balance with themselves. This has been fascinating and rewarding work.
When we (Anna Baranowski, Ph.D., co-developer) found that the ARP was even more effective than we had hoped, we were approached
by the Traumatology Institute to develop a training for clinicians wishing to implement the ARP with caregivers in their locale
suffering with compassion fatigue. We developed the Certified Compassion Fatigue Specialist Training (CCFST) [1] program and
began offering this training in January of 1999. Since that time approximately 1000 professionals have been trained as Compassion
Fatigue Specialists and are implementing the ARP model. The most exciting aspect of this training is that we have included most
of the interventions of the ARP in this two-day training to create a powerfully evocative and experiential certification training.
We reasoned that if the ARP was effective in ameliorating individual’s compassion fatigue symptoms, wouldn’t the CCFST be effective
in lessen the group’s? This was the advent of our “training-as-treatment” intervention that I have studied as part of my doctoral
work. Our data collection and analysis has shown that the CCFST does, indeed, significantly lower compassion fatigue and burnout
symptoms experienced by the participants. (Chick here for a PDF copy of the study: Treatment Effectiveness of the Certified
Compassion Fatigue Specialist Training Program [2].
We have found, in our clinical work and in our teaching, that compassion fatigue is both a blessing and a curse. A blessing in that
the symptoms force us to take seriously and honor the ways in which we provide care and the ways in which we care for ourselves. A
curse insofar that as we avoid making these necessary shifts in our perceptions and behaviors we can suffer immensely with the symptoms
of this insidious condition. The exciting thing is that compassion fatigue is amenable to treatment and as the care giver addresses
with intention the symptoms and causes of compassion fatigue, not only do these symptoms ameliorate but their life is often transformed
from pain and demoralization into a comfortable sanctuary from which they are empowered to become true givers of light—ever burning
bright and never burning out.
