Interventions Help Clinicians Overcome Compassion Fatigue

Practitioners in the fields of addiction treatment and mental health frequently are challenged by compassion fatigue, burnout, and trauma. The ability to recognize the signs and symptoms of each is integral to early intervention and the restoration of compassion resilience and ethical practice.

At the West Coast Symposium on Addictive Disorders on Thursday in Palm Springs, California, Aaron Olson, MS, CMHC, SUDC, a clinical coordinator at Cirque Lodge in Orem, Utah, discussed these challenges with attendees.

Ahead of his presentation, Addiction Professional spoke with Olson about the signs and symptoms of compassion fatigue, burnout, and trauma, the implications of caregivers continuing to practice when dealing with challenges to their own mental health, and interventions that can help staff members restore their compassion resilience and help colleagues do the same.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: What are 3 signs or symptoms of compassion fatigue, burnout, and trauma, and are there ways to differentiate between those issues?

Aaron Olson: Compassion fatigue is a way to describe burnout and secondary trauma combined. You can have burnout without secondary trauma. I think you can have secondary trauma without burnout. But when those 2 occur together, then we’re in what I would consider compassion fatigue.

What I would say is the biggest piece with regards to burnout is typically oriented around the workplace, and one of the things that I want to do is shift the perception that we’re taking about burnout, rather than making the workplace the problem, that problems are stemming from the workplace. What you’ll first start to see is that depersonalization, the loss of empathy—people start becoming lackadaisical in their charting, for example. The thing that I really pay attention to is, do people deviate off of their normal routine? That person that’s always Johnny on the spot, now, they’re coming late, leaving early, things like that. The job just seems to be getting a little bit overwhelming, tedious. You get the cynicism, those kinds of things. It’s more attitudes towards their environment and the conditions that they’re working in. So, the biggest piece for burnout is the perception that the costs of doing the job outweigh the benefits of doing the job.

Secondary trauma, on the other hand, involves symptoms of post-traumatic stress disorder (PTSD) stemming from elsewhere, not from the witnessed event. … A clinician, substance use disorder counselor, social worker, or whoever, repeatedly internalizes these events, these images, even though they didn’t see them. They’re hearing about them consistently and internalizing them while holding space for their client. In the long run, they begin to develop symptoms as well.

I heard a story one time about a client who was sharing the trauma of this big TV that fell on their child and then injured the child. Hearing this was so disturbing for the clinician, it just hit them in a vulnerable spot such that they went and made sure all the TVs were secured in their house. It seems somewhat reasonable, but again, it’s the intensity of hearing that. Symptoms of post-traumatic stress include hypervigilance, avoidance, nightmares, these types of things. When people start experiencing those, then we know that that secondary distress is in play.

In the best example from my own life, my dad was a homicide detective, and he had no problem sharing what he did at work at all. In high school, we would get him to bring his crime scene slides home. He would show crime scene slides on the wall of our house to me and all my friends and all the girls we could find to come to our house, and it was great social leverage. But when I handed my 16-year-old daughter the car keys for the first time to go out, it all came back, and I found myself sitting up, waiting up, just terrified, because I’ve seen images of what a car crash looked like. I didn’t experience it. I just saw a slide way after the fact in a very clinical setting, but it changed the way that I was engaging my personal life and the level of anxiety, fear, and avoidance, and those kinds of things set in.

When we’re talking about an addiction, there’s so much sexual violence, there’s violence involved. There are all the traumas that people have experienced as a result of their behavior or what’s underneath it. As you accumulate enough of that in an unhealthy state, and you find yourself in that hypervigilant, post-traumatic reactivity state. When you combine those 2 together, when both of those things are happening, that’s what we would then call the compassion fatigue: “My workplace is driving this. I’m physically and emotionally out of balance, and I feel very negative about what’s going on in my life, and in my work.”

AP: What are the implications, then, of having caregivers who are practicing in that state? You can certainly identify some of the traits that they might be displaying. What does that end up leading to in terms of the care that they are providing to patients?

AO: The care they’re providing is compromised dramatically. The first thing that pops into my head, and I want to be careful that being all dramatic about it, but it’s unethical, right? Because when I’m in a compromised state, I’m not going to be able to show up for my client in the way that they need me to and create the environment because I can’t even manage me. So, ethics are a part of it, and we’ve got to be able to call it and say, "I’m in no condition to be working this case or working at all." Depending on how severe it may be, in addition to the emotional and physical wellbeing of the counselor, a big concern that I have, and I haven’t been able to find any data of it, and I don’t think I will be able to, but I’m very interested in ethical issues, disciplinary issues on somebody’s license because they’re in that out-of-balance state, burnt out, that compassion fatigue state. Now we’re making poor decisions, our boundaries go down. It’s problematic. I think the NASW (National Association of Social Workers) just recently reported that there’s a dramatic majority, I think it was 60%, of social workers who identify as being depressed.

AP: If you have staff members who are struggling In this area, do you have interventions that you would recommend that that might be able to help them?

AO: Absolutely. As a supervisor, I’ve made it a point to include things in all of my sessions that we hold. For example, there is a tool called the Pro QOL­—quality of life—assessment that can be administered. It’s an objective instrument to get a sense of “this is where I’m at.” The most important thing we can do is provide a ton of peer support, just show up for each other. In regards to the compassion fatigue as we have identified it, we’ve got a group of supportive peers to show up, be present, and share. You’re not the only one dealing with this. We’re all human beings, we’re all susceptible to this. We use some of the skills that we’ve learned to reduce the intensity of that fight-or-flight response, to subdue that, to stabilize that, whether that’s physical activity, a variety of different breathing techniques, meditations to soothe the nervous system and restabilize that, and then begin to help people.

And that’s the thing: as clinicians, we’ve all heard this stuff. We’ve been taught it our whole lives or our whole careers in self-care. The challenge that I’m going to make is that we’ve also got to practice what we preach ourselves with regards to the cognitive behavioral tools, that change in perception, the way we’re talking to ourselves about what’s going on in our lives, particularly in addiction. It’s so isolating to feel like you’re the behavioral health expert, but you’re in a real rough spot, and you can’t tell anybody because you’re the person that’s supposed to have it all together and have all the answers. You feel isolated.

So, soothing the nervous system, being connected to other people, and applying the principles of whether it’s cognitive behavioral therapy or changing your perception of what’s going on, just challenging yourself in the way you’re talking about what’s happening to you.

Reference

Olson A. Filling up and emptying out: overcoming compassion fatigue, burnout and vicarious trauma for substance use disorder counseling professionals. Presented at West Coast Symposium on Addictive Disorders; June 1-3; Palm Beach, California.