For counselors, self-care is an ongoing and necessary endeavor in order not only to maintain their own wellness but also to provide the best care possible to clients. A feature story in the January issue of Counseling Today addresses exactly this topic — click here to read “Who’s taking care of Superman?”
As an online exclusive sidebar to the feature story, Counseling Today explores empathy fatigue, one of the handful of fatigue syndromes that can have a detrimental impact on counselor wellness. Mark Stebnicki, a professor in the Department of Addictions and Rehabilitation at East Carolina University who has been researching, writing about and presenting on empathy fatigue for more than a decade, talks about where empathy fatigue comes from and what counselors can do about it.
What is empathy fatigue and why can it happen to counselors?
Empathy fatigue is a phrase I coined and concept I posed in various articles and books I have written after being a member of the crisis response team in the aftermath of the Westside Middle School shootings in Jonesboro, Ark., on March 24, 1998 where an 11-year-old and a 13-year-old shooter took the lives of four students, one teacher and injured more than 15 others.
The experience of empathy fatigue I believe is different than compassion fatigue and burnout. Empathy fatigue results from a state of psychological, emotional, mental, physical, spiritual and occupational exhaustion that occurs as the counselors’ own wounds are continually revisited by their clients’ life stories of chronic illness, disability, trauma, grief and loss.
Empathy fatigue and the other various fatigue syndromes (e.g., compassion fatigue, secondary traumatic stress, burnout, vicarious traumatization) are natural artifacts of working in “high touch” professions such as ours. Counselors are trained in the facilitative skills of empathy. The nature of the client-counselor relationship requires a below-the-surface level of intense and compassionate listening. It requires us to be deeply involved in our client’s woundedness and to respond empathically.
What is empathy fatigue’s role in the greater idea of counselor wellness?
The cumulative effects of multiple client stories throughout the week may lead to a deterioration of our resiliency, coping and empathic abilities. In traditional Native American teaching, it is said that each time you heal someone you give away a piece of yourself until at some point, you will require healing. The journey to become a medicine man or woman (or a professional counselor) requires an understanding that the healer at some point in time will become wounded and require healing.
Jane Myers and Tom Sweeney I believe provide an excellent, comprehensive and enlightened view of human wellness in their “wheel of wellness” model. Stated in the most parsimonious way, the wheel of wellness integrates an individual’s emotions, sense of control, problem solving, creativity, realistic beliefs, social support and self-care into a holistic framework — all designed to increase personal wellness. It also provides opportunities for healthy spiritual development, which is where empathy fatigue may vary from the other fatigue syndromes. Thus, paying attention to our “cosmic consciousness, divine consciousness and unity consciousness,” as Deepak Chopra suggests, can provide a spirit-guide for purpose, meaning and connectedness to wellness.
What is the risk involved with empathy fatigue?
Risks involved with the experience of empathy fatigue I believe are best summed up in Sandra Ingerman’s work as a shamanic practitioner and are referred to by indigenous groups as “soul loss.” Soul loss involves a major shift in the mental body, emotional body, physical body and spiritual body.
In shamanic practices, the shaman performs the ancient rituals of a “soul retrieval,” which brings wholeness back to the person that is affected. In the Reiki tradition, this would be considered “blocked chakra energy.”
The modern day soul retrieval, I believe, requires a personal understanding of who is available to be our healing partners — others who can cultivate our mind, body and spirit. Soul retrieval may take the form of eating right, exercising often, having healthy thoughts and feelings, personal growth through individual or group counseling experiences, or consulting with a family elder, priest, minister or rabbi. Ultimately, when we are not well, our clients are not well. It is difficult to be empathic towards our clients’ pain and suffering.
Which counselors are most at risk?
Because empathy fatigue and other fatigue syndromes range on a continuum of low, moderate or high, the empathy fatigue reaction is highly individualized. I believe that empathy fatigue for some is a counselor trait; for others, it may be a counselor state.
The cumulative effects of working with persons who have chronic and persistent mental health issues may be an empathy fatigue trigger for some professionals. This may be because the counselor may not know how to handle their experience of countertransference in dealing with certain client issues. Other counselors work in organizations, agencies and systems that do not support the goals of wellness which actually increase ones’ organizational burnout.
Regardless of the counselor’s work setting and clients they serve, it is of paramount importance to know how to cultivate self-care approaches, resiliency and understand the cumulative effects that empathy fatigue has on one’s mind, body and spirit.
How might counselors know they’re experiencing empathy fatigue?
The most accurate depictions of the level, quality and degree of empathy expressed by counselors during therapeutic interactions are those observations involving a triad of raters, primarily the client, counselor, and expert rater or clinical supervisor. Carl Rogers spoke eloquently about empathy and hypothesized that clients who perceive their therapists as facilitating positive regard, empathy and congruence demonstrate a more positive outcome. So, we have years of research and observations suggesting what high levels of empathy are and how it is expressed in professional client-counselor interactions.
The same is not true of demonstrating the absence of empathy. I developed a theoretical measure of the holistic experience of empathy fatigue: Global Assessment of Empathy Fatigue (GAEF). I hypothesized in the GAEF that there are five levels of functioning as a therapist. Level five indicates the highest, while level one the lowest level of empathy fatigue. I further hypothesized that professional helpers may experience and project empathy fatigue in seven distinct areas that are rated on the five levels. These include cognitive, behavioral, spiritual, process/counseling skills, emotional, physical and occupational levels of fatigue.
Counselor fatigue and impairment appears to involve a constellation of states, traits, behaviors and other factors that encompass the person’s experience of empathy fatigue. The intent and purpose of the GAEF, in its early stage of development, is to provide a means of viewing the overall level of functioning as the professional helper experiences empathy fatigue.
Is there a solution to empathy fatigue?
One cannot provide a “solution” for empathy fatigue because it involves an ongoing commitment to self-care, wellness and conscious awareness of one’s empathy fatigue triggers. I am also beginning to understand that it does not matter how close one is to the epicenter of extraordinary stressful and traumatic events in order to be affected by empathy fatigue. Critical incidents such as the recent catastrophic effects of Hurricane Sandy in the Northeast, wars, civil unrest, tsunamis and other epidemics all impact our mind, body and spirit.
So, it is important to understand the occupational choice we make and the cumulative long-term issues that we will have to deal with in the present and future. I have become aware that empathy fatigue is an experience of journalists who cover stories involving catastrophic events as well as global relief workers. As fire, rescue and law enforcement workers prepare for the physical rescue, professional counselors must prepare for the mental health rescue.
I am sure that you have spoken with counselors who on some days would rather work at Trader Joe’s than deal with their clients’ pain and suffering. So, once the occupational choice has been made by the individual then it is up to the individual, counselor educators and supervisors, professional counseling associations and professional counseling practices to help cultivate resiliency and wellness approaches specific to counselor impairment and other fatigue syndromes.
Can you share any practical tips for avoiding empathy fatigue to begin with?
I believe that one cannot “avoid” empathy fatigue working in our profession for it would be unnatural to ignore, suppress and avoid the natural feelings and emotions that arise as a result of our professional role. However, if we are conscious of our empathy fatigue triggers then this should be empowering news to us so we can then take action to cultivate wellness approaches.
Breathing meditation, visualization, relaxation and mindfulness approaches have been shown to be effective for dealing with occupational stress, counselor impairment and other fatigue syndromes. Making a commitment to lifestyle changes such as nutrition, exercise, and social and individual support can bring meaning and purpose to our life. To nurture the mind, body and spirit requires us to practice the strategies and approaches we facilitate with our clients. Knowing how to show up, pay attention and be mindful of the outcomes and fruits of our personal journey should be intentional, not just for ourselves but for the counseling profession.
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