Knowing when to ask for help with compassion fatigue is an example of:

Are you feeling compassion fatigue?

By Sarah Jeanne Browne —

“Taking care of yourself doesn’t mean me first, it means me too.” ~L.R. Knost

We all want to help others, but what if that begins to take a toll on ourselves? When this happens, we may experience “compassion fatigue.” We feel like we have to be the strong person because we are the helper. But even the helper needs help. There’s a South African term called “Ubuntu” meaning “humanness is found through our interdependence, collective engagement and service to others.” Compassion and empathy are necessary for the survival of our species and the world. So, when we feel apathetic and depleted from overextending ourselves helping others, what do we do? The truth is that compassion fatigue is perfectly normal in a caregiving setting. We get attached and are affected by another person’s trauma and struggles.

Carla Joinson coined compassion fatigue in 1992, calling it loss of “ability to nurture” among nurses. Dr. Figley adopted this and defines compassion fatigue as “The emotional and physical burden created by caring for others in distress or secondary vicarious stress disorder compared to PTSD.” Another phrase other than compassion fatigue could also be “empathic strain,” empathic distress” or “empathy fatigue.” Dr. Kerry A. Schwanz calls it “empathy overload.” That’s because while compassion is caring for someone, empathy is feeling what the other person is feeling. It’s literally putting yourself in someone else’s shoes which can either be exhausting or rewarding depending on your level of codependency.

Julliette Watt says compassion fatigue is when “giving is no longer living.” She says, “Ask yourself what is the most important thing in your life? You’re going to say your children, your family, maybe your career so you can provide for your family. And all of that is the wrong answer. What if I told you the right answer was, ‘I am the most important thing in my life. Me.’” Try to reframe your perception with that.

Waylon Lewis, founder of Elephant Journal, doesn’t believe in compassion fatigue (well at least not completely) and says to Forbes “If we are feeling compassion burnout, we need to take a step back and reorient our compassion's intention.” In his article, “Compassion Fatigue? That’s not a Thing,” he also states, “Caring arises directly out of your basically good human nature—which is inexhaustible, unconditional. What’s exhausting is performative caring that isn’t rooted in our basic goodness. Sadly, caring or activism is often rooted not in empathy, but in aggression, ignorance, or clinging. That doesn’t mean don’t care, or don’t act—that means meditate before you do so, for the rest of your life—and establish your intention as being of benefit, not soapboxing.” 

That’s not to say burnout doesn’t happen. Slightly Better says the 6 signs you are experiencing compassion fatigue which mirrors general burnout are:

• Resentment towards the one you are helping
• Feelings of apathy
• Pessimism because nothing you do is help them
• Avoidance and isolation from others (not just those seeking help) due to overwhelm
• Indecision between going in or out and creating goals
• Decreased pleasure in helping others and even yourself

Good Therapy says physical symptoms of compassion fatigue are:

• Headache
• Insomnia
• Significant weight changes
• Chronic exhaustion (emotional and/or physical)
• Hypersensitivity

A way to test burnout is with Maslach Burnout Inventory, the gold standard for measuring burnout. Try this toolkit  by Mind Garden.

The good news is that you can still create change with boundaries and balance. You don’t have to give up the dream to make a difference. You can learn “compassion resilience.” According to Compassion Resilience Toolkit, “compassion resilience, is the ability to maintain our physical, emotional, and mental well-being while responding compassionately to people who are suffering.” There can still be compassion satisfaction where you focus on the wins of helping others and why you started in the first place.

Dr. Josie Badger, J Badger Consulting President, reflects on a recent situation of experiencing compassion fatigue with Forbes stating, “Since I learned of my cousin’s husband’s suicide, I have experienced exhaustion and countless bodily ailments. From thousands of miles away my heart broke for her, and I felt the pangs as if I was right there with her. I felt sort of silly with this level of exhaustion while being completely separate from the situation but the feeling was the same nonetheless. As I further thought about my current situation and about the physical embodiment of the past year and a half, no other term fits it better than ‘compassion fatigue.’ Even if we did not personally experience the loss of a loved one or significant illness from the pandemic, we’ve all felt some level of burnout and overwhelmed simply from watching the same story repeated itself on the news and feeling helpless. Health care rationing, wildfires, earthquakes… It is understandable why so many of us are feeling overwhelmed, even with completing what used to be non-stressful, ‘normal’ activities. I would typically associate compassion fatigue with caregivers or individuals who work in caring professions but this fatigue far surpasses any job title. As a disability lobbyist and advocate, I don’t usually deal with individual crises, but I deal with the brokenness of our community daily. As I hear one more story about a student with a disability being bullied or a young man on the autism spectrum being shot by a police officer, compassion fatigue consumes my body. The headache, neck pain, and stomach issues are glimpses into my mental status. Compassion fatigue can happen in many different situations and regardless of your job or caregiving role. As our world continues to live through, and hopefully heal from, the pandemic, we need to be serving others and ourselves with grace.”’

Here are 5 ways to combat compassion fatigue and create compassion resilience:

1) Ask for help

David Kessler is a grief expert and founder of Grief.com  who sought grief counseling after his son died. He wasn’t a grief expert doing this. He was a father burying his son. It was important for him to know where his support was. Even though he was an expert in this area, he still needed support. He reached out and got therapy. This helped him immensely, as he knew he was human too. He says on compassion fatigue, “So how can we survive and even thrive in our world of caring for the wounded, the broken-hearted? The mantra I live by is this: To feel too much is dangerous, to feel too little is tragic. My job is to find the balance in that every day.”

Aundi Kolber is a therapist and author of Try Softer who realized that she was exhausted trying to solve problems for some of her clients. She was overextending herself in order to help them. She was too caught up in getting results and fixing their trauma, as someone who also is a survivor of complex trauma. Her dad had mental health issues that weren’t addressed resulting in abuse for her and her siblings. Her mom is a recovering alcoholic. As a trauma informed therapist with her own trauma, it was difficult not to take on others’ issues and feel emotionally depleted. Her boss told her to try softer rather than harder. This was an “aha!” moment for her. She learned that she needed to ask for help. She learned that even therapists need an outlet and support. 

In the podcast, Mind, Body, and Soul: An Interview with Aundi Kolber by All Shall Be Well, Kolber discusses how medical professionals are often not trained to cope with compassion fatigue nor know how to ask for help. When we go to a doctor, we expect to be treated well, but many reported feeling unheard. Being overlooked and unseen is a common phenomenon that doesn’t happen to all but to many. That’s because the medical profession is often dealing with the subject of a patient’s pain. They don’t have the right tools to process it all so they shut down. This creates vicarious trauma, secondary trauma or otherwise known as compassion fatigue. This trauma gets stuck in the body mainly because of the lack of tools to cope with it. We go outside our window of tolerance, meaning the state of mind we can cope with tough emotions. For example, a med student listening to someone in pain might be afraid about what’s going on and not knowing how to help them. They are told it’s part of the job, to just deal with it. This fear in their nervous system is repressed, and as a result, there is disconnection from the body in order to keep going. They are essentially taught not to feel and to work like machines so they don’t get caught up in it all. The adaptive information process system in their body which processes the emotional information and pain is turned off. This is not a sustainable state to be in. The body will eventually give out. What happens is PTSD symptoms, addiction, panic attacks, misdirected anger and inability to handle emotions in general. Becoming cynical just sort of happens when compassion fatigue isn’t part of the curriculum. Self-care is important.

Kolber shares how she takes care of herself to avoid cynicism. She has a therapist, pays attention to her own nervous system and tracks her own body because she experiences feelings similar to what her clients feel along with having her own trauma. When she gets home, she unwinds and says she engages in mindfulness, contemplative prayer, walks in an intentional way, listens to music, connects to affirmations and reaches out to people close to her for support. She says, “Therapists are people too. We have to keep doing our own work to hold space in therapeutic ways for clients.”

It’s important to ask for help no matter what status you have or field you are in. Know though when someone isn’t a support. Just like you would like someone else to consider compassion fatigue in you, be aware of others’ emotional boundaries and capacity to take on your pain or trauma too. A mental health professional might be best for such circumstances. Try this matching tool to find a therapist in your area. If you don’t have insurance, you can find a therapist who offers affordable sessions at Open Path.

You can take the Professional Quality of Life  (ProQOL) measurement designed by Dr. Beth Hudnall Stall to assess your symptoms of compassion fatigue and general burnout. You can also bring up the topic in a meeting at your work and help others to speak up on the topic, validating their experiences with compassion fatigue. You can become a Compassion Fatigue Specialist with this training. There are also courses such as this one on compassion fatigue you can register for. Click here for a list of other resources on help for compassion fatigue. 

2) Set Boundaries

Dr. Karyn D. Hall suggests saying “not my experience, her experience” to maintain boundaries. You don’t have to carry their problems too. Being a safe space for others can be appropriate if there are boundaries. This counteracts codependence. 

Nedra Tawwab, boundary expert, says, “If you’re feeling guilty, here are some reminders: It’s healthy for you to have boundaries. Other people have boundaries that you respect. Setting boundaries is a sign of a healthy relationship. If boundaries ruin a relationship, your relationship was on the cusp of ending anyway.” Start with this boundary quiz by Tawwab here. It’s not a diagnosis. It’s just a resource. According to Tawwab, some boundary statements include:

• No, Thanks.
• I’m not taking on new things.
• That doesn’t work for me.

If you have no idea how to help someone, start by leading by example. Be the light. This stance of empowerment is one where you emulate qualities of resilience to help that person overcome their obstacles. You won’t have all the answers. That takes humility to accept. But what you do know is we are all in this together. Find common humanity and recognize yourself in others’ struggle, reinforcing the empathy that you found when you first took helping them on.

Step back on your role to control the outcome all the time. You cannot control their reactions or whether they take your advice. All you can control is that you do the right thing. In other words, you don’t have to be everyone’s teacher. Just showing up for them can make an impact. This relieves stress and the need to be perfect at problem solving. It also reduces guilt for not knowing how to help them all the time. And remember that you always have the choice to walk away. Sometimes, all you can do is plant a seed then hope it’s received.

3) Practice Self-Compassion

When you love yourself, that love will radiate onto the people around you. So helping others starts with you. Pour into your own cup first. You can take the self-compassion scale by Kristin Neff here. This tests how self-compassionate you are. According to Neff, there are three components to self-compassion:

• Being kind to ourselves vs judging ourselves. 
• Seeing our common humanity when we make a mistake vs isolating ourselves.
• Being mindful of our emotions vs over-identifying with them. 

Here is another self-care and self-compassion questionnaire with exercises towards being kinder to yourself. Give yourself time to complete each step and exercise. 

6 ways to be self-compassionate are as follows:

• Worry Journaling- Spend 15 minutes writing your worries down in a ‘worry window’ of time where that’s all you focus on otherwise known as ‘worry scheduling.’ This will help be mindful other times when you are not engaged with your worries. This also helps problem solving. Spend time coming up with solutions. You can put in your daily stressors related to caregiving.
• Create a self-soothe kit: According to Dr. Potter, this is also a ‘cope ahead’ method. One way is to ground yourself using your senses. To make this more meaningful, find items that remind you of the good in life.
• Sight: What items can you see that bring you peace? For example, a scrapbook of your favorite memories might be helpful.
• Sound: Try a playlist of music that relaxes you, ASMR such as this one by Vito ASMR, sound baths, motivational speeches or anything else you can listen to.
• Smell: Perhaps a scented candle, essential oils, perfumes, etc. Since your sense of smell is located in between the memory and emotional regulation centers in the brain, scents can be a nostalgic nudge towards good times and memories.
• Touch: Caress something that distracts you from distress. This could be a smooth rock, fidget spinner, lotion, a pet or loving exchange such as a hug.
• Taste: Indulge in flavors that bring you joy such as dark chocolate, your favorite icecream, mint gum, or tea. 
• Focus on the positive: Learn to laugh at yourself, find the silver lining, be curious, develop gratitude and have a general positive attitude towards your caregiving role. 
• Balance: Take breaks and invest in a personal life and your overall wellbeing. Have ‘rest days’ or schedule times where you just rest, doing nothing but being still.
• Self-forgiveness Affirmations: This type of affirmation is simply forgiving yourself for perceiving shortcomings and imperfections. You can tailor this to your caregiving role. For example, “I am allowed to rest. I am worthy of love. I am perfectly imperfect and will allow myself to be human.”
• Box Breathing: This is good for when you are overwhelmed and stressed. Inhale for four counts, hold for four counts, exhale for four counts and then repeat. Try this video on box breathing. It’s important to do this especially in stressful moments with the client.

4) Engage in Mindful Caregiving

Did you know compassion is a skill you can work on? There is a meditation called Loving-Kindness meditation by Tara Brach, and a study on it was done which resulted in increased altruism in participants. They developed compassionate thoughts and reflections which impacted compassionate action and deeds. Such mental activities led to changes in the brain. According to Feel Guide, “People who received the compassion training showed increased activity in neural networks involved in understanding the suffering of others, regulating emotions, and positive feelings in response to a reward or goal.”

You might think, “I’m burned out on compassion. Why would I want to do a compassion meditation?” The point is to make yourself available to people with intention for compassion and to remove codependency and let go of control. Letting go is what does the work for you.

The Loving-Kindness Meditation by Tara Brach starts with:

“May I be happy.”

May I feel safe.

May I be filled with loving presence, held in loving presence.

May I be at peace.”

You give care and kindness to yourself. Then, you extend it to others and the world around you such as with the following phrase:

“May you live with ease, may you be happy, may you be free from pain.”

You repeat similar phrases to those you know, neutral people in your life and to all living beings.

For the full meditation, go here.

There is another meditation called Compassion With Equanimity Practice for Caregivers in The Mindful Self-Compassion Workbook by Kristin Neff and Christopher Germer. To practice this, get into a comfortable position and think of the person you are caring for. Visualize them and the caregiving situation. Then say these words,

“We are each on our own life journey.

I am not the cause of this person’s suffering,

nor is it entirely within my power to make it go away,

even though I wish I could.

Moments like this are difficult to bear,

yet I may still try to help if I can.”

Inhale deeply and draw in compassionate attention towards yourself. Exhale and give  compassion for the person you are taking care of. As you breathe you could think, “One for me, one for you.” “In for me, out for you.” Then, repeat the words you spoke to yourself above again, giving more breath and attention to whichever parts of you or this person needs it the most.

You can also follow Neff’s guided meditation on Youtube here.

You can extend a level of mindful compassion for the person you are caring for by simply holding space. Sitting with someone’s pain is more important than trying to solve it. Emotions are not a problem to be solved. Emotions are to be shared not to be shamed. Megan Devine says “Some things in life cannot be fixed. They can only be carried.” 

You can teach others to be mindful and sit with their feelings too if a situation is hard. When you show them that they are more than what happens to them, they will assert themselves towards their own healing. 

5) Know What To Say

The caregiver may also be known as the attachment figure because the attachment bond is directly influenced by secure or insecure attachment styles which affect how we interact with people all our life. Thus, co-regulation is an important factor to caregiving. Self-awareness of your own emotions and attunement with theirs helps with co-regulation, as seen with parents and their children. This helps the caregiver respond rather than react. When this is off, compassion fatigue ensues. It’s important to self-regulate then in order to prevent compassion fatigue. They will follow your calm. Dr. Caroline Leaf says, “As you co-regulate with someone, the mirror neurons in their brain are activated, and this enables the person in the deregulated state to literally ‘mirror’ your calmness.” Click here for techniques for co-regulation.

You may have to discuss someone’s care with other professionals such as doctors, insurance agencies or even home aide agencies. Communication is key in these examples. It’s most important to involve the one you are caring for in the decisions you make, while keeping calm, doing your research and remaining open. It’s easy to get burned out or overwhelmed in relaying all your client’s needs and listening to your client. To avoid miscommunication, VeryWellHealth gives examples to say the following to the one you are helping:

• “Before we discuss this, I need to talk to you about some challenges I’m having managing my caregiving duties. I’d really like your thoughts on where we can go for help.”
• “I know you’re going through a lot. I’m feeling the stress, too. I think we should take a step back and talk about what just happened.” 
• “Who else do you think we should talk to about this? What kind of input or support do you think they could provide?” 
• “This might not be the best time to have this discussion. Why don’t we try again in a little while?”
• “I feel like we might have different expectations about how this will go. Let me tell you what I thought would happen, and then I’d like to hear your thoughts and expectations so we can get on the same page.”

It’s important to truly listen in a mindful way. Barry Boyce says of caring for his mother in a nursing home, “When it comes to extending care to others, good intentions may indeed pave the road to hell….Among the first lessons I learned was that presence takes precedent over words. I would arrive at my mother’s nursing home wrapped up in my thoughts, distracted by my important little entrepreneurial pursuits, and end up talking at my mother rather than with her. When I slowed down, listened with my whole body, and attended to her fully, I noticed how much my heart was breaking and how I’d been trying to run from that. If you’re truly present, there will be pain, and your heart will break lots...I try finding ways to convey caring and let the other volunteer whatever it is they wish to offer or ask, to let them have more agency, rather than being the object of my caring. It’s possible to offer the gift of warm or cool space, what Frank Ostaseski calls ‘bringing your whole self to the experience’ and finding ‘a place of rest in the middle of things.’”

If you find yourself still unsure of how to care for others as well as care for yourself, try asking the person you are helping for feedback. Let them guide you too. 

Sarah Jeanne Browne is a speaker, writer, and activist who has been published on Lifehack, Tiny Buddha, Thrive Global and more. See @sarahjbrowne.

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