The Practice Gap
The Practice Gap
#46: Compassion Fatigue: When Caring Hurts-With Alicia Lukachko DrPH
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Compassion fatigue represents an often-misunderstood occupational hazard affecting healthcare providers, therapists, and caregivers who regularly witness suffering. More than simple burnout, it's a specific type of exhaustion stemming from prolonged empathetic engagement with those experiencing trauma or distress.
Licensed clinical social worker Alicia unpacks this complex phenomenon, describing how sustained exposure to others' pain creates a constellation of symptoms including emotional numbness, detachment, irritability, sleep disturbances, and decreased empathy. These manifestations don't indicate personal failure or heartlessness but rather signal a natural response to emotional overload. The condition particularly impacts professionals in helping fields who often neglect their own wellbeing while caring for others.
For manual therapists like chiropractors, physiotherapists, and osteopaths, unique challenges emerge from the physically demanding, hands-on nature of their work combined with deep therapeutic relationships with patients experiencing chronic pain or trauma. The podcast explores practical strategies for prevention and recovery, emphasizing professional boundaries, work-life balance, mindfulness practices, and the crucial role of peer support. Most importantly, it highlights how healthcare providers must practice the same self-care they recommend to patients - not just as professional maintenance but as essential self-preservation. Whether you're experiencing symptoms yourself or supporting colleagues through their struggles, this episode provides vital insights into protecting the wellbeing of those who heal others.
Have you noticed signs of compassion fatigue in yourself or your colleagues? Share your experiences and strategies for maintaining empathetic resilience while protecting your own wellbeing.
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Elisabeth Aas-Jakobsen, DC, MSc
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Introduction to Compassion Fatigue
Speaker 1Hi and welcome to the Practice Gap, the podcast for closing the gap between the practice you have and the one that you want. I'm Elisabeth, a chiropractor, a business owner, USA. Could you please start by telling the audience a little bit about?
Speaker 2yourself. Thank you for having me on this podcast today. So, as Elizabeth mentioned, I am from New Jersey and I'm a licensed clinical social worker and I work as a therapist and also engage in some research around mental health, around engaging in treatment and interventions and how best to support individuals in schools, in the workplace and also individually at home.
Speaker 1The reason I have you on the show today is to talk about the subject, a subject I know very little about, and I know that you do. You know a lot about this subject called compassion fatigue.
Speaker 2What is that? So, yeah, so compassion fatigue it is really. It's a state of emotional and physical exhaustion out of a long-term or prolonged exposure to trauma, to traumatized individuals, to a high degree of stress, and we often see this in professions like social work, counseling, healthcare these types of professions that require a high degree of empathy, and we can also see this in caregivers. So this doesn't have to necessarily be tied to your professional life, but if you serve in a role as a caregiver, you can also see this as well, and it develops over time. Due to this workplace stress. It can also set in suddenly and be tied to that emotional demand.
Speaker 1That's part of caring for others so at some times you get super tired of all your patients. So is this like, if you're like, you're really happy and then one day it's just like, oh, you can't stand another person telling their terrible story and you just want to say like, get your shit together and move on. Can that be a little putting compassion fatigue at the end of the life? Or something.
Speaker 2Well, it can certainly show up like this, and it doesn't have to come on suddenly. It can. It can develop over time where you're really feeling a greater degree of of detachment, of numbness, a decrease in that sense of empathy, even as you were talking about like an irritability, a lack of patience, and this, this sense of being being overwhelmed.
Speaker 1And I mean this must. How common is this?
Understanding vs. Burnout
Speaker 2So it's common. Yes, we see this a lot and it's something where I think there's been greater attention to this topic, especially as we saw many of our first responders and medical professionals and also mental health professionals during the COVID pandemic and the heights of it, I feel this issue really came to the forefront. Of course, this is an issue that has been in the research during the pandemic. I believe that really led to a greater spotlight on this issue.
Speaker 1Could you explain to me the difference between being burned out and experience compassion fatigue?
Speaker 2burned out and experience compassion fatigue. So burnout is really that. I would say compassion fatigue is an element of burnout, so burnout similarly contains, it's a response generally to chronic workplace stress and there's an overlap between the two, certainly. But compassion fatigue it's really focused on more so the emotional toll and of helping others in distress, and burnout, I would say, is generally a result of that chronic workplace stress.
Speaker 1So I remember very many years ago I had a friend. She went to med school and she had a hard time the first year she practiced and then she said to me she just wanted to go into some kind of medical work that didn't require her ever to talk to patients and that really it stuck with me. I mean, this is many years ago. Is that? Could that be like an early, early, some early sign of severe compassion fatigue?
Speaker 2Yeah. So I mean that recognition, that and oftentimes we see this that there is a feeling like gosh, I really need to either shift gears or step away from that engagement because it's really causing a great degree of stress and I don't have the capacity for it anymore. So that's definitely something that can be seen and also that recognition is a very important piece. You know, individuals do have to take a step away and create, you know, be very aware of their feelings and setting up boundaries to really address those feelings of compassion, fatigue.
Speaker 1So if you have a friend that is struggling with something, if it's illness or a shitty divorce or a bad, bad relationship, can you, as a friend, start? That's like when you get tired of their story and nothing is changing. Is that also kind of? Is that compassion fatigue, or is that something else?
Speaker 2I would say that's something else. I mean there's a similar feeling of perhaps not having a high degree of empathy or patience, but compassion fatigue is really so much, so much more than that.
Speaker 1So it's more so if you are irritated at a friend, it's more other things and not compassion fatigue.
Recognizing Symptoms and Impact
Speaker 2Yes, I mean there could be an element of that, certainly. But when we're talking about compassion fatigue, it really is a larger set of symptoms where it is more pervasive, and not just in that moment, but more pervasive symptoms of the physical, emotional and behavioral symptoms. Really, as I mentioned, having those feelings of helplessness, having a chronic sense of fatigue, it can even lead to headaches and sleep disturbances. You could potentially even have you know, lead to withdrawal, sense of withdrawal from social interactions.
Speaker 1If you've been working for a while and suddenly just you're tired, there's a lot of things going on, it's rough with everything. It's just life is rough. How do you recognize that you're actually about these symptoms that really having an impact?
Speaker 2on different areas of your life, whether socially, at work, with your family, and I would really recommend reaching out to a professional to talk to a professional. I mean. Many times these symptoms of compassion, fatigue, they overlap with, they said, other symptoms of depression and anxiety, and better understanding what the sources of those are is really critical. But then also some of the ways in which to address those symptoms, no matter what the cause is, can be overlapping and very similar.
Prevention Strategies and Self-Care
Speaker 1But is there? Okay? So if I start feeling, I'm thinking like, okay, I might be suffering from a tiny degree of compassion fatigue Is there before I start seeking therapy, do you have any advice where you can start or actually how can you prevent it? Maybe that's a better question. Actually, how can you prevent it?
Speaker 2Maybe that's a better question. Actually, yes, yeah, absolutely so. I mean. One thing I think that's so critical is that piece around practicing self-care and really being aware of, of maintaining a balance between, you know, your work life and and home life. Home life like re really focusing on that work life balance which I know is much easier to um to say than to do but having, once you are aware of how you're feeling, these symptoms, really taking those steps to create those boundaries, establishing those professional boundaries, you know, so that you avoid that over-identification and that you know not only just the time but also the extent to which you may also need to create better boundaries with clients, with patients.
Speaker 2Also things like seeking help from your peers and peer support. You know it's so important to raise this topic and discuss experiences with your colleagues I'm just thinking in a workplace setting who might really understand and likely do, and also just in terms of staying informed and educated, really being aware of those symptoms so that you can take some steps to take care of yourself, not just in terms of your mental health but your physical health and well-being, which plays such a big role. They're so strongly interconnected. So really focusing on those healthy habits. Like you know, healthy diet and eating and exercise and getting enough sleep these are all very closely interrelated and help to not only address but prevent compassion fatigue of symptoms from really taking over not only address but prevent compassion fatigue of symptoms from really taking over.
Speaker 1So if I didn't manage to prevent it and I'm feeling it then I seek therapy. If I come to you, where would you start and how long will it take until I'm fixed? So I can't really say how long things take to necessarily it's kind of like your back when your back hurts, it's like you can't. I can't tell him how, how, exactly how long it will take it's the same in your profession exactly, that's very so, that's very individual.
Speaker 2but really, in starting to recognize one, to better understand and increase the awareness in clients of how they're feeling, you know really holding space for that sharing of those feelings, of feeling overwhelmed, feeling that lack of empathy, that the helplessness, the symptoms that might accompany compassion, fatigue, and I, you know there's a lot of guilt that comes with that as well. Particularly for those who are in, you know, in a helping profession or engaged in caregiving responsibilities, there's oftentimes a sense of you know, really feeling that you are, you know, not understanding where this is coming from, feeling guilty, like you're cold or there's a heartlessness, and that's. You know that's not the case. This is a result of that physical and mental exhaustion, from feeling overwhelmed for having such great exposure to these caretaking responsibilities, to even potentially, you know, the trauma that you're experiencing secondarily from helping others.
Speaker 1And I must also say it's a degree of shame in it, because you're I mean that's your profession you should be able to take care of people, that's it's not in the thing yeah if I know that you're not a chiropractor. However, I know you have chiropractic experiences, just as being a friend of a chiropractor that's me and then also from getting treatment yourself. How can, for, if you're a physiotherapist or chiropractor, osteopath, a massage therapist, is there things that we like that could relate more to our group than other groups?
Specific Challenges for Manual Therapists
Speaker 2Yeah, well, you know I I am quite fond of chiropractors and chiropractic care, which is really so, you know it's not only is there an emotional element to it in terms of, you know, as with medical, other medical professionals and care professionals, a sense of feeling responsible for patients' well-being. That piece, I think, can really put chiropractors at risk for compassion fatigue as well. As you know, there's also a very hands-on nature of the work. There are very close relationships that are built with patients who might have undergone some real trauma leading to the need for chiropractic care. There might also be, you know, issues around chronic pain or you know, be you know issues around chronic pain or you know even just the demands of chiropractors that could lead to that emotional exhaustion. There could be a sense of you know responsibility if patient's progress is slow or there might be setbacks. And I can really see not only that, those physical demands, but combined with that like emotional toll, it can really exacerbate those feelings of compassion fatigue and really contribute to that in the field.
Speaker 1Because I mean we all have those patients whose stories really really you're supposed to go in there and do your work and kind of detach and go back, you know, go to the next patient tower in there and do your work and kind of detach and go back, you know, go to the next patient tower. There are some stories that are just terrible. And then you you keep it's hard to detach, you kind of carry them with you and and you want, you really want to help so badly, but there it's like you have really you don't have the tools, so I mean it's, it's big things and you come at loss and they kind of keep following you their stories. You can't get like, you can't shake them, if that makes sense.
Speaker 2Yeah, no, absolutely, I see that.
Speaker 1What's a good way if you start having the or, like, if you have like a couple of those patients, what's a good way to actually detach more?
Speaker 2So I think one piece is, you know, making sure that you have these professional boundaries, which are just in the sense of, also a recognition that while you have such a big role and play such a big role in helping others and helping to relieve their pain, helping to improve their well-being, that you, you know that only extends so far, and recognizing and appreciating what you have to offer and then also those limitations, as hard as they may be to accept.
Speaker 2Another piece too is just around, again, trying to maintain that balanced lifestyle and being able to have those distinct shifts between the workplace and your work and then home or life outside of that and even within the workday, trying to incorporate some of those stress-relieving techniques into your daily routines, being able to step out and have some time away, whether it's going outside, whether it's taking a break in a different area, engaging in some mindfulness techniques. Also a big piece of it, I think, is the extent to which those you know, employers, can also create those healthy workplace routines and environments. And having that peer support I think is so important. Again, being able to discuss experience with colleagues who really understand the demands of chiropractic care.
Speaker 1And to have like the network of people around you. But as I'm listening to you, it also I mean so many of the things you are saying that we should do. These are the same, exactly the same things we are trying to teach our patients. But I think we might sometimes lose the connection that we actually have to do it ourselves to ourselves to keep us from being burned out and unhealthy and not yeah to yes to lose it really.
Speaker 2No, that's such an excellent point and I think that so many people in helping and caring professions also face this. You know they're used to being givers and so oftentimes there's a little bit of a fight lost in taking care of themselves and ourselves and that, and you know, having that focus on being able to care for yourself ensure that you are in a good place to be able to care for others.
Speaker 1Well, this makes a lot of sense. My last question to you, alicia, is compassion fatigue, like if I would. Is it well known? Does all therapists kind of know this? Is this a new thing? Does all therapists kind of know this? Is this a new thing? I mean how aware if I go to a therapist or a psychologist or a psychiatrist, how aware are generally the public, like these therapists, about this topic?
Speaker 2Well, certainly in the mental health professions and I can't speak to all areas or regions, but it's a widely known condition and phenomenon. So this is something that most, if not all, therapists should be aware of. Certainly, and, as I mentioned you know, there was greater recognition, I would say, in the past five years or so, because we were seeing such high degrees of compassion, fatigue and burnout during the pandemic, certainly in the United States and, I can very much imagine, across other countries as well, and so this is a topic that most therapists are very familiar with.
Speaker 1I was just on the note of pandemic in Norway. We were quite lucky that we didn't shut down the offices way too long, but we had a complete shutdown for five weeks in Norway. And then a lot of my friends and colleagues they said like when they couldn't work, some of them said they kind of felt like they lost their identity. It was like it was really hard because like, who are especially those who didn't have small kids at home or had to take care of other people? But it was just themselves. And then it's like who am I when I'm not taking care of others or I'm not being a chiropractor? And it was really tough. Would you translate this to maybe they are at the risk of having an unbalanced life and that you are actually at the risk of getting a compassion fatigue?
Creating Balance and Professional Boundaries
Speaker 2You know that is a really insightful point, elizabeth Beth. It's, you know, it definitely is a. It can be an indicator that a lot of your you know identity is wrapped up in in your profession, and that could be an indicator, too, that there is not you know, that there isn't this fully developed sense of self where you have other areas where you're getting a great sense of purpose. That purpose is not just in your profession, but also in the other roles that you play in life, and so I could certainly see that this could be one area that really puts individuals at greater risk for compassion fatigue potentially.
Speaker 1So, if I should sum up a little bit, if you are compassion fatigue is quite common among caregivers or people who has a lot of empathy in their work line of work it can be with therapists and it can also be other caretakers and then if you start developing symptoms of exhaustion, lack of exhaustion, lack of energy, bad sleep and general anxiousness, this could be part of a compassion for tea.
Speaker 1Is that right? Yes, yes, and to. The most important thing is to, especially to all those young practitioners out there. The way to prevent it is to work on having a work-life balance, to take breaks, take vacation, do a little meditation, walk outside and do all this wonderful thing that we actually tell our patients to do for their physical health and or for mental health. We need to do make sure we do it ourself. And also the important that we need peer support groups. We need friends to talk with, colleagues to talk with or other people to talk about the struggles we have in our work days, so they don't build up and become a problem. Does that sum it up?
Speaker 2Those are all that does sum it up, and those are all excellent recommendations, and I greatly appreciate the opportunity to talk with you today about this topic.
Speaker 1Thank you, alicia. It was lovely to hear your beautiful voice, so excited to share this topic with our audience, and I would love to invite you back another time.
Speaker 2Oh, thank you so much. It's been my pleasure.