Compassion Fatigue - Who Takes Care of the Caretakers?

Are you a person who constantly gives comfort, support and guidance to others? Are you a Funeral Director, Physician, Counselor, Crisis Intervention worker, a person taking care of an invalid spouse or caring for an aging parent, or a grandparent unexpectedly now caring for grand children? If you are in any of these positions or ones similar to them, the chances are high that you will periodically suffer from compassion fatigue.

Compassion fatigue is a feeling of depression or burnout experienced by a person who provides counseling or consoling services to others. It is similar to guilt by association. Constantly exposed to and involved with, the environment of grief, loss, trauma, or crises, caregivers experience periodic mental, emotional, and physical symptoms of sickness, depression and psychological instability.

When I first wrote about the debilitating stress encountered by caregivers like Funeral Directors and Counselors, more than 15 years ago, there was not much research to support the concept. There weren't many systematic approaches for dealing with it either. It was thought that the excessive stress just "went with the job," and had to be accepted. Thankfully, that has changed.

Due to the work of psychologists like Martin Seligman, Karen Reivich, Andrew Shatte' and others, there are now specific approaches to dealing with the stress of habitually stressful occupations. These researchers have built on the early post-traumatic stress disorder (PTSD) work by Dr. Charles Figley and Martin Seligman's "Learned Optimism." And, they have substantiated the B.R.E.A.D.S. Formula approach that I first suggested in 1989 and expanded in 2000 and 2009.

Since Funeral Directors in particular, often have episodes of compassion fatigue, I will use them as an example. However, what I say about them, also applies to anyone who deals with crisis type issues on a regular basis.

Funeral Directors deal with the finality of death, the ultimate human stressor, in a respectful way every day. It is their vocation and their business. Besides the demands of serving the bereaved, they face constant financial, competitive and regulatory pressures. Each of these, if neglected could ruin their practice.

When coupled with:

a) The long and often irregular hours that the profession demands.

b) Handling interrelationships with employees and often family members.

c) The depressing environment that grief can produce.

d) And, little leisure or private time, you have a potentially debilitating array of daily challenges that a Funeral Director must successfully manage, simply to survive.

Without professional detachment, a positive attitude in the midst of an apparent negative atmosphere, regular personal time, and good dietary, sleep and exercise habits, it is likely that you too will experience occasional episodes of what psychologist Charles Figley calls compassion fatigue. These episodes will vary in frequency, intensity and duration. However, even mild events can have significant consequences.

Dr. Figley is a professor of psychology at Tulane University in New Orleans. He is an internationally recognized expert on Post-Traumatic Stress Disorder (PTSD). These disorders are most often associated with veterans from the Vietnam, Kuwait, Iraqi and Afghanistan wars, or with the victims of violent attacks and large natural disasters. Dr. Figley found in his research there is another class of victim. He calls this other type of stress disorder, secondary traumatic stress. It involves the people once removed from the actual traumatic event. These victims are the wives and children of the police officer who just had to kill a sniper in the line of duty. They are the families of the rape or assault victim. In the work of the Funeral Director, they are the survivors. The traumatic stress experience in this case was the ultimate one, death. The secondary sufferers are the survivors who Funeral Directors deal with. They are the bereaved.

The compassion fatigue that you experience as a caregiver is a secondary traumatic stress experience caused by your involvement with the people and families you serve. It becomes complicated and worsened by the other demands made on you to run a successful practice, business, household or life outside of your care giving.

While it is easy to notice and detail these problems, it is often more difficult to develop practical solutions. What about this compassion fatigue? As a caregiver, should you simply resign yourself to it as part of life, part of the job? Do you have to be a victim?

The answer is an emphatic NO! You do not have to be a victim. You can exert more control than you might currently believe. There is a solution, and here it is:

Develop a personal SMART Stress Management and Relaxation Technique. This will take care of you, your family and staff. The issues that you routinely deal with might not be as final as death; however, any situation that subjects you to continuous, unrelenting stress can trigger a compassion fatigue episode and requires a process for relief.

Severe or continuous stress causes disruptions in sleep and dietary patterns. These can further weaken already highly taxed immune and psychological systems. When devising your personal SMART Program, you need to consider the three parts of the stress cycle: frequency, intensity and duration.

Consider the duration of the overall process of recovering from or learning to adjust to, the traumatic, stressful situation. Consider the frequency of the episodes. And then, consider the intensity of those episodes.

Duration is personal, and varies widely among individuals. However, through an effective SMART program, you can recover in the shortest practical time learning ways to be healthier and to cope more effectively. You can also learn how to avoid counter productive or self- destructive behavior patterns.

Frequency is individualistic also. The goal is to minimize the frequency of episodes, however, when you do have one, deal with it directly. You certainly don't want to encourage suppression of honest feelings and emotions.

With intensity, the techniques we'll go over shortly should help and should have a positive effect on both the frequency and intensity of your experiences. Developing a personal SMART program, that is proactive and directly addresses the stress that you deal with, should improve your chances of not succumbing to compassion fatigue. It should also enable you to recover faster if you do have an episode.

Your personal program has twelve parts. The word BREADS is an easy way to remember them. There are two parts for each letter, one psychological and one physical.

The twelve parts of the BREADS Formula are:

1) Breathing correctly using your diaphragm to relax or your chest when you need to feel energized.

2) Having a Belief system of something greater than yourself.

3) Practicing Relaxation techniques daily, like meditation or hatha yoga;

4) Develop and maintain strong close Relationships with other humans.

5) Exercising aerobically at least three times per week for 30 or more minutes. Be sure to get a physical before starting any new exercise program.

6) Educate yourself more about stress management. "The Resilience Factor" by Reivich and Shatte is an excellent book to consider.

7) Monitor your Attitude. Keep it positive and looking forward. Take a break when you find your attitude ruminating and becoming negative.

8) Keep Active. Have a hobby outside of your care giving if possible. Bird watch, fish, hike, getting out in nature is therapeutic.

9) Eat a healthy balanced Diet. As part of your education, learn about proper nutrition. You can eat well and still enjoy what you eat.

10) Determination is the next step. Resolve to be resilient. Develop what psychologists call a "hardy personality. Following the 12 steps of the BREADS Formula will help you become resilient and hardy.

11) Sleep naturally and get at least 6 hours of restful sleep per night.

12) Develop Serenity, the sense of inner calmness that comes from accepting life as good.

Yes, there are many pressures that you face in your role as a caregiver. Often, these pressures combine to increase the stress that you experience. However, by setting up a SMART program for yourself, you can reduce the negative effects of the stress you experience. It is your choice. You do not have to be a victim of compassion fatigue.