A little more than a week after the September 11 attacks, the Rev. Bonny Dillon, who oversees bereavement services at Bon Secours Richmond Health Systems,
in Virginia, traveled to northern New Jersey to consult at the Bon Secours hospitals in Hoboken and Jersey City. She wasn’t there to help take care of the hospitals’ patients, but rather their staff members.
In Hoboken, where the hospital had once had a view of the World Trade Center, hallways were lined with fliers posted by people searching for their lost loved ones. “Walking down the hallway, seeing them, was overwhelming,” she recalls. The impact of seeing every day the faces of scores of people they couldn’t help hit the hospital staff hard. As part of her work, Ms. Dillon says, she encouraged the employees to talk openly about their feelings. She and the workers came up with a plan: One month after New York City began issuing death certificates for the missing, they would take down the fliers, but post them in the hospital chapel as a way to honor the people who had died and give closure to the people who had hoped to help them.
What Ms. Dillon sought to prevent is known as “compassion fatigue.” although the phrase is thrown around casually in the news media, it also has a specific meaning that is recognized by mental-health professionals.
Compassion fatigue, sometimes known as “vicarious trauma” or “secondary traumatic stress,” affects people who are exposed to the traumatic suffering of others, such as doctors, nurses, emergency-service personnel, counselors, social workers, clergy members, and animal-shelter workers. Left untreated, symptoms can worsen and the condition can evolve into burnout, which can cause employees to quit their jobs.
Compassion fatigue may result in poor job performance and plummeting self-esteem, and thus it can even drive some people who experience it out of their professions entirely, says Ms. Dillon. Those who suffer from it can also experience tension in their home lives, or even fall into clinical depression or other mental-health problems, she says.
The signs of compassion fatigue can mimic those of post-traumatic stress disorder, which can afflict people who have survived a traumatic event like combat, rape, or assault. Sleepless, irritability, anxiety, emotional withdrawal, avoidance of certain tasks, isolation from coworkers, feelings of helplessness and inadequacy, and even flashbacks are among the symptoms.
Frank M. Ochberg, a Michigan psychiatrist who founded Gift From Within, a nonprofit group for people who suffer from post-traumatic stress disorder, says compassion fatigue happens when “the milk of human kindness dries up. you forget why you wanted to help people in the first place.” it can, he says, lead to excessive drinking or other unhealthy behavior. And vicarious stress can trigger a professional’s memories of trauma experienced firsthand, causing an accumulation of symptoms that can prove debilitating, says J. Eric Gentry, co-director of the International Traumatology Institute at the University of South Florida, in Tampa.
Those who experience compassion fatigue, says Charles R. Figley, a professor in the School of Social Work at Florida State University who founded the Traumatology Institute, find it is usually alleviated simply by acknowledging the problem and getting support. “The people who experience this are often the best and the brightest. They have extra sensitivity,” he says. And not giving these workers help can undermine not only an organization but its long-term mission. “If we don’t do something about compassion fatigue, we’re going to lose people.”
Although nearly everyone who performs emotionally intense charitable work can be susceptible to compassion fatigue – and those who work with traumatized children are considered at high risk – certain professions in the nonprofit field may not have sufficient help in handling their rawest feelings. Members of the clergy may be especially vulnerable, says Ms. Dillon, noting that they carry an especially heavy load during times of crisis. (Some clergy members in the New York City area, she notes, performed up to a dozen funeral services within a week after September 11.) There’s a feeling that clergy are invulnerable,” she says. “They can handle anything – after all, they have God.”
Employees of animal-related charities, such as shelters that euthanize unwanted pets, can also be hit hard by compassion fatigue – and contribute to high annual turnover rates at some shelters. unlike every other type of charitable work, killing is a part of the job at most animal shelters, notes Diane Less Baird, president of Angels for Animals, a shelter and pet-owner education center in Greenford, Ohio. “You can only hold so many animals in your arms and feel the life go out of them,” she says, “without it starting to suck the life out of you.”
What’s more, says Carol a. Brothers, a clinical psychologist in Annapolis, Md., who conducts compassion-fatigue workshops for animal shelters around the country, shelters tend to encourage workers to remain stoic when euthanizing or turning away unwanted pets, and those workers may be less likely than other charity employees to get support from people outside of work, either. “People in their lives start saying to them, ‘Oh, my God, it’s only a dog, ‘” she says.
For those who wish to prevent compassion fatigue – or manage it effectively when it occurs – charity managers and traumatic-stress experts offer the following advice:
Tell new or prospective employees what to expect. “Any person being interviewed for a job needs to be informed of what the toll will be,” says mr. Figley. “Many organizations don’t do that, and that’s a mistake.” at the Bridges Center, a grief-counseling organization in Louisville, Ky., that is associated with a chain of nonprofit hospices, managers tell new workers about resources, such as support groups for staff members, during orientation and encourage their use, says Barbara L. Bouton, the center’s director. “We recognize that compassion fatigue is probably inevitable in the work we do,” she says.
Establish support systems. Giving employees opportunities to talk about the emotional aspects of their work – and chances to blow off steam – can help keep compassion fatigue from taking over. for counselors, the checks and balances provided by mandatory clinical supervision, in which therapists seek an objective view of how they’re handling their current cases, can help them maintain perspective. Where possible, some charities might consider rotating people out of particularly tough assignments after a period of time, says Garnie Mitchell, manager of clinical services at the behavior health center at Phoebe Putney Memorial Hospital, in Albany, Ga. Her organization shifts employees between inpatient and outpatient duties to prevent work-related stress.
Support groups can make a world of difference in keeping charity workers on the job and effective, says Dottie Ward-Wimmer, director of children’s clinical services at the William Wendt Center for Loss and Healing, a grief-counseling organization in Washington, D.C. The Wendt Center runs the Recover Program, which dispatches counselors to the city’s morgue to aid families who come to identify bodies there. thanks in part to a regular support group for those counselors, Ms. Ward-Wimmer says, the two-year-old, emotionally intense program has experienced no turnover.
Informal support can also help, such as providing timeout rooms for employee use, says Ms. Brothers. And some organizations find creative ways to combine both the need for acknowledging loss and for lightening up. at the Bridges Center, for example, staff meetings begin with quiet reflection, the lighting of a candle, and the reading of the names of patients who have died recently in the hospices. yet the same meetings, says Ms. Bouton, might also include comic relief in the form of skits performed by staff members.
Encourage workers to talk about their feelings. After a particularly traumatic event occurs at work, start a conversation about it. “People worry that if employees start showing their feelings, they’ll just start breaking down all over the place and they won’t do their jobs,” says Ms. Brothers. “The truth is, when people can show their feelings, they do better work. They have more energy.”
Keeping an eye on not only the work employees do but also the manner in which they do it can help prevent compassion fatigue from overwhelming workers. Before he became the director of training and education at the William Wendt Center, Duane T. Bowers worked for the Red Cross, and three years ago, he was assigned to aid volunteers who were reuniting refugee families in Kosovo who had been separated by war. The Red Cross, he says, was diligent about monitoring the emotional state of its volunteers: “We’d watch for the amount of anger they’d express with refugees, the amount of times the volunteers would go out on assignments. We’d go to the bar in the hotel and see who was there, how often they were there, and how long they stayed.”
If a manager notices an employee’s behavior has changed, he or she should take the initiative and gently bring it up, says Ms. Mitchell. Persuade the worker to take a self-test that measures compassion fatigue, she says, and encourage him or her to seek help if needed.
On the other hand, says Beth Hudnall Stamm, research associate professor at the Institute of Rural Health at Idaho State University, don’t jump to conclusions about how employees will handle traumatic events at work. some will already have healthy coping skills. “Be sensitive,” she advises. “Talk around the coffeepot. Say, ‘I’m concerned, we all seem to be tired.’” If an employee needs help, she says, “make a referral to a counselor outside the organization and don’t ask for information back. I think it’s important to strike a balance between providing help and starting a witch hunt.”
Employees may fear that their candor will adversely affect their careers. Support from managers can make a big difference in whether a worker seeks help. “Normalize it,” Ms. Dillon says. “People get labeled as nonfunctional or slackers because they’re avoiding work situations that trouble them. They need to realize, ‘No, there isn’t anything wrong with me. I just need a little help.’”
Consider seeking outside help. If an organization performs a lot of work with traumatized patients or clients, it might want to seek training for its counselors in treating secondary traumatic stress. (See “Compassion Fatigue Resources” for details.) Another option might be to bring in an outside expert to conduct a workshop to help employees recognize the phenomenon, or to run support groups on a regular basis.
Ms. Brothers suggests contacting a state board of clinical social workers or a state psychologists’ association. Such groups might have members who would be willing to consult with a charity pro bono or for a fee determined on a sliding scale. Local hospices, hospital pastoral services, nursing homes, and bereavement associations may have staff members who are qualified to talk to charity employees about recognizing and handling compassion fatigue.
When sponsoring a workshop led by an expert who is being paid, suggests Ms. Bouton, invite managers from other local organizations to attend, and charge a small fee. The proceeds may help cover the guest speaker’s stipend.
Look out for your own needs and encourage employees to do the same. a healthier environment for helping professionals, says mr. Gentry, begins with the people in charge. “They can learn to manage themselves to lower their own anxiety,” he says, “so they don’t spew their anxiety on to their staff.” Relax abdominal and pelvic-floor muscles when they begin to clench, he says – that alone will alleviate some physical symptoms. let go of things that cannot be controlled, he says, and accept one’s personal best as good enough. “To be a caregiver means that we are choosing to walk into pain,” he says. “And we must learn to relax into it.”
Seek out stress-relieving activities outside of work, mr. Bowers says, and consider bringing in speakers who can let employees know about local opportunities for the same, such as massage therapy or yoga.
Above all, mr. Figley suggests that professionals who suffer from compassion fatigue give themselves a break. He says they should focus on the things they are doing right. “Think logically,” he advises. “What are your responsibilities? your limitations? Have you given yourself the same support you give your patients?” in most cases, he says, the problem can be solved by teaching people to remain sensitive but not allow themselves to get overwhelmed. “A good lecture,” he says, “is usually enough for most people.”
How do you and your organization combat compassion fatigue? Tell us in the Share your Brainstorms online forum.