Compassion fatigue a growing concern

dove floundering in waterSocial worker Lisa Wessan knows personally how debilitating compassion fatigue can feel — emotionally and physically.

She was one of many social workers who volunteered to help the people of New York City cope with the grief and uncertainty after the terrorist attacks of Sept. 11, 2001.

Following that day, Wessan continued to work as a geriatric social worker for a senior care center in the city. On several evenings and weekends she joined her alma mater, Hunter College School of Social Work, where it mobilized social workers to help the Red Cross deliver mini grief sessions at makeshift stations within a couple of miles of Ground Zero.

While aiding others with their sense of deep loss and the uncertainty of potentially more attacks, Wessan realized she was suffering as well. As the days progressed, she lacked sleep and found it difficult to focus on her work. Unexplained physical ailments materialized.

“I felt I was drowning in grief,” she said. “My nervous system was being stretched to its limits.”

Wessan and her colleagues had developed compassion fatigue, also referred to as secondary traumatic stress. Compassion fatigue is a combination of physical, emotional and spiritual depletion associated with caring for clients in distress, Wessan said.

Fortunately, Hunter College saw how the trauma was impacting social workers and established secondary traumatic stress support groups at the school. The groups offered grief counselors an opportunity to come together and talk after their Red Cross duties. “The professors and staff (at Hunter) were amazing during this crisis,” Wessan said.

“Nine-eleven forced me to reach out and get all kinds of extra help, including Reiki,” she said.

Since that time, Wessan, who now lives in Massachusetts and works as a psychotherapist and life coach, has taken the prevention of compassion fatigue to heart. She consults on the topic and performs in-service trainings at various health care organizations that offer attendees new skills in addressing stress and compassion fatigue.

“Our goal (at the trainings) is to learn to deeply let go and lighten up, to go beyond the autopilot,” said Wessan, who also is co-chair of the NASW Northeast Private practice Special Interest Group that is associated with the NASW Massachusetts Chapter.

Compassion fatigue is an issue that deserves greater attention, Wessan said. Social workers are more vulnerable than ever to develop the condition due to ever increasing demands on staffs to do more with less.

“I want to help prevent our social workers from changing careers due to compassion fatigue,” she said.

“In 1999, I rarely heard of a social worker leaving the field to become a real estate broker,” Wessan explained. “These days, I hear of a social worker leaving the field at least twice a month.”

Wessan said it is important that social workers take a time-out to examine whether they may be suffering from secondary traumatic stress. Symptoms include impatience, and feeling overwhelmed, teary and unfocused.

Employers also need to take responsibility in combating compassion fatigue for their staffs, Wessan said. Compassion fatigue results in decreased productivity and higher turnover rates.

“Your clients suffer as well, seeing you become worn out, sick and cranky,” Wessan said. “You are no longer a good role model for thriving behavior.”

Wessan published a top 10 list called Ways to Take Care of Your Precious Self and Prevent Compassion Fatigue for the NASW Massachusetts Chapter’s September 2013 newsletter.

Go to the NASW YouTube channel to see an interview with Wessan about the list.

Caregivers documentary

Bringing the issue of compassion fatigue to a public audience is a goal of social worker and filmmaker Vic Compher, of Philadelphia, Pa. He aims to put a public spotlight on the topic through a documentary film he is directing and producing called “Caregivers.” The project has an accompanying website, It offers a platform for other caregivers to share their stories of compassion fatigue and the chance learn about the project. Currently, Compher has a 21-minute version of the uncompleted film that he uses for workshops on the topic, which he delivers to a variety of audiences.

He said filming the documentary has broadened his understanding of how widespread compassion fatigue actually is and how important it is to address it.

“We lose excellent people who are working in high-stress environments with no support structures in place,” Compher said. “The workshops (I conduct) intend to hold onto those people.”

Social workers, nurses, doctors, firefighters and other caregivers share their experiences in the film. There are also stories of hope that offer those suffering with compassion fatigue the knowledge that progressive organizations are working to make a difference.

“We don’t think the public has an understanding of it,” Compher said. “We want to get the film out to the public to help with that, possibly (through) a PBS affiliate station.”

Vicarious trauma

Sandra Lopez, who recently retired as a clinical professor at the University of Houston Graduate College of Social Work, has been immersed in the topic of professional self-care for several years after experiencing what she calls vicarious trauma in the mid-1990s.

At the time, she had been working in her clinical practice with suicidal individuals and grieving families who had suffered the loss of a loved one to suicide. In addition, she was co-facilitating a group of survivors of suicide. Hearing countless stories from those struggling with their grief took its toll.

“After 10 years of working with this group I realized I had overstayed and that I had been hit hard by the stories and even held images of the many gory details I had heard along the way,” Lopez explained. “Unfortunately, I was unprepared for this and honestly couldn’t understand what I was experiencing.”

The strain forced her to seek her own recovery through therapy and research. In the end, a positive outcome grew from the experience. “I became a staunch advocate for helping the profession to know about these conditions,” Lopez said, “and to encourage policies and practices to promote resiliency for social workers across diverse settings.”

Lopez, who has authored and submitted policy statements on professional self-care in NASW’s “Social Work Speaks,” urges social workers to take the time to become self-aware of their feelings. Lack of self-awareness can lead to professional mistakes and the potential to become uncaring to clients, she said.

Lopez also has been commissioned to write an entry on self-care for the “Encyclopedia of Social Work.” She said constant reminders are needed through professional associations and training sessions to address compassion fatigue.

“I see this as a grave issue (and) if we don’t care for and support our social workers, we will, over time, lose high-quality professionals, as they will leave if they feel defeated by the work they do,” she said. “We also need to give permission to social workers to talk about their narratives of how they have been impacted by their social work without feeling a sense of incompetence or guilt.”

Lopez said hearing stories of resilience would help as well, as many social workers have “managed to not just survive but to thrive in their practice settings.”

‘We don’t have time for self-care’

The authors of the new NASW Press book “Self-Care in Social Work: A Guide for Practitioners, Supervisors and Administrators” said their research unearthed a range of coping strategies that social workers use for managing their reactions to client trauma.

“We wanted to share those with others,” said co-author Kathleen Cox, an associate professor at the School of Social Work at California State University at Chico. “We do so (in the book) through illustrations and stories submitted to us by social work employees and students. In addition, we feel strongly about the need to prepare new and aspiring social workers for some of the challenges they are likely to face in the field. We offer exercises and activities aimed at helping readers apply the self-care principles discussed.”

Misconceptions about self-care from social work undergraduate and graduate students also inspired Cox and co-author Sue Steiner — a professor at the same school of social work as Cox — to write the book.

Surprisingly, social work students actually felt frustrated when they were encouraged to practice self-care techniques, Cox said.

The students typically exclaimed, “We have so much work and responsibility; we don’t have time for self-care,” she said.

“We began to wonder ourselves about the meaning of self-care, and did an extensive literature review,” she said. “Next, we did a series of focus groups in the community to further explore its meaning to practicing social workers.”

Readers of the book can gain an appreciation of a new perspective on self-care, Cox said.

“We view it as much more than a health-promoting activity that happens only in the rare instance (when) one has some free time,” she said. “We view it as a state of mind that is considered an integral part of a social worker’s training. Responsibility for self-care lies in both the individual social worker and the organization in which he or she works.”

“Our book is focused on managing a variety of stress-related conditions seen in practicing social workers, including burnout, compassion fatigue/secondary traumatic stress, and vicarious trauma,” Cox explained. “It is important that workers understand both the personal and organizational sources of stress. Then they can develop a plan for addressing these issues so that their stress doesn’t spiral out of control. The research clearly shows that chronic stress can have damaging effects on our health and well-being.”

Education is the key, she said.

“It is important that social work practitioners learn how to balance empathy toward others with a need to stand apart from their pain,” she said. “If they soak up their clients’ pain like a sponge, they are likely to suffer in a variety of ways that can result in reduced empathy, effectiveness and productivity.”

She said the culture of some agencies is less than supportive of workers who disclose emotions related to client hardship and trauma.

“However, we found that many organizations are now encouraging workers to process their emotions in supervision or on-site counseling sessions,” Cox said. “That is good news for the field of social work.”

Watch the video: Self Care in Social Work