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Beyond Massages and Vacations: Healing Burnout and Compassion Fatigue

Beyond Massages and Vacations: Healing Burnout and Compassion Fatigue

Burnout and compassion fatigue are often misunderstood and underappreciated. This year’s Great Resignation is evidence that so many individuals, inside and outside of helping professions, are completely burned out. Yet is quitting the only option? Many individuals will experience some level of burnout or compassion fatigue over the course of their careers and quitting their jobs will not be workable. I wanted to know more about these topics, so I sought a regional expert.

Tiffany Johnson, LCSW, has always been interested in the topic of wellness. After experiencing burnout herself, she sought extensive training on this topic and now presents to a wide variety of professionals. Tiffany worked in a variety of hospital settings, including a Level 1 Trauma Center, before settling in a group practice in Reno, NV. Tiffany graciously sat down with me to discuss compassion fatigue and burnout. Here are some highlights of our discussion. 

First off, what are burnout and compassion fatigue? I’m not sure what makes up one versus the other. 

I like thinking about them on a continuum, where compassion fatigue comes before burnout. Compassion fatigue is when you start to feel your energy dipping, aren’t as engaged with patients, not as present at work and home, and perhaps have symptoms of agitation or irritability along with a depressed mood. When you reach burnout on the continuum, you are experiencing significant physical and mental health symptoms. Burnout can happen in any field, however, inside the helping professions the constant use of empathy is a significant risk factor.

Why does it matter? Why should we care about burnout and compassion fatigue, particularly for those in helping professions? 

It matters because it impacts our relationships with our clients, co-workers, friends, family, and partners. It matters because it is pervasive; it does not just stay at work. If we are experiencing compassion fatigue or burnout, we are feeling it at home as well. 

Who is at risk? Are there any predictable circumstances that lead to compassion or burnout? 

I think about it as a Venn diagram where you have circles with personal, professional, and organizational and in the center is that sweet, or not so sweet spot where they all impact each other. We all come to our work with different backgrounds and life situations. For example, maybe you are a caregiver at work, you are a caregiver for a parent, and you also have young children. Perhaps there are also organizational influences, like not having control over your schedule. That individual’s path to burnout is likely completely different from someone else who does not have additional caregiving responsibilities and has more wiggle room to address symptoms. 

Personally, I experienced burnout when I felt like I was not able to use my skills and was not seeing any client progress, which was largely a factor of the population I was working with at the time. 

You don’t see the fruits of your labor at that point, which leads into compassion satisfaction. 

Compassion satisfaction! I didn’t know that was a thing! Tell me more. 

Like burnout and compassion fatigue, there are many definitions. In a nutshell, compassion satisfaction is the satisfaction I get, the joy I get, out of doing my work. I can go through the motions of my job, but I don’t necessarily feel satisfaction unless I think I have done that job well. It’s the joy of knowing that I am making a difference. Compassion satisfaction can take a variety of forms. It can look like knowing I used solid clinical skills with a client, seeing progress in a patient, hearing a client reflect upon something in session and you know you helped him or her reach that insight or teach that skill. 

It isn’t when you have done oodles of work with a client and he tells you he watched one TikTok video that cleared up everything in his life? 

And yet, at least you laid the groundwork for that TikTok video to make sense to him. 

Yes! I love that. Thanks for the reframe. I’d love to hear more about compassion satisfaction. 

Compassion satisfaction also does not mean that everything is okay or ends with a great outcome. For example, let’s say you are a bedside nurse with a very ill patient who likely will not make it. Maybe you were able to give them an ice cream cup that helped them to feel better. It is making that human connection. We could look at it just as giving the patient some ice cream. Or, we can feel good about addressing this human being’s need. 

There’s a lot of meaning behind the ice cream cup. 

Yes, there’s meaning behind it and giving ourselves credit. It is saying to ourselves “I just made an impact on this human, and I feel good about that.”

I feel like they do not teach us that in helping professions. It is not about us. It is all about the client. We are not supposed to take credit for anything. Yet if we are not taking credit for anything, what are we doing day after day? 

Setting yourself up for burnout! I didn’t learn about compassion satisfaction until I started digging into the burnout literature. When I give trainings, very few people have ever heard of it. 

Has Covid affected compassion fatigue and burnout? 

Absolutely. A lot of clinicians overextended themselves, not wanting to say no. However, if we are not taking lunch, not keeping hourly boundaries, and not taking care of ourselves, we are not helping the cause at that point. Clinicians were also experiencing intense personal situations. They are trying to work at home with their kids at home. They are homeschooling. They are caregivers to others. Their social support shrank. Cups were draining with no sustainable way to fill them. 

How can we recognize burnout in ourselves and others? 

The symptoms are unique to the individual. The Maslach Burnout Inventory focuses on three dimensions of burnout: emotional exhaustion, depersonalization, and personal accomplishment. While it is the gold standard, we are learning there is more to it. In my education about burnout, we looked at 7 different areas to address: behavioral, physical, work-related, emotional, spiritual, relationships, and cognitive. When addressing each of these areas, there are two and a half pages of burnout symptoms. When I first encountered the symptoms list, it was eye-opening. I remember sitting in my kitchen on a gorgeous October day and all of it came together because I finally had a “diagnosis” to explain what I was experiencing. I was having interpersonal conflicts that were not typical for me. I was having emotional, behavioral, and cognitive symptoms. The symptoms list was the most important piece in getting me started on my path forward. I finally understood what was going on and could target my treatment in the areas I was experiencing the most symptoms. 

So… A vacation will not fix burnout. 

The “do more/better self-care” advice is too simplistic. Sometimes burnout requires more of a life overhaul. Internal and external locus of control also plays a role. Do I have an internal locus of control and feel I can do internal work and make positive changes, or do I have an external locus of control and feel my organization is solely responsible for my symptoms? We want both to be addressed, but where can I make the most impact? I may not have the power to change much about my organization, but I can make changes within myself and my behavior. If we focus too much on the fact that our organization is not supporting us, we may neglect to notice that we are saying yes to too many things, overachieving, have perfectionistic tendencies, have stressors at home, are not eating well, subsisting on caffeine, etc.

I like to start with these 4 questions you can ask yourself in terms of basic wellness:

1. How am I eating?
2. How am I sleeping?
3. How am I moving my body?
4. How am I socializing?

Prevention is probably very individual as well. 

Yes, education and training help, but they are not widely available. My goal is to teach individuals about these topics so they can identify what is happening and suffer less. 

It seems like everyone in a helping profession may experience compassion fatigue and burnout at some point. 

The statistics range anywhere from 30%-70% in any helping profession. This may be an underestimate though. If you are sending out an email expecting people to respond to questions about burnout, the individuals who are burned out won’t even respond whereas the people who have flexibility in their day and are not feeling pressured will. When you are feeling it though, it is 100% impacting every aspect of your life. 

Speaking with you has been eye-opening. When I think about burnout, I think about it impacting work, but it is impacting everything. How can we begin to heal?  

I’d love to share one of my favorite ways to start recovery. It is based on positive psychology and is called "Three Good Things". It is under the umbrella of gratitude practice, and the benefits of gratitude are huge: lowered cortisol, lower inflammation, better heart health, blood pressure reduction, increased tendency to exercise, better relationships with others, more pro-social behaviors, and on and on. According to the research, it trends better than Prozac. You get your first boost in mood in three days; you get your next boost in mood at two weeks. If you maintain this practice, you can have a small, but steady increase in mood for the next 6 months until it levels off. Once you stop, the benefit tends to drop. Of course, perfection is not the goal. You will forget, perhaps for even weeks or months at a time, but it is so easy to pick up again when you feel burnout creeping back. 

Three Good Things is merely identifying three good things that happen every day. Some examples: I get to chat with Liz about my favorite topic, or I put clean sheets on my bed today, or I woke up to snow this morning and didn’t have to drive. I give individuals the prompts of identifying what they saw, appreciated, laughed at, enjoyed, and noticed so they don’t feel overwhelmed by the word “grateful.” Ideally you would write these down at the end of the day, but as you get started, simply remembering to do it is great. You can do this while you are brushing your teeth in the morning, driving to work, or anytime.

You don’t need a fancy app or oodles of time to do this. And there is research to back it! 
Last question. Where can we find more information? 

The Greater Good Science Center at UC Berkeley is a wealth of information and resources for positive psychology, which is the key to prevention and treatment of burnout and compassion fatigue. The website is: https://greatergood.berkeley.edu/

This was so helpful. Thank you!

Elizabeth Mosco, Ph.D., PMH-C, CPLC

Elizabeth Mosco, Ph.D. is a licensed psychologist in Reno, NV. She opened a private practice after 10 years of conducting home-based assessment and therapy with the VA Sierra Nevada Health Care System. Dr. Mosco's clinical interests include maternal mental health, older adults, and third wave cognitive behavior therapies.

More by Elizabeth

Opinions and viewpoints expressed in this article are the author's, and do not necessarily reflect those of CE Learning Systems.

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