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Feb 24, 2017

Realities of Compassion Fatigue

               Something I got told a lot in graduate school was that self-care was paramount. We talked about all our self-care efforts during practicum and internship. We had to journal some of those efforts. While taking care of myself is important to my success in helping care for others (whether they’re my clients or my kids), I’ve also realized that I won’t self-care or “professional distance” my way into total prevention of compassion fatigue.

                You read that right. There isn’t some magical recipe for stopping the natural fallout of our work. That really flies in the face of what I was taught. I’ve had to spend time unlearning that information because it delivers the idea that if you experience compassion fatigue you’ve done something wrong. It’s not the work or the realities of what we do, it’s our fault for not being “professional” enough. We caused it.

                That just isn’t true.

                Viktor Frankl wrote, “That which is to give light must endure burning.” Truer words applicable to compassion fatigue are hard to find. It is a natural part of what we do. How we handle the compassion fatigue is up to us.

                There’s another myth I’d like to bust open: Compassion fatigue just happens to people working with trauma. This idea is suspect for two reasons. I’ve attended hours and hours of trauma and crisis trainings that all tell me that a person determines what is traumatic or crisis for them. What one person views as no big thing, someone else may experience trauma with. If that’s true for our clients, is it not also true for us?

                Assuming we do (hypocritically) hold ourselves to a higher standard of trauma response than we do our clients - let’s pretend we do say that client’s perceived trauma shouldn’t create pain or trauma for us. We’re assuming that because we’re counselors we should be immune (More famous words from Albert Ellis, “Stop shoulding on yourself.”). That means that we believe that there is some professional trick to building a wall of objectivity or stoicism that will somehow protect us from compassion fatigue.

                In all of my research I haven’t found a single study that links professional objectivity to resiliency. It just isn’t there.

                There is this undercurrent in our profession that we shouldn’t complain or be upset or experience compassion fatigue. If we do we’re weak, we didn’t self-care enough, we didn’t protect ourselves with the magical wall of objectivity. We’re to blame. So, we find ourselves in an interesting predicament. As counselors we tell the public, don’t let others stigmatize your behavior, you’re a person, and you’re entitled to your feelings, your experiences. Then as counselors we use language that tells our colleagues, coworkers, and even ourselves that we’re at fault and that there is something wrong with us if we find ourselves experiencing compassion fatigue.

                We balk when a colleague with fewer clients than we have expresses stress. We eye roll when a counselor down the hall feels overwhelmed. We tell other counselors, “Oh I’ve had way more clients and was fine/I’ve had clients with that kind of issue before, you’ll be ok!” So our colleagues and coworkers begin pulling their weight without comment or consultation. The load gets heavier and heavier with each step until who knows what - real burnout, immune system breakdown, headaches, emotional upheaval, avoidance…you all know the list of possible consequences. 

As a side note - Another big misunderstanding is that people experiencing compassion fatigue go straight to the big symptoms of avoidance, tension, fear, headache, stomach trouble, over-working, etc. A common symptom is thinking about work all the time. I know that you may have just read that and thought, “Yeah, well, I do that all the time, it’s normal.” You’re right. It is normal, but it is compassion fatigue if you can’t really focus on the road driving between appointments or find it hard to enjoy a show because you’re thinking about a client from earlier in the day or week.

                So, what is the reality of compassion fatigue? What can we do?

                Understanding the risk factors can be helpful. These include working in a rural environment, poor social support, higher client to counselor ratios, poor relationships with management, poor supervision or consultation access, perceived unfairness, personal history of trauma, and lack of emotional self-awareness.

                Protective factors do exist. Working in a cohesive team, plenty of social support, connection to community, having control over the work environment, having your own office to work in, greater self-awareness, and awareness of coworkers emotions are all protective factors. Cultivating those protective factors can help improve resiliency, but you’re not going to hot bath and candle your way into stopping compassion fatigue or preventing it entirely. It’s deeper than the number of ounces of water you drink in a day.

                Knowing the opposite of compassion fatigue is even better. Compassion satisfaction is a developing area of research. Compassion satisfaction is the positivity involved in caring. We’re all here in counseling because we see the good in what we do and find value in helping others. By emphasizing the protective factors we can increase compassion satisfaction. Engage with your community, create a good social support network, and find ways to relate with coworkers, etc.

To increase your resiliency in our work try some of this:

                 My favorite tip on compassion fatigue is finding a relationship with someone who feels comfortable saying to you, “Hey, things seem off - how’s the fatigue level?” or something similar. Someone who isn’t afraid to talk with you about it and someone you can be honest with. We tend to get defensive when someone hits the compassion fatigue buzzer on us, so this person has to be someone we trust. We often don’t see the fatigue coming so having someone that does is totally helpful.

                List your stressors. Make a list of your obligations and stressors in different areas of your life. Projects you’ve taken on, or specific tasks that you find stressful. Knowing what’s really on your plate is the only way to find out what can stay and what can go and where problems really lie. Talking about this with the person from the first step would be really productive too!

                Take a lunch break. Get out of the office. Do not eat at the office every day. Don’t eat with coworkers every day. Get out, get away, un-work, be away from it even just long enough to pick up a fresh Starbucks drink every day.

                Look at your caseload. If you’re overloaded speak up. If not, see if you could rearrange clients to avoid seeing ones you’re finding really challenging on different days instead of back to back on the same day.

                Transition between work and home can be hard. Create a routine that tells your mind and body, “I’m not at work anymore, I’m at home, I’m off.” For me this is getting home, throwing on my yoga clothes and sitting down with a book for a while (a fiction book that has nothing whatsoever to do with counseling).

                Think about what you’re consuming. If you’re surrounded by other people’s hurts all day and then go home and listen to the news, which is typically full of stressful stuff, and then go to bed while scrolling your facebook newsfeed equally full of stressful stuff (last week I accidentally saw a guy snap his leg in half in some facebook video! I didn’t need that in my brain!). Strike some balance. Reduce the news, or read it only. Make sure you’re spending just as much time exposed to non-upsetting material as you are to upsetting material. Tip the scales toward non-upsetting.

                Exercise when you can. Don’t force yourself to feel like you have to exercise and therefore label yourself a failure when it doesn’t happen. Just try to exercise more days a week than you don’t.

                Create a “Love Me” file. When someone gives you some positive feedback or pays you a compliment about your work write it on a sticky (sans names, etc.) and put it in a special spot in your desk. Pull it out and look through it when you need a boost at work.

                Take time off. I know that’s easier said than done, but if you have a week or even a month of time off built up, take a few days off. The world was spinning before you started working. It’ll keep going while you’re away for a few days. Of course you have to make arrangements in our field to be off, but do it. It isn’t selfish, it isn’t wrong. It’s your time. Take it. Five people I was in school with each just told me within the last few weeks they were stressed out and then when asked said they had vacation time…but then told me all the reasons they couldn’t take time off. Nonsense. That’s compassion fatigue talking to you!

                All of this being said, don’t forget: compassion fatigue is still a normal part of what we do. It’s there, it’s real, and it’s ok. Dr. Charles Figley called compassion fatigue “a disorder that affects those who do their work well”. I couldn’t agree more. Instead of seeing the symptoms of it as a sign that you’re doing poorly, recognize it as an indicator that you care, you’re in the fight, you’re doing your work, and you’re doing it well.

Be kind to yourselves!
Whitney White is a counselor working in Texas in multiple settings with diverse populations. Some of her areas of passion are anxiety, non-suicidal self-injury, and compassion fatigue. With an integrated approach utilizing client strengths, she supports others in achieving their best self. For more information please visit The thoughts expressed in Whitney’s blogs do not represent her employers. 


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