Compassion Fatigue and Vicarious Trauma

Compassion Fatigue: Seeking a Hidden Wholeness By David J. Powell, PhD
(Article slightly adapted by Haley Lowe to fit the work of JRA Parole Counselors)

Most Parole Counselors come into the field with a strong sense of calling, the desire to be of service to others. Yes, there are some who become Parole Counselors out of intellectual interest, to make a living, or because others encouraged them to do so. Yet, most feel a strong pull to somehow take their gifts and attributes and make themselves an instrument of service and healing in a world of suffering. Given what brought us into the field, we at times find ourselves caught in the stark contradiction between our hearts and the reality of our work life.

Ironically, Parole Counselors are blessed to have a front row seat on suffering, to life’s greatest dramas, and to see people get well. Somehow, though, over time, the joy of counseling begins to elude us. It is as if we were invited to a great banquet and sometime during the meal we realize that we’re eating grass, with an accompanying feeling of dryness and tiredness.

John, an alcohol and drug abuse Counselor, says, “I thought I came into counseling for the right reasons. At first I loved seeing patients. But the longer I am in the field, the harder it is to care. The joy seems to have gone out of my job. I don’t know how much longer I can do this. Should I get out of counseling as many of my colleagues are doing? I want to find a way of overcoming my burnout. I can’t keep going on like this. I don’t want to see any more clients.”

If you have ever said the following or (similar) words to yourself, you are not alone: “Hey, this is not what I wanted, not what brought me into the field. I spend all my time doing paperwork and not seeing clients. The money I make isn’t compensation enough for all that it takes out of me. When I do get to my counseling sessions, I feel drained by my patients. I go home with nothing left to give to my family, let alone myself. I want to get out.”

The helping professions risk losing many skilled and compassionate healers at the height of their catalytic powers because the life has gone out of their work. Here is the critical question you should ask yourself: Knowing what I now know about counseling, would I enter the field again?

If not, how could this have happened, given the zeal you once felt when you entered the field? Why have so many Parole Counselors, who felt such a sense of calling, been driven from their work? What can be done to replenish the deep internal reservoir that helpers need to sustain a lifetime of service? How do we help the helper to help others help themselves?

The nature of the problem,counseling is a demanding job. We are under enormous strain today with increased client loads, less funding, more complex diagnoses and problems encountered regulations and administrative demands, and less time with patients. Most explanations of these issues are about external forces impinging on our practices:

• Health care has become a big business, and seems to be only about the bottom line, high tech and low touch.
• Regulations and requirements take precedence over caring and counseling. We’re drowning in paperwork mandated by funding sources. (According to a CSAT Study in 2003, the average alcohol and drug abuse Parole Counselor spends 20 percent — one day a week — on paperwork. Most Parole Counselors tell me that is an underestimation of the time they actually spend on forms and files).
• If new funds are found for the field, most of the increased dollars go to higher administrative costs and technology. Salaries of Parole Counselors and caregivers actually seem to be going down relative to increased demands and the cost of living.
• We are asked to do more with less, serving on a 24/7 basis, to provide “fast food” psychiatry and counseling.
• The stress of being part of other persons’ problems is a staggering responsibility that at times seems unbearable.

We can and should direct our energies to the systemic problems, but the front-line practitioner may feel helpless to change the system. Some simply withdraw, care less, or get out of the field entirely. Some adopt holistic practices or self-pay systems that avoid third-party reimbursement requirements. Most just complain or suffer in silence. The problems seem so vast that most of us simply do not know what to do.

Seeking a hidden wholeness
Although there may be an external crisis in health care in America (a crisis “of the head”), we need to address the “crisis of the heart” in health care providers. We seem to experience too little joy, love and kindness to sustain the hearts of those who serve. When the heart lacks nutrients caused by blockages, the heart closes down and causes pain. Most caregivers live with another form of pain, caused by blockages of love to their heart. And before you can aid another in healing their pain, you have to heal your own. For if we do not transform our pain, we transmit it.

Yes, we need to work to improve the health care system. But we also need to look within, to become resilient again, and to rediscover what gives us joy, meaning and hope in what we do. We need time for reflection, to listen again deeply and authentically, to the silent singing of our hearts. We need to redevelop our innate capacity for compassion — to be an open-hearted presence for someone in his/her suffering.

We are well trained technically. But when it comes to the hatching of our hearts, our “spiritual training,” our development has been greatly lacking. These problems cannot be solved by systemic changes alone, nor by external means. You see, counseling skills can be taught, but a compassionate heart can only be caught. The journey to find that hidden wholeness starts individually. We each need to attend to our inner life, to be more and more human, more ourselves, to reclaim a sense of calling and an attitude of sacredness toward the healing arts. So, doctor, first heal yourself!

The great writer and theologian Henri Nouwen said, “… a deep understanding of your pain makes it possible for you to convert your weakness into strength and to offer your experience as a source of healing to those who are often lost in the darkness of their own misunderstood sufferings.” It is indeed through our pain and suffering that we are better able to serve others. Carl Rogers once said, “Expertise cures but healing comes from our shared experiences and wounds. Before every session, take a moment to remember your humanity. There is nothing a person has experienced that I can’t share because I too have experienced pain and suffering in my life.”

However, this is just the opposite of what we want to do when we are tired and rusted out. (I don’t think Parole Counselors burn out, they rust out. Burnout happens when you put a pot on the stove and there is too much fire under it. That’s not what happens to Parole Counselors. Instead, we lose our fire, our passion, and rust out.) We want to run away from the intense fire of our jobs, when in fact, we ought to rush into the fire by sharing with the patients their pain and suffering. In Buddhism, this is called “tonglen,” taking on the pain of others. Remember the scene in the movie, The Green Mile, when the big prisoner takes on the pain of others? That’s what we need to do — walk into the fire of pain, risking nothing less than everything.

There is an old Chinese story of a master potter who worked his entire life to find the right glaze for his work. He tried year after year to find the perfect finish for his pottery. Finally, in desperation, he walked into the hot kiln himself. When his apprentice came by and removed the pots in the kiln he found them covered in the most beautiful glaze, aglow with the spectacular glow. To find that glaze the potter had to give all of himself and walk into the intensity of the baking fire. How does one have the courage, or foolishness, to walk into the fire of passionate work when our natural desire is to go in the opposite direction? The subtitle of this article, “in search of a hidden wholeness,” comes from Thomas Merton’s classic phrase, “there is in all things….a hidden wholeness and the title of Parker Palmer’s latest book, A Hidden Wholeness: The Journey toward an undivided life (2004).

How does one find that hidden wholeness? It comes from listening to that still small voice within each of us that speaks the truth about me, my work and my world. Wholeness does not mean perfection: it means embracing brokenness as an integral part of life. You do not have to be perfect to be a Parole Counselor. In fact, the opposite is true: it is your wounds and suffering that gives you an understanding of another’s pain.

Years ago there was a popular book entitled I’m OK, You’re OK. The title might have helped sell books but it was not good philosophy, for you’re not OK, but that’s OK. Knowing this gives us a sense of hope that human wholeness — mine, yours, and ours — need not be a utopian dream, but can be lived out in the gritty reality of life, amidst all of its pain and suffering, amidst its 10,000 joys and 10,000 sorrows.

How do we listen to that still small voice amidst the din of daily “doing?” First, we do not have to do this listening for the still small voice alone. Nor, does it come simply in solitude. We can hear it through meditation, guided imagery, poetry, art, journaling, self-reflection, small and large group discussion, solitude and community. People need opportunities to tell their stories — much like what happens at an Alcoholics Anonymous meeting — and to listen and be touched by others. We should not do this inner work alone. There is a lovely Buddhist term, kalyanamitra, which is interpreted as “good friends,” or soul friends, who travel together and aid one another along their healing, spiritual path. There is an African expression that two antelope travel together so one can wipe the dust from each other’s eyes. Who is walking along with you today?

Another term for what Parole Counselors need to find their hidden wholeness is through “deep listening,” from one to another. What we need is another person or persons who can shift from fixing or doing for one another, to simply being present with another.

To continue to live a life in service to others, we need to re-find our soul that is longing to be heard, that speaks softly when it is drowned out by the noise of our busy personal and professional lives. We need an opportunity to slow down, to re-find what it was that brought us into the counseling field in the first place. We need to belong, to be-our-longing. What is it that you long to be today? What is awaiting you in life?

David Whyte expresses this well in his poem “Self-Portrait:”

“It doesn’t interest me if there is one God or many gods
I want to know if you belong or feel abandoned.
If you know despair or can see it in others.
I want to know if you are prepared to live in the world
With its harsh need to change you.
If you can look back with firm eyes
Saying this is where I stand.
I want to know if you know
How to melt into that fierce heat of living
Falling toward the center of your longing.
I want to know if you are willing to live,
Day by day, with the consequence of love
And the bitter unwanted passion of your sure defeat.
I have heard, in that fierce embrace, even the gods speak of God.”

Once we have experiences that deep listening ourselves, then we can display deep listening, caring and compassion with our patients. But, to get there, we must remember that a Parole Counselor cannot take a client to a place he/she has not been. Again, in the words of Carl Rogers, “Counselors can’t counsel from beyond whom they have become.”

To paraphrase Parker Palmer again, “We heal out of who we are.”

The antidote for tirednessDo you feel tired and rusted out today? Do you feel like you need a really long vacation, perhaps to a deserted island somewhere? Benedictine monk David Stendl-Rast said the antidote for tired may not be rest but wholeheartedness. Rest is good! We all need times of relaxation and re-creation. But, after we go on vacation and return refreshed, a month later we have already lost whatever gain we made. Instead, longer-term gain comes from finding what brings us peace and joy. What gives us meaning and purpose at work? When it is all said and done, when you have seen your last client, how do you want to be remembered? What do you want said about you as a Parole Counselor? Usually, Counselors’ responses are fairly simple to this question and they say, “I want to be thought of as a caring, compassionate person, a skilled helper.”

If this is what we would like when it’s all over (and believe me, some day your work as a Parole Counselor will end), what are we waiting for? We need to live that life of caring and compassion today, risking all. T.S. Elliott in The Four Quartets, says that this calls for risking nothing less than life itself.

What is the antidote for the tiredness you feel today? Yes, take a vacation when needed. But more importantly, find your wholeness, what gives you joy. Wendell Berry describes this fork in the road so well when he writes, “It may be when we no longer know what to do, we have come to our real work, and that when we no longer know which way to go, we have begun our real journey.”
David J. Powell, Ph.D., President, International Center for Health Concerns, Inc., is an internationally recognized lecturer and trainer, and author of Clinical Supervision in Alcohol and Drug Abuse Counseling. His most recent book is Playing Life’s Second Half: A Man’s Guide for Turning Success into Significance. For further
information, contact djpowell2@yahoo.com or www.ichc-us.org.

References
Palmer, Parker. A Hidden Wholeness: The Journey Toward an Undivided Life. San Francisco: Jossey-Bass, 2004.
This article is published in Counselor,The Magazine for Addiction Professionals, February 2006, v.7, n.1, pp.36-39.

Ways to Increase Self-Compassion

Ask yourself:
• What would a mother say to her child if she wanted the child to grow and develop?
• How will I learn and grow if it’s not OK to make mistakes?
• Can I feel my feelings of pain without getting lost in the drama or storyline of my situation?
• Can I fully accept this moment and these emotions as they are without suppressing, resisting or avoiding?
• Isn’t it true that I am not the only one going through such difficult times and that all people experience things like this, or worse, at some point in their lives?

More tips for increasing self-compassion, a self-quiz and suggested readings are at Dr. Kristin Neff’s self-compassion Web site.