Compassion Fatigue and Burnout
Scholarly works name several notions reflecting a persons negative mental condition burnout, compassion fatigue, secondary traumatic stress and vicarious trauma. These different, but related terms are often used interchangeably in literature that leads to confusion and difficulty in analyzing and comparing the research results of various studies.
A review of the literature was conducted utilizing the Psych Info, Psych Articles, and ERIC databases. The key terms used during the literature review included burnout, compassion fatigue, vicarious traumatization, vicarious trauma, secondary stress syndrome, secondary traumatic stress, compassion satisfaction, validation, validity, reliability, mental health worker, counselor, psychotherapist, therapist. A research was also conducted using a list of key authors (e.g., Figley, Pearlman, Maslach) in order to find out their publication histories, and information on the conducted tests and measures (e.g., The HYPERLINK javascriptvoid(0) Maslach Burnout Inventory, HYPERLINK javascriptvoid(0) Compassion Fatigue Self Test, the HYPERLINK javascriptvoid(0) Professional Quality of Life Scale, the HYPERLINK javascriptvoid(0) Life HYPERLINK javascriptvoid(0) Scale, the Traumatic Belief Institute Scale, the HYPERLINK javascriptvoid(0) Secondary Traumatic Stress Scale, and the HYPERLINK javascriptvoid(0) Burnout Inventory).
Compassion Fatigue
Compassion fatigue (CF), the concept that was developed by Charles Figley, has been characterized as a phenomenon that causes the caregivers reduced HYPERLINK javascriptvoid(0) interest in being empathic or bearing suffering of clients and the HYPERLINK javascriptvoid(0) natural consequent HYPERLINK javascriptvoid(0) behaviors and emotions resulting from knowing about a traumatizing event experienced or suffered by a person (Adams, 2006). The research has shown that CF affects those in helping professions, such as nurses, mental health professionals, physicians and clergy due to the amount of empathy expressed for their patients (Meadors, 2008). Similarly, the compassion satisfaction measures the extent to which the genetic counselors derive pleasure from helping patients, families and the society through their work as health system care givers. In some instances, the providers become exposed to the secondary traumatization, which is characterized by a professional who is affected by knowing about the traumatizing events of their patients (Meadors, 2008). This form of compassion fatigue leads to a variety of symptoms that are usually seen when one cannot deal with the possibility that they are unable to help their patient from the pain of their traumatizing situation (Adams, 2006). Often, professionals in helping careers are also exposed to an array of problems that their patients may be experiencing which may cause them to be personally affected by the primary traumatization. The primary traumatization, also a form of compassion fatigue, may occur when clients reveal their experience of abuse or even the significant suffering that was caused from a diagnosis or trauma to professionals. Dealing with such complex issues from clients can cause those in helping professions to experience the symptoms associated with compassion fatigue is often visible when the professional has unhealthy coping strategies (Meadors, 2008 HYPERLINK javascriptvoid(0) ). Reliving aspects of the trauma, avoiding reminders of the trauma, HYPERLINK javascriptvoid(0) heightened irritability, sleep disturbances, quick HYPERLINK javascriptvoid(0) withdrawal, and task avoidance are some of the many symptoms of CF that are unavoidable and unrecognizable (Benoit, 2007). In professionals who are unable to handle such symptoms, CF can be very devastating to both their career and personal lives. Just like others in helping professions, the genetic counselors also endure compassion fatigue. In addition to the primary and secondary traumatization, HYPERLINK javascriptvoid(0) there are a number of factors HYPERLINK javascriptvoid(0) that bring about compassion fatigue in counselors. One of such factors explored by Benoit and colleagues is the personality. They concluded that a counselors personality can also cause them to experience compassion fatigue.
Compassion satisfaction and Burnout
The compassion satisfaction has bee defined by Beth Stamm (2005) as the pleasure that one receives from their ability to do their job well (Alkema et al, 2008). The compassion satisfaction can be seen in all professions and careers. Feeling the compassion satisfaction has also been known to be a protective mechanism against the experiences of the compassion fatigue and burnout. Factors, such as the positive effect, being optimistic, maintaining good health, and leading a balance life can all cause compassion satisfaction (Sprang et al, 2007). Furthermore, by having and utilizing various social resources individuals are able to combat stress and maintain the proper level of satisfaction in their careers. The promotion of self-care plays a critical role in compassion satisfaction. The professional career, good HYPERLINK javascriptvoid(0) health, interaction with positive and supportive people and the adaptation to ones job environment all contribute to one being satisfied with their jobs (Alkema et al, 2008). In a recent study, it was reported that individuals within helping professions gain the greatest amounts of compassion satisfaction when they are a part of a supportive and productive team of colleagues. Witnessing the clients recovery and interacting with a supportive supervisor also allows helping professionals to have increased amounts of compassion satisfaction. For individuals who do not work in supportive environments or interact with positive people the possibility of experiencing job dissatisfaction can lead to compassion fatigue and burnout.
According to Figley (1995), there are three content domains of symptoms associated with compassion fatigue, namely, the following (1) HYPERLINK javascriptvoid(0) re-experiencing of the HYPERLINK javascriptvoid(0) traumatic, HYPERLINK javascriptvoid(0) (2) avoidance of reminders HYPERLINK javascriptvoid(0) the face of reminders and (3) persistent arousal. Compassion fatigue HYPERLINK javascriptvoid(0) is associated with a sense of helplessness, confusion, isolation from family and friends, and is triggered by the experiences of others (Figley, 2002). Furthermore, Figley (1995 1999) believes that the compassion fatigue is different from burnout in that it can occur suddenly and without any warning symptoms unlike the burnout which occurs during a gradual regression of a helpers emotions. Adams, Boscarino, and Figley (2006) suggest that the high emotional involvement without HYPERLINK javascriptvoid(0) adequate support HYPERLINK javascriptvoid(0) feelings ofthe HYPERLINK javascriptvoid(0) personal accomplishment may leave professionals vulnerable to burnout suggesting HYPERLINK javascriptvoid(0) that the job burnout and the secondary trauma HYPERLINK javascriptvoid(0) are likely central and critical clinical features of compassion fatigue (p. 104). This suggests that the burnout and compassion fatigue, while theoretically different, have related and overlapping associated factors. The compassion fatigue is associated with hyper-arousal symptoms, sleep disturbances, concentration difficulties, agitation, irritability, hyper-vigilance, diminished affect, distress and physiological reactions to reminders of their clients experience, a decrease in pleasurable activities, and contagion effect, resulting in the transmission of distancing, and emotional withdrawal to the helpers family and friends (Figley, 1995 Salston Figley, 2003). These symptoms are nearly HYPERLINK javascriptvoid(0) identical to those of the post-traumatic stress disorder HYPERLINK javascriptvoid(0) the exception that the traumatic event experienced is one that the client has shared with the helping professional (Salston Figley, 2003). The term compassion fatigue has begun to be used synonymously as secondary traumatic stress. Figley (1995) has stated that compassion fatigue is a term that is used due to its less derogatory companion secondary traumatic stress. Several variables have been shown to be significantly related to compassion fatigue including the personal trauma history, the meaning of traumatic events the social support, the coping style, the amount and type of caseload, the type of client (trauma vs. non-trauma) professional development, current stressors, and supports (Folette, et al., 1994 Figley, 1995 Pearlman MacIan, 1995 Ortlepp Friedman, 2002 Stevens Higgins, 2002 Nelson-Gardell Harris, 2003).
Burnout
The burnout has been characterized as a psychological syndrome that is defined by chronic interpersonal stressors at work (Ozyurt et al, 2006). The burnout is comprised of three dimensions that can lead to serious issues if not resolved. Feelings of ineffectivenessthe lack of accomplishment, depersonalization and emotional exhaustion are the components of the burnout (Bernhardt, 2009). Like the compassion fatigue, burnout is seen among professionals who are involved in high levels of interpersonal interactions and personal investments (McPhillips et al, 2006). If not managed, burnout may cause poor health conditions, sleep disturbances and an impaired job performance. The burnout may also lead to both job dissatisfaction and compassion fatigue. Several studies have indicated that burnout can easily develop into compassion fatigue if one is not careful (Ozyurt et al, 2006). Barbara Bernhardt and colleagues (2009) studied the burnout among individuals within the profession of genetics and revealed that being a genetic counselor, working in a university setting, and having fewer years in practice are all factors that contribute to the burnout. Her study also indicated that the genetic counselors were four times more likely to consider leaving the profession in comparison to other genetics professionals. Issues related to the reimbursement problems, the lack of institutional support, and the low earning potential may all be reasons why genetic counselors are more likely to consider leaving the field. Genetic counselors are more likely to experience burnout due to the moral distress they may encounter when providing patients with non-directive and unbiased counseling to enable the patients to make the best decision for themselves (Benoit et al, 2007). The moral distress is an emotional andor physical suffering that is experienced by an individual when either their internal or external constraints prevent them from the course of action that they believe is right (Bernhardt et al, 2009).
The workload and work performance HYPERLINK javascriptvoid(0) have been found to be HYPERLINK javascriptvoid(0) related to burnout, with higher workloads resulting in HYPERLINK javascriptvoid(0) higher levels of burnout (e.g., Greenglass HYPERLINK javascriptvoid(0) 2000 Shinn et al., 1984), higher levels of emotional exhaustion predicting poorer future work performance (Wright Bonnett, 1997), the work pressure and the demands being related to higher levels of emotional exhaustion (Savicki Cooley, 1994) and that burnout is negatively related to the job satisfaction and commitment (Bakker et al, 2004 Jenaro et al, 2007). Various consequences of the burnout include job turnoverabsenteeism, physical exhaustion, somatic difficulties, insomnia, substance abuse, marital and family problems, aggression, irritability, anxiety, depression, guilt, pessimism, difficulty concentrating, and withdrawal from others (Figley, 1995 Maslach, 1997 Collins Long 2003 Salston Figley, 2003 Bakker, et al., 2004).
The burnout affects a person in five different domains physical, emotional, behavioral, work-related, and interpersonal (Figley, 1999). While burnout shares similar characteristics to the constructs of HYPERLINK javascriptvoid(0) compassion fatigue, secondary traumatic stress, and vicarious trauma, it HYPERLINK javascriptvoid(0) does not lead to HYPERLINK javascriptvoid(0) changes in trust, feelings of control, intimacy, esteem needs, safety concerns, and intrusive imagery (Trippany et al., 2004).
According to Farber (2000), the burnout is a result of the increased external pressures, multiple obligations, inadequate financial rewards, and work incentives, such as the personal advancement, resulting in a feeling of inconsequentiality, a perception that efforts to help others are ineffective, the task is endless, and personal payoffs are few (recognition, advancement, accomplishment, appreciation) (p.590). Farber further suggests that burnout today is a social trend, as compared to the classic burnout of yester-year, in which individuals would work harder and harder to the point of physical and emotional exhaustion in order to pursue socially meaningful goals. Rather than looking at burnout as an interaction between biology and the environment, as one would with depression, it is more a manifestation of the interaction of personality with external stressors (organizational and societal) (Farber, 2000). The burnout then can be seen as a result of difficult and stressful work conditions and restrictions, high workloads, demands from administrators, managers or clients, feeling one has little autonomy or social support, and that there are few rewards in return for ones work.
Personality Factors and Compassion Fatigue and Burnout
Basic personality factors can be explained by five factors which are called the Big
Five (Bakker AB, 2006). They include the following (1) extraversion, (2) agreeableness, (3)
conscientiousness, (4) neuroticism, and (5) openness.
The extroversion has been defined as individuals who have a tendency to be self-confident, dominant, active, and excitement seeking. They also show positive emotions, have a higher frequency and intensity for personal interactions, and an increased need for stimulation (Bakker AB, 2006). Individuals, who are optimistic, have cheerful temperaments, and reappraise their problems positively are all considered to be extraverts. When working, these individuals have characteristics that negatively correlate them with depersonalization and exhaustion (Bakker AB, 2006).
Those who are altruistic, caring, trustworthy, modest, sympathetic, and warm
may be defined as having the factor of agreeableness. Agreeableness has also been
shown to be negatively correlated with the emotional exhaustion, but positively correlated
with the personal accomplishment (Bakker, 2006). Research has suggested that nurses
have the ideal stereotype of agreeableness (Bakker AB, 2006).
Characteristics, such as self-discipline, striving for achievement, dutifulness and
high competence are all used to describe individuals who are conscientious. These persons
also exhibit a positive relationship with the personal accomplishment, and in a research, involving call center workers, it was revealed that conscientious call center
workers, who experienced a high volume of calls were emotionally exhausted (Bakker, 2006).
Neurotic individuals have distressing emotions and possess traits, such as
fearfulness, irritability, low self-esteem, social anxiety, poor inhibition of impulses, and
helplessness. Individuals who suffering from the high levels of neuroticism tend to set high goals for themselves and then underestimate their own performance (Zellars KL, 2000). They also use coping strategies like denying, wishful thinking, and self-criticism to work through issues instead of using problem solving and proactive behaviors. The neurotic individuals do not work well under stressful situations, which cause them to have increased experience with physical illness (Bakker, 2006).
People who have a tendency to attempt to learn something valuable from taxing
experiences characterize the last factor of openness. They also strive for the personal growth and are thought to be flexible, imaginative and use humor to deal with stress and difficult situations (Adams, 2006). Positive relationships between the openness and the personal accomplishment exist, but the negative relationships between openness and depersonalization must be taken into account as well.
The Helping Professionals, Compassion Fatigue and Personality
Individuals who choose to pursue careers in helping professions are often exposed to an array of problems that their patients may encounter. Professionals involved in such careers are expected to be concerned with their patients on an extremely intense and personal level. The helping profession involves more the communication process that deals with human problems. It is through this process that the helping professionals are expected to be helpful in ways beyond the medical treatment, ensure that patients understand their options for coping with conditions, assist patients in making decisions that are in line with their goals, and to also make the best possible adjustment (Ellington et al, 2006). All these responsibilities can be extremely overwhelming for a genetic counselor and, if heshe is unable to handle the demands of the career, stress and compassion fatigue may occur. Research has implied that genetic counselors with the personality traits such as the desire to be liked, wanting to control a patients reaction, and perfectionism have all been speculated to be at an increase risk to experience compassion fatigue (Benoit, 2007).
The research has indicated that the personality plays an important role in the development of burnout, which has been closely linked to compassion fatigue (Zellars, 2000). The personality has been found to have a correlation to health, longevity, burnout, and even how individuals parent their children (Garcia LF, 2006). However, there has been no correlation to how personality relates to compassion fatigue or how the personality and compassion fatigue affect counselors.
Caring for patients is also a considerable component of counseling and may lead to the compassion fatigue because certain counselors have a desire to be liked by their patients. Emotionally applying many efforts may be beneficial to the patient, but this also makes the counselor more vulnerable to the patients reactions. In some situations, the genetic counselors may believe that they have had a negative impact on the patients life. They are constantly reminded of the time that they presented devastating or difficult news to a patient or to their family members. Delivering such news may cause guilt within the patient or other family member and may also change the patients family dynamics (Figley, 2002). Having such stress along with the desire to be liked by their patient can cause compassion fatigue in the counselor.
Some of the negative outcomes that could result from having characteristics such as perfectionism, wanting to control the patients emotions, and having the desire to be liked by their patients include countertransferance and detachment There are times when empathic connections with patients can lead to counter-transference and not being able to realize this type of relationship will cause compassion fatigue.
Counter-transference occurs when a counselor projects their emotional reaction or the behavior towards a client (Gladding, 2004). Within the field of counseling, there are two forms of countertransferance associative reactions and projective identification. The associative reactions occur when a clients experience provokes the counselor to have their own associations, thoughts, and images (Benoit, 2007). In these situations, the counselor is no longer focused on the client and is now focused on his or her own internal feelings. The projective identification, on the other hand, involves the counselor identifying with the client and then expecting the client to feel the same way as them. These types of counter-transference evoke painful emotions in the counselor (Benoit, 2007).
The last factor that contributes to the compassion fatigue is detachment issues that counselors may struggle with. Detachment is described as the counselors ability to detach themselves from patients and separate their work life from their home lives (Benoit, 2007). Detachment becomes a problem when counselors begin having dreams about patients, having intrusive thoughts, compartmentalizing or separating situations at work, selectively forgetting to carry out important tasks and rationalizing situations that have bad outcomes. With all of the factors that can contribute to or lead to compassion fatigue, it is important that counselors can effectively measure and assess the signs of the compassion fatigue.
Conclusion
In the field of any helping profession, it is important that counselors express some of regard, non-directiveness, and empathy (Eunpu, 2007). Such qualities make certain individuals are highly suitable for the profession. However, the research has also pointed out that counselors that are perfectionists, controlling, and have a desire to be liked by their patients are thought to be at an increased risk for the compassion fatigue (Benoit, 2007). Through numerous studies and researches, perfectionism has been known to have both good and bad implications. The consequences that are consistent with perfectionism are a future that is vulnerable to distress, a chronic sense of failure, indecisiveness, procrastination, and shame (Bieling, 2004). Perfectionism that includes such characteristics is deemed unhealthy and is called maladaptive perfectionism (Bieling, 2004). This type of perfectionism is also believed to be consistent with people who are concerned about how others evaluate them, express self- doubt, and worry about making mistakes that could lead to problematic behaviors (Bieling, 2004). The responsibilities of having to deliver bad news, not knowing what to say or having to disclose numerous abnormal results can be a difficult task to complete daily (Benoit, 2007). Counselors who have the characteristic of the maladaptive perfectionism may have problems with such tasks that are required in the profession of the genetic counseling.
Often counselors feel responsible for the patients suffering when having to convey abnormal test results counselors may feel that in some way they have caused the patients pain (Benoit, 2007). In addition, counselors may feel overwhelmed after giving bad news and the realization that the next discussion with their patient will be on topics of termination or continuation of their pregnancy can also result in the compassion fatigue (Benoit, 2007). Another area that causes the compassion fatigue in counselors has to deal with difficult patient issues, such as the terminal illness, where a family member or baby has died due to the genetic condition which can be very taxing on a counselor. Moreover, having to effectively counsel patients with mental health disorders, or not being able to diagnose a patient symptoms or condition may lead to fatigue. Situations in which counselors identify their patients and other family members as being high risk can be stressful for the counselor (Benoit, 2007). It is now the counselors responsibility to ensure that the patient fully understands the importance of the information at hand and is able to communicate the news with other family members. This in turn, causes counselors to be concerned about the legal ramifications when there is no documentation that states that the patient was informed of their risk and the risk of other family members (Figley, 2002). Having such feelings is where the characteristic of being able to control the patient and their emotions could lead to an increase in experiencing the compassion fatigue within the counselor.
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