Compassion Fatigue

[Mellowmish]

Does anyone have any advice for overly sensitive/empathetic people who want to enter the psychiatry profeesion. How does one combat compassion fatigue, and make sure while saving others from drowning, that they too stay afloat?

Self-care tips and advice?
How do you do it?

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[Bartelby]

A few starting points:

-Be realistic about how much you can do. Some people end up with rescue fantasies that inevitably get frustrated, and that can lead to burnout and bitterness. If that is happening identify it and (ideally) discuss it in your supervision.

-Keep boundaries. Be a genuine and present person with your patients, but follow the rituals the profession has in place. Avoid creeping into a "friend" role, and when you see boundary crossings beginning (frequent emails, abusing out-of-session calls, etc.) address them promptly.

-Enjoy your outside life. Friends, family, hobbies, outside academic interests. Don't let work become everything to you.

-Keep an appreciation for what you do and how meaningful it is. Understand that even when you feel helpless, angry, detached, etc. in a given case that you are probably doing a lot of good elsewhere. Stay honest with yourself about the negative feelings you have toward a given patient. If they are particularly troubling, discuss them in supervision or in your own therapy.

 

[Mellowmish]

A few starting points:

-Be realistic about how much you can do. Some people end up with rescue fantasies that inevitably get frustrated, and that can lead to burnout and bitterness. If that is happening identify it and (ideally) discuss it in your supervision.

-Keep boundaries. Be a genuine and present person with your patients, but follow the rituals the profession has in place. Avoid creeping into a "friend" role, and when you see boundary crossings beginning (frequent emails, abusing out-of-session calls, etc.) address them promptly.

-Enjoy your outside life. Friends, family, hobbies, outside academic interests. Don't let work become everything to you.

-Keep an appreciation for what you do and how meaningful it is. Understand that even when you feel helpless, angry, detached, etc. in a given case that you are probably doing a lot of good elsewhere. Stay honest with yourself about the negative feelings you have toward a given patient or case. If they are particularly troubling, discuss them in supervision or in your own therapy.

Thank you! =]

 

[singasongofjoy]

I think the more you do it the better you get at compartmentalizing. Not that that makes you any less empathetic, but that you're able to leave it at work. Like @bartleby said, maintaining appropriate boundaries is essential. Avoiding emotional burnout gets easier with practice, just like emotional regulation for my clients generally gets better after learning some skills and practicing them regularly. It got easier each year of my training (in psychology), and I'm better able to accept the fact that I am only one small part (though hopefully helpful part) of people's complex lives - they are ultimately responsible for their actions/reactions in life, not me; it's also up to them whether they will follow through on the things we've discussed in therapy. Don't try to mentally claim responsibility for more htan you're actually responsible for. I'll do my darndest to motivate and help clients as much as I can within my professional role, and point them in the direction of as many other relevant resources as I can, but I recognize that being overly-empathetic doesn't do anything to help them, and can be bad for their and other patients' care, so finding ways that work for you when you need them is critical. I vent or even occasionally cry to colleagues when I need to. It helps that at least in the settings I've been in, which have included psychiatrists as well, there's always someone around who understands that occasionally there is a patient/situation that just gets to you, is willing to listen before helping you get it back together and move on with your day. Good supervisors will also help you figure out how to navigate those situations.

Maintaining good self-care is critical though. Getting enough good quality sleep, exercise, making time for fun and social life, etc.

 

[clozareal]

I'm glad you started this thread because compassion fatigue and vicarious trauma are rampant in psychiatry probably more-so than many other fields of medicine and I feel like it often gets brushed aside as collateral damage from being part of this field. Burnout gets a bit more recognition but still does not receive the level of emphasis needed to prevent/manage it. I've worked extensively with this before I entered medical school and have met the leading experts in this field who've published on this (Babette Rothschild, Francois Mathieu, Laura van Dernoot Lipsky). Any of their books would be a great starting point, such as Help for the Helper, The Compassion Fatigue Workbook, or Trauma Stewardship.

First a few definitions:
Compassion fatigue - the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate their energy from placing too much effort in compassion in one area (which people who suffer from trauma often require) that they are not able to dedicate it to another (such as to their family or themselves)
Vicarious trauma - the shift in world view that occurs in those who repetitively bear witness to patients who experience trauma to the point where fundamental beliefs about the world are altered or damaged
Burnout - emotional and physical exhaustion that occurs when you have low job satisfaction, feelings of powerlessness, or feeling overwhelmed

Step 1: Notice the signs of it.
This is tricky to identify because the toll of vicarious trauma is slow and cumulative. Our worldview changes over time and in such a way that even if we do feel differently towards our health, life and relationships, it seems OK, if not inevitable. Some signs can be difficulty concentrating, intrusive imagery, feeling discouraged about the world, hopelessness, exhaustion, irritability, high attrition (helpers leaving the field) and negative outcomes (dispirited, cynical workers remaining in the field, boundary violations) many of which affect the workplace and can create a toxic work environment.

Step 2: Address those signs.
Given the workforce climate, organizational health researchers have been trying to find the most effective strategies to reduce mitigate, and prevent CF/VT/burnout because many businesses realize that an unhealthy work environment decreases productivity. Here is what has been shown to be most effective:
1. Working in a healthy organization (external factors) - Studies show that “who you work for” is one of the biggest determinant of employee wellness. This means having access to a supportive, flexible manager who is open to regular workload assessments in order to reduce trauma exposure, a manager who encourages staff to attend ongoing professional education and who provides timely and good quality supervision as needed. Employees who had more control over their schedule reported a higher rate of job satisfaction overall. That's why I think when picking a medical school, residency, fellowship, job, or where you spend most of your time such as the location/community is critical and needs to be done extremely as intentionally as practically possible (although many feel like they have little control over the job market, where they get interviews, etc.). It's like choosing a significant other to marry - you can't change someone into the perfect partner/spouse, you have to select for it (i.e., dating to find out) just as much as you do for a work environment. Leaving a toxic environment can be one of the best things for your mental wellbeing. It's not practical to change your workplace/hospital/clinic to make it more immediately healthy. Also, reducing hours spent working directly with traumatized individuals was the single most effective way of reducing VT. If you are more susceptible to VT, then plan to have a practice that maybe doesn't work with PTSD or child & adolescents or severe addiction.
2. Personal strategies (internal factors) - The top personal strategies identified were:
- Developing and maintaining a strong social support both at home and at work. This is key. Having people you can rely on at work (admin, co-residents, nurses, etc) and those who are supportive at home (family, friends, significant other) can help you decompress tremendously
- Increased self-awareness through mindfulness meditation (I really suggest a guided exercise to get started if you haven't done much of it before) and narrative work such as journaling
- Regular self care is unfortunately often an afterthought for psychiatrists. Compassion fatigue is a process that develops over time and so is healing from its effects. Maybe some people can return to a full well of resources by taking a holiday or going for a massage but most of us need to make life changes and put our own health and wellness at the top of the priority list. Psychiatrists (and all physicians/psychologists for that matter) need to develop stress resiliency skills so they can continue to be able to work with challenging patients and colleagues.

 

[F0nzie]

This is a great question. Psychiatry requires a high degree of thought, attention, and presence. Here are my secrets:

1. Exercise. I exercise to keep my body and mind strong so that I have more endurance throughout the day. When I stop exercising I am more likely to experience mental fatigue.

2. Rest. I need at least 7-8 hours of sleep to function at my peak. If I do not get enough sleep my thinking capacity is impaired-- my thoughts are slower, I am less attentive, and things in general are more overwhelming.

3. Diet. I eat 3 square meals a day. I try to have a balance of protein, vegetables, and some carbs. I am too lazy to eat fruit so I typically get it in the form of juice.

4. Socialize. Exclusively attending to the needs of others can weigh heavily if I isolate myself. I make sure that I connect with others to experience a healthy balance of giving and receiving support.

5. Goals. I keep a daily journal of inspirational quotes and short term/long term goals so that I maintain meaning and direction-- keeps me from getting thrown off course.

6. Action. Switching my mind from excessive thinking to more action in practice and in life. I try to be proactive through chart review before encounters and be mindful of all the things that are important to the patient. A strong alliance goes a long way toward reducing mental fatigue.

There are probably more things that help. But these are my essentials.


Sent from my iPhone using SDN mobile app

 

[WisNeuro]

As others have stated, compartmentalization is the biggest for me. Leave work, at work. Even if I have to do some work on weekends or off hours, I will still go to my office to do those things. It keeps my home life more geared towards home things. Honestly though, I find compassion fatigue to not be a huge problem. I think a bigger problem is trying not to get jaded working in inefficient and broken healthcare settings, public and private. Health care in general can be frustrating, and you'll need outlets to help with that. Get hobbies, exercise, travel, etc.

 

[Mellowmish]

I'm glad you started this thread because compassion fatigue and vicarious trauma are rampant in psychiatry probably more-so than many other fields of medicine and I feel like it often gets brushed aside as collateral damage from being part of this field. Burnout gets a bit more recognition but still does not receive the level of emphasis needed to prevent/manage it. I've worked extensively with this before I entered medical school and have met the leading experts in this field who've published on this (Babette Rothschild, Francois Mathieu, Laura van Dernoot Lipsky). Any of their books would be a great starting point, such as Help for the Helper, The Compassion Fatigue Workbook, or Trauma Stewardship.

First a few definitions:
Compassion fatigue - the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate their energy from placing too much effort in compassion in one area (which people who suffer from trauma often require) that they are not able to dedicate it to another (such as to their family or themselves)
Vicarious trauma - the shift in world view that occurs in those who repetitively bear witness to patients who experience trauma to the point where fundamental beliefs about the world are altered or damaged
Burnout - emotional and physical exhaustion that occurs when you have low job satisfaction, feelings of powerlessness, or feeling overwhelmed

Step 1: Notice the signs of it.
This is tricky to identify because the toll of vicarious trauma is slow and cumulative. Our worldview changes over time and in such a way that even if we do feel differently towards our health, life and relationships, it seems OK, if not inevitable. Some signs can be difficulty concentrating, intrusive imagery, feeling discouraged about the world, hopelessness, exhaustion, irritability, high attrition (helpers leaving the field) and negative outcomes (dispirited, cynical workers remaining in the field, boundary violations) many of which affect the workplace and can create a toxic work environment.

Step 2: Address those signs.
Given the workforce climate, organizational health researchers have been trying to find the most effective strategies to reduce mitigate, and prevent CF/VT/burnout because many businesses realize that an unhealthy work environment decreases productivity. Here is what has been shown to be most effective:
1. Working in a healthy organization - Studies show that “who you work for” is one of the biggest determinant of employee wellness. This means having access to a supportive, flexible manager who is open to regular workload assessments in order to reduce trauma exposure, a manager who encourages staff to attend ongoing professional education and who provides timely and good quality supervision as needed. Employees who had more control over their schedule reported a higher rate of job satisfaction overall. That's why I think when picking a medical school, residency, fellowship, job, or where you spend most of your time such as the location/community is critical and needs to be done extremely as intentionally as practically possible (although many feel like they have little control over the job market, where they get interviews, etc.). It's like choosing a significant other to marry - you can't change someone into the perfect partner/spouse, you have to select for it (i.e., dating to find out) just as much as you do for a work environment. Leaving a toxic environment can be one of the best things for your mental wellbeing. It's not practical to change your workplace/hospital/clinic to make it more immediately healthy. Also, reducing hours spent working directly with traumatized individuals was the single most effective way of reducing VT. If you are more susceptible to VT, then plan to have a practice that maybe doesn't work with PTSD or child & adolescents or severe addiction.
2. Personal strategies - The top personal strategies identified were:
- Developing and maintaining a strong social support both at home and at work. This is key. Having people you can rely on at work (admin, co-residents, nurses, etc) and those who are supportive at home (family, friends, significant other) can help you decompress tremendously
- Increased self-awareness through mindfulness meditation (I really suggest a guided exercise to get started if you haven't done much of it before) and narrative work such as journaling
- Regular self care is unfortunately often an afterthought for psychiatrists. Compassion fatigue is a process that develops over time and so is healing from its effects. Maybe some people can return to a full well of resources by taking a holiday or going for a massage but most of us need to make life changes and put our own health and wellness at the top of the priority list. Helpers need to develop stress resiliency skills so they can continue to be able to work with challenging patients and colleagues.[/QUOTE


This was super helpful! Thank you for the definitions and i'm definitely going to be checking those books out

 

[Mellowmish]

I'm glad you started this thread because compassion fatigue and vicarious trauma are rampant in psychiatry probably more-so than many other fields of medicine and I feel like it often gets brushed aside as collateral damage from being part of this field. Burnout gets a bit more recognition but still does not receive the level of emphasis needed to prevent/manage it. I've worked extensively with this before I entered medical school and have met the leading experts in this field who've published on this (Babette Rothschild, Francois Mathieu, Laura van Dernoot Lipsky). Any of their books would be a great starting point, such as Help for the Helper, The Compassion Fatigue Workbook, or Trauma Stewardship.

First a few definitions:
Compassion fatigue - the profound emotional and physical erosion that takes place when helpers are unable to refuel and regenerate their energy from placing too much effort in compassion in one area (which people who suffer from trauma often require) that they are not able to dedicate it to another (such as to their family or themselves)
Vicarious trauma - the shift in world view that occurs in those who repetitively bear witness to patients who experience trauma to the point where fundamental beliefs about the world are altered or damaged
Burnout - emotional and physical exhaustion that occurs when you have low job satisfaction, feelings of powerlessness, or feeling overwhelmed

Step 1: Notice the signs of it.
This is tricky to identify because the toll of vicarious trauma is slow and cumulative. Our worldview changes over time and in such a way that even if we do feel differently towards our health, life and relationships, it seems OK, if not inevitable. Some signs can be difficulty concentrating, intrusive imagery, feeling discouraged about the world, hopelessness, exhaustion, irritability, high attrition (helpers leaving the field) and negative outcomes (dispirited, cynical workers remaining in the field, boundary violations) many of which affect the workplace and can create a toxic work environment.

Step 2: Address those signs.
Given the workforce climate, organizational health researchers have been trying to find the most effective strategies to reduce mitigate, and prevent CF/VT/burnout because many businesses realize that an unhealthy work environment decreases productivity. Here is what has been shown to be most effective:
1. Working in a healthy organization - Studies show that “who you work for” is one of the biggest determinant of employee wellness. This means having access to a supportive, flexible manager who is open to regular workload assessments in order to reduce trauma exposure, a manager who encourages staff to attend ongoing professional education and who provides timely and good quality supervision as needed. Employees who had more control over their schedule reported a higher rate of job satisfaction overall. That's why I think when picking a medical school, residency, fellowship, job, or where you spend most of your time such as the location/community is critical and needs to be done extremely as intentionally as practically possible (although many feel like they have little control over the job market, where they get interviews, etc.). It's like choosing a significant other to marry - you can't change someone into the perfect partner/spouse, you have to select for it (i.e., dating to find out) just as much as you do for a work environment. Leaving a toxic environment can be one of the best things for your mental wellbeing. It's not practical to change your workplace/hospital/clinic to make it more immediately healthy. Also, reducing hours spent working directly with traumatized individuals was the single most effective way of reducing VT. If you are more susceptible to VT, then plan to have a practice that maybe doesn't work with PTSD or child & adolescents or severe addiction.
2. Personal strategies - The top personal strategies identified were:
- Developing and maintaining a strong social support both at home and at work. This is key. Having people you can rely on at work (admin, co-residents, nurses, etc) and those who are supportive at home (family, friends, significant other) can help you decompress tremendously
- Increased self-awareness through mindfulness meditation (I really suggest a guided exercise to get started if you haven't done much of it before) and narrative work such as journaling
- Regular self care is unfortunately often an afterthought for psychiatrists. Compassion fatigue is a process that develops over time and so is healing from its effects. Maybe some people can return to a full well of resources by taking a holiday or going for a massage but most of us need to make life changes and put our own health and wellness at the top of the priority list. Helpers need to develop stress resiliency skills so they can continue to be able to work with challenging patients and colleagues.

This was super helpful! Thank you, i'm definitely going to be checking those books out

 

[nitemagi]

Good self care tips. Those, plus below.

Here are the philosophies I emphasize for myself (and teach to others).
1. Practice detached compassion. That means feeling for the person, without necessarily being attached to a specific outcome. Like a teeter-totter, this kind of balance is more of a process than a state. You know more when you're leaning one way or another than when you're really balanced. And it's never a permanent state. If you notice yourself leaning too far in one direction (apathy/compassion, or attachment to outcome), lean the other way a bit more.

2. Don't work harder than your patient. This is the other half of detached compassion. It prevents burnout by your not investing more than them, but still giving an appropriate (proportional) amount of effort to them. Now of course you'll meet patients who can only do an inkling of progress, relative to what you need to do. But the metric is if you feel yourself overextending (or worse yet, feeling resentful towards them).

 

[deleted343839]

I agree that balancing compassion and detachment is a process. However, you may find in your training or other experience that certain groups or settings "pull" more from you and take up a lot of space in your mental life, while others may not interest or pull enough from you. We can't (and shouldn't) cherry pick whom we treat, but we can choose our work settings and populations wisely to facilitate this balance. If you need an example, find someone who only practices within a specific age group (kids, adults, geriatrics) and ask them why.

 

[smalltownpsych]

Maybe some people can return to a full well of resources by taking a holiday or going for a massage but most of us need to make life changes and put our own health and wellness at the top of the priority list. Helpers need to develop stress resiliency skills so they can continue to be able to work with challenging patients and colleagues.

There was a wealth of good information in your post, but I just wanted to highlight and emphasize this point. I have seen too many in mental health who have the thinking that change and growth is something that patients have to do and "I am just fine". Fortunately, the stressors of training at the highest levels whether in psychiatry or psychology tend to force most of us to make those changes which is another argument for high standards as well as rigorous and stessful training.

 

[Mellowmish]

Good self care tips. Those, plus below.

Here are the philosophies I emphasize for myself (and teach to others).
1. Practice detached compassion. That means feeling for the person, without necessarily being attached to a specific outcome. Like a teeter-totter, this kind of balance is more of a process than a state. You know more when you're leaning one way or another than when you're really balanced. And it's never a permanent state. If you notice yourself leaning too far in one direction (apathy/compassion, or attachment to outcome), lean the other way a bit more.

2. Don't work harder than your patient. This is the other half of detached compassion. It prevents burnout by your not investing more than them, but still giving an appropriate (proportional) amount of effort to them. Now of course you'll meet patients who can only do an inkling of progress, relative to what you need to do. But the metric is if you feel yourself overextending (or worse yet, feeling resentful towards them).

Very good points