Compassion Fatigue: “Dig Where the Ground is Soft” 


According to researcher and renown trauma expert Dr. Charles Figley, simply put, Compassion Fatigue is a disorder attributed to those who do their job well characterized by deep emotional and physical exhaustion (similar to depression and PTSD) AND a profound shift in the value of their work and sense of hope and optimism. All helping professions with the potential for high stress fall in this category.

Components of Compassion Fatigue include a combination of:

1) Burnout– Related to your job environment in which the stress is attributed to the job duties and surroundings such as paperwork and unsupportive supervisors etc.

2) Secondary or Vicarious Trauma – An adverse reaction or taking on of the trauma experienced by the person helped, as if it was your own, experiencing sleeplessness, fear etc.

Whereas, in contrast, your level of Compassion Satisfaction means being satisfied, enjoying, the work of caring for others. Compassion Fatigue symptoms are normal displays of chronic stress resulting from the care giving work we choose to do. Traumatologist Eric Gentry states, these are people who were taught at an early age to care for the needs of others before caring for their own needs. Authentic, ongoing self-care practices are absent from their lives.

Other researchers feel that compassion fatigue may emerge as the result of unsuccessful or maladaptive survival strategies. In particular, Velent (2202) attributed the development of compassion fatigue to the “unsuccessful, maladaptive psychological and social stress responses of Rescue-Caretaking. In contrast to empathy, they those suffering from Compassion Fatigue see a sense of burden, depletion self-concern; resentment, neglect and rejection.

Recognition of symptoms may appear as depression or PTSD. However, a skilled trauma specialist would be able to differentiate.

Normal symptoms present in an individual include:

• Excessive blaming

• Bottled up emotions

• Isolation from others

• Receives unusual amount of complaints from others

• Voices excessive complaints about administrative functions

• Substance abuse used to mask feelings

• Compulsive behaviors such as overspending, overeating, gambling, sexual addictions

• Poor self-care (i.e., hygiene, appearance)

• Legal problems, indebtedness

• Reoccurrence of nightmares and flashbacks to traumatic event

• Chronic physical ailments such as gastrointestinal problems and recurrent colds

• Apathy, sad, no longer finds activities pleasurable

• Difficulty concentrating

• Mentally and physically tired

• Preoccupied

• In denial about problems

I have chosen three careers with the potential for Compassion Fatigue to illustrate the material thus far. Two of these three careers I have experienced personally in the past, or currently practice, or a career closely related to it.  

 Victim advocates

Professionals trained to support victims of crime. Advocates offer victims information, emotional support, and help finding resources and filling out paperwork. Sometimes, advocates go to court with victims. Advocates may also contact organizations, such as criminal justice or social service agencies, to get help or information for victims. Some advocates staff crisis hotlines, run support groups, or provide in-person counseling. Victim advocates may also be called victim service providers, victim/witness coordinators, or victim/witness specialists.child-164317_640

Advocates’ responsibilities vary depending on their job description and where they work Typically, the role of an advocate may include:

  • Providing information on victimization;
  • Providing information on crime prevention;
  • Providing information on victims’ legal rights and protections;
  • Providing information on the criminal justice process;
  • Providing emotional support to victims;
  • Helping victims with safety planning;
  • Helping victims with victim compensation applications;
  • Helping victims submit comments to courts and parole boards;
  • Intervening with creditors, landlords, and employers on behalf of victims;
  • Helping victims find shelter and transportation;
  • Providing referrals for other services for victims; Helping to arrange funerals; and
  • Notifying victims of inmates’ release or escape.

Advocates work in many different locations. Some serve in the criminal justice system (in police stations, prosecutor’s offices, courts, probation or parole departments, or prisons). They may also be part of private nonprofit organizations such as sexual assault crisis centers or domestic violence programs. Some advocates are paid staff, and others are volunteers. Many advocates have academic degrees that prepare them to work with victims. They may have studied social work, criminal justice, education, or psychology. Advocates often receive significant additional training on the specific knowledge and skills they need on the job.

How Advocates Work with Victims

Advocates offer victims information about the different options available to them and support victims’ decision-making. Advocates do not tell victims what to do. Advocates are committed to maintaining the highest possible levels of confidentiality in their communications with victims. However, the level of confidentiality they can observe depends on their position, education, licensure, and the laws in each state. An advocate in a police department may have to share any information related to an investigation with officers. Yet an advocate at a domestic violence program may be able to keep most victims’ confidences private. However, all advocates must report certain types of information to the authorities. For example, they have to report any type of threat to a person (such as clients threatening to hurt themselves or someone else), and they have to report the abuse or neglect of children. It is important for victims to ask about confidentiality rules before they begin working with an advocate

 Geriatric social work

Adjusting to old age is somewhat difficult for most people. Elderly individuals often have to find ways to cope with all sorts of changes in their lives, including health, financial, and social

Geriatric social workers, however, can help elderly individuals adjust to and cope with problems they may experience. These professionals help make sure the needs of their elderly clients are met, each and every day. They might help them with financial issues, medical care, mental disorders, and social problems.

There are a number of problems that geriatric social workers might help their clients overcome or cope with. Some of these problems may include, but are certainly not limited to:

  • Financial problems, such as living on a fixed income or finding employment.
  • Medical problems, such as finding adequate care or applying for medical benefits.
  • Mental health issues, such as depression or grief.
  • Social issues, such as loneliness or finding social activities.

Helping elderly individuals is typically the most rewarding aspect of a geriatric social work career. However, not everyone is a good fit for geriatric social work careers. If you’re looking to start a career in this field, you should truly enjoy working closely with elderly individuals. You should understand their unique needs, and respect all that they have to offer. You should also be a patient and organized person, with excellent communication skills.

Why do we need geriatric social workers?

According to the Administration on Aging, the number of elderly Americans over the age of 60 jumped from 378 million in 1980 to 759 million in 2010. That’s over twice as many elderly individuals in this country today, as opposed to around twenty years ago. Because of medical advances and a higher quality of living, the average life expectancy of Americans is expected to continue rising in the coming years.

Due to the increasing number of elderly individuals in this country, individuals interested in geriatric social work careers are needed more than ever.

What does a geriatric social worker do?

The main goal of a geriatric social worker is to make sure that the needs of his clients are met. Before he can do this, however, he must first assess each client in order to determine exactly what their needs are.

Assessing elderly clients is often achieved a few different ways. Typically, a geriatric social worker will meet with and interview a new client. He might also interview family members and care givers, such as doctors and nurses, and possibly look at the client’s medical records as well. If the client still lives at home, the home visit is another very important part of this assessment. The geriatric social worker will typically visit his clients at home to ensure that they live in a safe environment and that they have everything that they need.

Assessing their elderly clients can help geriatric social workers determine what they may need. It also helps them determine what their clients’ abilities and limitations are. The social workers can then work on a plan to help meet the needs of their clients. This usually involves helping clients utilize services that they may not have known about or that they may have found confusing or complicated. For example, a geriatric social worker who finds that a client is struggling financially may help that client either find part-time employment or apply for financial assistance, depending on that client’s abilities and limitations.

One of the most common mental disorders that elderly Americans may be treated for is depression. Elderly individuals account for nearly 15% of suicides in this country. A geriatric social worker will also look out for his clients’ mental well-being as well. They may offer counseling services, for instance, or refer clients that need mental health services to counselors, therapists, or psychologists.

Geriatric social workers will also keep their eyes out for signs of elder abuse and neglect. This form of abuse might occur in facilities such as nursing homes, or in the elderly clients’ own homes. If a social worker discovers that an elderly client is being abused, he will often remove the client from the situation and find her a suitable and safe environment.

Periodic evaluations for each client are another very important part of a geriatric social work career. These types of social workers will often check on each of their clients on a regular basis. This allows them to determine if their clients’ needs have changed.

 Emergency Medical Technician

traffic-lights-49698_640They are the first on the scene to an accident or disaster of any kind, prepared to render immediate medical aid and transport to the nearest medical center. The requirements of this job are incredibly demanding, both physically and mentally. As an EMT may be required to pull an injured person out of a crushed car or fallen structure, they must be physically fit and very strong. There are four levels of EMT based on experience and amount of training. A level 1 EMT is the most basic and not licensed to transport an injured person; people such as firefighters, police officers, and community volunteers often have this level 1 certification. The other three levels are Basic, Intermediate and Paramedic. The final level requires upwards of 2,000 hours of training and experience.

An EMT’s workday may start at any time of the day or night, and often goes for a full 24 hours before the shift is over. As a result EMTs typically work an average of 50 hours a week, three or four days out of each week. This is because they must be ready to answer a call from Emergency Services dispatchers who will tell them where to go and who is in need of aid. Once at the scene, an EMT identifies the person in need of aid, taking note of the symptoms. If the person is in need of treatment beyond what the EMT can render, the EMT will attempt to stabilize the person’s condition by means of intravenous fluids, drugs, bandages and tourniquets to bleeding limbs. The patient is then loaded in a stretcher into the back of the ambulance. One EMT drives while the other stays in the back to monitor the patient’s vital signs. Once at the hospital, they unload the patient, bringing him into the emergency room and informing the doctors and nurses on staff of what’s wrong with the patient as well as what treatments and drugs have already been administered. Once the patient is out of the EMT’s hands, they wait for another call from the dispatcher to repeat the cycle.

Read more:

Read more:



Compassion Satisfaction and Compassion Fatigue

© B. Hudnall Stamm, 2009.

Professional Quality of Life: Compassion

Satisfaction and Fatigue Version 5 (ProQOL)

(This test may be freely copy as long as (a) author is credited, (b) no changes are made, and (c) it is not sold. )

Professional Quality of Life Scale (ProQOL)  (ProQOL) Version 5 (2009)

When you [help] people you have direct contact with their lives. As you may have found, your compassion for those you [help] can affect you in positive and negative ways. Below are some questions about your experiences, both positive and negative, as a [helper] Consider each of the following questions about you and your current work situation. Select the number that honestly reflects how frequently you experienced these things in the last 30 days






5=Very Often

Sample Questions: There are ten questions interspersed throughout the list related to Compassion Satisfaction, Burnout and Secondary Trauma: 

 1. I am happy.

2. I am preoccupied with more than one person I [help]

3. I get satisfaction from being able to [help] people.

4. I feel connected to others.

5. I jump or am startled by unexpected sounds.

6. I feel invigorated after working with those I help]

7. I find it difficult to separate my personal life from my life as a [helper]

8. I am not as productive at work because I am losing sleep over traumatic experiences of a person I [help]

9. I think that I might have been affected by the traumatic stress of those I[help]

10. I feel trapped by my job as a [helper]

11. Because of my [helping] I have felt “on edge” about various things.

12. I like my work as a helper

13. I feel depressed because of the traumatic experiences of the people I [help].

14. I feel as though I am experiencing the trauma of someone I have [helped]

 15. I have beliefs that sustain me.

16. I am pleased with how I am able to keep up with [helping] techniques and protocols.

17. I am the person I always wanted to be.

18. My work makes me feel satisfied.

19. I feel worn out because of my work as a helper.

20. I have happy thoughts and feelings about those I [help} and how I could help them.

21. I feel overwhelmed because my case [work] load seems endless.

22. I believe I can make a difference through my work.

23. I avoid certain activities or situations because they remind me of frightening experiences of the people I [help]

24. I am proud of what I can do to [help]

25. As a result of my [helping] I have intrusive, frightening thoughts.

26. I feel “bogged down” by the system.

27. I have thoughts that I am a “success” as a [helper]

28. I can’t recall important parts of my work with trauma victims.

29. I am a very caring person.

30. I am happy that I chose to do this work.


Compassion Satisfaction _____________

Compassion satisfaction is about the pleasure you derive from being able to do your work well. For example, you may feel like it is a pleasure to help others through your work. You may feel positively about your colleagues or your ability to contribute to the work setting or even the greater good of society. Higher scores on this scale represent a greater satisfaction related to your ability to be an effective caregiver in your job.

The average score is 50 (SD 10; alpha scale reliability .88). About 25% of people score higher than 57 and about 25% of people score below 43. If you are in the higher range, you probably derive a good deal of professional satisfaction from your position. If your scores are below 40, you may either find problems with your job, or there may be some other reason—for example, you might derive your satisfaction from activities other than your job.


Most people have an intuitive idea of what burnout is. From the research perspective, burnout is one of the elements of Compassion Fatigue (CF). It is associated with feelings of hopelessness and difficulties in dealing with work or in doing your job effectively. These negative feelings usually have a gradual onset. They can reflect the feeling that your efforts make no difference, or they can be associated with a very high workload or a non-supportive work environment. Higher scores on this scale means that you are at higher risk for burnout.

The average score is as above in the previous sections.

Secondary Traumatic Stress_____________

The second component of Compassion Fatigue (CF) is secondary traumatic stress (STS). It is about your work related, secondary exposure to extremely or traumatically stressful events. Developing problems due to exposure to other’s trauma is somewhat rare but does happen to many people who care for those who have experienced extremely or traumatically stressful events.

For example, you may repeatedly hear stories about the traumatic things that happen to other people, commonly called Vicarious Traumatization. If your work puts you directly in the path of danger, for example, field work in a war or area of civil violence, this is not secondary exposure; your exposure is primary. However, if you are exposed to others’ traumatic events as a result of your work, for example, as a therapist or an emergency worker, this is secondary exposure. The symptoms of STS are usually rapid onset and associated with a particular event. They may include being afraid, having difficulty sleeping, having images of the upsetting event pop into your mind, or avoiding things that remind you of the event.

The average score on this scale is as above in previous sections.

WHAT IS MY SCORE AND WHAT DOES IT MEAN?  See page three in this file for a chart of the sum of your questions per section, an assigned score and whether you are at low or high risk.


Self-Care Tips for those Prone to Compassion Fatigue, Finding Balance:

(Author: Francoise Mathieu, M. Ed, CCC Compassion Fatigue Specialist, March, 2007)

  1. Take stock of what’s on your plate what stands out? Recommended Book: Take Time for Your Life, Author Cheryl Richardson
  2. Start a Self- Care Idea Collection –Invite others to Join;
  3. Find Time for yourself every day– Do one nourishing activity every day!
  4. Delegate at home and at work;
  5. Make a transition plan from work to home (i.e. change into  cozy clothes, go for  run,etc;
  6. Learn to say no or yes  (help) more often;
  7. Survey the amount of trauma you are exposed to even subconsciously each day. Create a trauma filter to protect from the extraneous trauma;
  8. Learn more about Compassion fatigue and Secondary Trauma;
  9. Get more professional training in your field to combat feeling lacking in skills and incompetent;
  10. Consider joining a Support Group;
  11. Consider decrease your work hours to part-time;
  12. Exercise;
  13. Chinese Proverb – “Dig where the ground is soft.” In other words, work first with the client who exhibits the most willingness to change, NOT those who seem closed and defensive.



When you analyze the various types and your personal work history, if you are a baby boomer and have extended work history, I would surmise that most people fall in the burnout category.  We seldom have a work environment conducive to concentrating on the pure pleasure of the job without extraneous pressures. We may know in our heart that we love the profession or the people we serve, but more often than not, politics, impossible workloads and/or unsupportive supervisors and colleagues can send you into burnout mode.   Secondary traumatic stress appears to occur most often in those positions of constant stress and danger such as law enforcement, the military, etc.

As Patricia Smith, Founder of the Compassion Fatigue Awareness Project, states,

“Day in, day out, workers struggle to function in care giving environments that constantly present heart wrenching, emotional challenges. Affecting positive change in society, a mission so vital to those passionate about caring for others, is perceived as elusive, if not impossible. This painful reality, coupled with first-hand knowledge of society’s flagrant disregard for the safety and well-being of the feeble and frail, takes its toll on everyone from full-time employees to part-time volunteers. Eventually, negative attitudes prevail.” 

I too have become burned out or close to it many times within my chosen careers, for I am the ultimate giver, and compassionate person, for good or bad. However, the main factors that save me, I believe, are the absence of associated Secondary Trauma and a very high degree of resilience, coping ability and genetics.  You may not be as fortunate!

Yes, there is a price to pay and lots of sacrifice in order to meet future goals. However, I always have more self-care work to do than I care to admit. It is a balancing act, and I frequently fall off the beam!  However, I am still proud of the person I have become, compassion flaws and all!

Compassion Fatigue: “Dig Where the Ground is Soft”


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s