Counselling, Reading

Compassion ‘satisfaction’ and compassion ‘fatigue’ – are they inextricably entwined?

Most people who work in a discipline that involves a lot of empathic contact have probably heard the words ‘compassion fatigue‘ by now. In counselling it can be used to describe behaviours and feelings of therapists that include being overwhelmed by clients’ suffering, unable or unwilling to empathise with that suffering, and avoiding/minimising/reacting negatively to distress and pain. At it’s most extreme therapists can experience PTSD, secondary traumatisation, and serious mental illness.

There’s plenty of articles and books on ‘compassion fatigue’, but before this week I had never heard the term ‘compassion satisfaction’.

A paper entitled Common characteristics of compassionate counsellors: a qualitative study’ by Bowen and Moore (2014) popped up on my Academia feed on Monday, and whilst the paper’s focus is not really as the title suggests, it is thought provoking. In particular it made me realise how little analysis I’ve seen on what ‘compassion satisfaction’ really is, and how it occurs. The paper’s research data indicates that a big part of it is having a sense, as a therapist, that you’ve done your best and concurrently seeing some kind of amelioration or change for the client, or seeing that the client feels heard, safe, hopeful etc.

So far so good – we can frame ‘compassion satisfaction’ as the sense of one’s compassion having use and meaning for the other.

However what’s really interesting about the research paper is that it suggests that the client groups and/or presenting mental health issues that counsellors associate with contributing to compassion fatigue are the same ones that are their greatest source of compassion satisfaction.

Broadly these were named as children and young people, abuse victims, substance users, people with disabilities and those in the lowest socio-economic positions.

What’s that about? The article doesn’t discuss it in depth, but the evidence presented indicates that counsellors understand this to be due to the fact that the gains made by these clients through therapy are so critical to their lives, and perhaps can be more easily seen.

It seems to me that satisfaction is all down to making a difference – and the more we can see that we made a difference to a client, the more we are likely to feel satisfied. And of course a ‘difference’ doesn’t mean that they’re suddenly happy, or no longer anxious, because for some of the people we work with, something like continuing to stay alive can be the biggest difference in the world.

One of the things that most struck me from the interview excerpts published in the paper was that several counsellors talked in a way that suggested they were embarrassed or ashamed that they had cried or felt strong emotions in response to what their clients had said. I felt really sad that counsellors should feel that way. It is so incredibly important that we continue to be able to let our client’s stories move us and make us feel. Yes, we need to handle that professionally, but the ability to be affected by the other is a key part of the work itself – feeling for the other is the origin of compassion, and for me effective counselling is based on our ability to be a real, authentic person who is affected by, and affects, the other.

Therapy is a risky business, not just for clients but for therapists. Working in a humanistic and/or existential manner requires you to be vulnerable, to be real, and to feel. When we work, we take the risk that we will have experiences that lead to compassion fatigue, but it seems like when we risk the most, and work with the most vulnerable, the most challenging, then we stand to gain the most.

I also watched the TEDx talk below, and on the subject of compassion fatigue, and the importance of retaining an ability to feel, as well as noticing ways in which you are approaching burnout, it’s really worth a watch.

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