Drowning in Empathy: The Cost of Secondary Trauma

There has been considerable attention of late paid to the trauma experienced by those on the front-lines. Paramedics, police, nurses, doctors, social workers – anyone who works with our most vulnerable communities – can be deeply impacted by their interactions with these populations. The sheer number of fentanyl-related deaths has shone a spotlight on the issue of secondary trauma experienced by front-line service providers and caregivers.

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Such news stories lead us to wonder: how can we possibly care for others if we are constantly drowning in their sorrows? This question is at the centre of Amy Cunningham’s work on how secondary trauma can lead to compassion fatigue (https://www.youtube.com/watch?v=ZsaorjIo1Yc). Helping professionals such as doctors, police officers, social workers, counsellors, nurses, and firefighters can all experience secondary trauma – that is the exposure to someone else’s trauma can traumatize us.

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The repeated exposure to secondary trauma can lead to compassion fatigue, which Cunningham describes as a symptom akin to that of Post-Traumatic Stress Disorder. Individuals acting as helping professionals in their daily lives can also experience compassion fatigue. “If you are someone who is helping a friend recover from an addiction, raising children, or if you are caring for your elderly parents you may be susceptible to experiencing secondary trauma,” notes Registered Clinical Counsellor Kelly Besla-Mooker.  

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Secondary trauma, according to Cunningham, happens when we genuinely empathize with someone, by picking ourselves up and putting ourselves in their shoes, that is we “really get where they are coming from.” Each time we put ourselves in someone else’s shoes we feel what they feel, but by constantly experiencing secondary trauma, it changes us. Cunningham uses the example of silencing her phone while in a session with a client so the client knows they had all of her attention. From then on, silencing her phone led to her always associating that action with that client’s story. For years, she would be transported back to that room whenever she silenced her phone. Secondary trauma doesn’t only last until the next day or even the next week, you can still feel the effects weeks or even years later.  

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According to Cunningham, it is important to note the distinction between burnout and compassion fatigue. It was not until the late 80’s that Dr. Charles Figley did research on trauma and he noticed that compassion fatigue is different from burn-out. Burnout implies that you can no longer carry on with your work, because you are tired or worn-out and somewhere along the way you lost interest; compassion fatigue on the other, hand starts “to change who you are.” Cunningham uses the examples of a child protection social worker who is constantly vigilant and scared for her children or a nurse who to this day knows the smell of death from a patient that died.

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Cunningham notes how helping professionals do not admit to compassion fatigue – instead they say they are fine or that they are professionals and can carry on with their work. It becomes a problem when stress and trauma start to affect us and our body and mind are screaming that we are not okay. The behaviours of someone experiencing compassion fatigue can manifest themselves by sleeping too much or not enough, working too much, or feeling underappreciated. Cunningham notes that while we are still working the same job we started out with, it is us that has changed as a result of the constant exposure to trauma. The last symptom of compassion fatigue is self-entitlement; which Cunningham describes as the justification of negative maladaptive behaviours as a result of the positive things we do. For example, a social worker might justify their crankiness in the morning, because the night before they stayed awake all night helping a client. Or a nurse that works two shifts in a row, might justify drinking all weekend, because they put in 60 hours this week.

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Compassion fatigue is not a lifelong illness. Cunningham emphasizes that it can be identified, arrested and treated at any time. She labels this as post traumatic growth. In order to do that we must start by caring for ourselves first so we can care for others. Cunningham’s tip to overcome compassion fatigue is to spend ten minutes each day to ourselves, whether to pray, mediate, exercise, or take a walk. Take ten she says.

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Registered Clinical Counsellor Kelly Besla-Mooker states that, “we need to give ourselves a mindful reminder and consider that even in an airplane the air hostess informs that you must put on your own oxygen mask before assisting someone beside you, even if you are sitting beside a child”. This teaches us that in order to not suffer from compassion fatigue, frontline workers would benefit greatly from getting the help they need to cope with this trauma so they can effectively do their jobs in the future and also not be affected in their personal lives. This means lots of self-care, seeing a therapist and having a support system.