Empathy Fatigue: Healing the
Mind, Body, and Spirit of
Professional Helpers
OR
From Empathy Fatigue to
Empathy Resiliency
Mark A. Stebnicki, Ph.D., LPC, CRC, CCM
Professor, Dept. of Rehab Studies
East Carolina University
www.ecu.edu/rehb
The More We Stress Together…
 There are discrete, basic, and universal emotions that
persons react to on a Mind, Body, & Spiritual level.
 Emotions involve different body systems which arouse
our parasympathetic and sympathetic system.
 Chronic activation of the nervous system (stress
response) has both a physiological and emotional cost.
 Cumulative effects of multiple client problems lead to a
deterioration of the professional’s coping skills and
resiliency skills- esp. if symptoms go unrecognized.
A Paradigm Shift in Mental Health and
the Allied Helping Professions
 Horrific terrorist attack Sept. 11th (2,996 deaths)
 War in Iraq (4348 Am Military casualties) Afghanistan
(796 Am); 84K Iraqi Civilian deaths (320,000 AM TBI)
 Tsunami December 26th 2004 (275,000 deaths+)
 Hurricane Katrina 2005 (70 deaths +)
 Child Deaths (intentional-unintentional) by gun
violence (3,024 deaths/yr)
 School shooting deaths (323 deaths ‘92-’2007)
 4.2 mil worldwide living with AIDS
 3.1 AIDS-relates deaths
Etiology of Disaster
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Fire
Flood
Hurricanes/Tornados
Ice storms
Plane crashes
Volcanoes
Earthquakes
Epidemics
 Workplace violence
 Traumatic injury in
the workplace
 School shootings
 Bioterrorism
 Transportation
Accidents
 Civil Unrest
Native American Teaching
“Every time you heal someone, you give a piece of
yourself away, until at one point you will need
healing yourself”
* Shaman or Medicine Man/Woman in many indigenous
cultures understood that in healing practices the healer
sometimes must takes-on the pain and suffering of
others while planting the seeds for transformation.
* Each personal transformation should bring about the
necessary experiences for handling the next crisis so the
mind, body, and spirit can be transformed.
Empathy Fatigue (EF)
“ A dynamic state of physical, psychological,
emotional, social, occupational, and spiritual
exhaustion that occurs on a continuum, resulting
from the helpers’ own wounds that are
continually revisited by their client’s life-stories
of chronic illness, mental/physical disability,
trauma, grief, and loss.”
Empathy Fatigue Reactions and
Impaired Professionals
 APA – Impaired Professionals
 AMA- “Physician Impairment”: “physical,
mental, and behavioral disorder that hinders the
physician’s ability to safely treat pts.”
 ACA- Task Force on Counselor Wellness and
Impairment
 American Nurses Association
Theory of Empathy Fatigue
 Persons who work in “high touch” professions are more
vulnerable than those that don’t…
 A natural artifact of working with patients that have
intense acute and chronic physical conditions, mental
health, and behavioral issues.
 Many times an unconscious process where the
professional and those around them may not recognize.
 EF is cumulative and ranges on a continuum of low,
moderate, and high levels of physical-emotional-mental
spiritual, and occupational exhaustion.
Peripheral/ANS: SympatheticParasympathetic Nervous
The Neuroscience of Empathy Fatigue:
Our Emotional Brain
 There are discrete, basic, and universal emotions that
persons react to on a M-B-S level;
 Emotions involve different body systems which arouse
our parasympathetic and sympathetic system;
 Chronic activation of the nervous system (stress
response) has both a physiological and emotional cost;
 80% of all physical illness is cause by stress (Kabit-Zinn,
1990; Sapolsky, 1998; Selye, 1976; Weil, 1995)
Why Zebras Don’t Get Ulcers: An Updated Guide to
Stress, Stress-Related Diseases, and Coping
Dr. Robert M. Sapolsky
Q. Why Zebras Don’t Get Ulcers
Answer: Zebras don’t have cumulative stress
“If you constantly mobilize energy, You
never store it; Your muscles waste
away; Your vascular system is under
constant pressure; and constant
Cortisol production turns off growth
factors and can harm every system in
the body…”
The Cost of Being a Stressed
Professional
A study of 27,000 people in 50
different countries found that people
with significant stress levels
DOUBLED THEIR CHANCE
OF HAVING A
HEART ATTACK
(2004 Interheart study with 50 participating countries)
The Problem with Too Many
Unhealthy Thoughts, Perceptions &
Feelings: Empathy Fatigue !!!
 Excessive, recurrent, and intense emotional
arousal;
 Repeated reactivation of our perceptualcognitive-affective response;
 Stored unhealthy thoughts, perceptions, and
emotions, become a worn neural pathway which
leaves an imprint on our cognitive unconscious
and causes a mind-body interaction.
Hindu Parable: The Monkey and the Banana
Critical Pathways
 EF has both an acute, chronic, or delayed onset
reaction that ranges on a continuum of low,
moderate, and high;
 Communication (verbal/non-verbal) that is
exchanged between clients/patients and
professionals during therapeutic interactions are
integrated in the professional’s thoughts and
feelings and becomes associated as a physicalemotional reaction
The Nature of the Helping Profession
 Requires facilitating empathic approaches, cultivating client
connections and relationships where we must attend, listen, act
empathically to help our clients unfold the multiple layers of their
stress, grief, loss, or traumatic experiences by searching through
their emotional scrapbook.
 The search for personal meaning and purpose of our client’s pain
and suffering may contribute to the helper’s spiritual fatigue
experience.
 If professional helpers are mindful of this experience, and view
this as an opportunity for nurturing personal growth and
development, then they will learn resiliency strategies that can
help to replenish their wounded spirit.
Share Your Experiences as a
Professional Helper
1. How did you chose the helping profession?
2. In what ways are you encouraged or discouraged
by your clients’ successes or failures?
3. How is your mind, body, and spirit most affected
by intense interactions with others?
4. Describe any self-care you do and how you
cultivate resiliency?
EF: A Combination of other
Professional Fatigue Syndromes
 Countertransference: the unconscious absorption of
the patient’s issues, involves a type of symbolic or
parallel experience of emotional button-pushing. It
results in a sense of anxiety, stress, sense of loss,
grief, and over-identification w/pt.
 Compassion Fatigue: An acute stress reaction
unhealthy form of countertransference results from
emotional, mental, and physical exhaustion.
Professional Burnout
A negative shift in the way professionals
view people they serve. A cumulative
emotional exhaustion, depersonalizaiton,
feelings of a lack of personal
accomplishment resulting in a loss of
compassion, genuineness, and concern for
the patient.
Signs of Burnout
Feeling …..
 Tired and out of energy
 Worthless
 Emotionally out of control
 Constantly negative
thinking
 Alone and disconnected
 Depressed
 Stressed
 Anxious
 Substance abuse-addiction
Summative Philosophy of EF
It is not necessarily the nature of the client’s stress,
trauma, loss, grief, daily hassles, coping, or
disability adjustment that creates a sense of EF for
the professional; rather it is the professional’s
perception towards that particular client’s; and the
helper’s personality traits, states, and behavior that
determines the response; which is determined by
multiple factors that lead to a diminished capacity to
listen, respond empathically, provide competent
professional services…
EF Risk Factor Functional
Assessment
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Personality Traits
History of MH Problems
Maladaptive Coping Behaviors
Age and Experience-Related Factors
Organizational Factors
Job Duties within the Organization
Socio-Cultural Factors
Person’s Response to Past Events
Level of Support
Empathy Fatigue Resiliency Quiz
1= not true of me….5=exceptionally true of me
As a professional helper I perceive myself to be…
1.
2.
3.
4.
5.
Resilient, adapt quickly to new client issues as they arise,
and good at bouncing back after listening, attending, and
responding empathically to my clients’ stories all day.
Optimistic, perceive that my client can increase their level of
adaptive functioning regardless of how difficult their issues
are, and I anticipate that things will turn out well for them.
Calm and focused while my client’s life is in crisis.
A good problem-solver by facilitating appropriate
interventions by empowering my client with good resources.
Able to trust my clinical intuition and facilitate creative
solutions to my client’s stressful life-challenges.
Resiliency Quiz (continued)
6.Self-confident, optimistic, enjoy healthy self-esteem, and
have an attitude of professionalism about my work.
7. Playful, humorous, have the ability to laugh at myself.
8. Curious, facilitate good interventions, have a desire to
understand how things work in my client’s life, and consult
with others when I need help.
9. Constantly learning from my past mistakes during therapy
and from the mistakes that I see others make.
10. Flexible, and feel comfortable with things that are
somewhat complex in my client’s life, and can adapt to
various client behaviors and personalities.
Resiliency Quiz (continued)
11. Able to anticipate when my client will develop
specific problems and I have confidence that I will
know how to deal with the unexpected.
12. Able to personally deal with my client’s negative
or dysfunction life patterns and the ambiguity or
challenge this presents in my own life.
13. Non-judgmental, a good listener, possess good
empathy with my clients, express my feelings and
be able to “read” other people well.
14. Able to recover emotionally from my client’s
losses and setbacks, and let-go of negative feelings
that I may have and how to ask others for help.
Resiliency Quiz (continued)
15. Durable, keep on ticking after tough
client sessions and possess a balanced and
healthy fighting spirit.
16. Stronger and better after facilitating
interventions with difficult clients issues.
17. Able to discover some meaning in my
own life at the end of the day, even after
hearing multiple client stories of stress,
trauma, addiction, anxiety, and
depression….
Empathy Fatigue Resiliency Quiz Scoring
75 + = Very Resilient!!
65-75 = Resilient more than most helpers.
55-65 = Slow to rebound- but adequate.
45-55 = Whoa- I’m struggling as a professional.
45 or less = Leave now and seek help!
The Resiliency Advantage
Dr. Al Siebert
1. Making conscious choices in life.
2. Power of Positive Thinking.
3. Take responsibility.
4. Internal locus of control.
5. Self motivate yourself.
6. Don’t fear trying-out new things.
7. Take control of your life.
8. Practice positive approaches to life.
Cognitive Signs
of Distress
Loss of concentration,
lack of focus
Apathy, lacks meaning
in chosen profession
Preoccupation with
avoiding job tasks
Emotional
Signs of
Distress
Feelings of exhaustion,
lack of energy, sleep
problems
Emotional roller coaster of
highs and lows, feelings of
being overwhelmed
Irritability, agitation,
anger, resentment,
isolation, detachment
Being on edge, very
impatient
Feeling extremely
cynical, bad sense
of humor
Changes in eating
and grooming habits,
poor lifestyle
management
Signs of
Behavioral
Distress
Signs of
Physical
Distress
Stomach aches,
Headaches
Shallow breathing,
rapid pulse, heartbeat
Increased illnesses
due to lower
immunities
Interpersonal
Signs of
Distress
Withdrawal from
colleagues
Projection of anger or
Blame, increase in interpersonal conflicts
Poor communication
skills with family,
personal relationships
Spiritual
Signs of
Distress
Loss of meaning and
purpose with self and
career
Decrease in spiritual
and religious activities
Loss of faith in
higher Power, cynical
with past faith and
beliefs
Signs of
Occupational
Distress
Decrease in quantity
and quality of work
Low motivation, avoid
job tasks, increase in
absenteeism
Increase in mistakes
Case Illustration of Mental Health
Professionals
“While we were in counselor training, we were always
told to “be competent professionals.” No one ever said
exactly what that meant, or how to be a mental health
professional. I guess we thought it meant being cool
and calm under pressure, objective with our clients, and
not to get easily rattled by “crazy persons.” But I did
get rattled and upset at times- like the first time a client
attempted suicide. Somehow I felt responsible and felt a
mix of anxiety, anger, and sadness but I would be
fighting any expression of those feelings to my
colleagues because I knew that this was not the
“professional thing to do.”
MH Professional{continued}
“Everyone else seemed to be handling things
okay, which made me feel even worse- like a real
failure- like someone who wasn’t cut-out for this
kind of work. I didn’t dare say anything for fear
people would see out how weak I really was. It
wasn’t until much later in my career that I
discovered that most everyone else was just as
scared, sad, and angry as I was when it came to
persons who have chronic and persistent mental
health issue are those who have be traumatized”
Show-up
Pay Attention
Be Open to the Outcomes
Solution-Focus Prevention
 What would this problem situation look like if you were
managing it better?
 What changes in your present situation/life would make
sense right now?
 What would you be doing differently with your
problem situation if you were to make the changes you
wanted to make?
 What things have you thought about that would make
life better for you right now?
 What things/feelings in your life would you like to
eliminate right now?
 If you eliminated certain things in your life what would
that feel like?
 When do you plan on making these changes?
The Critical Stress Factor in Disease:
Optimizing the Healing System {Dr. Weil}
Lack of Energy
Poor Circulation
Restricted Breathing
Impaired Defenses
Toxic Overload
Age
Thoughts, Perceptions, Cognitions
Spiritual Problems
The Organization’s Responsibility in
Wellness
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Skilled & Competent clinical supervision
Mentoring approaches
Peer-supervision
Shift focus of treatment team meetings
Re-structure organizational philosophy to a
healthy person-centered wellness
Expression of Feelings
Expressive Drawing “Emotional
Landscape”
Journal Writing
 Spontaneous writing
(dreams, fantasies)
 Open and honest
 Accept whatever
comes to mind
 Grammar- spelling
fagetta-bout-it
 Process is just for You
Reducing Workplace Stress: It’s 15% Effort,
Productivity, and Showing-up - 85% Attitude!
 Wake up and affirm that you have a job (15.1 mil
Americans or 9.8 are unemployed)
 Leave your house with a heart full of gratitude (may
require some morning ritual)
 Recognize the range of opportunities and be open to all
the possibilities that your employment brings
 As you travel to work be aware of how you cultivateprepare your mind, body, and spirit for your profession
 While at work take a moment to be aware of how you are
cultivating and preparing your m-b-s for your profession
Cultivating-Preparing M-B-S for Your
Profession
 Be mindful of the toxins you take-in your M-B-S
 Lunch- an important part of your day- use it wisely
 Be aware of how you communicate with others
throughout your day (verbally and non-verbally)
 Get good closure with people, job tasks, and organize
yourself for tomorrow- leave your work personality and
behaviors-at work
 Get out of your work clothes immediately when you get
home and allow yourself to transition into your home
environment
 Brrreeaatthh!!!