Self-Care for Therapists:

Prevention of Compassion Fatigue

and Burnout
VIVIAN BARUCH

The helping professional who is mindful that compassion fatigue and burnout are givens in
therapeutic work, rather than indicators of personal inadequacy, is well-placed to recognise
and respond effectively when they experience the impact of these stressors. Therapists and
counsellors are able to see what clients need to do to care for themselves, but at times become
blind to their own needs to do the same. Self-care needs to be an area of primary concern for
counsellors and therapists. Some even suggest that it be viewed as a moral imperative and be
included in all training and on-going professional development programs. VIVIAN BARUCH
provides a practical, challenging and compassionate consideration of these issues.

Charles Figley (1995) suggests that work with clients who have suffered traumatic experience has specific occupational health
risks: ‘…there is a cost to caring…the most effective therapists are most vulnerable to this contagion effect…those who have
enormous capacity for feeling and expressing empathy tend to be more at risk of compassion stress…’ (p.1).

He defines ‘secondary traumatic stress’ in any of the counselling and therapy therapists we should attempt to practice
as ‘…the stress from helping or wanting trainings I have attended. Where it for our
ourselves what we encourage our
to help a traumatized or suffering person’. was addressed, the only recommended clients to do for themselves.
(p.7) and uses the term ‘compassion methods were supervision and personal Not only is it important to model
fatigue’ interchangeably with the term psychotherapy. Second, since my own authenticity, as any good therapist may
‘secondary traumatic stress’. Secondary brush with compassion fatigue twenty be expected to do (Walsh & Vaughan,
traumatic stress is distinguished from years ago, three years after I began 1993:161), but it is also important to pay
burnout by its rapid onset and the extent to practice as a therapist, it has been continual attention to our own inner
to which the affected therapist presents important to me to ensure that I pursue work and spiritual practice. In this
with similar symptoms to those affected de-stressing and healthy diversions to way we can highlight our own shadow
by post traumatic stress disorder. balance work and study. aspects, develop ethical sensitivity
Gilroy, Carroll & Murra (2002) Yoga and meditation form a and develop an appropriate sense of
stress that the key to prevention of significant part of my self-care responsibility. Of courses, at times
burnout lies in the establishment of a programme, and I continue to benefit of increased stress, it becomes more
professional ethos in which self-care is from their harmonising and integrating difficult to maintain such self-care
viewed as a moral imperative. In such a effects, as well as their ability to gently regimes. However, it is at precisely these
scenario, self-care would be stressed as expand my sense of self and meaning times that we can draw on the reserves
a priority in our work as counsellors by frameworks. Holistic methods of healing gained through an established
training bodies as well as professional emphasise prevention, which is generally self-care programme.
organizations. Self-care strategies would regarded as necessary to maintain and
be included in the training and on-going develop the health of body, mind and A search of the literature on
maintenance regimes of therapists. spirit. The potential for compassion counsellor and therapist self-care found:
My interest in the area of counsellor fatigue is often not considered, to say • psychological principles, methods
and therapist self-care arose for two nothing of methods to prevent the and research are applied rarely to
reasons. First, as a result of the failure condition in the first place. It seems therapists themselves. It’s interesting
for self-care to be addressed sufficiently straightforward that as counsellors and that we help clients to change in ways we

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don’t always practice ourselves. that possession of one particular skill is career in therapy. The literature points
• there is a paucity of systematic study less valuable than a variety of self-care to depression, mild anxiety, emotional
on therapists and self-care. skills. Other researchers, some of whom exhaustion, and disrupted relationships
• it appears that counsellors and incorporated cross-cultural studies on the as the common residue of immersion
therapists feel great shame around being impact of meditation and mindfulness, in the inner worlds of distressed and
impaired by our work. This is unrealistic found empirical evidence that these distressing people (Brady, Healy et
given a growing body of empirical methods show a marked influence on al 1995, cited in Norcross 2000). The
research attesting to the negative toll general well-being. (Brown & Ryan 2003; imperatives of confidentiality, the
exacted by a career in counselling Duglos & Friedlander 2001; Mahoney realities of isolation, and the shame
(Norcross 2000:2), as well as the effects 1997; Zetter 2003) felt when we experience the negative
of compassion fatigue.
• prevention is better than cure.
Studies of those who have managed
It seems straightforward that as counsellors and
with success to navigate years of
working with distressed clients can be
therapists we should attempt to practice for ourselves
of vital assistance to the field. (Coster
& Schwebel 1997 & 1998; Dlugos &
what we encourage our clients to do for themselves.
Friedlander, 2001; Norcross 2000).
• common themes have been • diversity and synergy of professional impact of our work, along with a host
identified in therapists who function well activities such as: conducting multiple of other considerations, lead us to
and their self-care methods. Recognition forms of therapy (individual, couples, overpersonalise our own sources of
of and emphasis on these common group); engaging in a range of activities stress, when in fact they are a given in
themes are needed in training and (e.g. therapy, assessment, research, psychological work (Farber 1983; Figley
continuing professional development. teaching, supervision, consultation); 1995; Geldard 1993; Gilroy, Carol &
work with a variety of clients and Murra 2002; Kramen-Kahn & Downing
There are important themes that problems (age, ethnicity, disorders); 1998; Mahoney 1997; O’Connor
appear in the literature around therapists continuing education; and balancing 2001; Skovholt, Grier & Hanson 2001;
who function well with regard to self- professional responsibilities with personal Norcross 2000). It is essential, and
care and prevention of burnout. Methods needs. (Duglos & Friedlander 2001; Guy indeed therapeutic, that we disconfirm
used by experienced therapists that 2000; Kramen-Kahn & Downing 1998; our individual feelings of unique
contribute to successful maintainance of Mahoney 1997; Norcross 2000). wretchedness and affirm the universal
well-being include: nature of the hazards in psychological
• self-awareness and self-monitoring, Other important concepts were: work. (Guy 2000; Norcross 2000)To
which requires attention to interpersonal • the need to recognise the hazards of do so leads us to corrective action and
feedback from significant others psychological practice. Empirical research informs preventative measures.
(Norcross 2000); support from peers, attests to the negative toll exacted by a • current policies in relation to
spouses, friends, mentors,
therapists and supervisors;
personal values that
help the practitioner to
observe ethical standards
of practice; a balanced life
that incorporates vacations
and stress-reducers, and
continuing education to
ensure that the practitioner
diversifies their work and
keeps abreast of changes
(Coster & Schwebel 1997;
Dlugos and Friedlander
2001; Norcross 2000; Guy
2000; Jennings & Skovholt
1999; Kramen-Kahn &
Downing 1998; Mahoney
1997; O’Connor 2001;
Skovholt et al 1997, 2001).
• embracing multiple
strategies for self-care.
Norcross (2000) suggests

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distressed and impaired practitioners supervision, meditation, and so forth… We all have times when the stress of
tend to be inconsistent and incomplete, At the institutional level, the current our clinical work causes us to become
and focus on code enforcement rather focus in universities and professional exhausted, anxious and agitated.
than on prevention efforts (O’Connor schools of psychology on clinical skills is Some of us are suffering now, or have
2001, cited in Gilroy, Carroll & not enough. It is imperative that personal suffered, from distress, compassion
Murra 2002). psychotherapy be mandated… Although fatigue or burnout. All are occupational
• it is difficult to estimate the overall the curricula in professional psychology hazards. We’ve discovered that our
prevalence of burnout in counsellors and programs may mandate courses in legal, inner reserves of empathy aren’t infinite.
therapists as unknown numbers leave ethical, and professional issues, risk Becoming more self-aware helps us to
the profession, or move towards teaching management, and so on, more attention is know the limits of what is possible in
and administration rather than frontline needed in terms of self-care and education our own lives as well as in the lives of
therapy (Warnath and Shelton 1976, cited concerning possible risk factors associated our clients. As therapists, we face the
in McLeod 2003:429). with such problems as compassion fatigue, challenges of a dwindling future, the
distress, and impairment’ (ibid). ‘...those struggles with managed care, and the
Outcomes from embracing self-care who are introduced to self-care and need to work harder with minimal
methods as a standard means to ensure personal therapy early in their professional institutional support for supervision
that the practitioner functions well were: lives are more likely to undertake such and continuing education. More than
high levels of personal accomplishment, means continually throughout their ever, we are isolated individuals who
general well-being, enhanced self- careers’ (Pope & Tabachnick, 1994 cited operate behind the closed doors of our
awareness, openness to experience in Gilroy, Carroll & Murra, 2002). practices. And while the resources and
and appreciation of the rewards of ‘It is important that such self-care organisational support dwindle, we hear
care-giving, which all led to increased action plans be comprehensive in nature more traumatic stories from clients than
job satisfaction (Brown & Ryan 2003; and include attention to the physical, we did years ago. Repeatedly we find
Dlugos and Friedlander 2001; Guy 2000; cognitive, emotional, recreational, and ourselves experiencing distress, faced
Jennings & Skovholt 1999; Kramen- spiritual dimensions’ (Carroll et al. 1999, constantly with our own helplessness and
Kahn & Downing 1998; Mahoney cited in Gilroy, Carroll & Murra, 2002). inadequate recognition of the limits of
1997; Norcross 2000; O’Connor 2001; Dlugos and Friedlander (2001) suggest what we can do to help clients bear the
Skovholt et al 1997 & 2001). In addition, that for the field to retain motivated, unbearable (Treadway, 1998:57).
an ‘enduring quality in an individual’s competent professionals training The plethora of today’s theoretical
functioning over time in the face of and education programmes need to and clinical approaches can leave many
professional and personal stressors’ was emphasise balance, integration of work of us bewildered and confused about
found(Coster & Schwebel, 1997:11). with the rest of life, and the spiritual the nature of counselling. How do we
Research clarified a sequence of steps and transcendent nature of therapy. sort out what is truly therapeutic in any
taken by therapists when they sensed Their research showed that ‘passionately given case? All these factors contribute
their functioning was compromised: committed psychotherapists’ experienced to compassion fatigue and burnout, and
they asked for help, cut back on case- a strong sense of spirituality. They found we experience these in unique ways.
loads and sought to focus on relaxing that an interest in activities unrelated Sometimes we don’t even recognize
and diversionary activities. Overall the to work as therapists, and attention to the danger signs. Conscious burnout
research information contradicted the spiritual disciplines and development drains us; unconscious burnout is
belief that well-functioning ‘ just happens’. were as crucial, if not more crucial, often taken out on the people we love
These therapists were pro-active in than the pursuit of professional avenues (Treadway, 1998:58). Our challenge is to
their self-care.(Coster & Schwebel 1997 of achievement. do everything to prevent burnout, and
& 1998; Dlugos & Friedlander 2001; Research on the regular use of should it happen, to handle it well when
Jennings & Skovkolt 1999; Norcross spiritual practice, in particular it comes. This involves development of
2000; Skovholt et al 2001). meditation, has shown the following our own survival strategies.
As stated earlier, Gilroy, Carroll benefits: provision of meaning
& Murra (2002) claim that the key frameworks for the human condition; Strategies for prevention
to burnout prevention lies in the beneficial effects on the physical, The following suggestions are drawn
establishment of a professional ethos in emotional, mental and spiritual aspects from Treadway (1998):
which self-care is viewed as a of being; provision of social support
moral imperative: networks and relationships; clarification Don’t go it alone
‘At a systemic level, the inclusion of and development of personal values and Many of us practice in too much
guidelines regarding the practice of self- ethics; enhancement of the capacities isolation. We often feel ashamed
care needs to be incorporated within of self-awareness, self-monitoring and when we experience any of the signs
professional codes of ethics… Other altruism, and the capacity to act on these of compassion fatigue, such as feeling
recommendations include the regular in a realistic manner (Vaughan 1989, inadequate and overwhelmed. Often
provision of continuing education credits 1995a & b, 1999; Walsh & Vaughan, 1993; this shame causes us to retreat further.
for participation in a variety of self-care Walsh 1999; Wilber 1989, 2000; Wilber, Prevention of isolation requires that
activities, such as personal therapy, peer Engler & Brown 1986, Zetter 2003). we have a sense of community - be it

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through a peer group, supervision, of when it is time to go back to therapy. touch our souls, just as we touch theirs.
attendance at conferences and so on. In It is also important to remember the Self-care is essential for stability, and
addition, we need a sense of belonging possibility of medication (which we to do so is to embrace mindfulness and
through family, friends, hobbies and encourage our clients to take), as well compassion towards ourselves. These
other means to ensure that we have a as the wide range of alternative healing qualities allow us to develop an effective
sense of self that is not just based on our methods available, like nutritional presence to the suffering of our clients.
occupation. supplements, herbs, acupuncture and so Such a delicate balance requires constant
forth. maintenance and adjustment because it
Maintain beginner’s mind is common knowledge that the beliefs
Cultivate passionate involvement in Stop for a refill and state of mind of the therapist – both
learning something new, such as a hobby, We need to be mindful of numbing- conscious and unconscious – determine
a sport, a new discipline, a language, a out activities that don’t replenish and to a great extent the nature of the therapy
new therapeutic model and so on. This restore us. Utilise alternatives like and, in particular, its outcome. (Wittine,
relieves us of the burden of having to be exercise, healthy eating and sufficient cited in Walsh & Vaughan, 1993:165)
an expert and gives us the freedom to sleep, plus hobbies that give a genuine It is this appeal to fulfi ll our calling
not know the answers. No matter how recharge. Find your own methods, such in increasingly responsible ways which
experienced and knowledgeable we are, as affirmations, prayer, massage, yoga, reminds us that ‘…the roots of modern
it is always good to have a teacher of journaling, support groups, spiritual psychology lie in spiritual traditions,
some sort as a way to be nurtured and to direction or meditation and use precisely because the psyche itself is
stay ‘open’. Beginner’s mind is not only them regularly. plugged into spiritual sources. In the
a basic stance from which to do the best
therapy, but it is one to incorporate into
the rest of our lives. Remember to let our
clients teach us – they are the experts in Empirical research attests to the negative toll
their own lives.
exacted by a career in therapy. The literature points
Prioritise
Through increased economic fears, we to depression, mild anxiety, emotional exhaustion
work harder for longer hours. However,
we must identify what materialistic and disrupted relationships as the common residue
needs are realistic and essential, as
opposed to what we want. The voluntary of immersion in the inner worlds of distressed and
simplification of our lives is a good
thing to aim for, before it is forced upon distressing people.
us. Richard Gregg eloquently stated a
rationale for voluntary simplicity: deepest recesses of the psyche, one finds
‘Voluntary simplicity involves both You are not ‘It’ not instinct, but Spirit – and the study of
an inner and outer condition. It means Treadway (1998) reminds us that all psychology ought ideally to be the study of
singleness of purpose, sincerity and honesty we require in order to have the healing all that, body to mind to soul …’ (Wilber,
within, as well as avoidance of exterior presence of the Higher Power in our life 2000:ix). This lofty invitation that
clutter, of many possessions irrelevant is to know that we’re not it! Repetition Wilber extends and calls being ‘integrally
to the chief purpose of life. It means of this, or any other prayer, puts us in informed’ in our work, comprises a need
an ordering and guiding of our energy the right relationship with the universe. to be mindful of integrating body, mind
and our desires, a partial restraint in Ultimately, the root cause of burnout and spirit in self, culture and nature. It
some direction in order to secure greater is to lose touch with our own spiritual suggests that we attend to these aspects
abundance of life in other directions. It centre. We all need to connect our of being – not only in our clients, but in
involves a deliberate organization of life individual lives to a pattern of purpose our own selves as well. Self care, in this
for a purpose…’ (Gregg, cited in Walsh & and meaning in the universe, in whatever way, becomes a far more holistic moral
Vaughan, 1993:248). way we understand it. This sense of place imperative. It is only with the ethical
and belonging allows us to continue in intention toward continual development
Therapist, heal thyself’ our daily work, to remember that to be of psychic wholeness based on the
It is the general nature of life that responsive to our clients’ suffering can integration of our body, shadow, persona,
a sense of mastery is elusive and make a difference, and that we are not ego, existential self and spirit that we as
inconsistent. One of the most acute responsible for their lives. therapists can assist our clients to do the
manifestations of compassion fatigue is same.
the loss of confidence in our own work. Conclusion
This can re-activate ‘old’ issues, which In the end, below the theory and
we feel we have dealt with many times technique, being a therapist challenges
before. Many of us resist the recognition us to be open to letting our clients

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References Practice. Vol. 29 (2) April 1998, pp. Treadway, D. (1998) Riding out
130-134. the Storm: A Therapist’s Guide
Brown, Kirk Warren & Ryan, Richard to Surviving Burnout. Networker,
M. (2003) The Benefits of Being Mahoney, Michael, J. (1997) January/February 1998. pp. 55-61.
Present: Mindfulness and Its Role in Psychotherapists’ Personal Problems
Psychological Well-Being. Journal of and Self-Care Patterns. Professional Vaughan, F. (1989). Awakening
Personality and Social Psychology. Vol. Psychology: Research and Practice. intuition. Anchor Books, New York.
84 (4) April 2003, pp. 822-848. Vol. 28 (1) February 1997, pp. 14-16. Vaughan, F. (1995a) The Inward
Arc: Healing in Psychotherapy &
Coster, Janet S. & Schwebel, McLeod, John. (2003) 3rd ed. An Spirituality. Blue Dolphin, CA.
Milton. (1997) Well-Functioning Introduction to Counselling. Open
in Professional Psychologists. University Press, Buckingham, Vaughan, F. (1995b) Shadows of the
Professional Psychology: Research and Philadelphia. Sacred – Seeing Through Spiritual
Practice. Vol. 28 (1) February 1997, Illusions. Quest Books, USA.
pp. 5-13. Norcross, John. C. (2000)
Psychotherapist Self-Care: Walsh, R & Vaughan, F. (ed) (1993)
Coster, Janet S. & Schwebel, Practitioner-Tested, Research- Paths Beyond Ego: The Transpersonal
Milton. (1998) Well-Functioning Informed Strategies. Professional Vision. Penguin Putnam Inc, N.Y.
in Professional Psychologists: As Psychology: Research and Practice.
Program Heads See It. Professional Vol. 31 (6) December 2000, pp. 710- Walsh, R. (1999) Essential Spirituality.
Psychology: Research and Practice. 713. John Wiley & Sons, USA.
Vol. 29 (3) June 1998. pp. 284-292.
O’Connor, Michael, F. (2001) On the Wilber, K; Engler, J; Brown, D. (1986)
Dlugos, Raymond. F. & Friedlander, Etiology and Effective Management of Transformations of Consciousness:
Myrna L. (2001) Passionately Professional Distress and Impairment Conventional & Contemplative
Committed Psychotherapists: Among Psychologists. Professional Perspectives on Development.
A Qualitative Study of Their Psychology: Research and Practice. Shambhala, Boston & London.
Experiences. Professional Psychology: Vol. 32 (4) August 2001, pp. 345-350.
Research and Practice. Vol. 32 (3) pp. Wilber, K. (1989) The Spectrum of
298-304. Skovholt, Thomas M., Grier, Tabitha, Consciousness. Quest, Illinois, USA.
L., Hanson, Matthew R. (2001) Career
Farber, B.A. (1983) Stress and counseling for longevity: Self-care Wilber, K. (2000) Integral Psychology:
Burnout in the Human Service and burnout prevention strategies for Consciousness, Spirit, Psychology,
Professions. Pergamon Press, New counselor resilience. Journal of Career Therapy. Shambhala, Boston &
York. Development, Vol 27(3), Spr 2001.
Development London.
Special Issue: Career centers. pp.
Figley, C.R. (1995) Compassion 167-176. Zetter, K. (2003) Keep taking the
Fatigue- Coping with Secondary Stress meditation. Good Weekend. The
Disorder in Those Who Treat the Skovholt, Thomas, M., Ronnestad, Sydney Morning Herald Magazine,
Traumatised. Brunner/Mazel, Bristol. Michael Helge, Jennings, Len. August 30. 2003.
Searching for expertise in counseling,
Geldard, D. (1993) Basic Personal psychotherapy, and professional
Counselling. A Training Manual for psychology. Educational Psychology
Counsellors. Prentice Hall of Australia Review, Vol 9(4), Dec 1997. pp. 361-
Review
369.
Gilroy, Paula, J., Carroll, Lynne and
Murra, Jennifer. (2002) A Preliminary Skovholt, Thomas M., Rønnestad
Survey of Counseling Psychologists’ Michael H. Learning Arenas
Personal Experiences With Depression for Professional Development:
and Treatment. Professional Retrospective Accounts of Senior
Psychology: Research and Practice. Psychotherapists. Professional
Vol. 33 (4) August 2002, pp. 402-407. Psychology: Research and Practice.
Vol. 32 (2) April 2001, pp. 181-187.
Guy, James, D. Holding the Holding
Environment Together: Self-
Psychology and Psychotherapist Care.
Professional Psychology: Research and
Practice. Vol. 31 (3) June 2000, pp.
351-352. A U T H O R N O T E S
VIVIAN BARUCH is in private practice in Newtown, Sydney and has
Jennings, Len., Skovholt, Thomas,
M. The Cognitive, Emotional, and worked as a counsellor, therapist and group worker since 1981. She has
Relational Characteristics of Master a Bachelor of Arts (UNSW), a Diploma of Naturopathy, a Diploma of
Therapists. Journal of Counseling Homoeopathy, a Graduate Diploma in Emotionally Focused Counselling and
Psychology. Vol. 46 (1) January 1999, Therapy and a Master of Counselling (UWS). She also has trained in Jungian
pp. 3-11.
dreamwork and sandplay, psychosynthesis and stress management using yoga
Kramen-Kahn, B. & Downing, Hansen, and meditation.
N. (1998) Rafting the Rapids:
Occupational Hazards, Rewards, and Comments can be sent to: vivianb@pnc.com.au
Coping Strategies of Psychotherapists.
Professional Psychology: Research and

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