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Welcome to the Carers’ Hearts blog post.

This week I am exploring what the term ‘Compassion Fatigue’ means in the caring context, why it is important to recognise its effect on your physical and psychological wellbeing and provide some activities to manage and reduce it.

I thought it would be helpful to start with an explanation of what compassion fatigue can be. Although I don’t usually use Wikipedia as a reference source, the other definitions I found were more related to the professional or work environment, but I thought this was a useful broad description:

Compassion fatigue is a condition characterized by emotional and physical exhaustion leading to a diminished ability to empathize or feel compassion for others, often described as the negative cost of caring.

Wikipedia

Carla Joinson (1992) first coined the term to describe the occupational hazard for individuals who encounter stress and trauma in their work environments, such as medics, nurses, mental health professionals, volunteers working with victims of disasters, the military and emergency services personnel. In these contexts, it is sometimes referred to as “vicarious traumatization” or secondary traumatization (Figley, 1995). It can also sometimes referred to as ‘burnout’, however, it signs and potential impact on mental wellbeing are different. In fact, in the caring context, compassion fatigue may be a precursor for carers stress syndrome or carer burnout, discussed in the last post.

However, in more recent years, its potential presence in any working or domestic environment has been explored and recognised as a potential hazard for many others. Even if you are in paid employment, which is completely separate from your caring activities, the caring element of your life is not a ‘job’, as it would be for a social or health care professional, where you would have the opportunity to call in sick, take paid leave or change roles, if it becomes too emotionally draining or you felt that your mental wellbeing was being negatively affected.

Although compassion fatigue is likely to develop as a secondary consequence of the caring role, it neither the less is a real factor that can contribute to unpaid carers developing increased levels of stress and anxiety, due to the negative feelings it can evoke and can even eventually lead to depression, if left unrecognised.

Previously, in my series about ‘Building emotional resilience as a carer’, I explored four of the strongest emotions that can lead to a negative impact on your emotional and psychological wellbeing:

Guilt, resentment, grief and anger

Experiencing all of these emotions, and more, for extended periods, regardless of whether you live with your loved one, or whether you support them remotely or see them less frequently, has the potential to build-up to the stage where it will dampen down your feelings of compassion for them, or at the very least, make it harder to respond with your usual levels of compassion when there is a triggering event, such as your loved one complaining of new pain or illness.

While it can be easy to simplify this reduction in compassion for your loved one as just being frustration or resentment at being at their ‘beck and call’ in what can seem like endless, emotional and physical demands, left unchecked, there is much more to it than that. The cumulative result of days, weeks, months and years of dealing with the sometimes endless emotional and physical demands of being an unpaid carer, can leave you feeling, not just frustrated and resentful of the sacrifices you are making for them, sometimes without recognition or thanks, but can lead to a more overwhelming feeling of hopelessness, isolation and emotional fatigues, which can lead into more serious mental health problems.

A caring relationship is usually founded on an empathic expression of compassion of one person, the carer or caregiver, for at least one other person, the cared-for-person (sometimes this can be for more than one person, such as a caring for a grandchild and elderly parent). Although this relationship might not be symbiotic, as in parent and child, or partner for a lover, there is likely an underlying level of empathy, respect and meaningfulness present in that relationship, certainly at the beginning of the caring journey. This allows the carer to set aside their own needs and dreams, to provide the depth and breadth of care the loved ones needs.

However, this isn’t always the case, as in some caring relationships one of the parties, potentially more often the cared-for-person might have a narcissistic personality, reducing the levels of compassion a carer might start the caring role with, or perhaps just a fractured relationship at the point of when the caring activities begin, however, the carer feels morally obliged to stay and provide care, or at least unable to leave the person because of the new circumstances.

These second type of relationships are much more complex from an emotional and psychological perspective and outside the scope of this article or my experience. However, in a future interview and post we are fortunate to have Caroline Strawson, an expert of narcissistic relationships and how to manage them, outline how, as carers, we can recognise this type of behaviour and share with us some practical activities to reduce the emotional impact.

So, back to how compassion fatigue can creep up on you when you start to experience emotional exhaustion. As with many emotional and psychological conditions, compassion fatigue exists on a spectrum and even if you have been on your caring journey for many years or even decades, it doesn’t necessarily mean that you are going to be at the extreme end of this spectrum, having completely lost empathy and compassion for your loved one. Conversely, it doesn’t mean that because you are the beginning of the caring journey, you are going to be filled to the brim with bags of compassion and empathy. It’s a scale and at any given point you are probably going to be moving forwards and backwards along it, depending on your own mental wellbeing and the circumstances of your caring role.

However, the key is noticing and recognising, when your responses and behaviour to your loved one changes from being, say occasionally indifferent or resentful of their needs or demands; to negatively and potentially emotionally and physically damaging actions, such as yelling, striking out or neglecting them. If, how you are responding to your loved one, regardless of the triggers, would NOT be behaviour that you would expect being shown to you, then it is likely that something isn’t right and is a good opportunity to reflect on, not only your own emotions, thoughts and feelings about yourself but also whether some changes need to be made to the caring relationship, that perhaps only you can make.

Some signs you may notice could be:

  • Feeling overwhelmed, emotionally exhausted and physically drained
  • Avoiding being around your loved one (choosing to work late)
  • Increase in your impatience and intolerance to almost everything they do or say
  • Angry outbursts that are out of character for you
  • Being sarcastic or rude when responding to questions or requests for help
  • A sense of hopelessness and meaninglessness
  • Increased anxiety
  • Impaired ability to make appropriate care decisions
  • Difficulty sleeping
  • Physical symptoms, such as headaches or gastrointestinal issues

Each one of us will have our own limits of tolerance and may experience none, some or all of these symptoms or others not mentioned on this list. As I said before, compassion fatigue is a spectrum and only you will know your own limits. However, the important point is to be present in your life and be aware of your thoughts and feelings in the first instance. It may be that you have the odd ‘bad day’ when you might be ‘snappy’ in responding to a question or off-hand with your loved one when they asked for help. This doesn’t necessarily mean anything is wrong, it may just be down to a bad night’s sleep or, simply waking up in a bad mood, it happens whether you are a carer or not.

However, in the caring context, this isn’t what might be of concern. Compassion fatigue is a systemic absence of empathy and compassion for someone, the care-for-person, which then negatively impacts on your emotional and psychological wellbeing AND your ability to care for them reasonably.  

I have already mentioned in several previous posts, that carers often don’t self-identify in the role, which can mean that they are less likely to reach out for help and support. However, this is a good example of when even if you don’t think of yourself as a carer, if you are carrying out any activities to help or support another person, you need to be your own advocate and think about how and more importantly, who can support you.  

Having a non-judgemental view of the situation, your behaviour and your relationship with your loved one will help you to unhook yourself from negative emotions, thoughts and feelings, and focus on any behaviour that is potentially becoming harmful, both to you and them. If, when you are reflecting on these things, you feel that you have lost sight of the balance between your behaviour and actions towards the cared-for-person, then I strongly suggest that you reach out straight away to your GP or a support organisation, before something happens that you regret.

If, however, although you recognise that you are experiencing less or no, empathy or compassion towards your loved one and that in honestly reflecting on your behaviour, it only falls short of what would be reasonably expected in caring for another person, then the signs are probably there, that you need to accept that you may be experiencing emotional exhaustion and start to focus on your own psychological wellbeing.

In the last post, I shared some great activities and exercises for you to explore and practice in addressing the symptoms of Carers Stress Syndrome or Carers Burnout. All of those exercises are in the reference section below and some are in both audio and written forms, such as the loving-kindness meditation and the 7-11 Breathing Technique.

In addition to these powerful activities, I would also recommend that you think about ‘self-compassion’ as a building block to tuning back into and recognising what compassion feels like, by showing it to yourself. In my first main post on the 17th June 2020, ‘COVID & Caring: 5 Practical activities to support you in a crisis’, I shared three exercises developed by Kristin Neff to help you to explore how showing compassion to yourself, can reduce stress and anxiety. So, please do go back and read that post or listen to the podcast version and I have put the links to her exercises and a few other resources relating to self-compassion in the reference section below.

The final resource I would like to mention is one adapted by an experienced coach, coaching supervisor and trainer, Michele Grant. I was fortunate enough to attend a compassion fatigue workshop with Michele in 2020 and she has kindly given permission for me to adapt one of her exercises in reducing compassion fatigue by helping you to reconnect with your values and purpose. In this case, this relates to the meaning and purpose of your caring role and the exercise explores areas where might benefit from discussing concerns with others, or reflecting on how you are currently feeling, and if you would like to make a positive change to those feelings. I have attached the exercise here and in the reference section below. There are no right or wrong answers, so just go through the questions with an open heart and mind and take the opportunity to reflect and think differently about the current situation and how you would like it to be in the future.

Next month is “March Male Carers Month” and we have a whole month of interviews and workshops, supporting the mental wellbeing of male carers. I will provide more details in a short post next Wednesday 24th February, BUT in the meantime, if you know a male carer, or perhaps a man who might be carrying out caring activities, please share the first workshop with them, which is on Wednesday 3rd March at 12pm and called Stress & the new normal – how to be your own best friend’ and is a practical & evidence-based workshop for male carers, which will provide practical tools to help to reduce stress &  develop new habits. It doesn’t matter if they are at the beginning of their caring journey, currently caring or the active part of the role has now ended, they are most welcome.

Thank you so much for reading this post. We hope you found it interesting and useful, that you can join us again next time and remember, what a special thing it is that you do.

Resource

Male Carers Month – Free Mental Wellbeing Workshop for Male Carers

Compassion Fatigue – When caregivers go beyond burnout

Compassion Fatigue

Mental Health America

UK NHS Mental Health Helplines

Health Direct – Australian Mental Health Helplines

Caregiver Stress

Caregiver Stress Syndrome

Seven Ways to Build Emotional Resilience – Chris Johnstone  (affiliate link)

7-11 Breathing Technique (audio)

7-11 Breathing Technique (written)

Chris Johnstone – Exercise 1 (worksheet)

Chris Johnstone – Exercise 2 (worksheet)

Self-compassion – Positive Psychology Today blog and Kristin Neff’s exercises

Kristin Neff – Definition of self-compassion

Kristin Neff – YouTube video explaining self-compassion

Kristin Neff’s Self-Compassion Exercises – Written

Kristin Neff’s 3 Self-Compassion Exercises – Audio

Loving Kindness Meditation (short audio)

Loving Kindness Meditation (written)

Understanding the Stress Response

Mind – Symptoms of Anxiety

The Short and Long-Term Effects of Anxiety on the Body

Compassion Fatigue Exercise

References

Description of meaning of Compassion Fatigue

Figley, C. R. (1995). Compassion fatigue: Toward a new understanding of the costs        of caring. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues             for clinicians, researchers, and educators (p. 3–28). The Sidran Press.

Joinson, C. (1992). Coping with compassion fatigue. Nursing.  22, 116-120

Music Composed by Michael Coltham – Black Lab Music

Black Lab Music