July 2017
Self
Care by Dr Elizabeth McCardell, M. Couns., PhD
I care about you. How often have we who care, heard this said to us? I
suspect, not often enough. And yet hearing it is medicine for the soul. It is
pretty hard working in the caring professions (nurses, doctors, paramedics,
counsellors, psychotherapists, psychologists, social workers, vets, etc) without
receiving some gentleness and care words, or even just someone to hear what we
have to say. We tend to push on doing what we feel we must do, even when we begin
showing signs of compassion fatigue, or its more chronic form, vicarious
traumatization, which is the cumulative effect of an a more than empathic
engagement with our client’s traumatic material to the point of feeling really
hurt ourselves. We sometimes care a bit too much and for too long. Empathy is
our greatest asset as well as possibly our greatest liability.
Compassion fatigue may not
become chronic and may not bleed into feelings of vicarious traumatisation and
may not eventuate ultimately in burnout, if we ask for help early and practice
necessary self care. Burnout is literally a feeling of running on empty. It is
characterized by exhaustion, depersonalization (which is disengagement or
detachment from the world around us) and lessened feeling of self efficacy.
Compassion fatigue is like a sort of catching of the other person’s
emotions as we might catch their flu infections and in this vulnerable state we
risk over-identifying with them and may seek to rescue or protect them beyond
the calling of our jobs, on the one hand, or avoid them altogether (thus not
doing our job properly). Absenteeism, low morale, job dissatisfaction,
depression, nightmares, intrusive imagery, irritability, difficulty forming
intimate relationships, high levels of stress, and, sometimes, substance abuse
are all signs of empathy gone to the point of profound fatigue.
I’ve known a few people (counsellors, doctors, paramedics, etc) who have
chronically over cared to the point of vicarious traumatization and, actually, burnout. These are people
who pushed themselves just too far to the next client in need (and maybe they
forgot they are human), without a break, without asking for help, without
practicing any self care at all. Their capacity to do their job just wasn’t
there anymore. Now some cannot work at all, while others have pushed on still and
now teach their profession. The lecturer in trauma counselling at the University of Notre Dame,
Fremantle, where I did my Master of Counselling degree those several years ago showed all the
signs of burnout. He was so strung out that he lived on a diet of Coca-Cola and
black coffee and cigarettes, despite recent major heart surgery. He talked fast.
without intonation, without engagement with us, like a dead man talking.
We do not need to get to the point of overload. We can learn to manage
our work-after work life so that we do not succumb to compassion fatigue and
the more intransigent vicarious traumatization and burnout. One of the ways is
to seek counselling not only when we are feeling fragile, but as a regular
component of our working life. This
shouldn’t be seen as a luxury, but as a necessity. Getting counselling, or the longer term psychotherapy, is
entering a safe place where what is said isn’t disclosed to anyone. This is a
confidential space where strategies for coping are learned, but more than this,
here is somewhere to simply say the things that need to be said and be heard by
someone, like myself, who cares.
Work-related stress in high empathy occupations has a physical impact on
us as well as an emotional impact and self care therefore needs to have a physical component as well.
Cardio exercise, swimming, qi gong, yoga, dance, music making, and a nutritious
clean diet are good. Practicing the quiet of meditation, mindful contemplation,
slow walking in nature, gardening, massages and smelling flowers may nourish
us.
Let us not forget ourselves in the caring dynamic. Caring for others,
needs to begin with self care. In this way, we can maintain throughout our
working lives, the sense of purpose that got us into the caring professions in
the first place.
