The Empty Well: Compassion Fatigue and Burnout in Caregiving
If you have been a caregiver (care partner) for any length of time, you have probably either experienced or know someone who has experienced compassion fatigue and/or burnout. It can look like: irritability, rushing through care duties without seeming to see the person/people for whom you’re caring, lack of sleep, feeling trapped, focus on end results rather than people, being overcome with sadness, and high sensitivity to change or criticism.
What’s the difference between compassion fatigue and burnout?
Sometimes compassion fatigue is defined as a more rapid and reversible form of burnout and burnout is thought of as a longer process. However, I think compassion fatigue can also be thought of as a rung on the ladder to burnout. We don’t naturally have a limited supply of compassion, but what is limited is our ability to hold the pain, loss, grief and fear of others without support and without an outlet.
We all have our own pain, our own loss, grief and fear which can be hard enough to carry. If we don’t have compassion for ourselves, our compassion for others becomes limited. It hurts to see others in pain day after day. It’s hard to confront death and to see others confronting it every day. And it’s hard to watch others grieve. So, what happens when we see these things every day as professional care partners or as carers for loved ones in the home? If we don’t have anyone to talk to about it or we don’t have time to think about it, we have to find some way to survive. So, we numb. We get tired. Our hearts get tired. And we gradually stop feeling: we don’t want to let the bad in. But guess what? We can’t stop the bad without stopping the good, too.
“When I turned by back on the devil, I turned by back on the angel, too.” - Leonard Cohen
When we numb the bad, we numb the good too. The result is a care partner/caregiver who seems cold or hardened. Someone who doesn’t see a person in front of her, but a duty or set of tasks. Someone who starts to find it hard to laugh or feel joy. And at that point, burnout is just a few steps away. Complete burnout can often include: making big mistakes with medication or other duties, burning bridges with co-workers, blow-up arguments, and even worse, abuse and neglect of the person for whom you’re supposed to be caring.
What Are the Causes?
The contributing factors leading to compassion fatigue and burnout can vary between professional care partners working in hospitals, senior communities and residential treatment settings, and those caring for a loved one in the home.
Professional Caregivers/Care Partners
For professional care partners, the environment of the settings in which you work plays a big role. Does the company for which you work invest in ongoing training and mental health support for its employees? Or is it a competitive environment where quantity and product are valued over quality and process? For example, are you told how important it is to provide individualized care, but then feel you are penalized for not getting enough tasks done during your shift when you try to slow down to provide that level of care? Many companies have noble intentions, but in a for-profit business model, profits often win out over quality of care. Part of this pattern is due to a lack of focus on the mental and emotional impact caregiving has on a person. Of all the trainings you’ve had in the course of your career in caregiving, in how many of those trainings have you been asked to talk about what it was like for you to be with people in some of the hardest times of their lives? How many of the trainings focused on offering you ways to cope with stress? To communicate with your fellow employees more effectively? On how to ask for help? And is asking for help seen as a sign of strength by your organization or a sign of weakness? Is vulnerability modeled by your leadership team or do you feel intimidated by leadership in your organization?
Other factors contributing to burnout might be the stressors you are already facing outside of work. Caregivers/care partners are often caregivers at home. Do you do everything for your family at home, too? The dishes, laundry, ensuring homework gets done?
You might or might not feel that you are able to effect change in your organization, but you can effect change in your own life. How? By seeking individual or group counseling with a therapist who understands caregiving/care partnering, by learning new ways to care for yourself, and/or by reaching to people in your life that you trust and letting them know what you’re going through.
Those Caregiving at Home
For those caring for a loved one in the home, the causes of compassion fatigue and burnout are a bit different. I’ll share a few common themes I hear from clients. One is expectations. Sometimes we expect that our loved one will be grateful for our care and that our relationship with our loved one will deepen as a result of our caregiving. What happens when our elderly parent does not show gratitude and is instead often angry, irritable, withdrawn, sad, depressed or anxious? What if instead of our relationship deepening, our parent seems lost in regrets about their past and seems to want to talk only about their own life? What often happens is that the caregiver is left feeling unappreciated and hurt. The caregiving adult child may find it hard to understand why their parent would want to “waste” their last years this way and may feel pulled to fix their parent. And trying to fix someone is often a surefire path toward compassion fatigue and burnout.
Another possible cause for burnout for those caring for a loved one, is loneliness and isolation. For those caring for a spouse with dementia or Alzheimer’s disease or for a child with chronic disability or terminal illness, the job of caregiving only ends when our loved one dies. And no one knows when that will be. There is pain and suffering and no end in sight. If you don’t find space and time for yourself as a caregiver, while you may not lose your compassion, you will burnout. This may look like coldness or explosive anger, but it could also come in the form of a sudden heart attack, headaches, digestive issues, a major depressive episode or panic attacks.
Preventing or Healing Compassion Fatigue or Burnout
One of the first things you can do that can make an immediate impact, is to evaluate the time you spend taking care of yourself. This includes: sleep, food and water intake, exercise, and time spent socializing or participating in pleasurable activities.
Why You Can’t Sleep and How to Fix It
And sleep is at the top of the list for a reason. Click here to learn why. How much sleep are you getting per night? If it’s 3-4 hours, that’s a huge red flag indicator that burnout is not far away. There is a reason you’re getting such little sleep and it’s not because you just don’t want to sleep, so this might take some work to figure out. If you aren’t sleeping because the person you’re caring for is also not sleeping and you are fearful for their safety, that is very different than not being able to sleep because you are plagued by the anxieties from the day. You may have to look into asking someone in your support network for help: a family member, close friend, etc. Someone who can come to relieve you for an evening or two a week or who can sit with your loved one so that you can take a long nap in the morning or afternoon. Or, if you have the financial means, there are in-home caregivers and respite care options to give you a break. Medicare covers some services and in some states (Colorado included) there are additional assistance programs that can also help with costs. If anxiety is what prevents you from being able to sleep, you may have to look into ways to improve your sleep hygiene and/or give mindfulness meditation practice a chance. Sleep needs to become a priority.
Fuel Your Body
When it comes to eating and drinking water, many of my clients have found setting reminders on their smartphones helps them remember to eat and drink more often throughout the day. If cooking meals every day is too overwhelming, can you try buying things you can cook in bulk or grab quickly, like soup and crackers, cut veggies with peanut butter or hummus? Could you make up a bunch of small sandwiches and wrap them individually so you can grab and go? If you have older teens or kids in the house who can help, it’s time to ask them to do so. If you have siblings who live in the same city, it’s time to ask for help. Sure, they might be busy, but so are YOU. And you’re not just busy, you’re drowning. Saying so doesn’t make you weak or a burden. It makes you human. When we admit we need help, we show others that it’s ok to need help. You might be hoping others in your life will just offer to help you—that they should know you need it! But…to those on the outside, you look like you’ve got it covered. Us humans, we’re really bad at mind reading.
Move Your Body 10 Minutes a Day (or More)
Once you’re getting more sleep and you’re making time to eat regularly and drink water, you can start to think about getting a brisk walk or bike ride or some other kind of activity into your routine. It doesn’t have to be hours of exercise every day to “count.” Think of exercise as just making time to move your body every day in a way that jump starts your brain and gives your anxieties and irritations a place to go. Because that’s what anxieties need! Anxiety, irritation and anger are often felt in the body as a restlessness or abundance of energy that feels trapped. And that’s because those emotions release chemicals into our bloodstream that are meant to see us through physical peril. They are meant to help us overcome physical danger, but in our modern world, they more often arise when the “danger” is emotional or mental. And if we aren’t able to act on anxiety or anger by yelling or kicking something (which just make things worse anyway) those chemicals just sit there in our bodies as we try to sleep at night. But if you can get out and walk, jog, do some jumping jacks, dance, hike or whatever it is you can do for 10-20-30 minutes a day, you’ll give those emotions and all that energy a place to go. Again, you might have to get creative. If you are caring for a loved one with dementia, can you take them with you on a walk? Or can you provide an activity for them to do in the backyard while you jump rope or do a dance workout on your laptop nearby? Or, while the person for whom you’re caring is watching television or napping, can you do a quick, 10-minute workout that doesn’t require anything but your own body weight?
Reconnecting with What Makes You, You
Until you can get some rest and figure out ways to meet your other basic needs, it can seem like an impossible goal to find time to socialize or get back to other pleasurable interests. But once they’ve got those basic needs met, many of my clients have found they have the mental space for hobbies and socializing. Again, many times it means getting creative and doing things differently based on your caregiving duties (as well as meeting COVID safety guidelines). Instead of meeting a friend for coffee at your favorite local spot, it might mean inviting them over to your back yard for morning coffee. Maybe they bring their own and you have yours from home. Or if you and some friends enjoy playing instruments, try facetiming or using some other video chat program to have a virtual jam session. I have even heard of crafters meeting virtually to chat while they work on various projects. For you, this could mean reading a book, taking a bath, calling a friend or making a favorite dessert.
Again, you don’t have to think big. Social time and hobby time can be 20 minutes a couple of times a week. Whatever is doable. But do it, you must! You’re a caregiver, yes, but you’re a human first. If you don’t replenish the groundwater, the well has nothing to pull from. Your basic needs as well as your emotional, social and spiritual needs are all necessary to sustain your life.
You are important and you are needed. But you have to show up for yourself, too.
When Might Counseling Be the Next Best Step?
We often wait until a crisis happens before we consider counseling. It’s as if we can’t justify the luxury of doing something to help ourselves until it’s almost too late. In reality, whether you’re a professional care partner or you’re caring for a loved one at home, counseling can help at any stage. Early in a career or caregiving role, working with a counselor who understands caregiving can offer guidance on what you can expect, specialized tools and strategies for addressing common problems and coping skills for caring for yourself on this journey. Counseling often becomes more critical when you are already experiencing compassion fatigue or burnout but this is often when it feels least like you have the time or energy to research counselors or fill out more paperwork to get started.
Unlike professional caregivers, if you are caring for a loved one in your own home, you likely aren’t getting a break from this work at all. And if you don’t have a support network, or (due to COVID) aren’t able to access that support in the same way, your risk of compassion fatigue and burnout may increase. But given you aren’t getting a break, when are you supposed to see a counselor or go to a support group? Well, one good thing that has come about during the COVID-era is the option for online support groups and online counseling. Can you join for an hour to hour and a half with other caregivers to talk about your experiences and to support one another? Or set aside an hour for an individual therapy session? I work with some caregivers who really can’t set aside an hour, but they can manage a 20-minute morning session and 20- minute evening session.
A New Era Requires New Options
Sometimes providers have to get creative and we have to rethink how to meet our client’s needs in new ways. If you find a counselor online that you think you might want to work with, it never hurts to ask if they would be willing to get creative with their treatment delivery. I have even had clients with whom I work via email some weeks. Clients can share about their experiences and emotions from the week and I can offer insights, ideas and tools for ways to address conflicts and ways to reduce the stress of caregiving. Some clients have offered that simply the act of sitting with, thinking about and sending off their email has helped them to better understand their experience. Email is not a preferred method of treatment for many reasons, one of which is security, and though I use a “safer” email delivery system, we do have to weigh the risks and benefits. But I am of the belief that when we need support, we have to look for it in creative ways.
For Professional Care Partners & Other Frontline Workers
Like other counselors that work with professional caregivers, I offer supportive, group and individual counseling options. Group counseling offers an affordable counseling option by spreading the cost of therapy out over a small group of participants, but is also a wonderful compliment to individual therapy. Imagine finding a small group of 6-8 other caregivers from different industries/organizations who really know what you’re going through and who want to hear your struggles. Together, you’ll talk about your experiences and you’ll learn new ways to cope with the stress, the sadness, the fear and the expectations of your job. All in a confidential setting.
For Those Caring for Loves Ones in the Home
Group counseling options are also available for at-home caregivers and offer the same benefits of group counseling for professional caregivers. You will find a space where you can share, without fear of judgment, your fears and frustrations. You can also share with one another what has worked and helped and can support one another on this care partnering journey.
Taking the Next Step
Click here to schedule a free, 15-minute consultation. And, if you haven’t heard it lately, thank you for the care you are giving. It may feel unseen, but it is seen. By your neighbors, the people or person for whom you’re caring, your family, co-workers, strangers you pass, doctors, nurses, etc. And the patience and kindness you show is felt in those moments and offers an example to us all. And when others see the irritation, impatience, and sadness you feel, may they offer help and care to you in return.
Denver-area Resources for In-Home Help, Respite Care Options, Veterans Benefits, and More
In-Home Caregiving Services that also offer Respite Care Options
BrightStar Care (Offering services for children, adults and seniors)
Veterans
Veterans Benefits for Longterm Care
For Caregivers of those with Alzheimer’s or another form of Dementia
The Colorado Chapter of the Alzheimer’s Association (offers training classes, support groups, and a 24 hour helpline to answer just about any question or concern you may have from the financial to the physical symptoms, to tools and tactics for all sorts of caregiving questions)
*I will be updating this resource list periodically, so bookmark or join my mailing list if you’d like to receive updates.
