Compassion Fatigue

This is an article that was first published in the Canadian Psychological Association communication, Psynopsis.

First responders have a job that is very demanding both physically, mentally, and emotionally.  I am not a first responder; the majority of my role involves individual and group counselling for post-secondary students.  On occasion there is a need for critical incident stress debriefing when the campus community is faced with an extenuating circumstance.  Part of my professional development involved participating in an Overcoming Compassion Fatigue workshop facilitated by Francoise Matthieu.  Following this introduction to compassion fatigue I became increasingly interested in the topics of health and wellness.  Babette Rothschild in her book “Help For The Helper” outlines how principles like neurobiological attunement and structures like mirror neurons are activated in response to bearing witness to human suffering.  She goes on to describe how providing care to others has the potential to slowly erode our ability to be empathic unless we are attentive to our own wellbeing both during and after providing care.


I recently had opportunity to provide a keynote address and a half day training on the topic of Compassion Fatigue in Winnipeg, MN for the Paramedics Association of Manitoba.  It was certainly a timely request from the organization to provide training for first responders stemming from the growing awareness that the work is quite challenging.  The presentation is focused on distinguishing the difference between burnout, compassion fatigue, and vicarious traumatization.  Burnout is something that can occur in any employment and stems from work demands that exceed capacity (ie: accountants during tax season).  Vicarious trauma is a term that highlights the fact that witnessing a traumatic event can result in symptoms of post-traumatic stress for the care provider.  Compassion fatigue refers to the “ninety-nine” that are not immediately in memory as opposed to the one that is impossible to forget.  Compassion fatigue is recognition of the fact that, while it is unclear where the images and stories go, there is an impact of providing care over time.


Compassion fatigue is a construct that can be assessed.  Individuals can complete a Compassion Fatigue Self-Test known as the Professional Quality of Life Inventory (Proquol) developed by Dr. Beth Stamm and Charles Figley  Francoise Matthieu has also made this instrument available via an email auto responder.  If you email you will receive the Proquol in a very easy to use self-scoring Excel file format.  The instrument measures not only compassion fatigue but also compassion satisfaction noting that it is the most caring who are most susceptible to developing compassion fatigue and vicarious trauma.  Interestingly there is also some suggestion that an increase in compassion fatigue generally correlates with an increase in the quantity and quality of work.  While this may seem counter intuitive it may be fitting in that an individual will attempt to work more in order to generate compassion satisfaction.  Unfortunately the eventual result is further erosion of empathy and decrease in overall wellbeing.  This trajectory is summarized nicely in a short video produced by a paramedic who evidenced signs of compassion fatigue and began to self-medicate using substance


The most important part of any discussion about Compassion Fatigue is exploring protective factors.  While it is important for individuals to be aware of their own unique risk factors and vulnerabilities it is even more important to be empowered to grow in awareness regarding what can be done to mitigate compassion fatigue.  This shifts discussion toward the topic of maintaining wellness through healthy lifestyle.  When care providers are doing a good job of taking care of themselves they are in a much better position to be able to provide care.  Self-care can be represented in many different forms but often divides up into active and passive strategies.  Active strategies include activities such as exercise, socializing, art, and music.  Passive strategies include things such as relaxation, meditation, prayer.    Maintaining an effective work/ life balance is elusive but is something that each one of us should be reflecting on and striving toward in order to promote our own wellbeing with a view to providing quality care.


Rothschild, Babette (2006). Help For The Helper: The Psychophysiology of Compassion Fatigue and Vicarious Trauma.  New York: WW Norton & Company.


Stamm, B. Hudnall, Ed. (1995).  Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators.  Baltimore, MD, US: The Sidran Press.



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