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Compassion Fatigue

Caring too much can hurt. When caregivers focus on others without practicing self-care, destructive behaviors can surface. Apathy, isolation, bottled up emotions and substance abuse head a long list of symptoms associated with the secondary traumatic stress disorder now labeled: Compassion Fatigue.  Learn the symptoms, causes and remedies from this week’s expert Patricia Smith, of the Compassion Fatigue Awareness Project.  

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Show Transcript

Parents Are Hard To Raise® S03 Episode 118 Transcript

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[00:00:37] Caring for others is good. It's what makes us human, and a fully functioning member of society. But is there such a thing as caring too much? This week on Parents Are Hard To Raise... Compassion Fatigue expert, Patricia Smith, talks about the hidden dangers of caring too much.

[00:00:57] Join 180 million monthly subscribers who can now listen to Parents Are Hard To Raise on Spotify.

Diane Berardi [00:01:16] Welcome to Parents Are Hard To Raise. Helping families grow older together without losing their minds. I'm elder care expert, Diane Berardi.

[00:01:26] Patricia Smith is a certified compassion fatigue specialist. As founder of the compassion fatigue awareness project she writes, speaks and facilitates workshops nationwide in service of those who care for others. She presented a TED talk entitled Navigating the Path to Wellness, Compassion Fatigue and Caregiving and has authored several books including the award winning, To Weep for a Stranger, Compassion fatigue in caregiving. Compassion fatigue is not just for caregivers of people, which is why her new book Stress, Compassion Fatigue and Burnout Handling in Veterinary Practice. Patricia Smith welcome to Parents Are Hard To Raise.

Patricia Smith [00:02:09] Well thank you for having me. I'm up here dancing, that music got me going.

Diane Berardi [00:02:15] [laughing] Well, that's great. We love that you're energized. That's great.

Patricia Smith [00:02:19] Yes. Yes. One way to lower your compassion fatigue level is to dance.

Diane Berardi [00:02:23] See. Here we go. So... Could you tell our listeners, What is compassion fatigue?

Patricia Smith [00:02:31] OK I'm going to start by actually reading a very brief definition that was written by Dr. Charles Figley who is the world's leading traumatologist. And this was coined in 1995. He said that so succinctly it's better just to listen to it from the horse's mouth, so to speak. "Compassion fatigue is a state experienced by those helping people or animals in distress. It is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper."

[00:03:05] So compassion fatigue is not that you're just too tired of giving which that may be true too. It is actually a secondary traumatic stress. By caregiving. By being empathetic and seeing people or animals in pain or suffering as compassionate people we open our hearts to that and we try to change it. And we are at risk for compassion fatigue.

Diane Berardi [00:03:26] Now, who is at risk? I mean is it personality? Is it... you know some people it seems can just go about caregiving, you know professionals, some nurses can do it and it seems not be affected and others are.

Patricia Smith [00:03:44] Well the answer to that is two prong answer.

[00:03:48] Number one perhaps they are not at risk because they learn the skills the necessary skills to keep their levels very low. You can also have very high levels of compassion satisfaction which is the joy we get from doing our caregiving work. And the other thing is they may not have the symptoms and what the causes of compassion fatigue. And I can talk to you about those right now if you'd like.

Diane Berardi [00:04:12] Sure yeah.

Patricia Smith [00:04:13] Those of us who have high levels of compassion fatigue are what they call other directed. At some point in our lives in our formative years we learned that putting the needs of others was more important than putting our own needs first. And that is probably the number one thing. And where did this come from? Unfortunately it comes from dysfunction in the family unit. And I always tell my participants you know don't be embarrassed don't be ashamed. We all come from something. But if indeed you were a little one in a family and you became the caregiver of the parents do to sexual abuse, domestic abuse, whatever, you learned to take care of everyone outside of yourself because you were so busy trying to balance everything. So we grow up with this this whole idea in our minds that we are other directed and we take care of others instead of ourselves. And the whole thing about that is if we don't care for ourselves first we have nothing left to give others and we can fall into unhealthy caregiving which brings out this set of symptoms. The other thing is providing service to others with stress or work related trauma. You know, people who are in helping professions are actually being traumatized by the work they do every day. Probably a lack of coping skills. There's a very good chance as little people and we were you know during our formative years we were not modeled good behavior, good financial health, good decision making, good exercise, good you know all of those things that are so important, the standards of self care. And so those are just some of the things. And of course what's really come up lately is these Adverse Childhood Experiences, the ACEs. And that's the unresolved childhood trauma.

[00:05:53] And what we do is we carry that into adulthood and it leaves a big hole in us and that's where compassion fatigue takes hold.

[00:06:02] That makes sense?

Diane Berardi [00:06:03] Yeah. You know it sounds like we should as young children be taught how to self care.

Patricia Smith [00:06:11] Oh this is... This is happening everywhere.

[00:06:13] Our educators are all... I speak to educators all of the time and counsellors. They are overwhelmed because they're being asked to be psychologists, nurses, parents, and they're trying to teach. So what they're trying to do is devise you know classwork that is trauma related so that they know how to take care of these kids, because these adverse childhood experiences create all kinds of symptoms.

Diane Berardi [00:06:41] It's amazing. And I don't know. You know growing up for me. I didn't have any experiences that you were talking about but I think... I don't know if it had anything I mean anything to do with. I'm the middle child.

Patricia Smith [00:06:59] Ah! I'm a middle child as well.

Diane Berardi [00:07:03] And for some reason like I I just have to please everyone.

Patricia Smith [00:07:08] Yes. Yes. And yeah all of that has to do with it. Introvert, extrovert, it all plays a part in whether you're at risk for this or not.

[00:07:18] And my middle son is my middle son is a marine biologist up here and Friday Harbor where I live and sometimes he just comes to me looks at me and says, Remember I'm the middle child. And I say, Yes. So am I.

[00:07:30] And yes. No you're exactly right. Our placement in the family is so very important and our relationship with our siblings is very important. All of these things play a part in this. But mostly it's the trauma. You know it is a secondary traumatic stress syndrome.

Diane Berardi [00:07:47] It's amazing. And you were talking about in 1995 this came out. We don't hear about this today.

Patricia Smith [00:07:57] Well here's what happened. If the psychologists the academics have known about it for a long time, vicarious trauma you know when psychologists and psychiatrists are trained they learn all of this. They know all of these terms.

[00:08:09] But what happens is it doesn't get down to us, to us regular folks. It stays up there in academia, and they know so much about this. And the way I first got into this, actually my background is journalism. I was into college textbook publishing and I wrote for The San Jose Mercury News for 20 years. And I decided after my daughter went off, of my last one was a single mom when my daughter Elizabeth went off to college I decided I wanted to do something with animals because I love animals so much. And I went into shelter work as a training and development manager in a huge shelter in San Francisco Bay Area and I found out about this whole thing, you know what was going on. And I was asked to do a shelter wide training. This was back in the 1990s at the beginning. And when the E.D. asked me to do the training I said I am happy to do it. And I thought I don't know what she's talking about. So I went upstairs and I Googled and what came up with the academic work of Dr. Charles Figley, who was at Florida State traumatology Institute at the time. And I told him I was working with animal welfare people and he said I would be more than happy to help you and so he has been my mentor for the last 20 years.

[00:09:16] The work that I put out there is backed by his work. And I said, What I would like to do is I would like to take all of your information I've worked with academics for many years. I'd like to take your information and put it somewhere where the rest of us can use it. And he was 100 percent for that. And like I said, you know when I when I speak I speak from his all of his studies for the last 40 50 years of his life that he's done this work.

Diane Berardi [00:09:44] Before the show we were talking about family caregivers. And you were talking about the mother daughter relationship.

Patricia Smith [00:09:53] Yeah. I mean when you know all of the helping professions the workers are at risk of psychologists, doctors, nurses, social workers, educators, law enforcement, animal welfare, they're all at risk for this.

[00:10:10] But family caregivers... You have another layer of intensity and emotion. Because you're caring for a loved one. And oftentimes that the end product is not ,you know, not a good one. And where I see it when I work with family caregivers is mother and daughters.

[00:10:25] There's a lot of unresolved issues that happened along the way and now they've got the daughter taking care of the mother or opposite the mother taking care of the daughter and all of these issues surface. All these triggers come out.

[00:10:40] And to me the answer is you've got to have that critical conversation, you've got to talk about it. I mean if certainly the one whose care you know is being taken care of if he or she, excuse me, if she is up to it to talk about it and try to heal some of those old wounds, because it can just be very, very contentious. I mean I have no caregivers that just break down and cry and they say you know I I'm trying to do my best. And I'm not being thanked. I'm not being you know it's a horrible situation and I'm the only one that can take care of her.

[00:11:14] So critical conversations, effective communication. Share your feelings. Be vulnerable, work of Dr. Berne Brown. Be transparent.

[00:11:23] That's what we have to do. It isn't easy. But as time goes on it will help the healing.

Diane Berardi [00:11:29] Now, what do you mean by be vulnerable?

[00:11:32] Be open. I mean, take the first step. Take the first step. Talk about how difficult the situation is. And you know if you really think about it you could talk about the fact that you think there's probably some underlying issues that haven't been resolved.

[00:11:48] Would the person be you know amenable to doing something about that. I think it's the only way you can move on. Otherwise there's guilt and remorse and I regret afterwards. And then you live with that for the rest of your life.

Diane Berardi [00:12:01] Yeah. Because it doesn't end, if...

Patricia Smith [00:12:04] It doesn't end.

Diane Berardi [00:12:05] It doesn't end. Yeah. I was going to say, because if the you know the parent passes away it still doesn't end.

Patricia Smith [00:12:12] No, no. And so yeah I know all of caregiving is difficult.

[00:12:18] I mean there's no... Personally I feel it's a gift.

[00:12:22] And I try to get participants in my workshops and trainings and when I give a keynote to really try to reframe the burden that is caregiving and turn it into a gift. I mean we are fortunate we're called to do that work. We can change a life.

Diane Berardi [00:12:37] That's a wonderful way to look at it. Yes.

Patricia Smith [00:12:39] Yeah yeah. And we can make the passage to the next whatever it is so much easier and peaceful for that person. I mean what a gift.

Diane Berardi [00:12:49] Yeah because you know what we all do, we talk about the burden of it but we don't focus on it being in the gift.

Patricia Smith [00:12:57] Right. Right. And it's all about reframing.

[00:13:01] And then the other thing with family caregiving that I hear a lot is I'm the only one who does anything. My brother won't even come and see my mother. My sister says she can't handle it. She doesn't have time. And you know I went through this with my mom a few years ago and my sister and I are very, very close and we worked on it together. We were with my mother every single day for two years. And my brother, It was hard on him but he was excellent as the executor of her estate. He was excellent at making sure all of that was taken care of. You know that her money was there if we needed something or you know whatever. That was his gift to us. You take care of mom and I'll take care of this so you don't have to worry about it. And that's what I think instead of trying to pull people in where they're so horribly uncomfortable especially mother and son. That's a real rough one. You know find out what that gift is. It may be that you know your brother is a great cook. Maybe he lives close by and he can bring meals every other night. Find some common ground where everyone feels they're doing something to help.

Diane Berardi [00:14:09] And that is the perfect point, because not everyone can do the same thing.

Patricia Smith [00:14:13] Exactly.

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[00:17:47] So Patricia... I have the million-dollar question for you now.

Patricia Smith [00:17:50] Okay

Diane Berardi [00:17:52] So I took the professional quality of life scale. Which is this questionnaire about compassion satisfaction and compassion fatigue.

Patricia Smith [00:18:04] Yes. That is our measurable. That's what we use. Yes.

Diane Berardi [00:18:08] I'm kind of a mess. [laughing]

Patricia Smith [00:18:11] Oh, I don't think so.

Diane Berardi [00:18:16] [laughing] I'm like oh my gosh. Well, my burnout scale is very high.

Patricia Smith [00:18:21] Oh yeah yeah. For burnout. The World Health Organization just named burnout in your workplace as one of the most dangerous things that's going on in the country. And it's like you know we've known about this for decades but now they actually recognize it.

Diane Berardi [00:18:39] Yeah. My compassion, which is interesting... My compassion satisfaction scale was low. [laughing]

Patricia Smith [00:18:51] OK. OK.

Diane Berardi [00:18:53] And I'm like... hmmm.

Patricia Smith [00:18:55] OK, so you've got some work to do.

[00:18:58] Probably not work to do. You probably have some things to think about. I'm not a psychologist. I'm not a psychiatrist. I can't really look at your scores but I can tell you what I know about those things.

Diane Berardi [00:19:10] OK.

Patricia Smith [00:19:12] Your compassion satisfaction... Perhaps you haven't really thought about what brings you joy in your work.

[00:19:19] I think the fact that you do this show and you talk to people and you bring incredible information out to the public would probably be a very high level of compassion satisfaction. Right?

Diane Berardi [00:19:30] That is. You're right.

Patricia Smith [00:19:31] Yeah. I think what you have to do is sit with yourself with a nice cup of coffee or a cocktail, whatever works for you, and start listing those things and become self aware. What is it that makes me continue to do what I do? And I do this all the time with the work I do, because I'm at the age where I am you know could certainly be retired and I have family members say, When are you going to give that up? I can't give it up. It means too much to me. It means too much to go out in the field and talk to all these incredible people who are suffering because of the good work they're doing. And once they you know have a workshop and they become more self-aware they have an aha moment.

[00:20:09] Many have an aha moment when they find out that what they feel and they think has a name, which is what happened to me. It was like Oh... all those years of these symptoms has a name. Now I can fix it.

Diane Berardi [00:20:21] That's right. That's right. Or you think what's wrong with me?

Patricia Smith [00:20:24] You know there's absolutely nothing wrong with you. And there was nothing wrong with me. I just had this particular set of symptoms called compassion fatigue. And there were things I could do to make it better. And I started on what I call the hero's journey the work of Joseph Campbell and started really working on myself and has brought me to a place where my life is a complete joy. I love what I do. I am able to use my what I consider my real talent is my writing to write books and help people and I hear back from them.

Diane Berardi [00:20:54] And that's wonderful.

Patricia Smith [00:20:54] Yeah. So that's my compassion satisfaction. As far as your out I think everyone is burnt out. Yes. We're all just having a real rough time with everything that's going on these days particularly from Washington D.C. doesn't matter what your political leaning is. It's a tough to have time.

Diane Berardi [00:21:13] Yeah.

Patricia Smith [00:21:13] And. And I'm hearing that from you know the helping professions everywhere. So I think there are things you can do for burnout. You know stress is too much. You've got too much coming at you. You got too many people who want things. You go into burnout. All of a sudden it's not enough. You don't have enough time. You don't have enough direction. You don't have enough funding. You don't have enough anything.

Diane Berardi [00:21:34] Right.

Patricia Smith [00:21:34] And there are actual things you can do.

Diane Berardi [00:21:36] What are some of the things you can do?

Patricia Smith [00:21:41] Well first of all for me what I did was I simplified my life. How can I make my life more simple? What have I said yes to that I really need to go back and tell them I'm really, really sorry, But right now I need to pull back. So that you have some room for yourself.

Diane Berardi [00:21:56] And that's a hard thing to do.

Patricia Smith [00:21:58] Oh my gosh, yes. Almost impossible for those of us that are you know caregiving mentality.

Diane Berardi [00:22:03] You just... You feel guilty.

Patricia Smith [00:22:10] Yes yes. Guilt. Shame. Selfish. Those are all things that need reframing.

[00:22:16] And it all it takes work. But I'll tell you the work is worth the outcome. You have to get those old tapes out of there and start thinking new ways. Have affirmations for yourself. Put them where you can see them to remind you who you want to be you know who you actually authentically are and you've gotten off the track. And then you have to ramp up the things that fill you up.

[00:22:39] The rhythm of a healthy caregiver is fill out empty up and fill out empty up and that is all day long. That's not just every two weeks. Going to the gym once a week will not do it. It's a good thing. Keep it on the list, but you've got to do things every single day that fill you up. And it can be... It's very personal. It has to be authentic to you.

Diane Berardi [00:22:57] Yeah.

Patricia Smith [00:22:59] You know if you like to climb mountains find a little mountain to climb. You know as often as possible if you like sitting reading quietly do that. If you like talking to a trusted friend do that walking when ever great is gardening. Find that thing and do more of it because of what you do as you're filling yourself up. And that's that's going to get you healthy.

Diane Berardi [00:23:20] Yeah. Because you know when you think about it I mean a caregiver I think if you you know if you have a piece of paper and you divided what filling up or emptying out, I can just say from myself I think the emptying now is just you know has so many more things on it than the filling up.

Patricia Smith [00:23:37] Exactly.

Diane Berardi [00:23:38] I don't even know if the filling up side has anything on it.

Patricia Smith [00:23:41] Yes. Yeah. Oh boy. I need to come out and spend some time with you. [laughing] No seriously. You are not alone. You're not alone.

[00:23:51] This is what I hear over and over and it can be any helping profession or family caregiver or people who know they have this they say the same thing, "I don't even know what fills me up."   That's the healing journey.

[00:24:04] I used to go on walks and I would look at a flower and I didn't even know if I liked that color or not. And I'd say to myself Do I like the color that I don't know.

[00:24:11] And I start to build a little framework for myself. Yeah. What is it that I do love?

[00:24:16] I love reading. I love writing. I love animals. I love being with the people I care about. I love nature. And that's why I moved up here to Friday Harbor from the San Francisco Bay Area. I needed to be closer to nature. And there was just too much cement everywhere that I was going. And so I made the move and it is improved my life 100 percent.

Diane Berardi [00:24:36] You know I think a lot of us. You don't look inside for the answers.

Patricia Smith [00:24:42] Nope. Healing is an inside job. It doesn't come from the outside. All those things we often think we do to make us healthy are out there. And what we need to do is take time for ourselves. And you know our nation particularly.

[00:24:56] I mean we're go getters.

Diane Berardi [00:24:58] Right.

Patricia Smith [00:24:59] We've been and look at what we're looking at. Tomorrow's the Fourth of July. You know we're doers. Progress is a huge thing.

[00:25:06] You know sometimes it's a sit back and say I don't need to progress this week I'm just going to be who I am and I'm going to drink coffee and I'm going to talk to my friends and I'm going to do my work but I'm going to fill myself up with some things that really make me satisfied.

Diane Berardi [00:25:20] Yeah.

Patricia Smith [00:25:21] Life is so short. It's social work.

Diane Berardi [00:25:23] No that's very true. And you know thinking about you know filling up and emptying out. I mean it's a simple concept, to think about but you don't you don't think about it.

Patricia Smith [00:25:38] Well and that's true because oftentimes when I'm speaking I also know I'm going to tell you something that you're going to say oh she's so simple. Good grief. That's not going to make any difference. You know one of the absolute best things you can do for yourself when you're stressed is take some time to breathe deeply.

[00:25:53] I just came into this about a year ago I used to read about breathing deeply I thought Oh come on. But you know what. It's nature's way of calming us down. And when you're a firefighter or an E.R. nurse or a hospice worker who's about to lose someone and you feel your body just saying oh my gosh you know. The trauma's hitting me. Deep breaths in and out along with mindful meditation. You've probably heard a lot about mindful meditation.

Diane Berardi [00:26:20] Yes.

Patricia Smith [00:26:21] Everybody is using it. It's the only thing. It's staying in the now. It's stay right where you are. And when you're with other people particularly people that have been traumatized and you're trying to be a caregiver for them just being 100 percent present for them and active listening is the absolute best thing you can do for them. They just want to be heard.

Diane Berardi [00:26:41] Yeah.

Patricia Smith [00:26:41] And that deep breathing puts you in a place where you actually can do can do that.

Diane Berardi [00:26:45] Yeah. Are your workshops open to the public for the most part?

Patricia Smith [00:26:51] No. Every once in a while there'll be a conference or something. But 20 years ago when I started the compassion fatigue awareness project I had decided because I was doing other work. I worked in health care. I worked in elder care. You know other things to support myself. I had decided along with my son who who's My webmaster and he's been with me for 20 years on this journey, decided that I would just let it grow organically. And so people will contact me all the time that I want to do what you're doing. How did you do it?

[00:27:22] I don't know what we did. All we did was put up the Web site and then I wrote some books and then I had people start contacting me. We had you know Patricia@Compassion fatigue and they started contacting you know me to speak. And we don't have any money for publicizing. We don't you know do any of that. They find me. And it's been an array of. Interesting caregivers. A few years back I spoke to three hundred and fifty state of Texas hostage negotiators.

Diane Berardi [00:27:54] Wow.

Patricia Smith [00:27:54] These were in San Antonio Texas. These were the folks who were with the Branch Davidians, the David Koresh thing. And they were all still horribly traumatized. A couple of months ago I was in Baltimore I heard from the Enoch Pratt Free Library. And the director there called me. She said, We need you to come out and speak. And I was going to give you four questions, a little survey to find out what exactly are the issues that are causing trauma. Because I thought a library?

Diane Berardi [00:28:20] Yeah.

Patricia Smith [00:28:21] I didn't understand. Anyway she got right back to me and there were things like people show up without their library card. People show up with books that they've written in. People lose their books. So I called her back and I said I think you need a customer service person. I don't think I'm the right person for you. She said, oh no we need you. Apparently what's gone on and this is something I completely missed in the last probably 10 years where it's become a huge issue is homeless, mentally ill, drug abusers use the library as their resting place.

[00:28:51] And it makes sense. Number one. Librarians are caregivers. They want to help them. They want to make it better.

Diane Berardi [00:28:57] Right.

Patricia Smith [00:28:58] It's warm. There's water. There's bathrooms. During the winter there's often a fireplace. And this is where they go. Well they also bring all kinds of dysfunction. That the librarians are not trained to train to do.

Diane Berardi [00:29:12] Yeah.

Patricia Smith [00:29:13] So I said I'm coming out. And it was one of the best sessions ever. I think you know about 100 state librarians and they just poured their heart out. And what they're doing is they're partnering. They're not trying to solve the problems. They're partnering with the firefighters and the law enforcement and the social workers. So when they go in the bathroom and there's someone who's had an overdose, they know who to call.

Diane Berardi [00:29:36] Right. Right.

Patricia Smith [00:29:36] And that's healthy caregiving.

Diane Berardi [00:29:38] Yeah.

Patricia Smith [00:29:39] They're not being called to solve these issues. They're not trained. They are trained to help. So like I said, it's just been a fascinating thing. And whoever calls I go.

[00:29:52] And what is your Web site?

Patricia Smith [00:29:54] It's, www.compassionfatigue.org

Diane Berardi [00:29:58] Well, this was wonderful. Thank you so much for joining us today.

Patricia Smith [00:30:04] Well I'm happy too. And e-mail me if you want to chat about your burnout. [laughing].

Diane Berardi [00:30:11] I know I looked at that score, I'm like, oh my gosh! [laughing].

Patricia Smith [00:30:14] Well thank you for the work you're doing. You're making a difference.

Diane Berardi [00:30:18] Well thank you. And thank you.

[00:30:20] And Parents Are Hard To Raise family, I love getting your e-mails and questions so please keep sending them in.

[00:30:26] You can reach me at Diane at Parents Are Hard To Raise dot org or just click the green button on our home page.

[00:30:31] Parents Are Hard To Raise is a CounterThink Media production. The music used in this broadcast was managed by Cosmo Music, New York, New York. Our New York producer is Joshua Green. Our broadcast engineer is Well Gambino and from our London studios the melodic voice of our announcer, Miss Dolly D.

[00:30:48] We love our parents but parents sure are hard to raise. Thank you so much for listening.

[00:30:54] Till next time... May you forget everything you don't want to remember and remember everything you don't want to forget.

[00:31:00] See you again next week.

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