Milton Woolley is a psychotherapist in Sonoma County, CA
caregiver fatigue
nurse burn-out symptoms of compassion fatigue
Milton Woolley MFT counsels men, women and children in Sonoma County
Licensed Marriage
and Family Therapist
MFC #14417
405 Chinn Street
Santa Rosa, CA 95404
7 Fourth Street #52
Petaluma, CA 94952
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Pychology Today


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Are You Vulnerable to Compassion Fatigue?

Milton Woolley, MS, MFT

This article may be helpful to any person who is in a position to offer support and/or services to people who are disabled, aged, dying, traumatized or in chronic physical pain. It is written as if speaking to therapists and professional care givers, however the information included may be applicable to any person who finds him/herself dealing with the issues of human suffering.

Compassion Fatigue is experienced by people who, for an extended period of time, give care to those among us who are suffering. When compassion and empathy are key ingredients in the relationship with others who are experiencing physical, emotional or psychological pain the caregiver is vulnerable to the effects of "Compassion Fatigue."

Empathy and compassion are essential components in the effective support and healing of those one attends. Empathy requires understanding at a feeling level. The way our brain and emotional systems operate we experience the feelings and events described by our client/patients as if we are watching from a distance. When this occurs our sympathetic nervous system is engaged and we begin to develop a "fight or flight" reaction. By making a serious effort to understand the experience of our client/patients, over time, we accumulate tension and in some cases symptoms of secondary post traumatic stress. This occurs because the human brain creates pictures when hearing a story told by someone else. Through our compassion we wrap these images in our own feelings. We begin to defend and protect against the pain we are witnessing by withdrawing our emotional availability. A compounding factor here is that most people who decide to be care givers, for example, therapists, first responders, family members, etc. do so out of a commitment to helping those they work with to have as full a life as possible. When this tension develops these healers feel guilty if they begin to feel irritated with the people they are serving. Without intervention this process becomes a shame bound secret and the person becomes increasingly less available to the resources and connection from others necessary to nurture and refuel themselves.

Eric Gentry, Ph.D., LMHC1 has researched this syndrome and trained professional caregivers how to take care of themselves when they begin to identify the symptoms of compassion fatigue. Gentry describes 5 phases in the development of compassion fatigue:
  • Zealot Phase
  • Irritability Phase
  • Withdrawal Phase
  • Zombie Phase
  • Pathology vs. Renewal/Maturation Phase
In the Zealot Phase, the person is committed, enthusiastic and ready to make a difference. Enthusiasm overflows and difficult situations are seen as challenges to problem solve and overcome.

Signals that one is moving into the Irritability Phase include looking for ways to cut corners, avoiding contact, sarcasm that mocks colleagues and those she/he cares for. One becomes distracted, possibly having daydreams rather than hearing a patient when he/she is talking.

In the Withdrawal Phase, enthusiasm begins to wane toward those one cares for. The patient is seen as less individualized, more objectified and their needs and demands are experienced as irritants. The agitation felt by the care-giver begins to interfere in other close personal relationships. Wariness becomes more prevalent and discussions regarding work occur less often and are often avoided all together. Tolerance and empathy weaken toward loved ones, defensive shields become thicker aiding in the blocking of sadness and pain experienced in their work.

When feelings of hopelessness turn to rage one has entered into the Zombie Phase. If questioned by coworkers and colleagues, strong feelings of dislike develop toward these people. Intense judgments form towards them, even questioning their competency. Disdain is experienced toward patients/clients. Complete loss of humor and an absence of fun occurs.

Without intervention the person's process enters the Pathological/Victimization Phase. The hopelessness reaches a level wherein one wants to leave the profession or care-giving situation. Often somatic illness can develop.

Gentry goes on to describe how these people can rejuvenate and re-establish their love and commitment to their important work. He lists the following as the intervention process that brings healing to the healer:
  • Acceptance
    • Acknowledgment of the symptoms
    • Recognition of the symptoms association with work related experiences
    • Recognition of the need for help
  • Intentionality
    • Develop a relationship with a few trusted colleagues with whom you can be transparent concerning the stories and issues that carry an emotional charge
    • Stop working when work ends and don't take it home with you..... you have done what you can do
    • Make a decision to address and resolve the symptoms
    • Determine the meaning of the symptom: pathology vs. evolution (sometimes this kind of difficulty is an indication of a need for a significant life change)
    • Decide to deepen professional development (continuing education regarding compassion fatigue)
    • Personal development via therapy or other supportive opportunities
    • Systematic self-care (development of outside interests and hobbies)
    • Balance - good diet, exercise 3 times a week, time off work for long restful weekends and vacations
This discussion is far from complete and if you are interested in this topic you might want to visit the Compassion Unlimited website at
1 Compassion Fatigue Prevention and Resiliency: Fitness for the Frontline; Training Manual by Eric Gentry Ph.D., and Anna Baranowsky, Ph.D.: A continuing education training
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Milton Woolley is a psychotherapist in sonoma county