Time-limited treatment with multi-problem clients creates work situations that can ignite the fires of unresolved countertransference, and can fan those fires with compassion fatigue and burnout. On a good day, addiction counseling is stressful work. Clients, suffering from the physical and mental ravages of addiction, as well as the traumatic life events that either initiated or resulted from it, seek help. Counselors must accurately diagnose these clients, as well as assess for trauma-related symptoms, all while functioning within stressful work systems.
It is no wonder that countertransference, compassion fatigue, and burn-out can result for the counseling professional. Let's look at a prototypical example. Tom, a seasoned counselor, struggles with the pressures brought on by aging parents, adolescent children, and a job in an addiction treatment center undergoing systemic changes. Tom postpones an overdue vacation to cover for a colleague on emergency medical leave. At the same time, an aging parent with Alzheimer's disease recently has moved in at his home. Also, Tom's son receives a second arrest for driving under the influence and denies that he has a drinking problem. These factors leave Tom particularly vulnerable to countertransference with his younger clients, as well as compassion fatigue and eventually full-blown burnout. A combination of stressful situations at work and at home leaves him with no safe haven.
Defining compassion fatigue
At the heart of effective counseling is the ability to join others in their painful journey and to lend strength to their process of recovery. Professionals' capacity for compassion sets the stage for countertransference, compassion fatigue, and burnout. In a discussion at a Women Healing conference sponsored by Hazelden in 2004, author and presenter Stephanie S. Covington, PhD, defined compassion as “losing ourselves in order to emotionally join with our clients.” Dr. Covington and I have discussed at this conference how counselors' constant surrendering to that “deeper than empathy” level can exhaust them and lead to compassion fatigue.
It is abundantly clear that alcohol and drug counselors must make a conscious decision to protect themselves if they are to survive working in the field, retain their effectiveness with clients, and live a fulfilling personal life. It is likely that counselors such as Tom, who face patients whose lives have similarities to their own, can quickly lose professional detachment if they have not integrated those past experiences. Endless compassion combined with personal and professional stress can destroy a counselor's optimism, diminishing the belief in the human spirit's resiliency. When counselors pull up to park at work, they have to remember that they are entering a danger zone where countertransference, compassion fatigue, and burnout can, if ignored, grow from a tiny acorn into a full-size oak.
Figley defines compassion fatigue as the convergence of primary traumatic stress, secondary traumatic stress, and cumulative stress/burnout.1 It is a state of tension and preoccupation with the individual or cumulative trauma of clients that is manifested by the reexperiencing of traumatic events, avoidance/numbing of reminders of the traumatic events, and persistent arousal. When compassion fatigue is combined with the effects of cumulative stress, burnout results. Counselors with their own personal histories of violence and trauma have an increased susceptibility to compassion fatigue.
Post-traumatic stress disorder symptoms of intrusion, avoidance, and hyper-vigilance combined with burnout symptoms of exhaustion, cynicism, and inefficacy deplete the counselor in the throes of compassion fatigue. Tom was particularly vulnerable because his son's behavior was reminiscent of behavior in Tom's adolescence, which opened him up to countertransference. Along with this stress at home, Tom's job situation created fertile ground for compassion fatigue to grow into burnout. Accepting that compassion fatigue must be guarded against, and that self-care is essential to the counselor's prevention plan, offers a step in the right direction.
Understanding burnout's dynamics and relationship to compassion fatigue and countertransference constitutes a tool in the counselor's burnout prevention plan. According to Maslach and Leiter, burn-out is a prolonged response to chronic emotional and interpersonal stressors on the job.2 Twenty-five years of research have validated that burnout results from the individual's stress within the larger organization. Experts contend that personal isolation, ambiguity surrounding success in treatment, and the emotional drain of remaining empathetic enhance counselor vulnerability.