I keep hearing that what I do is not who I am and that if I confuse the two, I place myself at risk for burnout or compassion fatigue. I recently had a very serious family medical emergency that was miraculously resolved, and as a result of this life-changing event I began reading a recommended book entitled The Myth of Tomorrow: Seven Essential Keys for Living the Life You Want Today, by Gary Buffone, PhD. I believe that the book's main idea of reclaiming what is most important in our lives, living in the moment, and making the decision to have the life we really want is excellent advice. Buffone exhorts the reader to find a purpose in life. He tells stories of people who have had traumatic or near-death experiences or are facing death and as a result have recognized that things (such as career, status, work, money, and roles as boss, parent, or spouse) pale in comparison to developing greater love and acceptance of self and others, and identifying and achieving one's purpose.
In Charles R. Figley's Figley Model Guide to Assessment and Treatment of Compassion Fatigue, indicators of vulnerability to compassion fatigue include empathic concern as the motivation to respond to people in need; empathic ability that enables us to notice others’ pain; and empathic response to others’ suffering. Sorry, Dr. Figley, but I want to keep my empathic concern, my empathic ability, and my empathic response!
Role as helper
I began to think about my situation and realized that “what you do is not who you are” did not quite seem to fit for me, and possibly for others. I am a helper. That is what I do and also part of who I am.
I have been working in the addiction field for more than 45 years. Some years I made a lot of money (at least by my standards) and some years I barely got by. Some years I was in a position of power and at other times what most characterized my situation was my powerlessness. Money is nice and I like it, but it has never been a driving force in my life. So what am I to give up in order to identify and achieve my purpose?
I realized that the driving force in my life is the need to make a difference. But for all of us who work in addictions, we understand that frequently our best efforts with patients don't seem to make the difference for which we had hoped. Logically, that would result in a blow to self-esteem, and if it happened frequently enough it could lead to burnout. But then I wondered, “Why wasn't I burned out?” My own perception, reinforced by others who have known me over the years, is that I am more energized, more enthusiastic, more passionate, and more inspired now than earlier in my career. What accounts for this?
I think I have found the answer. Like many/most people working in the field, a significant if not the primary motivating factor is our desire to create change (e.g., helping actively addicted persons achieve recovery). The problem lies in how we measure that change. While each of us has been able to help some patients recover, our overall rate of success—particularly for patients’ first treatments—is nothing to brag about. Because addiction is a chronic, relapsing disease, if I measure my success by looking at the outcome of achievement of sobriety by my patients or their avoiding relapse as a result of my treatment, my self-image is going to take a major blow. Said another way, if my self-image depends on the eventual outcome of treatment, I am in serious trouble. But by the same token, if my patient makes an incremental positive change in his/her journey to recovery, this is an outcome I can feel good about. Why would people work in a hospice facility knowing that their patients are going to die?
Shifting the focus
What if I measure the progress toward my purpose in life not by outcomes that I cannot control but by processes that I can? Do I continually try to enhance my skills as a clinician, trainer, and consultant? Have I kept abreast of the latest evidence to help me do what I do? Do I work collaboratively with colleagues? Am I open to changing my beliefs in the face of evidence to the contrary? Have I done all that I can to make a difference, regardless of the eventual outcome?
In all of this I must remember that I am merely a change agent and don't have the power to bring about recovery in a person suffering from addiction. In fact, I have to consider that doing all that I can is the outcome. Returning to the hospice scenario, the outcome is not changing the eventual outcome, but making the journey less arduous.
I am reminded of something I found on the Internet (author unknown):
A man walking on the beach became aware of a young woman picking up starfish from the sand and gently tossing them back into the sea.
“What are you doing?” the man asked.
“The sun is coming up and the tide is going out; if I don't throw them in they will die.”
“But young woman, there are miles and miles of beach with starfish all along it—you can't possibly make a difference.”
The young woman bent down, picked up another starfish, and placed it lovingly back in the ocean, past the breaking waves.
“I made a difference for that one,” she replied.
For me, then, the driving force in my life, the “who I am,” is what I do. Frankly, I do not want to change it.
Gerald Shulman, MA, MAC, FACATA, is a trainer and consultant who has also been providing or supervising the delivery of care for alcoholism and drug addiction since 1962. He wrote on integrating pharmacotherapy with treatment planning for alcohol dependence in the July/August 2007 issue. He can be reached at