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Empathy Fatigue: Healing the Mind, Body, and Spirit of Professional Helpers OR From Empathy Fatigue to Empathy Resiliency. Mark A. Stebnicki, Ph.D., LPC, CRC, CCM Professor, Dept. of Rehab Studies East Carolina University The More We Stress Together….

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Empathy Fatigue: Healing the Mind, Body, and Spirit of Professional HelpersORFrom Empathy Fatigue to Empathy Resiliency

Mark A. Stebnicki, Ph.D., LPC, CRC, CCM

Professor, Dept. of Rehab Studies

East Carolina University

the more we stress together
The More We Stress Together…
  • There are discrete, basic, and universal emotions that persons react to on a Mind, Body, & Spiritual level.
  • Emotions involve different body systems which arouse our parasympathetic and sympathetic system.
  • Chronic activation of the nervous system (stress response) has both a physiological and emotional cost.
  • Cumulative effects of multiple client problems lead to a deterioration of the professional’s coping skills and resiliency skills- esp. if symptoms go unrecognized.
a paradigm shift in mental health and the allied helping professions
A Paradigm Shift in Mental Health and the Allied Helping Professions
  • Horrific terrorist attack Sept. 11th (2,996 deaths)
  • War in Iraq (4348 Am Military casualties) Afghanistan (796 Am); 84K Iraqi Civilian deaths (320,000 AM TBI)
  • Tsunami December 26th 2004 (275,000 deaths+)
  • Hurricane Katrina 2005 (70 deaths +)
  • Child Deaths (intentional-unintentional) by gun violence (3,024 deaths/yr)
  • School shooting deaths (323 deaths ‘92-’2007)
  • 4.2 mil worldwide living with AIDS
  • 3.1 AIDS-relates deaths
etiology of disaster



Ice storms

Plane crashes




Workplace violence

Traumatic injury in the workplace

School shootings


Transportation Accidents

Civil Unrest

Etiology of Disaster
native american teaching
Native American Teaching

“Every time you heal someone, you give a piece of yourself away, until at one point you will need healing yourself”

* Shaman or Medicine Man/Woman in many indigenous cultures understood that in healing practices the healer sometimes must takes-on the pain and suffering of others while planting the seeds for transformation.

* Each personal transformation should bring about the necessary experiences for handling the next crisis so the mind, body, and spirit can be transformed.

empathy fatigue ef
Empathy Fatigue (EF)

“ A dynamic state of physical, psychological, emotional, social, occupational, and spiritual exhaustion that occurs on a continuum, resulting from the helpers’ own wounds that are continually revisited by their client’s life-stories of chronic illness, mental/physical disability, trauma, grief, and loss.”

empathy fatigue reactions and impaired professionals
Empathy Fatigue Reactions and Impaired Professionals
  • APA – Impaired Professionals
  • AMA- “Physician Impairment”: “physical, mental, and behavioral disorder that hinders the physician’s ability to safely treat pts.”
  • ACA- Task Force on Counselor Wellness and Impairment
  • American Nurses Association
theory of empathy fatigue
Theory of Empathy Fatigue
  • Persons who work in “high touch” professions are more vulnerable than those that don’t…
  • A natural artifact of working with patients that have intense acute and chronic physical conditions, mental health, and behavioral issues.
  • Many times an unconscious process where the professional and those around them may not recognize.
  • EF is cumulative and ranges on a continuum of low, moderate, and high levels of physical-emotional-mental spiritual, and occupational exhaustion.
the neuroscience of empathy fatigue our emotional brain
The Neuroscience of Empathy Fatigue: Our Emotional Brain
  • There are discrete, basic, and universal emotions that persons react to on a M-B-S level;
  • Emotions involve different body systems which arouse our parasympathetic and sympathetic system;
  • Chronic activation of the nervous system (stress response) has both a physiological and emotional cost;
  • 80% of all physical illness is cause by stress (Kabit-Zinn, 1990; Sapolsky, 1998; Selye, 1976; Weil, 1995)
Why Zebras Don’t Get Ulcers: An Updated Guide to Stress, Stress-Related Diseases, and CopingDr. Robert M. Sapolsky
q why zebras don t get ulcers
Q. Why Zebras Don’t Get Ulcers

Answer: Zebras don’t have cumulative stress

“If you constantly mobilize energy, You never store it; Your muscles waste away; Your vascular system is under constant pressure; and constant Cortisol production turns off growth factors and can harm every system in the body…”

the cost of being a stressed professional
The Cost of Being a Stressed Professional

A study of 27,000 people in 50

different countries found that people with significant stress levels




(2004 Interheart study with 50 participating countries)

the problem with too many unhealthy thoughts perceptions feelings empathy fatigue
The Problem with Too Many Unhealthy Thoughts, Perceptions & Feelings: Empathy Fatigue!!!
  • Excessive, recurrent, and intense emotional arousal;
  • Repeated reactivation of our perceptual-cognitive-affective response;
  • Stored unhealthy thoughts, perceptions, and emotions, become a worn neural pathway which leaves an imprint on our cognitive unconscious and causes a mind-body interaction.
critical pathways
Critical Pathways
  • EF has both an acute, chronic, or delayed onset reaction that ranges on a continuum of low, moderate, and high;
  • Communication (verbal/non-verbal) that is exchanged between clients/patients and professionals during therapeutic interactions are integrated in the professional’s thoughts and feelings and becomes associated as a physical-emotional reaction
the nature of the helping profession
The Nature of the Helping Profession
  • Requires facilitating empathic approaches, cultivating client connections and relationships where we must attend, listen, act empathically to help our clients unfold the multiple layers of their stress, grief, loss, or traumatic experiences by searching through their emotional scrapbook.
  • The search for personal meaning and purpose of our client’s pain and suffering may contribute to the helper’s spiritual fatigue experience.
  • If professional helpers are mindful of this experience, and view this as an opportunity for nurturing personal growth and development, then they will learn resiliency strategies that can help to replenish their wounded spirit.
share your experiences as a professional helper
Share Your Experiences as a Professional Helper
  • How did youchose the helping profession?
  • In what ways are you encouraged or discouraged by your clients’ successes or failures?
  • How is your mind, body, and spirit most affected by intense interactions with others?
  • Describe any self-care you do and how you cultivate resiliency?
ef a combination of other professional fatigue syndromes
EF: A Combination of other Professional Fatigue Syndromes
  • Countertransference: the unconscious absorption of the patient’s issues, involves a type of symbolic or parallel experience of emotional button-pushing. It results in a sense of anxiety, stress, sense of loss, grief, and over-identification w/pt.
  • Compassion Fatigue: An acute stress reaction unhealthy form of countertransference results from emotional, mental, and physical exhaustion.
professional burnout
Professional Burnout

A negative shift in the way professionals view people they serve. A cumulative emotional exhaustion, depersonalizaiton, feelings of a lack of personal accomplishment resulting in a loss of compassion, genuineness, and concern for the patient.

signs of burnout
Signs of Burnout

Feeling …..

Tired and out of energy


Emotionally out of control

Constantly negative thinking

Alone and disconnected




Substance abuse-addiction

summative philosophy of ef
Summative Philosophy of EF

It is not necessarily the nature of the client’s stress, trauma, loss, grief, daily hassles, coping, or disability adjustment that creates a sense of EF for the professional; rather it is the professional’s perception towards that particular client’s; and the helper’s personality traits, states, and behavior that determines the response; which is determined by multiple factors that lead to a diminished capacity to listen, respond empathically, provide competent professional services…

ef risk factor functional assessment
EF Risk Factor Functional Assessment
  • Personality Traits
  • History of MH Problems
  • Maladaptive Coping Behaviors
  • Age and Experience-Related Factors
  • Organizational Factors
  • Job Duties within the Organization
  • Socio-Cultural Factors
  • Person’s Response to Past Events
  • Level of Support
empathy fatigue resiliency quiz 1 not true of me 5 exceptionally true of me
Empathy Fatigue Resiliency Quiz1= not true of me….5=exceptionally true of me

As a professional helper I perceive myself to be…

  • Resilient, adapt quickly to new client issues as they arise, and good at bouncing back after listening, attending, and responding empathically to my clients’ stories all day.
  • Optimistic, perceive that my client can increase their level of adaptive functioning regardless of how difficult their issues are, and I anticipate that things will turn out well for them.
  • Calm and focused while my client’s life is in crisis.
  • A good problem-solver by facilitating appropriate interventions by empowering my client with good resources.
  • Able to trust my clinical intuition and facilitate creative solutions to my client’s stressful life-challenges.
resiliency quiz continued
Resiliency Quiz (continued)

6.Self-confident, optimistic, enjoy healthy self-esteem, and have an attitude of professionalism about my work.

7. Playful, humorous, have the ability to laugh at myself.

8. Curious, facilitate good interventions, have a desire to understand how things work in my client’s life, and consult with others when I need help.

9. Constantly learning from my past mistakes during therapy and from the mistakes that I see others make.

10. Flexible, and feel comfortable with things that are somewhat complex in my client’s life, and can adapt to various client behaviors and personalities.

resiliency quiz continued1
Resiliency Quiz (continued)

11. Able to anticipate when my client will develop specific problems and I have confidence that I will know how to deal with the unexpected.

12. Able to personally deal with my client’s negative or dysfunction life patterns and the ambiguity or challenge this presents in my own life.

13. Non-judgmental, a good listener, possess good empathy with my clients, express my feelings and be able to “read” other people well.

14. Able to recover emotionally from my client’s losses and setbacks, and let-go of negative feelings that I may have and how to ask others for help.

resiliency quiz continued2
Resiliency Quiz (continued)

15. Durable, keep on ticking after tough client sessions and possess a balanced and healthy fighting spirit.

16. Stronger and better after facilitating interventions with difficult clients issues.

17. Able to discover some meaning in my own life at the end of the day, even after hearing multiple client stories of stress, trauma, addiction, anxiety, and depression….

Empathy Fatigue Resiliency Quiz Scoring

75 + = Very Resilient!!

65-75 = Resilient more than most helpers.

55-65 = Slow to rebound- but adequate.

45-55 = Whoa- I’m struggling as a professional.

45 or less = Leave now and seek help!

the resiliency advantage dr al siebert
The Resiliency AdvantageDr. Al Siebert

1. Making conscious choices in life.

2. Power of Positive Thinking.

3. Take responsibility.

4. Internal locus of control.

5. Self motivate yourself.

6. Don’t fear trying-out new things.

7. Take control of your life.

8. Practice positive approaches to life.

cognitive signs of distress
Cognitive Signs of Distress

Loss of concentration, lack of focus

Apathy, lacks meaning

in chosen profession

Preoccupation with avoiding job tasks

emotional signs of distress
Emotional Signs of Distress

Feelings of exhaustion, lack of energy, sleep problems

Emotional roller coaster of highs and lows, feelings of being overwhelmed

Irritability, agitation,

anger, resentment,

isolation, detachment

signs of behavioral distress
Signs of Behavioral Distress

Being on edge, very impatient

Feeling extremely cynical, bad sense of humor

Changes in eating and grooming habits, poor lifestyle management

signs of physical distress
Signs of Physical Distress

Stomach aches,


Shallow breathing,

rapid pulse, heartbeat

Increased illnesses due to lower immunities

interpersonal signs of distress
InterpersonalSigns of Distress

Withdrawal from


Projection of anger or

Blame, increase in inter-

personal conflicts

Poor communication skills with family, personal relationships

spiritual signs of distress
SpiritualSigns of Distress

Loss of meaning and

purpose with self and


Decrease in spiritual

and religious activities

Loss of faith in higher Power, cynical with past faith and beliefs

signs of occupational distress
Signs of OccupationalDistress

Decrease in quantity

and quality of work

Low motivation, avoid

job tasks, increase in


Increase in mistakes

case illustration of mental health professionals
Case Illustration of Mental Health Professionals

“While we were in counselor training, we were always told to “be competent professionals.” No one ever said exactly what that meant, or how to be a mental health professional. I guess we thought it meant being cool and calm under pressure, objective with our clients, and not to get easily rattled by “crazy persons.” But I did get rattled and upset at times- like the first time a client attempted suicide. Somehow I felt responsible and felt a mix of anxiety, anger, and sadness but I would be fighting any expression of those feelings to my colleagues because I knew that this was not the “professional thing to do.”

mh professional continued
MH Professional{continued}

“Everyone else seemed to be handling things okay, which made me feel even worse- like a real failure- like someone who wasn’t cut-out for this kind of work. I didn’t dare say anything for fear people would see out how weak I really was. It wasn’t until much later in my career that I discovered that most everyone else was just as scared, sad, and angry as I was when it came to persons who have chronic and persistent mental health issue are those who have be traumatized”

show up pay attention be open to the outcomes

Pay Attention

Be Open to the Outcomes

solution focus prevention
Solution-Focus Prevention
  • What would this problem situation look like if you were managing it better?
  • What changes in your present situation/life would make sense right now?
  • What would you be doing differently with your problem situation if you were to make the changes you wanted to make?
  • What things have you thought about that would make life better for you right now?
  • What things/feelings in your life would you like to eliminate right now?
  • If you eliminated certain things in your life what would that feel like?
  • When do you plan on making these changes?
the critical stress factor in disease optimizing the healing system dr weil
The Critical Stress Factor in Disease: Optimizing the Healing System {Dr. Weil}

Lack of Energy

Poor Circulation

Restricted Breathing

Impaired Defenses

Toxic Overload


Thoughts, Perceptions, Cognitions

Spiritual Problems

the organization s responsibility in wellness
The Organization’s Responsibility in Wellness
  • Skilled & Competent clinical supervision
  • Mentoring approaches
  • Peer-supervision
  • Shift focus of treatment team meetings
  • Re-structure organizational philosophy to a healthy person-centered wellness
journal writing
Journal Writing

Spontaneous writing

(dreams, fantasies)

Open and honest

Accept whatever comes to mind

Grammar- spelling fagetta-bout-it

Process is just for You

reducing workplace stress it s 15 effort productivity and showing up 85 attitude
Reducing Workplace Stress: It’s 15% Effort, Productivity, and Showing-up - 85% Attitude!
  • Wake up and affirm that you have a job (15.1 mil Americans or 9.8 are unemployed)
  • Leave your house with a heart full of gratitude (may require some morning ritual)
  • Recognize the range of opportunities and be open to all the possibilities that your employment brings
  • As you travel to work be aware of how you cultivate-prepare your mind, body, and spirit for your profession
  • While at work take a moment to be aware of how you are cultivating and preparing your m-b-s for your profession
cultivating preparing m b s for your profession
Cultivating-Preparing M-B-S for Your Profession
  • Be mindful of the toxins you take-in your M-B-S
  • Lunch- an important part of your day- use it wisely
  • Be aware of how you communicate with others throughout your day (verbally and non-verbally)
  • Get good closure with people, job tasks, and organize yourself for tomorrow- leave your work personality and behaviors-at work
  • Get out of your work clothes immediately when you get home and allow yourself to transition into your home environment
  • Brrreeaatthh!!!