May 13th, 2020

Helping the Helpers to Overcome Compassion Fatigue and Burnout

Josephine Ferraro, LCSW, SEP

Compassion fatigue and burnout are real challenges in the helping professions, which include psychotherapists, counselors, pastoral counselors, doctors, nurses, physicians assistants, social workers, hospice workers, and other professionals that are part of the healthcare and helping professions (see Managing Your Stress: What Are the Telltale Signs of Workplace Burnout? and The Consequences of Workplace Burnout).

Helping the Helpers to Overcome Compassion Fatigue and Burnout

Many people in these professions are so devoted to their patients and clients that they put themselves last in terms of getting the emotional support that they need.  They often don't engage in the kinds of self care activities that would help to calm, soothe and help them to feel replenished . Even before the current crisis, historically, helping professionals often neglected themselves to serve others. While this might appear to be noble, these professionals often need more emotional support than most other professionals because they're often containing the anxiety and emotional needs of the people they're helping, and their burnout rate is high.

What is Compassion Fatigue?

Compassion fatigue is emotional and physical exhaustion for those in the helping professions who deal with their patients' problems.  When an individual experiences compassion fatigue, they often withdraw emotionally from their patients because they're too exhausted to continue.

What Are the Symptoms of Compassion Fatigue?

Helping professionals often don't recognize the signs of their own compassion fatigue or burnout because they're so busy taking care of their patients. The following is a list of symptoms for compassion fatigue:

  • Emotional exhaustion

  • Physical exhaustion

  • Insomnia 

  • Irritability

  • Anxiety

  • Depression

  • Apathy

  • Depersonalization: A state in which one's thoughts and emotions feel unreal

  • Feelings of shame and self contempt

  • Feelings that they're being treated unfairly

  • Poor job satisfaction

  • Chronic aches and pains, including headache, backache and muscle tension

Fictional Clincial Vignette: Helping the Helpers With Compassion Fatigue and Burnout

The following fictional vignette illustrates some of the typical problems experienced by helping professionals with compassion fatigue and burn.  It also addresses how psychotherapy, including online therapy, can help.


From the time Nan woke up in the morning until the time she went to bed, she was on the go.

When she woke up in the morning, she had about 10 minutes to herself before she got her children off to school, made her husband, Tom, breakfast, and sat down to a quick cup of black coffee before she headed off to the hospital where she was a nurse.

By lunchtime, she was starving, but there was so much to do that she often didn't take a lunch.  During the time that would have been her lunch hour, Nan spent time doing what she loved best--talking to the patients and their families. This was the part of her job that she derived the most satisfaction from, and she knew that the only way she could engage with patients and their families was to talk to them on her lunch hour because there was no time during the rest of the day.

Later on in the afternoon, she would grab an energy bar or a muffin rather than sitting down to lunch.  Some of her colleagues who had been there longer warned her that she was going to burnout if she tried to keep up this fast pace without taking a break, but she ignored them.  She thought of herself as being much more devoted to her profession than these other nurses who took lunch and their 15 minute breaks.

She often got home late.  Her husband would help the children with their homework because he got home first. He also cooked their dinner and often sat down alone to eat his dinner because Nan often worked overtime.

By the time she got home, Nan was often too exhausted to eat.  She would take a few bites of her food, and then she was off to bed to wake up early in the morning and start the same routine over again.

On the weekends, Nan and her husband were too busy tending to the children and doing chores to pay much attention to each other.  Her husband often complained that their sex life was practically nonexistent, but Nan was usually too tired to think about sex.  She brushed off her husband's concerns and told him that she had no choice but to continue working the way she had been doing.

Nan had always wanted to be a nurse.  Both her mother and grandmother were nurses.  Nan was proud of them and she wanted to be like them.

Before she started her training, she imagined that she would sit with patients and talk with them as well as administering to their medical needs.  However, once she was in the profession, she quickly realized that her job was so fast paced and demanding that she had no time to chat with patients.  She was under so much stress that, even though she was a diligent nurse, she often feared that she would give the wrong medication to a patient because she was often frantically busy on the hospital floor.

When Nan was in her fifth year of nursing, her health began to break down.  She was having backaches, not only from lifting patients but from holding onto stress and not practicing any stress management techniques.

She was also getting debilitating headaches, and her husband urged her to take a day off to rest and recuperate from her busy schedule. But Nan knew her hospital was understaffed with nurses, and she didn't want to let down her patients or colleagues.

By her sixth year, Nan was showing physical and emotional signs of compassion fatigue and burnout.  Although she used to love her job, now she was often irritable and snappy with her patients and colleagues.  One day, she even snapped at her supervisor, who brought Nan into her office and recommended that Nan take time off because she feared that Nan was burning out.

Although Nan knew that she was physically and emotionally exhausted, she didn't want to take time off.  She felt there was just too much to do, so she apologized to her supervisor and went back to work.  But when she snapped at a patient's mother, the mother complained to the administration and Nan was given a verbal warning by her supervisor that if this or anything else like it occurred again, Nan would be written up, and if it continued to occur, she would be brought up on disciplinary charges.

Nan was upset with herself.  She knew better than to get into a verbal altercation with a patient's family member, but she was so tired that she didn't have the patience to speak calmly to this demanding relative.

When she got home that night, she was confronted by Tom, who told her that he wanted to talk to her after the children went to bed.  She told him that she was too exhausted to talk or to even eat, she had a very stressful day, and she was going to bed.  But Tom was adamant that they had to talk, so she took a nap for an hour and then got up after the children were in bed.

Since Nan had chronic insomnia by now, her hour-long nap did little to alleviate her exhaustion.  She felt resentful that her husband was insisting that they had to talk.  She wished he would just allow her to sleep and they could find time to talk in the morning.  But Nan also knew that there would be nothing different about the morning--she wouldn't have time to talk because she would be rushing around the house and, at the same time, trying to get ready to go to work.

So, wearily, she sat next to her husband on the couch and waited for him to begin talking. As she looked at him, she noticed his face looked strained.  Then, he looked like he was about to cry and  she got anxious, "Oh God. What's wrong? Are you alright?"  "Nan," he began talking slowly, "I don't think I can take much more of this. We haven't been intimate in months. We barely have time to talk. I don't want to leave you and the kids, but I'm so unhappy. Something needs to change."

Nan was shocked.  She felt her stomach lurch and the pain in her back intensified.  For a few seconds, she didn't know what to say, so Tom continued, "I want you to take time off.  You have so much sick and vacation time. Let's plan a vacation just for the two of us.  We haven't gone away in years.  We'll leave the kids with my mother. What do you say?"

Nan's first inclination was to say she didn't have time, but she knew now that Tom was seriously unhappy, and she didn't want him to leave.  After a few more seconds, she put her head back and closed her eyes.  Then, she could feel the tears coming and she couldn't hold back any more.

A few minutes later, Nan agreed that she couldn't keep up the pace and she knew she needed to take a break. She knew her supervisor would be thrilled if she took time off from work, so she told Tom that he should pick out a destination and she would go.

Two weeks later, Nan and Tom were in Puerto Rico.  Although, initially, Nan felt uncomfortable and restless, by the third day, she was feeling more relaxed than she had felt in years and enjoying her time off with Tom.  They rekindled their love life and enjoyed each other's company for the first time in a long time.  They also made a commitment to each other to go on vacation at least once a year.

By the time Nan got back, the first cases of COVID-19 began to pop up in New York City. Within a short period of time, she and her colleagues were inundated with coronavirus cases, and Nan felt like she had never gone on vacation.

She felt herself becoming irritable and snappy again, and her supervisor saw the warning signs.  She recommended that Nan seek help through online therapy to deal with her emotional and physical exhaustion. She also insisted, despite the shortages of nurses, that Nan stop working so many extra hours of overtime.

At first, Nan resisted the idea of online therapy because neither she nor anyone in her family had ever been to therapy before, and she resented being told to go.  But she also knew that both her marriage and her job were on the line, so she made an appointment for once a week online therapy, and after a couple of weeks, she was glad that she did.

Not only did she feel less physical and emotional strain, but she felt she was coping much better than most of her colleagues. She could feel that her therapist understood her and cared about her.  Her online therapist scheduled an appointment that was convenient for her and she could talk to the therapist from the privacy of her bedroom while Tom kept the children entertained.

Nan noticed that she was no longer having backaches and headaches.  She also learned to switch her attention to her husband and children once she got home rather than ruminating about work like she usually did.

Her therapist helped Nan to develop a self care routine, which Nan never had before.  She also taught Nan meditation and breathing techniques that she could use on her own (see: Breathwork to Cope With Stress: The Square Breathing Technique and Learning to Relax: Going on an Internal Retreat).

Even though Nan was going through a stressful time at the hospital, she no longer felt burnt out.  In the evenings and weekends, she took time for herself first before she spent time with her husband and children, and this made her time with her husband and children more enjoyable.

Throughout the crisis, Nan continued to attend her online therapy sessions, and both she and her therapist agreed that once the crisis was over, she would make time to come into her therapist's office to do in-person therapy.  Her only regret was that she hadn't started online therapy earlier.


Compassion fatigue and burnout are real problems among helping professionals.

Often other people, like a supervisor or spouse, notice the problems first because the helping professional is usually dedicated and immersed in work.

Online therapy sessions are an alternative for helping professionals who are working long shifts and doing stressful work.  They are both convenient and an effective way to provide mental health services to busy professionals.

Josephine Ferraro, LCSW, SEP is a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP and Somatic Experiencing therapist. She works with individual adults and couples and provide online therapy sessions during the COVID-19 crisis, and provide Emotionally Focused Therapy (EFT) for couples.