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Monday, 19 March 2018

Therapists: can your empathy get you down?

'Compassion fatigue is caused by empathy. It is the natural consequence of stress resulting from caring for and helping traumatized or suffering people'
Dennis Portnoy [1]
You might also find compassion fatigue referred to as 'Caregiver Fatigue', 'Vicarious Stress' and 'Secondary Traumatic Stress', and it most often appears in those who help others, provide them with support and/or listen to their upsetting or traumatic stories.
Compassion fatigue is not an illness or a medical condition, it's more a set of signs and symptoms which happen because of your circumstances, and how effectively you cope with them.

Compassion fatigue is thought to have three main elements and it’s how they interact that can cause problems. The elements are:

  • job satisfaction - the joy and positivity you get from doing your job well
  • exposure to risk - how often you are exposed to people's problems, and how severe or traumatic these are
  • stress levels - partly those from your job (including exposure to risk, above) but also family issues and problems which have an effect on your wellbeing

Essentially when the three elements are balanced, you have all the resources you need to cope with the demands that life has placed upon you. Generally things are pretty good. But if your pleasure in helping people is undermined for some reason, or your risk or stress levels increase, there is an imbalance. Over the short term this might be manageable, but if it persists, it will start to impact upon both your physical and emotional health.

Symptoms of compassion fatigue

These can include
  • physical and emotional exhaustion or feeling overwhelmed
  • sadness, anxiety, fearfulness, depression, anger
  • poor concentration, memory and/or sleep patterns
  • feelings of detachment and/or persistent negativity
  • physical illness, such as headaches
  • avoidance of situations we perceive as being difficult to cope with
If you are a therapist who deals with stressed, depressed or anxious clients you'll probably recognise this list. What it shows is that you are not immune to the pressures and stressors that affect your clients. Accept it - you are only human.

Risk factors for compassion fatigue

Those most at risk are
  • perfectionists
  • those who consistently put others' needs before their own
  • those who have low levels of social support
  • those who have high levels of stress in their personal lives
  • those in the caring professions
Up to 85% of healthcare workers, 25% of ambulance paramedics, 34% of hospice nurses, and a 2011 study showed that up to 72% of mental health professionals working with Hurricane Katrina victims suffered anxiety or other symptoms of STS[2].

Although I couldn't find any specific figures for hypnotherapists, it seems reasonable to consider that they come under the 'caring professions' and are at risk.  

Compassion fatigue: prevention and cure

As you might have guessed, there is no 'cure' as such, but stress management and relaxation techniques plus effective self-care programmes help in reducing and preventing the symptoms. These include breathing exercises, guided meditation, self-hypnosis and exercise. You also need to establish firm professional boundaries and an effective support network.

Of course, having an effective support network when you offer a confidential service to your clients can be tricky. You can’t come home and unload about your day to your family or friends, as most people can. In this context, a support network has to be professional and that means good supervision throughout your career. Although supervision is often thought of as 'where you go when you don’t know what to do', it should also (among other things) ensure that you have self-care protocols in place and that they are working.

Tips to help therapists avoid and reduce compassion fatigue

  • Be aware of how you're feeling and accept that you might sometimes need help
  • Recognise your stress triggers, at home and at work
  • Use the good advice you’d give to a client in the same situation
  • There's nothing wrong with having high standards or seeking to improve things, but accept that now and then you need to give yourself a break
  • Keep work and home separate
  • Set time aside for yourself, do something you enjoy regularly
  • Look for practical solutions to difficult situations and put them in place; get help with this too if you need it
  • Delegate, and learn to say no (if you need help with this, ask for my information sheet on how to gracefully say no - and mean it)
  • Be realistic about how many clients you can help at times when your stress levels at home are high, and vice versa
  • Get a good supervisor and use their services regularly


  • I run a facebook group where therapists can swap their skills with other local therapists to improve their self care regimes.
  • Need a hypnotherapy supervisor? - I offer supervision in person or by phone all over the world, or if you're looking for someone local to you, please ask me for a referral.
  • Want to be a hypnotherapy supervisor and offer support to others? I offer accredited training which will help you offer the best service to your supervisees

[1] Portnoy, Dennis (2011) 'Burnout And Compassion Fatigue: Watch For The Signs' in Health Progress July - August 2011 pp. 46-50 on http://www.compassionfatigue.org/pages/healthprogress.pdf
[2] cited on https://en.wikipedia.org/wiki/Compassion_fatigue

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Author: is an experienced hypnotherapist and hypnotherapy trainer. She is the author of Their Worlds, Your Words and has co-written the Hypnotherapy Handbook, both of which are available from Amazon.
Find out more about Debbie's services on
Yorkshire Hypnotherapy Training - multi accredited hypnotherapy practitioner training, taster days and foundation levels.
CPD Expert - accredited CPD and other therapy training (online and workshops options), expert and qualified hypnotherapy supervision


  1. I am extraordinarily affected beside your writing talents, Thanks for this nice share.

  2. It is said that many scientists are working to determine whether the power of suggestion can affect cognitive processes such as learning, with a view to using hypnosis in educational settings (Wark, 2011). Good therapist always understand the thoughts and feeling of the patient. Empathy encourages prosocial (helping) practices that originate from inside, as opposed to being constrained, with the goal that we act in a more compassionate way.

  3. Thanks Claire, your thoughts are much appreciated.