What to do about compassion fatigue
The United States government’s Substance Abuse and Mental Health Services Administration (SAMHSA) provided a manual for the TIC approach in 2014 (link), which is heavily cited in content regarding TIC (including Rajaraman et al., 2021). SAMHSA talks about secondary trauma, which this publication uses interchangeably with compassion fatigue. The following advice is provided.
Reference: Substance Abuse and Mental Health Services Administration. Trauma-Informed Care in Behavioral Health Services. Treatment Improvement Protocol (TIP) Series 57. HHS Publication No. (SMA) 13-4801. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
Feelings of connectedness to employer is documented to predict lower rates of compassion fatigue among teachers working remotely during the pandemic (Yang, Manchanda, & Greenstein, 2021). Brown (2021) reported a similar finding among 106 surveyed behavior analysts, reporting that negative life and job attitudes were related to higher levels of burnout. In addition, the article explores the prevalence of behavior analysts being at odds ethically with their employers.
Self-care is also cited as a necessary protective factor for jobs that put professionals in contact with people who have experienced trauma. Rivera-Kloeppal and Mendenhall (2021) conclude from a literature review that self-care plays a role in preventing and mitigating compassion fatigue, especially for mental health providers. The article suggests that while protecting clinicians from the amount of trauma that they see from clients may be impractical, better self-care may be normalized and encouraged by the working environment.
Mindfulness vs. Moral Disengagement
An interesting take on compassion fatigue presents clinicians with a choice of two options: mindfulness or moral disengagement. In a report on animal protection administrators in Taiwan, Wu (2020) describes using moral disengagement to cope as a failure to engage in mindfulness. Use of external strategies such as religion, music, arts, group counseling, and seminars will only work if they transform to internal coping strategies. This distinguishes active mindfulness from passive emotional separation. Though more of a philosophical conceptualization, it does leave clinicians to consider –
Do I have internalized active coping strategies?
And, if not, what will be the default response to ongoing stress?
A Skills-Based Treatment Approach
The Accelerated Recovery Program (ARP) is a treatment for professionals affected by compassion fatigue. It was described by Gentry, Baranowsky, and Dunning (2002) in the edited book Treating Compassion Fatigue and continues to be studied. Cocker and Joss (2016) describe the 5-session program as effective in alleviating compassion fatigue symptoms as well as teaching participants to identify symptoms, identify triggers, master arousal reduction, and reflect on their work history and achievements, among other tasks. While not developed by behavior analysts, it includes behavior analytic tools and behavioral skills training techniques, such as rehearsal. Its procedures are described in more detail in an application to nurses working in India (Rajeswari et al., 2020).