By Joan Cook
December 2, 2015
IDEAS

Cook is a psychologist and associate professor at Yale University and an Op-Ed Project Public Voices Fellow

We still don’t know all the details of the deadly mass shooting that occurred at a center for the developmentally disabled in San Bernardino, Calif., Wednesday. But we do know the feelings of horror, exasperation and numbness that follow each new atrocity in what seems like an endless list of horrible events, including last week’s shooting at a Colorado Springs Planned Parenthood that killed three.

According to one calculation, there have been more than 350 mass shootings in the U.S. this year. Tuning in to these horrific atrocities so often, we have begun to tune out. Psychotherapy with trauma survivors offers at least a partial explanation as to why that happens—and what we can do about it.

In the mental-health field, we’ve known for a long time that working with traumatized individuals, families and communities can negatively impact our work. Bearing witness to peoples’ stories of pain and suffering can bring on intense emotions for psychotherapists. Like the trauma pioneer Charles Figley said: “Just as we breathe in the second hand smoke of a smoker, we breathe in the emotions of the traumatized.”

The term “compassion fatigue” was first used in 1992 to describe how nurses get wiped out and wearied by daily hospital emergencies. A few years later, Figley, a combat medic who served in the Vietnam war, applied the concept to health-care professionals working with the traumatized.

The concept can easily be applied to real-world people listening and watching and reading about the world’s traumatic events. Just as psychotherapists can absorb the stress of survivors of childhood abuse, domestic violence, violent crime, disasters, and war and terrorism, the deep awareness of others suffering linked with the desire to relieve it can negatively impact everyone’s personal well-being.

We may feel depressed or hopeless. Our views may become pessimistic, and we may believe that the world is primarily or solely a dangerous place and that we have little power or control to impact it, stay safe and keep our loved ones out of harm’s way. We essentially become “too tired to care.”

For psychotherapists who wear compassion fatigue like an iron uniform, we not only loss interest or capacity to feel for our patients, but it also may even diminish the quality and effectiveness of the therapy we provide and lead to premature job termination. Might hearing about traumatic events similarly impact the world’s productivity?

There are some critics who say that exposure to patients’ traumatic material does not impact therapists. They suggest that general work-related stressors predict therapist distress. I don’t buy that. If you’ve ever listened deeply to the descriptions of a woman being gang-raped or a military service member describing how his closest friend was blown into pieces right before his eyes, you know this is real.

A number of scholars believe that compassion fatigue is a natural consequence, or an occupational hazard, of providing clinical care to traumatized populations. And that may be true. A number of others believe that the negative effects, sometimes called secondary traumatization, are permanent. But that’s not what most of the empirical literature has found, and that’s certainly not what I have experienced in my 20 years of doing therapy with traumatized individuals.

Having deep feelings of empathy for another person’s suffering can be a good thing, a beautiful experience, a rich and powerful curative power within which people heal. But when it seeps into our soul and negatively impacts the way we see ourselves, others and the world, that’s a problem that needs to be fixed.

So how do psychotherapists prevent or mitigate the unwanted negative effects? And how does the world bear witness to human evil and death without becoming overwhelmed by or numb to it? The former has answers, the latter, we need to work on.

There are some pilot studies showing the effectiveness of interventions to reduce compassion fatigue and increase resilience in health-care providers. The target populations, however, were military and civilian registered nurses, licensed practical nurses and medics who treat wounded soldiers—not everyday people.

But like psychotherapists, all of us can likely benefit from recognizing the signs of compassion fatigue and acknowledging its effects. We can take an inventory of our strengths and vulnerabilities in terms of taking in the traumatic news of the day and developing our own personal plan for self-care.

Bearing witness to traumatic events is hard, and the costs of caring are huge. But the alternative is worse. Although it is horrifying for us to see images and hear stories from the tragedy in San Bernardino, it is equally awful that the country seems to feel numb to it, knowing that it could happen again.

It doesn’t matter if you’re a military chaplain providing spiritual counsel in a war zone, a fire-fighter, paramedic, or emergency medical personnel working under the threat of impending terrorist attacks, a volunteer relief worker giving aid to those after a natural disaster, or the average Joe or Jane witnessing the terrible things happening in our world. We all need to find ways to maintain health and vitality in our lives by bearing witnessing to the horrors—experiencing anger, disgust and profound sadness, but also maintaining our own emotional health.

Joan Cook is a psychologist and associate professor at Yale University and an Op-Ed Project Public Voices Fellow.

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