Compassion Fatigue in Therapists: When Empathy Becomes Exhausting

‘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 (2011)

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.

What Is Compassion Fatigue?

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 has 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
• 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.

Signs of Compassion Fatigue in Therapists

Symptoms of compassion fatigue 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 or helping professions

Culver et al, (2011) suggest that compassion fatigue and secondary traumatic stress are quite common in helping professions. Studies have estimated that between 16% and 85% of healthcare workers experience compassion fatigue symptoms at some point. More than 25% of ambulance paramedics in one study showed severe post-traumatic stress symptoms, while around 34% of hospice nurses met criteria for secondary traumatic stress or compassion fatigue. Research into clinicians working with survivors of Hurricane Katrina found that around 73% reported high anxiety levels and 35% experienced depressive symptoms.

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

Compassion Fatigue vs Burnout: What’s the Difference?

Although these terms are often used interchangeably, burnout and compassion fatigue are not quite the same. Burnout usually develops gradually as a result of workload, pressure, long hours and feeling overwhelmed or undervalued. Compassion fatigue is more directly linked to emotional exposure to other people’s distress and trauma. It’s sometimes called “the cost of caring” for that reason. A therapist experiencing compassion fatigue may still enjoy the work itself, but feel emotionally drained, numb or less able to empathise because of the constant exposure to suffering

How to Protect Yourself from Compassion Fatigue

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.

How to 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
• Have healthy work-related boundaries: leave work problems to working hours when you can
• Self care is important, as is doing 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 (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

References:

Culver, L.M., McKinney, B.L. and Paradise, L.V. (2011). Mental Health Professionals’ Experiences of Vicarious Traumatization in Post–Hurricane Katrina New Orleans. Journal of Loss and Trauma, 16(1), pp.33–42. doi:https://doi.org/10.1080/15325024.2010.519279. {accessed May 2026]
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 {accessed May 2026]

Disclaimer
The information and ideas shared on this blog are based on the author’s professional experience, research, and training. They are intended for educational purposes and to support reflection and professional development. Therapists should always apply their own professional judgment and consider the needs of individual clients when using any techniques or suggestions discussed here.
While every effort is made to ensure the information is accurate and helpful, no responsibility can be accepted for any loss, damage, or difficulties arising from the use or misuse of material contained in these articles.