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Destroyers of Self-Care: Empathetic Intensity

Posted on January 13, 2017

In my recent dive back into self-care literature, I searched for a deeper understanding of helping trauma and burnout. The deeper I dove, the more I saw similarities between the research on the impact of helping trauma and the research on the impact of burnout. It did not take much for me to put the pieces together and see how trauma and burnout go hand in hand – and how their results can tragically complement one another.

As many of us enter the New Year with resolutions for improved well-being and health, I would challenge us all to put the strategic avoidance of helping trauma and burnout on our list. In this post, I will present on a foundational component of helping trauma, empathetic intensity. In the coming weeks, we’ll examine the types of dangers associated with our work, including compassion fatigue, vicarious trauma, secondary trauma, and burnout. Next, I’ll present a progressive model of trauma and burnout, and discuss how each step impacts our well-being and ability to bring our best selves to our helping practice. Finally, we’ll examine some strategies to both protect us from these dangers and bring our best self to work every day.

Miller and Rollick, the founders of Motivational Interviewing, define empathy as, “An ability to understand another’s frame of reference and the conviction that it is worthwhile to do so.”

The more our clients feel that we know their pain and suffering, the stronger the helping relationship can be. The quality of the relationships we create with the clients predicts successful outcomes in services. To gain this success, the helper has to understand, and to some extent feel, the emotions the clients experience.

While it improves client outcomes, empathy has a vulnerable side as well. When we connect in a deep way with a client and allow them to talk about the trauma and stress in their life, we help them to get some of the cortisol (the stress hormone) out of their system. This reduction in cortisol helps them to regulate their emotional state, and promotes the ability to engage cognitively with us around a task, treatment, educational lesson, or referral opportunity.

Think about a time where you had a tough day at work and were lucky enough to have a friend or loved one that cared enough about you to listen to your frustrations and anger. You probably felt better after this opportunity. We have a great saying to describe this situation: “Got it off my shoulders.” When we do this, we often feel physically better, and even lighter, from “unloading our burdens.”

We do this for our clients every day. Allowing a client to talk about their stress supports intellectual engagement in services and that client’s overall well-being. Unfortunately, there can be a cost to this activity, called empathetic intensity. Empathetic intensity is the transfer of emotions and pain from a client experiencing trauma to an empathetic helper.

Emotions are contagious, and the stronger they are, the more infectious they become. The struggles of our clients often are accompanied by intense feelings of grief, depression, anxiety, terror, and hopelessness. It is nearly impossible not to become impacted by this exposure to our clients’ suffering. If we provide a safe place for clients to unload their burdens, we also risk taking their burdens on as our own.

I have to admit that I struggle with this as a trainer. Attend one of my Motivational Interviewing Trainings, and I will spend the majority of the day talking about how we can deepen our empathy and connection with the clients. In essence, I’m asking you to make yourself vulnerable and connect in a meaningful way to clients’ pain. Some of you engage in this very activity for hours each day.

Attend my Thrive: Self-care Trainings and I will warn you that empathy puts you in a psychologically vulnerable position. In certain situations, the traumatic stories and emotions of the client can traumatize you, resulting in negative consequences for your psychological, medical, and social health. I often quote my friend Dr. Deb Borne from San Francisco, who describes this situation as, “The fire we signed up to walk into when we decided to do this work.”

She is right. We knew going into this work that we would be exposed to clients’ pain and suffering, and hear devastating and traumatic stories. Even though this is the “fire” we knew would meet us in our jobs, it does not mean we will never get burnt. In the upcoming weeks, we will put some definitions around these burns including compassion fatigue, burnout, vicarious trauma, and secondary trauma.

I want to open up the comment section this week for you to share times where you have found empathetic intensity overwhelming, and how you have been able to cope and learn from the experience. Until next time, take care of yourself!