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Stages of Helping Fatigue: Exhaustion

Posted on March 10, 2017

One of the major insights I had in my recent re-thinking of self-care is the relationship between burnout and vicarious/secondary trauma. In the past, I presented a four-stage model of burnout. The longer someone struggled with burnout, the more likely it was that they would progress to the next stage, with each staging having a greater impact on work, personal, medical, and psychological health. After reading Lipsky and Burk’s Trauma Stewardship, I started to see how the model I was using for burnout mirrored their research on the progression of vicarious and secondary trauma.

This realization got me thinking about the relationship between compassion fatigue, vicarious trauma, secondary trauma, and burnout. At their core, these dangers are different manifestations of stress reactions, and they all impact the body and mind of someone who both connects with clients experiencing trauma and deals with stress from their work environment. In other words, all this stress goes into one cup.

I worked for several weeks, connecting the research around burnout with that of helping trauma, and found that my four-stage model, with slight adjustments, works well to show the collective impact of both burnout and helping trauma. These stages include:

1. Exhaustion
2. Guilt and Shame
3. Cynicism and Callousness
4. Crisis

Over the next few weeks, I want to take a closer look at each stage. The goal in presenting this is to help us realize that we might have some characteristics of a particular stage. If a realization occurs, it is important for us to act to recover, through taking time off, increasing our focus on self-care, and changing work/personal habits to prevent future ventures into the stages. PLEASE do not beat yourself up if you identify as being in any of these stages – you can act to correct the situation!

In many ways, the first stage, exhaustion, is the most critical. I make this statement because if we don’t act to address exhaustion, we can quickly, as we’ll examine in future posts, move to stages of guilt and shame, and cynicism and callousness. If we identify we are in exhaustion, we can act, and not experience the negative consequence of later stages.

One key aspect of addressing exhaustion is knowing your physical, psychological, and social triggers. These are signs that your work and/or overall stress level is starting to negatively impact your functioning. Think of these triggers as your mind and body telling you that something is going wrong and it is time to act or do things differently.

Physical triggers are often the easiest to identify. Stiff necks, sore backs, strained muscles, headaches, colds that will not go away…these are physical triggers for many people. Psychological triggers include dreaming about work, trouble sleeping, obsessive worry or thinking about work, and minor depression or anxiety. Social triggers include a lack of desire to connect with friends and family, increased difficulties in romantic or family relationships, and less patience with kids. The important thing with triggers is to know when your mind and body are telling you something is wrong.

In addition to triggers, the exhaustion stage also impacts to our work with clients. It becomes harder to empathize and be present with clients. Empathetic listening is an intense activity that takes lots of focus, energy, and attention. As exhaustion creeps in, it becomes harder to engage fully in conversation and connect emotionally to clients.

We can also experience a diminished capacity of creativity, cognitive flexibility, and the ability to handle the complexity of our work. We do not get nearly enough credit for how complex and intense our work is, both emotionally and intellectually. Helping clients change and heal requires lots of creativity and innovative thinking. Unfortunately, these are some of the first things to go when we enter the exhaustion stage.

Over time, it gets harder to get out of bed, find excitement in work, and locate the energy for social interactions in our personal and professional lives. The devastation of exhaustion is that we do not stay in the phase for long. We all know that our clients need us at our best every minute of every day. When we are in exhaustion, we start to realize that we are not meeting this challenge. Unlike many professions, our work has great impact and consequence in the lives of other people who we care deeply about. The realization that we can no longer give our best to our work quickly moves us from exhaustion to the second stage of guilt and shame.

My challenge this week is to identify your triggers. How does your body tell you that your cup is filling up? The good news is that if we catch ourselves in the exhaustion stage, a long weekend might be all we need to get out of the stages altogether. The danger lies in inaction!