Stress and Grief Reactions Among Rehabilitation Professionals: Dealing Effectively with Empathy Fatigue

Journal of Rehabilitation, Jan-March, 2000 by Mark A. Stebnicki

Many rehabilitation counselors are exposed to counseling-related activities in which they must be empathically available to individuals and family members who are survivors of a variety of chronic illnesses, traumatic, and life-threatening disabilities. Professional rehabilitation counselors are compelled by ethical obligation to sometimes sacrifice their own needs for the needs of their clients. The nature of beneficent actions by rehabilitation counselors are clearly pronounced in the Code of Professional Ethics for Rehabilitation Counselors (1987) which reads: "Rehabilitation counselors shall endeavor at all times to place their clients' interest above their own" (p. 27). Regardless of how beneficent rehabilitation professionals may appear, the lack of empathy, when working with persons with disabilities, will greatly diminish the counselor's ability and obligation to act in a manner that promotes the well-being of others (Rubin & Roessler, 1995). Consequently, as rehabilitation counselors are compassionate and empathic in their service to others, there appears to be a state of emotional, mental and physical exhaustion that may occur as the counselors' own wounds are revisited by issues raised concerning their client's life stories and experience of disability.

The concept and phenomenon of "compassion fatigue" was first introduced by Joinson (1992) in the nursing literature. This concept, which was expanded in the psychology and trauma stress literature by Figley (1995), may assist rehabilitation counselors in describing the state of emotional, mental, physical exhaustion, and the secondary stress reaction that occurs during therapeutic interactions with persons who have experienced traumatic life events. Figley's (1995) wellspring of research illustrates how compassion fatigue among professional counselors is identical to secondary traumatic stress disorder (STSD) and is equivalent to post-traumatic stress disorder (PTSD) in terms of its symptomatology. Because compassion fatigue has been recognized as a form of professional burnout, this condition may manifest itself within the helping relationship as a pattern of secondary traumatic stress (STS; Figley, 1993).

To date, the rehabilitation literature has not addressed issues related to compassion fatigue. Rather, this concept, as it relates to rehabilitation counseling and administration, has been discussed in terms of the phenomenon of "burnout." Burnout has been described as a syndrome of cumulative physical and emotional stress that is observed among rehabilitation professionals who work in organizations that serve persons with chronic and several disabilities (Blankertz & Robinson, 1996; Cranswick, 1997; Gomez & Michaelis, 1995; Riggar, Godley, & Hafer, 1984; Vash, 1980). The term "empathy fatigue" will be used in this article because historically, considerable attention has been given to developing the skills of empathy as a fundamental tool and resource for the preparation of masters-level rehabilitation counselors-in-training (Stebnicki, 1998). As Rogers (1980) emphasizes, "the ideal therapist is, first of all, empathic" (p. 146). Empathy as a "way of being" is the foundation for establishing and building the working alliance within client-center models of counseling and is necessary for working with the psychosocial aspects of adjustment and adaptation to disability.

Empathy fatigue transcends the experience of professional burnout. The experience of burnout emerges gradually within the individual and results in cumulative emotional and physical exhaustion. Compassion fatigue (Figley, 1995) or empathy fatigue, as described here, can emerge suddenly with little warning as an unhealthy form of countertransference or STS.

If professional helpers are not empathically available to the persons they serve, then there should be little concern for the influences of STS reactions or compassion fatigue (Figley, 1995). Yet, unavoidably, many rehabilitation counselors will be exposed to some degree of STS depending upon their professional role, organizational setting, and the persons they serve. Consequently, empathy fatigue may be a natural artifact of working at an intense-level of service provision for persons with acquired chronic illnesses and disabilities. Rehabilitation counselors who may or may not be aware of this parallel process must be open and invited to develop healthy coping responses and strategies that lead to a decrease of the secondary stressors associated with empathy fatigue.

A Framework for Understanding Empathy Fatigue

Cultural and social factors (e.g., gender, ethnicity, cultural differences) have an impact on how emotions are expressed. These factors influence the way in which counselors respond emotionally to their work. Thus, knowledge of the client's cultural and social norms for expressing emotion is critical in working with persons who are culturally different.

Cultural Empathy

The multicultural counseling literature addresses the relevance of client-centered models of counseling using empathy as a therapeutic approach. This literature suggests that cultural and social factors have an impact on how emotions are expressed and perceived. These factors also influence the way in which counselors respond empathically to their clients. By the very nature and use of empathy in client-centered interactions, the focus should be on the individual's frame of reference (Freeman, 1993), thus allowing an opportunity for the counselor's cultural values not to be imposed which may hinder the working alliance.