Compassion Fatigue vs. Empathic Distress? How can you tell the difference?

by April Tully, LCSW, Clinical Director, Freedom Institute

We have been hearing a lot about Compassion Fatigue these days, but is this really what is happening?

Those of us in helping professions, whether mental health, physicians or nurses, really anyone who is in a position of ‘caretaking’, may struggle with the poorly understood paradox of “empathy” versus “compassion”. Almost everyone I know tends to use the words “empathy” and “compassion” as if they were identical when they are actually quite different. Compassion is being sensitive to the emotional aspects of the suffering of others, "feeling for another," and an act of compassion is defined by its helpfulness. 
 
Empathy is experiencing another’s suffering as if it were your own, and while it is certainly an element of compassion, too much empathy can produce a contradictory response in the bearer. Too much empathy can suppress the prosocial aspects of the trait, the wish to aid others, and create an aversive reaction instead when the practitioner becomes saturated with negative affect. Thus, rather than desiring to lend assistance where indicated, the empath is driven to take the opposite course, wanting to withdraw from those who require care. Emotional overload can quickly tax the limits of the provider’s endurance (also known as the window of tolerance), frequently leading to avoidance, depression, irritability, despair; a sense of hopelessness, futility, or ineffectiveness; exhaustion, and possibly even a rethinking of life goals or ambitions, any, or all of which can culminate in what is commonly termed “burnout.” This is a condition besetting many medical providers and therapists in epidemic proportions and may even be viewed as a 'second pandemic' in the wake of COVID, though it definitely preceded the emergence of the global disease and has continued undiminished ever since.
 
What, if anything, is the antidote or “vaccine” for this ailment of the psyche?
 
The answer may surprise you. The cure for an overabundance of empathy is–compassion.
 
Allow me to explain: One of the presenters at the 2021 International Trauma Conference in Boston which I attend annually was Dr. Tania Singer of the renowned Max Planck Institute for Human Cognitive and Brain Sciences in Berlin, who is a social neuroscientist/ psychologist and a world expert on empathy and compassion. Dr. Singer created the ReSource Project and through this organization, she pursued her interest in the contemplative traditions of the east, which led her to research the difference between empathy and compassion. One of her early ambitious studies entailed subjecting some of the members of the Dalai Lama’s inner circle (among them Matthieu Ricard, who had trained as a neuroscientist himself in the 1960s before leaving academia to become a Buddhist monk, and who is also the author of several acclaimed books such as “Altruism” and “Happiness”) to fMRI scans to see which parts of their brains became activated when they alternately engaged first in empathy and then in compassion. What Dr. Singer discovered is that different neural pathways and regions were stimulated depending upon which qualities were evoked. When the subjects’ capacity for empathy was tested by immersing them in images of human tragedy, even the minds of monks who had been meditating daily for an average of 40 years became overwhelmed!  
 
However, when compassion was accessed, the monks were able to feel empathy without the negative consequences of shutdown or withdrawal. These findings were replicated among laypeople once the experiment was broadened to include cohorts of local Berliners. Participants were taught to focus on increasing their empathy or compassion skills, while a control group was tasked only with improving their memories.  
 
Now, some people are more naturally empathic than others, but the defining characteristics of empathy and compassion are centered more on perspective than emotion. People who are able to understand the feelings of another without fully duplicating them (compassion) are better able to retain enough critical distance to stay motivated to offer help. The key is to avoid becoming paralyzed by a negative response.
 
One of the best ways to improve compassion is through utilizing compassion meditation techniques.  Dr. Singer was able to demonstrate that teaching her lay subjects the time-honored compassion meditation exercise (known in Buddhism as the Karuna meditation, which guides participants toward compassionate thoughts) enabled the participants to become more compassionate without suffering the undesirable effects of empathic overload. This particular meditation has been adapted by Westerners and there are many versions. All of them involve some kind of progression, from hoping that a cherished person be happy, peaceful, and free from suffering; a neutral person; a person with whom you have a challenging relationship; yourself; and ultimately the entire world. The order may vary but the outcome is the same, which results in feelings of tranquility and groundedness.  
 
To further inoculate oneself against stress and create boundaries that are firm and yet permeable, it is most effective to anchor this meditation within a regular mindfulness practice.  It is important to know, however, that mindfulness includes meditation but is not limited to it, and that both activities embrace a heightened form of tuning in rather than tuning out.  Whether you prefer meditation or mindfulness overall is a matter of individual taste; what is most important is that mental health care providers develop a habit of self-care, which is something most of us are already encouraging our patients to do.  
 
If it works for them, it will work for us, so to quote from another spiritual source, “Physician, heal thyself!” You will thank yourself, your patients will thank you for it, and we can all help diminish the epidemic of burnout.