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Future of Health Care

Taking The Fatigue Out Of Compassion

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Shawn Fisk

Shawn is an engaging educator, clinician, facilitator, and public speaker whose professional expertise is informed by more than 20 years of experience with systems of care for Substance Use Health needs.  As an ally, counsellor, therapist, and peer, Shawn directs his passion for the study of psychology, concurrent disorders, mental health and Substance Use Health, towards standing beside and supporting those whose health needs care

Do you feel worn out when helping others?  Would you believe that “compassion fatigue” is not to blame?

CAPSA has trained thousands of service providers, in the caring professions, on substance use stigma. Consistently, participants raise urgent concerns of burnout, frustration, and fatigue. They ask how they can continue caring, in compassionate ways, when they feel like they have reached their limits. So, CAPSA decided to look more closely at this issue, to better understand what factors are at play when people insist that they are suffering from compassion fatigue and to create ways to practice true compassion in a way that doesn’t lead to a lack of wellness for both the caregiver and those seeking care. 


Does this feeling really come from too much compassion? Or is it a question of too much focus on and attachment to the anticipated outcomes of our help? Being kind to others doesn’t need to fatigue those whose job it is to help them. Let’s explore this.

True compassion does not have associated conditions or demands. It doesn’t come with expectation of compliance to a caregiver’s expertise, nor to what they hope will happen. Compassion means there are no strings attached to care beyond the here and now. A focus on being present, without jumping ahead to results, is a skill that is learned, re-learned, and practiced, and not an emotion, natural ability, or personality trait as is often portrayed. 

Compassion is the skill to be in the presence of someone while wishing them well, whatever that is in the moment. It is not demanding or controlling of any outcome.

The most instructive lessons on compassionate care come from untrained strangers — people with lived and living expertise (peers) – who gather to provide parallel Substance Use Health care outside of the formal health system. This care emerged out of necessity. Until the passing of Canada’s first National Drug Strategy in 1987, substance use, and health were treated as separate issues, with no formal services as we know them to exist today. 

It is telling that in over a century of mutual aid, we have rarely heard a peer say they felt burned out or fatigued by helping. These words are not used in peer circles. We first heard these words when we started accessing services. The disconnect between care from peers versus that from professionals underlines the gap between the understanding and the practice of compassion in the health field today. 

Compassion is nothing new to health professionals. Carl Rogers (1961), the founder of client-centred practices, put compassion at the centre of the client-service provider relationship. Rogers laid out the core components in his seminal work, On Becoming a Person, that are central to compassionate practice. Long before they were named as skills or referenced in the literature, these practices helped people be well. They have stood the test of time and are held as self-evident truths among peers. 

Compassionate practice requires a careful balance of intimacy and space; in excess, both can lead to a decline in wellness. Caregivers’ beliefs about themselves and those they help often determine whether they can strike this balance. Do they believe that they are heroic and can save others from their peril, or are they prepared to sit beside someone and offer their unconditional support in that moment?

Have you ever heard yourself say things like: 

  • If you would only listen to me, things would be better
  • I know what you need
  • If others can do it, so can you
  • You need to make better choices
  • Aren’t you tired of this
  • I can help protect you from yourself

These messages make assumptions about the other person and are  attached to outcomes that you believe to be important and this slowly erodes true compassion. Instead, here are some beliefs that signal a healthy practice of compassion:

  • I don’t suffer as a consequence of caring for others
  • Caring for others is not sharing their pain
  • Sadness is not the same as burnout, it’s a sign that I care
  • Showing compassion is not about my demands or expectations

These are the practices that demonstrate compassion, yet we hear from caregivers that they suffer from compassion fatigue. Can simply caring for someone actually make someone unwell? Perhaps, what is being experienced is control fatigue, a form of exhaustion coming from the belief that one has power over another person’s outcomes. 

Control, the attempt to manage the outcomes of others, is hard to shake. When we fixate on the future of others through the lens of our own expectations and timelines, what we know to be control, it becomes a barrier to care. This barrier results in weaker relationships, inadequate helping processes, and poorer long-term health outcomes for us all, which manifests itself as fatigue for the caregiver.

So, what can be done about this? The first thing to do is recognize when expectations and control are leaking into our caregiving. This is the source of frustration and fatigue.  Then, by practicing and developing the skill of compassion we can learn to let go of our demands. By using this skill on behalf of those we care for, we can be with them as and how they need, holding hope for their wellness.

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