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When caring hurts

section identifier imagethe front cover of a crosscurrents magazine- the main image is a vase with bold coloured flowers

Compassion fatigue strikes addiction workers

By Helen Buttery

Autumn 2005, Vol 9 No 1


Leigh MacEwan knew something was wrong. “My soul felt weary,” she recalls of the time in the early 1990s when she worked as an addiction counsellor at Lakeside Centre, part of the Northern Regional Recovery Continuum in Sudbury, Ontario, which treats women with substance use problems. Fast-forward to 2005. MacEwan, an assistant professor at Laurentian University’s School of Social Work in Sudbury, is getting ready to defend her PhD thesis at the University of Sussex in Brighton, U.K. Her topic? Compassion fatigue. Almost 15 years ago it plagued her soul – and, as she has discovered through talking with more than 500 social workers in Ontario, it is affecting many workers in the addiction field.

Making an early appearance in 1992, the term “compassion fatigue” described nurses worn down from dealing daily with hospital emergencies. Since then, its meaning has been fine-tuned and the phenomenon goes by many names. “Compassion fatigue is synonymous with secondary traumatic stress and vicarious trauma, but it’s the more user-friendly term,” explains Dr. Charles Figley, director of Florida State University's Traumatology Institute. In his groundbreaking book Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, Figley defined compassion fatigue as “the natural consequent behaviours and emotions resulting from knowing about a traumatizing event experienced by a significant other – the stress from helping or wanting to help a traumatized or suffering person.”

When MacEwan starting searching for what was ailing her, she didn’t know what to call her problem – or even if it had a name. She came across Figley’s work describing the parallel effect on trauma workers and mental health workers from listening to the ordeals of clients – what Figley describes as “bearing the suffering of clients.” The symptoms of compassion fatigue share a striking resemblance to posttraumatic stress disorder (PTSD) symptoms. For instance, someone with PTSD might have recurring dreams of the event, and a person experiencing compassion fatigue might have disturbing dreams about a client’s event. But nothing in the literature looked at whether, or how, addiction workers experienced compassion fatigue.

MacEwan links this neglect to a lack of recognition of the connection between addiction and stories of violence. “Workers in a shelter know they’re going to listen to stories of violence and see women with black eyes,” says MacEwan. “But when you sign up for addiction treatment, you go in with the idea that you’re going to be working strictly with addiction. You don’t realize that when the anaesthetic of drugs and alcohol wears off, these painful stories come out.” These are stories of sexual abuse, including child sexual abuse and rape; physical violence and emotional violence.

The heavy burden of hearing terrible stories of substance abuse and violence may be compounded by the personal experiences of addiction workers. Some are themselves in recovery from substance use or have family members who have struggled. In these cases, empathy for clients often comes from the worker’s intimate understanding of the issues. But it’s a double-edged sword. What makes these workers good at what they do also makes them vulnerable to compassion fatigue. “When you put those two things together, there’s a much higher probability that addiction workers will develop compassion fatigue,” says Figley.

MacEwan decided to explore this uncharted territory, delving into the experiences of addiction workers who listen daily to stories of violence and trauma. Her research brought her full circle to her former workplace, Lakeside Centre, where her study involved intense interviews with 12 staff members. MacEwan's study posed five questions: What are addiction workers’ experiences of listening to clients’ stories of violence? What are the effects on addiction workers of listening to stories of violence? How do addiction workers cope with listening to clients’ stories of violence? What are the benefits of doing addiction work? What strategies do addiction workers recommend to maintain their health and well-being?

MacEwan’s study has found that the symptoms Lakeside staff described came close to and, for the most part, replicated those experienced by other workers exposed to trauma through their work. For instance, staff described intrusive imagery, difficulty sleeping and taking their work home with them. Through the study, Kathryn Irwin-Seguin, executive director of the Northern Regional Recovery Continuum and a participant in MacEwan’s research, recognized her own symptoms from her 15 years of working on the front line of addiction treatment. “When I got home at night, I wasn’t as present for my family,” she recalls. “I started reacting to what I thought was petty complaining from my family, thinking, ‘Gee, if you heard what I heard today you’d be thankful for what you had.’”

This type of day-in, day-out exposure to stories of violence and trauma differs from what trauma workers deal with on the scene of a large-scale traumatic event, such as the tsunami in Asia. Workers at a catastrophe scene are away from home, in an environment they will soon leave. “There’s a tendency to just work and work and not take breaks because when you do, you feel guilty,” says Figley. “But it’s interesting that there’s a natural tendency to take care of yourself once you return from the field.” For addiction workers, there is no returning from the field.

“Every time you think you’ve heard the worst story, you hear something else,” says Irwin-Seguin. “After a while, you hit a saturation point.” To deal with this constant onslaught, Lakeside Centre staff now have formal and informal strategies for coping with the stressors that may cause compassion fatigue. MacEwan's study participants spoke of spiritual, mental, physical and emotional resources they use to cope. The centre has now also established a wellness committee. Staff meet monthly for three hours for retreats and fun days. Some sessions discuss coping strategies; others are designed to de-stress staff through normalizing experiences, such as interior designer visits, painting class and golf lessons.

Since staff participated in MacEwan’s research, they are more willing to use the Employment Assistance Program and reach out for help. “In the past, the attitude was ‘Suck it up, you should be able to handle this or you’re not in the right field,’” says Irwin-Seguin. Instead of recognizing compassion fatigue as an occupational hazard, workers often blamed themselves, thinking they were incompetent. Fortunately, that attitude is shifting. “Compassion fatigue is not inevitable, but compassion stress is,” says Irwin-Seguin. “Stress is a demand – a demand for attention.”


Compassion fatigue versus burnout


Compassion Fatigue

• Related to worker’s interaction with client’s traumatic material

• Faster onset, occurs with little warning, faster recovery rate

• Characterized by physical emotional, cognitive, spiritual, mental symptoms



• Related to work environment

• Gradual process that gets progressively worse

• Characterized by physical, emotional, mental exhaustion


Source: Moira Ferguson, Kathryn Irwin-Seguin, Leigh MacEwan and Vivian Munroe, Compassion Fatigue and Relational Spirituality: A Participatory Action Research Project with Northern Ontario Addiction Counsellors, presented at the 2005 Annual Addictions Conference, Addictions Ontario.


Compassion satisfaction: It’s good for you

Unlike compassion fatigue, which describes the negative costs of caring, compassion satisfaction, a term developed by psychologist Dr. Beth Hudnall Stamm at Idaho State University, describes the positive costs of caring and the pleasure derived from this work. Leigh MacEwan, a social worker conducting research on compassion fatigue among addiction workers, found that despite the toll of their work, staff at Lakeside Centre, an addiction treatment centre for women in Sudbury, Ontario, had tremendous resiliency stemming from job satisfaction and feeling privileged to be able to make a difference. Stamm developed the Professional Quality of Life scale to measure compassion fatigue, compassion satisfaction and burnout. (Download the scale for free).


Self care at work inventory

The below inventory is adapted from a 2003 Green Cross Foundation workshop conducted by Kathy Regan Figley called “You too! Introduction to professionals who care enough (about others) to ignore their own needs.” The foundation trains and dispatches trauma specialists around the world.


  1. Do I take a lunch break every day and do something unrelated to work?
  2. Do I work reasonable hours?
  3. Do I schedule breathing room every day so I can step back, and reevaluate my priorities?
  4. Is my office free of clutter?
  5. Do I have adequate lighting and clean air?
  6. Do I delegate work to free my time and empower others?
  7. Do my family/friends honour my work time? If no, have I asked them?
  8. Do I have blocks of uninterrupted time without distractions and interruptions?
  9. Do I have a “Do not disturb” sign?
  10. Have I scheduled specific times for returning phone calls and checking e-mail?
  11. Have I stopped taking on more than I can handle?
  12. Do I drink enough water when I am at work?
  13. Do I have comfortable shoes/slippers at my office?
  14. Do I schedule time off from work (sick leave and/or vacation time) to take care of myself?
  15. Do I have someone to talk with about my professional life?
  16. Do I have creature comforts that make my office pleasant? (music and other sounds, aroma, artwork)
  17. Do I say “yes” to commitments that I later regret?


Fewer than 10 “yes” answers and more than eight “no” answers indicate violation of standards of self-care.