When Caring Starts Wearing You Down

Dr. Jerry Cunningham (0:00)

We are told that caring is a good thing, and of course it is. Empathy makes us better spouses, better parents, better friends, better psychologists, and even better human beings.

But there's a side of caring that we don't talk about enough. What happens when you keep giving emotional support day after day, week after week, and there's never really a point where you get to recharge? You're listening, helping, fixing, comforting, worrying, yes, checking in about it, showing up, and then carrying other people's pain until one day, somebody tells you about another crisis, and something inside you says, I'm going to need you to take a number here. Research on compassion fatigue has found that prolonged exposure to the suffering and needs of others can take a real emotional toll, particularly when that person doing the caring has little time or support to recover.

And this is not limited to psychologists, nurses, doctors, or first responders either. Family caregivers can experience it too. You can love someone deeply and still reach a point where caring for them starts draining parts of you that you didn't realize were running low. You may start feeling emotionally numb, irritable, detached, exhausted, or even guilty because you're not responding to someone else's pain in a way that you once did. Then you start beating yourself up because you think, what kind of person gets tired of caring for the person they love? Well, apparently a human one. This is Off the Couch Psychology Podcast, where we take what's going on in your mind, break it down, and help you get back into control of your life. I'm Dr. Jerry Cunningham. I'm a psychologist and author, and today we're breaking down the research on compassion fatigue. But before we go any further, this podcast is here to help educate and inform, but it does not replace advice or treatment from your doctor or psychologist. Think of this episode as something can help you better understand what's happening and what you might need to bring into those conversations with those professionals. Because sometimes the person who spends all their time taking care of everybody else, needs someone to finally ask, who's taking care of you? So what exactly is compassion fatigue? That term gets thrown around a lot, and sometimes people use it as another way of saying, I'm tired of dealing with people. That's not really what we're talking about with compassion fatigue. Compassion fatigue is the emotional strain that can develop when you spend a lot of time caring for people who are suffering, traumatized, sick, or dependent on you.

It has been studied heavily in nurses, doctors, psychologists, therapists, first responders, and other helping professions. But research is also starting to pay attention to what prolonged caring can do for a family caregivers. A recent study and research of family caregivers of older adults, and people living with dementia found that compassion could be supported by love, meaning, attachment, sense of purpose. But it could also be undermined by chronic responsibility, fatigue, guilt, emotional over-identification to the caregiver role, and then limited support from others. Now, I've said a whole bunch of terms there floating around so far in this episode. So let me separate them before we need a flow chart, three highlighters, and somebody from a university explain them what a flow chart even means. Burnout and compassion fatigue do overlap, but they're not exactly the same thing.

Burnout is generally connected to this long-term stress that leaves someone feeling emotionally depleted or drained.

Secondary traumatic stress is different from that. Secondary traumatic stress refers to emotional distress that can develop from exposure to another person's trauma, either through these repeated contacts with the person or sometimes even a significant single exposure to the situation. Then there's something called compassion satisfaction, and I really like that word because the research is not saying that helping people is inherently damaging to you either. Compassion satisfaction is the positive side of helping. The sense of meaning, the purpose, the satisfaction that can come with knowing that you made a difference in somebody's life.

That's important because I don't want somebody listening to this and thinking, well, apparently caring about people was my first mistake. No, caring is not the problem.

The issue is what happens when the demands of caring continues while the opportunities to recover keep disappearing. Researchers commonly study these experiences with measures such as the professional quality of life scale or what they also call the Pro QOL.

It looks at the competition satisfaction, the burnout, and the compassion fatigue, or this secondary traumatic stress that I was talking about earlier. One important caution that I want you to be aware of is that the organization behind the Pro QOL does not recommend that this particular measure is for family caregivers. Family caregiving has its own circumstances and measures, which is another reason we should not automatically treat a nurse caring for patients and a granddaughter caring for her grandmother at home as though these situations were identical because they're not. So I want to put this into southeast Missouri terms. Imagine that every person you care for makes a small withdrawal from your emotional checking account. Most of the time, that's fine because you make deposits too. You sleep, you laugh, you spend some time with people and you enjoy it. Sometimes somebody helps you out, you take a break, you do something that has absolutely nothing to do with anybody else's problems and your emotional account gets some things added to it and gets replenished. But now imagine that the withdrawals keep coming and the deposits stop. Somebody needs you in the morning, somebody needs you at lunch, somebody calls you at night. There's another appointment, another problem, another difficult conversation, another crisis, another decision that has to be made and you keep saying, I'm okay, I'm okay, I'm okay, I've got it.