December 20, 2021

BURNOUT

health-nature

If you’ve read my first post, you know that I am taking us on an exploration of mindfulness and compassion from the perspective of several fears that frequently serve to block the experience or expression of compassion. The first fear I want to explore is the fear of burnout. I start with this because I think it is a fear that captures the heart of our ambivalence toward compassion. We fear it because at heart we know we care, we care a lot. We fear we will care too much, and that we will be damaged as a result.

A typical scenario is that of a beginning therapist. A person becomes a therapist because they want to help, and usually they come to the job equipped with a more than average ability to empathize. The therapist knows that in order to help, they have to understand their patient. But understanding the complexities of a stranger’s psychology is difficult, and takes a great deal of training, as well as a period of time to get to know the patient. It can be quite a while before the therapist, particularly an inexperienced one, can feel on reasonably firm ground in their cognitive understanding of the patient. But usually a sensitive empathic therapist can “feel with” or empathize with the patient right away. And that feels good to most patients. They feel understood, and heard, even if only on a nonverbal, emotional level. I say only, not because it is an unimportant point of contact and understanding, but it is incomplete. It doesn’t serve to take the patient’s understanding further, beyond the place of suffering.

Meanwhile, our caring, hard-working therapist is “feeling with” her patient quite well. But, if her patient is in pain, that means she is too. If the patient is angry, she feels twinges of anger as well, if not more. If her patient is hopeless, our therapist may feel depleted and without any resources. This is not a helpful state of affairs. And it’s exhausting. And it leads quickly to burnout, or what some call “compassion fatigue”. The opposite of resilience.

However, this is a misnomer. Empathy and compassion are different states of relating to another person, with very different impacts on the person in those states. So some definitions are in order here. Empathy is, as I’ve described, simply a state of resonating with the other’s emotions, of “feeling with” them, or how you at least imagine them to feel. Compassion however, is a more complex state. Compassion combines emotional contact, or empathy, with the wish or even intent to act to relieve that suffering. Adding the expectation of taking positive action to relieve suffering dramatically alters the experience of caring from one of helpless suffering with the other to an enlivening and often pleasurable state. In her groundbreaking research on compassion, Tania Singer (1) has shown on fMRI (functional magnetic resonance imaging, an imaging method that allows visualization of the brain’s blood flow and activity in real time) the differences in brain activity between empathy and compassion states. When empathizing with a painful image, the subject’s brain shows intense activity in the areas correlated with painful emotional experience. When asked to generate compassionate states through loving kindness and compassion meditation, the subject’s brain showed strong activity in both pain and pleasure centers. This benefit occurred even in new meditators, after only a few hours of practice. Simply put, we get a lot of positive emotional payback for generating compassion. The addition of the positive emotional component of compassion serves to protect us from burnout. We effectively nurture ourselves with positive emotions while we care for others.

Let’s return to our unfortunate beginning therapist. Her problem, as it turns out, isn’t her tendency to feel with her patient. It’s that she is not yet confident that she can actually DO anything about it. She can feel, and perhaps, not much more. At least not until she is a little more experienced. So she may suffer from “empathy fatigue”, and would benefit from a fuller sense that she can actually act out of compassion. Then, she would be moving forward with her patient in a more positive sense of constructive action. And she would feel GOOD.

Now, anyone who does therapy knows of the ups and downs, the plateaus, and the complexities of perhaps any session, much less a longer arc of treatment. But the essential distinction holds, and is immensely important. For a simpler example, recall a time when you were caring for an infant, your own, or perhaps if you were once an older sibling, or babysitter. Recall the vast difference between the distress of trying to comfort a wailing child, who cannot be soothed, and the satisfaction and pleasure of feeling with that same infant’s distress, but having the needed remedy. The joy we feel in being able to deliver the necessary care and comfort is biologically hardwired, else few babies would survive infancy. Compassion cultivation is about utilizing that basic human wish and capacity to enhance one’s own wellbeing as well as others.

But, you say, the mom who’s frantically soothing her inconsolable child wants to help, she is actively engaged in trying to help! She’s not simply “empathizing”; she’s compassionate, isn’t she? Yet she isn’t feeling warm all over. She’s stressed! So what gives? This excellent observation points the way to some important risk factors for burnout.

Lack of self-compassion and self-care is one very important risk factor for burnout. A confident mom with a good self-caring relationship with herself won’t castigate herself if her child has a fussy day or a difficult phase of development. When possible she gets help, gets away for a few hours or has someone else get up for the 3 am shift. A caring and tolerant attitude towards one’s own inevitable failures and shortcomings is an essential component of compassionate living.

Another risk factor is an attitude of martyrdom, or even masochism, on the part of the caregiver. Clearly, there is something amiss if we don’t feel we deserve the same care we strive to give to others. We’ve all known people, whether as friends, relatives, doctors, nurses, teachers, whomever, who feel they have to suffer in the course of caring for another’s suffering. This can be due to pride or pleasure in self-sacrifice or pain, or a belief that self-suffering is all that is deserved. The caregiver may feel guilt at being healthier or in a better situation than the person she is caring for. Another scenario is the selfless caregiver who is in denial of their longings and needs. Denial doesn’t last forever, and when it gives way, a collapse into burnout and resentment is likely. At an even deeper level is a mistaken belief that caring involves a kind of merging of identity, a sharing of suffering, rather than a differentiated relationship between two mutually respecting and deserving participants.

These obstacles to self and other compassion can be stubborn and difficult to alter in therapy. They often lie at the heart of a person’s deeply ingrained relationship and emotional response patterns. The fear of change and the belief that loss of love or safety will result can be intense and entrenched. But they can and do change. A powerful lever for such change is the experience of feeling the impact of self compassion, of accessing the emotional and bodily sensations of caring for the self, as well as the expansive, empowering impact of actively generating and developing the feeling of compassion for others. This experience is extremely compelling and a powerful engine for change because it is hardwired into our beings and is a state we naturally gravitate to and thrive on. This experience is what Resilience Through Compassion Training offers in its sequence of weekly meditations and associated exercises. Check out lyonmd.com for more information about the course being offered this fall. And look for my next blog post to learn even more about barriers to compassion and what compassion training can offer you.

(1) Klimecki O.M., Leiberg S., Lamm C., & Singer T. (20

12). Functional neural plasticity and associated changes in positive affect after compassion training.

Cerebral Cortex, 23(7): 1552-61

Image by Bessi from Pixabay