Part of The Cost of Caring series on burnout, compassion fatigue, vicarious trauma, and caring for others without disappearing from the equation yourself.

Caring about other people is generally something we value in ourselves. We want to be the parent who listens, the friend who shows up, the partner who notices, the colleague who helps. For some of us, caring is also part of our work.

And usually, that caring is not the problem.

But being closely involved with other people’s distress does affect us. Sometimes we notice it immediately. More often, the changes are quieter. We have less patience than usual. We stop returning messages. We think about someone else’s problem long after the conversation is over. We feel responsible for making things better. We become tired in a way that sleep doesn’t quite fix.

Or we simply realize that there seems to be less of us left for everything else.

There is a whole body of language in the helping professions for different versions of this experience: burnout, compassion fatigue, secondary traumatic stress and vicarious trauma. These terms overlap, and even the professional literature has not always used them consistently (Diaconescu, 2015; Figley & Ludick, 2017; Mento et al., 2020).

You do not need to know which label fits before paying attention to what is happening to you.

Caring can be meaningful and still take something out of you

Compassion fatigue has been described as emotional exhaustion and stress connected to repeatedly offering empathy and compassion to people who are struggling (Estacio, 2019). That does not mean compassion is unhealthy, or that caring less is the answer. It does mean there is a person on both sides of every caring relationship.

When someone we care about is hurting, our attention naturally moves toward them. What happened? What do they need? What can I do? Are they going to be okay? Those are reasonable questions.

The problem is that it can become very easy to stop asking another set of questions:

• What is happening in me?
• What is this asking of me?
• Do I actually have the capacity for what I am taking on?

That is not selfishness. It is information.

The signs don’t always look dramatic

We often imagine burnout as a final stage: someone completely exhausted, unable to work, perhaps saying, “I’m burned out.”

But the earlier changes can be much less obvious.

They may show up in your sleep. Your relationships. Your hobbies. Your mood. Your patience. Your self-care. Your work. Your use of substances. Even the way you are beginning to see yourself or the world.

You might notice that you are:

• more irritable with people who have done nothing wrong;
• less interested in things you normally enjoy;
• starting to avoid the person who needs you because you cannot tolerate hearing one more difficult thing;
• thinking about somebody else’s situation when you are supposed to be resting;
• feeling increasingly helpless about problems you cannot solve;
• or becoming emotionally numb when you would normally feel connected.

In the professional literature, related signs include increased reactivity and negativity, decreased patience, reduced self-efficacy, lack of purpose or motivation, relationship difficulties, and trouble separating work from personal life. Similar symptoms can occur across compassion fatigue, vicarious trauma and burnout (Phillips, 2020; Salloum et al., 2015).

None of those signs, on their own, tells you exactly what is happening.

But they are worth noticing.

Not all kinds of “too much” are the same

One reason the terminology can be confusing is that different kinds of strain can look similar from the outside.

Burnout, for example, is more closely associated with workload and difficult or unsustainable working conditions. Secondary traumatic stress is connected more specifically with exposure to another person’s trauma. Vicarious trauma refers to something different again: repeated exposure to trauma may begin to affect a helper’s beliefs and assumptions about people and the world (Jenkins & Baird, 2002; Phillips, 2020).

You might therefore feel exhausted because you are simply doing too much. Or because you have been emotionally present for too much suffering. Or because somebody else’s trauma has begun to stay with you. Or because several of those things are happening at once.

Understanding the difference can eventually help us figure out what kind of response makes sense.

But before we get very interested in terminology, there is a simpler question: What has changed?

Start with noticing

If you are someone who is accustomed to caring for other people, your instinct may be to jump immediately to solutions. Sleep more. Exercise. Meditate. Set better boundaries. Take a day off. Those things may help. But first, it is useful to notice what is actually happening.

When you are doing well, what does your life look like? What happens first when you begin to have too much on your plate?

Maybe you stop cooking and start eating whatever is easiest. Maybe your house gets unusually messy. Maybe you become short-tempered. Maybe you cancel plans. Maybe you stop reading. Maybe you cannot stop thinking about the person you are worried about.

Someone else may have completely different signs. That is why a generic checklist can only take us so far. One of the most useful things we can learn is our own pattern.

Sometimes helping more is not actually more helpful

There is another uncomfortable piece of this. When someone else is struggling, it can feel wrong to pull back. If they need us, how can we say no? If their problem is bigger than ours, why should our tiredness matter? If we can technically keep going, shouldn’t we?

But capacity matters precisely because the quality of our presence can change when we are depleted. In professional caring relationships, compassion fatigue and secondary traumatic stress can affect the wellbeing of both the professional and the person receiving care, as well as the therapeutic relationship itself (Martin et al., 2015).

There is a version of this in ordinary life too, even if we do not give it a clinical name. Most of us know the difference between being present with someone because we genuinely have room for them, and listening while silently wishing they would stop talking.

Those are not the same kind of help. Sometimes the caring thing is to stay. Sometimes it is to say, “I can listen, but I don’t have the capacity to figure this out tonight.” Sometimes it is to help someone widen their circle of support instead of becoming their entire circle. And sometimes it is to recognize that you need support too.

Empathy does not have to mean absorbing everything

There is a larger question underneath all of this about empathy. If I care about somebody, how much of what they are feeling should I feel too? Can I really understand someone’s suffering without taking some of it into myself? And if I become less emotionally affected by other people’s pain, does that mean I am becoming less compassionate?

Researchers have drawn a distinction between empathy, compassion and empathic distress. Empathy involves sharing in another person’s experience, while compassion involves concern for the other person. Empathic distress describes the point at which another person’s suffering becomes a strongly negative experience for the observer and can create an urge to withdraw from it (Singer & Klimecki, 2014).

For now, I think there is a useful middle ground between emotional distance and emotional absorption. We can care deeply about what is happening to another person while still remaining aware that it is happening to them. We can be close without becoming indistinguishable.

What helps when you realize you’re carrying too much?

There is no single self-care practice that protects everyone from burnout, compassion fatigue or secondary traumatic stress.

Research discussed in this series points instead to a combination of approaches. Ongoing self-reflection can help professionals notice early changes in themselves. Mindfulness and self-care practices may help manage emotional arousal and distress. Trauma-informed self-care can also include managing caseloads, seeking additional training, referring work when necessary and collaborating with other professionals on difficult cases (Estacio, 2019; Martin et al., 2015; Phillips, 2020; Salloum et al., 2015).

There are also more ordinary forms of support: talking to someone, protecting time away from the demands of caring, noticing when boundaries have begun to shift, and asking for help before things become unmanageable.

What I like about this broader way of thinking is that only some of it is what we usually think of as “self-care.” Sometimes the answer is rest. Sometimes it is asking for help. Sometimes it is changing something that is asking too much of you. Sometimes it is having another person help you think clearly when you are too deep inside the situation to see it well yourself. And sometimes it is realizing that what you are experiencing deserves more attention than you have been giving it.

The best time to decide what you will do when you reach that point is usually before you reach it.

Caring without disappearing

I don’t think the goal is to become unaffected by other people. That would take something important out of caring.

The goal is to become better at noticing the line between being moved by someone else’s experience and being consumed by it. To notice when our capacity is changing. To recognize our own warning signs before we are completely depleted. And to remember that taking care of the person doing the caring is not separate from caring well.

Sometimes the first step is simply asking: How am I doing in all of this?

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This article is part of The Cost of Caring, a series about burnout, compassion fatigue, vicarious trauma, and how to care for others without losing yourself.

References

Diaconescu, M. (2015). Burnout, secondary trauma and compassion fatigue in social work. Social Work Review / Revista de Asistenta Sociala, 14(3), 57–63.

Estacio, R. D. (2019). The factors of compassion fatigue among guidance counsellors. Global Journal of Guidance and Counseling in Schools: Current Perspectives, 9(3), 115–130. https://doi.org/10.18844/gjgc.v9i3.4343

Figley, C. R., & Ludick, M. (2017). Secondary traumatization and compassion fatigue. In APA handbook of trauma psychology: Foundations in knowledge (Vol. 1, pp. 573–593). https://doi.org/10.1037/0000019-029

Jenkins, S. R., & Baird, S. (2002). Secondary traumatic stress and vicarious trauma: A validational study. Journal of Traumatic Stress, 15(5), 423–432. https://doi.org/10.1023/A:1020193526843

Martin, L., Shepard, B., & Lehr, R. (Eds.). (2015). Canadian counselling and psychotherapy experience: Ethics-based issues and cases. Canadian Counselling and Psychotherapy Association.

Mento, C., Silvestri, M. C., Merlino, P., Nocito, V., Bruno, A., Muscatello, M. R. A., Zoccali, R. A., & Kawai, T. (2020). Secondary traumatization in healthcare professions: A continuum on compassion fatigue, vicarious trauma and burnout. Psychologia, 62(2), 181–195. https://doi.org/10.2117/psysoc.2020-B013

Phillips, L. (2020). Grappling with compassion fatigue. Counseling Today, 63(3), 28–33.

Salloum, A., Kondrat, D. C., Johnco, C., & Olson, K. R. (2015). The role of self-care on compassion satisfaction, burnout and secondary trauma among child welfare workers. Children and Youth Services Review, 49, 54–61. https://doi.org/10.1016/j.childyouth.2014.12.023

Singer, T., & Klimecki, O. M. (2014). Empathy and compassion. Current Biology, 24(18), R875–R878. https://doi.org/10.1016/j.cub.2014.06.054