Episode 1: Compassion Fatigue 101

 *Opening Music*  

Listen up, animal care pros, compassion fatigue is real, and I'm here to help you address it. I'm Alissa Hebert-Wallace, an LCSW with over 20 years in the field, and this is Pawsitive Outlooks. On the show we'll take a look at various aspects of compassion fatigue and compassion satisfaction, including general information, mental health aspects, self-directed interventions, and a few guests along the way. 

I want to start by acknowledging that I live, practice, and learn in the traditional unceded homelands of the Acolapisa, Chakchiuma, Choctaw, Ofo, and Yazoo people, who continue to be stewards of this land. I also acknowledge the Houma people who were driven from this territory and on whose settled, unceded land I was raised. I mourn the loss of the individuals and tribes that did not survive the colonization, genocide, and warring of European countries. Finally, I acknowledge that this information regarding tribal lands was primarily taken from colonizers' records. 

 *Musical Interlude* 

Hello everyone. Welcome to the first episode of Pawsitive Outlooks. I'd like to take a minute to tell you a little about myself and my positionality. As I stated in the introduction, my name is Alissa Hebert-Wallace, and I'm a licensed certified social worker and a board-approved social work supervisor. I'm a 43-year-old, white, cisgender female, and I use she/her pronouns. I live in central Mississippi with my husband, our giant dog, and a cat who thinks she owns us. My career spans more than 20 years of clinical and administrative social work, and I am nearing the end of my doctoral studies. 

 Now that you know me, let's get to know the podcast. A transcript for every episode can be found at PawsitiveOutlooks.blogspot.com. That's "Pawsitive", spelled P-A-W-S-I-T-I-V-E. You get it right? I'll put a link in the description for you. Speaking of links in the description, any website, form, or exercise mentioned during the show will also be there for your convenience. 

Exercises in a podcast? Yep, this is an interactive show and I will, from time to time, ask you to complete an assessment, stop to consider or practice something, or scrounge up some materials. When that happens, I'll play a little jingle like this. 

 *Action Music* 

 And I'll always be waiting on the other side to move forward right along with you. 

So why did this social worker create a show geared toward helping veterinary professionals? That's a great question. Let me tell you a little bit more about my experience. For most of my career, I've worked with folks who have experienced trauma, both personal trauma and large-scale trauma like hurricanes and other catastrophic events. As a COO, I noticed my staff experiencing some of the same symptoms as the trauma survivors that I had worked with, so I began studying compassion fatigue as a way to provide some intervention to my staff. Since then I have provided training to other social workers and mental health professionals as both education and intervention. Most recently, I've been studying and practicing veterinary social work. In doing so, I have also focused on how veterinarians and other animal care professionals experience compassion fatigue. 

What is veterinary social work? No, I don't provide therapy to animals! It all starts with the human-animal bond. While you take care of the animals, I take care of the humans. Let's take a minute to explore what that means. 

The AVMA defines the human-animal bond as "a mutually beneficial and dynamic relationship between people and animals that is influenced by behaviors essential to the health and well-being of both. This includes, among other things, emotional, psychological and physical interactions of people, animals and the environment." Evidence of this bond has been found dating back to prehistoric times, as relationships with animals developed from resource, to symbol of spirituality, to agricultural tools, and finally to the companion bonds we have today. Although the strongest bonds may be found in companionship or service relationships, studies show that similar bonds exist in zoos, research settings and agriculture. 

Both the AVMA and veterinary social work specialists recognize the significance of the human-animal bond not only to individuals but also to communities. Recent research shows that animals in the home increase physical and mental health outcomes and contribute to a sense of safety and resilience. Additionally, communities with a large number of companion animals and low animal violence experienced greater community cohesiveness.

Veterinary social work evolved from the therapeutic use of animals in various institutions as far back as the late 18th century. Florence Nightingale is quoted as saying, "a small pet is often an excellent companion for the sick." The therapeutic use of animals increased, and in 1978 social workers began interdisciplinary work at the veterinary hospital at the University of Pennsylvania. Finally, in 2002, Doctor Elizabeth Strand developed the first veterinary social work certificate at the University of Tennessee. 

The veterinary social work specialty has four concentrations. In addition to providing grief support after the loss of companion or service animals, veterinary social workers provide animal assisted therapy and other interventions and study the relationship between animal and human violence. We also work with veterinarians experiencing compassion fatigue, which brings us to the reason for this podcast. 

Let's start out by defining compassion fatigue. Compassion fatigue is described as physical and mental exhaustion due to the demands of a role that requires empathy and compassion to promote healing in those who are suffering. Compassion fatigue has been identified as affecting professionals in social work and other therapeutic roles, medical vocations such as nurses and doctors, and law enforcement, and with the evolution of veterinary social work as a specialty, we've come to understand that animal care professionals from veterinary medical providers to zoo keepers to shelter staff all experience compassion fatigue. While compassion fatigue has been extensively researched and various interventions have been studied for people helpers, studies relating to veterinary practice and other animal care professions have really focused on all the things that go into compassion fatigue, including contributing factors and symptomology, rather than forward-focused interventions. 

So that's where I come in with this podcast. Instead of continuing to pathologize compassion fatigue in animal care workers, I want to give you some things that can help you out, right? So what we're going to do in this podcast is provide a strengths-based perspective and address some of the symptoms that you're feeling and some of the effects that you're feeling from compassion fatigue. 

Although this podcast is meant to move forward with interventions and helpful things to do, I figure we really ought to go over a little bit about compassion fatigue so you know what we're dealing with! I know I said this podcast was going to be a look at moving forward—all about self-directed interventions and moving away from the symptoms, but in order to do that, first we have to take a look at what compassion fatigue really is, what we're feeling, and talk a little bit about the differences between burnout and compassion fatigue. 

So let's get started. 

In the beginning, compassion fatigue was used to describe how burnout affected nurses in a particular way. Later, Doctor Charles Figley of Tulane University, who is a trauma guru, let me tell you, took the concept and developed it to explain how the impacts of burnout and secondary traumatic stress can combine and affect helping professionals in all caring professions, not just nursing, due to reoccurring exposure to secondary traumatic stress. 

Doctor Figley noted that the route to compassion fatigue is by way of numerous distressing and toxic circumstances. He also noted that compassion stress or fatigue among animal care workers emerged from particularly toxic situations that started with genuine concern and caring for their animal patients on the part of such workers. 

So genuine concern and caring is the crux of compassion fatigue, right? Without it, it's just burnout. So while anybody can feel burnt out, compassion for your patients and clients is what elevates it. So say somebody is, I don't know, a building inspector. They might get burned out by being there every day, looking at the same light bulbs and duct work, and having to deal with the same people all the time. But you don't inspect buildings because you care about people. That's not what you do. You're there primarily to make sure everything is working properly and in its proper space and to make some money. For those of us in helping professions like social work and animal care, we're in these professions because we care. We care about helping people to move forward. We care about helping animals and healing animals we care about, providing great assistance to our clients. We are in this profession to help them get from point A to point B, which is most of the time in a positive direction. Although sometimes we know we experience loss in both of our professions, and that's the beginning of compassion fatigue. 

The interesting thing is that veterinarians and other helpers with the greatest empathy towards their clients are really at the most risk of developing compassion fatigue. You see, compassion on its own can be a source of happiness, because feeling compassion for another being, whether it's a human or an animal, actually increases dopamine and all those brain-related processes that increase our happiness. This brain chemistry creates what we call compassion satisfaction. It gives us the pleasure of working to help our clients. And when we consider the relationship between compassion fatigue and compassion satisfaction, they're not necessarily inverse of each other, so as your compassion fatigue heightens or increases, your compassion satisfaction is not necessarily going down. Which means that you can continue to feel a great sense of fulfillment in your work, and you can continue to want to care for sick animals and their humans. 

Because let's face it, you guys just don't care for the animals, right? You care for us as handlers, owners, and partners, but, unfortunately, as you do you're experiencing our trauma. You're experiencing the hurt that the animals feel; you're experiencing the stress that humans feel when their animals are going through something. Maybe we don't know the next step to take in treatment, and we're worried about making the wrong choice so we look to you for help. While you are experiencing all of this compassion related stress, you are also experiencing some secondary trauma. When you do experience these things you're developing compassion fatigue. 

You might then experience some symptoms such as self-doubt in your work. Maybe you are experiencing an inability to concentrate on anything. You might experience some hypersensitivity or heightened emotional responses, or you might just become numb to everything. You might also turn towards some not-so-healthy coping skills, such as substance abuse or binge eating, to deal with these symptoms. Prolonged experiences with no interventions can lead to increased mental health symptoms and even suicide, which we will address in a future episode. 

Now we'll take a look at some other factors that can increase compassion fatigue in veterinarians. In addition to the secondary traumatic stress that you're feeling just from providing help to humans and animals, you are also facing other extreme stressors. These outside stressors also contribute to symptoms of compassion fatigue.  First, while you're providing medical care to animals, you're also facing high demands of their humans, right? Research tells us that pet owners see their animals as part of the family, and in some cases, as taking place of human children, which can create sort of a role confusion with these humans thinking that their vets should act more like pediatricians. In attending to the needs of both animal and human clients, you may find yourself in states of moral distress believing that you have little power to choose the ethical plan of care for the animal due to the necessity for high human customer satisfaction. A recent study showed that more than half of the veterinarians surveyed indicated that they felt that they had, at times, prioritized the needs of the human clients over their animal patients. 

Additionally, veterinary medicine comes with a high degree of financial stress, although that practice offers various multidimensional career paths which require high ambition in education, the socioeconomic structure of the field remains a source of mental well-being issues that can contribute to compassion fatigue. Research shows that in comparison to human medical practitioners, veterinary professionals have a higher debt to income ratio, especially when beginning practice. One research participant indicated that if he could time travel, he would return to change his course of study to human medicine instead. At times, the interactions with human clients can also impact your finances, as higher client satisfaction can influence client loyalty and adherence to treatment plans, which we know can impact practice income. 

Unlike human medical practitioners, vet practitioners experience euthanasia, sometimes on a daily basis. So not only are you at one step healing and helping, but at the next step part of your job is...Well, part of your job is to send some animals to the Rainbow Bridge, right? That can be very traumatic and very stressful for you, and for some it can be something that occurs on a daily or near daily basis. While euthanasia is warranted in many cases, some veterinarians continue to be faced with unwarranted euthanasia for convenience or due to behavior issues that have the potential for improvement. While many veterinarians do refuse to perform unwarranted euthanasia, they remain saddled with the knowledge that the human may seek the service elsewhere, or that these animals will become shelter animals and face euthanasia due to failure to thrive or or overcrowding. 

The final piece of the puzzle is the lack of DEI, or diversity, equity and inclusion in the field. Although the practice is becoming more feminized, many of the top positions in practices and in education are still held by men. It is of note that female practitioners often have a higher degree of empathy toward their clients, increasing the potential for a higher degree of compassion fatigue. Also, there continues to be a global pay gap that favors male practitioners, further increasing the financial stresses of females. Again, increasing the likelihood of compassion fatigue. Additionally, there is a lack of racial diversity in the field, especially in the US, England, New Zealand, and other predominantly white countries. Even further, less than 2% of veterinary practitioners globally are indigenous peoples, despite the key roles of animals for many tribes and communities. Both the National Association of Black Veterinarians and the Multicultural Veterinary Medical Association identify increasing awareness and spotlighting representation as essential aspects of combating institutional racism in the profession. Lastly, cisgender heterosexual individuals continue to be the majority of providers. One step to decrease gender and sexual identification related compassion fatigue is to decrease assumptions of heteronormativity and cis-normativity in the field.  

All of these aspects of DEI can lead to microaggressions and blatant discrimination based on sex, race and sexual orientation or gender identity. It is true that many practices do have formal policies around DEI, but research indicates that empowering environments and supportive workplace atmosphere have more of a positive or decreasing effect on compassion fatigue than these policies. 

Not only that, you're human, you're experiencing stress in your daily life. Maybe there's something going on in your family. Maybe you're buying a house. Stress can be good or bad. All of this combines to increase compassion fatigue in veterinary professionals and we've just left you out there with very few vocationally specific interventions other than formal mental healthcare. So, hopefully through this podcast you'll find some self-directed things that you can do on your own to alleviate some of these symptoms of compassion fatigue. 

 *Musical Interlude* 

So now that we've looked at a broad overview of compassion fatigue and some of the contributing factors, you may be wondering, “Am I experiencing compassion fatigue?” “What's my level of compassion satisfaction?” or “Is what I'm experiencing just good old burnout?” 

The good news is it can all be measured. The Professional Quality of Life Scale or ProQOL is one of the most widely used instruments to determine levels of compassion satisfaction and compassion fatigue, through measuring secondary traumatic stress and burnout, in professionals who help people who have been affected by trauma. 

Therapists were the original target of the measure, and now it is widely used with various other professionals, including medical, humanitarian workers, teachers, and law enforcement. Even lawyers and military personnel have used the measure. Recent studies have also shown that this measure is viable for determining these levels in professionals who work with animals. 

The ProQOL is continually reviewed with data volunteered from researchers around the world. The scale has been validated using nearly 1300 samples from various studies. Thus far, there has been no statistical difference across age, gender, or type of employment. It is noted that BIPOC individuals—that is Black, Indigenous, and People of Color—BIPOC individuals reported more compassion fatigue and burnout than their White counterparts. While the number of females in the study was nearly double that of the males, the number of BIPOC participants and White participants only differed by about 100 individuals. The ProQOL has also been translated into 28 languages. 

So I've included a link to the ProQOL in the description for you, and in a minute, I'll ask you to take it. As you do, remember that this is a tool for your own self-awareness. While there will be a method for you to submit your score and participate in wider research, that is completely anonymous and completely voluntary. Also note that you'll be asked to complete the ProQOL again following future episodes so that you can be aware of any changes that are taking place as you engage in these interventions. Once the tool is completed, you will have a rating of compassion satisfaction, burnout, and secondary traumatic stress. 

The following are excerpts from the descriptions and these are taken directly from the protocol Measure manual. 

Compassion satisfaction is about the pleasure you derive from being able to do your work well. Higher scores on this scale represent a greater satisfaction related to your ability to be an effective caregiver in your job. If you were in the higher range, you probably derive a good deal of professional satisfaction from your position. 

Most people have an idea of what burnout it is. From the research perspective, burnout is one of the elements of compassion fatigue. It is associated with feelings of hopelessness and difficulties in dealing with work or in doing your job effectively. Remember, we talked about that before. These negative feelings usually have a gradual onset. Higher scores on this scale mean that you are at a higher risk for burnout. However, your score might reflect your mood. Perhaps you were having a bad day when you took the assessment, or you're in need of some time off. If the higher score persists, or if it is reflective of other worries that you know that you have, you may wish to discuss this with your supervisor, a colleague, a trusted friend, or a mental healthcare professional. 

The second component of compassion fatigue is secondary traumatic stress. It is about your work-related secondary exposure to extremely or traumatically stressful events. Developing problems due to exposure to others’ trauma is somewhat rare, but it does happen to many people who care for those who have experienced extremely or traumatically stressful events. Now, these traumatic events are from the viewpoint of the person you're caring for, right? Like sometimes they might experience a trauma that we don't think is traumatic, but we are also experiencing their stress. OK. I'll go back to the definition now. These symptoms of secondary traumatic stress are usually rapid in onset and associated with a particular event. They may include being afraid, having difficulty sleeping, having images of the upsetting event pop into your mind, or avoiding things that remind you of the event. So, remember I talked about I was noticing symptoms in my staff that mimicked the symptoms that I had seen in trauma survivors? That's what this is. Now higher scores do not mean that you do have a problem, but they're an indication that you might want to examine how you feel about your work and your work environment.  

Keeping these descriptions in mind, it is important to remember that the ProQOL is not a diagnostic tool. It is simply a measure of your feelings at a particular point in time. It can be used as a guide to help you understand the balance of positive and negative feelings associated with your work, and it may serve as an indicator that one or more self-directed or professional interventions would be beneficial. 

Alright, it's time for your first exercise! So hit pause and check out the description. Unless you're driving, don't do that! Seriously though, take as much time as you need and come back when you're done. I'll be waiting to discuss some of the findings with you. 

 *Action Music* 

Now, that wasn't so bad, was it? I'd like you to take a look at your results. Let's go over a few things, keeping in mind that this is a snapshot of how you're feeling today. If you took this tomorrow, it might be different. This is just an instrument to give you an idea of how you're doing and some things to be mindful of. 

Do you have high compassion satisfaction and moderate to low compassion fatigue and burnout scores? You're likely not carrying a whole lot of significant concerns about your work, and you're probably a positive influence in your practice. 

What about high burnout scores and low compassion fatigue and compassion satisfaction scores? This is classic burnout, and it might be a result of a breakdown of organizational factors, or it could be personal. You might benefit from taking time to step away and taking a break from your work. 

Do you have high secondary traumatic stress scores with low or moderate burnout and compassion satisfaction scores or high compassion satisfaction scores? You will most likely benefit from taking part in one or more of the self-directed interventions presented later in this podcast--and maybe some formal mental health treatment. 

Finally, are your scores in burnout and secondary traumatic stress high with a low compassion satisfaction? You might benefit from taking a step back from your work and working with your administrators to reorganize your workflow. You may also need to seek formal mental health assistance. The self-directed interventions in this podcast will be a benefit, but they might not solve the problem. 

Again, I am going to stress that this is not a diagnostic tool, nor is it a prescriptive tool. It is simply a tool to bring you some self-awareness of your levels of compassion satisfaction and compassion fatigue. Please hang on to this score as it will be beneficial for you to evaluate any changes that are happening after engaging in the self-directed interventions in this podcast. 

*Musical Interlude* 

Now that we've talked a little about compassion fatigue and you've self-assessed where you are now, let's spend some time talking about what you can expect later in the series. 

Our next episode will focus more on how compassion fatigue can affect mental health and how to build resilience. Following that, each episode will focus on one or two self-directed interventions, sprinkled in with some interviews with veterinary and social work professionals, providing you with some insight into their experiences and how they deal with compassion fatigue. So let's take a brief look at some future episodes. 

First, we'll talk about mindfulness, including why and how it works. We will also practice some mindful grounding techniques together. In that episode, we will also discuss expressive writing and its benefits. You guessed it, will also take some time to practice expressive writing. With each technique that we discuss in the future, I will always work to practice with you so that you know how to use it on your own time. 

In a later episode, I'll tell you about guided imagery and how that practice can alleviate some of the symptoms of compassion fatigue. Included in that episode will be a few different guided imagery sessions to get you started. I'll also discuss where you can find other examples and how to create your own guided imagery or guided meditation prompts. 

We'll also take a look at how compassion fatigue specifically affects practice leaders. In that episode, I'll provide some information on various leadership styles and how putting these styles into practice, either alone or mixed, can help leaders not to not only address their own compassion fatigue, but also improve the morale and lessen the symptoms of their teams and their staff. 

And let's not forget about self-care. I'll spend an episode discussing the importance of self-care and how it can be beneficial to alleviating some symptoms of compassion fatigue.  Looking further into the future of the podcast, I'll explore grief, emotion regulation and distress tolerance, and other topics generated by your feedback. There is a link to a feedback form in the description of every episode. 

*Musical Interlude* 

Before we end today, I'd like to go over some ethical considerations regarding compassion fatigue and why it's important to address for both veterinary professionals and social workers. As a practicing animal care professional, I know that you are well versed in the AVMA code of ethics, but please indulge me this time to take a deeper look at how it directly addresses practicing under the burden of heightened compassion fatigue and burnout. 

Principle number three of the Code of Ethics states “a veterinarian shall uphold the standards of professionalism, be honest in all professional interactions and report veterinarians who are deficient in character or competence to the appropriate entities.” The AVMA further clarifies this, stating “veterinarians who are impaired must not act in the capacity of a veterinarian and shall seek assistance from qualified organizations or individuals” (That's me!) “colleagues of impaired veterinarians should encourage those individuals to seek assistance and to overcome their impairment.” Further impairment is defined by the AVMA as “a veterinarian who is unable to perform his or her duties in veterinary medicine with reasonable skill and safety because of a physical or mental disability, including deterioration of mental capacity, loss of motor skills, or abuse of drugs or alcohol.” 

Now, in exploring those statements and recalling that compassion fatigue can affect your mental health by causing hypersensitivity or numbness or questioning one's work ability or possibly turning to substance abuse, not to mention other mental health symptoms like anxiety and depression, we can see that it is a veterinarian's ethical responsibility to address their symptoms of compassion fatigue. The Code of Ethics also calls on colleagues of quote “impaired veterinarians” to encourage assistance, and I would say provide support to their colleagues. That means you need to share this podcast with your friends. While I’m mostly kidding about that, sharing information such as this podcast, or articles, or anything that you can think of might be, or maybe one of the interventions in the future episodes, might be an easy way for you to help a colleague without saying, “Hey, I noticed that your mental health is really in the gutter” or “You know what? I think you need to see a therapist!” 

In the same vein, social workers, according to the NASW Code of Ethics, must practice with competence, which is why it is important for us as helpers to address our own compassion fatigue and burnout. 

 

As a social worker, I am also bound to practice with service and integrity and to recognize the dignity and worth of persons. As someone who is knowledgeable in the effects of compassion fatigue and the interventions both formal and self-directed, I am bound to educate others and provide these interventions. This is where my professional ethics are guiding the creation of this podcast. 

Furthermore, I recognize that a contributing factor to compassion fatigue and veterinary professionals is a lack of DEI in the field. Social workers are ethically compelled to work for social justice, which is why I have been intentional about including the voices of marginalized persons in this podcast, through references and as interview participants. Additionally, it was important for me to discuss my positionality at the start of the series to acknowledge that my voice is that of the perceived dominant culture and to provide insight into the intersectionality that shapes my voice as the content creator. Finally, it is important for me to begin each episode with a land acknowledgement to address the erasure of the Indigenous people, as I see it. 

Thank you for joining me today and I look forward to spending more time with you as we address compassion fatigue together. 

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Compassion fatigue can have a detrimental effect on our mental health. If you need mental health assistance, please contact Not One More Vet at nomv.org. If you need to speak with someone right now or feel you are having a mental health crisis, please call the US National Crisis Line at 988 or visit nomv.org/crisis-numbers outside of the US. Please seek immediate assistance by calling 911 or your local emergency number if you feel unsafe. 

This has been Alissa Hebert-Wallace with Pawsitive Outlooks. If you enjoyed the show, hit that follow or subscribe button, tell a friend, and leave a review wherever you access podcasts. Also, your feedback is always welcome, just click that link in the description. 

Thanks for listening, and we'll see you next time. 

*Closing Music*