The Common Perception of Therapy Work
“I could never do your job” is a commonly expressed sentiment to therapists from others, even amongst specific types of therapists to other types of therapists (working with substance abuse, to kids, to couples, etc.) When this is said, people are usually referencing their perceived limitations of mental and emotional capacity to help others on a consistent basis. The idea is that chronic exposure to the suffering of others would result in what is called compassion fatigue.
What is Compassion Fatigue?
Compassion fatigue (CF) is defined as indifference and/or exhaustion physically, emotionally and mentally as a result of secondhand traumatic stress combined with burnout from caring for others. Indications of compassion fatigue include irritability, burnout, emotional numbing and reduced empathy, but can include various emotional, cognitive, behavioral and physical symptoms.
Symptoms and Consequences
Other identifiable CF symptoms are social withdrawal, difficulty concentrating, reduced sense of purpose, fatigue/insomnia, and weakened immune response. These symptoms unchecked can lead to maladaptive ways of coping, such as avoiding certain situations/people, difficulty with boundaries and/or increased use of substances/food/etc.
Who is Affected by Compassion Fatigue?
It’s prevalent in fields where there is emotional and physical caretaking. Healthcare workers, first responders, and educators, for example, have varying rates of CF. Craig and Sprang (2010) reported 23.3% of counselors experience high CF. The rates are actually (and maybe surprisingly) generally lower than other helping professional fields, like veterinary care, legal aid, human resources, and teaching, likely due to required training, supervision and emphasis on self-care in the field of counseling.
Client Concerns and Boundaries
There have been instances where clients will check in on how I’m doing or worry about how the things that they are telling me are impacting me. While it is usually an intentional kindness conveyed on behalf of a client, it is not a space that is supposed to be held for the therapist.
Ethical Responsibility of Therapists
As a professional counselor, it is our ethical duty to tend to our own self-care in order to promote competency and effectiveness, as well as prevent doing harm to our clients. It is written in what’s called our ACA Code of Ethics, which are professional guidelines that we must follow in the field of counseling (American Counseling Association, 2014, C.2.g.).
Impact on the Therapeutic Relationship
CF can impact anyone, but professionally speaking, people who are relying on a mental health professional for support can be dangerously impacted if that therapist is experiencing CF. In therapy, one of the biggest predictors of successful outcomes is the relationship that exists between therapist and client, regardless of techniques and modalities used (Martin, Garske, & Davis, 2000).
There are many ways that CF can negatively influence how a therapist presents in session, including impaired clinical judgement, blurred boundaries, modeling of unhealthy coping skills, irritability and withdrawal, lack of of professionalism, and more.
If that therapist sends off signals that they have limited or no capacity for presence, have impaired clinical judgement, or the what was already a solid, healthy relationship begins to diminish, then a client may fall victim to harm or regression by missing opportunities for goal accomplishment, no longer trusting the therapist, or feeling confused, conflicted and/or abandoned.
Recognizing and Addressing Compassion Fatigue
If you are identifying with CF, the first step is awareness. As Brene Brown so eloquently said, “You can’t intervene in a world you can’t see.” Preventative care is always best, but it’s okay if you are already at this point as long as you acknowledge and tend to it.
Focusing on self-care practices, such as starting therapy, engaging in physical exercise, getting into good sleep routines, setting up supervision or mentorship, identifying and practicing boundaries, and finding fulfillment through enjoyable activities outside of work, are beneficial in lowering symptoms of or preventing CF.
When You Suspect a Professional is Experiencing CF
If you think that a professional helping you may be experiencing CF, do not dismiss your feelings. Some things to pay attention to are if you notice there are shifts in behavior, continuously missed sessions or time off, and seeing considerable disengagement across sessions.
Taking note of what has been happening, naming your experience to discuss (only if you feel emotionally safe to do so), and seeking support elsewhere is perfectly okay to do to ensure that you are getting the care you need. Self-compassion is necessary here, regardless of whether you are the professional experiencing CF or you are the person on the receiving end of someone experiencing CF.
References
American Counseling Association. (2014). ACA Code of Ethics. https://www.counseling.org/resources/aca-code-of-ethics.pdf
Craig, C. D., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety, Stress & Coping, 23(3), 319–339. https://doi.org/10.1080/10615800903085818
Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450. https://doi.org/10.1037/0022-006X.68.3.438
Written (9/5/2025)