Even though we have used the words ‘burnout’ and ‘compassion’ since I was in graduate school, not a lot was actually taught in school – we did not actually learn the skills that would grant self-compassion and stave off burnout – for therapists/providers or for clients. It has only recently come to the fore, with the Center for Mindful Self-Compassion, Kristen Neff and Chris Germer and their research into compassion, in 2022 the first “Compassion in Therapy Summit” for providers, and in many other spaces that have been getting attention.
Compassion literally means “to suffer together.” Among emotion researchers, it is defined as the feeling that arises when you are confronted with another’s suffering and feel motivated to relieve that suffering. Compassion is not the same as empathy or altruism, though the concepts are related.Greater Good
Since I first started working in the field, I have come to see mindfulness as a kind of stepping stone for compassion, and self-compassion. All of that research and all of the resources I am linking throughout this article echo that idea, and seem to indicate that there is a positive feedback loop between mindfulness, compassion, and cognitive flexibility.
Some of my best teachers, for mindfulness and for compassion, have been my dogs. My 14 year old retriever-mix, Penny (Penelope means loyal, and she certainly is that, as well as the fluffiest, softest black mutt I have ever met), especially, has been a great teacher for all of these. Even though she cannot see me clearly anymore, she always looks at me with absolute love and absolute trust. She comes to sit on my foot when I am upset. She submits to my hugs, even though I know dogs are not always thrilled with hugs (though I have trained all my dogs, at least the ones I have had since they were puppies, in the art of the ‘10-second hug’ and they appear to enjoy them more than other dogs I know). Penny is always down for a cuddle and scratch, will always come to me, and is always in the moment. She is always mindful and always has an open heart.
Perhaps because they do not have the same egos that humans do, dogs are better at recognizing emotion than humans and can ‘catch’ our emotions (like you can ‘catch’ a yawn) through all of that empathy. Not all breeds are as good as others – there is a reason Golden Retrievers are the most popular dog in the US, and it is at least in part because they are really good at this. They have also evolved to look appealing to humans and to be super “gregarious” over the thousands of years of domestication. All dogs have personalities and preferences and their own experiences. I have had dogs that flinch when I kiss them (history of trauma before she came to me), dogs that ask to hold my hand, dogs that will comfort me but do not want me to come to them, and dogs that think a nice walk is a cure for everything.
Enough about dogs’ mindfulness and compassion – what about humans? What about therapists?
In a talk about resilience that I saw in 2021, they talked about compassion v. empathy, and that compassion does not fatigue, but empathy does. What that means is that the act of compassion is sustainable – therapists and other caregivers can maintain compassion without burnout, because it is a different process than empathy. Empathy is the emotional experience of connecting to others, and it can be exhausting. No one can keep empathy all the time. Think about the difference between experiencing loss and the feeling you have, even if a little abstract, when you hear about someone else’s loss. This is not a bad thing! If you run wide open, emotionally, all the time, it will drain you. This is the difference between compassion and sympathy, empathy, or personal experience.
This is also why it can be difficult to maintain a compassionate distance on certain topics. Throughout my career, I have found it difficult not to tear up when clients share about the loss of a beloved dog and go through their grieving process. When my father died, it was difficult for a long time to discuss loss, especially of parents, with clients. I actually had several clients who I needed to be up front with about my personal situation, so that they would understand my reaction, and so we could work through it as more of a team than the traditional psychotherapist model – I just was not able to maintain my distance from the experience of loss at the time. That kind of disclosure is very strange for me, as I am used to keeping those things separate, but I realized that it just was not a reasonable expectation for me at that time. There are other times and experiences that trigger an emotional reaction, of course, I am just using this one as an example of the different experience of empathy and compassion.
Compassionate distance is one of the things that helpers need to learn – and a lot of us are not good at it. Most of the helpers I know went into their fields, at least in part, because they had a natural sense of empathy; I cannot tell you how many times I have heard “I am the one people tend to go to for help” or “people just tell me things” or “I just want to help people” from other therapists and providers. If you don’t develop any distance, you will burn out. On the flip side, we cannot always maintain that kind of distance – we are humans first! We also have to take care of ourselves. To me, this has been the essence of compassion from the therapist side – being honest about what is reasonable and humane, not constantly expecting more than I would of anyone else.
I, along with the rest of the world, have thought and talked a lot more about burnout in the last couple years. I, myself, was part of the ‘Great Resignation’ (twice!). For me, I woke up to the idea that this wasn’t how it had to be, and that I needed to do something about it. This goes hand in hand with compassion – for years, people have been asking more and more of employees, friends, families, partners, parents, etc. without allowing any additional resources or compassion.
The best illustration of this was the front line workers at the beginning of the pandemic – hospital employees of all types, grocery store workers, child care workers, teachers, etc. We asked all of these people to put aside the uncertainty and fear that we all felt, and to carry on taking care of the rest of us. In many cases, without even thinking about the cost, because we also did not have the bandwidth to deal with it, and without validating their experiences.
This was so demoralizing and unfair, but it had been coming for a long time. For the last 20 years, as a healthcare worker, I had been asked to do more and more and more – documentation, groups, see more clients, handle more administrative issues – without any additional resources or compensation. I was conditioned, really, to think that I just had to take it and do more in order to keep my job and in order to be a good person. It didn’t matter that I could feel the burnout coming – we all just shrugged and tried to keep going. Caregivers and people pleasers are especially prone to this, and women have been even more conditioned to accept this treatment despite all common sense.
The World Health Organization defines burnout as feelings of energy depletion or exhaustion, negativity or cynicism related to your job and reduced professional efficacy with three main causes – too much to do, boredom, and people pleasing. Burnout has stages and signs – some of them are detailed here, but the one that I noticed most was ‘cynical detachment.’ I saw it everywhere – in myself, in clients, in friends, in the news, in other professions (most notably police, healthcare, and teachers). It is the opposite of the compassionate detachment I mentioned before. Burnout keeps you from accessing mindfulness and acceptance. It keeps you from seeing what is happening clearly. And it tricks you into thinking you have to keep going when sometimes the most compassionate thing you can do is to stop.
What can we do?
So that is the thing I want people to try to do. To stop. To think. To be mindful and accept whatever comes to their thoughts and emotions without judging it. To try to be as compassionate about that thought as you would be if your closest friend were saying it out loud. To treat yourself as you would a friend, not as you think you are supposed to treat yourself. With grace and loving kindness instead of criticism and contempt.
We will need to practice. Things will happen that will test us. We have, collectively, centuries of negative thinking to overcome. All of that takes willingness to change, and we all know that change is hard.
Compassion is something we can apply right now. Whatever thought is in your head, whatever you are telling yourself about it, try to catch it and look at it. Try one of these exercises. Listen to a podcast. Try one of these mindfulness exercises. Just think about it. Every bit of kindness helps. The research indicates that just doing some of this has a multitude of positive effects.
When you do those things, try to accept them. Try to allow them, and not dismiss it. See what happens.