Compassion Fatigue: Keeping on and Moving Forward

By JayTee Barbour, STAR Medical Advocate, New Orleans

One of the most rewarding parts of working in the human services field is the ability to assist our clients and feel rewarded in that same interaction. In this process, we are taking in and learning from every experience what it means to be human.

The brain is largely still uncharted territory. Most of what we understand of its functions are still pending in hypotheses. In Dr. Daniel J. Siegel’s Mindsight, he lays out how what he calls our resonance circuit, also known as emotional contagion. This theory develops our understanding of emotions, empathy, and ourselves.

In our brain lives what are known as mirror neurons. These fire both when we act and when we observe the same action. Mirror neurons are the root of empathy (Siegel, 59), once they fire the insula located in the cerebral cortex sends a message to the brainstem which then tells the body what to do with that message. In this way humans are able to resonate physiologically with others, allowing us to sync responses like respiration and heart rate when our mirror neurons fire recognizing when someone is acting in a way we have before (Siegel, 63). For example, when we walk into a room of laughing people and find ourselves smiling, it is the cause of mirror neurons informing our body of an appropriate response.

When the resonance circuit functions correctly, as service providers we gain a deeper understanding of human emotion and inform our own internal emotional understanding while allowing our clients to weave us into their inner world and carry us with them.  In this way they are provided with a sense of security to begin exploring an inner emotional understanding of their inner selves by learning from our healthy emotional responses to whatever they may be struggling with.

The danger comes when we stop differentiating the pain and suffering of our clients from our own. For instance, when we stop resonating or relating and start mirroring or taking on their emotions as our own. Suddenly, instead of our insula taking in the emotional signals from our client, we are feeling the white rush of blood as our heart rate increases, our brain floods with adrenaline and our clients anger over an event from their past becomes our own. When it goes wrong, Seigel hypothesizes, we can actually loose our sense of self in those relationships with our clients. It can become hard to retain perspective on how past interactions with others influence current decisions (75). Once we stop tracking the distinction between empathy and a full internalization of our client’s feelings our objectivity, effectiveness and mental state are at risk (63).

While Dr. Siegel’s theories are respected, they are just one theory among many on what is happening in our brains when we are working with clients. But here is what I know from experience: to be able to make a person who has seen the darkest parts of humanity feel seen, heard, and ultimately empowered is some of the most incredible work. But we ride a fine line in the work we do. Taking that on and coming out the other side completely unaffected is impossible, because it is rooted in empathy. To feel that empathy you are physically and emotionally taking on the burden of every client interaction. And because our personal narratives and understandings of our own inner worlds are shaped by our understandings of other emotions, we are shaped by these intense interactions. We carry them with us as closely as they carry us.

So, every once in a while, my fellow champions of human compassion, when you start to feel that weight, recalibrate. Take a step back and remember all that pain you have taken on is powerful knowledge to help inform your advocacy, it is not your pain. You are not your job, you are you. Reconnect with all the other things that make you wonderful and strong and support your own personal narrative. Do the work with yourself to identify your own warning signs of stress and fatigue. Do it so you can come out the other side of this hard work we do mentally healthy and happy and able to live your own life.



  1. Mindsight: The New Science Of Personal Transformation. Daniel J. Siegel, M.D. – Bantam Books – 2011.

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