The 'Joy - Pain Spectrum' in helping: risking connection (Part 4/5)

a man holds both hands over his face with trees backlit by the sun going down | risking connection at work | Tempo Therapy and Consulting

25 May 2022

We can hardly explore the joy-pain spectrum in helping roles without looking at the pointy end. While previous blogs in this 5-part series explored the positive, protective factors, this post examines the risks in empathic connection when working with those who are suffering. Here, we will consider the symptoms, contributing factors and the differences between empathic strain (compassion fatigue), burnout, secondary traumatic stress and vicarious trauma.

Categorised in:

One can give nothing whatever without giving oneself, that is to say risking oneself.

James Baldwin, American author

Risking connection

Caring for and helping others necessitates joining their experience: it is a reciprocal, neurobiological exchange that can impact workers both positively and negatively. Previous blogs on vicarious resilience and compassion satisfaction examined the protective aspects of presence and connection in helping roles.

Whilst higher levels of compassion satisfaction and vicarious resilience can buffer the impacts of empathic strain (compassion fatigue), secondary traumatic stress and vicarious trauma, they are not mutually exclusive: it is a complex dance.

The cumulative toll of working with those who are suffering can be significant, with 25 years of research, originally led by Figley in the 1980s, confirming that connecting with the suffering of others is a risk to the mental and physical health of helpers.

Some statistics:

Did you know that scores of emotional exhaustion are higher for younger, less experienced practitioners?

And that you may be at higher risk of secondary traumatic stress if you:

  • are a young OR inexperienced practitioner
  • are a woman
  • practising in a rural area
  • new to your field
  • have a pre-existing anxiety or mood disorder
  • use detachment as a coping strategy?

The banana cake analogy

I love the smell of a baking cake; so wholesome, cosy and wintery!

  • The way it fills the house with the smell of baked goodness
  • The nostalgia of cakes gone by
  • The promise of a tasty treat
  • The way the fragrant wisps of steam swirl and dance into my system as a whole-bodied sensory feast!

So, let me ask you a question:

Have you ever tried to take the banana out of a banana cake?

No? That would be impossible, right?

I want to let you in on a secret… the same thing is true for us.

Take me, for example:
I am the same person at work, at home, on holidays. Sure, different parts of me operate in different ways, depending on the place, my role, the people I’m with etc.

But I am just one person.

Do you remember being told that you need to keep work at work, and your personal life at home?

We can’t do this - just as we can take the banana out of the cake.

Let's get some clarity!

The terminology around secondary traumatic stress can be a little baffling.

Compassion fatigue, empathic strain, vicarious trauma, primary stress, secondary traumatic stress and burnout - these terms are often used interchangeably, making things very confusing.

Further, leading experts in secondary traumatic stress from TEND and the Secondary Traumatic Stress Consortium called for a change in terminology from 'compassion fatigue' to ‘empathic strain’ early last year - see Part 3 in this blog series here for an outline of the key points of the discussion​. This is an important conversation but certainly adds to the complexity of an already term-laden area.

How do we differentiate the aspects of cumulative strain on workers who help others?

Empathic strain / compassion fatigue

Empathic strain / compassion fatigue refers to the physical, mental and emotional exhaustion that can arise as a result of engaging with the suffering of others for a prolonged period without adequate support.

For example: empathic strain occurs when a worker no longer feels anything in response to someone else's pain; there can be a sense of emptiness or not caring, or a feeling of "I don't want to hear about this any more".


Originally defined by Herbert Freudenberger in 1974, burnout is described in the World Health Organization's 11th Revision of the International Classification of Diseases (ICD-11) as an "occupational phenomenon" that has three components:

  • emotional exhaustion (energy depletion; fatigue from the cumulative toll of caring)
  • depersonalisation (a sense of distancing, feeling negative towards or cynical towards one's tasks / job)
  • decreased sense of accomplishment (reduced efficacy)

Burnout can be a slow burn (pardon the pun): struggling to focus, experiencing ongoing brain fog, no longer caring about work and finding it difficult to accomplish anything; through to the more extreme end, where helpers find they are physically unable to carry on. Dr Yumiko Kadota's story of burnout in her book Emotional Female describes this extreme end of burnout brought on largely by the excessive demands of working long hours without support as a junior doctor. At this end of the burnout spectrum, sufferers are unable to function and even carry out tasks of daily living: it can be a state of physical shutdown.

Empathic strain and burnout are often a result of inadequate organisational supports and the subsequent development of emotional exhaustion and moral injury.

Primary or secondary traumatic stress?

Primary traumatic stress occurs when you have direct exposure, that is:

  • when you experience or witness a potentially life-threatening traumatic event, and
  • you feel intense fear, helplessness or feelings of horror.

A primary traumatic event can be

  • personal: such as being involved in a car accident; or
  • professional: when you are assaulted or threatened at work.

Secondary traumatic stress involves indirect exposure to traumatic material through a second-hand experience such as hearing or reading about traumatic events or experiences: when the felt experience of the trauma is transferred to another through repeated listening and empathetic engagement with people who have experienced primary trauma.

For example: when you hear or read about an incident of abuse or someone tells you the gory details of a car accident.

Secondary traumatic stress has also been identified in relation to medical errors resulting in patient harm.

Many types of jobs expose workers to secondary traumatic stress: teachers, nurses, doctors, lawyers, counsellors, therapists, psychologists, allied health professionals, emergency service providers, NDIS providers, disability care workers, aged care workers, volunteer staff in many areas and all kinds of advocates; certainly anyone in a helping, or advocacy role.

As highlighted by Montana State University in 'Secondary Trauma in the Workplace', there are three key concepts that are important in understanding secondary traumatic stress:

  1. "secondary trauma is an occupational hazard
  2. secondary trauma is a by-product of empathetic engagement with individuals who have experienced first-hand trauma
  3. secondary trauma can have serious consequences for our health, both mental and physical".

Vicarious trauma

Vicarious trauma refers to the process of internal change that can occur in helpers through empathic engagement with the traumatic experiences of others. Vicarious trauma describes a shift in one's perception of themselves or in their world view.

For example: a worker who previously felt comfortable walking to their car late at night, may feel unsafe after being exposed to someone's experience of being attacked at night, because they have internalised the real danger and a felt sense of the terror of being attacked.

Vicarious trauma is a given in workplaces where there is exposure to traumatic experiences. It is the responsibility of each workplace to expect, manage and support workers to ensure that experiences of vicarious trauma do not deteriorate into secondary post-traumatic stress disorder.

We know the risks to connection in helping roles - how do we manage this?

Through this blog series we have explored both ends of the 'Joy - pain spectrum': the positive, fulfilling and protective aspects, and the challenges of emotional strain and vicarious traumatisation when working in service of others.

See part 5 in this blog series here where we explore the individual and organisational supports required in mitigating the risks of connection in helping roles.

Related Resources

Header image: Tim Mossholder