The risks to bereavement and other trauma-related counsellors for burnout, compassion fatigue and disenfranchised grief have been a frequent focus of interest and research. Although Maslach began researching burnout in the late 1980s, her recent book (2003) provides a summary of her findings in the area of burnout. Burnout comprises emotional fatigue, cynicism about the value of the work being done, and symptoms of depression in the counsellor (Maslach, 2003).
Burnout may include physical fatigue, poor concentration, and loss of pleasure generally, not just in the implicated work. Compassion fatigue, a construct developed more recently, does not feature the cynicism of burnout; rather, compassion fatigue develops in counsellors who share themselves without maintaining healthy boundaries, neglect self-care and/or receive inadequate professional and personal support (Maslach, 2003). Compassion fatigue encompasses “professional exhaustion” due to over-identification with persons’ suffering. (Maslach, 2003)
Compassion fatigue appears to arise from the traits which counsellors believe make them good counsellors: empathy, the ability to identify with persons, and gaining emotional satisfaction from the work (Maslach, 2003). Papadatou (1997) asserted that an over-emphasis on empathy correlates to increased risk of compassion fatigue among persons working with the dying as well as bereaved families. There can be a blurring between professional and personal experiences, leading to a contagion of counsellors’ mental space by the fears, pain and trauma of persons’ experiences (Siebert, 2004).
This may be exacerbated by workplace conditions. For some (e. g. , clergy) whose job is intrinsic to lifestyle, it may be nearly impossible to clearly mark personal versus professional time, leading to personal and family difficulties (Siebert, 2004). In other situations, lack of adequate supervision or collegial interaction may lead to symptoms of compassion fatigue or burnout (Maslach, 2003). Researchers have found that some counsellors seem to put up barriers to empathy as self-protection;
Kirchberg, Neimeyer and James (1998) asserted that experienced therapists who were “saturated with death themes” (p.99) tended to exhibit the least empathy. However, they also found that with increasing age and experience, counsellors reported more comfort with death-related issues as well as exhibiting greater empathy. Papadatou (1997) explicitly mentioned teaching health professionals working with the dying and bereaved families empathy as a skill set including understanding but also emotional distancing to reduce the risk of trauma to the professional.
She also encouraged the participants in the training to let themselves experience their grief processes, a practice echoed in many hospice workers’ attendance at patients’ funerals. Some research has been done on how to help healthcare workers cope with grief; Moss, Moss, Rubenstein and Black (2003) have explored how using family metaphors and language to describe the relationship between staff and deceased patients in nursing home settings facilitated staff expression and resolution of grief related to work and family experiences.
In other settings, researchers have found negative staff outcomes in the case of caretakers who grow attached to patients and grieve for them, whose grief is disenfranchised not only by those outside the profession but those within who assert that professionals should maintain detachment (Lamers 2002). Men’s grieving behaviour may be generally disenfranchised compared to women’s because of differences in expression of affect or unaccepted behaviour styles, such as throwing oneself into work as an escape from grief.
On the other hand, Reynolds (2002) asserted that most grief models have been designed by men and represent an action-oriented model of grieving, (e. g. , Worden’s tasks or Freud’s work), comparing these models to the more developmental model suggested by Kubler-Ross. In general, trauma counselling, including bereavement counselling, can lead to physical, emotional and mental distress in the bereavement counsellor.
The risk of harm to the counsellor translates to a risk of ineffective work with persons, which presents professional and ethical dilemmas (Gamble 2002). Carl Rogers’s Person-Centred Therapy in Bereavement Counselling Rogers’ three conditions—congruence, empathy and unconditional positive regard—are fundamentally important to virtually all humanistic traditions in psychotherapy.
Person-centred therapy believes that if therapists convey congruence, empathy and unconditional positive regard to their persons, positive personality changes will occur (Raskin & Rogers 1989, p. 172). This is the theorem on which the person-centred approach is based. Person-centred therapists also say that if the three attitudes are presented by therapists, persons will not only become less dependent on the therapist but will rely less on introjected values (Tomlinson & Whitney 1970, p. 459).