Treating compassion fatigue.

For me, ‘compassion fatigue’ used to be a flippant term to describe the adverse effects of excessive pre-Christmas charity appeals. Here, however, it refers principally to secondary traumatic stress disorder (STSD) in professionals who treat the traumatized. It can also be applied to the stress experienced by long-term helpers and carers, though this is not the main focus of the book. Apparently, the term was coined in 1992 to refer to nurses worn down by daily hospital emergencies. Do you ever get the impression that there is a stress industry out there? This book is the 24th in the Brunner-Routledge Psychosocial Stress series, of which eight volumes have been edited or co-edited by Charles Figley, director of the Traumatology Institute at Florida State University, amongst many other positions and achievements. There are 14 other contributors so there is inevitably some overlap and repetition, both in the text and especially in the references. Even the briefer chapters may have two or three full pages of references. Had these been amalgamated, the book could well have been 16 or so pages shorter. Although the subject may not appeal automatically to all family doctors, the book puts forward concepts which can be applied to their own day-to-day work, with regard both to patients working in vulnerable environments and to the doctor’s own professional well being. There are several scales and questionnaires to help in assessing the risk of compassion fatigue, and preventive measures worth consideration for patient and doctor alike. The book makes a clear distinction between compassion fatigue and burnout, although ‘compassion satisfaction’ is seen as an antidote to both. The symptoms of STSD may parallel those of post-traumatic stress disorder, and one chapter has an exhaustive list of possible symptoms in seven categories including cognitive, somatic, spiritual, work performance, etc. Terms such as ‘vicarious traumatization’ and ‘empathic strain’ for the therapist may ring a bell with the GP reader, and the resulting defensive response of avoidance, whether by withdrawal or by retreat into less threatening areas, is also familiar and challenging. However, some of the writing could be more reader-friendly. The sentence “Misdiagnosis leads to treatment-fit inadequacies as clients are not being offered validated treatment modalities shown to have clinical efficiency” seems to merit treatment by the Plain English Society. Three chapters deal with the specific situations of working with traumatized children, the aftermath of the Oklahoma city bombing and post-war Bosnia and Croatia. They consider how the experience gained can be used to improve the training, supervision and, when necessary, treatment of those workers at risk. Not surprisingly, it is noted that helpers and therapists become more vulnerable when clients’ trauma reflects their own unresolved issues, so training and support programmes need to take this into account.