Praxis Blog

Overcoming Burnout: Moving from Empathy to Compassion

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Author: Ronald D. Siegel, Psy.D, Center for Mindfulness & Compassion, Harvard Medical School

Being a clinician isn’t easy. While occasionally our clients tell us about promotions, wonderful new love relationships, or their kid’s graduation—we hear a lot more about cancer, car crashes, addictions, and other tragedies. Naturally, we’re empathic. But resonating empathically to pain day in and day out can be overwhelming, leaving us exhausted, emotionally shut-down, and burnt out.

There’s an alternative to this empathy fatigue that until recently has received little attention from clinicians or researchers. It involves deliberating cultivating compassion rather than empathy.

Mattieu Riccard, a French scientist turned Tibetan monk, has been dubbed “the happiest man alive” based on numerous scans of his brain at universities studying meditative states. He tells a story of being in an fMRI scanner at the Max Plank Institute in Germany, being shown images of people in pain. At first, he was instructed to tune into his experience—just being with the pain of seeing another person hurting. After following the instruction for a while, he begged the research team, “Can I please switch to compassion practice? This is getting too painful to bear.” Once he made the switch, he found that he could keep up the practice indefinitely.

Historically, psychotherapeutic traditions haven’t differentiated clearly between empathy and compassion. Carl Rogers, the master of empathic resonance, at various times eloquently and elegantly described empathy as feeling the pain of another, as though it were one’s own, without losing the perspective of “as though.” Modern neuroscientists suspect that our capacity for empathy rests on our mirror neurons—our hard-wired ability to feel in our own bodies what we imagine we’re witnessing in another (if you’ve ever been to an erotic film or horror movie you’ve seen these in action).

Virtually all clinicians since Rogers have agreed that empathy is essential for successful psychotherapeutic work, and Scott Miller, John Norcross, and other’s contemporary work monitoring clinical outcomes confirms this. Yet empathically resonating to pain all day takes its toll on us. Luckily, there’s another approach.

What, exactly, is this alternative of compassion?  The English term comes from Latin and Greek roots meaning to “suffer with.” This capacity actually begins with empathy. To be compassionate we need first to be able to sense another’s feelings. Of course, we can experience empathy for either pleasant or unpleasant feelings. We might resonate with the joy of our friend who just got engaged, or landed a dream job. This sort of empathy is different from compassion, however. Compassion involves a particular sort of empathy—empathy for painful experiences—the stuff we hear about all day at work.

The Power of Altruism

But compassion also involves an additional element. It includes an altruistic wish, a desire for the other person to feel better or be well. When our friend or client is hurting, we feel his or her pain and we have a wish in our heart for our friend to feel better. These needn’t be pie-in-the sky wishes. We might wish, for example, that a friend or client with stage four cancer have a peaceful last few months, or an easy death, not necessarily a miracle cure.

Compassion has some close cousins that don’t quite carry the same benefits. Sympathy involves feeling for someone’s pain, but with a bit of distance—like sympathy for someone who lost his or her job while we imagine that ours is secure. Pity is even more distant—as though the other person is somehow beneath us. Non-smokers pity the smoker who gets lung cancer. Neither sympathy nor pity includes the altruistic wish to help, nor do they connect us to others like compassion does. Love usually includes compassion, but since it has erotic overtones and can involve possessiveness, we tend to shy away from the word in clinical circles.

So how does adding this altruistic wish to empathy help? First, generating the wish for the other to be well provides us with a sense of agency—we’re being active rather than passive—which tends to be easier for most people. But on top of this, the altruistic wish awakens and enlivens the mammalian tend-and-befriend system, the oxytocin-based nurturing capacity hardwired in all of us to make us care for children, other family, and members of our tribe—not to mention puppies, kittens, and other creatures that we see as non-threatening. 

While our caring capacity can be easily overwhelmed by other motivational systems, such as our fight-freeze-flight threat-response circuits, or our drives for food, sex, shelter, and social rank, when we deliberately cultivate compassion, these competing concerns tend to quiet down. We find ourselves connecting to others, experiencing a sense of “we” or common humanity. This safe social connection can be deeply nurturing and calming to us as well as our clients.

See also: How Mindfulness Works: Avoiding Avoidance

Contrast this to the dynamics of burn-out stemming from empathically resonating to our clients’ pain. When we’re burnt out, a lot of our exhaustion comes from these other motivational systems—feeling threatened in some way by what we’re hearing in the office. When we empathically resonate to a client whose kid has been in an accident, it’s not a big leap to imagine the same happening to our loved one. We naturally respond with fear, and it’s this sort of fear, day after day, that wears us out.

But if we cultivate compassion, including altruistic wishes in response to pain, we can remain empathically attuned but less frightened and perhaps even more deeply connected, appreciating our shared humanity.

Sound good? While there are many ways to cultivate compassion, loving-kindness practice (which has been studied extensively in recent years) or tonglen practice (a Buddhist technique of imagining taking in suffering and sending out good wishes) are possible places to start. You can stream or download meditations designed to develop these at my website, mindfulness-solution.com, and find detailed instructions in The Mindfulness Solution: Everyday Practices for Everyday Problems among other sources. 

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