Keep Counselling Confidential
With thanks to Nogah Ofer for this article. Nogah is a solicitor at Centre for Women’s Justice, she is a policy adviser and heads the legal advice team. In 2023, Rape Crisis England & Wales bega...
Compassion fatigue and secondary trauma are often spoken about as though they’re by-products of caring too much, but there are complex reactions and interactions teeming beneath the surface of our selves: physically, emotionally, and neurologically.
At a basic level, compassion fatigue describes the emotional and physical exhaustion that can come from sustained exposure to others people's suffering. It’s what happens when our empathic systems are over activated, again and again, without time to fully recover. While burnout is usually linked to systemic issues like workload or working conditions, compassion fatigue is deeply relational, and stems from being emotionally present with pain, both repeatedly and intimately.
When we hear trauma stories, our bodies respond. Our limbic system, particularly the amygdala, may trigger stress responses, activating the sympathetic nervous system and releasing cortisol and adrenaline. In small, time-limited doses, this is part of what allows us to attune and respond sensitively to our clients. But when exposure is chronic, and especially when it’s accompanied by a sense of helplessness or emotional isolation, these systems don’t get a chance to recalibrate. That’s when we start to see the symptoms of compassion fatigue and secondary trauma: emotional numbing, intrusive thoughts, difficulty sleeping, hypervigilance, or even physical symptoms like headaches, fatigue, or gastrointestinal issues. Over time, our prefrontal cortex, which is responsible for emotional regulation and executive function, can become less effective at modulating these responses, which means we may begin to feel overwhelmed, disconnected, or struggle to switch off: our nervous system has been stuck in ‘on’ for too long, and doesn't know how to switch itself off again - at least, not without some conscious help.
In the therapy room, these physiological responses are often amplified by the very skills that make us good at what we do; our ability to attune deeply, to hold silence, to be fully present with someone else's emotional world, are the relational superpowers that we've spent years training for. They do also mean, however, that we're constantly engaging our empathic circuitry, and that can lead to some repercussions.
Over time, especially when working with trauma, grief, violence, or injustice, our nervous system can start to internalise our clients' experiences. We might find ourselves absorbing their affective states, or struggling to let go of a session that’s stayed with us in our body as much as our mind. This can play out in different ways - perhaps a sense of dread before a particular client, a session that leaves us inexplicably tearful, or a growing discomfort we can’t quite name. In particularly difficult times, there can be a blurring of the boundaries between our own distress and what’s been shared with us.
While we’re trained to manage transference and countertransference consciously, secondary trauma can creep in through the back door, and it’s not that we’re doing anything wrong when that happens, but it’s that the work is, quite literally, changing how our brain and body respond to the world.
Compassion fatigue and secondary trauma rarely arrive all at once. More often, they build slowly, threading themselves insidiously through our practice. It might begin with a sense of emotional depletion at the end of the day, or a creeping reluctance to sit with clients whose stories echo those we've already heard too many times. In the short term, we might dismiss it as a busy week, a tricky case, or just needing a bit of a break. Over time, though, that persistent empathic exposure, especially when combined with systemic pressures (things like personal stress, or a lack of replenishing spaces) can leave us more vulnerable to fatigue. It’s important to note that it's not just the content of what we hear that affects us, but the relationship we form to it. Our work often demands stillness, presence, emotional receptivity... even when we're holding distressing or traumatic material. That sustained internal effort, especially without outlets for processing, can lead to what some researchers describe as an ‘empathetic residue’.
This can show up in all sorts of ways. You might notice that you’re emotionally flattening: finding it harder to connect, or even just going through the motions - unable to really connect with your clients and your work, and just trying to get through the day. Or the opposite might also be true: you might find yourself feeling everything too much, becoming more reactive or tearful, with the emotional boundary between you and your client starting to feel porous.
Outside of sessions, compassion fatigue might manifest as chronic tiredness, headaches, or digestive issues, or as mood shifts, like irritability, numbness, or withdrawal from people you care about. You might struggle to focus, find yourself avoiding certain clients or issues, or experience a persistent, background sense of dread. With secondary trauma in particular, there can also be more acute signs, like intrusive images, nightmares, or heightened startle responses, as if your nervous system is beginning to react as though the trauma has happened to you.
Be reassured here, if you're visiting this page because you suspect this might be you: none of this is a sign that you’re not cut out for the work. They’re signs that your system is doing exactly what it was designed to do, but without enough recovery time in between.
So we know what it is, how it happens, and what it looks like. But what can we actually do about it? Mitigating compassion fatigue and secondary trauma hinges on creating more space for recovery, regulation, and reflection. How could that look? Perhaps like pacing your caseload more intentionally, especially if you’re holding a lot of trauma work, or allowing time between sessions to re-centre rather than rushing straight into the next. It also means listening to your internal signals, even the faint ones. Personal therapy, but at minimum good quality supervision, can help with this. Look out for things like a sense of dread before a session, a rising tension in your shoulders, the way your thoughts linger on a client’s story long after the session ends... these are just some ideas, but you know yourself, and give yourself some honest space to really check in.
Outside of supervision, reflective practice, whether through journaling, peer discussion, or simply noticing your emotional rhythms, can help build the kind of self-awareness that protects against emotional overload. There's also something here about knowing that you have the right to be impacted, and recognising that needing space to process what we’ve heard is an important part of keeping ourselves well.
Self-compassion is one of the most evidence-based protective factors against compassion fatigue, but it’s also one of the hardest things to practise when we’re overwhelmed. It asks us to soften instead of brace, and to care for ourselves with the same depth of understanding we offer to our clients. That might mean setting clearer boundaries around work time, letting yourself say no to a new referral, or taking seriously the emotional toll of the work you’re doing. Connection helps too. Isolation tends to magnify fatigue, while honest conversations with trusted peers and supervisors can offer both validation and perspective. It’s often in these spaces that we remember we’re not the only ones who’ve felt this way.
When things start to feel too much, the most important thing is to not retreat into silence. There can be a strong desire, especially for those of us in counselling & psychotherapy, to manage it all ourselves. To tell ourselves that it’ll pass, that we just need a good night’s sleep, that we should be able to cope. Saying to ourselves: this is what we do; we can get through this, it's our job. Compassion fatigue and secondary trauma, though, are signs that something needs attending to, and that we might need support of our own. For many, that begins with an honest conversation in supervision, naming what’s going on without fear of judgement or perceived failure. Good supervision can hold space for both clinical reflection and emotional processing, offering a mirror to help us see where we might be overextending or under-supported.
Sometimes, though, supervision isn’t enough. If your symptoms are affecting your day-to-day life, your relationships, or your sense of self, it might be time to access your own therapy. Many experienced practitioners speak of the value of returning to therapy at different points in their career. If things feel acute, if you’re experiencing signs of secondary trauma like intrusive thoughts, sleep disturbances, or heightened anxiety, it may also be worth speaking to your GP. It’s OK to need support. And it’s OK to press pause for a little while. Taking time to regroup is a responsibility you have to yourself, to your clients, and to all the hard work you've done so far to get where you are.
Take a look at the NCPS directory to find someone who can help.
References & Further Reading:
How can I manage compassion fatigue? : https://www.bmj.com/content/373/bmj.n1495
Building Compassion Fatigue Resilience: Awareness, Prevention, and Intervention for Pre-Professionals and Current Practitioners: https://pmc.ncbi.nlm.nih.gov/articles/PMC8812061/
Five ways to combat compassion fatigue: https://www.rcn.org.uk/magazines/Wellbeing/2022/May/Five-ways-to-combat-compassion-fatigue
5 Pathways for Healing Compassion Fatigue:
https://ctrinstitute.com/blog/5-pathways-healing-compassion-fatigue/
How to prevent compassion fatigue: https://www.counselling-directory.org.uk/articles/how-to-prevent-compassion-fatigue
The role of self-compassion in the relationship between empathy and compassion fatigue in counselling psychologists: https://ejcop.scholasticahq.com/article/88375-the-role-of-self-compassion-in-the-relationship-between-empathy-and-compassion-fatigue-in-counseling-psychologists
Therapy for Therapists: Coping with Compassion Fatigue: https://psychcentral.com/pro/therapy-for-therapists-coping-with-compassion-fatigue#1
