By Dr. Mark A. Stebnicki
Disclosure: This article was drafted with the aid of generative AI using content from our proprietary courses. It has been reviewed, edited extensively, and verified for accuracy by Dr. Mark A. Stebnicki.
I’ve spent a lot of years sitting with clients whose lives have been shaped by natural and person-made disasters, warfighting, chronic illness, disability, trauma, grief, and loss. Military service members, veterans, veterans with disabilities, and military families oftentimes bring stories into therapy containing themes of an intense and horrific nature that morph into chronic conditions of the mind, body, and spirit. In some Native American cultures, it is told that each time a medicine man/woman heals someone, they give away a piece of their mind, body, and spirit. At some point in this process, you may also require healing.
Practitioners who serve as wounded healers should be mindful of how empathically attuned they are with their military or civilian clients. At times, we take-on the soul wounding traumas experienced by our clients. This may impact our ability to bring empathic concern to the therapeutic relationship. Otherwise, we may experience the professional fatigue syndrome I describe as “empathy fatigue”- a word I coined in 1998 and first published on the topic in 1999. Empathy fatigue is a phenomenon that I have been conceptually describing, evaluating, measuring, and treating ever since. Similar observations and measurements have been recognized over time and have been discussed as compassion fatigue, secondary traumatic stress, burnout, and vicarious traumatization. However, the construct of empathy fatigue is differentiated from other fatigue syndromes and professional impairments.
This article will elucidate the unique characteristics of empathy fatigue, which is multidimensional in nature. It is differentiated from other fatigue syndromes and professional impairments. More importantly, it is my hope that you will be able to recognize, identify, prevent, and develop a plan of self-care to decrease your experience of empathy fatigue while cultivating empathy resiliency.
🧠 What is Empathy Fatigue?
In my original definition of empathy fatigue, I suggested that this phenomenon results from a state of psychological, emotional, mental, physical, spiritual, and occupational exhaustion that occurs as the therapists’ wounds are continually revisited by their clients’ life stories of stress, traumatic stress, grief, loss, chronic illness, and disability. In my most recent work, Transcending Empathy Fatigue: Cultivating Empathy Resiliency https://cognella-titles-sneakpreviews.s3-us-west-2.amazonaws.com/84391-1A-URT/84391-1A_SP.pdf (2025, Cognella Publishing, sample chapter) I comprehensively offer readers ways to identify, functionally assess, and develop a plan of self-care. The Counselor Empathy Fatigue Scale (CEFS) and the Global Assessment of Empathy Fatigue Functioning (GAEF-III) are offered as in-depth measures of empathy fatigue and resiliency. For purposes of this article, I focus on the essential points which advocate for the importance of practitioners being mindful of how to achieve an optimal work-life balance with an emphasis on developing empathy, resiliency, and a plan of self-care.
Skilled and competent therapists use empathy to earn the circle of trust by simply attending, listening, and empathically responding to the individual’s thoughts, feelings, behaviors, and experiences. Many clients want to feel “heard” by their therapist. So, empathy serves as a foundation to the therapeutic relationship as we enter into our clients sacred space. Over time, practitioners can become out of touch and desensitized to some clients they serve. This occurs due to repeated and intense exposure to the client’s extraordinarily stressful and traumatic events they have experienced. Genuine and authentic empathic responses recognize that we, as therapists, might share the same medical, physical, and psychological concerns but we have not “walked in the same shoes” as our clients. The therapeutic use of empathy communicates to clients that we understand, at some level, what the client may be thinking and feeling. However, we must recognize that their experiences are unique.
It is important to be open to the idea that when it comes to extraordinarily stressful and traumatic events, that we are all having a normal response to abnormal and unhealthy thoughts, feelings, behaviors, and actions. Our mind, body, and spirit are not built to sustain the chronic, persistent, and cumulative nature of stress as experienced in the 21st century. Simply, we accumulate psychological, emotional, physical, and spiritual stress on a personal and professional level if we allow the following to occur:
- Excessive, recurrent, and intense emotional arousal of an unhealthy nature that becomes unrecognized, ignored, undertreated, and untreated because we rationalize that we “don’t look professional” with our clients if we become distressed.
- Storing unhealthy thoughts, perceptions, and emotions that become chronic and persistent, worn neural pathways, which ultimately imprint on our cognitive unconscious, hindering our personal and professional lives from growing in mind, body, and spirit.
- Not recognizing how cumulative stress can impact the therapeutic encounters that may lead to the deterioration of our empathy, coping abilities, interpersonal communication with others, and our capacity to build empathy resiliency.
To understand the soul of empathy fatigue is to be mindful of the existential and spiritual impact that our clients’ extraordinary stressful and traumatic events have on us, and our ability to competently and ethically serve others. The questions of Why do bad things happen to good people? Or Why do good things happen to bad people? Or Where is God or our Higher Power when things hurt? are existential and spiritual in nature. These issues cannot be addressed solely by talk therapies, a step-program, or a self-help book. Empathy fatigue occurs as a parallel experience with our clients' repeated stories of extraordinarily stressful and traumatic life events. Thus, it is essential that we recognize, identify, and implement a plan of self-care using all available opportunities for optimal wellness.
⚖️ How is Empathy Fatigue Different?
The primary distinctions between empathy fatigue and other professional impairments are as follows: (a) the theoretical underpinnings of empathy fatigue are distinct and unique from other fatigue syndromes and professional impairments because of the therapeutic tools of empathy which remains constant within the person-centered relationship, (b) burnout has been measured and described extensively as it relates to the burnout experienced in ones’ occupation, career, and organization, (c) compassion fatigue was originally described in the nursing literature whereas empathy fatigue’s origin is based in the fields of counseling and psychology, (d) the constructs of empathy fatigue are measured differently and have unique psychometric properties, (e) researchers who mischaracterize empathy for compassion fatigue typically utilize instruments that measure the practitioner’s quality of life, empathy and compassion satisfaction, job burnout, and secondary traumatic stress whereas empathy fatigue has different psychometric properties and functional assessment features, (f) training in the therapeutic use of empathy (not compassion) is part of a core competency cited in accreditation standards for graduate level clinical counseling and psychology programs, and (g) neuroscientists make a distinction in functional magnetic imaging (fMRI) scans that show, from a biophysiological perspective, compassion and empathy as emotions, react to different neural pathways when presented with stimuli intended to elicit an emotional response. There are other clear distinctions between empathy fatigue and other fatigue syndromes.
One of the most parsimonious explanations in the critical pathways to describe empathy fatigue may be the nature of how therapists express or communicate compassion and empathy with clients. For example, compassion is communicated as “I’m sorry this has happened to you…my thoughts are prayers are with you.” Whereas empathy is expressed at a higher level of interpersonal communication and reflects, “I’m sorry this has happened to you…my thoughts and prayers are with you…How can I help? Thus, empathy reflects the individual’s thoughts, feelings, emotions, and experiences. However, empathy is “feeling with” others’ painful experiences; whereas compassion is more “feeling for” or feeling sympathetic towards others.
🩹 The Wounded Healer in Trauma-Informed Therapy
I’ve described empathy fatigue as a wounded healer experience. This is because many of us were drawn to this work by our own life histories of family experiences, personal losses, prior exposure to trauma, or connections to other client characteristics that occur in this dynamic of unhealthy transference or countertransference. We come into the field itself with our own wounds, some of which are not as well-processed as others. It’s important to be open to the idea that, as therapists, the experience of being a wounded healer can teach us something. It is within this therapeutic dynamic that helps connect us with our client’s pain and suffering.
Indeed, there is a “shadow side” to the use of empathy as a therapeutic tool in client-centered relationships. As we enter the world of deep emotional pain, suffering, and trauma with our clients, we use empathy as a natural way of being. It helps us earn the circle of trust so we can bring empathic concern into the therapeutic relationship. The use of basic and advanced empathy can also help cultivate client awareness, understanding, insight, and motivate clients to change unwanted thoughts, feelings, emotions, and behaviors. Accordingly, working at the epicenter of extraordinarily stressful and traumatic critical events, requires therapists to be empathically attuned to our clients’ level of stress, trauma, loss, grief, and other critical life-events. As a consequence, this may place a strain on the therapist's level of empathy. A healthy and vibrant level of empathic attunement strengthens the therapeutic bond and offers greater opportunities for us to cultivate empathy resiliency.
🧾 Ethical Considerations in Professional Impairment
Codes of ethics in counseling, psychology, social work, and mental health professions assert that practitioners and clinical supervisors monitor themselves for signs of professional impairments (e.g., substance use, major depressive, anxiety disorders) that could potentially harm their clients. It is the ethical responsibility of the therapist to seek help for a professional impairment. If a medical, physical, or psychological condition persists, therapists must limit, suspend, or terminate their professional responsibilities until it is determined by self and others that they can practice safely and competently. The emphasis is on “do no harm” and not impose risks on the client’s welfare. The following ethical questions are useful for both clinical supervisors and clinicians to ask as they relate to issues of professional impairment:
- To what degree do I recognize my own issues and how might they impact clients?
- Once recognized or identified- What steps have I taken to deal with them?
- Do I have regular and ongoing self-care practices in my personal and professional life?
- Do I listen when family, friends, or colleagues say they’re worried about me?
- Am I willing to ask for help—from peers, supervisors, consultants, or another therapist?
Overall, maintaining a vibrant career in the helping profession requires clinicians to cultivate self-care approaches that maintain optimal levels of personal and professional wellness.
🌱 Cultivating Empathy Resiliency of the Mind, Body, and Spirit
It is vital to understand and explore the subtle attributes, characteristics, and traits of persons perceived to be high in empathy resiliency. Professionals that are high in empathy resiliency theoretically communicate the following characteristics. The professional helper:
- Communicates empathy in a genuine and authentic manner.
- Establishes a constant state and trait of empathy during therapeutic interactions.
- Presents themselves as approachable, respectful, and recognizes any unique cultural attributes and nuances that empower clients with natural support and resources.
- Demonstrates the ability to integrate client clinical assessment into a comprehensive plan that empowers individuals for optimal health and wellness.
- Establishes therapeutic opportunities with clients, and humbly in return, feels a sense of personal satisfaction and accomplishment bringing meaning to their work.
- Has consistent positive optimism involving thoughts, feelings, and perceptions about the quality of their therapeutic interactions with others.
- Feels deeply for their client’s medical, physical, emotional, mental, and spiritual wellbeing without compromising their motivation for quality therapeutic interactions.
- Despite feeling the negative impacts of their client’s mental-emotional contagion, recognizes and attempts to prevent higher levels of empathy fatigue.
- Identifies their level of empathy fatigue and chooses to reach out to personal and professional self-care resources.
Professional helpers who experience higher levels of empathy resiliency understand how to harness the power of positive optimism about the good work they do with others. As a result, they have a greater sense of meaning and purpose about their work-life balance and can bounce back from adversity in their personal and professional life. Professionals who know how to accelerate their empathy resiliency are in a better position to handle work-related and non-work-related stressors. Ultimately, these professionals know how to thrive, rather than just survive in a career that deals with intense levels of client interactions.
🎓 Further Learning
The concepts and strategies I’ve shared lay a foundation for understanding empathy fatigue and empathy resiliency in military-related and general mental health practice. For clinicians who want a more comprehensive framework, extended case material, and continuing education credit, I explore these topics in depth in the Clinical Military Counseling Certificate Program (CMCC) as well as the Transcending Empathy Fatigue by Cultivating Empathy Resiliency course offered through the Telehealth Certification Institute.
Click here to view the Transcending Empathy Fatigue by Cultivating Empathy Resiliency course.
🎯 Conclusion
Empathy fatigue is not a sign that you are weak or defective. It is a sign that you have been using one of your most powerful clinical tools—empathy— in therapeutic environments that deal with trauma, loss, and chronic suffering. Both military and civilian mental health work intensifies this exposure.