Counting Myself In
A call-to-action email popped up in my inbox several weeks ago with an “ask” that seemed as reasonable as it was straightforward: a national non-profit wanted clinical psychologists to volunteer therapy services to frontline healthcare workers experiencing compassion fatigue. “CF” has been described as the “cost of caring” for others. Participation in an effort aimed at ameliorating pandemic related depression, anxiety, social withdrawal, sleep disturbance and a host of other symptoms known as “burnout” initially struck me as a no-brainer. Of course I would help.
Since closing my therapy practice three years ago, I had gained better control over my time commitments. However, perhaps intuiting that one day I might use them again, I’d kept my credentials up-to-date and had the necessary skill-set for this ask: crisis intervention had been a key part of my work throughout my career. And, as a stalwart advocate for ready access to mental health care, why wouldn’t I respond with a Sure! Count me in!
A few hours after reading that email, with the afternoon sun streaming through the windows of my study, I pulled up the application on my computer. The expected questions appeared on the screen—name, title, license number, along with a message that the services provided would be telehealth therapy. How did I miss that? I wondered. Of course, COVID restrictions would preclude ‘in person’ therapy! And in that moment, reticence flashed over me. My fingers weighed down the keys. Trying to make sense of my sudden hesitancy, I grasped for practical reasons to understand what I was feeling: How do you know this program is actually legit? Where’s the proof that all the safeguards for doing crisis therapy over the internet are in place?
My thoughts homed in on what I wanted to see as a critical flaw in the project’s plan. For such an ambitious undertaking, I hadn’t read anything in the email that had even touched on the logistics. I had no idea, for example, how the services would be coordinated. Jeez, crisis intervention is a team effort! I murmured. And to Zoom with someone who may be in very rough shape, alone, and possibly with no in-person monitoring for safety and support? I took a long breath. How could I possibly triage services, if necessary, not knowing what resources were available in a community that wasn’t my own?
These were the questions that a close inspection of the application materials might have addressed satisfactorily—but my mind was having none of it; an internal voice had sounded an alarm. You can’t do this, the voice insisted—not shouldn’t, or don’t, or this isn’t wise, but can’t. Unsettled, I sat upright in my chair as a new emotion emerged: feeling burned to a frazzle was something that, as a mental health care provider, I’d experienced, too. Did I want to put myself through all that again?
I knew that the exhaustion I’d felt when working in the field was nothing like that experienced by COVID frontline healthcare providers, all of whom had direct exposure to traumatic events, some with little or no relief for what had now been a full year. My fatigue had been intermittent and fluctuated over the course of my career of thirty years. Moreover, I hadn’t witnessed young and old dying on my watch, isolated, hour after hour, day after day. With retirement, I’d been confident—and grateful—that I had left behind the stress of my private practice. Nevertheless, my reluctance to volunteer my services suggested otherwise; suddenly I was disinclined; that emotion slowly seemed to be morphing into dread.
Staring at my computer, I recalled the times when my work as a therapist had been the most draining, which, not surprisingly, had been whenever a crisis intensified and the possibility of losing someone to suicide loomed over me. As I worried when someone for whom I’d arranged hospitalization had been discharged far sooner than I believed wise, as I listened to a cryptic or even ominous message on my answering machine, as I learned that a vulnerable client had gone missing—each of these situations came to the fore like muscle memory. They sparked the fear and helplessness that had always accompanied the adrenaline rush of attending to an emergency.
The chances that I would volunteer my services for this purpose had dwindled to nil. I could no longer imagine having the energy for what might happen if I did take on clients: how I might be called upon to spend hours worrying after a telehealth call—which was a kind of therapy that before the pandemic I had viewed as questionable, and nowhere near “best practice;” now I was already agonizing about whether I could create a safety net sustainable for the individual I was attempting to help.
Could telehealth therapy provide the right kind of help, at all? We are reminded every day through both television and print that frontline workers are both worn out and down to critical conditions. Like so much else about our pandemic, providing online therapy services to a whole battalion of caregivers represented an uncharted path. How could I be certain that an intervention meant to ease compassion fatigue wouldn’t nudge open a door to deeper, even more traumatic pain—pain that could not be adequately managed over a screen that was impersonal? What a nightmare, I thought, as feelings of guilt, anxiety, and sadness swept over me.
Later that day, I reached out to my former business partner, a colleague I’d worked alongside for decades. How did we do it? I asked, in a serious tone. Prevent and put out so many fires for so many years and for so many people? Am I just “cooked” for the time being, or am I one hundred percent “done?” On the other end of the wire came a pause and then a big laugh. Oh, Terry, my dear, need I remind you that we’re OLD? And that we’re TIRED? Then, more quietly, she reminded me of what I already knew to be true: We were terrific at advising others on the importance of self-care, but how many times did we keep trudging on when our own little wells were absolutely dry?
Indeed. Like so many compassion fatigued workers, I had been able to open my heart and mind to my clients previously, but this very process of empathy had made me vulnerable and taxed my reserve. How obvious that now I had heard the you can’t directive so emphatically. And wasn’t this message—of accepting one’s limits—an important one for me to finally absorb? And to share in some way with those for whom the path to healing might be arduous and slow?
As I write this, I hope that the liminal space I am in right now—uncertain how I can be of service to anyone experiencing the pain of compassion fatigue—will be short-lived. I hope my next step will indeed be a genuine no-brainer: finding a useful and rewarding way to make a difference. To count myself in.
Best,
