Caring for Caregivers: Compassion Fatigue

Caregivers are one of the most overlooked segments of our population. The most recent statistics gathered by the Family Caregiver Alliance (2004) indicate there are more than 28 million caregivers in the United States; that's more than 30 million caregiving hours per year at a staggering dollar value of $306 million. Unfortunately, caregivers are not well-understood in terms of their own very specific needs. Clearly, caregivers require care themselves, to which Terry V. Eagan, MD, and David Cohen, LAc, of Moonview Sanctuary in Santa Monica, Calif., can attest. In this exclusive interview, Acupuncture Today explores this population so desperately in need of AOM services.

AT: Can you tell me a bit about your background and what got you interested in working with caregivers?

TE: I am a physician/psychiatrist in Los Angeles and the medical director of Moonview Sanctuary (www.moonviewsanctuary.com), a psychological healing/peak performance center that specializes in the combination of Eastern and Western modalities of treatment. My father was a minister and my mother was a teacher, so I was raised in a "helping" household. Over the past 15 years, I have been a medical director for numerous inpatient/residential/outpatient psychiatric centers, and had a very large private practice in Beverly Hills, Calif. I have had the opportunity to treat numerous clergy, physicians, teachers, therapists, etc., and became interested in the phenomenon of compassion fatigue.

AT: What types of caregiver-specific programs do you offer?

TE: Here at Moonview Sanctuary, we offer individual and group programs for individuals dealing with a host of psychological issues, including stressors associated with caring for the ill, indigent, underserved, etc.

AT: In your experience, what are some of the unique needs of caregivers?

TE: Many caregivers have been providing care since childhood. They may have had special attributes to which others were drawn in regard to problem-solving or advice-giving, or knew how to "lessen the load" of others. Many of these individuals then find themselves in the helping professions. If they do not take special care of their own emotional/psychological/physical/spiritual needs, they may then be at risk for developing compassion fatigue, a syndrome where caregivers begin to experience some of the very symptoms of the clients they serve (for example, dealing with patients who have suffered extreme trauma may take an emotional toll on the caregiver). Caregivers are often self-sacrificing, overly identify with the suffering of others, and do not practice good self care.

AT: What are some of the benefits that acupuncture/Oriental medicine might offer to caregivers?

DC: Acupuncture is inherently stress reducing, and has a distinctly calming effect on the central nervous system, so regular acupuncture treatment can help to restore piece of mind by simply removing stress in the short term. The more consistent the treatment is given, of course, the more cumulative the effect. Beyond this, implementing the practice of TCM into a caregiver's life provides a fresh way of looking at these stresses, as well as a new set of tools including dietary precepts, calming and energizing exercises like qi gong or tai qi as well as acupuncture, nutritional guidelines and massage, all of which promote balance and stability. One of the fundamental precepts of virtually all spiritual systems, and one which is certainly true for Taoism and Chinese medicine, is that the healer's first responsibility is to themselves. Involvement in an integrated wellness program such as TCM offers can be tremendously empowering and tremendously restorative.

AT: Is there any specific background/training a practitioner would need to have to work with caregivers?

DC: While TCM offers a unique and powerful approach to psycho-spiritual issues, it is always useful to have a clinical understanding of the psychological demands of Alzheimer's or other critical-stage diseases. It is dangerous for untrained practitioners to undertake counseling caregivers without some degree of training which familiarizes them with the clinical realities. With proper training, the TCM approach to psychological stresses fits very effectively into a well-managed integrative program.

AT: Can you provide an example of how a caregiver patient was helped by your services?

TE: I worked with a particular patient who was a therapist working with terminally ill patients. The therapist had become depressed, irritable, less compassionate and frustrated with the work. We had to look at the therapist's life history to see when "caretaking" first expressed itself in their life and how it had informed many of the choices they made in terms of education, personal relationships, career choices, etc. We looked at the reward patterns that were reinforcing their "self-sacrificing" behaviors (i.e., others' approval and gratitude, feelings of importance, significance of the work, etc.). We also looked at the many ways the therapist was not taking good care of themselves and created a correction plan that helped them implement new behaviors of self-care in body, mind and spirit. A comprehensive treatment plan is most likely going to be more effective in helping a patient achieve the results for which they are looking and create a more sustaining positive effect in their life. Supporting them through the transition is key.

AT: Obviously, this sort of work is draining. How do you take care of yourself after a long day of taking care of other caregivers?

TE: This work is indeed rewarding, challenging and draining. It is important not to overschedule yourself. Collaborate with colleagues, take time to laugh, play, relax, develop a regular exercise practice, get proper sleep, mind your nutrition and get consultation/support/therapy as appropriate. Spend time enjoying and cultivating your personal/family/love relationships. And pets are great!

AT: What can caregivers do themselves to maintain their own physical and emotional health?

TE: See above. I also feel some form of creative expression, e.g., music, art and dance, is a great stress reliever and psychological balancer. The other thing I would recommend is that the therapist tends to their own "spiritual" needs, e.g., "care of the soul." This may be in the form of a meditative/mindfulness practice, religious affiliation, prayer, 12-step affiliations, etc. All are very important in helping the caregiver stay grounded, grateful and available to provide the quality services that they find so important.