_____________________________________ Setting Ethical Limits: For Caring and Competent Professionals
client; with empathy, you feel the client’s pain. Although a counselor can get caught up in the client’s feelings, he or she should always strive to empathically understand what the client is experiencing while maintaining emotional detachment. This potentially provides a broader perspective that extends beyond the client’s situational distress. Mental health professionals want to employ the best tools in order to affect change in their clients without causing harm, and empathy surpasses sympathy in terms of effectiveness. Research has validated the importance of empathy, unconditional positive regard, and congruence for achieving an effective therapeutic relationship [18]. Compassion-focused therapy is a rapidly growing, evidence- based form of psychotherapy that pursues the alleviation of human suffering through psychological science and engaged action [19]. According to Gilbert, the following are attributes of compassion-focused therapy [20]: • Sensitivity: Responsive to distress and needs; able to recognize and distinguish the feelings and needs of the client. • Sympathy: Being emotionally moved by the feelings and distress of the client. In the therapeutic relationship, the client experiences the counselor as being emotionally engaged with their story as opposed to being emotionally passive or distant. • Distress tolerance: Able to contain, stay with, and tolerate complex and high levels of emotion, rather than avoid, fearfully divert from, close down, contradict, invalidate, or deny them. The client experiences the counselor as able to contain her/his own emotions and the client’s emotions. • Empathy: Working to understand the meanings, functions, and origins of another person’s inner world so that one can see it from her/his point of view. Empathy takes effort in a way that sympathy does not. • Nonjudgment: Not condemning, criticizing, shaming, or rejecting. It does not mean nonpreference. For example, nonjudgment is important in Buddhist psychology, which emphasizes experiencing the moment “as it is.” This does not mean an absence of preferences. Empathic Boundaries Counselors strive to achieve empathy with their clients while maintaining boundaries that protect their own energies. Professionals should ‘‘sense the client’s private world as if it were [their] own, without ever losing the ‘as if’ quality,’’ and while not becoming entangled with their perception of the client [12; 21]. It takes work to maintain a healthy distance emotionally while feeling and intuiting what the client is saying.
Too much sympathy, or working with empathy without proper boundaries in the therapeutic relationship, drains the counselor of energy and leads to burnout. In a study of 216 hospice care nurses from 22 hospice facilities across Florida, it was found that trauma, anxiety, life demands, and excessive empathy (leading to blurred professional boundaries) were key determinants of compassion fatigue risk [22]. In other words, there can be too much of a good thing. In order to motivate client change, there should be a limit to the use of empathy in therapy. Empathy is but one tool that a compassionate mental health professional can use to ensure client growth. THE COSTS OF CARING Humans need humans and heal best with compassionate care. However, mental health professionals must guard against caring too much. While hearing about and sharing the joyous parts of a client’s life is wonderful, most therapeutic work involves listening to a client’s emotional pain, which can take its toll on even the most seasoned professional. STRESS Stress is a warning sign that indicates that self-care needs to be increased. Stress tells you that something is not right. It is like the “check engine” light on your car’s dashboard, which, if ignored, can lead to major engine malfunction. Stress that is left unchecked or poorly managed is known to contribute to high blood pressure, heart disease, obesity, diabetes, and suicide [23]. Stress reminds us that we are human and that we have limits. The symptoms of stress include [23]: • Headaches, muscle tension, neck or back pain • Upset stomach • Dry mouth • Chest pains, rapid heartbeat • Difficulty falling or staying asleep • Fatigue • Loss of appetite or overeating “comfort foods”
• Increased frequency of colds • Lack of concentration or focus • Memory problems or forgetfulness • Jitters, irritability, short temper • Anxiety
Other warning signs that more self-care is needed include outbursts, depression, anxiety, and lowered tolerance to frustration. Fatigue, whether physical, emotional, mental, or spiritual, can lead to reactivity and poor judgment. Little or no self-care can contribute to burnout, illness, and even addiction. It can also leave the professional vulnerable to crossing or violating boundaries.
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