A Therapist on Learning to Empathize Without Burning Out

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Almost immediately, I realized I couldn’t handle it.

A few years into in my clinical training as a therapist, I was assigned to a study with men who had been sexually abused as boys. I was excited — the project was desperately needed, and I hoped it would be effective. But I had two little boys of my own, a fact that ended up changing everything. The stories the men told hit me like nothing ever had in my young career: boys cornered in bathrooms. Boys abused in their own beds by cousins or fathers. Boys left confused, shamed, silenced. I felt sick. I blinked back tears.

Normally, I loved my work. It was, and continues to be, a privilege to help people get their lives unstuck, like pushing a mired car out of the mud. You work together with great effort, and when the car lurches forward and rolls free, everyone cheers. But that time, it felt like the mud was sucking me down. Mercifully, I was transferred to another project before it closed in over me, but still, I was surprised by my own response. For the first time, it had been too much — too much pain, too close to home. And maybe, on my part, too much empathy.

***

Empathy is necessary. As a psychologist, in order to do a good job, I need to get it. I need to get the doubt of the client with OCD, who circles his car back again and again to check if he’s inadvertently run down a pedestrian. I need to get the insecurity of the winsome client with social anxiety, who is quietly convinced of her own ineptitude. If I don’t, I risk alienating them as yet another person dismissing their very real experience.

Wanting to get it is hardwired in each of us: As social animals, we have evolved to take care of each other. It means we’re there for the friend who’s going through a messy divorce, the brother-in-law with lung cancer, the daughter getting bullied. We want to get it. We want to feel a genuine connection, an authentic understanding. But even those of us who take care of others for a living struggle to find the line between understanding the pain of another and taking on that pain as our own.

According to emotional intelligence researchers, empathy isn’t as straightforward as it seems; instead, there are three distinct ways of perceiving what someone else is feeling. Cognitive empathy, for example, is understanding on an intellectual level how another person thinks and feels, without getting tangled in shared emotion. It is a conscious and deliberate taking of another’s perspective — you understand what will motivate or move them. Cognitive empathy is the cornerstone of trusting relationships; when someone understands you, you begin to trust them.

But in the wrong hands, understanding how someone else feels can be a dangerous thing. Sleazy advertisers, bullies, and tyrants lording over a country or a household know how to tap into the wants and needs of others without the inconvenience of caring. Knowing another’s mind-set without an emotional connection can be a perfect setup for manipulation, exploitation, and abuse. A recent study, for example, found that online trolls tend to score high in cognitive empathy. And yet while cognitive empathy is great for negotiating a contract or rallying a team, understanding without caring can come across as cold or detached when trying to help a distressed client (or, for that matter, a distressed friend or family member).

In contrast, emotional empathy is the sharing of emotion, feeling what others feel, the proverbial “putting yourself in their shoes.” As a skill, it’s practically a superpower. It keeps us in sync with one another, allowing us to feel the joy of a friend’s wedding, or the giddiness of a child on Christmas morning. Beyond that, standing in the shoes of a demographic “other” can sharpen the person into focus as a living, breathing individual rather than blurring them into a stereotyped group.

But here, too, there’s a problem. Emotional empathy may be necessary and often amazing, but it can weigh you down: A study by three Australian researchers found that, under stress, emotionally perceptive individuals reported higher levels of depression and hopelessness. Indeed, excessive emotional empathy was my Achilles’ heel with the men in the sexual abuse study. I felt their pain so acutely that I was incapacitated.

As I learned, unchecked emotional empathy can render you useless; you can’t see clearly with eyes filled with tears. But also, absorbing other people’s pain is exhausting. Over time, it burns you out. Tiny things push you over the edge. Humor gets dark and sarcastic. Getting it is replaced by a sense of resentment (“These people don’t even appreciate me”), purposelessness (“What’s the point?”), and endlessness (Next!). There are many names for this: “empathetic strain,” “overidentification,” and “pathological bonding.” But one comes up again and again: “empathy fatigue.” So our dilemma continues. How do you connect on a genuine level without letting the connection bleed you dry? When your day — professional or personal — consists of managing others’ pain and suffering, how do you keep your soul from callusing?

Enter the third kind of empathy: compassionate empathy. This type allows us to feel alongside another, understand what they might be going through, and, crucially, move us to help. But how do we switch on the compassionate empathy? If we don’t want merely to cry together, nor sit with coolly detached understanding, how can we activate the altruism of compassionate empathy? In the years since I worked on the sexual abuse study, I’ve gained an inkling. As a novice psychologist, I focused on the tragedy. I focused on the horror of what had happened and pictured my boys in their place. What I didn’t do was look forward.

And this is the crucial difference. Before, I focused on the suffering; now, I focus on the relief. Before, I felt helpless; now, I feel hopeful. These days, when I hear a story, I look forward — to what we can do to relieve their suffering, how we can work together to help them feel better, how we can push the car out of the mud.

The term empathy fatigue implies there is something inherently exhausting about compassionate empathy and the caring actions it prompts. But studies of health-care workers find a lower incidence of empathy fatigue in older, more experienced providers. The highest levels of empathy fatigue occur in the young guns with the least experience, like me when I couldn’t absorb the stories of boys being used and abused. This tells us that empathy doesn’t slowly drain from a person like water draining from a tub. It doesn’t deplete over the course of a friendship, a career, or a lifetime. Instead, when it sparks compassion and altruism, empathy can be energizing.

So rather than letting your heart break, let your heart respond, whether that’s administering evidence-based treatments, making a donation, volunteering your time, bringing over takeout, or simply listening in sympathetic silence. What someone suffering needs is not a mirror, but a sounding board, a plan, or simply a vehement affirmation that they’re not crazy. These days, the stories I hear are still heartbreaking, but rather than leaving my heart in pieces on the floor, or detached with cold intellectualization, my heart fills — because I can respond.

Ellen Hendriksen is a clinical psychologist and the author of How to Be Yourself: Quiet Your Inner Critic and Rise Above Social Anxiety

A Therapist on Learning to Empathize Without Burning Out