This is the rough draft of an article I am working on. Eventually I will seek to publish it outside my blog, but in the mean time, because the experience of compassion fatigue is so prevalent in the lives of therapy and health care workers, it feels important to me that I make this work available to the public even as I continue to develop my thoughts and research.
A Necessary Shift in Perception
I have been an art therapist for 25 years and an initiate into the dual callings of artist-healer all my life. I spent childhood painting, writing, dancing, and singing as rheumatoid arthritis flared, faded, and flared again in my body. The first three letters of arthritis are a-r-t, so I decided art was the blessing in the disease. In another culture, elders might have recognized the illness initiating me into my adult role as healer. Instead, I have navigated my art therapy vocation despite internal confusion and resistance and with contradictory encouragement and discouragement from family and friends.
After 13 years in the field, I experienced what is commonly called compassion fatigue or secondary traumatic stress, with its cluster of struggles about personal psychological issues; changing beliefs; the demands of the therapeutic relationship; work institutions and environments; social systems and power issues; and physical health (Stamm, 1999). During my descent into these struggles, I schemed for ways to divorce the two components of my work, to be artist but no longer therapist, thinking that the therapist role caused my exhaustion, anxiety, and depression. Instead, external circumstances (the need to pay bills) and internal forces (the need to be whole) never allowed me to divorce from the therapist part of myself. My recovery instead required that I recommit to being a therapist and engage with this work more wholeheartedly.
From the get-go, I struggled with the words used to name this experience: burnout, vicarious traumatization (Pearlman & Saakvitne, 1995), secondary traumatic stress (Stamm, 1999), trauma exposure response (Lipsky & Burke, 2009), and compassion fatigue (Figley, 1995). I preferred “compassion fatigue.” I liked that the root meaning of the word compassion is “suffering with.” But the term “compassion fatigue” still felt inadequate. “Fatigue” implies overuse, as if compassion is a thing that becomes injured from repetitive work, like a muscle, or mechanical object. But in that case, recovery and healing of compassion would require using that “muscle” less. However, trying to be less compassionate proved to be both impossible and not at all healing.
In fact, being more compassionate, less defended, less separate was the curative response for my fatigue. I needed to learn more fully how and why I was “suffering with” my therapy clients, my family, and the world. I needed to let go of desire to separate or protect the artist self from the therapist self. I needed to let go of concepts of self as solitary or fixed, and more fully inhabit the shared suffering, both human and environmental, that is our common home. I needed a deeper relationship with compassion, and this relationship required an ego-stripping reorganization of my life. I needed to identify and address internal and external problems that created, and were caused by, a deprivation of compassion. When I understood this requirement, I had to trust that – despite wanting to fend off or avoid such upheaval – my “compassion fatigue” experience was actually creative, generative, soul-driven, and much more than a pathologic reaction to working and caring too much.
Until I began to recognize these needs, like most people from a modern, secular background, I used the word “compassion” without knowing its meaning, or what, being compassionate involves. I can now no longer think of compassion as an objectified character trait and have come to understand it as powerful archetypal energy requiring a series of upheavals and transformations that will birth wholeness of Self, shattering the defenses of ego.
When we speak of “compassion fatigue,” these upheavals are what we are trying to name. But, while fatigue is part of rupture and transformation, it is only a fraction of the whole experience. Using the term “fatigue” to describe an individual’s suffering in response to collective suffering is like mentioning only “difficulty sleeping” when we are falling in love. In place of “compassion fatigue,” a far better name for these upheavals is initiation.
The psyche requires initiation of us several times in our lives. Through the process of initiation, we let go of no-longer useful, increasingly false definitions of self, experience ego-death, and then return, rebuilding our selves in more mature, authentic, and compassionate ways in order to be more fully part of community (Moore, 2001; Turner, 1969; Van Gennep, 1960; Eliade, 1958; Levine, 1992). Much focus has been given to the study of initiation and rites-of-passage in non-Western cultures. Psychotherapy is often described as a process of initiation for the client (Corbett, 2011). When I realized that my compassion fatigue was more fully understood as a process of initiation resulting from ongoing engagement with the archetype of compassion, I was surprised to find very little written about the work of psychotherapy as an initiatory catalyst for the therapist. I think this lack is in part due to cultural misperception of compassion as a character trait we already possess before becoming therapists. Like most neophyte therapists, I entered this field believing just that.
After seeing compassion as archetypal energy demanding ongoing initiation, my perception and work has shifted radically. This realization humbled me to the truth that I do not possess compassion. Compassion possesses me. When I assume compassion belongs to me, as simply part of my character, I run into trouble. I take both self and compassion for granted, and act with only a superficial understanding of compassion’s energy. But when I am aware that, in seeking to develop compassion, I have entered into sacred terrain and am engaging with a divine force whose energy is much bigger than my ordinary human self, I behave with mindfulness, awe, and deep respect for the divine energy that is taking possession of me.
This radical shift in thinking recognizes that self, soul, and compassion are not things, or objects. They are processes, actions. They are, as Matthew Fox (2014) writes, in his exploration of 13th century mystic Meister Eckhart, “spaces where God works compassion and where the love of God is active” and where we experience “the radical level of interdependence that is the basis of all compassion and indeed of our whole existence” (p. 122). In other words, we do not have a soul, a self, or compassion as a personality feature. Instead, soul, self, and compassion are inter-related active processes initiated through our engagement with the active process that is the soul, self and compassion of the Divine. “Until we become a conduit for the Divine compassion,” Fox continues, “we do not yet have soul. Soul is something we birth, and we birth it in proportion to our developing love and compassion” (p. 123).
Reorienting the Work of Art Therapists
Within the therapy community, reflection on personal experiences of compassion initiation serve to help others in the community recognize and navigate the upheavals required by the archetype of compassion for our maturation. Perceiving compassion as archetypal energy demanding maturation has given me a deeper appreciation of “the Self-changing nature of care-giving work” that repeatedly exposes the therapist to human suffering and requires reorientation of the self in response to such suffering (Stamm, 1999, p. xxxviii). Reorientation and reorganization of self toward greater spiritual maturity and selfhood is a key component of the initiatory process.
I believe, as does secondary traumatic stress researcher Stamm (1999), that “the greater the demand and/or the fewer the resources the person has with which to make the change, the greater the potential for the stress to be traumatic or even pathological” (p. xxxviii). Within our work environments, deep understanding of the nature of both therapeutic work and trauma is often insufficient and so resources fostering self-care are lacking. When work environments hinder self-care needs, or the therapist does not make conscientious efforts to prioritize self-care, these lapses occur as a result of broad cultural misunderstanding of what trauma is and how compassion is developed, nurtured, and engaged with in assistance of others. In the West, our individualistic, competitive culture does not fully recognize that community is essential for healing.
Laura van Dermoot Lipsky (2009) writes about the need for “trauma stewardship,” through which individuals and communities of trauma workers engage in daily practices to develop “a deep sense of awareness needed to care for ourselves while caring for others and the world around us” (p. 12). Her work on trauma stewardship provides readers a thorough description of the effects of working to respond to trauma and a compass reorienting individuals and organizations toward more mindful self-care. However, while her writing is an extremely valuable framework, it does not address compassion development. Including a deeper understanding of compassion initiation with the framework of trauma stewardship will help us understand why our initiations into mature compassion are often fraught with the crises and psychopathologic reactions that we associate with compassion fatigue and vicarious trauma. We can then acknowledge that these crises and injuries occur, in large part, because, culturally, there is not adequate, supportive, sacred space within which the called-for initiation can occur.
In addition, the path toward mature compassion requires not one initiation, but a series of initiations. “There is no such thing as being finished with your initiations,” states Jungian analyst Robert L. Moore (2001). “Once you get through the initiation you are in now, and get your reconstitution, and you get to this next plateau in your life, then the next one comes along” (p. 117). Compassion initiations happen concurrently with other life-stage transitions. We are students, begin our careers, practice and grow more seasoned, and respond to the world’s suffering as we also marry, become pregnant, adjust to being new parents, enter midlife, divorce, experience our children leaving home, become elders, and grieve for lost loved ones. Our compassion initiations as therapists happen within the complex stages of our personal initiations.
Beyond the layer of personal maturation, human initiations also happen in the midst of, and in large part, because of, the collective trauma that is felt by all within one’s culture, inherited with generations of wounding, affecting the culture as whole (Burstow, 2003; Watkins, Shulman, 2008). Initiation and collective trauma are deeply interconnected. In modern Western society, collective trauma is in part perpetrated because the culture rejects the psyche and instead subjugates psyche into servitude for the industrial state. Every effort to complete the necessary developmental stages of soul-growth requires simultaneous efforts to heal the collective trauma within which our lives take place. Initiation, by its very nature as one of the primary forces of the psyche, breaks us free from this servitude and asks us to know ourselves as beings more soulful, strongly interconnected, and alive than the tamed or narcissistic visions of self that are offered by the dominant over-culture. Through initiation, we shed layers of false-self created to survive within the collective trauma – and we are reborn as more whole, authentic selves who respond, compassionately and maturely, to heal others who are wounded within our community.
Eco-therapist, depth psychologist, and wilderness guide Bill Plotkin (2008) describes how initiation serves to shift adults within Western culture away from “egocentric” worldviews and into “soulcentric” and “ecocentric” worldviews. Initiations that are approached from soulcentric awareness are, according to Plotkin,
designed to assist all members in discovering and living from their deepest and most fulfilling potentials (their individual souls), in this way contributing their most life-nourishing gifts to their community and environment and, in doing so, actualizing the culture’s potential (the cultural soul) and supporting its ongoing evolution. (p. 45)
By acknowledging the initiations at the heart of compassion fatigue, we recognize that within suffering, soulcentric processes of individual and cultural maturation are at work.
In addition to these layers of initiation, an art therapist’s complex initiatory process includes growth into dual vocations as artist and healer. An art therapist’s vocation is most authentically lived from within the center of four polarities on intersecting continuums. At the extremities, we over-identify or under-identify with our roles. We over-identify as healers when we call ourselves shamans. We over-identify as artists when we imagine ourselves Orpheus, insisting that artists are uniquely gifted for deep soul journeys. We under-identify as healers when we act like charlatans with only tricks and techniques to offer, or feel helpless to respond effectively to the world’s huge suffering. We under-identify as artists when we relegate our personal creativity to a hobby that is less valuable, or less necessary than others, failing to make time for our own art, considering commercial sales and gallery shows as the only proof of artistic success, not participating with our local art community and other artists, or not turning to art for self-care. Our work institutions and communities push us toward these poles. For example, in some places art therapy is seen as something anyone who knows how to use a pair of scissors and glue can do. While at the other extreme, art therapists are given the most challenging, traumatized cases because the rest of the treatment team wants the art to help break through a client’s defenses.
Each pole is part of who we are and how our work manifests. As healers, we are indeed called to do what shamans do, and we are in many ways helpless in the face of world suffering. Art does pull us into deep, healing, soul journeys. And sometimes being an artist increases our pain, and demands more time than we can give. It also requires endurance of long fallow periods in which creativity is barren. Balance is reached in the middle between the extremes.
Without this middle ground, we become inauthentic, ungrounded, inflated or deflated. Our experiences of compassion fatigue, burnout, and secondary trauma are in part triggered by personal and institutional undervaluing of what art therapy can offer while also demanding more than is realistic, causing us to feel trapped, unable to resolve the internal conflict of this imbalance. To become balanced, we need to develop mature identities as both artist and healers. In other words, our dual roles as artists and healers require initiation so that we live and work authentically, maturely, and compassionately.
In all these ways, the compassion initiation experience is actually a complex web of initiations that are concurrent and interconnected, permeating every step of our development as art therapists. We traverse personal life-stage initiations while responding to collective trauma and maturing vocationally, as both healers and artists.
A Process for Sharing Compassion Initiation Stories
Art therapists need to tell stories of how we wandered, without a map, into and through the liminal and complex terrains of our initiatory journeys. I have begun inviting colleagues to share with me their stories of compassion initiation. And, as an instructor of graduate level art therapy classes and supervisor of art therapy interns, I warn students that our education and work environments exist within a culture that is mostly ignorant of what compassion and initiation truly are. I work to prepare student therapists for the realities of working long-term within the web of collective trauma, personal maturation, and vocational identity growth, with little training in the spiritual practices of compassion.
According to the Dalai Lama (2002), if a person is:
…at an early stage of compassion practice, a more complex environment will be much more challenging, and the person will be less able to deal with it compassionately. At this initial stage, before you have reached a stage of stability, it is much more effective to avoid the situation rather than trying to confront and deal with it. Until you get to the point where it is stabilized, you are much more vulnerable to external conditions. Given this idea, according to Buddhist thinking, if a person who has attained stability in his or her compassion training continues to stay in seclusion, that person is not really doing anything with compassion. That person should now be out, running around like a mad dog, actively engaged in acts of compassion. (p. 91)
An opposite approach is used when it comes to training therapists. In spiritually impoverished, highly stressed modern culture, students do not spend years in seclusion, training in compassion toward self and others before engaging with the world. Instead, after a brief period of protected observation and internship, graduates are sent immediately into complex environments to “run around like mad dogs” engaged in compassionate work with cultural trauma. They are advised to avoid compassion fatigue, by developing adequate self-care, personal creativity, meditation, and mindfulness practices. They will need to learn these spiritual practices on the fly, however. In class, we could only spent minimal time cultivating them.
I tell my students that instability of self and career will occur in response to working to heal our complex, violent, competitive culture. I acknowledge the inadequacy of our spiritual training in compassion. Hoping to better prepare art therapy students to respond to the initiatory responses they will have, I engage my students in an adaptation of Stephen K. Levine’s (1992) “Bearing Gifts to the Feast” student initiation process. In his work, Levine teaches his students about the initiation process in rite-of-passage ceremonies, and facilitates their journey through the stages of preparation, liminal transition, and return, as they create and provide an art-based presentation to the class that makes present “the pain and suffering in their lives” and the “pathos” of their soul. In response to each presentation, the feedback classmates give must “be in an expressive mode, i.e., it must use an artistic or expressive medium” (p. 44, 45).
In my classes, I ask students to contemplate the suffering they experience as they engage in their internship field experiences and to then connect this collective trauma to their own personal pain and life struggles. I ask each student to, as artist, “sit right in the middle of the karmic struggle, all the sufferers of all times and places hanging on his brush – and then with full awareness to pick up that brush” because “the least mark on the paper” will be “an act of supreme courage in which the suffering of the artist and his world are alchemized” as Stephen Nachmanovitch says (1990, p. 197). Nachmanovitch also points out, paradoxically, the more fully we come to know and be ourselves, including our suffering, “the more universal” our message. As we “develop and individuate more deeply,” we “break through into deeper layers of the collective consciousness and the collective unconsciousness” (p. 179). By accepting and sharing, publicly, the wounds we have rejected and hidden, we become more fully human, and our specific stories are more clearly seen as part of the existential suffering experienced by all.
I also ask my students to dialogue about psychotherapy as a spiritual practice, as a “sacred cauldron”, as Lionel Corbett (2011) describes it, in which both therapist and client are transformed. Regarding the importance of suffering in our client’s lives, Corbett states the following:
We need a perspective that is both large enough to help individuals and also able to guide our cultural response to suffering. It would be helpful to think of suffering as an essential life transition with important psychological effects and developmental consequences. We can view suffering as an initiation into a new level of awareness and a new state of being. The most difficult part of this process involves a temporary stage known to anthropologists as liminality, which is a characteristic of the middle stage of rights-of-passage seen within tribal cultures. In the liminal stage, the initiate or the suffering person is not completely out of the old state…and not quite into the new. He or she is betwixt and between, in a situation of radical change, so that liminal states produce uncertainty and anxiety about the future. During this period, we lose our sense of who we are but have no idea where we are heading. This stage involves ambiguity and confusion. (p. 290)
In class we talk about this passage from Corbett and the importance of seeing our clients as initiates, and then we talk about seeing our own suffering, as we engage with the archetype of compassion, through a similar understanding of initiation.
Also included in the course is Toward Psychologies of Liberation, by depth psychologists Mary Watkins and Helene Shulman (2008), who thoroughly articulate the dissociation that is felt by all members of traumatized communities and recognize that such dissociation serves “the function of expressing deep distress.” Watkins and Shulman state:
In cultural environments where such distress can be heard and witnessed, healers may interpret symptoms as calls to put something right in the environment. The whole community may come together to dialogue about and heal the breach. But where such symptoms cannot be heard and interpreted, there may be a descent into a chronic state of psychological dissociation and the lonely suffering of symptoms that compromise vitality, creativity, eros, and compassion.” (p. 75)
The class is a bringing together of community “to dialogue and heal the breach.” We acknowledge how failure to see our compassion fatigue as a call “to put something right” through initiation prevents us from hearing, interpreting, and witnessing and therefore increases feelings of dissociation, loneliness, and loss of vitality and compassion.
Finally, students use personal image journaling and in-class art reflections throughout the semester. These art reflections track the student’s experiences of Self-change and reorientation in response to suffering. Students shape these art meditations into a final presentation, which is shared and responded to in the last weeks of the semester.
Each year, I continue to refine and deepen the structure of my course to make this initiation process the heart of the class so that students work deeply with their initiation experiences. In addition, I present to the class my own compassion initiation story, describing my own past and current struggles.
Teaching Vulnerability
What I share in my presentation changes as I change. This year, I will show them a new art piece I will make in response to empty nesting grief as my daughter begins college. I will pair it with a monotype of a weeping pregnant woman beside a river of blood, made when I was a new mother and worked at a women’s counseling center/domestic violence shelter (above). I will share the mosaic self-portrait pieced together during the years after I left both my work at the women’s center and my marriage. I will also share a more recent body tracing self-portrait made after my mother’s death, using art materials that belonged to her. I will talk about how each of these art pieces reveals my own struggles with the experience of being undernourished; I will describe how this theme is encountered daily in my work at an eating disorder treatment center.
My goal in sharing my own story and art, and in engaging students in their own rite-of-passage presentation, is to model how we might witness for each other the initiations we must navigate as we are matured by the archetype of compassion. As artist-healers, we must ask of ourselves what we ask of clients – that we go deeply into our pain and express it through art making. And we must do this repeatedly. With no fixed balance ever attained, we need to make time and energy available for this personal attention in the midst of other obligations, and despite time constraints and community fragmentation within which we live and work.
To be honest, I struggle while sharing suffering and therapeutic artwork with students. In doing so, I reveal the messes of my life, the self-injury I’ve caused myself, the ego-defenses I armor myself with, the foolish risks I take in search of love, the times of wandering and confusion I struggle through. I fear I will look crazy, too openly vulnerable, too revealing of self and therefore entirely unprofessional as teacher and therapist. But I also know that I cannot ask students to be this vulnerable but shield myself behind false, invulnerable authority. In his book, The Archetype of Initiation, Robert L. Moore (2001) states:
When people act “crazy” by conventional standards, they are often searching for some kind of extraordinary space that will allow them to leave an old phase of life behind and experience initiation into an entirely new phase. Age-old human existential issues bring with them a yearning to locate and enter a sacred “temple” where the issues can be addressed, where a constructive reorientation can safely occur, and where the behavior of self and others can once again begin to reintegrate and make sense. (p. 20)
Therefore, I choose to share my compassion initiation stories, my suffering, and my art responses to it, with students, and even at professional art therapy conferences, in front of peers whose work I highly respect. Being “crazy” enough to be this radically vulnerable is essential and serves a two-fold purpose. In addition to the primary purpose of showing, through personal example, the process of compassion initiation as it occurs within one artist-healer’s career, my vulnerability helps us enter sacred space within our therapy communities.
Conclusion
We need to create and protect such opportunities for each other. It is only by being vulnerable that we provide the therapy community a “sacred temple”, where each of us can be held and witnessed as we reveal our suffering, our fatigue, our reactions to trauma. By doing so together, the profession as a whole can be initiated into new spiritual maturity, through which old, inadequate perceptions of compassion will dissolve. Through this, we can make sense of our suffering as therapists, and reorient our work in new depths. By providing such extraordinary space for witness, we take our turns as elders helping guide colleagues through the complex and ongoing process of compassion initiation. We will continue to learn how profoundly our work, our relationships, our culture, our world will be changed as we more fully respect, value, and engage with compassion as an archetypal, and therefore spiritual force whose energy is much bigger than any of us imagine.
References
Burstow, B. (2003). Toward a radical understanding of trauma and trauma work. Violence Against Women, 9(11), 1293-1317.
Corbett, L. (2011). The Sacred cauldron: Psychotherapy as a spiritual practice. Wilmette, IL: Chiron Publications.
Dalai Lama, in Davidson, R. and Harrington, A, ed. (2002). Visions of compassion: western scientists and tibetan buddhists examine human nature. New York: Oxford University Press.
Eliade, M. (1958) Rites and symbols of initiation: The mysteries of birth and rebirth, trans. Trask, W. R. New York: Harper and Rowe. Reprint edition (1994), Woodstock, CT: Spring Publications.
Figley, C. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. London: Brunner-Routledge.
Fox, M. (2014). Meister Eckhart: A mystic warrior for our times. Novanto, California: New World Library.
Levine, S. K. (1992) Bearing gifts to the feast: The presentation as a rite-of-passage in the education of expressive therapists. In Poeisis: The language of psychotherapy and the speech of the soul. London: Jessica Kingsley.
Lipsky, L. & Burke, C. (2009). Trauma stewardship: An everyday guide to caring for self while caring for others. San Francisco: Berret-Koehler Publishers.
Moore, R. L. (2001). The archetype of initiation: Sacred space, ritual process and personal transformation, M.J. Havelick, ed. Philadelphia: Xlibris Publishing.
Nachmanovitch, S. (1990) Free play: Improvization in life and art. Los Angeles: Jeremy P. Tarcher, Inc.
Pearlman, L.A & Saakvitne, K.W. (1995) Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: W.W. Norton.
Plotkin, B. (2008). Nature and the human soul: Cultivating wholeness and community in a fragmented world. Novanto, California: New World Library.
Stamm, B.H., ed. (1999). Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators, 2nd edition. Lutherville, MD: Sidran Press.
Turner, V. W. (1969) The ritual process: Structure and anti-structure. Ithica: Cornell University Press.
Van Gennep, A. (1960) The rites of passage, trans. Vizedom, M.B. & Caffe, G.L. Chicago: University of Chicago Press.
Watkins, M. and Shulman, H. (2008). Toward psychologies of liberation: Critical theory and practice in psychology and the human sciences. New York: Palgrave Macmillan.
Soulfaring - 