Mental Health: Compassion Fatigue & Self-Care Practices

By Jennifer Alumbaugh, LMFT

“Compassion Fatigue is a state experienced by those helping people or animals in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper.” ~ Dr. Charles Figley

heart handWe’ve all had our experiences with being stressed out—feeling overwhelmed at the end of a long day or a trying week full of deadlines and intense interactions with others. Usually a good night’s rest or a day or two off are enough to recuperate from stress. When that stress builds up over time without proper attention, it leads to burnout which thankfully can usually be relieved by a longer span of time off—like a week vacation or holiday break. Compassion fatigue rests on the more intense end of the spectrum of the impact of caring for others. Sometimes known as “vicarious” or “secondary trauma,” it is the most extreme manifestation of stress resulting from exposure to those who are suffering. It is important to note that compassion fatigue may present after sustained exposure or after only a single event.

In my work providing professional development and support to other professionals in the fields of mental health, social work, medicine, foster care, juvenile justice, family interventions, and community social services I often encounter colleagues who are inclined to underestimate the severity of the effects of compassion fatigue.

sad boy

There is something so uniquely vulnerable about sitting with children and youth who are hurting, who are suffering.

The general stigma is, “that’s not really an actual thing, and even so, I’ve got it under control.” I know. I thought the same thing for years as I worked as a community mental health clinician in Los Angeles County. For five years I saw children and youth who all had histories of physical, sexual, and/or emotional abuse; exposure to community and gang violence; or had experience in the system as a foster child or in a juvenile corrections facility or sometimes all of the above. When I first learned about compassion fatigue—in depth and as an actual issue complete with symptomatology—I thought I was fine. I had it together. I used the phrase “self-care” frequently to qualify activities in which I engaged. I went to supervision. I debriefed with colleagues. I had it all under control.

But I didn’t.

As I moved through that first compassion fatigue training, I began to connect the dots of what I was experiencing. I completed a self-evaluation and found myself to be off the charts with compassion fatigue and burnout and in subzero territory with barely any restorative assets in sight. I was in dire straits.

hair ladyWhen compassion fatigue hits, we feel it across the landscape of our entire being: cognitive, relational, emotional, spiritual, physical, and behavioral. Just like any other ailment of the mind or body, the symptoms begin to interfere with our normal, everyday functioning. We begin to question not only the meaning of our work, but the existential angst spreads to every area of our lives. Compassion fatigue unchecked has the power to unravel us entirely, even rocking our foundation of our core beliefs. It’s serious. It’s real. It deserves our undivided attention.

Thankfully, there is hope. Like with so many other challenges in our lives, awareness and education are vital first steps. Understanding the pervasive scope of compassion fatigue, how we are personally at risk or affected, and what practical steps are necessary to recover and maintain wellness and to prevent future instances.

Most importantly, we need to be kind to ourselves, honoring the truth that it is not a result of our own short-comings that we may experience compassion fatigue. In fact, “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water and not get wet,” (Remen, 1996).

water sitAfter awareness comes action. It is vital that as professionals we intentionally pursue our own wellness. If experiencing compassion fatigue, a season in personal therapy is strongly recommended to address personal and professional circumstances leading to the secondary traumatization. Additionally working through an assets inventory will help to identify specific areas of life that need a boost in self-care practices, people, and pampering. The process is unique for everyone but it is not optional. As Dr. Charles Figley—expert in the field and Director of the Tulane Traumatology Institute–asserts, “It is unethical to not attend to your self-care as a practitioner, because intentional self-care practice prevents harming those we serve.”

Professionally and personally this time of year is often ripe for stress, burnout, and compassion fatigue. While an in-depth training usually spans several hours of teaching, self-evaluations, discussion, and workshopping self-care plans, I couldn’t leave you without a few quick tips for self-care best practices!

Quick Tips for Self-Care Best Practices:

Helpful hint 1: DO spend time with non-traumatized people (this includes family and friends!) who replenish your empathy, joy, and compassion. – Going out with colleagues after work or at lunch is only replenishing if you instate a “No Talking about Work” rule and hold each other accountable!

Helpful hint 2: Set firm boundaries around the time and space you spend with those who deplete your energy, compassion, and nurturing…yes, even/especially when they are your family and friends. It is difficult, not impossible.

Helpful hint 3: If you feel you must spend time with people who deplete you, plan your visit outside of your home, office, or personal space—go to their home, a restaurant, coffee shop, other public venue. This allows you the freedom to leave on your own schedule, avoiding the awkwardness of guests overstaying their welcome in your space.

Helpful hint 4: Set a specific amount of time for your visit and let them know at the beginning that you’ll need to leave by X time. You don’t need to give an explanation for where or why you need to leave, and you don’t need to contrive elaborate fictions. It may sound something like, “Sure let’s grab coffee, I can meet at 1pm and will need to head out by 2pm.”

Self-Care Challenge: Before the stroke of midnight on December 31, 2015, I challenge you to engage in three (3) activities of at least 1 hour each that serve only you. Meaning, you are the only beneficiary of the activity—be it a massage, a walk along a favorite hiking trail, a small gift for yourself, watching the game with friends, getting a sitter for a night out, engaging in a creative/art outlet, or turning off your electronics and going to bed early—whatever resonates with you, do that thing, guilt-free, and practice radical acts of self-love and care.

aJennifer Alumbaugh, MS is a Licensed Marriage and Family Therapist providing clinical and professional development consultation services at Enrichment Training and Counseling Solutions. She practiced as a mental health clinician throughout Los Angeles County working with children, youth, and their families from 2007-2012. In Central Texas, Jennifer has worked as a Site Coordinator with Communities in Schools of The Heart of Texas at G.W. Carver Middle School; as an independent consultant and professional development trainer; and conference speaker. In 2016 Jennifer created an implemented a therapeutic creative writing program, Brave Young Voices, at Klaras Center for Families and at the Texas Juvenile Justice Department correctional campus at Mart, TX.  Jennifer has extensive experience working with adolescent and adult survivors of psychological and spiritual abuse, trauma (sexual violence, childhood trauma, interpersonal violence); and complex PTSD. These, along with grief and loss work are her areas of specialization.  She may be reached at: or 254-405-2496.

The Act Locally Waco blog publishes posts with a connection to these aspirations for Waco. If you are interested in writing for the Act Locally Waco Blog, please email for more information.


November is National Hospice Month: Loving Care at the End of a Tough Journey

(Note: This is Part 2 of a two-part series on Hospice for National Hospice Month. Here is the link to Part 1: National Hospice Month, Part 1: “I don’t want to read about dying!)

by Tammera Ryan

When we honestly ask ourselves which person in our lives means the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm and tender hand.” ~ Henri Nouwen

We got to be involved with a patient that touched us. His name was Robert.

Robert had lived a rather interesting life. Throughout his 58 years, circumstances had left him homeless, living on the streets; finding his way where he could, and disconnected from his sister.    Although that is important, we won’t dwell on that part of his life’s journey.     Because sometimes in life, it’s not how you start, it’s how you finish.

If you read last week’s blog, you will remember that I said I would share a patient’s story. This is one that makes me proud to work for a not-for-profit hospice, specifically, Providence Hospice. Providence has never had to turn anyone away regardless of payment source. Providence Hospice offers many programs in the community: bereavement support to anyone who needs it, children’s grief programs, a specialized Veteran’s Program, a Pathways program and more.

Now, back to Robert. I mentioned that Robert’s circumstances had left him homeless. He was found by another homeless gentleman laying between two buildings. He was in obvious pain due to a terminal illness, had not been able to have a bath in weeks, had a hard time communicating, and needed help desperately. Somehow, Robert’s friend managed to get him to a local physician’s office.   Fortunately, that physician contacted her friend; a Providence Hospice Social Worker.   With very few questions asked, the wheels were in motion for Robert to get great care at Providence Hospice Place.

Robert was given a private room at Providence Hospice Place. He got immediate medications to help relieve his pain and received a much needed warm bath in the facility’s state-of-the art bathing system. He got undivided nurse’s attention, and received a hospice physician visit every day he was there. Perhaps just as important, that same social worker who got the call that someone needed help made sure she found him clothing, shoes, and other basic life necessities.

Now that Robert was safe and his physical pain was managed, Robert knew he needed something deeper. Robert had lost his faith. He knew he believed, but he had no way of connecting with his spirituality.   With the help of the Providence Hospice Chaplain and through many heartfelt conversations and a complete bearing of his innermost thoughts, he began to reconnect and found his faith again.

After five days of care at Providence Hospice Place, it became necessary for Robert to be moved to a long-term care facility.   When it came time to make that move, he was not worried about his new clothes or the few other items he had collected.   The one thing he wanted more than anything was to take with him the Bible that had been laying by his bed.  Of course, the staff let him take that Bible.

Robert was at peace living in the facility. He enjoyed his meals and the new friendships he made. The Hospice staff who visited him at the nursing facility always found the Bible he had taken with him right beside him every time they visited. They could tell it was being read.

A few more weeks went by and Robert grew weaker and weaker. He continued to thank the Providence Hospice team who took him in, who clothed him, who bathed him. He talked about a sister. One day the nurse sat with Robert helping him to write a letter to his sister.

A few more days went by and on a peaceful night, Robert took his last breath….a Bible laying by his bed. That Bible was given to the hospice nurse who was with him those last moments.   Inside the Bible, in feeble hand-writing, was written a name and address. The nurse knew it was the sister he had talked about. The nurse was able to connect with his sister and was able to tell her of how he was at peace, of how he was well cared for during his last months, and of how well he “lived.” That same Bible where her name was written was given to Robert’s sister.  She was very thankful because she had lost track of her much loved brother. Robert’s sister eventually took his ashes and had them scattered over his parents’ grave.

Volunteers are an integral part of our hospice agency’s ability to care for patients such as Robert.   Medicare hospice guidelines require that at least 5% of the work that hospices provide be done by volunteers.   Providence Hospice exceeds these requirements with a great group of highly trained volunteers. If you are looking for a special place to serve using your unique skills and abilities, I hope you will consider volunteer opportunities with Providence Hospice. Our Volunteer Coordinator, who has been with us for over 19 years, is dedicated to finding the right opportunity to match your talent.

His circumstances had left him lonely and disconnected.   He touched us! He lived! He mattered! His name was Robert.

Tammera Ryan-2Tammera Ryan has worked with Providence Hospice for the past Thirteen years.   She has held various roles within the agency including Community Liaison, Executive Director, and Director of Business Development.   She has been married for 27 years. Together, she and her husband have raised their two sons and are very happy to have welcomed a daughter – in- law into their family four years ago. Her favorite quote comes from Ghandi, “Be the change you wish you see in the world.”

The Act Locally Waco blog publishes posts with a connection to these aspirations for Waco. If you are interested in writing for the Act Locally Waco Blog, please email for more information.

We have the right to disagree. Do we have the wisdom to work together anyway?

by Ashley Bean Thornton

A few weeks ago on a Sunday most of us who read the Waco Trib opened our paper to find a dramatic advertisement – two full pages. The ad expressed a love of Waco and went on to list several beliefs that the signers — more than 100 folks in town, mostly local pastors — hold dear. Not everyone agreed with the beliefs listed in the ad. A group of people who believe differently responded via Facebook posts, letters to the editor and an op-ed piece expressing their own love of Waco and listing their own beliefs. Good for us! I’m sure I don’t need to remind anyone to be thankful for this precious liberty to freely express our widely differing beliefs without fear of being “disappeared.”

We have the right to be divided! But, progress comes from unity. How do we make that paradox work?

I have friends who signed the ad, and I have friends who wrote letters and editorials disagreeing with the ad. Must I choose between them? I profoundly disagree with some people in our community about beliefs that are at the very core of their faith and their identity. Can we still work together to build a stronger Waco?

I generally subscribe to a “live and let live” philosophy. I can be very tolerant when it comes to matters of taste. You like country music, it grates on me a little — but fine, I don’t really care that much. You like the Mavericks, I like the Spurs– it might take me a while, but I can make peace with that.

There comes a point, however, when differences of opinion enter the realm of right and wrong and justice. Who is allowed to marry whoever they want, and who is not? Does a pregnant woman get to be the one who decides if she will carry her pregnancy to term or not? In regard to these kinds of issues my mind is made up. I believe I am right – morally right. That means that to me some of you are wrong. I don’t mean “Wow, that’s an ugly sweater” wrong, but morally wrong, on the wrong side of justice wrong. There comes a point I can no longer “go along to get along,” I have to speak out. Does that mean I can no longer be your friend? Does that mean we can no longer work together on other issues? I worry about that. I don’t want the bitter divisions that seem to be making progress so difficult in our national politics to get in the way of people working together in my own community.

I have had a couple of conversations lately that have shed a little light on this concern. The first conversation was with a new friend. We’ve seen each other’s names for years connected with various community efforts, but we had never really had a talk. She noticed on Facebook that I took a stand that surprised her in regard to Planned Parenthood. She invited me to lunch. Instead of preaching to each other or trying to convince each other to change sides, we simply shared our history with the issue. We talked about what was at the heart of the matter for each of us. It wasn’t a debate. Neither of us changed our minds. We just listened to each other and got to know each other better. I think we parted better friends, despite our deep disagreement about this controversial issue.

The other conversation was with a Pastor friend. We were meeting to discuss job programs and community outreach, but we drifted into a conversation about “The Big Ad.” We talked candidly about some of the areas where our personal convictions are most different from each other. We parted, as we always do, with a hug.

I’m sure these kinds of conversations take place every day, but I don’t want us to take them for granted. They are crucial to the work of our community, and, at the risk of being overly dramatic, I believe they are crucial to the work of democracy. I am deeply thankful for free speech and the freedom to disagree, but if all we know how to do is disagree with each other, we will have a tough time moving forward.

I have reflected a bit on what made these conversations possible. I believe it is that these friends and I know more about each other than just our opinions on a couple of hot button issues. We are complicated to each other. I know, for example, that both these people love Waco. They love the people of Waco. They are working hard. They give generously of their time and energy and creativity to make our community stronger. And so, I can approach a conversation with them – even about a difficult topic – with respect and curiosity instead of with “shields up.” I can be vulnerable to them. I can expose my own mixed feelings without fear that they will use them against me. In both these conversations there was an implied rule that we weren’t trying to change each other, we were genuinely trying to get to know each other more deeply.

Making progress together while holding sacred our right to disagree is complicated. It’s easy for me to stay nested with other folks who believe just like I do and to reduce the people who believe differently to one-dimensional targets. To work together across our differences we have to be complicated to each other. We have to know more about each other than just our points of disagreement. To do that we need to figure out ways to spend some time together, to get to know each other, and to talk…not debate, not negotiate, not persuade…just talk and listen.

me and omarThis Act Locally Waco blog post is by Ashley Bean Thornton, the Manager of the website and the editor of the WHOLE Enchilada newsletter. The Act Locally Waco blog publishes posts with a connection to these aspirations for Waco.

If you are interested in writing for the Act Locally Waco Blog, please email for more information.



How to Prepare for Final Exams

By Diego Loredo

One of the biggest reasons why college can be stressful is because of final exams. It’s unavoidable. Every student has to take them at the end of the semester (unless your teacher decides to not have one). It can be really stressful studying for these exams, but they’re not that bad if you do the right things.

Final exams are almost here, which always causes students to stress out (myself included). My first semester experiencing college final exams was tough. I wasn’t really prepared and would often be up late at night in my dorm studying for my exam the next morning. But now that I’m a sophomore, I’ve gotten kind of used to finals and have developed my own way of studying for exams.

Review your notes!

I know this seems pretty obvious, but it isn’t something you should underestimate. Some professors do not provide review sheets and just say “your notes are your review sheets.” Trust me, it sucks when that happens. Hopefully this is something that you’ve been doing throughout the semester, if not ask to borrow a friend’s class notes. Read over your notes and maybe compare them with a classmate’s.

Work on the review sheet with your classmates

The more the merrier, right? Although you might prefer to study on your own so that you can focus, studying with a group of classmates has its advantages. You might learn something from your classmates that you might have missed during class. Also, if there is something you didn’t understand, maybe your classmates know and can help you understand. Working on the review sheet with a few classmates is always better in my opinion.

Study early

Don’t wait until the last minute to study for exams. It’s best to study about a week or two before the exam to ensure that you can go over the material as much as possible. Waiting until the night before to study for an exam is the worst thing you can do. I learned this the hard way. During my freshman year, I waited until the day before my final exam for statistics (which is the toughest class I have taken so far). That wasn’t a very smart decision, especially regarding how hard stats was for me, and I ended up getting a D on the exam. I got a C for the class, in my defense I was two points away from a B! Anyway, always make sure you study early on to make sure you don’t miss anything.

Have a friend quiz you

One good method of studying is having a friend quiz you over what will be on the exam. Ask your roommate or a classmate to ask you questions that will be on the exam. Keep track of those you get right and those you get wrong. Doing this will give you a sense of what you need to study and what you already know and don’t need to study as much. Do this several times until you are confident enough to take the exam. This will also help you memorize material for the exam.


This is probably the most important thing to remember when studying for exams. Just relax! Don’t stress too much over exams, overthinking it will only hurt your chances of getting a good grade. There’s also such a thing of studying too much. Take a few breaks while studying. Just stay calm and be confident!

Exams can be intimidating, but if you study properly then you should do well. However, don’t get discouraged if you get a bad grade on one or more of your exams. It happens to all students, just think of what worked for you and what didn’t work and use that to come back stronger next semester. These last few weeks of the semester are always hectic, with final projects being due and studying for finals, but as long as you stay calm and study properly you should be fine. Best of luck!

diego loredo - 2Diego Loredo is a sophomore at the University of North Texas. He is majoring in public relations. He graduated from University High School in 2014. Although he is still not quite sure what exactly he wants to do, he thinks he wants to work somewhere in sports PR (preferably soccer or college football). His hobbies include playing soccer and golf. He is 19 years old.

The Act Locally Waco blog publishes posts with a connection to these Aspirations for Waco. If you are interested in writing for the Act Locally Waco Blog, please email for more information.

Restoring Dignity, Building Hope: Hygiene Products for Homeless Women

By Pam McKown

What does it mean to be a woman? For some it means you calmly usher children to school, engage in a productive day at work, and then settle in safely at home with family to rest peacefully before doing it again.

Yes, this is the reality for some women, but for many women life looks different. For some it means you look as though you have it all together, but inside there is a battle being waged that includes feelings of guilt, insecurity, fear and vulnerability, and regret for mistakes made. For some women life looks like illness, death, loneliness, depression, or anxiety. For some women, it feels like you have sacrificed everything and you have nothing. You find yourself homeless and striving to find a safe place to sleep while wondering “How did this happen?” You could be secretly planning to leave an abusive partner, questioning how you will make it, or what freedom will look like. You may be trying to convince yourself, “It isn’t so bad here…” even though you know it is. For some of us the story of our lives may include any and all of these things.

Take Heart Ministries (THM), a new non-profit here in Waco, is working to connect women of all walks of life through the uniqueness that makes us women. Our mission is to build dignity, improve health, and restore hope to women who are homeless or in transition by providing them with female hygiene products.

See…women may all look different, feel different, be different and have different stories, but the one thing we share is that fact that we all have dealt with menstruation. Take Heart Ministries hopes to address the needs of homeless women by providing a month’s supply of tampons, pads, cleansing wipes, a box of granola bars and bottled water in a purple backpack called a “Love Tote.” What possibly could some tampons or pads mean to a woman who has nothing? It’s not going to feed her; it’s not going to clothe her; it’s not going to sustain her. But, at Take Heart Ministries we believe it will help her maintain her health and restore her dignity. It might help her stand tall with their face lifted and say, “I’m going to overcome.” And let’s be honest…we all long for that.

As women we all share the physical fact of menstruation. Take Heart Ministries seeks to build on that physical similarity to unite women of this community in a genuine authenticity that comes from being honest with ourselves and other women about our stories. Because if I’m honest, I have an understanding of the need to be loved deeply. I have my own feelings of loneliness, depression, feeling unknown and without purpose. I have made choices to give myself “love” or “happiness” through excessively drinking alcohol, sex, an addiction to pornography, battles with postpartum depression and infidelity in my marriage. These things gave me an immediate outlet to give my love to something or someone but continually left me empty and longing.

I have felt out of control in anger, addiction, sadness, guilt and isolation. Though the battle has been won and my head has been lifted, I still feel plagued at times with the lessons that I learned from this time. Even now, when things get tough, I face a strong urge – not return to the behaviors – but to revert back to the safe place of shame.

What does this mean? It means that in order to share a model for authentically loving others, we have to get real and honest. It means your story and my story are not perfect, but they also are not over! If we as women unite in brokenness and authenticity, love can heal what hurt divides. Mercy is waiting on the other side of our honesty. This is the very heart of Take Heart Ministries: to be honest with our own stories in order to share them. In doing so, we relate in the foundation of being a woman and become available to show God’s redeeming love to others by living out the very redemption He has given us.

Our hope is to engage you in this conversation, to challenge the women in this community to let down the walls that divide us, to join hands in serving and loving each other, and in recognizing the value that we all have simply by being uniquely ourselves. Take Heart Ministries would love to share our heart with you and groups that you are involved in. We currently have community partners that are distributing our Love Totes. We would love to see how we could provide that gift to your agency or group. It is a small gesture that relieves a woman of one burden she is carrying. Check us out at and feel free to contact me about how you can become involved in the life changing work taking place here.

Pam McKownPam McKown is a Clinical Social Worker who provides individual therapy to those dealing with mental health or substance abuse issues at Journey Counseling Center. She is the Co-Founder of Take Heart Ministries. She is a long time native of Waco. She has a passion for social justice and journeying with people through life and finding true meaning and hope. She also is highly passionate about her family and the Baylor Bears.

The Act Locally Waco blog publishes posts with a connection to these aspirations for Waco. If you are interested in writing for the Act Locally Waco Blog, please email for more information.