Compassion fatigue has been described as the physical, mental and emotional fatigue or exhaustion that arises from caring for people who are suffering and feeling the desire to alleviate their pain. 

Deeply rooted in the helping professions, compassion fatigue comes from repeated exposure to physical and emotional suffering.

Ellen Lake APAM (below), the chair of the APA Mental Health national group and an accredited counsellor, says compassion fatigue highlights the fact that we can’t engage with suffering and distress on a consistent basis and not be affected.

‘There is an often-quoted statement,’ says Ellen, ‘in reference to compassion fatigue, which was made by Rachel Remen, a
paediatrician and teacher of integrative medicine. 

Ellen Lake.

'It goes like this. “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 without getting wet.”

‘There is a reason this statement is so frequently quoted and that’s because it is so insightful. 

'When we really understand what is being said here and incorporate that understanding into our experience of being a physiotherapist, then we can adjust and modify our work life in a way that supports our wellbeing, growth and career longevity while positively affecting patient outcomes.’

Ellen says compassion fatigue often manifests as emotional exhaustion, which can lead to physical fatigue, irritability and
reduced capacity for empathy. 

Unlike burnout, which stems from workplace stress and systemic issues, compassion fatigue is tied to the emotional demands of caring for others. 

It can overlap with vicarious trauma—the cumulative distress caused by witnessing or hearing about traumatic events—and secondary traumatic stress, a more isolated experience of taking on the stress of others or re-experiencing some aspect of a past trauma of our own.

‘When we are engaging empathically,’ says Ellen, ‘we tend to be paying attention, leaning in and listening intently and, as
neuroscience tells us, our mirror neurons are firing. 

'This is part of the empathic process. However, this firing means we can feel like we are actually having the experience being described or it can trigger remembering. This is where therapy can become personal.

‘As physios, we work with people who are experiencing physical ill health, disability and injury, but also mental ill health and psychological distress. 

'It is important for us to be aware of compassion fatigue and to acknowledge that this is part of our profession. 

'It is part of being a physiotherapist and it makes sense to plan and build coping and intervention strategies that can support us in staying at work and staying well.’

Signs and symptoms

Awareness and education are critical for recognising compassion fatigue, Ellen says. 

‘Many physiotherapists might not even know what compassion fatigue is or recognise it in themselves,’ she says. 

Common signs of compassion fatigue include emotional depletion at the end of the day, difficulty recovering overnight, avoidance of activities that normally bring joy and feelings of irritability, impatience or detachment.

‘A key indicator is that you’re not bouncing back. If you go home, follow your usual routine and still wake up the next day feeling emotionally drained, that’s a sign that something needs to change,’ Ellen says.

Ellen also notes that acknowledging the inevitability of emotional depletion can be empowering. 

‘As physios, we’re going to have these experiences. 

'The goal isn’t to avoid them but to manage them in a way that allows us to recover and return to work with resilience,’ she says.

The Professional Quality of Life health manual offers an evidence-based tool for healthcare workers to monitor their wellbeing
and assess the impact of their work, Ellen says. 

By measuring critical factors such as compassion satisfaction, burnout and secondary traumatic stress, the Professional Quality of Life tool helps practitioners identify areas of concern before they escalate into more severe issues like compassion fatigue. 

The tool not only empowers individual clinicians to take proactive steps for their mental health but also provides organisations with actionable insights to implement systemic changes. 

Regular use of the Professional Quality of Life tool, whether individually or in group settings, supports a culture of self-awareness and resilience that is vital for sustaining long-term effectiveness in caregiving professions such as physiotherapy.

Working it out

Ellen believes that physiotherapy practices play a critical role in addressing compassion fatigue. 

‘Practices need to create safe spaces for staff to talk about their experiences. This can include peer support, mentoring or access to employee assistance programs,’ she says. 

Adjusting rosters and case loads can also help to prevent emotional exhaustion. Workplace culture has a significant impact on the mitigation or exacerbation of compassion fatigue. 

Ellen recalls discussions with colleagues in the UK about moral distress during the COVID-19 pandemic. 

‘They described situations where they had to make impossible choices about resources, which created immense emotional strain.

'These systemic challenges highlight the need for organisational support,’ she says.

Isabelle’s story

Brisbane-based APA Titled Sports and Exercise Physiotherapist Isabelle Kelly MACP has experienced compassion fatigue throughout her career, beginning during her student placements. 

However, like many, Isabelle didn’t recognise it for what it was at the time.

‘The first warning sign for me is driving to work and thinking “I just can’t face talking to this person today”. That’s when I know I’m doing too much and need a break,’ Isabelle says. 

Isabelle Kelly.

For Isabelle, compassion fatigue often manifests as a loss of curiosity and engagement. 

‘I’ll go through the motions in patient interviews, ticking boxes rather than truly engaging. It’s not the standard I hold myself to,’ she says.

Isabelle’s experience reflects a broader issue within the physiotherapy community. 

She explains that many physiotherapists, particularly those in private practice, feel pressure to meet demanding schedules. 

This can lead to emotional exhaustion that diminishes their capacity to provide high-quality care. 

‘In private practice it’s not uncommon for clinicians to face back-to-back appointments with little time to recover emotionally between sessions,’ she says.

Isabelle says mentoring programs can help to create a culture of openness and resilience. 

‘I’ve seen how meaningful it is for new graduates to have someone they can talk to about their challenges,’ she says. 

Mentoring fosters a sense of community and helps clinicians develop coping strategies in their early careers, she believes.

Coping strategies and prevention

Both Ellen and Isabelle emphasise the importance of proactive strategies to manage compassion fatigue. 

Ellen highlights several key strategies that physiotherapists can employ, including the following:
•    Awareness and education—‘Understanding what compassion fatigue is and recognising it in yourself is the first step,’ Ellen says. She likens this to educating patients about their chronic pain. Awareness empowers meaningful action.
•    Self-care practices—Ellen stresses the importance of identifying a fundamental practice or pastime that supports emotional, psychological and physical health. For her, this is physical activity. ‘For someone else, it might be meditation, art or connecting with loved ones. The key is finding what nourishes you and then committing to that, not as a nice thing to do, when there is time, but as a key pillar in your own wellbeing.’
•    Grounding techniques—simple practices such as deep breathing, sipping a cup of tea, drinking cold water, walking outside or talking to a colleague can help physiotherapists reset after emotionally intense sessions.
•    Structured support systems—Ellen advocates for organisational support frameworks that encourage open discussion about emotional wellbeing. ‘Having a buddy system, monthly mentoring or access to psychological supervision can make a big difference,’ she says.
•    Self-growth—an aspect of compassion fatigue is the desire to want to make a difference. ‘Sometimes we are too hard on ourselves—we are making a difference even when it looks like there is no measurable change. At other times, that voice of dissatisfaction can lead us to the awareness that we would benefit from further training or skill development in a certain area. Growing our skills as a physiotherapist is a practical, effective way to support compassion satisfaction,’ Ellen says.

Isabelle, meanwhile, has developed her own strategies, which include scheduling quarterly long weekends and working part-time.

‘I’ve realised that I’m not cut out for full-time work and that’s okay,’ she says. 

She also emphasises the importance of setting boundaries and prioritising rest. Ellen and Isabelle agree that building a supportive workplace culture is essential. 

Ellen suggests that employers consider flexible rostering to reduce emotional strain on staff. ‘Scheduling breaks and balancing case loads can go a long way towards preventing emotional exhaustion,’ she says.

Time for yourself

Ellen talks about the protective role of self-compassion in preventing compassion fatigue. 

She points to the concept of compassion satisfaction—the sense of fulfilment that comes from helping others—as a key buffer.

‘We can listen to suffering if we feel like we’re making a difference. 

'But we also need to be kind to ourselves when we fall short. There will be days when we’re not at our best and that’s okay,’ Ellen says.

Ellen shared a personal experience of secondary traumatic stress when listening to a client’s heartbreaking story. 

‘I felt a visceral reaction, like the bottom had fallen out of my stomach. 

'Later, with the help of colleagues, I realised that the story I was listening to had triggered memories of a loss experience of my own,’ she says. 

This moment underscored for her the importance of seeking support and being prepared to process our own emotions.

Isabelle has also learned to separate her identity from her professional role. 

‘Now I say “I work as a physio” rather than “I am a physio”. Investing in my life outside of work has been a game changer,’ she says. 

Hobbies, relationships and personal goals provide her with a sense of balance and fulfilment.

The next steps

Addressing compassion fatigue requires a cultural shift within the physiotherapy profession, Ellen believes. 

Ellen and Isabelle both agree that increased awareness and proactive support are essential. 

Ellen suggests integrating discussions about compassion fatigue into professional development and creating structures that allow for emotional recovery.

Ellen advocates for prioritising the wellbeing of staff as a core value. 

‘When staff feel supported, they’re better equipped to provide high-quality care to patients,’ she says. 

This holistic approach benefits clinicians and their clients.

For physiotherapists, finding sustainable strategies to manage emotional demands is key. 

‘Invest in your personal life and find what works for you. What nourishes you outside of work will also sustain you at work,’ Isabelle says.

COURSE OF INTEREST: Mental Health Physiotherapy Level 1