Learning to recognize your signs and symptoms of empathic strain and secondary traumatic stress has a two-fold purpose:

First, it can serve as an important check-in process if you are feeling unhappy and dissatisfied, but do not have the words to explain what is happening to you.

Second, it allows you to develop a warning system, enabling you to track your levels of emotional and physical depletion and quickly implement preventative strategies.


Developing Your Warning Systems

The first step is to identify your ES/STS symptoms on a scale of 1 to 10. A rating of 10 represents the worst you have ever felt and a rating of 1 represents the best you have ever felt.

The second step is to identify what a rating of 8/9 looks like for you. This signals that you are starting to approach your “red zone”. For example, you may notice that you don’t return phone calls, think about calling in sick, turn down a friend’s dinner invitation, or are unable to watch violent TV.

The ability to recognize that you are approaching your red zone is the most effective way to implement strategies immediately before things get worse.

This process also allows you to identify solutions to your depletion. For example, if you know you are approaching your red zone, you may refuse to take on new clients with a trauma history, may choose to take a day off or schedule an appointment with your supervisor and/or therapist.

In order for you to develop your warning scale, you need to develop an understanding and an increased awareness of your own symptoms of empathic strain and secondary traumatic stress. These symptoms will manifest differently in each of us. This is not a diagnostic test, but rather a process whereby we begin to understand our own physical and psychological reactions to the work that we do.

Saakvitne and Pearlman (1995) have suggested that we look at symptoms on three levels: physical, behavioural and psychological.

Please note that experiencing any of these symptoms on their own do not constitute a serious problem. However, if you have concerns, please check in with your healthcare provider. 


Physical Signs of Empathic Strain and Secondary Traumatic Stress




Getting sick more often

Somatization – refers to the process whereby we translate emotional stress into physical symptoms. Examples are tension headaches, frequent stress-induced migraines, gastro-intestinal symptoms, stress-induced nausea, unexplained fainting spells, etc. The ailments are very real, but the root cause is largely emotional and stress related.

Hypochondriasis – refers to a form of anxiety and hypervigilance about potential physical ailments that we or someone we love may develop. Milder versions of hypochondria can happen to many of us who work in the health care field. For example, if you work in cancer care (particularly at the diagnostic end), you may find yourself concerned about every bump and bruise on you or your loved ones.



Behavioural Signs of Empathic Strain and Secondary Traumatic Stress

Increased use of alcohol and drugs – There is evidence that many of us are relying on alcohol, marijuana and/or over-the-counter sedatives to unwind after a hard day. The difficulty with increased reliance on drugs and alcohol is that there is often a lot of shame associated with it and is not often something that we feel can disclose to others.



Anger and irritability – This can manifest as anger towards colleagues, family members, clients, or chronic crisis clients. You may find yourself irritated with minor events at work such as hearing laughter in the lunch room. You may feel annoyed or angry when your client tells you that they did not complete the homework you had assigned to them. You may yell at family for not completing chores when you get home. The list goes on and on, resulting in a list of behaviours that do not make you feel particularly good about yourself as a helper, parent or spouse.

Avoidance of clients/patients – Examples of this behaviour might include not returning phone calls in a timely fashion, hiding when you encounter a challenging person, or delaying booking clients or patients who are in crisis – even though you know you should see them right away. Many of us work with some very challenging individuals. If you do front-line work, I am sure that you can easily call to mind an individual or family that has severely taxed your patience and your compassion.

Impaired ability to make decisions – We may feel professionally incompetent and doubt our clinical skills or our ability to help others. A more severe form of this can be finding yourself in the middle of an intervention and feeling totally lost and unable to decide what should happen next.

Problems in personal relationships – When I worked as a couples counsellor, many of my clients confessed that they often felt spent, “done” by the end of their day and had nothing left to give. Others found themselves being impatient with loved ones, often thinking to themselves: “How dare you complain about that? Do you have any idea what I saw today?”

Compromised care for clients/patients – This can take many forms such as using dismissive labels including “borderline” or “frequent flyer” for some clients or patients as a code word for “manipulative.” Whenever a diagnosis is being used in a way that pigeonholes a person that we serve, we are showing our inability to offer them the same level of care as to others.


Psychological Signs of Empathic Strain and Secondary Traumatic Stress

Emotional exhaustion


Negative self image

Reduced ability to feel sympathy and empathy – This is a very common symptom among experienced helpers. Some describe feeling numb or highly desensitized to what they perceive as a minor issues brought forth my their clients, patients or  loved ones. For example, you may feel angry or irritated when a family member complains of a non life-threatening injury. Reduced ability to feel empathy can also occur when you are working with a very homogeneous client population.

Cynicism – Cynicism has been called the “hallmark” of empathic strain. You may express cynicism towards colleagues, clients/patients and family and friends. Examples include eye-rolling at the brand new nurse who is enthusiastically talking about an upcoming change or idea to improve staff morale, groaning when seeing a certain client’s name on your roster or cynicism towards your children’s ideas or enthusiasm.


Dread of working with certain clients/patients

Feeling professional helplessness

Diminished sense of enjoyment or career satisfaction

Depersonalization – Many of us space-out once in a while, but if you find yourself dissociating frequently during sessions or interviews with clients or patients, this may indicate ES/STS.

Disruption of world view/heightened anxiety or irrational fears – One of the key symptoms of secondary traumatic stress. Frequently hearing traumatic stories has an impact on you and your view of the world. Over time, your ability to see the world as a safe place may be severely impacted.

Intrusive imagery – Another key symptom of secondary traumatic stress –  finding that the stories you hear are intruding on your own thoughts and daily activities. It is not unusual for intrusive images to last a few days after hearing a particularly graphic story, but when they stay with you beyond this, you may be having a secondary traumatic stress experience.

Hypersensitivity to emotional material

Insensitivity to emotional material

Difficulty separating personal and professional lives – I have met many helping professionals who, quite frankly, have no life outside of work. They work through lunch, rarely take their vacations, carry their work phones with them at all times and are on several committees and boards related to their work.

Failure to nurture and develop non-work related aspects of life – Many of the helpers that I meet confess that they have lost track of the hobbies, sports and activities that they used to enjoy. Some tell me that they collapse in bed at the end of their work day, too tired to consider joining an amateur theatre group, go curling or join a book club. Yet, “having a life” has been identified as one of the key protective elements to remaining healthy in this field.


© Françoise Mathieu, 2017, 2020

Updated from the original article originally published April 11th, 2010

Adapted from The Compassion Fatigue Workbook: Creative Tools for Transforming Compassion Fatigue and Vicarious Traumatization 

Sources: Mathieu (2012), Saakvitne (1995), Figley (1995), Gentry, Baranowsky & Dunning (1997)


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