Te Role of Empathy in Burnout, Compassion
Satisfaction, and Secondary Traumatic
Stress among Social Workers
M. Alex Wagaman, Jennifer M. Geiger, Clara Shockley, and Elizabeth A. Segal
Social workers are at risk for experiencing burnout and secondary traumatic stress (STS) as
a result of the nature of their work and the contexts within which they work. Little attention
has been paid to the factors within a social worker’s control that may prevent burnout and
STS and increase compassion satisfaction. Empathy, which is a combination of physiological
and cognitive processes, may be a tool to help address burnout and STS. This article reports
on the fndings of a study of social workers (N = 173) that explored the relationship between
the components of empathy, burnout, STS, and compassion satisfaction using the Empathy
Assessment Index and the Professional Quality of Life instruments. It was hypothesized that
higher levels of empathy would be associated with lower levels of burnout and STS, and
higher levels of compassion satisfaction. Findings suggest that components of empathy may
prevent or reduce burnout and STS while increasing compassion satisfaction, and that empathy should be incorporated into training and education throughout the course of a social
worker’s career.
KEY WORDS: burnout; compassion fatigue; compassion satisfaction; empathy; secondary
traumatic stress
Social workers provide support and assistance to clients in a variety of potentially stressful work environments. Despite training in self-care,
social workers are especially susceptible to burnout
and secondary traumatic stress (STS) (Lloyd, King, &
Chenoweth, 2002). Burnout has been linked to
stressful working conditions, vicarious trauma, and a
lack of resources and support. Without effective strategies for managing stress and burnout, overall satisfaction with work and helping others—compassion
satisfaction—may be compromised (Stamm, 2010).
Secondary trauma is the secondhand exposure to
traumatic events, typically experienced while listening
to others telling their life stories (Pryce, Shackelford,
& Pryce, 2007). Such vicarious trauma can contribute
to feelings of burnout (van Heugten, 2011). On the
surface, the relationship between secondary trauma
and burnout suggests that sharing the feelings of one’s
clients can be detrimental to a worker’s mental health.
However, practitioners are urged to be empathic.
Competency skills for social work education include
learning to use empathy to engage diverse client systems (Council on Social Work Education, 2014). This
relationship highlights the need to better understand
the role of empathy in social work practice.
Much of the research conducted with social workers and burnout has focused on the influence of environmental factors, such as work environment, on
worker well-being rather than the characteristics or
factors related to the individual (Maslach, Schaufeli,
& Leiter, 2001; Schaufeli & Enzmann, 1998). Although sharing emotions may contribute to burnout, empathy as a protective factor has not been fully
explored as a means to address the potential risks
associated with service-related work. The level of
empathy a social worker has may influence his or
her ability to manage the stressors associated with
burnout and STS, as well as the level of compassion
satisfaction.
WHAT IS BURNOUT?
Burnout refers to overwhelming emotional exhaustion, depersonalization, and feelings of professional
insufciency. It results from demanding and emotionally charged relationships with clients such that
an individual can no longer fulfll even the most basic
personal and professional responsibilities or duties
(Boyas, Wind, & Kang, 2012; Maslach & Schaufeli,
1993). Burnout as it applies to social workers is generally conceptualized as a gradual process that rarely
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occurs suddenly or with one event, but instead builds
over time as healthy defenses are worn down from
an onslaught of emotional demands, frustrating
job setbacks, or difcult situations or individuals
( Jacobson, Rothschild, Mirza, & Shapiro, 2013). It
is believed that “the single largest risk factor for developing professional burnout is human service work
in general” (Newell & MacNeil, 2010, p. 59). Burnout has been associated with physical and mental
health problems such as depression, insomnia, and
gastrointestinal issues (Burke & Deszca, 1986; Lee &
Ashforth, 1996) as well as decreased job performance,
increased absenteeism, and high turnover (Kahill,
1988). Burnout has also been shown to lead to lower
organizational commitment, which is related to
higher staff turnover and lower productivity (Maslach
& Leiter, 1997), and potentially decreased effectiveness in work with clients (McCarthy & Frieze,
1999). Practitioners with personal trauma history,
anxiety or mood disorder (Newell & MacNeil,
2010), personal relationships involving conflict, low
threshold for minor annoyances, as well as boredom
or lack of commitment to the profession can be at an
elevated risk for burnout (Kulkarni, Bell, & Hartman,
2013).
Work behaviors that may signal burnout include
chronic tardiness, missing work, poor completion
rates or low performance, work errors, or isolation
from others (Newell & MacNeil, 2010). Work environments also invite burnout, such as roles in
which workers have less control of their time or
tasks, higher levels of bureaucracy, lack of clarity
with job roles, higher work demand, greater confusion of work identities, and difculties with people
(Newell & MacNeil, 2010). In addition, disconnect
with supervisors or coworkers prompts higher risk
of burnout (Kulkarni et al., 2013).
STS AND SOCIAL WORK PRACTICE
STS is a condition characterized by fatigue that can
arise from the witnessing or listening to the accounts
of disturbing experiences or traumatic events (Bride,
2007). STS can lead to workers experiencing trauma
themselves, where rumination, flashbacks, physiological responses, fear, dread, or other active symptoms of psychoemotional strain (Bride, 2007) cause
interruption in their work (Perkins & Sprang, 2013).
STS is a syndrome comprised of symptoms that
closely resemble those of posttraumatic stress disorder
(Bride, 2007) and may include hypervigilance, nightmares, sleeplessness, agitation, or fatigue (Newell &
MacNeil, 2010). The National Institute of Mental
Health (2014) reported that the primary symptoms
of STS include hopelessness, inability to embrace or
disdain of complexity, avoidance of clients or others,
fear, physical ailments, and minimizing problems and
guilt. One study reported that the prevalence of at
least one symptom of STS among social workers is
70 percent (Bride, 2007).
APPROACHES TO REDUCE BURNOUT AND STS
A number of self-care strategies have been suggested
for social workers to prevent and manage the risks
associated with burnout and STS. Figley (2002) and
Stamm (1999) recommended that those working
in human services and other professionals strive to
address their own personal, familial, emotional, and
spiritual needs while responding to the demands
and needs placed on them by clients. Setting goals
and boundaries with regard to breaks at work, workload, and client care has also been suggested to reduce the risk of burnout (Maslach, 2003). A healthy
network of personal connection, compatibility with
an effective supervisor, collegial support, and having
and using a voice at work may also reduce the effects
of burnout and STS (Lakey & Cohen, 2000). Experience managing social work challenges with the
guidance of an effective supervisor or role model
builds resilience and reliance, which help to reduce
burnout risks (Boyas et al., 2012). In general, maintaining overall physical health with adequate exercise,
recreation, sleep, and nutrition can also reduce
susceptibility to STS and burnout (O’Halloran &
O’Halloran, 2001; Zimering, Munroe, & Gulliver,
2003).
Structured approaches to reducing burnout are
typically directed at the individual or the organization. The cognitive–behavioral approach, directed
at the individuals, typically involves actions such as
enhancing job competency through training and
education, skill development, fostering relaxation
and social support, and increasing personal coping
skills (Awa, Plaumann, & Walter, 2010). Organizationdirected approaches include changes in work processes, supervision and supervisory relationship evaluation and modifcation, and increased job control
and decision making. A combination of personal
and organizational interventions have longer lasting positive effects in reducing burnout (Awa et al.,
2010). However, it is believed there is too much
focus on treating burnout after it occurs, rather than
preventing burnout. Newell and MacNeil (2010)
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suggested including consistent and accurate information about the key features, signs, and symptoms
of burnout and STS in social work education as a
means of raising awareness and preventing burnout
and STS among social workers.
COMPASSION SATISFACTION
Compassion satisfaction is “the positive feelings
about people’s ability to help” and relates to quality
of work life (Stamm, 2010, p. 8). In contrast to
burnout or STS, a worker’s sense of achievement,
sustained motivation, or even inspiration and enjoyment from emotionally demanding social work can
prompt compassion satisfaction. Compassion satisfaction is an effective means of reducing burnout
and STS as it provides motivation, stamina, interest,
and a sense of accomplishment in aiding clients to
overcome trauma (Bride, Radey, & Figley, 2007).
Compassion satisfaction leads to situations in which
social workers can vicariously beneft from their
clients’ improved functioning, personal growth, or
therapeutic gains as they share the positive outcomes
and feelings of empowerment, energy, and exhilaration (Pooler, Wolfer, & Freeman, 2014).
Providing energy, insight, or strengthened resolve
for helping and service, compassion satisfaction is
most commonly seen in heightened performance,
positive attitude toward work, enhanced value, or
greater hope for positive outcomes that resonate
among successful social workers (Kulkarni et al.,
2013). Compassion satisfaction may be viewed as
antithetical to compassion fatigue, where exhaustion
or hopelessness takes over one’s work, leading to
burnout (Stamm, 2010). Yet no formula or simplifed
approach to compassion satisfaction is known.
THE VALUE OF EMPATHY
A critical skill in social work practice and other
helping professions is the ability to empathize with
others, particularly one’s clients (Gerdes & Segal,
2011). Empathy is a multidimensional process involving cognitive and affective components of understanding and identifying with the thoughts,
feelings, and emotional states of others (Batson,
2011; Gibbons, 2011). Empathy is the ability to
understand what other people are feeling and
thinking and is an essential skill in facilitating social
agreement and successfully navigating personal
relationships (de Waal, 2010; Toussaint & Webb,
2005). Empathy helps to create and maintain social
relationships and bonds by enabling individuals to
comprehend, share, and respond to the emotions,
gestures, thoughts, and experiences of others (de
Waal, 2010).
Studies agree that empathy is critical for effective
clinical practice and positive therapeutic outcomes
(Elliott, Bohart, Watson, & Greenberg, 2011; Gibbons,
2011; Neumann et al., 2009). There is also evidence
that empathy is related to positive moral development (Eisenberg & Eggum, 2009; Killen & Smetana,
2008) and promotes prosocial behaviors, particularly
during adolescence (Batson, Håkansson Eklund,
Chermok, Hoyt, & Ortiz, 2007; Laible, Carlo, &
Roesch, 2004; McMahon, Wernsman, & Parnes,
2006).
THE BUILDING BLOCKS OF EMPATHY
Varying defnitions of empathy have emerged over
the years; however, recent advances in cognitive neuroscience have identifed key components that together make up the full array of empathy (Decety,
2011; Decety & Moriguchi, 2007). This research is
based on the cognitive neuroscience conceptualization of empathy. As such, empathy comprises four
subjectively experienced components: (1) affective
response, (2) self–other awareness, (3) perspective
taking, and (4) emotion regulation (Gerdes, Lietz, &
Segal, 2011). Affective response is a physiological
component that involves the automatic and unconscious process of affect sharing, or the mirroring of
another person’s actions. For example, when sitting
with a client who is crying, a practitioner might feel
as if she or he is going to cry. This is a result of the
automatic mirroring action that is going on unconsciously. Our mirroring neuron system activates the
same physiological sensations as if we are actually
doing the action. However, rather than begin to cry,
the practitioner experiences the other components
of empathy that are triggered to process this affective
response. The other three components are cognitive
processes. Self–other awareness consists of an ability
to recognize and understand one’s own emotions and
thoughts as well as distinguish the self from others.
Perspective taking involves the ability to understand
another’s experiences while maintaining awareness
of the self and the distinction from the other. Emotion regulation refers to one’s ability to control or
regulate one’s emotions.
In the aforementioned example, by engaging all
three of these cognitive components, the practitioner is able to feel the client’s distress of crying but
recognize the difference between the client’s actions
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and the practitioner’s own physiological reactions,
use those feelings to engage in deep understanding,
and simultaneously regulate her or his own emotions
so as not to be overwhelmed. For the full array of
empathy to occur, all four components need to be
well functioning. Each component, and consequently empathy as a whole, involves skills that can
be learned.
The purpose of this study was to examine the
relationship between social workers’ empathy and
level of (a) burnout, (b) STS, and (c) compassion
satisfaction. The authors hypothesized that the components of empathy would be signifcant predictors
of lower levels of burnout and STS, and higher levels of compassion satisfaction.
METHOD
Data Collection
Field instructors from a large southwestern university’s school of social work were invited via e-mail to
participate in an online, Qualtrics-based survey
(Qualtrics Online Survey Software, 2014). Field instructors were community-based practitioners who
voluntarily supervised social work students in their
feld placements. Field instructors were asked to support a snowball sampling technique by forwarding
the invitation e-mail to other services providers in
their agencies or communities. Data were collected in
July and August of 2011. A total of 185 participants
responded. Of those, 173 reported having at least one
degree in social work, and these were included in the
analysis for the current study. The study was approved
by the university’s institutional review board.
Measures
The online survey included demographic items,
such as gender, race or ethnicity, age, and highest
level of education. Participants also responded to
items about their professional career and current
work: years they had worked as a social services
professional overall; the nature of their current work
(such as child welfare, behavioral health); whether
their current work was in a direct practice position,
administrative or supervisory position, or a combination of both; and years they had worked in their
current position.
Participants also completed measures of empathy, burnout, compassion satisfaction, and STS. The
Empathy Assessment Index (EAI) is a valid and reliable 20-item, self-report instrument (Gerdes, Geiger,
Lietz, Wagaman, & Segal, 2012; Lietz et al., 2011)
that includes four subscales measuring the components
of interpersonal empathy (affective response, self–
other awareness, perspective taking, and emotion
regulation), with fve items each. Items were measured
on a six-point Likert scale ranging from 1 = never
to 6 = always. The Professional Quality of Life Scale
(ProQOL) consists of three subscales: Compassion
Satisfaction, Burnout, and STS. Each subscale has
10 questions. As conceptualized by the scale developers, both burnout and STS are components of a
latent construct, compassion fatigue. Each item was
measured on a fve-point Likert scale ranging from
1 = never to 5 = very often, and included items such
as “I am preoccupied with more than one person I
serve.” The ProQOL has been identifed as a reliable
and valid measure of compassion satisfaction and the
components of compassion fatigue (Stamm, 2010).
Sample
The sample (N = 173) was predominantly female
(87.8 percent, n = 151) and white/Caucasian (73.8
percent, n = 127). Twelve percent (n = 21) identifed
as Latino; 5.8 percent (n = 10) identifed as African
American. Participants ranged in age from 20 years
to over 70 years, with a majority (58 percent,
n = 101) being between the ages of 40 and 60. A
majority of the sample (97.1 percent, n = 168) had
a master’s degree or higher, and 93.6 percent
(n = 161) of the participants’ highest degrees were
in social work. Time working in the profession
ranged from two to over 40 years, with approximately 75 percent of the participants (n = 131) having been in the profession for 10 years or longer.
Participants reported working in a broad range of
contexts at the time of the survey, with the most
common being child welfare (12.1 percent, n = 20),
behavioral health (18.8 percent, n = 31), health or
medical services (18.8 percent, n = 31), and schoolbased services (8.5 percent, n = 14). Other work
contexts reported by participants included policy/
advocacy, early childhood development, crisis response services, aging, and veteran services. The
largest proportion of participants (42.1 percent,
n = 69) reported working in direct practice, with an
additional 33.5 percent (n = 55) reporting doing supervisory or administrative work, and 24.4 percent
(n = 40) reporting both. Time having worked in
their current positions ranged from less than a year
to 28 years. The majority (58 percent, n = 93) reported having been in their current position fve
years or less.
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ANALYTIC STRATEGY
Multiple regression was used to analyze three
models—one with the dependent variable burnout, a second with the dependent variable compassion satisfaction, and a third with the dependent
variable STS. Each model included as independent
variables the four component scores of empathy
from the EAI—affective response, self–other awareness, perspective taking, and emotion regulation—
and controls for time in the social services feld
overall, time in current position, and type of work
performed in current position (direct practice,
supervisory/administrative, or both). Current work
type (both direct practice and supervisory/administrative) and current work type (supervisory/
administrative) were created as dummy variables,
which were compared with a reference group
of current work type (direct practice). The dependent and independent variables are summarized in
Table 1.
RESULTS
The model results are summarized in Table 2. In the
frst model, with burnout as the dependent variable, 24 percent of the variance (R2 = .28, adjusted
R2 = .24) was accounted for by the independent variables listed earlier [F(8, 142) = 7.12, p < .01], with
emotion regulation [β = –.36, t(142) = –4.08, p < .05]
being the only predictor with signifcant contributions individually. In the second model predicting
compassion satisfaction, 20 percent (R2 = .24, adjusted R2 = .20) of the variance was explained by
the model [F(8, 140) = 5.70, p < .01], with self–
other awareness [β = .24, t(140) = 2.45, p < .05] and
affective response [β = .19, t(140) = 2.50, p < .05] as
the only signifcant predictors. The models for both
burnout and compassion satisfaction varied signifcantly by time overall in a social services profession.
Those having been in the profession longer were
associated with lower levels of burnout and higher
levels of compassion satisfaction. In the third model,

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with STS as the dependent variable, 14 percent
(R2 = .19, adjusted R2 = .14) of the variance was
accounted for [F(8, 145) = 4.34, p < .01) with self–
other awareness [β = –.26, t(145) = –2.65, p < .01] and
emotion regulation [β = –.21, t(145) = –2.31, p < .05]
as individually signifcant predictors. The model for
STS varied signifcantly by the type of work done.
Those in supervisory- or administrative-only positions had lower levels of STS than those in direct
practice positions, all else being held constant.
The fndings of this study indicate a signifcant
relationship between empathy and both compassion
satisfaction and compassion fatigue among social
work practitioners. Self–other awareness and emotion regulation, which are cognitive components of
empathy, appear to be signifcant contributors to
components of compassion fatigue as compared with
the other components of empathy. In contrast, affective response, which is a physiological component
of empathy, was identifed as a signifcant contributor to compassion satisfaction. These fndings do not
vary signifcantly by time in the current position.
DISCUSSION
The fndings of this study suggest that there is a
signifcant opportunity to use empathy in the preparation of social work practitioners to cope with the
factors related to burnout and STS. The study fndings also suggest that empathy may be a factor contributing to the maintenance of the well-being and
longevity of social workers in the feld.
It is important to explore the specifc components
of empathy for which there was a signifcant predictive value, to understand the relationships that they
suggest. Self–other awareness is a cognitive component of empathy that emphasizes the ability to separate oneself from others, including one’s thoughts
and feelings, which is the process of setting and
maintaining boundaries. The results of this study
suggest that attention to specifcally training social
workers in self–other awareness, both before entering the feld and while in the feld, could serve as a
protective factor against STS. Similarly, the relationship between self–other awareness and compassion
satisfaction, as indicated by the fndings, suggests
that self–other awareness training may help to prevent burnout and STS by increasing compassion
satisfaction. Empathy can help social workers maintain professional boundaries by training them to be
mindful of self–other awareness and emotion regulation in their everyday practice, which may also protect social workers from decision-making patterns
that reflect poor boundary setting and maintenance.
Affective response, which was found to have signifcant predictive value for higher levels of compassion satisfaction, is thought to work in concert with
the cognitive component of emotion regulation.
Unregulated affective response is seen as having the
potential to create distress in an individual. The fndings of this study suggest that affective response has
a positive relationship with compassion satisfaction.
Social workers may need to be able to share emotion
with clients. This process of affect sharing, while
often contextualized in terms of trauma and pain,
would also include sharing in a client’s joy and successes. Such affect sharing may be important to the
maintenance of a feeling of satisfaction in one’s work,
which is linked to a lower risk of compassion fatigue.
Emotion regulation, a cognitive component of
empathy, and its association in this study with burnout and STS suggest that the ability to regulate the
emotional responses to clients that are physiological
in nature equips social workers to protect themselves
from repeated exposure to those who have experienced pain and trauma. Emotion regulation is a skill
that can be learned and honed through training.
The identifed relationship between the type of
work (direct versus administrative or supervisory
practice) and STS is an important reminder that
supervisors who move out of engagement in direct
client contact need to remain aware and sensitive to
the vulnerability of their supervisees to developing
STS. From an organizational perspective, this may
suggest a need for supervisors to maintain some direct client work or engage in empathy-related training to better understand the experiences of their
supervisees.
Finally, the fact that the relationships identifed
between empathy and burnout and compassion satisfaction varied signifcantly by time in the profession is an important fnding, particularly given that
more years in the profession overall was associated
with lower levels of burnout and higher levels of
compassion satisfaction. This fnding suggests that
social work professionals can learn from strategies
used by long-term social workers that prevent burnout and maintain compassion satisfaction. Clearly,
burnout can be prevented and managed across one’s
professional career. Given that issues of retention
are important in the profession, this fnding has
important implications for intervention with social
workers, particularly in those areas of the profession
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found to be a greater risk for burnout and STS, such
as child welfare (Sprang, Craig, & Clark, 2011).
Identifcation of practice settings with increased risk
of burnout, STS, and turnover may provide direction for targeted efforts to enhance social workers’
empathy where there is greatest need.
Study Limitations
Primary limitations of this study are that the sample
was drawn from one community and was fairly homogenous in terms of race and gender, limiting generalizability. Second, despite our attempts to identify
the type of work and context, the data were not able
to differentiate between those whose work directly exposed them to crisis, those whose work directly exposed them to trauma, and those whose
work directly exposed them to both crisis and trauma on a regular basis; or between those who worked
in supervisory positions and those who worked in
strictly administrative positions. No data were collected on environmental factors that the research
literature suggests may contribute to burnout, compassion satisfaction, and STS, such as workload; perception of support for setting boundaries and
engaging in self-care; and having positive, supportive
relationships with one’s supervisor and colleagues. And
fnally, given the cross-sectional nature of the study,
no causal relationship can be drawn from the fndings.
Implications
Previous research has emphasized the environmental or organizational factors related to burnout,
with less attention to individual factors that may be
within the control of social work practitioners. Empathy and its components, particularly the cognitive
aspects, can be taught and learned by social work
practitioners. Such training does not have to solely
occur in social work education; it can be conducted
in practice settings. Strategies such as mindfulness
techniques and emphasis on boundary setting are
ways that social workers can tap into the process of
affect sharing and increase their self–other awareness.
To increase the capacity for emotion regulation, we
must frst recognize the emotion, understand the
meaning and context of the emotion, and then use
specifc strategies to reduce the intensity of the emotion as necessary. Some strategies include practicing
self-talk or verbal cues, physically removing oneself
from a situation to a more comfortable or familiar
setting, and practicing effortful control of one’s
physical or verbal reactions.
Training in these techniques can be pursued by
individual social workers, as well as by organizations
and human services systems. Such training may also
be incorporated into continuing education requirements for license renewal as a way to emphasize its
importance throughout one’s career. The fndings
of this study suggest that future research should further examine the relationships between empathy
and the components of compassion fatigue over
time and in diverse samples, as well as explore individually oriented and organizationally oriented
interventions designed to prevent or minimize experiences of burnout and STS. Empathy is an important factor that can be incorporated into a dually
focused intervention.
Social workers are vulnerable to burnout and
STS. This study demonstrates that empathy is a viable skill and strategy in buffering against the negative effects of compassion fatigue and may increase
compassion satisfaction, longevity, and personal and
professional well-being. Empathy can and should be
explored, cultivated, taught, and learned in formal
educational settings, professional development programs, and continuing education for social workers
to improve work with clients, self-preservation, and
organizational outcomes.
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M. Alex Wagaman, PhD, MSW, is assistant professor, School
of Social Work, Virginia Commonwealth University, 1000 Floyd
Avenue, PO Box 842027, Richmond, VA 23284–2027;
e-mail: [email protected]. Jennifer M. Geiger, PhD, is
postdoctoral fellow, Arizona State University, Phoenix. Clara
Shockley, MSW, LCSW-C, CPC-AD, is a doctoral student,
Virginia Commonwealth University, Richmond. Elizabeth A.
Segal, PhD, is professor, Arizona State University, Phoenix.
Original manuscript received June 18, 2014
Final revision received September 15, 2014
Accepted September 22, 2014
Advance Access Publication May 1, 2015
Wagaman et al. / Te Role of Empathy in Burnout, Compassion Satisfaction, and Secondary Traumatic Stress 209
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