When someone in the helping professions tells me they’re exhausted, can’t switch off and wonder if it’s burnout, I have a few questions.
‘What stays with you when you go home?’
‘What are you being asked to go back to tomorrow?’
‘What keeps you doing the work that you do?’
And
‘Can you, or do you, consider your own needs?’
I’d spent more than ten years in domestic abuse services, including frontline work in high-risk services, when I began researching how the work affects us as part of my psychotherapy and counselling training. I’ve spent over a decade since returning to these questions in therapy, in teaching and training, and in reflective spaces with practitioners.
I’m intensely interested in what helps people stay in work they care about without having to leave or lose themselves in the process.
By helping practitioners/ professionals, I mean those of us who spend much of our working lives supporting people, including those in pain or distress. I’m thinking of counsellors and psychotherapists, social workers, care workers, healthcare professionals, emergency responders and teachers, among many, many others, in paid and voluntary roles.
It's what we do in our roles that matters here, not the specific sector we work in or the job title we hold.
Some of this may also feel familiar if you’re someone your family or community relies on. If you are caring for a family member or a parent because parts of what you do are very much a part of this conversation. It’s not about being paid for what you do; it is about what you do.
I also want to add that we need to be able to talk about the impact of caring while still caring deeply about the people we support. I think we need room for both conversations if we want to keep doing the work.
Understanding the Umbrella
Professional Trauma and Fatigue (PT&F) is an umbrella term I use to describe the emotional, psychological, and relational impact that can come from caring for others, both as human beings and, as a helping practitioner.
It is not about giving us another label to carry, but about offering a way of making sense of the load that can build over time, as well as the real experience of sitting with others’ trauma.
Under this umbrella sit a number of concepts and terms. These are not always clearly defined in the literature, and often overlap. People may experience aspects of several at once, or move between them over time.
The aim is to notice how the roles we do might be affecting us, and to think about what might help. This isn’t always about working with people who have experienced trauma. It’s also about the ongoing work of giving, compassion and empathy. Having language for this can help us notice the load earlier.
Where Professional Trauma and Fatigue began
I developed Professional Trauma & Fatigue (PT&F) as a term, during my 2016 MSc research at Keele University. I interviewed practitioners who worked with those who had experienced domestic abuse: specifically counsellors, child protection social workers and specialist domestic abuse practitioners. I wanted to know what support they were given as they listened to and supported survivors in their different roles, and what helped them keep doing work they cared about.
They described some strikingly similar effects, both at work and away from it, but the understanding and support they received from their organisations varied. This contrast gave me something worth following up: if the work affects people in similar ways across roles, what determines what support is available and whether people can access it? And what might help make a difference when we struggle, and stay in the work we’ve trained for and cared about?
I called the study Looking Through a Lens of Terribleness, after a participant described how the work had changed the way she saw the world. For a time, she saw risk everywhere, and it had a considerable impact on her daily life. That stayed with me. “I’m exhausted” might be an element of their experience that is exactly right, but there was clearly more to understand than having too much work!
The huge cross-sector literature review gave me words for parts of what I was hearing: stress, burnout, compassion fatigue, secondary trauma and vicarious trauma. These were not all familiar at all ten years ago, and for me, leaning into medical models felt uncomfortable when describing a way we were being hurt by a job.
There was, and still is, disagreement about where some of those concepts begin and end, so I wanted a way to hold them together and talk across professions without having to decide which label fitted first or whether a clinical diagnosis applied.
I have since written about PT&F in many different places, but initially published Pillars of protection (PDF), in the BACP Workplace Journal in January 2019. Structurally as a model, more recently, I’ve brought moral distress and moral injury under the umbrella too. They feel more and more relevant in the conversations I have with practitioners. When resources are stretched and demands change quickly, people can find themselves unable to do a job in the way they believe it should be done. That can hit hard when the work sits so close to their values and sense of who they are.
There was also a slightly peculiar lesson for me in the research itself. Towards the end of the project, while I was practising as a counsellor and writing up the study, I got quite run down and fell ill. Nothing serious, but the people close to me noticed before I did. There I was, studying what happens when people listen to difficult things and don’t have enough space to think about the impact, and I hadn’t made that space for myself.
It’s one of the reasons that I’m so careful about assuming that knowing about this stuff means we’ll be able to spot it in ourselves. Sometimes we notice it in others before we notice it in ourselves.
Burnout isn’t the whole story
What follows is a ridiculously succinct way of opening up some rather big conversations. I’m not going to do justice to vicarious trauma in three sentences, and I wouldn’t expect you to read three sentences and know exactly what’s going on for you.
But sometimes a word helps. You can take it into supervision and say, “I wonder if this is part of what’s happening to me.” And sometimes you find you need several words.
You might be worn out by the rota, still thinking about something you heard on Tuesday, and furious that you couldn’t offer someone what they needed. Language matters. Where on earth would you put all that if burnout was the only idea you knew about?
Sadly, many of us have limited space to reflect and make sense of this intrinsically human work and the responsibility we hold for others, the language can make a difference to how we use what little space there is.
This is why I feel the umbrella has more and more to offer. It gives us room to talk about what might be happening and to ask the practitioner what might actually help. I firmly believe that the practitioner knows what the practitioner needs. They might not have the words for it yet, but never underestimate the value of listening, being heard and offering that space to each other.
What sits under the Umbrella?
Stress is part of being human, not something restricted to those of us in the helping professions. It can be short-lived or go on for a long time, and sometimes a bit of pressure helps us do what we need to do. But when a difficult shift, a sick parent and a night of broken sleep all land within the same human, dropping a cup can be the thing that tips us over when we’ve already had as much as we can take. We only have one mind and body, not a work one and a home one.
Burnout, as the World Health Organization describes it, is specifically about work. It can result from chronic workplace stress that haven’t been successfully managed. It can show up as exhaustion, growing distance from the job and feeling less effective. Leiter and Maslach’s six areas of worklife give us somewhere to look: workload, control, reward, community, fairness and values. I find this a useful way to break it all down a bit, because it brings the workplace itself into the conversation. If you’ve had no say over a caseload that nobody could reasonably manage, that matters. Being able to talk to your manager, feel heard and make sense of what’s happening matters too. Very much!
Compassion fatigue is used in different ways. Some frameworks bring burnout and secondary traumatic stress together under that term. In my framework, I use it for the cost of being emotionally available to others over time: that sense of having less empathy left to give. You can recognise that in a caring role outside of paid work, and it doesn’t require the person you’re supporting to have experienced trauma.
Secondary traumatic stress, sometimes called secondary trauma, describes reactions that can follow indirect exposure to someone else’s trauma. Something you heard or read, might keep coming back when you don’t want it to, or you might feel on edge or start avoiding reminders.
Vicarious trauma draws attention to what can change in how you see yourself, other people or the world through engaging with others’ trauma. You might notice you’ve started expecting danger in places where you used to feel safe. That’s the distinction I find useful: something can keep coming back to you, and the work can also change what you expect to find when you look out at the world. Those experiences can overlap. You’ve endeavoured to be with your client empathically, as though you were in their world. You might notice a physical response to what you hear, too.
When Kate and I deliver training, we talk about compassion fatigue in terms of what it costs to keep giving of yourself, and about vicarious or secondary trauma in terms of what you’ve been exposed to, or receiving because of and through the work.
Moral distress can arise when you believe you know what good care requires and the conditions of the job make it hard or impossible to offer it. Moral injury can describe a lasting impact after something happens that deeply violates your values, including something you did, couldn’t prevent or witnessed, or a betrayal by someone you trusted. There are different definitions in the literature.
What I look out for now
These days, I’m wary of asking how someone is coping before I’ve understood what they’re being asked to cope with. Sometimes it’s what they’ve heard that stays with them. Sometimes it’s knowing what would help the person in front of them and having no way to offer it. Often there are elements of both, on top of a workload that leaves precious little room to think.
In addition, when I’m working one to one, in therapy or in a reflective space, one of my priorities is to help you find out what might get in the way of giving your own needs some attention. Being the person who can be relied on might be a huge part of who you are. It might also have been part of how you learnt you were valued. If that’s the case, being told to put yourself first can feel like quite a leap. It’s worth spending time on what makes that difficult. If “me first” feels uncomfortable, what would “me as well” look like if you wanted to be more intentional about looking after yourself?
When I’m working with a group, whether we’re training or reflecting together, understanding PT&F can change the conversation. That moment of recognition and relief when we realise its not just us. It’s possible to go a long time assuming everyone else is managing better, especially if nobody talks about it. We can start to think we’re weak or rubbish at our job, and that it’s only a matter of time before everyone else realises we are too.
Someone banging away on a keyboard across the office may look as though they’re in control, but it might be their way of avoiding colleagues and shutting the world out. The struggle can still be there.
Then suddenly, someone describes what happens when they get home after a difficult day and another person says, “Oh. I do that too.” Suddenly there’s room to talk about what is hard about the work, what helps people cope with it and what needs to change. Finding it hard tells us something about what the work asks of people. I’m much more interested in that than in deciding how strong or resilient someone is.
The Five Pillars of Protection
I set out the Five Pillars of Protection in my 2019 BACP Workplace article, drawing on the research and what practitioners had told me. Kate and I have developed that work further at SelfCare Psychology.
The Pillars are designed to buffer the impact of Professional Trauma and Fatigue and help us stay alongside it in a more supported way. They can’t remove the impact altogether.
It is not about getting every pillar to a perfect ten. A simple 0 to 10 scale can be a helpful way of noticing where each pillar sits for you at any given time. The focus is less on perfection and more on balance. When one pillar starts to feel lower, wobbly, or even a little cracked, it can be a gentle prompt to consider what might be needed there.
Awareness: noticing what the work is doing to us.
Supervision: making space to reflect on how the work affects us, alongside thinking about the people we support.
Peer support: having colleagues who get it and with whom we can talk honestly and confidentially. That’s why I call it peer power.
Trauma-informed practice: paying attention to safety, trust and choice for ourselves and our colleagues as well as for the people we support.
Self-care: making room for the ordinary things that help us to look after ourselves. Staying hydrated is a really good place to start!
Keeping an eye on how your pillars are holding you up can be helpful. Here’s a question to consider alongside my July 2026 BACP Workplace Q&A (PDF):
What is yours to carry, and what belongs with the organisation or the wider system?
What the work gives us
Supporting other human beings changes us. Some of those changes are ones I’m glad of. I’m interested in what makes someone say, after a particularly difficult week, “I still love the work.” It might be seeing someone begin to trust their own judgement, or noticing that you’ve made a difference for someone you work with. This is why we do what we do, but at the same time, what has been described as ‘Compassion Tax ‘cannot be used to squeeze more out of us, because we care.
Compassion satisfaction gives us a name for the fulfilment that can come from doing this work and knowing your part mattered. Vicarious resilience describes how witnessing someone else’s resourcefulness can change your own sense of what’s possible. Post-traumatic growth describes positive changes that some people notice as they struggle with the aftermath of trauma.
If you ask someone what’s keeping them in the work, you might find out something worth protecting. You might also hear how much they love it and how close they are to leaving. Both can be true in the same conversation.
Good questions to ask yourself or take to supervision
Think of one thing from work that’s stayed with you this week. It might be a story, the pace of the work, a decision you couldn’t change or something you’re glad you were there for.
What part of it is still with you?
What would help with that particular part, and who can make it possible?
Am I able to look after myself? If not, how might I, even in a very small way?
My hope is for a future where we prepare people not only to care for others, but to understand what that caring can ask of them, and where supporting the people who help becomes an ordinary, expected part of professional practice.
For more ideas, see my free resource, Looking After Yourself: Ordinary Things That Matter.
If you supervise or manage others, try asking the same questions and leave yourself enough time to hear the answer.
For a companion to that reflection, see my free guide, Stress: Understanding What Your Body Might Be Carrying.
Research and further reading
I spoke with Nicola Banning for the October 2026 issue of BACP Workplace (subscriber login) about education and the impact of working in the helping professions. I’d like these conversations to start while people are learning their roles and to carry on once they’re in them. I would like PT&F to be a specialist area of support. If you’re training as a counsellor or working as an affiliate in a workplace setting, for example, recognising these concepts is important, especially when a trauma response is being played down as ‘just stress’.
Boucher, S. (2016). ‘Looking through a lens of terribleness’: A thematic analysis of the experience of practitioners working in the field of domestic violence. Unpublished MSc dissertation, Keele University.
Boucher, S. (2019). Pillars of protection (PDF). BACP Workplace, 99, 8–15. The term “professional trauma and fatigue” is discussed on p. 11.
Boucher, S. (2026). The weight of my caseload feels increasingly heavy. How can I sustain myself to keep doing the client work that I love? (PDF). BACP Workplace, July, 30–31.
Both PDFs are also listed on my Writing & Publications page. For more on the framework, see Professional Trauma & Fatigue at SelfCare Psychology.
I also wrote about the language we use in Why Language Matters in Professional Trauma and Fatigue.
Books to explore further
Babette Rothschild — Help for the Helper. The updated and expanded edition explores compassion fatigue, vicarious trauma and ways of supporting ourselves while helping others.
Judith Herman — Trauma and Recovery. A wider exploration of trauma and recovery, including the social conditions around people’s experiences.
Christina Maslach — Burnout: The Cost of Caring. An early foundational book on burnout and the demands of work that involves caring for others. First published in 1982; the link gives the original publication details.
Dr Claire Plumbly — Burnout: How to Manage Your Nervous System Before It Manages You. A contemporary exploration of burnout, stress and the nervous system.
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