One Foot In, One Foot Out

Enhance Clinical Effectiveness and Protect Against Compassion Fatigue

A woman in therapy | Photo by Karolina Grabowska/Pexels

Remember when you were you a new therapist in training? Can you recall that mixture of the eager anticipation of making a difference along with the trepidation of doing or saying the wrong thing?

I was recently reminded of this while supporting a young therapist in training. Her compassion and anxiety were equally palpable in our sessions. Lucky for us, I was guided in my early days by a wise, gentle supervisor: Dr. Jack Russle, who was the psychologist equivalent of Mr. Rogers in both manner and appearance.

It was the fall of 2001. The world had just been rocked by the 9/11 attacks and I was starting my placement. Like all of us who go into the profession, I was deeply empathic and excited at the prospect of helping someone “feel better.” But I wasn’t prepared for the incredible sadness and helplessness I would absorb from my young clients.

Empathy is described as putting ourselves in another’s shoes to resonate with their experience so they can feel heard, seen, and validated. It is at the heart of the client-centered therapy I offer clients. My high sensitivity allows me to offer advanced empathy. “That’s exactly how I’ve been feeling, I just didn’t know how to put it into words” is a phrase I’ve heard over the years. However, as I’ve learned from my certified compassion fatigue training, empathy without separation can lead to empathic distress or what’s been traditionally referred to as compassion fatigue. Over time, not only are therapists and other helpers at a higher risk of burnout, but also a decreased empathic response and growing dissatisfaction in their work.

Thankfully my mentor’s sage advice “One foot in, one foot out” helped me in the early years to not drown in my clients’ sorrow or hopelessness, but rather help them connect with their strengths and options to get the most out of our work together. Essentially it helps us move from empathy to compassion.

What Does This Look Like in Practice?

Case Example 1) – Moving out of Complicated Grief

Let’s take my grieving client for example, Sarah. Sarah was a lovely, intelligent young woman who was shocked and devastated by the unexpected death of her boyfriend in an accident. In initial sessions with Sarah, I validated her pain and the complexity of emotions grief triggers. I also invited her to share about her partner and their relationship. I remember the heaviness in the room as Sarah wept, and I felt my own eyes well up with tears. How could life be so cruel, I thought.

In supervision, I let the tears flow and mirrored Sarah’s stuck feeling agonizing with her: would she ever find love like that again? With both feet in her shoes, there was no distance to protect me from being overwhelmed by her pain.

It was only when, with my supervisor’s suggestion, I took a step back so that I could see that her grief was complicated by an idealized version of the relationship. Understanding she was holding on unconsciously out of fear of betraying her beloved, we moved slowly. With one foot now anchored on solid ground, I could shift to compassion and begin offering her gentle invitations to move towards acceptance, while looking at the complexity of the relationship and the possibility of love again. My empathy was still needed to ensure she didn’t feel judged or rushed. But simply resonating with her despair would not help her move along her healing journey. Instead, as we ended our work together, she expressed a renewed sense of hope for the future.

Case Example 2) – From Victim to Survivor

Natalie initially left me taking on her sense of hopelessness. Disowned from her family and culture for divorcing her abusive husband, her tired eyes reflected her pain and the bleakness of her situation. Her head hung low in shame while I struggled to lift her out of her depression and prevent myself from slipping into it.

Once again, I realized I needed to “step back” and anchor into (what I’ve come to learn from Polyvagal Informed therapy training) my ventral vagal nervous system state. It is here that we can access our compassion, curiosity, and creativity and open up to new possibilities. For me that was shifting out of identifying with her as a victim and helping her see herself as a strong and brave survivor. I didn’t bypass her grief but helped protect her from internalizing shame. Together we put the shame and blame where it belonged.

Her story was tragic, but in our sessions, we celebrated her strength and connected with the part of herself that knew she deserved better. Instead of feeling hopeless, we both began to feel a growing excitement for the limitless possibilities that awaited her in this next chapter of her life.

Case Example 3) – Defenses Against Shame

Remembering “one foot in, one foot out” has also helped me in my work with men who used abuse against their partners. While co-leading groups, it wasn’t uncommon for at least one man to blame their partners or the system for their circumstances. While empathy helped me build a strong therapeutic alliance with these mandated and often resistant clients, keeping one foot out, metaphorically speaking, helped ensure I didn’t collude with them or personalize and react against their defenses against shame. Instead, I could validate their pain from childhood and the denial of their vulnerability while inviting them to take responsibility for their actions. By maintaining a sense of safety and shifting to compassion, we empowered them to look at the contrast between their values and desires and the harmful messages they had received from patriarchy.

The Importance of Nervous System Regulation

Trauma and compassion fatigue expert Dr. Eric Gentry says, “You do not have to suffer to be a professional caregiver, and if you are suffering, you are doing it wrong.”

As a highly sensitive person, who’s recovered from compassion fatigue and burnout, I have learned how important it is to honor my needs and boundaries and tend to my nervous system both as a caregiver at home and work. Awareness of when we’ve slipped into both our client’s shoes is essential to enhance clinical effectiveness and protect against compassion fatigue.

If you are looking for a deeper look at your sensitivity and self-regulation along with ways to protect your energy at home and work, reach out to join the waitlist for my virtual four-week program “Caring without Carrying it All” with intuitive coach Julie Cusmariu starting in November.


Photo by Karolina Grabowska/Pexel

Nicole Schiener

Nicole Schiener, RP, CCC, CCFP, is an award-winning Registered Psychotherapist and Certified Compassion Fatigue Professional in Ontario, Canada. She provides articles and webinars for The Gottman Institute and has been featured on podcasts and local media. Nicole is passionate about fostering healthy relationships at home and work and is on a mission to liberate mothers and helping professionals from perfectionism and the pressure to do it all. A proud mom of teens, she loves reading memoirs, being in nature, and collaborating. Learn more on her website.