Interview with Veronika Gold, MA, LMFT — Compassion Fatigue (Heal the Healer)

Understand Compassion Fatigue in psychotherapy with Veronika Gold, MA, LMFT. Learn how to prevent and manage this professional challenge.
Compassion Fatigue.
Author: Katharine Chan, MSc, BSc, PMP
By Katharine Chan, MSc, BSc, PMP
April 18, 2024(Updated: April 22, 2024)

Therapists are trained to learn, understand, and recognize compassion fatigue for several vital reasons. For instance, compassion fatigue could directly affect a therapist’s ability to provide effective and ethical care. When therapists experience compassion fatigue, burnout, vicarious traumatization, or secondary PTSD, their capacity to empathize and connect with clients may be compromised. This lack of capacity can harm the overall therapeutic relationship and hinder the client’s progress.

“The material that comes up in the sessions needs to be metabolized and integrated by the client but also is held and metabolized by the therapist”

Veronika Gold, MA, LMFT

In addition, understanding, recognizing, and addressing compassion fatigue can lead to greater capacity as a therapist. A therapist’s self-care contributes to the development of their resilience. Therapists equipped with the knowledge and skills to navigate the challenges of their profession are better positioned to bounce back from stressors, adapt to changes, and sustain a long and fulfilling career.

However, understanding compassion fatigue is particularly important when working with non-ordinary states of consciousness (NOSC) in psychotherapy. We spoke with Veronika Gold, MA, LMFT, to get her insights on what compassion fatigue means for those working in the psychedelic space. She offers practical and effective tips for healers on practicing self-care, setting boundaries, and preventing burnout.

How Veronika Got Into the Psychedelic Space

Veronika Gold is a marriage and family therapist who specializes in trauma treatment. She is originally from the Czech Republic and made the Bay Area her home in 2013. When she was sixteen, she met Stanislav Grof at a transpersonal conference in Prague. His work with non-ordinary states of consciousness and transpersonal teaching changed Veronika’s life. She decided to become a psychologist and became fascinated with the healing potential of expanded states of consciousness.

Veronika has been working in the psychedelic-assisted therapy field since 2016. She is a Certified Somatic Experiencing Practitioner, EMDR therapist, consultant and facilitator, and Realization Process Teacher

She has undergone multiple trainings in psychedelic-assisted psychotherapy. These include advanced training through the Ketamine Training Center and Kriya Institute, Beckley training in 5-MeO-DMT-assisted therapy, and MDMA-assisted therapy training through MAPS. She is also currently a Sub-Investigator and Co-therapist, a supervisor, and a trainer on the MAPS MDMA-assisted therapy clinical trials for treatment-resistant PTSD. 

She regularly presents at conferences and teaches about trauma and psychedelic-assisted therapies. Veronika is a lead trainer in the Polaris Insight Training Program.

Veronika’s Special Interest in Compassion Fatigue Within Psychedelic-Assisted Therapy

Before working with psychedelics, she was particularly interested in the themes of burnout, compassion fatigue, and vicarious trauma. Her main focus was trauma and PTSD. So she began thinking about the impact this work had on therapists who had clients who had gone through significant pain and suffering.

She had gone through periods where she experienced compassion fatigue and exhaustion from the work. Then, she would recover. Over the years, she developed ways of caring for herself and supporting herself as a trauma therapist.

Dive Deeper With Veronika Gold and These Related Resources:

When she started working with psychedelic medicines, she started thinking a lot about the differences between regular therapy and psychedelic-assisted therapy sessions. For instance, psychedelic-assisted therapy sessions are longer; therapists might experience empathic overload. Veronika thought about sharing and supporting others about the need for increased self-care for those who provide this type of therapy.

“Psychedelic medicines create a space of a greater porosity in the sessions. There is amplification. It’s like a nonspecific amplifier…also there can be a decrease in inhibition, and it can be easier for clients to share details of their traumas. The material that comes up in the sessions needs to be metabolized and integrated by the client but also is held and metabolized by the therapist,” explains Gold.

Compassion Satisfaction: When Does It Start to Take Away From Us?

Healers, clinicians, and practitioners value supporting others in connecting with and healing pain. They are natural caregivers. Veronika spoke about compassion satisfaction. She described it as the following:

“There is something beautiful and nourishing [about compassion satisfaction]…in being helpful, in providing this care and love and that there is a satisfaction we are getting back… it’s not only giving, but we are also receiving by that giving,” explained Veronika.

However, she ponders the following questions:

What is Compassion Fatigue?

Compassion fatigue is a form of emotional exhaustion resulting from the demands of caring for others. It is due to spending extended time with people who are suffering from trauma without enough self-care to regulate the body. The exhaustion affects the person’s ability to be present and want to show up for their clients and for the work they’re doing.

Therapists who neglect their well-being are at risk of burnout, stress-related health issues, and reduced job satisfaction. Learning about compassion fatigue equips therapists with tools to manage stress and prioritize self-care.

Signs of Compassion Fatigue

Recognizing signs of compassion fatigue within themselves can allow therapists to take proactive steps to address it. Symptoms can be biological, psychological, social, or any combination of these. Veronika shared the following symptoms:

Biological Symptoms

  • Feeling tired
  • Having headaches
  • Stomach aches
  • Indigestion

Psychological Symptoms

  • Sleep disturbances such as not being able to fall asleep or frequently waking up.
  • Easily irritated
  • Depressed, not feeling joy
  • Losing interest in things that you used to enjoy
  • Feeling too tired to do anything

Social Symptoms

  • Not wanting to be with friends 
  • Avoiding work, seeing few clients, feeling happy about canceled sessions
  • Overworking, taking more clients, packing the schedule with back-to-back sessions

Another sign of compassion fatigue is developing behaviors that might feel soothing. However, these behaviors aim to numb the overwhelm that the person is experiencing. They do not help to address the root issue. These include substance use, smoking, alcohol use, shopping, binge eating, and watching excessive amounts of TV.

It’s important to realize that we need much more time to recover from these [psychedelic-assisted therapy] sessions to process.

Veronika Gold, MA, LMFT

Veronika emphasized that just because you have one of these symptoms doesn’t necessarily mean you have compassion fatigue. Instead, it’s crucial to look at the other things. Looking at the whole picture, you can see whether it results from overextension. 

For some people, it happens suddenly. For instance, they have a client who has experienced significant trauma. They are completely exhausted before the session and do not have enough professional support. They might start to feel these symptoms immediately.

For others, it can happen gradually over time. They don’t remember to take complete breaks and keep adding more, and they don’t feel symptoms until much later.

The Importance for Healers to Recognize Compassion Fatigue in Psychedelic Sessions

Veronika stressed that therapists and healers must be especially aware of compassion fatigue. There are certain aspects and situations of psychedelic sessions that do not typically happen in a regular therapy session.

Psychedelic Therapy Sessions Are Longer 

Psychedelic therapy sessions occur for longer periods. Veronika explained that because of the extended time in the non-ordinary state of consciousness (or the expanded state of consciousness), there could be greater and faster access to the client’s inner material. 

Metabolizing a Larger Amount of Trauma

Veronika shared that we’ve often heard how a client undergoing one psychedelic session helped more or brought up more than months of therapy. The therapist in that situation is witnessing, supporting, and processing a significantly larger amount of trauma. For instance, the client and the therapist may metabolize six months of therapy in a few psychedelic-assisted therapy sessions.

Increased Porosity 

Veronika explained that psychedelic medicines amplify the expressions and feelings that come out during a session. There is greater porosity for the client—but also for the therapist. Therapists absorb and feel more from a client in a non-ordinary state of consciousness than a client in an ordinary state of consciousness.

Breaking Down Protective Parts

Psychedelics can help decrease fear, shame, the protective parts that a person might have, or any combination of these. As a result, the client will share more details in their sessions. The volume and intensity of the material that a client shares are greater. This increase in sharing is because their defensive walls are broken down, and the session lasts longer.

“It’s important to realize that we need much more time to recover from these [psychedelic-assisted therapy] sessions to process ourselves the material the client was processing and be with the pain of what was shared, to work with the grief that we might have been feeling with the client and then really taking care of our bodies,” advised Veronika.

The Parallel Process in Psychedelic Work for Clients and Healers

Veronika shared that there is a parallel that exists in how therapists talk to their clients about psychedelic work and the healers themselves. The session has a preparation period, followed by recovery and integration

However, it’s not only for the client but also for the therapist. The therapist should practice a special self-care routine to prepare for the session. Equally important, they should develop a way to process the material after the session.

Greater Risk of Psychological Backlog

Veronika shared that many therapists often mistake approaching and doing psychedelic sessions as regular therapy sessions. They fail to take the necessary precautions and approach for self-care and heightened self-awareness before, during, and after these sessions. 

One problematic result might be when there is a surplus of unprocessed, emotional, psychological, and possibly traumatic material of both therapist and client that builds up in the mind and body of the therapist without their realizing it. 

Such congestion can affect the therapist in various ways, including the mind, body, and spirit. It can also affect how they treat others in their regular life. How they might relate to other clients in the days after such sessions can also be affected.

Tips to Help Prevent Compassion Fatigue

Closely linked to burnout, compassion fatigue is a pervasive issue in the helping professions. Educating therapists about compassion fatigue helps prevent it. Therapists can learn coping strategies, stress management techniques, and the importance of maintaining a healthy work-life balance. 

Therapists proactively addressing compassion fatigue are more likely to provide higher-quality care, leading to positive client outcomes. Clients benefit from therapists who are emotionally available, attuned, and capable of maintaining a therapeutic alliance over time.

“The more we are able to stay present in the session, the easier we will be able to metabolize what was shared.”

Veronika Gold, MA, LMFT

We asked Veronika for ways healers can use to increase recognition of and reduce the risk of compassion fatigue.

Simple and Basic Self-Care

First, Veronika mentioned the most essential thing to help prevent compassion fatigue is to practice good self-care. This care includes getting adequate sleep, adopting a healthy and nutrient-rich diet, and exercising regularly. 

Other ways to care for the body include acupuncture, massage, and contemplative practices such as meditation. Find ways to process and express yourself creatively, such as drawing, painting, making music, digital media, etc.

Lastly, a fulfilling social life can reduce stress, lighten your mood, and improve your overall emotional and mental well-being. For some people, it means having one good friend you confide in. For others, it means meeting up with friends once a week. Find what works for you. Balance is key.

“The more the person is balanced to start with, the easier it is to recognize when something is out of balance and to use these techniques and strategies in the recovery,” advised Veronika. 

Preparation Before a Session: Get Your Mind and Body Ready

Veronika mentioned the parallel process that occurs for both the client and healer during a psychedelic session. She recommends that healers hold the work the same way as the client before, during, and after their sessions. 

She gave the following example of an 8-hour MDMA-assisted therapy session. Therapists should prepare their mind and body at least a day before the session.

This preparation includes thinking about what they will intentionally do to prepare for the session. For example, you may want to exercise more because you may not be able to do that on the session day. You may want to eat healthy and nutritious foods for sufficient energy and focus. You would want to get a good night’s sleep to be fully rested.

During The Session: Stay Fully Present

Being mentally and physically prepared can help cultivate presence during the session and, in turn, reduce the risk of compassion fatigue. Veronika advises that on the day of the session, really try to put everything else on the side so you can be fully present. 

“The more we are able to stay present in the session, the easier we will be able to metabolize what was shared. When we are distracted, we are taking it in but not actually metabolizing it at the same time,” explained Veronika.

Recovery After the Session: Follow a Clearing Practice 

Veronika shared that healers must create a self-care routine after a session and follow it accordingly. For many people, there will be a type of clearing practice. This practice could be taking a shower with intention, getting into a bath, or going into a flotation tank. Others find movement helpful, such as attending a dance class or swimming. 

She suggested that unstructured movement can often be more helpful because it is a way for us to allow things to move. However, structured exercise such as running is still beneficial because it helps us get in our bodies. 

Journaling can help track where you are. It lets you see if there is something you need to process. Or the journaling itself is processing.

Adopt Grief Practices

Veronika shared that using grief practices is really important because most of us and our clients have unprocessed grief. 

Some of the things shared in sessions are very painful. It’s crucial to find a relationship with the grief. We need to have practices that allow us to breathe and release some of what we heard or witnessed in the session. Then, it’s about getting good sleep and, ideally, having time to recover and care for ourselves.

Veronika shared that she does not typically book MDMA-assisted therapy back-to-back sessions. She would not want to go into a session the next day without having enough time for self-care and processing. Instead, Veronika can do two KAP sessions in a day or back-to-back. However, she is mindful of how many sessions or how many days of sessions she takes on.

She shared that each clinician can develop their own special practice to help them. The training that she developed focuses on tending to the self of the therapist, which she has personally found really helpful. 

Get Regular Psychotherapy

Veronika stressed that healers need to have their own consultation and psychotherapy. This space gives them the opportunity to continue talking about what’s coming up. It’s not only the material; their colleagues can notice when you’re not being yourself. 

Track and Recognize Signs in Yourself

Veronika emphasized that it’s essential to recognize and track signs in yourself when you are shutting down or overdoing it. These signs could look like numbing with food or alcohol. It could also mean withdrawing from social events, watching too much Netflix, or taking more clients—even though you’re completely full. 

You’re not able to set boundaries and keep them. These behaviors may mean the person is experiencing vicarious trauma or secondary PTSD. 

For some people, just knowing and recognizing this is enough for them to make a shift to take care of themselves. They compare it to taking care of their house or car so that it can continue functioning.

Other people may need to do some personal work. For instance, they may believe they can only offer value when caring for others. As a result, they start to neglect themselves and their own needs.

Other Healing Practices

Veronika shared that she likes to engage with sound healing, such as singing, humming, and chanting using aroma oils. She works with these oils with herself and clients to support her process. 

Being in nature can be very grounding. For instance, putting your hands into the soil or playing with sand with the kids are helpful practices because they help us release energy.

Boundary Setting: “Doing Less Is Actually Doing More.”

We asked Veronika about setting boundaries for healers and knowing how to take a step back and start taking care of ourselves. She advised them to start a little bit at a time. The change might take time. However, when you begin to see how those changes make you feel better, that’s when the shift happens. 

“I think once you [see that shift of how these changes can make you feel better], then it’s easier to set the boundaries because it’s almost like doing a little bit less is actually doing more,” explained Veronika.

Veronika’s Concerns for Psychotherapists in the Psychedelic Space

Veronika strongly believes in understanding the significant impact of compassion fatigue on psychotherapists who are practicing in the psychedelic space. Unfortunately, she knows many therapists who feel exhausted and overwhelmed. They don’t realize they are in burnout, compassion fatigue, or have vicarious trauma and secondary PTSD.

“My concern is that we are really going to see a crisis as these medicines are going to the mainstream. People are going to start working with it with the same expectations as they’ve worked before, not realizing the greater possible impact.”

She hopes therapists can engage in their own healing so they can feel more alive and have more satisfaction in doing the work and supporting others.

Connect With Veronika

There are several ways to learn more from and about Veronika and her work:

The content provided is for educational and informational purposes only and should be a substitute for medical or other professional advice. Articles are based on personal opinions, research, and experiences of the author(s) and do not necessarily reflect the official policy or position of Psychedelic Support.

Published by:
Author: Katharine Chan, MSc, BSc, PMP
Katharine Chan, MSc, BSc, PMP
Katharine has over 15 years of experience working in British Columbia's healthcare system, leading patient safety incident investigations, quality and systems improvement projects, and change management initiatives within mental health, emergency health services, and women's health. She has published in scientific journals and co-authored health research books. Her bylines include Verywell Mind, CBC Parents, Family Education, Mamamia Australia, HuffPost Canada, and CafeMom. Check out her books at Sum (心,♡) on Sleeve.

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