Background: Compassion-fatigue is a condition which therapists are forced into as a consequence of the nature of their work. The phenomenon has historically, and to some extent currently, been described as secondary trauma, vicarious trauma, secondary traumatic stress and burnout. The goal of this paper is to bring clarity as to what the phenomenon is and how it has been used in research, how common it is, what factors have been identified in the research that increase or decrease risk of developing it and lastly if any attempts have been made to develop a specific approach in preventing and/or treating the condition. Method: This current paper is a scoping review with a systematic approach.12 published studies, quantitative and qualitative in nature, were included and passed for review. Results: The result of the review indicates a deficit in data regarding prevalence of the phenomenon in the population and a general lack of randomized and experimental data. Most of the published studies were exploring psychologist experiences and secondarily attempting to identify factors predicting the development of compassion-fatigue. In conclusion, the phenomenon, regardless of what term is used, seems to be clearly delineated from conditions more akin to exhaustion and depression. Discussion: According to this study compassion-fatigue seems to be a condition that is sparked by the extraneous use of one’s empathic abilities past a tolerable point. Increased exposure by psychologists to work with patients with trauma may increase the risk of developing compassion-fatigue. It is still unknown what the mechanisms are that causes the condition and its prevalence among the population and further research, preferably randomized and experimental with comparison groups, is needed in order for this area to be fully mapped and explained.

Inledning: Ramen är grundförutsättningen för terapiprocessen. Det saknas i dagsläget kunskap om hur psykoterapeuter resonerar kring de svårigheter som kan uppstå för psykoterapeuter när den psykodynamiska ramen påverkas och förändras under de särskilda omständigheter som Covid-19 pandemin inneburit. Syfte: Att undersöka hur psykodynamiskt skolade psykoterapeuter resonerar kring sitt arbete med den psykodynamiska ramen och den yttre påverkan under Covid-19 pandemin.  Metod: Kvalitativ metod användes där fem psykoterapeuter intervjuades med semistruktureradr intervjuer. Materialet analyserades med tematisk metod. Resultat: Alla deltagare beskrev den psykodynamiska ramen som oerhört viktig och som ett fundament för terapin. Samtliga deltagare i studien återgav ett förhållningssätt i sitt kliniska arbete, som utgick från tydliga överenskommelser i tid, plats, betalning, sekretess och anledning till att träffas för att prata kring det som patienten ville arbeta med. Alla deltagare ger en enhetlig och klar bild av att politiska direktiv i samband med Covid-19 påverkat dem. Diskussion: Diskussionen visar tre betydelsefulla delar, hur ramen är ett krav för en terapiprocess, att ramen behöver anpassas efter verkligheten och att ramen både är konstant och föränderlig. Studies resultat bekräftades i relation till tidigare forskning. Mer kvalitativ forskning behövs i ämnet. / Abstract: The "frame" is the basic prerequisite for the therapy process. There is currently a lack of knowledge about how psychotherapists reason about the difficulties that may arise for psychotherapists when the psychodynamic "framework" is affected and to change under the special circumstances that the Covid-19 pandemic has entailed. Purpose: To examine how psychodynamically trained psychotherapists reason about their work with the psychodynamic "framework" and the external influence during the Covid-19 pandemic. Method: Qualitative method was used where five psychotherapists were interviewed with a semi-structured interviews. The material was analyzed using the thematic method. Results: All participants described the psychodynamic framework as extremely important and as a foundation for the therapy. All participants in the study reported an approach in their clinical work, which was based on clear agreements in time, place, payment, confidentiality and reason for meeting to talk about what the patient wanted to work on. All participants give a uniform and clear picture that political directives in connection with Covid-19 affected them. Discussion: The discussion shows three important parts, how the frame is a requirement for a therapy process, that the frame needs to be adapted to reality and that the frame is both constant and changeable. The results of this study were confirmed in relation to previous research. More qualitative research is needed on the subject.

Text in Afrikaans / Die objek van studie in hierdie proefskrif is ietwat ongewoon. Die studie is outobiografies en is gegrond op die aanname dat daar tussen die psigoterapeut, sy geskiedenis, die wetenskap (etnografie en tweede-orde kubernetika) en die klient(e) 'n unieke patroonverband bestaan. Die psigoterapeut in die platteland het weens afstand of finansies nie altyd die voorreg om supervisie van 'n eksterne supervisor te ontvang nie. In so 'n situasie kan selfsupervisie, deurdat dit 'n proses van selfontdekking is, 'n belangrike rol in die psigoterapeut se selfontwikkeling speel. Selfsupervisie plaas die klem op die psigoterapeut as persoon en as terapeut; oor wie hy is, waar hy vandaan kom en waarheen hy binne die psigoterapeutiese proses op pad is. Vir enige psigoterapeut is dit belangrik om na 'n hoer vlak van psigoterapie te streef. Hierdie strewe impliseer 'n proses van selfondersoek, delwing, selfevaluasie en disseksie. Hierdie proses is aan die hand van dagboekinskrywings gedoen, waar die psigoterapeut sy daaglikse ervarings en gebeurtenisse vanuit die verlede interpreteer het. Dit plaas die psigoterapeut as hoofspeler, met sy familiegeskiedenis en huidige interpersoonlike opset as inherente deel van sy mondering, op die voorgrond. In hierdie proses word die psigoterapeut sentraal geplaas met die klem op eie verantwoordelikheid met betrekking tot die proses van selfsupervisie. Die probleme wat deur hierdie persoonlik gekleurde, wetenskaplike studie aangespreek word, is probleme wat die psigoterapeut deur middel van sy selfsupervisie ge1dentifiseer het. So 'n selfondersoek lei tot 'n diepere selfkennis wat die psigoterapeut tot voordeel van homself, sy gesinsisteem en klientsisteem kan gebruik. Hierdie studie is 'n poging om 'n nuwe wyse van navorsing te identifiseer. Dit is omvattend en lei tot persoonlike vervulling asook diepere selfkennis en is 'n man waardeur ander psigoterapeute ook hulself en hul werelde kan ontdek. Dit is 'n stadige en pynlike proses. Hoofstukke 1 tot 4 is die teoretiese, wetenskaplike beredenering van die studie en hoofstukke 5 tot 12 is 'n uitbeelding van die geskiedenis van die psigoterapeut. Hoofstuk 13 plaas selfsupervisie as selfevalueringsmetode binne die psigoterapeutiese beroep. / The object of this study somewhat unusual. The study is an autobiography based on the assumption that there exists an unique patterned connection between the psychotherapist, his history, science (ethnography and second-order cybernetics), and his clients. Due to distance or financial problems, a rural psychotherapist cannot experience the privilege of supervision with an external supervisor. In such a situation selfsupervision could play an important role in the self-development, because it includes a search of self that will lead to more effectiveness in psychotherapy. Self-supervision focuses on the psychotherapist as a person and therapist, who he is, where he comes from, and in what direction he, as a psychotherapist, is developing within the psychotherapeutic process. It is important to any psychotherapist to strive towards a higher level of psychotherapy. This implies a process of selfinvestigation, dissection and self-evaluation. This process was conducted by means of diary entries in which the psychotherapist interpreted his daily experiences and events in terms of his past. This places the psychotherapist, with his family history and current interpersonal situation, as intrinsic parts of himself, in the foreground. In this process the psychotherapist takes centre stage with emphasis on his responsibility concerning the process of self-supervision. The problems addressed by this personally coloured, scientific study, are problems that the psychotherapist identified through the process of self-supervision and introspection. Such introspection leads to a deeper personal knowledge which the psychotherapist can use to his own benefit but also to the benefit of his family and client system. This study is an attempt to identify a new way of research. It is comprehensive and leads to personal fulfilment and deeper self-knowledge and is also a method by which other psychotherapists could discover themselves and their worlds. It is a slow and painful process. Chapters 1 to 4 comprise of the theoretical rationale of the study and chapters 5 to 12 depict the history of the psychotherapist. Chapter 13 situates self-supervision as a method of self-evaluation in the profession of psychotherapy. / Psychology / D. Litt. et Phil.

Text in Afrikaans / Die objek van studie in hierdie proefskrif is ietwat ongewoon. Die studie is outobiografies en is gegrond op die aanname dat daar tussen die psigoterapeut, sy geskiedenis, die wetenskap (etnografie en tweede-orde kubernetika) en die klient(e) 'n unieke patroonverband bestaan. Die psigoterapeut in die platteland het weens afstand of finansies nie altyd die voorreg om supervisie van 'n eksterne supervisor te ontvang nie. In so 'n situasie kan selfsupervisie, deurdat dit 'n proses van selfontdekking is, 'n belangrike rol in die psigoterapeut se selfontwikkeling speel. Selfsupervisie plaas die klem op die psigoterapeut as persoon en as terapeut; oor wie hy is, waar hy vandaan kom en waarheen hy binne die psigoterapeutiese proses op pad is. Vir enige psigoterapeut is dit belangrik om na 'n hoer vlak van psigoterapie te streef. Hierdie strewe impliseer 'n proses van selfondersoek, delwing, selfevaluasie en disseksie. Hierdie proses is aan die hand van dagboekinskrywings gedoen, waar die psigoterapeut sy daaglikse ervarings en gebeurtenisse vanuit die verlede interpreteer het. Dit plaas die psigoterapeut as hoofspeler, met sy familiegeskiedenis en huidige interpersoonlike opset as inherente deel van sy mondering, op die voorgrond. In hierdie proses word die psigoterapeut sentraal geplaas met die klem op eie verantwoordelikheid met betrekking tot die proses van selfsupervisie. Die probleme wat deur hierdie persoonlik gekleurde, wetenskaplike studie aangespreek word, is probleme wat die psigoterapeut deur middel van sy selfsupervisie ge1dentifiseer het. So 'n selfondersoek lei tot 'n diepere selfkennis wat die psigoterapeut tot voordeel van homself, sy gesinsisteem en klientsisteem kan gebruik. Hierdie studie is 'n poging om 'n nuwe wyse van navorsing te identifiseer. Dit is omvattend en lei tot persoonlike vervulling asook diepere selfkennis en is 'n man waardeur ander psigoterapeute ook hulself en hul werelde kan ontdek. Dit is 'n stadige en pynlike proses. Hoofstukke 1 tot 4 is die teoretiese, wetenskaplike beredenering van die studie en hoofstukke 5 tot 12 is 'n uitbeelding van die geskiedenis van die psigoterapeut. Hoofstuk 13 plaas selfsupervisie as selfevalueringsmetode binne die psigoterapeutiese beroep. / The object of this study somewhat unusual. The study is an autobiography based on the assumption that there exists an unique patterned connection between the psychotherapist, his history, science (ethnography and second-order cybernetics), and his clients. Due to distance or financial problems, a rural psychotherapist cannot experience the privilege of supervision with an external supervisor. In such a situation selfsupervision could play an important role in the self-development, because it includes a search of self that will lead to more effectiveness in psychotherapy. Self-supervision focuses on the psychotherapist as a person and therapist, who he is, where he comes from, and in what direction he, as a psychotherapist, is developing within the psychotherapeutic process. It is important to any psychotherapist to strive towards a higher level of psychotherapy. This implies a process of selfinvestigation, dissection and self-evaluation. This process was conducted by means of diary entries in which the psychotherapist interpreted his daily experiences and events in terms of his past. This places the psychotherapist, with his family history and current interpersonal situation, as intrinsic parts of himself, in the foreground. In this process the psychotherapist takes centre stage with emphasis on his responsibility concerning the process of self-supervision. The problems addressed by this personally coloured, scientific study, are problems that the psychotherapist identified through the process of self-supervision and introspection. Such introspection leads to a deeper personal knowledge which the psychotherapist can use to his own benefit but also to the benefit of his family and client system. This study is an attempt to identify a new way of research. It is comprehensive and leads to personal fulfilment and deeper self-knowledge and is also a method by which other psychotherapists could discover themselves and their worlds. It is a slow and painful process. Chapters 1 to 4 comprise of the theoretical rationale of the study and chapters 5 to 12 depict the history of the psychotherapist. Chapter 13 situates self-supervision as a method of self-evaluation in the profession of psychotherapy. / Psychology / D. Litt. et Phil.