I entered massage therapy to serve others, and oncology massage therapy because of how deeply that service affected me. In general, massage therapists enter the profession because we care: about people as a whole and in particular about their health and well-being.

But, could caring end up hurting or draining us?

Those of us helping professions — nurses, doctors, social workers, chaplains, massage therapists, and more — can be strongly affected by working with clients experiencing trauma in the form of a health crisis. This strain can happen as a result of working with one particular client, or it can be a cumulative pile-on of a number of different emotionally difficult cases.

There is a lot of discussion and not much agreement out there about the exact meaning of the terms "compassion," "empathy," "compassion fatigue," and "burnout." We'll lump them together under "being deeply affected by a client's experience."

Deeply Affected by a Client's Experience

Whatever we call it, it's important to look at any hard-hitting emotional toll on ourselves when we care for people experiencing pain, trauma, mortality, and suffering. Imagine you are seeing a particular client diagnosed with advanced cancer, and she shares with you how hard and emotional her treatment is, how she is too fatigued to play with her children, and how, most of all, she is terrified of dying before she gets to see them grow up.

That's all just from what your conversations. During the hands-on session, you learn about the physical pain in her hands and feet, the restricted movement from past surgery or radiation, and the ongoing wear of chemotherapy on her hair and skin. You know these things intimately as your hands touch her body in a full hour of time. This intimacy can challenge the separation we need — or think we need — between ourselves and our own fears of cancer, mortality, pain, and suffering.

So our knee-jerk reaction to this might be, "How can I protect myself? How can I establish good boundaries like we were taught to do in massage school?" We don't want to feel our clients' emotional pain and distress, so we might rush to put up strong dividers between "us" and "them."

When our clients represent our worst fears, and we spend a huge amount of effort to protect ourselves from those fears, our lives and our work can suffer. Here, the discussion typically turns to the boundaries we must have for this protection. Healthy boundaries can help us manage our own emotional well-being, but it's worth discussing what those boundaries should look like. The boundaries in my own work that have been most important are regarding self-care, rather than separation or protection from clients' experiences.

Taking on My Own Suffering, Not Others

My first lesson in this came from Irene Smith, more than twenty years ago. Irene is a longtime massage therapist, educator, and author. She founded Service Through Touch, serving people with HIV in the San Francisco Bay area in the 1980's. She has gone on to teach us much about massage in illness and at end of life, and maintains her blog and schedule at www.everflowing.org.

Irene said, "I don't believe that we take on another human being's suffering. I believe that what happens is that we find ourselves in an experience that simply opens us up to our suffering."

With her words and instruction, Irene taught me that, while I might think I am absorbing my client's expressed or unexpressed pain, in reality, the situation is provoking my own pain. If I follow her guidance, I can learn much about my old losses, current fears, and the human condition in general. As I've learned about myself, I've become more present with others.

With this lesson, my relationship to compassion began evolving. I have learned important lessons from several teachers about joining with people and separating from people during hard experiences.

Many Teachers on Compassion

Lauren Muser Cates, an oncology massage therapist and educator, has some more passionate wisdom for us in her blog post, "Boundaries, Schmoundaries." She suggests that instead of putting up walls to try to keep ourselves "safe" and "protected," which can leave us feeling empty, we should work with staying open to others' experiences and ourselves. Lauren tells us that boundaries have their place in the practicalities of massage therapy — scope of practice, payment, set hours, and so on — but "When it comes to emotion and our essential humanness, boundaries, as they've been taught to us, are a myth."

Additional teachers came to me a couple of years ago, when I put together a series of webinars on hospital-based massage therapy (HBMT). I sought out several people who had HBMT programs in place for years, looking for their wisdom on program development, longevity, and the practicalities of making massage work in the hospital. In the process, I interviewed and recorded people from five HBMT programs: Paula Gardiner, MD; SatSiri Sumler, LMT; Carolyn Tague, LMT; Briane Pinkson, LMT; and Karen Armstrong, LMT, about their HBMT work.

When participants in the conference asked these people about the emotional impact of their work, a common theme emerged. The panelists spoke to the importance of some sort of contemplative practice — often yoga or meditation — in maintaining balance and resilience. Self-care was mentioned, of course, but with a particular emphasis on reflection and stillness. I heard their message loud and clear.

More recently, I have come to know the work of Joan Halifax, PhD, founder of the Upaya Institute and Zen Center in Santa Fe. She has worked and been present in end of life care for decades. She has shared important wisdom about compassion through her writing, speaking, and teaching.

In particular, I remember her stating once that true compassion can be enlivening, not draining. She, too, underscores the need for a contemplative practice, so that the mind can be resilient when challenged by pain and suffering. For those of us looking for "everyday compassion for everyday use," she has developed the "G.R.A.C.E." method of cultivating compassion.

These are some of the teachers I have encountered along the way of my own calling in oncology massage, but one more is worth mentioning: myself. I am glad to be able to count myself on my list of teachers. From meeting myself and listening closely, I become better able to be with my own feelings and vulnerability. Lived in more presence, my life is teaching me to feel whole in my own pain and suffering, and to be more present with the pain, suffering, and wholeness of others.

It's also teaching me how that wholeness looks in practice. In fact, in this very column, years ago, I shared my own list of self-care measures. Little has changed over the years on that practical little list. If you read that column and substitute "hula-hooping" for "skating" as my preferred physical outlet, plus add "meditation," the column will be entirely up-to-date for 2015.

Test Your Compassion Fatigue

Because wholeness comes with awareness, I am a fan of most anything that helps us ask the right questions. Once can test one's own compassion satisfaction, compassion fatigue, and burnout levels at many different websites, but one of my favorites is the Professional Quality of Life Scale at the Compassion Fatigue Awareness Project.

The inherent emotional aspects of our profession, those same aspects that may have drawn us toward populations such as oncology massage, hospice and palliative work, can make things like boundaries, presence, and compassion a messy affair. There is rich wisdom to be learned in this messiness, if we choose to pay attention.