When the Helper Hurts

How Gaps in Personal & Professional Life Lead to Harm in Service Use

by Nelly Kwasinwi M, MA Social Work (Oct 2025)

Feeling conflicted and stressed

In sectors devoted to care and support such as health, social work, education, and mental health, the aspiration is to serve with dignity, empathy, and competence. Yet service users sometimes experience treatment that is dismissive, harassing, disempowering, or otherwise harmful. Understanding WHY this happens means looking both outward to systems, work culture, resources, and inward at personal history, emotional capacity, and biases. This article explores key gaps that contribute to mistreatment, what the research says about their effects, and what can be done about them.

Key Gaps & Consequences

Below are recurrent themes from research, showing how personal and professional gaps lead to negative outcomes for service users, sometimes indirectly and sometimes overtly.

1) Burnout and Emotional Exhaustion

In practice, constant high caseloads, insufficient rest, emotional and/or secondary trauma without relief and working beyond capacity.

The consequences when professionals become emotionally distant, may depersonalise clients, offer minimal engagement, increased errors, neglect or insensitive treatment. Users sense being ‘just a case number.’ Professionals may suffer mental health, absenteeism, and turnover more likely.

Systematic review reveals that mental health professionals show about 40% emotional exhaustion and about 22% depersonalisation (Cambridge University Press, 2018).

In physicians, high empathy fatigue, high burnout (Southwest China study) linked to thoughts of quitting (BMC Psychiatry, 2024).

Senior Medical Officers (SMOs) with patient-related burnout show reduced empathy (NZMJ, 2021).

2)         Empathy Misconceptions or Poor Emotional Regulation

In Practice, professionals believing empathy means absorbing all suffering, or unaware of boundaries may lack of skills to regulate emotions.

They may feel overwhelmed, leading to either emotional collapse (compassion fatigue) or shutting down (indifference, detachment). They may lash out, avoid difficult conversations, or be judgmental. Thus, damage professional relationships.

A study by Community Care (2013) ‘Empathic social workers at higher risk of burnout and stress’ indicate that high empathy without supportive reflective practice led to higher stress, anxiety and depression among social work trainees.

Research by PubMed (2021) reveals that when burnout increases, empathy declines.

3)         Poor Organisational Support & Oversight

In practice, there is the lack of consistent reflective supervision, lack of safe staffing, heavy administrative burdens, insufficient resources, weak leadership and culture that dismisses staff wellbeing.

This results to professionals feeling overwhelmed and unsupported, higher likelihood of errors, skipping steps, and minimal relational work. Service users on the other hand, receive care that is transactional, rushed, cold and sometimes unsafe. Professionals may leave the profession altogether.

The British Journal of Social Work (2024) revealed ‘Safe staffing in UK social work’ that those who believed their service had unsafe staffing reported more burnout, lower wellbeing, and higher intention to leave.

The Cambridge University Press (2022) published studies of crisis care, lack of supportive workplace culture seen as contributing to poor practice.

DovePress (2021) revealed studies in COVID-19 era showing lack of support mediates empathy via burnout/depersonalisation.

4)         Personal Histories, Unprocessed Trauma, & Biases

In practice, professionals bring unresolved trauma, unexamined biases (racial, gender, socioeconomic, tec), moral distress, lack of awareness of how their identity or experience shapes responses.

This can lead to projecting fears and/or judgments onto users of services, avoiding certain cases, reacting defensively, microaggressions, failure to see users’ full humanity. Users may feel misunderstood, invalidated, or judged.

Several studies including PubMed (2021) and Front Psychiatry (2022) on secondary trauma and vicarious traumatisation on mental health professionals during COVID-19 reported moral injury, trauma exposure, vicarious suffering.

5)         Role Clarity, Skills & Training Gaps

In practice, professionals are not trained adequately in relational, trauma-informed, or culturally competent care, unclear expectations, insufficient feedback or reflective practice.

The consequences of poor handling of crises, escalation, shaming or blaming of users, miscommunication, worse outcomes. Users lose trust, disengage; professionals become demoralised.

A review of mental health crisis care: staff report being insufficiently trained for crisis-work with people with complex emotional needs; this contributes to burnout and poor practice (PubMed, 2022).

Research by PubMed (2017) reveals empathy as a variable to predict burnout, however the misconceptions of empathy are risk factors for burnout.

6)         Why Mistreatment is Often Unintended

It’s important to emphasise that mistreatment by professionals is often not malicious. Rather, it arises through:

• Cumulative stress and fatigue that reduce patience and capacity for empathy.

• Emotional self-protection: to avoid feeling pain, professionals may detach, becoming cold or curt.

• Time pressures and systemic constraints that force choices: e.g. clinician has limited time per case, must prioritise immediate tasks over relational connection.

• Lack of awareness: people may not realise how their own unresolved issues or biases are affecting their behaviour.

• Mismatches between training and real requirements: especially when training focuses on technical or procedural skills over relational, emotional, ethical dimensions.

Real-World Impacts on Service Users

Mistreatment can manifest in multiple negative ways, including:

• feeling ignored, invalidated or humiliated

• loss of trust, leading to non-engagement, avoidance of services

• worsening of mental health (trauma, shame, self-blame)

• physical neglect or errors (in healthcare settings)

• unequal treatment, especially for marginalised groups

Making Changes

Addressing these gaps requires work at multiple levels from the individual, organisational, and systemic.

a)        Personal Level

Self-reflection and therapy; emotional regulation training; cultivating self-compassion; bias awareness work; engaging in supervision and peer support; mindfulness and related practices.

b)        Professional Development & Training

Integrate trauma-informed practice, cultural humility, and relational communication into curricula and continuing education, train in recognising and managing empathy fatigue, teach boundary setting, clarify roles and expectations.

c)         Organisational Culture & Supervision

Ensure regular, high quality reflective supervision, psychologically safe workspace for emotional debriefing, promote shared accountability, ensure adequate staffing, reduce excessive administrative burden and leadership that models compassion.

d)        Systemic / Policy

Fund care systems adequately, protect safe staffing ratios, allow time for relational work, embed professional support, measure service user satisfaction (with relational, emotional dimensions, not only technical/outcomes), and policies that promote staff wellbeing as integral to quality of service.

In conclusion

At its core, mistreatment in service provision is often a symptom of broken or under-resourced relational systems: when professionals are not supported, when their emotional lives are neglected, when their roles are overburdened, and when they are untrained in how to maintain compassion under pressure. The risk is not only to service users, but to the professionals themselves, whose wellbeing deteriorates, whose sense of purpose is compromised, and whose capacity to help is eroded.

Bridging these gaps is not optional, it is essential. The dignity in service, in care, in education, depends on this. When professionals are cared for, supported, and trained, their ability to treat others with respect, empathy and effectiveness grows. It’s not enough to aim to ‘do no harm’ we must aim to do good with wholeness, humility, and human connection.

References

BMC Psychiatry (2024).

Cambridge University Press (2018).

Community Care (2013).

DovePress (2021).

NZMJ (2021).

PubMed (2017).

PubMed (2021).

PubMed (2022).

The British Journal of Social Work (2024).

The Cambridge University Press (2022).

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