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, our 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 requires us to look both outward at systems, work culture, resources, and inward at our personal history, emotional capacity, and biases. This article explores key gaps that contribute to mistreatment, what the research says about their effects, and what we can do 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, we often face constant high caseloads, insufficient rest, emotional and/or secondary trauma without relief, and the pressure of working beyond our capacity.

The consequences of this burnout can be severe. When we become emotionally distant, we may depersonalise clients, offer minimal engagement, and increase errors. This neglect can lead service users to feel like ‘just a case number.’ Moreover, we may suffer from mental health issues, increased absenteeism, and a higher likelihood of turnover.

A 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 and burnout have been linked to thoughts of quitting (BMC Psychiatry, 2024). Senior Medical Officers (SMOs) experiencing patient-related burnout show reduced empathy (NZMJ, 2021).

2) Empathy Misconceptions or Poor Emotional Regulation

In practice, some professionals believe that empathy means absorbing all suffering. Others may be unaware of their boundaries and lack the skills to regulate their emotions.

This overwhelming feeling can lead to emotional collapse (compassion fatigue) or shutting down (indifference, detachment). We may lash out, avoid difficult conversations, or become judgmental, damaging our professional relationships. A study by Community Care (2013) indicated that ‘empathic social workers are at higher risk of burnout and stress.’ High empathy without supportive reflective practice can lead to increased stress, anxiety, and depression among social work trainees. Research by PubMed (2021) reveals that as burnout increases, empathy declines.

3) Poor Organisational Support & Oversight

In practice, we often encounter a lack of consistent reflective supervision, inadequate staffing, heavy administrative burdens, insufficient resources, and weak leadership. This culture can dismiss staff wellbeing.

As a result, we may feel overwhelmed and unsupported, leading to a higher likelihood of errors, skipping steps, and minimal relational work. Service users, in turn, receive care that is transactional, rushed, cold, and sometimes unsafe. The British Journal of Social Work (2024) revealed that those who believed their service had unsafe staffing reported more burnout, lower wellbeing, and a higher intention to leave. The Cambridge University Press (2022) published studies indicating that a lack of supportive workplace culture contributes to poor practice. DovePress (2021) revealed studies during the COVID-19 era showing that a lack of support mediates empathy through burnout and depersonalisation.

4) Personal Histories, Unprocessed Trauma, & Biases

In practice, we bring unresolved trauma and unexamined biases (racial, gender, socioeconomic, etc.) into our work. This can lead to projecting fears or judgments onto service users, avoiding certain cases, reacting defensively, or displaying microaggressions. As a result, users may feel misunderstood, invalidated, or judged.

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

5) Role Clarity, Skills & Training Gaps

In practice, many of us are not adequately trained in relational, trauma-informed, or culturally competent care. We may face unclear expectations, insufficient feedback, or lack of reflective practice.

The consequences can be severe: poor handling of crises, escalation, shaming or blaming of users, and miscommunication can lead to worse outcomes. Users lose trust and disengage, while we become demoralised. A review of mental health crisis care revealed that staff often feel insufficiently trained for crisis work with people who have complex emotional needs, contributing to burnout and poor practice (PubMed, 2022). Research by PubMed (2017) shows that empathy is a variable predicting burnout; however, misconceptions about empathy also pose risk factors.

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, we may detach, becoming cold or curt.

• Time pressures and systemic constraints that force choices. For example, a clinician may have limited time per case and must prioritise immediate tasks over relational connection.

• Lack of awareness: we may not realise how our unresolved issues or biases affect our behaviour.

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

a) Personal Level

We can engage in self-reflection and therapy, emotional regulation training, and cultivate self-compassion. Bias awareness work, supervision, peer support, and mindfulness practices can also be beneficial.

b) Professional Development & Training

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

c) Organisational Culture & Supervision

It’s vital to ensure regular, high-quality reflective supervision and create a psychologically safe workspace for emotional debriefing. Promoting shared accountability, ensuring adequate staffing, and reducing excessive administrative burdens are crucial. Leadership should model compassion.

d) Systemic / Policy

We must fund care systems adequately, protect safe staffing ratios, and allow time for relational work. Embedding professional support and measuring service user satisfaction (with relational and emotional dimensions, not only technical outcomes) is essential. Policies that promote staff wellbeing must be integral to quality service.

In Conclusion

At its core, mistreatment in service provision is often a symptom of broken or under-resourced relational systems. When we are not supported, when our emotional lives are neglected, when our roles are overburdened, and when we are untrained in maintaining compassion under pressure, the risk extends not only to service users but also to ourselves. Our wellbeing deteriorates, our sense of purpose is compromised, and our capacity to help is eroded.

Bridging these gaps is not optional; it is essential. The dignity in service, care, and education depends on this. When we are cared for, supported, and trained, our 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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