408 -Ethics, Burnout & Self Care in Human Service Professions
Dr. Dawn-Elise Snipes, PhD, LPC-MHSP
Counselor Toolbox Podcast
Objectives
– Identify signs and causes of burnout
– Explore techniques for burnout prevention
Is Self Care an Ethical Issue
– Burnout is associated with suboptimal care and reduced patient safety. 1, 3, 4
– High demands are associated with greater risk of burnout, regardless of level of other work supports. 2
– Suboptimal care can negatively impact the public’s view of the profession and deter people from seeking treatment
– 26% of MAT counselors in one study reported burnout
– Depersonalization is characterized by loss of empathy and
Your Brain on Stress
– Even mild acute uncontrollable stress can cause a rapid and dramatic loss of prefrontal cognitive abilities.
– Prolonged stress exposure –> Anatomical changes in prefrontal nerve cells and amygdala enlargement
– Focus, Attention
– Self Control of Behavior and Speech
– Plan and Organize
– Perspective Taking
– Cognitive Flexibility
– Medical and other Decision Making
– Ability to Defer Gratification
– Estimating Time
– Working Memory
Ethics
– In 1996, the National Association of Social Workers updated the NASW Code of Ethics to cover issues of professional impairment (section 4.05).
– Social workers should not allow personal problems, psychosocial distress, or mental health difficulties to interfere with their professional judgment, performance, or responsibilities to clients
– Social workers who experience these problems should “immediately seek consultation and take appropriate remedial action” by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others”
– Social workers with direct knowledge of another social worker’s impairment should, when feasible, consult with and assist the social worker in taking remedial action
Signs of Burnout
– Physical and emotional exhaustion
– Insomnia
– Impaired concentration or memory
– Physical symptoms (heart palpitations, HBP)
– Appetite changes
– Increased illness
– Increases in depression and/or anxiety
– Absence of positive emotions
– Cynicism and disillusionment
– Lack of patience
– Lack of resilience (everything is a crisis)
– Relationship deterioration
– Substance abuse
– Forgoing important personal activities
Malasch Burnout Inventory
– The Maslach Burnout Inventory (MBI) is the most commonly used self assessment tool for burnout
– The MBI explores three components: Exhaustion, depersonalization and personal achievement.
– MBI pdf C. Maslach, S.E. Jackson, M.P. Leiter (Eds.), Maslach Burnout Inventory manual (3rd ed.), Consulting Psychologists Press (1996)
– Abbreviated MBI from SAMHSA
Causes of Burnout
– Excessive workload
– Emotionally draining work
– Lack of support
– Lack of resources
– Lack of rewards
– Lack of a sense of control/say
– Unclear or everchanging requirements
– Severe consequences of mistakes
– Work/life imbalance
– Perfectionistic tendencies; nothing is ever good enough
– Pessimistic view of yourself and the world
– The need to be in control; reluctance to delegate to others
– High-achieving, Type A personality
– Poor work/person fit
– Value conflicts
– Lack of debriefing (See Restoring Sanctuary by Sandra L. Bloom)
– Unpleasant environment
– Cultural differences
Burnout and Difficult Clients
Reactions to Difficult Patients
– Anger that you have to see the client when there are other people who WANT help you could be seeing
– Guilt that you truly dislike the client
– Fear that you will not be able to deal with the problem
– A sense of failure if you cannot engage or help the client no matter how hard you try
Clinician Strategies to Consider
– Be aware of your negative feelings toward certain types of clients (seek supervision if needed)
– Identify what upsets you about these clients
– Remember that you are not a “bad” clinician because you have difficulty having positive feelings toward a client
– Recognize that you are not alone
– Remember that all behavior is a form of communication— change the dialog from “Why are you doing this-” to “What happened to you that led to the development of this behavior-”)
Patient Strategies to Consider
– Reassure the client
– Encourage clients to discuss fears in session
– Set and maintain emotional, physical and social boundaries
– Reward independence and self-empowered actions
– Give clients choices to increase control and optimism
– Foster a collaborative approach with the client as the expert on him/herself
– Resist challenging entitlement
– Validate clients feelings, thoughts and perceptions as their reality
Interventions
– Individual interventions reduced burnout in the short term (6 months or less)
– A combination of both person- and organization-directed interventions had longer lasting positive effects (12 months and over)
Interventions
– System Strategies
– Provide adequate supervision
– Paid time off (accessible)
– Increased staff-wide get togethers (community building)
– Increased staff input on changes/decisions
– Improved communication
– Reasonable caseloads (size and complexity)
– Efficiency audits
– Work/Life Boundaries
– Positive recognition
– Effort/reward balance
Efficiency Audit
– Have each staff member track what takes time for a week
– Identify common reasons for time loss
– Drop-in clients / interruptions (email, phone)
– Problems with the EMR
– Getting notes done
– Lengthy assessments
– Repetitive orientations (residential and group work)
– Weekly treatment plan updates
– Driving between home-visits
Morale Audit
– Identify factors inherent to the job that impact morale
– Client attrition
– Noncompliance
– Secondary traumatization
– Things that increase the likelihood of ST
– Similarity
– Stressors
– Substance abuse or mental health issues
Individual Interventions
– Conduct periodic self-assessments
– Listen to concerns of colleagues, family, and friends
– Engage in pleasurable activities
– Exercise
– Take breaks during workday
– Reduce isolation by maintaining regular supervision and network with colleagues
– Take needed “mental health” days
– Use stress-reduction techniques
– Arrange for reassignment at work, take leave, and seek appropriate professional help, as needed.
Interventions
– Develop support (co-workers, peers, supervisor)
– Know and ask for what you need in terms of resources
– Create work/life balance
– Develop and nurture relationships (schedule it in if needed)
– Leave work at work (sorta)
– Keep work out of your personal social networking
– Take time for self-care and relaxation
– Eat healthfully
– Check your need for perfectionism and control
– Describe why you got into the field and visualize that intention (collage, etc)—money, help, adrenaline, status/power
Interventions
– Use psychological flexibility
– To me, a rich and meaningful life is…
– Is what I am doing/thinking/feeling helping me move toward those things-
– If not, what can I do to improve the next moment
– Perspective taking
– Decision making
– Coping and emotion regulation
– Assertiveness
– Relaxation
– Cognitive restructuring
Interventions
– Identify the strengths and resources you do have
– Practice mental agility:
– Look at situations from multiple perspectives (client, clinician, Supervisor) and to think creatively and flexibly. (cheap, fast or right)
– Practice mindfulness
– How do you feel emotionally and where is it coming from-
– How do you feel physically and what does it mean-
– What are your current thoughts and where are they coming from-
– Be aware of your trauma triggers
– Regularly take squeegee (cleansing) breaths
– Take time to add in the positive DAILY
Interventions
– Set SMART goals for work
– Brainstorm ways to work smarter, not harder
– Each day identify 3-5 things that went well
– Keep a scrapbook or journal of your positive experiences (no PHI)
– Perennial Garden
– Ornaments/windchimes/stepping stones/backsplash tile wall
– Journal
– Limit your contact with negative people
– Connect with a cause or a community group that is personally meaningful to you
Interventions (GODIVA)
– Develop resiliency
– Gratitude
– Optimistic explanatory style: the ability to notice and expect the positive, to focus on what you can control, and to take purposeful action
– Distress Tolerance
– Integrity
– Vulnerability prevention and mitigation
– Acceptance and awareness of what you can and cannot control (Live in the And)
Put the PIECES Together
Summary
– Burnout work environments are a reality
– Burnout does not have to be
– Burnout causes problems in
– Health
– Mental Health
– Relationships
– Work environment and employee retention
– Ability to provide client services
– Develop resilience and identifying the sources and interventions for your burnout