Audrey Cleary, Ph.D.

Licensed Psychologist

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Paying Mind to Psychologist Burnout

Posted on 1 June, 2018 at 9:20 Comments comments (1)
The syndrome known as burnout is an occupational hazard of many professional fields and has been given increased attention in other media (including the January 25 Monitor on Psychology). Maybe you can think of clients whose work burnout brought them into our offices; in addition to being a distressing psychological condition itself, it is associated with a risk of health problems that psychologists treat. Psychologists and our colleagues in allied fields are also at risk. A recent research review (Morse et al., 2012) indicated that between one-fifth and two-thirds of mental health workers experience some degree of burnout. The term “burnout” has been defined and used colloquially in a number of ways, though much of the research converges on a definition comprising three main facets (below developed by Maslach and colleagues):
 
1) Emotional exhaustion: feeling tired, depleted, overextended, and a sense of not having much more to give.
Among those who specialize in mental health, this may be the most common and pervasive of the burnout symptoms. The work of a practitioner requires us to tune in to others’ distress and constantly check and monitor our own reactions, and as such can demand much emotional energy. Those with emotional exhaustion will, quite obviously, give less effort in professional activities and produce less.
 
2) Depersonalization: negative attitudes toward clients or work in general.
For anyone drawn to their field by passion or a sense of idealism, a belief in the human spirit, or an abundance of compassion, this could be a troubling one to notice. Depersonalization is a swing in the opposite direction from those motivators and can be a jarring place to be for those who identify strongly as helpers. It is common to feel somewhat demoralized when repeated efforts don’t result in success. We’ve all learned lessons about our limits, though someone experiencing burnout may generalize these cynical attitudes to new or unevaluated situations.
 
3) Low or reduced personal accomplishment, or a negative evaluation of one’s own work effectiveness.
This self-evaluation may be a realistic appraisal of struggling performance or a cognitive distortion arising from an environment that demands more than what the worker can reasonably do. It can lead to questioning whether one has a place in one’s chosen field.
 
Burnout is more than the occasional fatigue or frustration that any of us might feel after a tough day or week. It is also different from job dissatisfaction, which may arise due to the constraints or frustrations of a specific job while keeping intact one’s views of belonging in the profession. One might expect to see increased rates of psychologist burnout as budgets to mental health are cut, leading to expectations that clinicians will do more with the same, or fewer, resources. Burnout takes several tolls: it is associated with greater risk of health problems, such as depression, anxiety, sleep problems, substance abuse, and various stress-related medical conditions. It seems intuitive that burnout would disrupt the quality of care provided to clients/patients, through the self-fulfilling prophecy of low personal accomplishment, the loss of compassion inherent to depersonalization, or the reduced capacity associated with emotional exhaustion.

Burnout is often discussed as an individual psychological condition, akin to a mental health disorder. An alternate view treats burnout similarly to a prominent view on trauma reactions, as an injury which can result from certain work conditions that are fertile ground for burnout-related experiences. In fact, among mental health professionals, organizational and practice demands appear to be stronger predictors than individual factors of burnout. One such demand is an emphasis on quantity or productivity over quality and balance. There could be a conflict between the goals of the organization and those of the worker; as the worker begins to feel unable to meet the goals that drive them, personally, to their commitment to the profession, the risk of burnout rises. Other problematic system factors include limited autonomy (indeed, feeling in control at work seems to be a protective factor against burnout), limited supervisor and colleague support, low opportunities for reward, and inequities in the workplace. These risks apply to any field. Burnout could be a warning sign, a precursor or opportunity to ward off significant professional crisis.  

What can anyone do about it? Use of stress management strategies and self-care may help prevent or reduce burnout. In research, interventions that targeted by organization and individual factors appeared to have the most success in preventing and reducing burnout. Colleague support is important. Being on a team at work or joining a peer consultation group can provide a system of such support, and the opportunity to confer with colleagues is just one benefit of belonging to a professional association. Those at risk may benefit from colleague feedback or permission, so to speak, to prioritize their own care. Studied individual interventions have incorporated cognitive-behavioral coping skills, such as cognitive restructuring and skills training (including in assertiveness and relaxation), mindfulness and meditation, and interventions informed by positive psychology, such as incorporation of gratitude. Fortunately, these practices are the stock-in-trade of many psychologists. As humans, we are built to try to make meaning out of our lives, and having a purposed, meaningful work identity could work to counter burnout in our field. There is no easy answer, and the hardest task for dedicated psychologists experiencing burnout may be giving themselves permission to take time out to heal. 
 
Some APA resources include the Advisory Committee on Colleague Assistance, a committee which “focuses on the prevention of professional distress and impairment and on the consequences of impairment for the professional and the public” 
 
You can find APA guidance on self-care here:

Practicing what we preach: Self-care for psychologists

Posted on 20 November, 2017 at 16:23 Comments comments (0)
The following article appears in the fall 2017 newsletter for the Miami-Dade-Monroe County (FL) Psychological Association. I address psychologists, though the principles of self-care usually apply irrespective of profession.

Anyone who has flown on a commercial airplane has heard the safety briefing, with its included instruction to “Make sure your air mask is secure before helping others.” Intuitively, most people hearing this instruction understand its meaning: we need to stabilize ourselves before we can allow others to rely on us. As students and scholars of psychology, we understand that taking care of ourselves is vital to all aspects of our functioning, including providing service to others. Those of us who see patients or clients often assess how they care for themselves, and may recommend a healthy self-care regimen as a first step in treating mood disturbances, anxiety, and many other presenting concerns. Despite this awareness, many of us thrive amid professional demands that are antithetical to good self-care. We may overlook its importance in the course of a packed or overwhelming day, week, or month. We may also have complex lives with many competing personal demands on our time. It’s rare that we all share a common stressor, though we did to an extent during the hurricane season in fall 2017, which challenged the ability of many of us South Florida psychologists to maintain (and later re-establish) valued self-care routines.

The sources of stress inherent to our roles as psychologists are many. They include a) knowing firsthand about human suffering and trauma, b) shouldering a high level of responsibility for client welfare as Department of Health licensees, though without concurrent authority (as outside of inpatient settings, we cannot control what our clients do), and c) changes in the profession, such as lower reimbursement rates from managed care organizations. Early career psychologists face dilemmas regarding how we will establish our livelihoods amid a changing market. Business owners may feel the market stress of self-employment, and those in solo practice may experience isolation from colleagues. Psychologists in academic and research settings often require long hours for competitive research grants and face a tough job market for those starting out. Those of us who provide therapy know that the ability to monitor our own reactions to understand our patients or clients better can be an invaluable therapeutic tool. This ability, however, can take a toll as we experience the resultant emotions, frustrations and transferences, and are responsible for finding ways to deal with them. Most practitioners experience the death of a client to suicide or to worsening mental health difficulties. Any of us may inadvertently do things to compound the natural stress, such as overloading our work or limiting our personal time.

Good self-care includes several components, as we focus on caring for the whole person that we each are. It includes physical self-care: sleep (the October 2017 APA Monitor on Psychology includes an article documenting the importance of sleep for healthy aging), proper nutrition, hydration, physical activity and movement within one’s abilities, and attending to any chronic conditions, including by taking time away from work to do so. It also includes mental or emotional self-care: being patient with oneself, responding to mistakes in a way that allows for correction and learning then moving on, exercising one’s rights, and monitoring the ways that we talk to ourselves. (In short, we apply the compassion and caring that we have for the people we serve to ourselves.) We can add social support, including from loved ones, friends and family, though also with colleagues – seeking consultation and support related to the difficulties of the work that we do. Self-care often includes principles of responsibility management, including saying “no” when unable to deliver without undue cost to ourselves. Professionally speaking, self-care often includes allowing for time away: taking breaks during the workday, spending time outside of work with people important to you, and enjoying leisure time. 

The University of Miami, where I am a staff psychologist in the student counseling center, has been host to several recent discussions of self-care. In the UM Counseling Center’s doctoral internship program, colleagues and doctoral interns had a planned discussion of self-care. This meeting occurred during a seminar time for interns, though we recognize checking in on self-care as important to all of us. The APA Insurance Trust similarly advocates a good work-life balance as part of good risk management. They recommend that psychologists increase their use of risk management strategies during times of personal and professional transitions, in addition to building a support network, and note that those psychologists who are most able to distance themselves from work are best able to perform upon returning.

Psychologists may not yet be at the point where we need to make self-care an ethical mandate (and effective self-care is different from person to person), but perhaps we can be liberated during challenging times to make a point to take care of ourselves.

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