ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
June 22, 2001
"He that leaveth nothing to chance will do few things ill, but he will do very few things.
George Savile, politician, essayist
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National Clearinghouse for Alcohol and Drug Information
http://www.health.org
A service of the Substance Abuse and Mental Health Services Administration, the site
offers an extensive list of books, brochures, reports, fact sheets and other resources
grouped by drugs of abuse. Other highlights include a newsroom with up-to-date articles
and press releases on substance abuse treatment, intervention and prevention, and an
archive of short briefs that sum up scientific research on drugs and alcohol. Visitors can
also submit requests for further information and literature searches, and obtain referrals
to alcohol and substance abuse organizations and centers through the site.
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Guide to Science-Based Practices. This report is a three-part guide to the requirements
for a credible substance abuse prevention program. The guide outlines strategies and practices
that have produced positive results. Contact: Stephen Gardner; (301) 443-9110.
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July 15-26: Fourth Annual Psychology of Aging Institute, Duluth, MN.
Sponsored by Division 20 (Adult Development and Aging) of APA and the National Institute on
Aging, this training institute is designed for psychology faculty seeking to strengthen skills
for developing an active agenda on healthy aging and integrating research on aging with
teaching. Contact: Chandra M Mehrotra, Director, Research Training Institute, College
of St. Scholastica, 1200 Kenwood Ave., Duluth, MN 55811; EMAIL: cmehrotr@css.edu
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SUMMER COURSE on DISASTER SERVICES AND CRISIS INTERVENTION IN DISASTERS
A one credit course offered through the Counselor Education Department
at the University of Wyoming for upper level and graduate credit. The
course will be offered on July 27-28, 2001. See the online flier for
more details at: https://www.angelfire.com/biz3/news/flier.html
Also, the information about the course and registration can be
accessed at: http://www.uwyo.edu/summer
The course is listed under Counselor Education.
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The ACISA 2001 “Trauma Across Cultures” Conference Program is now
available on http://www.acisa.org.au/conference2001
The Conference will be held at the Carlton Crest Hotel in Brisbane 2 -
5 August. Post-Conference workshops will be at Warilda Conference
Centre, Brisbane, on 6 August. For further information please contact:
Sally Brown Conference Connections
PO Box 108 Kenmore QLD 4069
Telephone (61 7) 3201 2808
Facsimile (61 7) 3201 2809
E-mail sally.brown@uq.net.au
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The Red Cross Disaster Mental Health Services-I (DMHS-I) course will
be offered in Casper, WY on Friday-Saturday, September 14-15, 2001.
If you want to take this course as a Disaster Mental Health
Professional, please send an email for further details on how to
register to: larlion@usa.net The enrollment is limited to 20
participants. APA has approved this course for 12 CEUs. Other
mental health professions have also approved it for continuing
education.
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HOW TO AVOID BOREDOM AND BURNOUT
The term "burnout" describes an occupational stress syndrome frequently seen among people working
in human services (Maslach, 1976). Symptoms of burnout include the loss of motivation and
effectiveness in connection with work; reduced energy, interest, and satisfaction in work; and
even a dread of work. The metaphor is a vivid one. In addition to spent candles, burnout evokes
the image of an overloaded electrical system. Fuses, unable to withstand the power input, melt
and burn out, and the current is interrupted. What burns out in human service professionals,
according to Christina Maslach (1982), one of the earliest writers on the subject, is the
capacity to involve oneself in the painful emotions of others. Maslach suggests that emotional
fatigue is the crux of the burnout syndrome.
This perspective is particularly relevant to burnout among older, more seasoned workers. Years
of intense involvement may have taken their toll. Changes in the worker's life may result in a
loss of inspiration. Burnout may be the end point in a long process with complex, personal
origins. Freudenberger (1977) pointed out that a large percentage of professional burnout takes
place early in careers. It often occurs in young professionals who bring the most dedication,
sensitivity, and commitment to the field.
Stress derives from social interaction. Research by Farber and Heifetz (1982) indicates that
professional gratification is related to the ability to develop a helpful relationship. When
we see and hear that our verbal responses have had a soothing, reassuring, or otherwise
helpful effect on others, we feel effective. Research suggests that as long as we feel this
effectiveness, as long as out efforts seem to "pay off", the difficult and stressful nature
of our work is acceptable. For new or beginning workers (especially disaster workers) there
is an especially strong correlation between a sense of success, or effectiveness, and
resistance to emotional fatigue. When burnout develops in a beginning worker, its roots more
than likely can be found in painful feelings of ineffectiveness.
In burnout among workers, there are three predisposing factors that come into play:
conditions of the profession or type of work; inner qualities and personal characteristics
of the worker; and attitudes toward work. The relationship to a diminished sense of
effectiveness in the worker becomes apparent. Symptoms of burnout develop as a defense
against feeling ineffective.
Conditions of the Profession
Disaster workers work in a setting of emotional intensity. The degree of empathy, emotional
awareness, and tolerance for ambiguity that is required can be exhausting. Adjustment to
this degree of emotional intensity - an adjustment that is made to avoid emotional
exhaustion - can actually lead to burnout. In an effort to put emotional distance between
themselves and distressed people whose needs may be overwhelming, workers develop detachment.
The right balance of detachment and concern enhances effectiveness, and can prevent emotional
exhaustion. However, what frequently happens is that detachment, serving as a defense against
emotional involvement, gradually increases to the point where the worker has developed a
hardened, dehumanized stance toward clients. At this point, genuine empathic response to
clients are blocked, and, as a result, the relationship breaks down.
Such a breakdown can occur intermittently. For example, when a worker feels tired during a
meeting, they may tend to detach more. They may become silent and less responsive with a
client and ther is a temporary break in the relationship. While a certain degree of
fetachment is necessary for effectiveness, workers (particularly mental health professionals)
cannot significantly reduce the emotional intensity without running the risk of losing
their most valuable tool, the personal connection.
Personal Characteristics
There are personal qualities that can inhibit the worker's ability to counter tensions
and uncertainties created by the work itself. Personal characteristics and needs can
predispose a worker to feeling ineffective. By far the most common personal characteristic
connected with the syndrome of burnout is compulsivity. Burnout is pathological (and
almost inevitable) when there is a compulsive element in the worker's relation to work.
Disaster workers are often attracted to the work because of a great need to help or rescue
others. The sense of mission and omnipotent wishes around rescuing others may have a
compulsive quality. They may mask a need for expiation, for making reparations (Edelwich,
1980). The worker whose unconscious motivation is to make reparations works harder and
harder, keeping longer and longer hours. But underneath all the "dedication" and "commitment"
is the compulsion to expiate a neurotic guilt. When the need to be an all-powerful rescuer
is thwarted - as it surely will be - the "guilty" worker feels helpless and frustrated.
To escape these intolerable feelings the worker may begin to feel bored. He or she may
lose concentration or interest, and may feel relieved when meetings or client meetings are
canceled. The worker's mind may begin to wander during meetings. These are "soft signs",
or precursors of a burnout syndrome.
In addition to inner guilt, omnipotent wishes around rescuing others may conceal inner
sources of self-doubt. Workers with a compulsion to rescue others make exaggerated
demands on their own performance. AS Cooper (1986) suggests, when they fail, they are
prone to vicious self-recriminations. They never give themselves credit for doing the
best they can. Instead, they experience an agony of self-doubt. To defend against
these painful feelings, the worker develops a burnout syndrome. Self-doubt can generate
compulsivity in relation to work. At that point, the need to help people may be far
greater than the ability to be effective with clients. If these feelings are not
analyzed in supervision or in personal counseling, a sense of dread in connection
with work may develop. Eventually, burnout takes the form of negative attitudes
toward clients and a generalized nagativity toward the work itself. Clients begin to
seem all the same or meetings all the same. Impatience with and resentment and hostility
toward clients increases, and a burned-out, nihilistic, angry stance develops with
regard to the work.
Christina Maslach (1982) examined other "selfish" reasons why people enter helping
professions. One, which applies particularly to psychotherapists, is the need for close
personal relationships. Therapists who have difficulty establishing close relationships
may use their clients to satisfy their own needs for intimacy. In the client-therapist
relationship, the therapist is in the "safe", passive, less vulnerable position.
Relationships with clients are intimate and intense. They focus on deeply personal
issues. However, it is the client who initiates the relationship and the client's
issues are the focus of treatment. The therapist can attempt to fulfill a personal
need for closeness without personally taking the risks involved in an intimate
relationship. An inner deadness remains in the therapist, however, as personal needs
for intimacy may be partly, but never fully, met by clients.
Another personal need that workers often try to satisfy through relationships with
clients is the need for control over their own personal problems. Many workers are
drawn into their profession or work by way of their own therapy, to work out - or
avoid working out - their own pathology. Focusing on other people's problems can be
an attempt to relieve the tension around one's own issues.
But, as Maslach (1982) points out, workers who attempt to meet personal needs for
expiation or self-esteem through their work can still provide a high quality of care
to clients. Nevertheless, there are dangers. One danger is that personal motivations
can interfere with the quality of care, particularly when workers are unaware
of their underlying motivations. Unconscious, compulsive motivations become the
source of emotional burnout, because clients do not provide all the intimacy or
identity or approval that the worker needs or wants. Frustration around one's own
needs being thwarted is eventually expressed in hostility toward clients, who
respond accordingly - by getting worse. The worker's effectiveness and self-esteem
are reduced, leaving the worker ripe for burnout.
Unfortunately, many workers respond to the initial stages of burnout in a way that
aggravates the syndrome. By increasing steadily the number of clients seen or the
hours worked or the meetings attended, workers work even harder in an attempt tp
get affirmation or other personal needs met. This is done compulsively, without
reflection or a sense of option, and usually results in a chronic sense of being
overburdened.
This is the time to be alert for burnout symptoms. As a worker, one has to assess
how much one can do in a week or other given time period for optimum effectiveness,
enjoyment and creativity. If one continually exceeds that limit, there is apt to
be a compulsive component to one's work. The overburdened worker should ask himself
or herself: Why am I overworking? Am I being competitive with other workers? Am I
being greedy? Does my work have an expiative function? Am I making reparations?
Workers may not be successful in ridding themselves altogether of compulsivity.
Many are, or become, unreconstructed workaholics. But if we can analyze and understand
the compulsive component of our work, we can avoid or analyze countertransferences
that inevitably develop when personal needs are not met. Our countertransferences
can wreak havoc on work with clients and leave us feeling ineffective and demoralized.
Work Attitudes
Attitudes that may predispose a worker to the syndrome of burnout are often closely
related to personal characteristics. Every contributor to the literature on burnout
stresses the importance of expectations, role definitions, and goals. Unrealistic
expectations, an exaggerated sense of responsibility, and too much zeal are attitudes
that lead to excessive energy output. Overcommitment and overdedication to a job
end in exhaustion and disappointment. Burnout develops as a defense against exaggerated
personal expectations that have been frustrated. The worker's loss of energy and
interest serves as a defense against an underlying disappointment and anger.
The appropriate stance, according to most writers, is a contradictory one. It includes
fervor and distance. Workers must be involved, dedicated, and optimistic, but they
also must realize that they cannot, ultimately, be responsible for rescuing clients
from pain, nor can they be solely responsible for positive change in their clients'
lives. All workers should be dedicated and concerned, and in extreme situations,
where there is a threat of suicide, homicide, or spouse or child abuse, or other
extreme behaviors, must assume complete responsibility and intervene immediately.
At these times, there is a genuine rescue operation (Friedman, 1985).
A certain distance provides the worker with space to reflect, improvise, and work
creatively with clients. When there is a balance between optimism and concern, on
the one hand, and distance, on the other, there is an atmosphere conducive to
spontaneous thought and inventiveness. The worker is open to a wider range of ideas
and can take risks. For example, a mental health professional can explore an issue
with a client that does not conform neatly to psychotherapy theories. It is the
exploration of these issues that so often provides a client with a realization
of the idiosyncratic aspects of himself or herself, and a heightened experience
of individuality. Excessive worker zeal, with its emphasis on theory, its
unrelenting search for the pathological, its sense of urgency, and its goal focus,
does not permit this kind of "diversion".
By emphasizing distance, Cooper (1986) and other writers do not imply a support
of "abstinence" on the part of the worker, or a reduction of involvement with
clients. Involvement with clients is not what causes burnout. Excessive performance
demands and overcommitment to unrealistic expectations are the attitudes that
lead to burnout.
Workers least susceptible to the syndromes of boredom and burnout may be those who
maintain dialogues with themselves as well as with clients. A great deal has been
written about workers being drawn to the field in an effort to control their own
pathology. While the dangers of this are real, there can be an advantage to having
a "selfish" motivation. Workers who are still engaged in their own "soul searches"
may continue to make discoveries about their own lives. For example, a client may
say something about his or her childhood that changes the worker's perspective
on the worker's own childhood. Or a client may touch on something else in life
with which the worker identifies strongly. These experiences stimulate positive
feelings toward clients and the profession.
In order to experience profound identifications with clients, however, the worker
must have an "other" life, outside the profession. As committed to and excited by
our work as we may be, we cannot live through our clients. Our clients terminate
with us; they leave us and move on, living their lives. As much as our work deals
with the "stuff of life", it cannot be our life. We must have other
interests and involvements and relationships that provide us with experiences and
feelings to associate to, process, and understand as we listen to our clients and
try to help them understand their lives.
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REFERENCES
Cooper, A. (1986). Some limitations on therapeutic effectiveness: The "burnout
syndrome" in psychoanalysis. Psychoanalytic Quarterly, 55(4), 576-598.
Farber, B. & Heifetz, L. (1982). The process and dimensions of burnout in
psychotherapists. Professional Psychology, 13, 293-301.
Freudenberger, H. (1977). Speaking from experience - Burnout: The organizational
menace. Training Development Journal, 31, 26-27.
Friedman, R. (1985). Making family therapy easier for the therapist: Burnout
prevention. Family Process, 24 (4), 549-553.
Maslach, C. (1976). Burned out. Human Behavior, 5, 17-22.
Maslach, C. (1982). Burnout: The cost of caring. Englewood Cliffs, NJ:
Prentice-Hall.
For further information on this topic, go to the url below and search for and purchase
books on the topic. Begin your search by trying the following descriptors: Work
attitudes, burnout, boredom, burnout and personal characteristics, burnout and stress,
burnout and work, burnout and compulsivity, etc.
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
