Like the oxygen masks on an airplane, you put your mask on firstBryan Mingle / Rise Health Contributing Blogger
One of my favorite modules in a year-long classroom certification program for Alcohol and Drug Counseling addressed "burnout." The instructor, who was at the top of her license in Orange County, Calif., treatment centers overseeing SAMHSA services, told the future counselors that it was the No. 1 enemy for the new and the experienced.
While many jobs and professions bring on burnout, health-care fields involving contact with patients carry the highest risks -- and the lowest tolerance. Can you imagine being a frightened patient in need of empathy and an even-keeled delivery and facing a doctor whose manner and energy said "shell-shot."
Luckily, burnout precautions and preventative plans often are provided for counselors, nurses, physicians and other providers in health-care settings. But not always.
I learned during my first year as a chemical dependency counselor in a chaotic detox unit in Jacksonville, Fla. that the greatest teacher is experience itself. In other words, the old adage of no pain, no change, proved very true.
While self-care was reviewed during evaluations by my supervisors, practicing it when 12-hour days were piling up was a challenge and a reality that myself and fellow social workers knew too well. I had one or two role models where I worked, but for the most part staffers around me were drowning in work and documentation of that work. At some point, the return on such workaholism showed up negatively. I'll never forget one evening, after several days in a row of 12-hour shifts, I was scouring the nurses station for a missing chart and one of my patients, watching and waiting in his nearby med line, shouted out: "Bryan, are you OK? You look like you really need a drink." Good insight.
Other therapists and I began to engage in "process sessions" on van rides to the parking lot before and after our shifts, or during gobble-down lunches on a picnic table roped off from the milieu. We vented about work. About patients. We basically had big complaint sessions, which, as it turns out, is one of the top tell-tale signs of compassion fatigue and burnout.
Real patient-centered care mandates that the providers walk their talk and center some care around their own lives. I left the detox unit after a year and began working at Rise Health in a practice support center that was a virtual extension of primary care practices for a safety-net hospital in Boston.
Call volume was high from the start, and many of the patients on the other end of the phone had a low tolerance for frustration and were demanding of their needs. What I learned as a counselor applied to all of our patients on the other end of the phone at Rise: Offer unconditional positive regard and genuine empathy; do no harm. Listen, reflect back and offer options/solutions.
To do that on a consistent basis requires the self-care that my instructor in California relentlessly taught about.
Today I came across a column and a web site that are echoes of my concerned teacher, who frequently told us that she wanted each of us to be the counselor who would treat her daughter the same way we would our own family member. I am publishing it here to remind myself and others in the health-care field about a very basic component of any treatment plan: self-care. If you never leave the basics, you don't have to return to them.
Cynicism and sarcasm are among the first signs of burnout
Physician Burnout and Physician Stress – Find Solutions Now
Rebecca Morse-Horn • As addiction professionals, I believe we find ourselves growing sarcastic or cinical because it is possible to feed others but starve to death ourselves. We work in other people's pain, guide them through it, the process is is draining, it is impossible to not give a piece of your spirit to each client. Developing a healthy level of detatchment is very important, but so is investing in outside activities that are personally renewing. Family life, service work, or my Faith are examples of what I do to relieve compassion fatigue and renew my spirit. I think that anyone in the addiction/treatment industry began their career with a genuine desire to help other people and if we remember that, the day won't be so long. I think the cynicism around my office is purely a defense mechanism to avoid yet another disappointment in an arena where bad things happen to clients sometimes.
ReplyDeleteScott McMillin • Interesting question. A form of dark cynical humor is found among most people who work in difficult jobs with few immediate rewards (police, emergency medicine, combat military, social services, etc). Probably just a coping mechanism. I think many people enter the helping professions with unreasonable expectations and become cynical out of disappointment. It's a challenge to survive our own ambition.
Robert Rozsay, BCBC, CADC, CASAC • Rebecca, I agree that we give a piece of our spirit to our clients but, we also pick up some of their pain. If we accept the fact that we also use things, with more moderation than our clients can, to relieve our pain, anxiety and stress we can keep a healthy perspective and avoid expressing subtle anger and disappointment with sarcasm and cynicism.
The dark humor is sometimes unavoidable due to the prevalence of bazaar circumstances our clients get involved in.
4 hours ago• Unlike
Michael Stevens • Cynicism and sarcasm are often signs of anger, depression, yet I often wonder if there is a tendency to overly diagnose folks. We all have different experiences in life and our stories have developed for different reasons. I’m not saying that cynicism and sarcasm is not a sign of compassion fatigue. If a individual counsellor is being sarcastic and cynical with clients I would say stepping back for a period of time is necessary in order to get a refreshed. The issue for me is that what was happening beforehand and is there ongoing supervision where the counsellor is able to put his or her feelings on the table. I would also suggest that counselling or some form of therapy during this time is critical.
ReplyDeletePaul deRoulet • Melissa, I think people who are ALWAYS sarcastic and cynical are in a state of anger. I think at times we all fit that category, especially those of us in the helping fields. I try to live with a "peace, love, joy" attitude of life but fall back to sarcasm, especially with my co-workers from time to time. Once I catch myself doing that, I reflect on what's going on in my life for the change of attitude.
Judy Barnes • To be able to work in this field and manage compassion fatigue, you need to have a good self-care plan that you follow "religiously".
Tom Lord • to Melissa Killeen: To address your point from a few days ago about people that are always cynical and sarcastic -
ReplyDeleteOften people like that have more on their plate than they can handle. Many people are stressed out. When someone complains or is angry all the time, what they are saying is "You don't know how hard I have it." The way to deal with them is to listen and then begin by agreeing with them by saying something to the effect of: 'I don't know how you do it, you carry the weight of the world on your shoulders'. I wouldn't use those exact words but that is the message I would want to get across to them. Then let them vent. You can gather a lot of information by listening. Find out how they see the world. Often they have isses from their childhood that keep surfacing in their lives. Life is unfair. If you've watched the news anytime in the last 10 years, you might have noticed that. They talk about the Peter Principle, that people rise to the level of their incompetence. Many people in business have reached that level. They have worked their way up to the moderate middle and they are stressed out, busy, working for another moderately incompetent boss and that can take a toll. The key in any organization is being able to communicate values throughout an organization, so that people know what is expected of them without being micro-managed. But that actually takes a lot of work to be able to have those long discussions about seemingly trivial issues. How do those values really apply in a particular situation? It's one thing to just say, 'We're for serving the customer' and then know how to do that in a real world situation caught between two goods such as delighting the customer and saving money for the company. It takes a lot of work for people to know what is expected of them in a unique situation.
Many managers and especially executives are out of touch with the day-to-day operations of an organization. They are more concerned with insulating themselves from any blame or liability. They are more concerned with their own survial than in helping other flourish.