Break the [wounds + unawareness] cycle and guard your descendents

Avoid Burnout from Working
with Complex Multi-problem Families

By Peter K. Gerlach, MSW
Member NSRC Experts Council

The Web address of this article is http://sfhelp.org/pro/basics/burnout.htm

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        This article is one of a series on effective professional counseling, coaching, and therapy with (a) low-nurturance (dysfunctional) families and with (b) typical survivors of childhood neglect and trauma. These articles for professionals are under construction.

        This series assumes you're familiar with:

        Before continuing, pause and reflect - why are you reading this article? What do you need?

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        This article...

  • defines "clinical burnout;"

  • proposes why burnout is a risk when working with many complex, multi-problem clients like those served by this clinical model;

  • describes common burnout symptoms; and...

  • suggests burnout-prevention options for clinicians, supervisors, and case managers.

  What is Clinical Burnout"?

        Have there been periods or situations in your life where you felt some mix of [ overwhelmed + apa-thetic + confused + directionless + frustrated + "blocked" + anxious + guilty ] about part or all of your life? These are common symptoms of local overwhelm. burnout, or breaking down. Try saying out loud how you would describe "burnout" or equivalent to an average high school student.

        A common surface definition might sound like "Burnout or overload happens when a person feels overwhelmed and exhausted by current responsibilities, relationships, worries, and/or workload." A more perceptive definition might expand that by saying...

        "Burnout is a symptom of a person not being currently able to...

  • clearly discern their current primary needs and personal rights,

  • set and stick to realistic local and long-term personal priorities, and...

  • assert and enforce appropriate personal boundaries (limits) with (a) themselves and/or (b) other people.

        I propose that the most accurate definition is: "Burnout is a normal symptom (sign) of dominant personality subselves...

  • distrusting and disabling the person's resident true Self, and...

  • feeling too confused, weary, hopeless, conflicted, guilty, scared, shamed, hurt, angry, frustrated, and bored to (a) acknowledge this and (b) correct it without help."

Metaphorically, this is like a weary, distracted, frustrated classroom teacher who is overwhelmed with rioting students and "gives up" trying to restore order and stability.

  Why is Burnout More Likely With These Clients?

        This clinical model focuses on working effectively with these client systems:

  • divorcing biofamilies;

  • pre-commitment (courting) stepfamilies;

  • committed stepfamilies denying significant primary relationship problems;

  • committed stepfamilies admitting significant primary relationship problems;

  • re/divorcing stepfamilies; and...

  • low-nurturance families with one or more members seeking personal false-self wound-recovery.

        Typical divorced-family clients are led by wounded, unaware adults in protective denial. They usually (a) can't discern and prioritize their current primary needs clearly, (b) can't communicate or problem-solve effectively, (b) may be blocked in grieving webs of major losses, and (c) are usually hindered from effec-tive co-parenting teamwork by a group of inter-related barriers and family-adjustment tasks.

        A significant minority of divorced-family clients ask for clinical help while struggling with - or because of - major legal battles between ex mates. This adds more discordant combatants (e.g. attor-neys, judges, mediators, and psychological evaluators) to the family system, each with his or her own wounds, values, priorities, and agendas.

        The antagonistic legal process usually creates a mosaic of hurts, resentments, distrusts, misunder-standings, and frustrations that can take years to recede, without skilled help. If the ex mates have minor children, their kids have several sets of concurrent adjustment needs that are apt to be foreign and stressful to their parents - specially if the adults can't resolve values and loyalty conflicts and relationship triangles, which is common.

        Typical multi-home stepfamily clients have all these traits, and more concurrent stressors. They usually have many more members, more adjustment tasks to master, many new relationships, rituals, and family roles to negotiate and stabilize, and many more complexities and concurrent uncertainties, conflicts, and special needs to master as they merge three or more biofamilies over many years. This compound stress is usually amplified because typical needy, unaware, wounded mates made up to three wrong commitment choices - and they don't want to admit that or what it means.

        Bottom line: typical multi-home divorced-family and stepfamily clients present clinicians with significantly more complex, concurrent "problems" (unmet primary needs) to assess, stabilize, and change than typical intact-biofamily clients. Clinicians who...

  • have a discordant system of personality subselves ruled by a false self,

  • work with many multi-problem divorced and stepfamily clients at once for many months, and who...

  • lack necessary requisites and environmental resources to manage such client cases...

are at increasing risk of burnout - specially novice professionals. Wounded clinicians (their dominant false selves) are also at risk of denying or minimizing this stress, not taking appropriate care of themselves (self-neglect), and rendering ineffective service to their needy, troubled clients. Does this make sense to you?

  Typical Symptoms of Clinical Burnout

        Trying to single out symptoms of burnout risks losing sight of the two interactive deeper problems that promote it: chronic unawareness + false-self dominance. Premise: trying to reduce local burnout without assessing and reducing these two core stressors will inexorably yield only first-order (temporary surface) changes. Do you agree? Common symptoms of these core stressors are (a) behavioral traits like these, and (b) an inability to answer - or disinterest in learning about - fundamental questions like these.

        If you have known someone suffering from professional or personal overwhelm, see if these symptoms match your perceptions of them:

  • complaining of, showing signs of, or depending on medication to alleviate "depression;"

  • (a) a notable increase in taking "personal time" from regular work hours, and (b) righteous justification, excessive denial, defensiveness, apologizing, whining, or joking about that;

  • a recent increase in significant personal health problems, including signs of one or more addictions, weight changes, and/or notable sleep or digestive "problems;"  

  • unusual reactivity and anger or crying "outbursts," sighing, eye rolling, sarcasm, combativeness, and/or swearing or name-calling;

  • increasing feelings of dread, reluctance, and/or anxiety about going to work;

  • recent serious personal, family, and/or social "problems" (unfilled needs);

  • a notable increase in making clinical "mistakes" with some or most clients;

  • increasing unwillingness to seek or listen to empathic, informed supervision;

  • persistent fantasizing about changing jobs and/or locales;

  • notable decrease in empathy with clients, and/or increasing impatience and judgmentalism with them;

  • difficulty staying focused on work-related matters, and/or difficulty making clinical decisions;

  • increasing vague or specific complaints about "management," (some) colleagues, and/or "work conditions;" and...

  • notable apathy, indifference, or lack of enthusiasm at work - in general, or with certain multi-problem clients.

This symptom list is illustrative, not comprehensive. Would you add any other traits? Each person exhibits their own unique pattern of symptoms like these. The signs may indicate (a) mounting professional burnout and/or (more likely) a mix of work-related and/or personal problems, and (b) an inability to sort them out (identify primary needs), and (c) problem-solve them effectively, one at a time.

  Core Factors That Promote Burnout

        The psycho-spiritual condition of clinical burnout signals the confluence of a group of interactive factors. Once aware of these factors and motivated to change them, clinicians can avoid or reduce overload from sustained work with these complex clients. Primary meta-factors that promote personal and staff burnout (in general) include...

  • Traditional Euro-American indifference to parental ignorance and the psycho-spiritual wounds that result from inadequate child nurturance (neglect); Some symptoms of significant wounds in a clinical setting are:

    • indifference to personal wholistic health - self neglect

    • choosing a low-nurturance work environment

    • not asking for appropriate professional help, and/or ignoring it

    • consistently choosing to work over ~50 hours per week, and rarely taking breaks or vacations;

    • setting no limits to the number of active clinical cases, and not balancing the current case load in terms of client complexity and stress.

  • a low-nurturance work environment (metasystem) dominated by wounded, ignorant professionals in denial, and hindered by inappropriate organizational policies and state and federal laws; and...

  • clinicians, supervisors, consultants, and co-workers who lack too many of these seven requisites - and don't (want to) know or correct that.

Individual clinicians and colleagues can't change these meta-factors. They can take personal responsibility for avoiding or reducing burnout in themselves and people they supervise or work with. I propose that human-service workers inherit this implicit responsibility when they choose to serve other people - do you agree?

        What are their choices?

  Options

        Now we'll explore ways to (a) prevent burnout with a caseload of these complex multi-problem family systems, and (b) options for reducing existing burnout.

Preventing Clinical Burnout

        Protecting against clinical burnout requires that clinicians (a) value their own wholistic health, (b) understand burnout and what causes it, and (c) know how to assert relevant limits with themselves, their co-workers, and their clients. People who are guided by their true Selves and are reasonably self-aware will do this automatically.

        They will also be self-motivated to get regular medical checkups, take their vehicles in for preventive maintenance, eat and exercise sensibly, and steadily balance working, playing, and resting. I suspect if you are such a person, you wouldn't be reading this article...

        Mental-health providers can lower the odds of clinician burnout by...

  • screening potential employees for psychological wounds, and requiring significantly-wounded employees to commit to personal recovery - as they would with an active addiction;

  • evolving and enforcing workplace policies that promote balanced clinical workloads;

  • maintaining a high level of awareness in co-workers about the causes and symptoms of professional burnout - e.g. with periodic in-service sessions and/or handouts;

  • choosing clinical directors and supervisors who are (a) personally well-balanced (minimally wounded), and (b) can accurately assess co-workers for signs of burnout, and confront them empathically when needed;

        And organizational leaders can protect against burnout by...

  • not assigning or allowing caseloads which only focus on low-nurturance, multi-problem client families - i.e. only focusing on divorcing families and stepfamilies (or on terminal illness, homeless, or Alzheimer's cases, etc.);

  • encouraging participation in co-worker case-discussion groups. Veteran therapist Dr. Carl Whitaker called these "cuddle groups;"

  • periodically evaluating whether required clinical paperwork (e.g. case notes) has become excessive or unnecessary; and...

  • promoting a workplace environment that fosters (a) calm (vs. anxious) self-awareness and (b) respectful assertion about workload and workplace changes. In high-nurturance organizations, this will happen automatically.

        These options are illustrative, not comprehensive. Would you add anything to them?

        If you or someone you care about is showing signs of current overwhelm now, what are your and/or their options for restoring balance? 

Reducing Existing Burnout

        I propose that a core requisite for reducing current overwhelm is acknowledging that we all  make (a) superficial, temporary (first-order) changes, and (b) core attitude shifts - permanent second-order changes. Clinicians suffering from burnout risk making fist-order changes, so the core personal and/or environmental causes of their overwhelm remain untouched. Do you agree that all first-order changes (in any area of life) are always a sign of false-self dominance + unawareness?

        Dilemma: wounded, unaware adults usually deny their wounds, and aren't aware of their unawareness. Often, overwhelmed clinicians will deny or minimize their burnout until (a) their employer, clients, or family members confront them; or (b) they hit bottom on their own. If they do admit burnout, they will view it as a local situation, rather than a long-term problem

        Typical (fruitless) first-order changes to reduce burnout can look like...

  • reassigning or referring some current cases to someone else;

  • arranging fo5r a co-therapist and/or case consultant;

  • c/overtly declining new cases with multi-problem families;

  • changing jobs, consultants, supervisors, and/or locales ("the geographic cure");

  • forcing yourself to take up a hobby, "go home earlier," take "more time off," or take a vacation because you "have to." vs. really wanting  to; and...

  • vowing to make changes like these and not acting on them.

        To permanently reduce current professional overload, people need to...

  • hit bottom - i.e. admit they are overwhelmed, and decide "I can no longer live like this;"

  • accept that overload is a symptom of a long-term problem, not a local one;

  • accept that the root causes of their overwhelm are psychological wounds and unawareness, and then assess for each of those honestly - probably with appropriate professional help;

  • clarify your current priorities, and (b) admit and resolve any local personal and/or client-related crises - perhaps by intentionally making appropriate first-order changes like those above. Premise: If you don't spontaneously rank personal wholistic health as your top priorities (higher than your marriage and/or children), your odds for lasting burnout-reduction plummet.  Then...

Assess for psychological wounds

  • Become familiar with the concept of personality subselves and their traits and dynamics, and decide whether you feel it's valid and applicable; then...

  • honestly (a) self-assess for personal false self wounds, and (b) take responsibility for appropriate action; including committing to personal wound-recovery. Then (if appropriate)...

  • empathically assess a burned-out colleague (e.g. a trainee or co-worker) for false-self dominance; and (b) review your responsibilities and options; and/or...

  • assess your workplace environment for wounded leaders and policy makers, and meditate on your priorities, ethical responsibilities, current primary needs, and options. If your true Self leads your other subselves, use your integrity as a reliable guide to decide what you should do next. If not, decide if you want to harmonize your inner-family of subselves at this time. If you do, consider investing in some version of inner-family therapy as a way to do this, over time.

        As you do these things, also commit to...

Assess for Unawareness and Ignorance

        If your Self (capital "S") is stably guiding your other subselves (personality), (1) honestly assess your abilities to...

  • identify and validate your rights as a dignified, worthy person, and...

  • clearly discern and assert your primary needs, and...

  • stay grounded in the face of resistance or rejection from others; and...

  • upgrade these learnable skills as needed. Lesson 2 in this site and its related guidebook offer practical options for doing this.

        If your protective subselves have chosen to endure working in a low-nurturance workplace, asserting firmly for what you need to reduce burnout may feel too risky ("I could lose my job!"). Reality: the primary long-term problem is false-self dominance and choosing a higher-nurturance workplace, not losing your job! Expect narrow-visioned fearful, distrustful, cynical, and other dedicated Guardian subselves to strongly disagree!

        If you feel an overwhelmed co-worker or colleague is burned out, ask if they're open to reading this article and discussing how it may apply to them. If s/he declines or postpones this, apply these wise guidelines to help you accept that s/he is probably dominated by a false self and doesn't know that, or what to do about it. If you feel clients are getting inadequate or harmful service because of the burned-out person's unawareness and wounds, you have an ethical responsibility to intervene on the clients' behalf. Notice your reaction to this opinion...

  Recap

        In our society, burnout generally means personal mind-spirit-body exhaustion + overwhelm +  shutdown. Its symptoms are similar to those of depression and blocked grief. This article

  • defines "burnout" as local overwhelm and dis-integration of a person's dominant subselves; and...

  • suggests why clinical burnout is specially likely when working with complex, multi-problem, clients like divorcing families and stepfamilies, and illustrates...

  • factors that promote burnout, and common symptoms of this condition.

 The article closes with some key options for avoiding and reducing burnout in a clinical setting.

        Reflect - why did you read this article? If you didn't get what you needed, what more do you need? If you got what you needed, what do you want to do now?

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Updated September 25, 2014