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 [
+ apa-thetic + confused + directionless +
+ "blocked" + anxious +
] 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
and personal
rights,
-
set and stick to realistic local and
long-term personal
and...
-
and enforce appropriate personal
(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
-
distrusting and
the person's resident
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
adults in protective
They usually (a) can't
and
their current primary needs clearly, (b) can't
or
effectively, (b) may be blocked in
webs of major losses, and (c) are usually hindered from effec-tive
co-parenting
by a group of inter-related
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
and
conflicts and relationship
which is common.
Typical multi-home stepfamily
clients have all these traits, and more concurrent stressors. They usually
have many
more adjustment tasks to master,
new relationships,
and family
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
unaware, wounded mates made up to three wrong commitment
- and they don't want to admit that or what it
|
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
system of personality
ruled by a false self,
-
work with many multi-problem divorced and
stepfamily clients at once for many months, and who...
-
lack necessary
and environmental resources to manage such client cases...
are at increasing risk of burnout -
specially novice professionals. Wounded clinicians (their dominant
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
+ false-self dominance. Premise:
trying to reduce local burnout
without assessing and reducing these two core stressors will inexorably
yield only
(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
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
and the psycho-spiritual wounds that result from inadequate child
nurturance
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
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
- 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
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
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
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
and (b) admit and
any local personal and/or client-related
- 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)
for personal false
self
and (b) take responsibility for appropriate
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
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
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
and
assert your
and...
-
stay grounded in the face of
resistance or rejection from others; and...
-
upgrade these learnable skills as needed.
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
and other dedicated
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
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
you need? If you got what you needed, what do you want to do now?
+ + +
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https://sfhelp.org/pro/basics/burnout.htm