Overview

This course will provide strategies to promote enhanced health and well-being. A special component will address the importance of professionals who are in addiction or mental health recovery themselves to maintain stabilization and achieve growth. Relaxation techniques will be reviewed, including deep breathing techniques, imagery exercises, and self-guided meditations that can help professionals to better cope with their work life. Other topics include balancing personal and professional life, recognizing when stress is reaching dangerous levels, coping skills for the workplace, and the importance of healthy lifestyle choices. As part of this course, participants will be exposed to some of the latest research on self-care issues, use personal reflection activities to further explore these concepts, conduct an evaluation of their burnout potential, and develop their own self-care/wellness plan.

Education Category: Management
Release Date: 06/01/2016
Expiration Date: 05/31/2019

Audience

This course is designed for helping professionals of any kind, including counselors, social workers, therapists, and chemical dependency counselors, who require the tools necessary to address issues of work-life balance.

Accreditations & Approvals

NetCE has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6361. Programs that do not qualify for NBCC credit are clearly identified. NetCE is solely responsible for all aspects of the programs. NetCE, #1092, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) www.aswb.org through the Approved Continuing Education (ACE) Program. NetCE maintains responsibility for the program. ASWB Approval Period: 03/13/2016 to 03/13/2019. Social workers should contact their regulatory board to determine course approval for continuing education credits. NetCE is accredited by the International Association for Continuing Education and Training (IACET). NetCE complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, NetCE is authorized to issue the IACET CEU. NetCE SW CPE is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #0033. This course is considered self-study, as defined by the New York State Board for Social Work. Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of licensed master social work and licensed clinical social work in New York. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice for an LMSW and LCSW. A licensee who practices beyond the authorized scope of practice could be charged with unprofessional conduct under the Education Law and Regents Rules.

Designations of Credit

NetCE designates this continuing education activity for 1 NBCC clock hour(s). Social workers participating in this intermediate to advanced course will receive 4 Clinical continuing education clock hours, in accordance with the Association of Social Work Boards. NetCE is authorized by IACET to offer 0.4 CEU(s) for this program.

Individual State Behavioral Health Approvals

In addition to states that accept ASWB, NetCE is approved as a provider of continuing education by the following state boards: Alabama State Board of Social Work Examiners, Provider #0515; Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, CE Broker Provider #50-2405; Illinois Division of Professional Regulation for Social Workers, License #159.001094; Illinois Division of Professional Regulation for Licensed Professional and Clinical Counselors, License #197.000185; Illinois Division of Professional Regulation for Marriage and Family Therapists, License #168.000190; Texas State Board of Social Worker Examiners, Approval #3011; Texas State Board of Examiners of Professional Counselors, Approval #1121; Texas State Board of Examiners of Marriage and Family Therapists, Approval #425.

Special Approvals

NetCE is approved as a provider of continuing education by the California Consortium of Addiction Programs and Professionals. Provider Number 5-08-151-0618. NetCE is approved as a provider of continuing education by the California Association for Alcohol/Drug Educators. Provider Number CP40 889 C 0617. NetCE designates this continuing education activity for 4 continuing education hours for addiction professionals.

Course Objective

Although work stress and burnout are present in every occupation, human service professionals, who spend their work lives attending to the needs of others, are at the highest risk. The purpose of this course is to orient the participants to the ramifications of not taking care of themselves and to promote strategies for enhancing health and well-being as individuals while working as professionals.

Learning Objectives

Upon completion of this course, you should be able to:

  1. Distinguish the difference between stress and burnout.
  2. Outline the costs of stress and burnout.
  3. Describe deep breathing, imagery, and meditation and how they may be used to assuage stress and burnout.
  4. Discuss the importance of making time for self-care.
  5. Identify special considerations for self-care among recovering professionals (both addiction and mental health).
  6. Outline the self-assessment of compassion fatigue and satisfaction.
  7. Describe several promising self-care strategies for optimal personal and work functioning.

Faculty

Jamie Marich, PhD, LPCC-S, LICDC-CS, RMT, travels internationally speaking on topics related to EMDR, trauma, addiction, and mindfulness while maintaining a private practice in her home base of Warren, Ohio. She is the developer of the Dancing Mindfulness practice. Dr. Marich is the author of EMDR Made Simple: 4 Approaches for Using EMDR with Every Client, Trauma and the Twelve Steps: A Complete Guide for Recovery Enhancement, and Trauma Made Simple: Competencies in Assessment, Treatment, and Working with Survivors. Her new book, Dancing Mindfulness: A Creative Path to Healing and Transformation, was released in 2015.

Faculty Disclosure

Contributing faculty, Jamie Marich, PhD, LPCC-S, LICDC-CS, RMT, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Division Planner

Alice Yick Flanagan, PhD, MSW

Division Planner Disclosure

The division planner has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

About the Sponsor

The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.

Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.

Disclosure Statement

It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

Table of Contents

Technical Requirements

Supported browsers for Windows include Microsoft Internet Explorer 9.0 and up, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Supported browsers for Macintosh include Safari, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Other operating systems and browsers that include complete implementations of ECMAScript edition 3 and CSS 2.0 may work, but are not supported.

#71462: Self-Care for Behavioral Health Professionals

  • Back to Course Home
  • Participation Instructions

INTRODUCTION

Self-care can be extremely challenging for helping professionals. Taking care of oneself is critical to survival as professionals and as people, yet it is often neglected in the modern-day human service professions. This course will challenge behavioral health professionals to consider the ramifications of not taking care of themselves while working as professionals. This course uses education to promote strategies for enhancing personal health and well-being, with a special component addressing issues unique to professionals who are in addiction or mental health recovery themselves. Above all, tools for relaxation will be provided, including deep breathing techniques, imagery exercises, and meditations that can enhance coping ability. Other topics will include work/life balancing, recognizing when stress is reaching dangerous levels, coping skills for the workplace, and the importance of healthy lifestyle choices. The latest research on self-care issues will be reviewed, and personal reflection activities will allow for further exploration of these concepts. The course also allows an opportunity to evaluate burnout potential and develop a self-care/wellness plan.

Because of the print nature of this course, professionals are encouraged to work through at their own pace and to use this course as an opportunity to grow as a clinician. Throughout the course, exercises will be provided. These exercises are designed to further build upon an existing knowledge base. For the exercises that are geared toward relaxation, imagery, and meditation strategies, time may be necessary to complete them as suggested. However, the knowledge gained from these exercises will be a benefit to both everyday life and the work environment.

FOUNDATIONS

STRESS AND BURNOUT

Stress and burnout are terms that are often used interchangeably amongst professionals, but their meanings are quite different. Understanding the fundamental meanings of these two concepts and their essential differences are important to develop an overall appreciation of the basics of self-care.

According to the American Psychological Association, stress is "a state of physiological or psychological response to internal or external stressors. Stress involves changing nearly every system of the body, influencing how people feel and behave" [1,2]. On the other hand, burnout is defined as [1,2]:

Physical, emotional, or mental exhaustion, especially in one's job or career, accompanied by decreased motivation, lowered performance, and negative attitude towards oneself and others. It results from performing at a high level until stress and tension, especially from extreme and prolonged physical and mental exhaustion or an overburdening workload, take their toll.

Interestingly, the word burnout, as described in this passage, was first used by an American psychologist to describe the phenomenon that he observed in human service professionals with unmanageable numbers in their caseloads [3].

Although these are the dictionary definitions of the terms, it may be helpful to utilize the metaphor of one's work life being a fireplace to understand the fundamental differences between stress and burnout (and how the two can be interrelated). When properly managed, a fireplace continues to stay warm and regulated, serving its purpose to heat the house. Outside stressors, like gusts of air or wind, adding too many logs to the fire, or needlessly poking the fire, can cause it to rage out of control, having the potential to cause serious damage. This is like stress, when work life is being overburdened and tasks are not adequately controlled.

Burnout, on the other hand, is the fire going cold. In some cases, the fire dies after it has burned all of its fuel and there is nothing to burn. In other situations, the fire burns out before it is depleted of fuel because of the fire keeper's failure to properly maintain and cultivate the fire. If the fire of professional capacity dies due to lack of care (especially if that capacity had once burned brightly), then all of the other aspects of life (e.g., personal identity outside of work) can feel the chill. For those people who are so wrapped up in their professional identities that the other aspects of themselves have disappeared, the loss of the work "fire" can be devastating.

Many who work in the helping professions enter the field with a passion to make a difference. Even when this is the case, if professionals do not take the necessary steps to cultivate their practice and engage in healthy habits, the environmental and pragmatic realities of working in the helping professions can kill the passion that was once a motivator. People who succeed in their profession in the long term are those who have managed to keep the fire regulated over years of working in the difficult conditions that come with the human service professions.

It becomes clear that stress is not the same as burnout. The essential difference is that stress involves too much and burnout implies nothing at all and no hope of improvement. Burnout in workplaces is typically preceded by the mounting effects of stress that have accumulated and gone unaddressed. For some people, this stress builds over many years. For others, the breaking point can come much more rapidly. However, learning to prevent and to deal with stress now can help prevent burnout, which is a much more difficult condition to address with professionals.

It is important to recognize the signs and symptoms of stress and to evaluate the work environment for stressors that may be eliminated or lessened. According to the National Institute for Occupational Safety and Health (NIOSH), the following job conditions are most likely to lead to stress [8]:

  • Design of tasks: This includes factors such as long hours, infrequent breaks, heavy workloads, and constant requirement to complete duties that have very little meaning for the employee. The underutilization of an employee's skills and abilities falls into this category.

  • Management style: Poor communication within the work organization and employees feeling as if they do not have a voice in the organization can be a root of stress. This area also relates to companies who do not have family-friendly policies.

  • Interpersonal relationships: Relationships within the workplace can be the cause for stress in the workplace when the employee feels there is insufficient support or help from coworkers or supervisors or when the general environment of the workplace is negative.

  • Work roles: This includes feeling vague or uncertain about job responsibilities or feeling as if too many responsibilities have been assigned. This can also relate to taking on work that others within the company should be doing per their job descriptions.

  • Career concerns: This involves a large range of factors, from lack of job security and frenetic, unexpected changes within a company to feeling that there is no opportunity for advancement within the company.

  • Environmental conditions: Any part of the work environment that has an unpleasant or adverse effect, including poor air quality, high noise levels, or cramped office/cubicle space.

As discussed, stress involves too much: too many pressures that demand too much physically and psychologically. But, stressed individuals have hope that if everything were under control, they would feel better. Burnout, on the other hand, is characterized by feeling empty, devoid of motivation, and beyond caring. Professionals experiencing burnout often do not see any hope of positive change in their situations [4]. One of the most common feelings associated with burnout is powerlessness. Several factors have been identified as prime causes of burnout [4]:

  • Work-related factors: This includes factors that are directly related to the work environment or expectations. Burnout can be caused by a workplace that is too stressful or, on the other extreme, is not challenging enough for the employee. The perception of a lack of control in the workplace or a lack of acknowledgement from management or coworkers can also cause burnout.

  • Lifestyle factors: Burnout can also occur when an employee has too many roles and responsibilities, works too many hours, or lacks support often provided through close, personal relationships. Similarly, burnout can be caused by a lack of sleep and personal time to relax and spend time with family and friends.

  • Personality factors: Certain employees may be particularly prone to burnout because of their personality type. For example, employees who are perfectionists, overachievers, or who take on more tasks without sharing responsibilities with other employees may experience burnout. Also, employees who have a more negative worldview may be more likely to burn out.

Each professional should evaluate the stressors and burnout risk in their own practice. If one feels that he or she is susceptible to burnout, steps may be taken to avoid further progression.

SUSCEPTIBILITY TO STRESS AND BURNOUT

Some professionals are more vulnerable to experiencing stress and burnout than others. Although work stress and burnout are present in every occupation, human service professionals, who spend their work lives attending to the needs of others, are at the highest risk, especially if their work puts them in frequent contact with the dark or tragic side of human experience. This heightened risk is exacerbated if professionals feel underpaid, underappreciated, or criticized for matters beyond their control [4].

NIOSH has identified and described seven risk factors for developing stress or burnout [8]. The first is the nature of the stressor. Central aspects of one's life (e.g., marriage, job) and chronic issues (e.g., a physical handicap, living from paycheck to paycheck) are more likely to cause severe distress than less significant or short-term issues.

The second risk factor is experiencing a crisis. Sudden, intense crisis situations (e.g., being attacked, having an unexpected death in the family) are understandably traumatic. Without immediate intervention and treatment, stress symptoms are common and can lead to long-term debilitation [8].

Multiple stressors or life changes can also contribute to the development of burnout. The more life changes or daily inconveniences one experiences at any one time, the more intense the symptoms of stress [8]. It is important to remember that stress can accumulate. Perception of the stressor influences coping as well. The same stressor can have very different effects on different people. For example, public speaking is a stress for many, but others thrive on it. If a person is able to see some benefit to the situation, the stressor can be easier to deal with.

Knowledge and preparation can counteract the effects of stress. The more one knows about a stressful situation, including how long it will last and what to expect, the better equipped he or she will be to face it. Interestingly, research has indicated that behavioral health professionals who work with clients with severe and persistent mental illness are less likely to feel competent in their abilities and more likely to report stress and burnout symptoms [5]. This is also related to level of stress tolerance. Some people adapt well to changes and obstacles, while others are unable to cope with the slightest frustration or obstacle. Confidence in oneself and perseverance contribute to the ability to gracefully cope with stressful situations.

Lastly, the presence of a support network can prevent the accumulation of stress [8]. A strong network of supportive friends and family members is an enormous buffer against life's stressors. Loneliness and isolation increase the risk of stress and burnout. Organizations can address this factor by fostering a positive work environment and ensuring that professionals have an outlet to discuss problems and potential solutions.

As with many inventories, the greater number of positive risk factors, the more susceptible an individual is to stress and burnout. Professionals may benefit from evaluating the stress factors in their lives, particularly those that may be improved to mitigate experiences of stress. The exercises presented later in this course will provide tools to decrease these susceptibility factors.

COSTS OF STRESS AND BURNOUT

There is a clear connection between workplace stress and physical and emotional problems. According to NIOSH, early warning signs of job stress include [8]:

  • Headache

  • Sleep disturbance

  • Upset stomach

  • Difficulty concentrating

  • Irritability

  • Low morale

  • Poor relations with family and friends

Evidence suggests that workplace stress plays an important role in several types of ongoing health problems, especially cardiovascular disease, musculoskeletal conditions, psychological disorders, and workplace injury [4]. Several studies have further highlighted the hidden costs of stress and burnout. According to the Journal of Occupational and Environmental Medicine, healthcare expenditures are nearly 50% greater for workers who report high levels of stress [6]. According to the St. Paul Fire and Marine Insurance Company, problems at work are more strongly associated with health complaints than any other life stressor—more than financial or family problems [7].

Studies show that stressful working conditions are associated with increased absenteeism, tardiness, and intentions by workers to quit their jobs, all of which have a negative effect on productivity and profitability. As such, the impact of stress and burnout must be carefully considered by managers and policy makers within a company. Some supervisors may benefit from reviewing the NIOSH publication Stress at Work [8]. In this booklet, there are many practical suggestions for implementing positive, cost-effective interventions to assuage the stress experienced by employees.

EXPLORING CASE STUDIES

In this section, cases of professionals who are experiencing various levels of stress in their workplaces will be presented. The cases will be revisited throughout the course as solutions to stress and burnout are explored. While reading the cases, think critically about whether the person is experiencing stress or burnout.

Case 1

Ms. Z is a woman, 31 years of age, who just completed her Master's degree in counseling. She is a recovering alcoholic and has been sober for five years. She is now working her first job as a counselor at a small facility for dual-diagnosis patients. At first, Ms. Z likes her job and feels it is a blessing that she is able to work in an environment that promotes recovery. As a result, her own attendance at 12-step meetings has decreased. About three months into the job, Ms. Z notes that certain aspects of her job are overwhelming. She is finding it difficult to keep up with the rate of discharges and admissions, and she is disheartened that so many patients who she thought would do well are re-admitted to the hospital. Ms. Z has noticed that her heart is beating faster at work, and it is taking her longer to settle down at the end of each day. Nonetheless, she is still optimistic about the prospect of working as a counselor and has been talking actively to her sponsor in Alcoholics Anonymous about how to best cope.

Case 2

Dr. V is a psychiatrist, 50 years of age, who works in an inpatient hospital. Dr. V has been described as unusually kind, compassionate, and empathetic toward patients and colleagues alike. He has a history of dysthymia, for which he received antidepressant therapy. However, Dr. V stopped taking the medication five years ago. Four years ago, Dr. V was offered the position of medical director at a large, reputable psychiatric facility, and he was very excited about procuring this prestigious position. However, Dr. V quickly learned that the job was intense, time-consuming, and stressful. He realized that many of the administrative duties were burdensome, and when dealing with the facility's chief financial officer, he always felt like he was being punished. In the last two years especially, Dr. V has felt that the facility is sacrificing quality of care in order to accommodate more patients. He feels powerless to change much of what he sees wrong in the hospital. Although Dr. V maintains that he enjoys being a psychiatrist, he is wondering if he is right for the position that he once coveted. He recently became concerned when he learned that many of his nurses, who once described him as unusually compassionate, have become afraid to approach him.

Case 3

Ms. P is a social worker, 35 years of age, who has been working for the child protective services agency in her county for seven years. Ms. P's time at work is spent in a crowded cubicle at the office or going out into very dangerous situations in the field. At first, Ms. P enjoyed helping others, but she very quickly found working for the agency, who she perceives as corrupt, to be burdensome. When she entered the field, she was eager to help people but became frustrated that so many of the families she worked with did not seem to want help. At first, she took their rejection of help personally, but over the last several years, she discovered that she just does not care anymore. It is not uncommon for Ms. P to refer to the agency's clients by derogatory names. There are days when she finds herself running to her car at the end of a work day because she is so eager to leave. One day on the way home, Ms. P drives by a local fashion boutique and sees a "Help Wanted" sign. Her thoughts immediately become fixated on applying for a job at the boutique. Although her husband discourages it due to the inevitable pay cut, Ms. P applies for the job and is hired. Happier than ever, Ms. P vows that she will never use her social work degree again.

DEEP BREATHING AND IMAGERY EXERCISES

DEEP BREATHING

Breathing is something most people take for granted. However, not taking the time to really breathe can have serious ramifications on health and wellness. Some have suggested that slow, rhythmic breathing may be the basis of the mechanism synchronizing the brain and the autonomic response [9]. Furthermore, studies have shown a positive relationship between yogic breathing and alleviation of stress, anxiety, and depression [10,11,20].

The Western medical definition of breath is the air inhaled and exhaled in respiration [12]. Clearly, the absence of breath is typically equated with the absence of life. Those who practice yoga or other Eastern philosophies view breath as even more significant. In Eastern conceptualizations, breath is a life force, the link between the physical and the spiritual. Because most people have not taken the time to notice their breathing patterns, starting breathing exercises can be difficult. Good breathing takes discipline and deliberate practice, but the effects on self-awareness and coping can be considerable.

Like many things in life, breath work takes practice, but developing these breathing techniques is worth the discipline. The more they are practiced, the more effective they will be. It is a simple technique that can focus one's concentration and calm the physiological responses to stress. For more information on breathing exercises and yogic breathing, please visit https://www.verywell.com/breathing-exercises-for-stress-relief-3145183

IMAGERY AND MEDITATION

Like breath work, imagery and meditation are also valuable, cost-effective skills that can be used to increase coping and resilience, but they also take practice and discipline. The technical definition of imagery is the "cognitive generation of sensory input from the five senses recalled from experience or self-generated in a non-experienced form" [1]. Imagery is often conceptualized as putting the imagination to work. Of course, imagery in therapy can be a positive activity used to enhance relaxation or build positive coping skills, or it can be used to promote catharsis of negative, traumatic memories. Imagery, also called visualization, is a powerful tool. Although the concept of meditation often has spiritual connotations, it can simply be viewed as extended thought, reflection, or contemplation for the purpose of restoring a sense of balance. Meditation comes from the Greek root meaning the restoration of equilibrium. Clearly, imagery and meditation can go hand-in-hand. Whether used together or independently, both can help restore a professional balance.

Imagery can be difficult, particularly for non-visual people. For these individuals, using sounds/music or pleasant scents, such as candles or essential oils, may facilitate relaxation better than visual imagery. A more advanced form of imagery exercises is guided imagery, during which a professional will talk an individual through the visualization.

For additional information regarding imagery and meditation strategies, please see the resources section at the end of this course.

MAKING TIME

Lack of time is possibly the most common excuse professionals give when they are not engaging in self-care activities. In the modern era, when productivity equals survival, it can be too easy to justify not having the time or resources to take care of oneself. However, it is important for individuals who are experiencing symptoms of stress and/or burnout to consider the costs of not making time to reduce stress. Persons who are burned out have difficulty engaging in all aspects of their lives and being there for family and friends. As discussed, stress and burnout also negatively impact productivity. This is particularly important for professionals whose relentless quest to complete tasks is affecting their work and personal lives.

As behavioral health professionals, it is also important to consider the negative influence that stress and burnout can have on clients. If, as psychiatrist Irvin Yalom suggests, the effective therapist should never force discussions of any content area, but should allow sessions to be relationship-driven, attentiveness in all therapeutic sessions is necessary [13]. A heightened sensibility to existential issues influences the nature of the relationship of the therapist and patient and affects every therapy session. Professionals who are stressed or burned out will most likely be less attentive to clients. Failure to engage in effective self-care can be a client care issue.

Making the time to take care of oneself is a personal decision. For some, spending one or two minutes each day practicing breathing or imagery may be a good place to start. When individuals start to see the benefits, they are often inspired to expand their self-care regimen.

CONSIDERATIONS FOR PROFESSIONALS IN RECOVERY

Many behavioral health professionals enter their chosen field because they have had their own experiences with recovery from an addiction, a mental health issue, or a medical issue. The desire to help others often stems from their gratitude that someone once helped them. Recovering professionals may offer important insights to what clients and patients experience. However, it is important to remember that working with recovering patients is not a way to ensure your own personal wellness and recovery. Being healthy as a professional is contingent upon being healthy as a person. Professionals who are in recovery may have to be especially attentive to their own plans of recovery in order to meet the emotional demands of their profession.

Although these questions are specifically regarding addiction recovery, they apply to mental health and medical recovery as well. Too often, functional professionals with long-term conditions that are best treated through medication view the treatment as a sign of weakness. Pride can be a significant roadblock to wellness. Being a mental health professional should not be a barrier to appropriate treatment, either mental or physical. Loss of productivity is just one domain to consider. As discussed, lack of personal wellness can negatively impact the client relationship if it impedes one's ability to be present for the client.

Disclosure of one's recovery from addiction, mental illness, or physical condition is a personal matter that varies greatly depending on the context of the work environment. Many professionals find it beneficial to let their immediate supervisors know about their recoveries in order to ensure an extra level of wellness monitoring. However, behavioral health professionals have every right to be discreet. If this is a consideration, it is advisable to review a company's policy regarding disclosure before accepting a job. In some cases, disclosure of a treatment episode could be required on a licensure application or insurance credentialing forms.

EXPLORING CASE STUDIES

Case 1

Let us return to Ms. Z, a woman who has been working as a counselor and is also a recovering alcoholic. To deal with her mounting stress, Ms. Z elected to talk to and be honest with her sponsor about her mounting stressors at work and her erroneously held belief that she was getting recovery vicariously through her patients by working with them on their own recovery. As a result, Ms. Z increased her own 12-step meeting attendance to four meetings a week and made a point to attend meetings her patients were not likely to frequent. She and her sponsor also made a plan to check in by phone once a week about the work-recovery issue.

Case 2

Recall also Dr. V, a psychiatrist flirting with burnout. After talking to friends for support, Dr. V decided to visit his own psychiatrist again after five years of being off of medications. Dr. V and his physician mutually decide to initiate a low dose of a selective serotonin reuptake inhibitor antidepressant. He also begins to see a professional counselor again to readdress and redevelop a plan for self-care. For the time being, Dr. V agrees to be monitored by his psychiatrist with appointments every three months.

COMPASSION SATISFACTION AND FATIGUE (CSF) TEST AND SCORING

Compassion fatigue, or vicarious or secondary trauma, is a term used to describe the emotional exhaustion associated with caregiving. It is relatively common among those in the helping professions, particularly those who care for trauma victims [14,15]. While related to stress and burnout, compassion fatigue is generally brought on by a specific situation [16,21]. Furthermore, those experiencing compassion fatigue retain the capacity for caring, unlike those with burnout. However, an accumulation of stressors can lead to a progression from compassion fatigue to burnout if symptoms are not adequately addressed. On the opposite end of the spectrum, compassion satisfaction refers to the positive feelings associated with helping others through one's work.

In order to prevent burnout and improve their quality of life, behavioral health professionals are recommended to continually assess their work-life balance. An inventory to examine worker characteristics as well as the current (previous month) situation has been developed by Figley and Stamm [17]. The Compassion Satisfaction and Fatigue Self-Test for Helpers consists of 30 items, and the score obtained indicates the professional's risk for compassion fatigue or burnout; it also can provide insight regarding an individual's potential for compassion satisfaction. A copy of the test may be accessed online at http://ncwwi.org/files/Incentives__Work_Conditions/Compassion-Satisfaction-Fatigue-Self-Test.pdf. The results of the test can be very helpful when creating a personal self-care plan.

DEVELOPING A SELF-CARE PLAN

There are many small steps that can be taken to begin an effective self-care plan. Starting with a few small actions, then adding more as time passes, is a way to ensure that one's unique professional and personal needs are being met.

NIOSH has identified the three essential components of a self-care plan [8]:

  • Balance between work and family or personal life

  • A support network of friends and coworkers

  • A relaxed and positive outlook

While this is a good overall framework, many professionals require more specific strategies that will bring the framework to life. The following actions can be taken at work to address feelings of stress and/or burnout; some may be more realistic or applicable than others, depending upon the situation [4]:

  • Clarify your job description

  • Request a transfer

  • Ask for new duties

  • Take time off

  • Resist perfectionism

  • Flip negative thinking and look for the positive

  • Take a time out

  • Talk about perceived problems or issues

  • Recognize sources of support at work

  • Find humor in the situation

  • Learn how to say "no"

  • Avoid people who add stress

  • Take control of your environment

  • Avoid hot-button topics

  • Pare down your to-do list

  • Express and share your feelings

  • Be willing to compromise

  • Be more assertive

  • Manage your time better

  • Do not try to control the uncontrollable

  • Learn to forgive

  • Reframe problems

  • Look at the big picture

  • Do something you enjoy every day

While these suggestions may improve a work situation or environment, it is also vital to address stressors in one's personal life. One way to do this is to adopt a healthy lifestyle. Take time to engage in activities that nourish the body and/or mind in a positive way, such as [4]:

  • Exercising regularly

  • Eating a healthy diet

  • Sleeping seven to eight hours per night

  • Spending time in nature

  • Talking to a supportive friend

  • Writing in a journal

  • Taking a long bath

  • Playing with a pet

  • Getting a massage

  • Reading

  • Listening to music

Just as it is important to take proactive steps to overall wellness, it is also important to consider what should be avoided in order to fully embrace this lifestyle of self-care. A few habits that should be avoided or eliminated include [4]:

  • Smoking

  • Self-medicating with alcohol or illicit drugs

  • Relying on sleeping pills or tranquilizers to relax

  • Overeating or undereating

  • Procrastinating

  • Withdrawing from friends, family, and activities

In addition to these lists, which provide a good starting point for developing a personalized plan of self-care, there are other steps that may be useful. A spiritual belief system is often a basis for dealing with stress, and clergy or religious leaders can be a valuable resource. Always make time for enjoyable hobbies or activities; even when time is minimal, there may be greater consequences later if all activities that bring joy are abandoned.

Do not be afraid to seek outside help if necessary. Professional counseling may be necessary to deal with the stressors of being a helping professional, and many workplaces offer employee assistance programs that can make a referral. Another major suggestion is to use healthy boundaries at all times, both personally and professionally. Although it is important to have some collegial bonds at work, if possible, avoid workplace drama. Learn who can be trusted and who are positive people to be around.

FIVE-MINUTE ACTIVITIES TO MINIMIZE STRESS

In addition to having a long-term self-care plan, it is often useful for professionals to have a selection of tools to address stressors when they first appear. These strategies are not meant to be replacements for engaging in a healthy lifestyle, but if they are helpful, they may be incorporated into the self-care plan. These activities can be used to help cope with work, personal, or other stresses.

ACE

The acronym ACE (accept, change, or eliminate)can help one explore available options when feeling stuck or overwhelmed. These options are available in any situation in which one is feeling trapped or stressed. The situation can either be accepted for what it is, changed to the extent possible (which generally means changing something about oneself), or eliminated (e.g., leaving a toxic work environment). After the option has been selected, it should not be revisited until it either continues to add stress or may be addressed more completely.

Make a List

The process of creating a to-do list and marking off completed items is very helpful for some. Even with the proliferation of computer programs that can generate task lists, the act of physically writing may help to expel some of stress. Maintaining a list can help with organizing and prioritizing, critical self-care skills. Crossing items off a list can give a sense of accomplishment and empowerment, which is helpful to get through a stressful day.

The "God" Box

Although this exercise is traditionally referred to as the "God" box, it is not necessary to believe in God to use this technique. If one is not a believer in God, the term can be replaced with another Higher Power or even just referred to as the "away" box.

At home or at your office, earmark a container of some sort. This container can be a shoebox, a small gift box, a bag, or a drawer—any convenient and private container. This container represents "God," "Higher Power," or the energy that will be the recipient of stressors. Whenever a worry of a task is taking up too much mental energy, write it down, fold the paper as many times as possible, and put it in the box. The writing can be detailed or vague. The mantra if the thoughts return could be: "It is in the box…God has it now," or "It is in the box…it is away." It can be interesting to go back and read the slips of paper in the box after weeks or months have passed, as many of the stressors will no longer be an issue.

Slogans and Positive Affirmations

Although slogans, sayings, or clichés can appear trite at first, they can be useful tools and reminders of positive philosophical approaches to life. Some examples of these sayings include:

  • Easy does it.

  • First things first.

  • Acceptance is the answer to all my problems today.

  • The pain is not in the letting go, it is in the resistance.

  • Have an attitude of gratitude.

  • Fake it until you make it.

For some, these slogans are used during deep breathing exercises or meditation to focus thoughts in a positive direction. Others post slogans around their workplace as reminders.

Many behavioral health professionals have used the concept of positive affirmations with clients but have not considered utilizing this tool themselves. Affirmations should be personally significant and empowering; they may be a small or large part of the self-care plan. When an individual is experiencing stress, the affirmations may be repeated until the stress symptoms subside.

Examples of positive affirmations include:

  • I can do this.

  • I am capable.

  • I have dealt with this before; I can do it again.

  • I can handle whatever comes.

  • Challenges bring opportunities.

PUTTING THE SELF-CARE PLAN INTO ACTION

Formulating a self-care plan is important, but implementing the plan should be the goal. Using the tools provided in this course, behavioral health professionals may be more prepared to cope with the stresses involved in their professions. Evaluating progress and adherence to the plan daily, weekly, or even monthly can help ensure that action is being taken to appropriately deal with stressors and avoid burnout.

It may also be helpful to partner with someone, perhaps a close friend or colleague, who is also creating a self-care plan and check in with each other to see how each is progressing. Having an accountability partner is an effective way to ensure that a self-care plan is successfully executed.

CONCLUSION

The turnover rate is high in the human services professions, due in part to lack of self-care while working in stressful climates. Learning to apply basic strategies, such as those discussed in this course, can promote a healthier sense of work-life balance amongst helping professionals. Moreover, personal clinical experience suggests that those clinicians who take the best care of themselves are usually in the best position to take care of their clients. Creating and practicing an effective plan for self-care can improve many aspects of a professional's life and can result in a higher quality of client care.

RESOURCES

National Institute for Occupational Safety and Health
Stress at Work
http://www.cdc.gov/niosh/docs/99-101
Help Guide
http://www.helpguide.org
Compassion Fatigue Awareness Project
http://www.compassionfatigue.org
The Trauma Therapist Project
http://www.thetraumatherapistproject.com
Trauma Made Simple
http://www.www.traumamadesimple.com

BOOKS

Oasis in the Overwhelm: 60-Second Strategies for Balance in a Busy World by Millie Grenough
Tapping In: A Step-By-Step Guide to Activating Your Healing Resources Through Bilateral Stimulation by Laurel Parnell
The Trauma Toolkit by Susan Pease Bannit
Trauma and the Twelve Steps: A Complete Guide to Recovery Enhancement by Jamie Marich

Works Cited

1. VandenBos GR (ed). APA Dictionary of Clinical Psychology. Washington, DC: American Psychological Association; 2012.

2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

3. Freudenberger H. Staff burnout. J Soc Issues. 1974;5:59-165.

4. Smith M, Jaffe-Gill E, Segal J, Segal R. Preventing Burnout: Signs, Symptoms, and Coping Strategies. Available at http://www.helpguide.org/articles/stress/preventing-burnout.htm#causes. Last accessed April 21, 2016.

5. Acker GM, Lawrence D. Social work and managed care. J Soc Work. 2009;9(3):269-283.

6. Goetzel RZ, Anderson DR, Whitmer RW, Ozminkowski RJ, Dunn RL,Wasserman J, Health Enhancement Research Organization (HERO) Research Committee. The relationship between modifiable health risks and healthcare expenditures: an analysis of the multi-employer HERO health risk and cost database. J Occup Environ Med. 1998;40(10):843-854.

7. St. Paul Fire and Marine Insurance Company. American Workers Under Pressure Technical Report. St. Paul, MN: St. Paul Fire and Marine Insurance Company; 1992.

8. Sauter S, Murphy L, Colligan M, et al. Stress at Work. Cincinnati, OH: U.S. Department of Health and Human Services; 1999.

9. Jerath R, Barnes VA. Augmentation of mind-body therapy and the role of deep slow breathing. J Complement Integr Med. 2009;6(1):31.

10. Brown RP, Gerbarg PL. Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part 1—neurophysiologic model. J Altern Complement Med. 2005;11(1):189-201.

11. Kjellgren A, Bood SA, Axelsson K, Noprlander T, Saatcioglu F. Wellness through a comprehensive yogic breathing program: a controlled pilot trial. BMC Complement Altern Med. 2007;7:43.

12. Breath. The American Heritage Medical Dictionary. Boston, MA: Houghton Mifflin Company; 2008.

13. Yalom ID. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients. New York, NY: Harper Perennial; 2009.

14. Conrad D, Kellar-Guenther Y. Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers. Child Abuse and Neglect. 2006;30(10):1071-1080.

15. Craig CD, Sprang G. Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety Stress Coping. 2010;23(3):319-339.

16. Rourke MT. Compassion fatigue in pediatric palliative care providers. Pediat Clin North Am. 2007;54(5):631-644.

17. Figley CR (ed). Compassion Fatigue. New York, NY: Brunner/Mazell; 1995.

18. Grenough M. Oasis in the Overwhelm: 60-Second Strategies for Balance in a Busy World. 2nd ed. Charlotte, NC: Beaver Hill Press; 2012.

19. Parnell L. Tapping In: A Step-By-Step Guide to Activating Your Healing Resources Through Bilateral Stimulation. Boulder, CO: Sounds True Books; 2008.

20. Wolever RQ, Bobinet KJ, McCabe K, et al. Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial. J Occup Health Psychol. 2012;17(2):246-258.

21. Portnoy D. Burnout and compassion fatigue: watch for the signs. Health Prog. 2011;92(4):47-50.


Copyright © 2016 NetCE, P.O. Box 997571, Sacramento, CA 95899-7571
Mention of commercial products does not indicate endorsement.