January 30, 2012
David Fawcett, Ph.D., L.C.S.W., is a substance abuse expert, certified sex therapist and clinical hypnotherapist in private practice in Ft. Lauderdale, Fla.
The text alert came in the middle of a session. It was from a colleague and read simply "call asap." I dialed his number between patients, and when he answered, I was surprised at his quiet tone and his admission that he was really shaken. We often utilized each other for consultation and support, but on this day he sounded defeated. He told me that a patient had just died.
This had, of course, happened before. We both had spent the better part of our professional lives working with AIDS patients and their mental health concerns. Simply due to the nature of the work, we had seen plenty of pain, both emotional and physical, and had experienced significant loss.
This patient had been a middle-aged man co-infected with HIV and hepatitis who succumbed to liver failure. In the absence of any family, my colleague had invested extra effort fighting a disorganized health care system in an attempt to address his needs.
That frustration, combined with growing emotional exhaustion and ultimately his sense of failure that the patient died, made obvious to both of us that my colleague was experiencing burnout.
Burnout Syndrome (BOS) was identified in the 1970s and results from prolonged exposure to a variety of job stressors, ranging from long work hours (number of night shifts, time since last vacation, workplace organization or conflicts) to emotional upheavals. BOS is characterized by diminished emotional coping abilities, increased depersonalization (detachment and cynicism), and a low sense of personal accomplishment. It can be indicated in a variety of ways: long term exhaustion, feelings of failure, irritability and physiological symptoms such as headache and insomnia.
Health care professionals working with HIV/AIDS patients -- physicians, nurses, social workers, and other personnel -- are at a very high risk for BOS. Some studies estimate that as many as 50% of workers in this field either currently or previously have experienced burnout. There are even more specific risk factors within our ranks. For example, younger workers experience more burnout than older ones. (Perhaps those that endure in this field develop coping mechanisms or have more control over their work environments.) Individuals with unresolved prejudice about sexuality or concerns about death may also be at risk. Conversely, internally based coping strategies, such as expression of feelings, patience, persistence, and a sense of optimism, appear to be protective factors.
What can be done about burnout? Organizations can have a significant impact by carefully managing how staff and procedures are structured, as well as by focusing on communication and team building. Individuals, as well, can employ a number of strategies to keep themselves emotionally fit and resilient. Here are a few that will strengthen one's ability to keep burnout at bay.
Self Care. I frequently hear myself telling patients about the importance of self care: rituals of renewal that provide grounding for the turmoil we inevitably face on a daily basis. These can take many forms: meditation, relaxation, physical exercise, healthy eating. In my own life, I know that these essential activities can often be deferred while other priorities vie for my attention. It never fails, however, that if I invest time and effort in myself, I am much more present and effective in my professional life.
Interpersonal Skills. There are common, self-defeating patterns that contribute to work-related frustration and burnout that, once identified, can be easily corrected. Among these are:
- Overreacting -- that is, trying to find an immediate solution to every problem. Answers may not always be immediately clear, or they may require some thought in order to reach a good decision.
- Taking ownership of problems that are not our own. Individuals in the helping professions frequently have co-dependency issues that contribute to the false belief that everything is our problem to solve. Clear boundaries are essential to survive in this field.
- Remembering to act on facts, not feelings. If we are tired or worn down, it's easy to react on the basis of emotions (anger, hurt, fear) rather than facts. It's important to take a step back, breathe, and get a sense of what is really going on inside. Old feelings can often be triggered by present circumstances and sometimes seriously distract our focus.
Balanced Living. At a recent a workshop of health care workers in HIV/AIDS, I asked people to share how they employ recreation in their lives. Surprisingly few hands were raised. Many of the participants admitted they lacked a hobby, a passion or any other recreational activity that got them physically and emotionally out of their workspace. Our brains and bodies need balance in order to function well. Remember that having fun is essential to one's health.
Connection. Whether through friends, family, partners or spirituality, each of us needs a strong sense of connection to the world around us. It is easy to get caught up in the drama of our professional lives and forget to nurture the other relationships that are essential for our well-being. It is through these that we practice receiving love and support. Many health care workers find it much easier to give rather than receive in their relationships, and they often give until they are depleted. In the end, giving and receiving must be in balance.
The work we do is vital. It can be emotionally and physically taxing, but it doesn't have to be personally harmful. It we pay attention to our needs, acknowledge the other people in our lives, and monitor how smoothly we move through our day, we can create a professional life that is not only rewarding, but sustainable as well.
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