Burnout among health care professionals has become a common and critical problem affecting staff, the agencies for which they work, and the clients they serve. As a therapist working in the health care system for over 30 years, I have seen a great many of my colleagues suffer from the various types of stress that can adversely affect workers in this field. I have watched some of them “burn out,” using up their paid sick time, taking stress leaves, resorting to unhealthy coping behaviours, and sometimes leaving the profession altogether. I have also seen others deal with their stresses in healthier ways, choosing to practice such self-care strategies as seeking out personal counselling and taking refreshing holidays.
In the course of my career as a health care professional dealing with my own occupational stresses, I have come to believe that we do not have to burn out; although it is a relatively common occurrence, it is not a necessary requirement of the work. In my opinion, the key lies in the willingness to become self-aware and make the changes necessary to remaining holistically healthy. I believe it is incumbent upon us, as healers, to serve as guides and role models for our clients. As such, we must be doing our own personal work in order to most effectively assist our clients to do theirs.
Working in the various health care professions is not an easy task. When clients come to healers for assistance, it is generally because they are at a point in their lives of needing, be it physically, emotionally, mentally, or spiritually. The nature of the work dictates that the giving and receiving of support between client and counsellor is not equitable. One reason burnout occurs is that healers sometimes lose sight of this. Instead, they become depleted and defensive, taking it personally when clients are demanding or manipulative in getting their needs met. Because counsellors and therapists often give a lot of themselves to their clients without receiving equitably from the clients in return, they can wind up feeling emotionally drained. This type of emotional exhaustion, coupled with the high ethical and moral standards they often set for themselves, can lead to feelings of frustration, anger, and resentment.
There are specialized issues facing health care professionals that may not be present in other occupations. Physically, for example, healers might find themselves pierced by a needle with a client’s blood on it. Today, this could pose a significant threat to the professional’s health. As well, workers may be required to do continual shift work, which can be damaging to their overall state of health. Emotionally, due to the non-equivalent nature of the relationship with clients, healers can find themselves feeling drained, experiencing emotions they may not be able to name for themselves, and often with few, if any, emotional supports in place with which to deal with the stress. From a mental health standpoint, workers could find themselves alone in an office with a mentally psychotic or otherwise unstable client, who might exhibit unpredictable and potentially dangerous behaviours such as rage or delusional ideation. Spiritually, healers may be assisting terminally ill clients and their loved ones to deal with end-of-life issues.
Any one of the above scenarios can produce an inordinate amount of stress for a professional caregiver; if more than one issue is present, and if there appears to be no respite from the seemingly ever-present stress, health care workers could well be on the road to severe burnout. Added to that are the inappropriate and unrealistically high expectations that counsellors and other healers might place upon themselves to be able to help all those who seek their assistance. It is imperative that they take a proactive stance by broadening their understanding of what burnout is, why it develops, how it can manifest, and what can be done to counteract it before it gets out of control for them. An appreciation of the elements of healthy and appropriate self-care is an essential tool for the prevention of occupational burnout.
Causes of Burnout
In talking with other healers, I have discovered that there seem to be as many definitions of burnout as there are people defining it. Despite these variations, however, it would appear that burnout has, at its core, three features in common: physical fatigue, emotional exhaustion, and gradual disillusionment with the work itself. Other contributing factors that can lead to burnout may include work overload, lack of appreciation and recognition, strained relationships among colleagues and/or supervisors, and job dissatisfaction. As healers become disillusioned, they may become self-critical and feel as if they are not doing enough to help other people. In fact, one of the most damaging causes of occupational burnout occurs when health care professionals mistakenly believe that they can “cure” their clients, thus taking on the responsibility for their clients’ recovery and often working harder than their clients do. When this happens, the healer may unknowingly attempt to pressure clients to seek alternatives for their recovery that the therapist “approves” of. In order to avoid burnout, health care professionals must understand that clients ultimately suffer when their personal responsibility for making choices is decreased or taken away, and that such enabling behaviour can actually disempower the healer as well.
Manifestations of Burnout
There are many ways that the symptoms of occupational stress and burnout can manifest. Physical symptoms such as headaches, gastrointestinal disturbances, chronic colds, changes in appetite, and sleep difficulties can appear or become worse. Emotional manifestations can include feelings of depression, helplessness, anxiety, nervousness, guilt, irritability, and emotional depletion. Behavioural symptoms may show up as tardiness, absenteeism, poor performance, or participation in gossip at work, all of which can lead to low morale. As the experience of burnout continues, therapists may develop negative attitudes toward the work, themselves, their clients, or life in general. This can manifest in defensiveness, pessimism, cynicism, or intolerance toward clients or other people. They may then find it difficult to focus on others, choosing instead to withdraw from clients, friends, and family members. They may prefer to engage in such solitary activities as isolative substance use, excessive reading, watching too much television, or spending inordinate amounts of time on the internet. In order to avoid facing the fact that something is amiss in their lives, others may choose chaos, preferring to keep themselves very busy and socially active.
It is important to remember that clients who come to health care professionals for assistance often have narcissistic needs. Therapists who expect to have any of their own needs met by clients are at risk for burnout. Countertransference can develop when the healer’s own unresolved conflicts and defenses are triggered by “difficult” clients. When exploring various occupational hazards of the health care professional, it is vital to understand and acknowledge that the healer’s emotional investment may be quite high, thus making it easy to feel disappointed. In addition, healers who work in isolation may not have opportunities to debrief with colleagues or supervisors when they find themselves triggered. Therefore, it is essential to continually be self-aware and to seek the support necessary to prevent symptoms of burnout from taking over their lives.
Prevention of Burnout
It is unfortunate that many health care professionals, including therapists and counsellors, still believe that practicing “self-care” is equivalent to being “selfish,” rather than seeing healthy self-care as vitally important in terms of a well-rounded, holistic plan for burnout prevention. Choosing to practice healthy self-care can incorporate a great many alternative types of coping responses. For example, having insight into one’s own “compassion fatigue” is crucial to the prevention of the burnout that can easily occur when working with traumatized clients. It is also necessary for healers to establish and maintain a balance between their personal and professional lives, and to find ways to interact with each other. Imagine what it would be like if, at a specified time each day, therapists were encouraged by their supervisors to meet with their colleagues and share with each other any negative thoughts or feelings that might be interfering with their interactions with clients. Workers can also talk with their supervisors and request that agencies provide more for them in the way of ongoing self-care workshops and training. In addition, healers need to pursue extracurricular activities and find ways to enjoy themselves. Some of these might include hobbies, sports, cultural events, socializing with friends and family, taking vacations, or engaging in coursework outside of their area of professional expertise. Holistic self-care also includes eating well, getting regular exercise, getting enough rest and sleep, having reflective time alone, engaging in spiritual pursuits, and having fun!
It is essential that we pursue our own healing, because it is only when we are self-aware and are comfortable with our own unique personhood that we can effectively assist clients to become comfortable exploring theirs.
Work organizations can play an indispensable role in the prevention of occupational burnout. Increased autonomy, effective supervision, ongoing training, realistic work demands, appropriate vacation and sick time, and supportive contact with colleagues are some of the ways that agencies can assist their workers to reduce the potential for burnout.
It is unrealistic to think that burnout can be completely eliminated. Internal and external stressors will always affect people from time to time. However, when we are aware of occupational stress and its causes and manifestations, we can develop and implement preventative strategies that will greatly decrease unnecessary burnout among health care professionals.