Embed Size (px)
Citation preview
Avoiding Burnout:Supervisory, Clinical, and Ethical Issues
presented by Ken Montrose, MA, CAC
Greenbriar Treatment Center6200 Brooktree Road, Suite 210
Wexford, PA 15090(724) 934-8435
ii
About the Author
Ken Montrose is the Director of Training and Publications for Greenbriar Treatment Center. Mr.Montrose has provided training for numerous mental health and chemical dependency treatmentagencies. He is the author of Celebrating Small Victories (Hazelden, 1995: with Dennis Daley)
and Understanding Schizophrenia and Addiction (Hazelden, 1993: with Dennis Daley). A CertifiedAddictions Counselor, he also holds a Master’s degree in Developmental Psychology and actively pursueshis own recovery from alcohol addiction.
About Greenbriar
Greenbriar Treatment Center provides comprehensive inpatient and outpatient treatmentfor chemically dependent adults. Greenbriar offers dual diagnosis treatment,detoxification, inpatient rehabilitation, day and evening outpatient programs, and
individual counseling. Outpatient sites are located throughout western Pennsylvania. Forinformation please call 1-800-637-HOPE (4673).
Copyright Information
All rights reserved on original materials. No part of this publication may be reproduced or utilizedin any form by any means, electronic or mechanical, including photocopying, or by anyinformation storage and retrieval system, without written permission. On the other hand,
permission to copy this material can be easily obtained by contacting Ken Montrose at:Greenbriar Treatment Center6200 Brooktree Road, Suite 210Wexford, PA 15090(724) [email protected]
Cover art is from Art Today, http://www.arttoday.com.
The numbered items are adapted from the Search and Rescue Society of British1
Columbia’s homepage htpp://www.islandnet.com/sarbc/ciss8.html. The italicized items arespecific to counselors, ICMs, etc.
1
I. Introduction
Why is burnout a key issue for mental health and substance abuse professionals? More so thanin other fields, our emotions are central to what we do. For example, the bottom line is thesame no matter how the accountant feels. The tensile strength of steel is the same at 54E C,
regardless of the state of the engineer’s marriage. Our ability to deal with clients’ and colleagues’ needsmay change as our moods change.
Our job is to sell recovery. When we are burned-out, we make lousy sales people. How can wesell clients on the stable, sober life when we don’t seem any happier than they are?
As a professional you have an ethical duty to provide the best care possible. You cannot do so ifyou are “fried.” Nor can you be an effective supervisor if your mood at work consists of long stretchesof apathy broken only by disgust or rage.
Hopefully, this training will help you recognize burnout in yourself and your colleagues. Youcan then take steps to overcome burnout, understanding that some burnout is normal in the helpingprofessions. Good luck.
II. Recognizing Burnout
Working in social service agencies can be very trying. Managed care has managed to makematters worse. Cheap, readily available heroin, and the growing popularity ofmethamphetamine have added to our problems. We are often asked to do more with less.
How well are you holding up? The quiz that follows may help you gauge your own burnout.Please check any of the following that apply to you at least some of the time. 1
Burnout Quiz__1. Do you tire easily? Feel fatigued rather than energetic?
__ Ever tried to inject the coffee directly into your veins?
__2. Are you annoyed when people say “You don’t look so good lately.”
__ Do people call the paramedics whenever you stop moving?
__3. Are you working harder and accomplishing less?
__ Is it a good day when you fall only a little further behind?
__4. Are you increasingly cynical and disenchanted?
__ Are you starting to believe your clients fake problems just to make you crazy?
2
__5. Are you often invaded by a sadness you can’t explain?
__ Do you whimper at the site of your car keys, laptop, or briefcase?
__6. Do you forget appointments, deadlines, and responsibilities?
__ At the end of a long day, have you ever forgotten where you live?
__7. Are you increasingly irritable? More short tempered?
__ Ever extended your middle finger to another driver leaving the parking lot after a religious
service?
__8. Do you have less contact with friends and family members?
__ Ever wondered whose pictures are in your wallet and why they look so much like you?
__9. Are you too busy to do routine household chores?
__ Has the EPA obtained a court order forcing you to clean your apartment?
__10. Have you experienced physical complaints?
__ Do detox patients tell you that you don’t look healthy?
__11. Do you feel disoriented when the activity of the day ends?
__ Have you started having blackouts where you “come to” in some government office, but
you’re not sure which one?
__12. Is joy elusive?
__ Is Joy the woman you were supposed to take to the Welfare Office, or the woman who grooms
your dog? (She seemed angry when you forced her into your car and even less pleased when you
dropped her off downtown.)
__13. Are you less able to laugh at yourself?
__ Do you laugh at catastrophes, spontaneously giggling and drooling in a crowded elevator as
you remember last night’s news about natural disasters?
__14. Does sex seem like more trouble than it’s worth?
__ Do you panic after sex because you can’t remember how to document your time?
__15. Do you have less and less to say?
__ Are you giving your pets ‘the silent treatment’?
from When Helping Starts to Hurt, by Grosch & Olsen (1994), p. 6. Published by W.W.2
Norton & Company, New York.
3
1-10 You haven’t worked in a long time, or do not understand your job. You probably abusedinhalants when you were an adolescent.
11-20 You are starting to smolder. Make sure your health insurance includes generous mental healthbenefits. Lock the liquor cabinet.
21-30 Meltdown is imminent. Do not handle sharp objects. Have your name, address, telephonenumber, and next of kin tattooed onto your chest. Do not drive.
® ® ® ® ® ® ® ® ® ® ® ® ® ® ® ® ® ®
Unless you have a heart of stone, burnout is a normal response to constant contact with human
misery. (How many of your clients came to treatment to escape the unremitting happiness?) Our clients
are in pain. They are addicted, infected, and/or about to be incarcerated. They have burned bridges to
people who love them. They have been used and abused. They feel guilt and shame for having used and
abused others. Their lives hurt. We can’t help but be affected by their pain.
Fortunately, there are ways to deal with burnout. We can take care of ourselves and celebrate the
positive. We can do the best we can do, and accept the results as beyond our control. We can laugh at
ourselves. But before we do any of these things, we have to recognize our own burnout.
Symptoms of Burnout2
As you look at the signs of burnout, keep your ‘baseline’ in mind. (Assuming you haven’t been
down for so long that being completely burned-out feels normal.) If you are a naturally energetic
person for example, your depressed energy levels may look ‘normal’ to someone who isn’t as naturally
energetic. For the less energetic person, being tired at the end of the day may be due more to metabolism
than burn-out. The trick is to compare how you function now with how you function normally.
The physiological signs of burnout include fatigue, irritability, gastrointestinal disturbances,
back pain, weight change, and changes in sleep. All of these can be due to other causes, so don’t jump
to the conclusion you are burned-out when you may have a mild case of food poisoning.
Behavioral symptoms include a loss of enthusiasm, tardiness, and long hours with little done.
You may not turns cartwheels as you arrive ten minutes early for work, eagerly anticipating observing
thirty patients urinate. But neither should you arrive half an hour late, wishing the day was over, cursing
4
your high school guidance counselor, and hoping the facility burns down so you won’t have to explain
why your notes are six months behind.
Beware of your own use or abuse of substances. If you are in recovery, clearly any use of alcohol
and other drugs is an extremely bad sign. Even thoughts of using that intensify while you are at work are
cause for concern.
If you are not in recovery, the context of your substance use is important. Having a glass of wine
with a co-worker after work probably isn’t a problem. Drinking that wine in her car, from a bottle
hidden in the glove compartment, and cursing patients by name as you take each sip, is.
Withdrawal can also be a behavioral symptom of burnout. If you are normally an outgoing
person, avoiding people can be a sign of burnout. You need to ask yourself, why am I withdrawing?
Are you avoiding your neighbor’s new PowerPoint presentation of his granddaughter’s toilet training
triumphs? Or, are you hiding from your family because you are too weary, irritable, or depressed to deal
with them?
The psychological symptoms of burnout overlap with those of depression. Depressed mood,
feelings of emptiness, negative self-image, pessimism, self-blame, and guilt are all cited by Grosch and
Olsen (1994) as the hallmarks of burnout. Other symptoms to watch for include:
� Loss of faith, with feelings of alienation, estrangement, or a change in values.
� Clinical problems, such as cynicism towards clients, daydreaming in session, hostility
towards clients, boredom, quickness to medicate, or to ask for medication change.
Quickie Diagnostic Guidelines for Burned-Out Professionals
; Anyone who disagrees with you is resistant
; Anyone who smiles at you is manic.
; Anyone who fails to smile at you is depressed.
; Anyone who fails to look at you is in withdrawal, and probably depressed, – serves ‘em
right for using drugs in the first place.
; Any display of anger is a sure sign of borderline personality disorder
; Anyone who laughs is high, or bi-polar, or both.
; They are all paranoid, you can tell by the way they watch your every move.
This is taken from Transforming the Pain: A workbook on vicarious traumatization by3
Saakvitne, et al, (1996), published by W.W. Norton & Company.
5
Vicarious Traumatization
Many of us hear and see too much of life’s misery, abuse, neglect, and violence. Too often we
gloss over the second-hand horror. Vicarious Traumatization (VT) is the way exposure to3
other people’s misery and villainy changes our view of ourselves and the world.
Below are some of the changes professionals may experience due to VT. Hopefully this list will
help you see that any negative reaction you have to your clients’ traumas is natural and common.
(Paraphrased from Transforming the Pain: A workbook on VT, pp. 31-41.)
� Not feeling like the same person you were when you entered the field. Losing your
idealism, empathy, or concern.
� Your view of the world has changed, and not for the better.
� Your faith, spirituality, and/or belief in a Higher Power are severely tested.
� Your emotions seem out of control, numb, or not connected to reality.
� Losing sight of what you can and cannot do. Resenting your inability to do the
impossible.
� Being overly cautious because of what you hear from victims and perpetrators.
� Giving in to feelings of helplessness, or trying to control everything in an effort to
overcome these feelings.
� Working with survivors of sexual traumas interfering with your own sexuality.
� Feeling guilty about “having it so soft.”
� Symptoms that resemble PTSD, including imagery, nightmares, numbing, etc.
When Burnout Becomes Depression
Denial is not limited to addiction. Those of us who treat mental illness often fail to recognize the
signs in ourselves. Like the functional alcoholic who sees skid-row types as the only true
alcoholics, we may see only folks who are suicidal as being truly depressed. We may use similar forms
of denial.
Denial by comparison is where we convince ourselves we’re really not depressed when
compared to somebody else. “I’m not as bad as: a) the guy in the next office, b) the woman who just
Taken from Recovery from Mental Illness and Substance Abuse:4
A Loved Ones! Guide by Ken Montrose. Available through Greenbriar Treatment Center at (724) 225-9700 or by contacting the author at [email protected].
6
quit, or c) the State Hospital patient.
Rather than taking a look at ourselves, we blame others for our foul mood. “I’m not really
depressed, it’s just my: a) job, b) wife, c) kids, d) wife and kids, e) wife’s kids, f) kids’ wives, and/or
g) managed care reviewer.”
Others use denial by permanent attribute, a fancy way of saying “I’m not depressed, I’m just
someone who: a) never sleeps, b) never eats, and/or c) has no interest in sex.”
Some of us will even admit we feel depressed, while denying we suffer from depression. We do
so by labeling our depression a symptom, and denying it is a disease in its own right. “Depression is just
a symptom of my: a) sleep disorder, b) viral infection, c) allergies, and/or d) ankle sprain.”
If you experience depressive symptoms for longer than a few weeks, do yourself and your clients
a favor and get help. Talk to somebody, seek professional assistance, look for ways to change your
attitude and the world around you. Be proactive, don’t wait until you are overwhelmed to take action.
Symptoms of Depression
To be diagnosed as depressed you must have experienced at least five of the symptoms listed below
during the same two-week period. Of the five, one symptom present has to be either depressed mood4
or loss of interest or pleasure:
__loss of energy __depressed mood, reported or observed
__feeling worthless or very guilty __ trouble concentrating or making decisions
__restlessness or lack of movement __thoughts of death, especially suicide
__losing weight you weren’t trying to lose, gaining weight you weren’t trying to gain
__anhedonia, which is a loss of interest or pleasure in things you used to enjoy
__sleeping way too much or way too little, especially when compared to how you used to sleep
Adapted from the training materials for Professional Enabling, Disabling, and5
Empowering, by Ken Montrose.
7
III. Clinical and Supervisory Issues
How staff-friendly is your agency? The questions below explore several areas related to job
satisfaction or burnout. Read the attribute and circle which option best describes your agency or5
employer.
Agency Quiz
1. Staff-friendly agencies have as few rules as possible.
a. All the rules my agency has are absolutely necessary.
b. My agency has a few rules that don’t seem to make sense.
c. Our agency policy book is 300 pages long.
d. We wear agency uniforms and are restricted to 7.5 minutes, and 3.0 two-ply sheets
or 4.0 single-ply sheets, per bathroom break.
2. Management enforces what few rules they do have as fairly as they can.
a. A rule is a rule.
b. A rule is a rule for most people, but there are exceptions made.
c. Rules are enforced in the most arbitrary fashion imaginable.
d. Nobody knows the rules, nobody enforces the rules.
3. Staff in these organizations can question the rules.
a. Staff not only question the rules, we change them when we need to.
b. If enough people don’t like a rule, it can be changed with a lot of effort.
c. The rules are written in stone
d. Question the rules on Tuesday, find your belongings in a box and someone new in
your office on Wednesday.
4. Boundaries are respected.
a. The agency respects whatever reasonable boundaries I set.
b. The agency respects my boundaries, but occasionally asks me to do more than I
am comfortable doing.
c. Getting the agency not to encroach on my time, space, and ethics has been a
constant battle.
d. Sometimes my boss follows me into the bathroom to hand me more paperwork.
8
5. Caseloads are manageable.
a. My caseload is manageable.
b. My caseload is difficult to manage, but with a lot of effort and organization I can
keep up.
c. I can barely do the essentials – if they ainte in crisis, they can wait.
d. My goal is to meet 50% of the people assigned to me before they die or go to jail.
6 Clinical flexibility is a hallmark of staff-friendly organizations. Professionals are allowed to
tailor treatment to the client’s needs rather than taking a “one size fits all” approach.
a. We have no treatment plan templates. We tailor treatment to each client.
b. We have treatment plan templates that leave room to tailor treatment.
c. Each client gets the same treatment plan.
d. We write their group notes and discharge summaries from a template before
patients are admitted.
7. Training is encouraged.
a. My agency provides time off and pays for trainings.
b. My agency provides time off for trainings.
c. Training is strictly on my time and my dime.
d. Outside training subverts our glorious agency Director’s teachings and is a
thought crime.
8. Staff- friendly organizations monitor staff stress.
a. I have a standing supervision time. My colleagues and I meet regularly – they
would notice if I was burning out.
b. If somebody looks depressed or frustrated, colleagues address the situation.
c. Our motto is “If you can’t stand the heat, get out of the kitchen.”
d. A 38 year old colleague had a heart attack after working 75 hours per week for 34
straight weeks. The agency deducted $230 in fines from her final paycheck
because of unfinished paperwork.
9. Managers can empathize with line staff.
a. My boss has a caseload.
b. My boss helps with our caseloads.
c. My boss remembers what it was like to have a caseload.
d. Dealing with my boss is like having a second caseload.
9
10. Professionals have an opportunity to vent their frustrations.
a. Any time they want.
b. At appropriate times.
c. If they don’t mind crappy performance reviews
d. At their new agency, ‘cause if they don’t like it here, they have to leave.
11. Staff celebrate their successes.
a. My colleagues and I often discuss people who have done well. Our agency has an
alumni organization that helps us stay in touch with successful clients.
b. Every now and then we talk about people who have done well.
c. We don’t talk about who has done well because we focus on those who need help.
d. When clients leave this building they are dead to me.
Characteristics of a healthy agency are described in the first sentence of each quiz item. Within
these items are three underlying characteristics useful for evaluating an agency’s potential for burnout:
� There is order, and staff have a say in how order is established and maintained.
� Staff are asked to do the possible, and are given the tools and freedom to succeed.
� Staff have the attention and understanding of higher-ups. They have a forum for
complaints and for celebrations.
Managers have to be aware of their own burnout. Powell (1993) suggests that managers have
regular meetings with peers and superiors to discuss their concerns. He also suggests managers have a
small caseload, seek outside counseling, and maintain balance in life. Doing so affords managers the
“...best chance to remain relatively sane...” (p. 215).
IV. Un-Frying Yourself and Your Agency
Burnout need not be permanent. You can take steps to improve your attitude and deal with
symptoms of VT and depression. What follows are commonsense approaches for dealing with
daily stress. You may also want to look deeper for issues you bring to your job.
10
Sober Hedonism
“We absolutely insist on enjoying life.” (Alcoholics Anonymous, p. 132)
In a nutshell, sober hedonism is squeezing the joy out of everything life has to offer, except alcohol
and other drugs. Not using alcohol and other drugs leaves people the rest of life to enjoy. Sober
hedonists know, however, that joy may not come looking for them. Sober hedonists take responsibility
for their own happiness. Relying on others to make them happy is a sure ticket to resentment. Picture
the lazy camel sitting ten feet from the water hole, cursing the water boy: “Why am I still thirsty? Aren’t
I the nicest, most deserving camel in the caravan? When will that no-good water boy bring me
something to drink?”
Thinking about the things I can’t have is like staring into a closet I once hid in, while the rest of life’s
mansion goes unexplored. I may crave the familiarity of that closet, but with enough searching I will
certainly find something I enjoy more. The more I enjoy the rest of life, the less likely I am to crave
the things I can’t have.
Sober hedonists squeeze the joy out of every experience. Not only will they stop to smell the
coffee, they will savor its warmth, smell its aroma, and use it as the perfect complement to rock-hard
biscotti. They drink every cup as if it were their last.
Sober hedonists know that not all pleasure is physical. Helping others, improving their conscious
contact with a Higher Power, finding a meaningful higher purpose, doing the right thing, and learning,
can all be as rewarding as physical pleasure. Sober hedonists pursue physical, psychological, and
spiritual pleasures.
Sober hedonism requires a realistic outlook. Life can be full of pain. Since the pain is often out
of their control, sober hedonists seek pleasure, but accept pain as best they can.
Sober hedonism has nothing to do with gluttony. In fact, sober hedonism is the antithesis of
gluttony. Sober hedonists squeeze the most joy out of life. Gluttons stuff things into their lives. The
sober hedonist relishes eating a single hot dog. The glutton eats hot dogs with relish. Sober hedonism
improves the quality of life. Gluttony is trying to increase the quantity and is usually a part of addiction.
Half of sober hedonism is comparing the joy with what was, or with what might have been. The
sober hedonist enjoys the oasis because he has been in the desert. Or, he has nearly drowned. He knows
This was taken from the “Foreword to the First Edition,” page xiii of Alcoholics6
Anonymous, 3 Edition, (1976), NY: World Services, Inc.rd
11
that too much, or too little, of a good thing can kill him. He compares the purposeful enjoyment of life
with the mindless pursuit of addiction.
Sober hedonism is the purposeful movement away from a painful lifestyle. The sober hedonist
not only enjoys whatever pleasure she can find, now she anticipates avoiding pain in the future. She
knows that if she takes positive steps now, her future will be brighter.
Relaxation Techniques
BREATHING, PMR, VISUALIZATION: Studies have shown that deep breathing, progressive muscle
relaxation, and visualization will reduce blood pressure, heart rate, and stress levels. They can be
done at work and become more effective with each repetition.
A simple way to squeeze relaxation into your busy day is to count breaths during meetings,
presentations, etc. while you stare intently at the presenter. This gives the illusion that you are paying
attention. You may want to save some generic answers in case you are called on to answer a question.
a. “I’m sorry, I was still focusing on that fascinating bit of information you gave us a minute
ago.”
b. “I think there are other people in those room whose opinions would be more valuable
than mine.”
c. “I’m sorry, I was lost in prayer.”
Lessons From Twelve Step Programs
The Big Book of Alcoholics Anonymous points out that the Twelve Step way of living has
“advantages for all.” What follows are lessons from Twelve Step programs that can be used by6
anyone to fight burnout.
GRATITUDE LIST: People feeling overwhelmed can lose sight of all that they have. Writing a
gratitude list keeps their focus on blessings, accomplishments, and being grateful for escaping from near
misses. The list can include both positives and negated negatives. Positives include all that we possess,
all that we enjoy, all our pleasant memories, and all the potential we have left. Negated negatives
Taken from The Care and Feeding of Your Higher Power: Starting your spiritual7
journey in early recovery. Montrose (2002). It is available at www.greenbriartraining.com or bycalling Ken Montrose at (724) 225-9700.
12
include all the pain we have escaped or overcome, all the bad things that nearly happened, and all pain
we avoided.
Don’t limit your gratitude list to the warm and fuzzy. Be grateful that your obnoxious neighbor is
being audited by the IRS, or somebody who richly deserved to go to jail has.
ACCEPTANCE: The founders of AA recognized early that people waste too much energy railing
against things they cannot change. This can lead to resentment, and for alcoholics, to a drink.
Resentment is a poison to addicts and non-addicts alike. It hardens our hearts, raises our blood pressure,
and clouds our judgement. Rather than allow resentment to destroy us, Twelve Step programs suggest
that we “accept the things we cannot change.” They also suggest we pray for the folks we resent.
MEDITATIONS/CONSCIOUS CONTACT: Many Twelve Step meditation books focus on improving
our “conscious contact with our Higher Power.” In addition to these daily readings, I suggest a daily
review. The following is just one way of many to review your day with your Higher Power: The key to7
this inventory is to not go to sleep at night until you have RAPT (wrapped) up the day.
R Review the day with your Higher Power. Imagine you are reporter presenting your reader
with the “who, what, when, where, how” of your day. Who did you spend the day with?
What did you do today to hinder or help your growth? When did you face, fix, or find
what you needed to grow? When did you run from, ruin, or wreck the things you needed?
Where were you today? Were you in places of growth? Or were you, in person or in
thought, back to harmful places? How did you strengthen your body, mind, and soul
today?
A Apologize for times you fell short of your ideals. For example, if your Higher Power
wants you to treat others with respect, and you didn’t, apologize.
Taken from Choosing a Higher Purpose: Early recovery for agnostics and atheists, by8
Ken Montrose, (2002). Available at www.greenbriartraining.com or by calling Ken Montrose atGreenbriar Treatment Center (724) 225-9700.
13
P Petition your Higher Power for the things you will need tomorrow. You may need more
patience to treat others respectfully. You may need wisdom to handle situations that still
baffle you. While you are at it, why not ask for courage to change, and serenity to accept
what you cannot change? (Hopefully, this sounds very familiar!)
T Thank your Higher Power. Review your gratitude list with your Higher Power. (pp. 12-
13)
FIND A HIGHER PURPOSE
If you don’t believe in a supernatural Higher Power, have you found a higher purpose? People who
make the effort to formulate a well-defined higher purpose often reap many benefits:
� A well chosen higher purpose can relieve us of the burden of self-involvement.
� If our higher purpose involves others, we can gain support, feedback, and a sense of
responsibility to a group.
� Having a higher purpose gives us direction and goals.
� At the end of the day we can account for ourselves with pride and satisfaction.8
Sarcasm, Silliness, & Other Stress Busters
DAYDREAMING: Daydreaming is harmful only if you spend more time dreaming than doing. But
what is wrong with spending a little time in fantasy? (My guess is that somebody, somewhere, is
charging people $350 to attend half day lectures on “creative forward flashing.”)
Fantasy is a very close cousin to guided imagery. There are scores of books on guided imagery.
Most of them are very helpful. The problem with many of them is that don’t tap the sarcastic, vengeful
brat within. Sometimes the inner child has to take a back seat to the brat. Otherwise we choke on the
goodness and light.
From Feeling Good: The new mood therapy, by David Burns, M.D.9
14
GETTING ON THE ELEVATOR: The elevator can be a magical place where you can deposit some of
your stress. All that is required is an elevator with people, some doors that are about to close, and a
colleague. The key to this technique is to speak just as the doors are closing so there can be no rebuttal.
The following are examples:
“Relax, it’s just an indictment, not a conviction.”
“You left your copy of Babes in Boots in the staff bathroom again.”
“Sorry to hear you were banned from the petting zoo.”
MEETINGS: Skip meetings whenever possible. I doubt there is any social service organization
anywhere in America that does not have an unnecessary meeting. Skip these meetings. Make sure
people see you skipping the meeting. Page a friend out of the meeting. Set up a rotating schedule for
paging people out of meetings. Use the overhead page to see who can come up with the most creative
reason for leaving a meeting.
BULLETIN BOARD: Many agencies keep logs or bulletin boards of quotes, blunders, etc.
committed by staff and clients. You may want to remove these when inspection time rolls around.
“TO DO” LIST MANAGEMENT: You may be doing more than you need to out of habit. Take a
long look at what you do and why. The template in Appendix I should help you sort tasks.
Cognitive Therapy
David Burns describes several ways to change the thoughts that often contribute to depression.9
These same techniques can be applied to burnout.
1. Identifying the thought patterns – cognitive distortions – that undermine your happiness,
serenity, and self-confidence. These distortions are defined in Appendix II.
2. Eliminate double standards. Are you being harder on yourself than you would be with a
close friend?
3. Conduct experiments that challenge negative assumptions. Do the first part of a task you
expect to be overwhelming. Was it impossible, or merely difficult?
15
4. Think in shades of gray. Is your job really miserable, or only parts of it?
5. Conduct informal surveys. Are you the only one behind on paperwork?
6. Define terms in more realistic ways. Are you defining success/failure in ways that make
you miserable?
7. Use the semantic method, substituting wants for shoulds. “I want to be more caught up. I
will be less worried when I am less behind.” vs. “I should be up-to-date, why am I such a
loser?”
8. Make sure you correctly attribute problems to all of their causes. Is the problem you, or
are there factors beyond your control?
Celebrate Small Victories
What follows is a list of suggestions for avoiding burnout by celebrating small victories, and not
being a victim of your own treatment system. Hopefully you will realize that some of them
were written tongue-in-cheek.
� Lower your expectations of others.
� Quit shoulding on yourself. Take steps to improve your life and forget all those shoulds.
� Expect to be a little burned-out.
� Check for mirrors before you make faces behind the boss’s back.
� Change your attitude: it is the only thing you truly control. You may have no control over
the three p’s, policy, paperwork, and people. That’s why you feel p’d on.
� As they say in AA, there is no problem so bad a drink cannot make it worse.
� Learn to take a complement. Don’t deflect praise while taking criticism to heart.
“ Show me a sane man and I will cure him for you.” -C.G. Jung
� Remember that you set a good example just by going to work every day.
� Remember that nobody can prove you heard the overhead page.
� Publicly take full credit for your successes. Examine mistakes in private.
16
� When clients ruin their lives, try to see their problems as a way to get their attention.
� Keep your long term goals high: expect people to completely recover, someday. But
understand that miracles take time. In their time, in His time, but maybe not in your time.
“Your lack of planning is not necessarily my crisis.”
Sign posted in the Registration Office at Pitt’s School of Social Work.
� Take a newspaper into the bathroom. People will be less like to disturb you.
� Take steps to ensure your safety. Be a little paranoid.
� Evaluate the decision making process rather than the decision. Did you take the time to
gather all the information you needed? Did you let someone else influence you decision?
Did you let your mood influence your decision? Expect to make mistakes, celebrate
when things go well.
� Drop politically correct notions that all clients are equally wonderful. Just like the rest of
us, some clients are wonderful and some are difficult.
You can drag a horse to water but you cannot make him drink. Keep dragging him
until he’s thirsty. Keep dragging him until he drinks just to get you off his back.
� Spend time effectively. Redefine effectively as anything that strengthens your relationship
with your client.
� Don’t expect to have everything under control. Sometimes there is no right answer or
quick solution. Expect chaos, and work to establish order.
� Find someone who is positive, unless way-too-happy people make you nauseous.
� If you eat your lunch in your car, as you talk on the phone, while you drive, there are too
many demands on your time.
� Find someone in tune with your negatives: it’s not whining if you harmonize.
� Never volunteer for anything, especially not for anything involving food.
From Clinical Supervision in Alcohol and Drug Abuse Counseling: Principles, models,10
and methods. By David Powell, with Arche Brodsky (1993), published by Lexington Books.
17
“The graveyard is full of indispensable men.” -Charles DeGaulle
� When facing a stupid request, play dumb. Force people to explain stupid requests aloud.
� Avoid people who are across-the-board negative. (They don’t talk about solutions, they
talk about the stupid way they do things around here.)
� Find someone to listen to you. Find someone other than the people you serve.
� Find a niche and publicly kill anyone who violates it.
� Relabel problems focusing on the client’s choice.
� Keep as heros those consumers who struggle to overcome disabilities. Accept that not all
consumers struggle mightily.
� Accept your limitations.
“. . . the seeds of burnout are often planted in the initial stage of enthusiasm, when the
novice has unrealistic expectations of success, recognition, and fulfillment.” Powell &
Brodsky, 1993, pp. 213-214.10
� Wallow in your successes. Wallow in your successes. Wallow, wallow, wallow.
� Admit when you are beaten.
� Ignore useless paperwork. Go to the source and ask them to justify the need for certain
paperwork. Pick on superiors who claim to understand how overworked you are.
� Get some exercise and eat healthy -- a donut, two cups of coffee, and three cigarettes are
not a balanced diet.
� Relax and do something you cannot do and think about work.
� Question the unwritten rules and etiquette of the workplace
� Leave in the middle of boring presentations, trainings, etc.
18
“There are only two ways to live your life. One is as though nothing is a
miracle. The other is as though everything is a miracle.”
-Albert Einstein
19
Appendix I
To Do List
ASAP Part of my indispensability delusion
Today Really somebody else’s job
Must be done, but with:
�extreme resentment
It would be nice
�mild annoyance Beneficial to me, but not absolutely necessary
�calm acceptance
Only my perfectionism keeps these items on the list
from Feeling Good: The new mood therapy, by David Burn, MD, (1980, William11
Morrow & Company.)
20
Appendix II
Checklist of Cognitive Distortions11
1. All or nothing thinking: Looking at life in absolute, black and white categories.
2. Overgeneralization: Seeing a negative event as a never-ending pattern of defeat.
3. Mental filter: Dwelling on negatives and ignoring positives.
4. Discounting positives: Insisting that your accomplishments or positive qualities “don’tcount.”
5. Jumping to conclusions; A) Mind reading -- assuming that people are reacting negativelyto you when there is no definitive evidence for this; B)Fortune telling -- you arbitrarilypredict that things will turn out badly.
6. Magnification/minimization: Blowing problems out of proportion or shrinking theirimportance inappropriately.
7. Emotional reasoning: Reasoning from feelings -- “I feel like an idiot, so I really must beone.” Or “I don’t feel like doing this, so I’ll put it off.”
8. “Should statements:” Criticizing yourself or others with “shoulds” or “shouldn’ts. “Musts,” “oughts,” and “have tos” are similar offenders.
9. Labeling: Identifying yourself with your shortcomings. Instead of saying “I made amistake,” you say “I am a loser.”
10. Personalization and blame: Blaming yourself for something you weren’t entirelyresponsible for, or blaming other people, overlooking ways that your own attitude andbehavior contributed to a problem.
