香港六合彩精准资料

Emma,* a London-based counsellor in private practice, realised all was not well when she found herself unable to make decisions. 鈥楨ven small, inconsequential decisions, like what to do at the weekend, began to feel overwhelming,鈥� she says. Qualified for just six months, she decided to 鈥榙ip her toe鈥� into private practice. 鈥楶eople said it would take time for my caseload to grow, which suited me,鈥� she says. But, within weeks she had 16 clients and was feeling overwhelmed.

鈥楶eople would say, 鈥淵ou鈥檙e doing great!鈥� But it didn鈥檛 feel great. It felt too much. I wish I鈥檇 been told to approach it like running a marathon 鈥� you need to build up to a large caseload, rather than aiming to get a full caseload straight away, because it is totally different to any other job in terms of the emotional and physical demands.鈥�

Emma had what she calls a 鈥榤ini-breakdown鈥�, where she withdrew from her social life and felt increasingly anxious and fearful. She came close to giving up, but, after a planned holiday, put some changes in place, including reducing her client load and changing her working hours, which made it possible to carry on. 鈥業t鈥檚 not easy, as it鈥檚 my sole source of income, but I realised that the number of clients I take on can鈥檛 be determined by finances,鈥� she says.

We may be mental health professionals, but counsellors don鈥檛 always 鈥榳alk the talk鈥�, and it鈥檚 all too easy to focus on improving our clients鈥� self-care and neglect our own. Even with an awareness of compassion fatigue and the impact of vicarious trauma, we can think 鈥榠t won鈥檛 happen to me鈥�. 鈥楥ounsellors find it hard to admit when they are struggling. It鈥檚 similar to what I see in first responders and medical staff 鈥� there can be a shared culture of being strong, here to help others,鈥� says Fiona Dunkley, 香港六合彩精准资料 senior accredited counsellor and trauma specialist. 鈥榃e sacrifice our self-care for the greater cause.鈥�

We can also fall into the trap of thinking that, because the lives of our clients are so awful, our needs pale by comparison, says Lisa Jenner, a 香港六合彩精准资料 accredited counsellor and supervisor, who also delivers training on preventing vicarious trauma. 鈥榃e can be blind to the impact on ourselves until it鈥檚 almost too late. It鈥檚 often friends and family members who recognise that we are struggling before we do.鈥�

Nor is it necessarily about size of caseload; a manageable caseload can be tipped over into unbearable by just one client presenting with particularly acute or distressing needs.

Jenner herself didn鈥檛 realise that what she dismissed as 鈥榯iredness鈥� and the effects of juggling full-time work and family life were the warning signs of burnout. 鈥楶eople started to bring my attention to my memory and concentration problems. I was still able to be very present for my clients, but, outside the counselling room, I couldn鈥檛 follow a conversation. It was disorientating, and I got very irritable with my family and people close to me. Then, when I was driving, I would suddenly forget which pedal did what. I saw my GP and ended up in an MRI scanner and being tested for Alzheimer鈥檚. Then, when everything was ruled out, it became clear I was suffering from stress and burnout.鈥�

What is burnout?

Burnout is a 鈥榮yndrome of emotional exhaustion, depersonalisation and reduced personal accomplishment that can occur among individuals who do 鈥減eople-work鈥�,鈥� explains Professor Christina Maslach, the US psychologist widely known for her pioneering research in this field and co-creator of the Maslach Burnout Inventory.¹ She first came across it in the late 1970s, when she was an assistant professor at the University of California, Berkeley, and researching how people in the emergency services, hospitals and psychiatric units responded to challenges at work. 鈥業 stumbled across it in the interviews I was doing. A pattern emerged 鈥� people talked about feeling overwhelmed, emotionally and physically exhausted, and losing their sense of compassion. But when I first wrote an article about it, it was for a magazine, not a journal, because no journal was interested in it. They dismissed it as 鈥減op psychology鈥�. But that article got sacks of mail from people saying, 鈥渢his is happening to me.鈥� A lot of people had been struggling on, thinking it was just them, and they couldn鈥檛 let anyone know. If everyone else seems outwardly confident and competent, we look around and think, 鈥淚 have to put on my happy face and not let anyone know I鈥檓 not doing as well.鈥� But once we become more open to talking to each other, we realise we aren鈥檛 the only one feeling this way.鈥�

What differentiates burnout from exhaustion, depression or anxiety, is often the most devastating symptom for therapists 鈥� compassion fatigue: the loss of a sense of caring about clients, or feeling irritated by their problems. 鈥楾here can be shame in admitting that we are experiencing compassion fatigue, but we are humans, and we are not protected from stress just because we have therapeutic skills,鈥� says Dr Linda Dubrow-Marshall, 香港六合彩精准资料-accredited counsellor and lecturer in psychology at the University of Salford. 鈥楢dmitting this means we can address these issues.鈥�

Another insidious and undermining symptom is a sense of hopelessness about the efficacy of our work, says Professor Thomas Skovholt, educational psychologist at the University of Minnesota and author of The Resilient Practitioner.² 鈥榃e can feel less intensity in offering hope for the demoralised client, and a loss of a sense of the work being meaningful.鈥�

Other symptoms vary from individual to individual. I know I am becoming emotionally 鈥榢nocked off balance鈥� by a client鈥檚 material when I lose tolerance for any other 鈥榙rama鈥� outside the counselling room, including plot lines in TV programmes and films. 鈥榃hen you have absorbed an amount of trauma vicariously, you can find that you no longer have the capacity to absorb it in entertainment,鈥� says Dunkley. 鈥業 am very mindful of what I expose myself to in social media and TV. I am exposed to enough trauma in my work, so I have to watch what I absorb in my personal life. Trauma is very related to adrenaline, so you can become overloaded.鈥�

For others, burnout shows up in the body 鈥� we find ourselves more prone to bugs and viruses, or physical symptoms. 鈥榃e need to listen to our body as it holds a wealth of information,鈥� says Dunkley. 鈥榃e might be telling ourselves to keep going, but our body will be telling us to slow down by creating physical symptoms, aches and pains or illness.鈥�

The toxic environment

But there is a danger in being too prescriptive about 鈥榯ypical鈥� symptoms of burnout, and therefore medicalising the condition, believes Maslach. 鈥楾hat was never the aim of my research. What worries me about making it into a 鈥渕ental illness鈥� is that it is essentially saying something about the individual 鈥� that they have a disease, they have a problem, so we have to fix the person. We should also be thinking about what is going on in the work environment. Burnout is a regular, chronic, everyday experience at work that wears you away, so that you can鈥檛 deal with stressors as you would normally.鈥�

Maslach鈥檚 research has identified six factors that make burnout more likely: work overload, lack of control, insufficient rewards, breakdown of workplace community, absence of fairness, and value conflict.¹

Organisational conflict is another risk factor, says Skovholt. 鈥業nternal conflict, especially among senior management, increases the risk of burnout. I have come across this even in senior therapists 鈥� we are supposed to be experts on human development, and these people are fighting and hating each other. That can be really distressing for the counsellors they are managing and supervising. It鈥檚 also hard when your values don鈥檛 match those of the organisation you are working for. Anything that takes away the meaning of the work or the sense of fairness or justness increases the risk of burnout.鈥�

For Helen,* it was a sense of not being valued that undermined her wellbeing when she was working as a counsellor for a national charity. 鈥業t seems crazy now I look back on it, given that the charity was national and high profile, but I didn鈥檛 feel supported or that the work I was doing was valued. As an organisation, there was an awareness of vicarious trauma, but nothing was put in place to prevent it. I didn鈥檛 have enough supervision and, as I worked out in the field, I felt isolated from my colleagues. I also wasn鈥檛 paid very much, and that made me feel unappreciated. But it was my first job after qualifying, and I felt lucky to get it, so I didn鈥檛 question the conditions. By the time I felt confident enough to think it wasn鈥檛 right, the environment had undermined my resilience and I was finding it increasingly hard to deal with clients鈥� material. I had nightmares about my clients, became exhausted, and stopped eating and sleeping properly. All I wanted to do outside of work was zone out in front of the TV. In the end, I felt I had no choice but to leave.鈥�

Skovholt has also explored this, with his colleague, Michael Helge Ronnestad, in their book, The Developing Practitioner.³ They describe how newly qualified practitioners in relationship-intense professions can easily become overwhelmed by the emotional demands of the work, especially in the early weeks and months, and can be driven to take an 鈥榚arly exit鈥�, although most adjust and continue in their career.

Grief and uncertainty

Aspects of the work itself can also put the counsellor at risk 鈥� notably, according to Skovholt, the 鈥榓ccumulation of unresolved grief鈥�. 鈥楢 therapist鈥揷lient relationship is a human relationship. As therapists, we are always being left by our clients,鈥� he says. 鈥榃e have to let go of them, but what do we do then? Do we think about them? And we also have to keep up the capacity for new clients. We have to keep making attachments but we are always losing them.鈥�

Another key factor is feeling you are not making a difference with clients. 鈥楤urnout is related to unclear, disappointing outcomes. It鈥檚 hard to sustain work where the results aren鈥檛 concrete,鈥� he says. Dr Els van Ooijen, supervisor, trauma specialist, and writer, agrees that it鈥檚 important to monitor your sense of 鈥榙oing a good job鈥�. She says: 鈥榃orking outside of your experience and capability is extremely undermining. But, in organisations, counsellors can be in a situation where this feels unavoidable.鈥�

There is also the ever-present element of anxious uncertainty from not knowing what work with a new client will involve. It can be particularly difficult if we have personal issues that are causing us distress when clients present with similar issues, says Dubrow-Marshall. 鈥榃hen my father died, I did not want to take on new clients who were coming to work on grief issues. Some family members were also demanding of me during that time, so I took a short break from working with very demanding clients, which allowed me to recover and heal. I also undertook personal therapy, and got outside input when I was ready to return to a more demanding and challenging practice.鈥櫶�

Protection and prevention

Babette Rothschild, in Help for the Helper,⁴ suggests varying the intensity of empathy in sessions as a protective measure. Skovholt says counsellors should aim simply to be a 鈥榞ood-enough counsellor鈥�, and know when a B+ effort is enough for a client, rather than A+. He says that experienced counsellors often operate with 鈥榖oundaried generosity鈥�. 鈥楤eing an effective therapist requires boundaries, but also generosity and willingness to give only so much,鈥� he says. 鈥業t鈥檚 like the advice about oxygen masks on an airplane 鈥� you have to put on your own before you can help anyone else.鈥�

Maslach talks about the 鈥榙etached concern鈥� used by medical professionals as a burnout defence. Of course, detachment is more difficult for therapists, for whom 鈥榩utting ourselves into our clients鈥� shoes鈥� is core to our work. 鈥榊ou can work with 鈥渙ne foot in, one foot out鈥�, rather than both feet in,鈥� says Dunkley. 鈥榃ith both feet in, you are too meshed with the client, and may not be the most effective in helping them.鈥�

But it鈥檚 not easy. 鈥業 have experimented with Rothschild鈥檚 鈥渧arying the intensity鈥� with clients and it just isn鈥檛 possible for me,鈥� says Jenner. 鈥業 can鈥檛 focus on the client and also hold something back for my own self-care. In the past, I have got over-involved; I鈥檝e followed clients鈥� court cases to the point where I felt like I was also going through it with the client. I no longer do that. But I鈥檝e realised I can鈥檛 control my level of empathy, so my self-care needs to focus on what I do after sessions.鈥�

鈥楥are for self鈥� is one of six core principles that underpin our work as counsellors; 鈥榬esilience鈥� is one of the 鈥榩ersonal moral qualities鈥� we are advised to aspire to, defined as 鈥榯he capacity to work with the client鈥檚 concerns without being personally diminished鈥� in the 香港六合彩精准资料 Ethical Framework. As Professor Tim Bond, author of the framework points out: 鈥楾aking care of ourselves as practitioners matters to our clients. They need to know that we are sufficiently resilient to be able to work with them and to be able to withstand the challenges of that work.鈥�

Effective supervision plays a key part, says van Ooijen. 鈥楽upervisors need to get to know their supervisee well enough so that they can tell when they are not themselves. I spend some time with supervisees at the start of the session checking that they are OK. You need to develop a working relationship so they feel they can discuss honestly with you what is going on.鈥�

Independent supervision can be particularly important for those working in an organisation, she believes. 鈥楢n independent supervisor is there as a check that your supervisee is not put into a position where they are working outside their level of experience and competence. That is where the Ethical Framework is helpful. I would advise counsellors to keep a copy with them at work and draw their employer鈥檚 attention to it when necessary. We also need to encourage counsellors to do appropriate CPD, particularly in areas where they feel under-confident. It helps them have confidence in themselves by developing their own reflective and critical thinking skills.鈥�

After taking a four-month sabbatical, Jenner made changes to reduce the risk of burnout in the future, including reducing her counselling days. 鈥楳y sabbatical reaffirmed that I loved being a counsellor, and I wanted to remain a counsellor, but doing it full-time wasn鈥檛 sustainable for me in the long term,鈥� she says. 鈥業 now see clients on two days a week, and focus on training and writing on the others, which affect me in a different way.鈥�

Multiple roles can give a sense of perspective, agrees Skovholt. 鈥極ver the years I have thrived on doing teaching, supervision, therapy, research, and writing. But it doesn鈥檛 work for everyone 鈥� for some, it just adds to their sense of being overwhelmed.鈥�

We also need to give some thought to what we do in our leisure time, he believes. 鈥業n my research, one of the things that has helped protect people from burnout is an element of 鈥渧itality鈥� in their lives 鈥� having something in their personal life that really gives them a sense of pleasure, energy and high satisfaction. We are dealing with distressing, difficult things a lot of the time, so we need a contrast to that in our life, and for that to be ongoing. For one practitioner I talked to, it was absorbing herself in weaving.鈥�

Dunkley recommends using a 鈥榬itual鈥� to ground yourself after a difficult session. 鈥榊ou need to find a way to symbolically shake off the energy that you have taken into your body. Sometimes I mindfully wash my hands, or do a simple breathing exercise, or some yoga moves. Another therapist I know uses juggling balls. If you don鈥檛 get rid of the energy, you risk bringing it into the next session, and then taking it home with you at the end of the day, which can spill into your personal life.鈥�

Skovholt similarly sees value in rituals. He says he sometimes gets home from seeing several clients in a row in a state of what he calls 鈥榚motional depletion鈥�, unable to think, listen or talk. 鈥業t鈥檚 a danger for the counsellor鈥檚 personal and family life. Rituals can help with the transition from counselling work to personal life.鈥�

For Jenner, a key change was scheduling longer gaps between client sessions. 鈥業 make sure I do something physical in the break, such as stretching, or walking outside. It鈥檚 such a simple change but it makes significant difference.鈥� Dubrow-Marshall also suggests paying attention to the scheduling of clients: 鈥業 used to keep Monday mornings free for my most demanding clients 鈥� usually the least personally motivated to change or the most disturbed or narcissistic ones 鈥� as I had more energy after the weekend. I sometimes saw these clients one after the other, because I got into the therapeutic space I needed to be in order to work effectively with them.鈥�

The most protective factor of all, says Maslach, from her four decades of research, is something that counsellors tend to be good at: human relationships. 鈥楻esearch about work and psychology for decades has shown that we are better able as human beings to live life, do well and cope, and be generally healthy if we have good relationships with other people. The more people we have who are fun to be with, teach us, and support us, the better off we are. It鈥檚 about keeping yourself grounded in the everyday and knowing you have people around who have your back.鈥�

*Some contributors preferred to be anonymous.听

Sally Brown is a counsellor and coach in private practice (), a freelance journalist, and Executive Specialist for Communication for 香港六合彩精准资料 Coaching.

References

1. Maslach C. The cost of caring. Los Altos: Major Books; 2015.
2. Skovholt TM. The resilient practitioner: burnout prevention and self-care strategies for counselors, therapists, teachers, and health professionals (3rd ed). New York/London: Routledge; 2016.
3. Ronnestad MH, Skovholt TM. The Developing Practitioner. New York/London: Routledge; 2012.
4. Rothschild B. Help for the helper: the psychophysiology of compassion fatigue and vicarious trauma. New York: WW Norton & Co; 2006

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