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Burnout Syndrome In The Helping Professions Essay

 

Burnout in Social Services:

What is the problem and how can we address it?

Marie K. Van Buskirk

Sian Muir

May 2017

 

 

 

Definitions

Burnout

The term was first coined by psychologist Herbert Freudenberg to describe the effects of highly stressful and idealistic work in “helping professions.” There is no clear single definition of burnout, but it commonly defined as “a psychological syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.”  Another relevant definition is “a defensive response to prolonged occupational exposure to demanding interpersonal situations that produce psychological strain and inadequate support.” While burnout was originally used to describe a phenomenon unique to helping professions, it has been broadened to apply to various different types of work that involve human interaction. There are three main symptoms of burnout: emotional exhaustion or the depletion of emotional resources, depersonalization or callus, pessimistic feelings about one’s clients, and reduced personal accomplishment or the tendency to evaluate one’s work negatively especially when referring to client work. Depersonalization seems to be related to and a main effect of emotional exhaustion. Some consider it a misfit between intentions and reality in helping work. Often it can go unnoticed and is self-perpetuating because part of the problem is a lack of adequate coping strategies.

Emotional Labor

There are two types of emotional labor, job focused EL and employee focused EL. For the purpose of this paper, job focused EL or the emotional demands of service work will be the focus of this definition. Emotional labor is the emotional demands of an occupation that arise from the necessity of emotional control, expression, and the interaction with clients’ emotions. The intensity, quality, and variety of emotional expressions necessary during interactions with clients are key dimensions of emotional labor and also predict burnout. The emotional labor of service professions is considered one of the major factors that contributes to the higher rate of burnout in these fields.

Compassion Fatigue

Compassion fatigue is specific to workers in social services that work directly with victims of trauma. It is characterized by episodes of sleeplessness, anxiety and depression.  The more empathetic a therapist is, the more likely they are to internalize the trauma of their client.  Compassion fatigue can be difficult to distinguish from burnout, but normally has a quicker onset than burnout and may contribute to long term burnout. Compassion fatigue has symptoms of fear and sadness and a generally faster recovery rate when compared to burnout. Social services workers experiencing compassion fatigue may have thoughts or experiences than reflect something similar to the reactions of their patients. Compassion fatigue is also referred to as secondary traumatic stress.

Introduction

I chose to do an individual major because I wanted to understand something; how do you effectively help others? My major allowed me to explore this theme by conducting research in South Africa on effective programming and evaluating existing programming at Tubman. While that contributed to my knowledge of effective services, I started to notice a real problem with my coworkers and myself. In South Africa and Texas, I encountered dangerous working situations and little support or training. I found myself losing my passion and ability to help clients.

After coming back to St. Olaf, I realized that focusing on clients had blinded me to the ways helping professionals impact service and care. After experiencing burnout myself and watching co workers leave after a mere three months on the job, I realized that there was something systemically wrong in the social services world. I continued to work for nonprofits and saw time and time again a high turnover rate. Employees were dissatisfied with jobs that they chose because they were passionate about the work. The leaders that I worked for seemed to accept that this pattern was unavoidable. But the consequences of burnout are real and extremely negative for employees and organizations, not to mention quality of client services.  I started researching this topic because I realized that my major focused on effectiveness in service delivery and the biggest impediment I could find to that was burnout, changing staff, caulous staff, workloads that were impossible, and overall lack of care. The problem was no one seemed to be talking about or addressing it. The more I researched, the more I found data about how burnout affects employees, organizations, and clients. I hope my senior project and this paper can be used to further education about burnout and change in the social service industry.  

Methodology

I collected data and information for this paper by using research databases and Google Scholar. Through collaboration with a St. Olaf research librarian, I narrowed my search by using keywords like burnout, emotional labor, self care, and employee care. I also used the references of key articles to inform further study. Throughout this process I discovered that there was little research or information on nonprofit burnout rates, but there was a greater variety of information on social work statistics. Because social work often overlapped with my own experiences and the nonprofit field I relied heavily on social work data.

Research Questions

  • What is burnout?
  • How does it affect employees, organizations, and clients?
  • What factors make employees or organizations vulnerable and what factors protect against burnout?
  • How can organizations and individuals protect against and address burnout in social service organizations?

The Problem

When compared to other jobs that require frequent client interactions, social service positions are defined by the emotional intensity and subsequent increased emotional labor of their jobs. Research demonstrates that social service workers, when compared to service/sales, managerial, and physical labor work, perform more emotional labor and have lower emotional autonomy.  While there is little research on burnout rates in nonprofits, other fields of social service, like social work have investigated burnout to a greater degree. Daniel Fox found that chronic burnout contributes to a turnover rate exceeding 60% every year. When looking specifically at social workers, studies in the United States, Ireland, and Norway found a majority of social workers (from 46% to as high as 71%) suffer from moderate to severe intensity burnout as measured by the Maslach Burnout Inventory. These studies also found 40% of social workers from a variety of fields report that they will likely be changing jobs in the near future. According to the National Association of Social Workers Membership Workforce Study in 2014, 37% of social workers experience psychological problems related to work stress, 23% experience sleep disorders, and 66% experience fatigue. Their survey concluded by making the assertion that burnout is the main reason people are leaving the social work profession. Other fields in the social services also experience high levels of burnout. 40 to 50% of teachers burnout within the first five years and nursing faces a chronic shortage because of fatigue. In summation, burnout is widespread and contributes to incredibly high turnover rates.

But how does burnout affect helping professionals and their work? Not only does burnout contribute to an incredibly high turnout rate, but burnout is incredibly costly. It is estimated that the cost of each employee lost is anywhere from five thousand dollars to 25% of an employee’s yearly salary to recruit, train, and make up for lost efficiency. Because of the budget constraints that nonprofit and social services already struggle with, this expense is unneeded drain on already limited funds. Research in Palestine identified significant individual costs as well. Burnout contributes to hopelessness, anger, exhaustion, and a multitude of mental and physical ailments. Most frightening may be the effect on client relationships. Employees experiencing burnout have decreased contact with their clients and are less willing to help. Additionally, burned out employees are less efficient, more often absent, perform poorly, and are less committed to their organization and work. Employees experiencing burnout demonstrate more of the following behaviors: derogatory language meant to put others down, refusing to help, refusing to be professional or civil, and failing to provide services or help.  Burnout also affects relationships outside of work and may contribute to marital and familial problems. Burnout affects all aspects of an employee’s life and contributes significantly to more negative client outcomes and organization culture.

Risk Factors

Work Environment

Helping professions come with certain inherent risks for poor work/life balance. Many choose social work and other social service professions because of their desire to help. While this is an important qualification to be impactful in the field, it puts workers at risk for over involvement in their clients’ lives and boundary issues. Social work is a profession of relationships and social workers must balance the demands of work, clients, and pressure for certain outcomes. Valuing social justice, individual worth, and empowerment may clash with work expectations due to budget and time constraints. Balancing all of the expectations, while still attempting to empower individual clients, can be a delicate balancing act. Some consider social work inherently stressful because of these complexities.

Organizational culture is an important factor in protecting against or contributing to employee burnout. Carolyn Dillon, a professor and researcher in clinical social work, studied burnout in the workplace. She found that the common structure of social service organizations contributed negatively to employee stress. Her research revealed that social workers have little autonomy or control in working with clients. Social workers often did not dictate who they saw, how long they saw them, when they interacted with clients, and what was expected of them in such meetings. This lack of autonomy and control contributed to social workers’ stress and their risk for burnout. Many researchers have examined what work structures contribute to stress. In the social work field, Borland found that administrative goals are not always the same as the goals of social workers. The social worker’s goals of helping the client might not be cost effective or, in following procedure, social workers may have to make choices for clients that are at odds with their idea of what is best. This can cause social workers to feel they have little power when it comes to discharging clients, making important decisions, or impacting change.

Another stress within the workplace can be other co workers attitude towards social work. Social work can be undervalued by other workers, as well as society in general. Reid et al. found that in the mental health field workers experienced increased frustration because their role was not understood or appreciated by their co workers. This lack of social support negatively affects workers and is another leading cause of burnout. This feeds into a general trend of role conflict and role ambiguity. Role conflict, or a situation in which a social service worker is expected to play two roles that conflict with each other, increases the amount of dissatisfaction and burnout experienced by social workers. Role ambiguity, as studied by Balloch et al., was found to be another important factor in job dissatisfaction in social service employees. Employees who were expected to do things outside of their job description, unable to do things that were part of their job, and unsure of expectations were more likely to experience lack of job satisfaction, lower motivation and self esteem, greater desire to leave their job, and burnout.

Occupation stress in social workers is often increased by work overload, unnecessary paperwork, and time pressure. The National Association of Social Workers reported that  25% of social workers surveyed (around 4,000) said that their heavy workloads contributed significantly to their stress, and many noted they were unable to complete their daily tasks. 31% of respondents indicated that they lacked the time required to complete the necessary tasks of their job. Other stressors identified by the survey were having to complete paperwork/tasks with little value, getting minimal support from coworkers, being expected to work long hours, and having few opportunities for advancement.

Client and Social Worker Variables

Stress affects certain demographics at greater rates than others. While some research has found no link between sociodemographic characteristics (gender, age, race) and stress, other studies report that younger female social workers are more likely to encounter work related stress and experience emotional exhaustion. Female workers report more incidents of work/life conflict, which is a significant contributor to stress. Social workers who have experienced trauma themselves report higher levels of emotional exhaustion, but also report higher levels of personal accomplishment. Older social workers are more likely to have developed strategies that help them cope and found resources to mitigate work stress.  Additionally, studies have linked higher introversion and neuroticism with burnout while extraversion, agreeableness, and openness appear to be buffers against emotional exhaustion and burnout. Certain types of clients seem to affect burnout rates as well. Fields with clients who more commonly have poor prognoses are linked with much higher rates of burnout. Specifically social service workers whose clients are schizophrenic, psychotic, have another form of chronic mental illness, struggle with substance abuse, or frequently engage in aggressive, stressful, or violent behaviors are more likely to experience burnout.  There are individual factors that protect against burnout like high emotional intelligence and life satisfaction. Nina Oginska-Bulik explored the effect of emotional intelligence on stress and health outcomes in social service jobs. Her research uncovered the essential nature of emotional intelligence as a method of perceiving occupational stress and preventing negative health outcomes in social service employees. Those with higher emotional intelligence were less likely to experience burnout because of this heightened awareness. General life satisfaction combined with social support is also associated with decreased risk of burnout. This may be because burnout affects all aspects of life including general life satisfaction.

Methods of Decreasing Burnout

Self Care

Caring for employees and giving employees tools to care for themselves is essential to mitigating the stressful and emotionally draining work that often comes with the social service territory. The question then becomes: what methods of intervention and support are effective at decreasing rates of burnout and improving employee health? A national study of social workers showed that social workers cope with stress through exercise (73%),  meditation(27%), therapy (25%), use of prescription medication (22%), yoga (18%), alcohol (17%), and absenteeism (7%). Carroll et al. provides a method of conceptualizing the many aspects of self care by dividing self care into four categories: intrapersonal work, interpersonal work, professional development and support, and physical or recreational activities.

Physical or Recreational Activities

Physical or recreational activities like exercising, reading, watching tv, or engaging in personal hobbies are another important part of self care. These activities help employees enrich their definition and use of self, as well as relieve stress. Physical exercise can be used as a way of alleviating physical stress specifically. Hospice workers commonly engage in amusement activities like gardening and fishing or expressive tasks like drawing, writing, or singing as methods of self care.

Intrapersonal Self Care

Counseling

Research on the impact of workplace counseling demonstrates that counseling positively affects stress and psychological symptoms. Counseling was also shown to affect symptoms of depression and as an effective treatment of burnout and occupational post traumatic stress.  Counseling can also save organizations money as counseling has been shown to reduce sickness absence by 20-60%. Counseling has also been linked to higher retention rates as well as improved client ratings of performance in their work. Other studies have shown counseling lowers the number of accidents and disciplinary cases among staff.  Based on a meta analysis of research on client satisfaction with workplace counseling, 80% of clients were either satisfied or highly satisfied with the service.

Meditation

Mediation also falls into this category and is a practice commonly used by social workers according to the National Association of Social Workers. Meditation is the cognitive practice of quieting the mind and teaching recognition and control of intrusive thoughts. It focuses on teaching participants to respond to situations, as opposed to reacting to them. Research shows many benefits to meditation including mental clarity, concentration, and increased ability to manage daily stress. Yoga has also been studied as a method of intervention. In a study on psychotherapists who practice yoga in their daily lives, their ability to self reflect and relax were shown to improve. Meditation can be an effective intervention for stress and burnout because it can rejuvenate and refocus tired minds.

Mindfulness Based Stress Reduction Programs is another method of intrapersonal intervention in stressful workplaces. Mindfulness is defined as “paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.” Mindfulness has been shown to decrease and prevent stressors, as well as increasing wellbeing. Mackenzie et al. studied the effect of a mindfulness intervention in the nursing population. Nurses reported relief from burnout symptoms and increased satisfaction and relaxation. Shapiro et al. investigated MBSRP as a method of self care for therapists. They demonstrated that MBSRP decreases mental challenges and enhances positive health practices. Mindfulness is proposed to be a bridge between self care and wellness.

Professional Development and Support

Organizational Structure

The number one reason people leave the field of social work is work overload. Unhealthy and unsafe work environments also contribute to burnout. Giving workers the freedom to act, agency, and autonomy contributes to worker well being. The lowest rates of burnout are found in organizations that have social cohesion, goal congruence, autonomy, and self efficacy. As mentioned in the predictors of burnout, organizations that are understaffed, put high pressure on employees, and require staff to lift physical burdens have a higher rate of burnout. Reducing those stressors can positively impact individuals and the entire organization.  Increased financial compensation can also be a factor in reducing occupational stress.

Supervision

Supervisors can be an added layer of protection against burnout. Having an active and caring supervisor has been shown to assist professionals during stressful periods and increase their patience with clients. Caring supervision also ties in closely with social support and a healthy work environment. Receiving support and engaging in positive interactions with other coworkers who encourage self care and manageable caseloads decreases the likelihood of burnout. Adequate supervision can be a safety net for catching burnout before it severely affects employee health and client care. Supervisor relationships also affect employees views on organizational climate, wellbeing, employee commitment, and psychological capital. Employees that rated their relationship with their supervisor highly were more likely to also view the organization and their work more positively. Positive supervisor relationships are also associated with a greater engagement with coworkers to resolve and discuss problems. Supervisor support and good supervision are critical factors in employees staying at their jobs even under high levels of stress.

Interpersonal Support

Social support can be a method of coping with high stress jobs. Whether through informal or formal support, the main effects model supports a linear relationship between social support and burnout where social support protects employees from burnout. As social support decreases, rates of burnout increase. The buffering hypothesis offers an alternative theory: that seeking social support from other employees who have depersonalized worsens burnout. Research on this hypothesis has been inconclusive, but it is important to note that workers seeking support from other workers also experiencing burnout may exacerbate the problems.

Self Care Planning

A crucial part of effective self care strategies is self care planning or planning a balance between output and input energies in personal and professional life. Self care planning can help employees to relieve stress by identifying effective strategies and recognizing what aspects of life cause stress. Self care planning takes into account physical, emotional, spiritual, cognitive, and relational aspects of life. Activities like gardening or crying can be identified and capitalized upon in an individual specific way to alleviate stress and create a better balance in all aspects of life.

Organization Ideas for Addressing Burnout

Based on my experience, my coursework at St. Olaf, and this research, these are my suggestions for changes to organizational structure to promote healthy environments and address chronic burnout.

Prioritize Supervisor Relationships

Supervisor relationships are key to employee health and resilience. While doing research at Tubman, I saw that those who did not feel like their supervisor cared or invested time in them were more likely to have an overall negative experience at Tubman. Through collaboration with Tubman’s Volunteer and Intern Services we developed these methods of strengthening supervisor relationships:

  • mandatory weekly checkins
  • mandatory exit interviews
  • supervisor handbooks
  • volunteer/intern quarterly surveys
  • collecting positive quotes about supervisor and emailing them as forms of encouragement
  • scheduling meetings with supervisor who had the most negative feedback to create ways of strengthening these relationships

Training

Training is very important to address client needs but more training on self care and burnout is necessary. being able to recognize signs of emotional exhaustion and burnout can help employees communicate and advocate for themselves.  The onboarding process can also be pivotal. Giving employees the tools to do their job and grow in their skills was missing at one of my jobs and it put me in a very vulnerable position to feel insecure about my abilities. Trainings should address:

  • methods of self care
  • information about burnout
  • meditation training
  • in depth job specific training
  • self care planning

Create Community

In the three Tubman surveys that I analyzed I found a common theme. Volunteers wanted to connect to those who did their job and form relationships with their co workers. Many people asked specifically for support groups and community activities. Here are some possible activities for nonprofits:

  • book club/ monthly reading list
  • have a social after mandatory training
  • create social spaces in break room with ways to write notes/communicate positively with co workers
  • have informal meet ups at entertainment activities   

Offer Flexibility

The for profit world has embraced the idea of offering employees the agency to dictate more of their schedules. This is obviously not possible for many direct care jobs but making sure positions are manageable is possible. Other suggestions:

  • remove unnecessary paperwork
  • evaluate job responsibilities
  • offer employees input into important decisions
  • giving more flexible paid time off options

 

Conclusion

Burnout rids the field of social work of its passion and ability to help. The effects of burnout are various and extensive, but they point to a key struggle in the social services field moving forward. Leaders in the field need to prioritize preventative measures to retain employees, save money, and gain better outcomes for all involved. There are methods proven to be effective and they should be implemented along with training on self care. But overall the field of social services needs reasonable workloads, higher salaries, and a conversation about stress and burnout. Some interventions may be more difficult to accomplish than others, but caring for employees lies at the heart of effective service. However, more research needs to be conducted on which interventions are the most effective at addressing burnout and which can be implemented into organizational structure at a low cost.

From the data presented here, the only conclusion to be drawn is burnout is an epidemic in the social services and it is vital that employees and organizations move to prevent against and address chronically unhealthy environments. Burnout is not a problem that can be ignored or failed to addressed as it affects most social servants and the effects are disastrous, not only to client services, but to individual’s holistic health.   It is the responsibility of organizations to care for their employees and clients. Addressing burnout is a major part of that responsibility in the social service sphere. It is also important for employees to give feedback about work/life balance and prioritize self care. It benefits all aspects of an organization to have healthy employees who can provide the emotional labor and care they were hired for.

From personal experience, I know that toxic workplaces take a toll on the soul. I almost lost my passion for the work I love and helping professionals need to know when enough is enough. Another important element of burnout is knowing when you can no longer work in a certain environment and having the awareness to know it’s not your fault. Recognizing the signs of exhaustions and workplace elements that fail to support employees is vital to retaining social workers, teachers, nurses, and other helping professionals. The work is incredibly important, but so are the workers and their needs.

 

 

Appendix

This information was obtained from data collected by an adoption agency in Texas. They graciously allowed me to analyze their exit interview data for the purpose of greater understanding of nonprofit turnover.  

This organization has a current turnover rate of 67% which matches data collected by other agencies.

Burnout was not a choice in this survey, but it begs the questions: do employees know if they are leaving because of burnout? 30% listed their reason for leaving as supervision inadequacies which further reiterates the importance of good supervision and leadership. Work life balance could be a category that directly translates to burnout. These results support the importance of proper pay, opportunities for advancement, and clear job roles.

These two graphs demonstrate what an important impact work environment has on employee turnover. Employees also noted lack of training, communication, work/life balance, and leadership as key factors in turnover.

Lastly, this research shows a systemic problem with supervisor relationships and leadership within this nonprofit. Many said their supervisor never resolved their problems property, gave usable performance feedback, encouraged/listened to suggestions,or  mentored them. Additionally, growth opportunities, workload, training, morale, and communication were severely lacking.

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Balloch, Susan, Jan Pahl, and John McLean. “Working in the Social Services: Job Satisfaction, Stress and Violence.” British Journal of Social Work 28.3 (1998): 329-50. ProQuest. Web. 27 Mar. 2017.

 

Borland, James J. “BURNOUT AMONG WORKERS AND ADMINISTRATORS.” Health and Social Work 6.1 (1981): 73. ProQuest. Web. 27 Mar. 2017.

 

Brotheridge, Céleste M., and Alicia A. Grandey. “Emotional Labor and Burnout: Comparing Two Perspectives of “People Work”.” Journal of Vocational Behavior 60.1 (2002): 17-39. Idea Library. Web. 27 Feb. 2017. <http://www.personal.psu.edu/faculty/a/a/aag6/Brotheridge%26GrandeyJVB.pdf>.

 

Conrad, David, and Yvonne Kellar-Guenther. “Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers.” Child Abuse & Neglect 30.10 (2006): 1071-080. Research Gate. Web. 27 Feb. 2017. <https://www.researchgate.net/profile/Yvonne_Kellar-Guenther/publication/6780017_Compassion_fatigue_burnout_and_compassion_satisfaction_among_Colorado_child_protection_workers/links/54fdc3840cf270426d12cc65/Compassion-fatigue-burnout-and-compassion-satisfaction-among-Colorado-child-protection-workers.pdf>.

 

Doğan, Laçin, and Tutal. “Predicatives of the Workers’ Burnout Level: Life Satisfaction and Social Support.” Procedia – Social and Behavioral Sciences 191 (2015): 1801-806. Web.

 

Fox, Danielle, “Burnout among Mental Health Workers in a Nonprofit Organizational Setting” (2012). Master of Social Work Clinical Research Papers. 120. http://sophia.stkate.edu/msw_papers/120

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Lloyd, Chris, Robert King, and Lesley Chenoweth. “Social Work, Stress and Burnout: A Review.” Journal of Mental Health 11.3 (2002): 255-66. ProQuest. Web. 27 Mar. 2017.

 

Mackenzie, Corey S., Patricia A. Poulin, and Rhonda Seidman-Carlson. “A Brief Mindfulness-Based Stress Reduction Intervention for Nurses and Nurse Aides.” Applied Nursing Research : ANR 19.2 (2006): 105-9. ProQuest. Web. 27 Mar. 2017.

 

Maslach, Christina, and Susan E. Jackson. “Maslach Burnout Inventory–ES Form.” PsycTESTS Dataset (1981): 191-218. Research Gate. Web. 27 Feb. 2017. <https://www.researchgate.net/publication/277816643_The_Maslach_Burnout_Inventory_Manual>.

 

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Sharon cares.

The 26-year-old counselor cares for the clients she leads in two groups composed of individuals with substance abuse and mental health problems. She cares for the few individuals she has time to see when her groups aren’t meeting three times per week, three hours per session. She even cares about doing a good job on the mounds of paperwork that clutter her desk.

It turns out, though, that Sharon may not be spending as much time caring about the person who matters most — herself — while she tends to the needs of others at the community mental health center where she works.

“Last week, I felt that I definitely was burning out,” says Sharon, who asked Counseling Today not to reveal her last name. “I felt that I had symptoms of generalized anxiety disorder, of post-traumatic stress disorder. I dreamed of getting shot.”

So Sharon decided to shift gears. “The newest belief I’ve adopted is that I’m doing a job and not doing therapy,” she says. “If I look at it that way, I can cope with my stress better.”

Counselor burnout. With increasing caseloads, managed care headaches, mounting paperwork and the ever-present stress of listening to other people’s tales of despair all day before going home to play with the kids at night, it is an issue that many in the counseling profession take very seriously.

“It can’t be overstated,” says Gerard Lawson, an assistant professor of counselor education at Virginia Tech and coleader, along with Jane Myers, of the American Counseling Association’s Wellness Interest Network. “Everyone in the helping professions, especially counseling, wants to help people. But it’s all meaningless when the instrument — you — isn’t OK.”

When Lawson chaired the ACA Task Force on Impaired Counselors from 2003 to 2007, he and Beth Venart wrote a paper titled “Preventing Counselor Impairment: Vulnerability, Wellness and Resilience.” They defined counselor impairment as something that occurs “when there is a significant negative impact on a counselor’s professional functioning which compromises client care or poses the potential for harm to the client.”

Impairment, Lawson and Venart wrote, includes substance abuse or chemical dependency, mental illness, physical illness and personal crisis. The term “burnout” was included under the personal crisis category.

But what is burnout? What leads to it? How can it be treated? And, perhaps most important, how can counselors avoid it?

Counselor burnout is defined by its symptoms: feelings of exhaustion, detachment and dehumanization when dealing with clients, in addition to feelings of depression and inadequacy. And then there is burnout’s close cousin, compassion fatigue, when the helper is traumatized by her efforts to be compassionate with the individual suffering from the initial trauma.

“We find that 5 percent of people in the helping professions suffer from burnout and 10 percent suffer from compassion fatigue,” Lawson says. “That should give us pause. It’s not a huge number when we look at the 95 percent who aren’t suffering from burnout, but what do we do with the 5 percent, and how do we make sure that the 95 percent doesn’t slide into the 5 percent?”

Few protections in place

Graduate school would be an obvious place to stem the tide before people enter the counseling profession. Or so it would seem.

“It’s not attended to enough,” says Myers, a professor in the University of North Carolina at Greensboro Department of Counseling and Educational Development and a past president of ACA. “We focus on professional development as part of the curriculum, but we don’t have any training on burnout.”

Likewise, according to the task force Lawson chaired in 2003, state licensing boards don’t deal with the issue adequately. The task force found that few intervention programs existed to assist counselors and only a few states — Minnesota, Michigan and Virginia — had good impairment programs that defined impairment to include stress, substance abuse, mental illness and physical illness.

So graduate programs turn out counselors who gladly dive into the deep water. Helping people is their goal, and burnout is generally the furthest thing from their minds. They often start out at community mental health agencies because they can work there before getting licensed. This is where they are given freedom to see clients — individually and in groups — pretty quickly. And this is where clients with the most serious mental illnesses await.

“If you want to burn people out,” Lawson says, speaking of community mental health agencies, “we have the perfect recipe.” Namely, new counselors seeing clients with not-so-new problems.

“A lot of our graduates talk about the severity of their caseloads,” Myers says. “It’s very difficult when you’re treating the severely impaired. If I feel I’m not a success as a counselor, there’s a good chance I am going to burn out.”

Battling against burnout

Burnout certainly isn’t restricted to recent counseling graduates or workers at community mental health centers, however. Still, Lawson acknowledges that private practice offers greater control, and control mitigates against burnout.

Balance also is a key to the prevention of burnout, whatever the age of the counselor. “Meditation, exercise, vacation, dedicating time to your family … Folks that tend to these aspects of their life fare better with burnout,” Lawson says. “There’s a significant improvement with work when you do wellness activities.”

“There’s a crossover between our professional and private lives,” Myers adds. “We’re more prone to high stress if there are problems at home. It’s easy for our clients to become secondary when we have problems in our private lives.”

Myers also emphasizes the importance of engaging in non-counseling activities. “On a scale of one to 10, I’d say that’s about a 15,” she says. “You have to have balance. You have to do things that renew you in other areas of your life.”

Counselors can also benefit from practicing what they preach, including seeking counseling themselves. “I think counselors can be reticent to see other counselors,” Myers says. “When you’re a counselor yourself, you might not think another counselor will be effective dealing with you. … (But) the best theorists and clinicians in our field, starting with Alfred Adler, have stressed the importance of having someone else hear our stories and help us gain new perspectives.”

Adds Lawson, “Going to counseling contributes to the counselor’s development in that it improves interpersonal skills and flexibility to meet the needs of clients, insulates clients from the influence of the counselor’s own unresolved issues and bolsters the counselor’s ability to manage stresses related to counseling work and to renew themselves. From our research, we know that 83 percent of counselors have been in counseling at some point in their life, including 18 percent who indicated that they were currently attending personal counseling.”

Good supervision is another key to preventing burnout. “It’s the No. 1 way to mitigate burnout and compassion fatigue,” according to Lawson. “And good supervision should, in my estimation, include more than discussion of cases. It should include a supervisor asking, ‘How are you doing?’”

“One of the challenges of the burned out counselor is that she/he is likely to be unaware of the impact of the burnout,” Myers says. “Burnout creates, to a greater or lesser extent, an impairment of our ability to be fully present to our clients. Although we can often overcome the effects of burnout with time, a rapid return to wellness is best and most quickly achieved if we truly believe in and are willing to practice the power of our art. So I strongly encourage counselors experiencing burnout to seek both professional peer supervision of their work and personal counseling to help them move beyond impairment to wellness and to follow a self-reinforcing path to a high level of wellness.”

Still, even with these safeguards in place, counselors can experience burnout. Bills pile up. Paperwork piles up. Clients with serious mental health problems don’t get better overnight. Left unchecked, burnout can make a counselor who was once so eager to help others equally as eager to leave the profession altogether.

“One of the components of people who get into this profession is that they are passionate about what they do,” Lawson says. “They want to help. There’s a great potential for burnout, especially when they don’t see the payoff until way down the line.”

Finding renewal

Things weren’t paying off five years ago for Cathy Woodyard, an ACA member based in McKinney, Texas. She was teaching at Texas Woman’s University, seeing clients individually and experiencing signs of burnout.

“I gave up my job as a counselor educator because I found it was depleting me,” Woodyard says. “I gave myself a week in a cabin. I took movies. I took scrapbooks.” And she came away with a feeling of renewal.

Woodyard and Connie Fox, a friend and counselor Woodyard had met at an ACA Conference, decided to put together retreats for counselors. The counselors, mostly from Texas and Oklahoma, go on weekend retreats twice a year. One of the retreats in Oklahoma City included a talk by a therapist who specialized in dream work. Another retreat incorporated psychodrama. A retreat in Santa Fe, N.M., last fall included a visit from a shaman. A massage therapist was featured at another retreat.

Woodyard plans to expand her retreats to include individuals from other professions. Meanwhile, the counselors who attend Woodyard’s retreat talk about themselves. They talk about cases. But mostly, they engage in renewing activities.

“I couldn’t counsel if I didn’t do something like this,” Woodyard says. “My therapy would turn into problem-serving. It wouldn’t be about growth. I don’t trust a counselor who doesn’t work on themselves.”

A counselor herself for nearly 20 years, Woodyard sees individuals, runs four groups and conducts a monthly experiential workshop that primarily focuses on self-exploration and dealing with fear. From her perspective, what are the top three factors contributing to counselor burnout? “Lack of self-care, a schedule that is too full and seeing a population that is too demanding,” she says.

On second thought, make that four factors. “I think you need a variety of clients,” she says. “If I worked with all children, I think I’d burn out. If I worked only with an older group, I think I’d burn out. When you’re working with a tougher population especially, there’s something refreshing about seeing different types of people.”

Woodyard’s husband, Jim Bray, is in a different profession altogether, working as an electrical engineer. “I’m so glad he’s not a counselor,” Woodyard says. “It forces me to remember that there’s a different world out there. He’s into antique cars. When he’s talking about that, it brings me out.”

Meanwhile, Sharon is trying to bring herself out of her funk. Sometimes, to protect herself, she calls what she is doing “a job,” not therapy. She also has another name for what she does. “I look at myself as a drive-through therapist,” she says. “You pull up, and you get a kernel of something that can help you.”

But what can help Sharon?

“I care immensely about these people,” Sharon says. “But there are moments of frustration that I can’t fight through.”

ACA member Chris Morkides is a psychotherapist in private practice in Swarthmore, Pa. Contact him at cmorkides@aol.com. Letters to the editor: ct@counseling.org.

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