Part Three: The Climate We Create – The Culture We Feed
By Françoise Mathieu, M.Ed., CCC.
Practitioner impairment is a complicated phenomenon and is often the result of a combination of compassion fatigue, burnout, secondary trauma, moral distress and sheer overload from the incredibly hectic lives many of us lead. So, what is the solution? How do we unpack the contributing factors so that we can find a path forward? How do we become, or continue to be, healthy, grounded professionals who also have a life?
In 2008, Toronto-based Kyle Killian’s research confirmed previous preliminary findings suggesting that social support was vitally important for a healthy workplace: “Individuals in the helping professions who reported greater social support suffered less psychological strain, had greater job satisfaction, and greater compassion satisfaction,” Killian wrote. The cruel irony is that one of the first casualties of compassion fatigue and burnout in the workplace is connection with others – we develop a “poverty mentality” and nitpick one another on the length of breaks, or the fact that one person always leaves early to pick up their children at daycare. Unhappy staff engages in office gossip and create cliques where they vent about the inequities of the work, or where they compete to share graphic stories from their trauma cases over the lunch hour. In essence, on the road to burnout, we lose compassion for one another as staff members.
Research shows that we also lose compassion towards our own selves – we become hypercritical of our decisions, actions and behaviors: “Why did I say that, what’s wrong with me?” “Why am I not doing a better job with this client?” “I slept in again today and missed my workout, what a lazy slob I am”. Helping professionals are not known, in general, to be a group that is kind and generous towards itself.
Although recent research shows that the best solutions to CF reside in helping professionals’ working conditions, this does not mean that we, as professionals, are helpless. We cannot blame our workplaces entirely for our CF and STS – we also need to take personal responsibility. Trauma specialist Laura Van Dernoot Lipsky is deeply concerned by what she sees as a disturbing trend among helping professionals – the development of a form of abdication: “I really do think that there is a huge seduction and addiction to being externally focused e.g. ‘you don’t get my boss, I’m in a dysfunctional agency, you don’t understand…’ When we get overwhelmed we fall into reductionist binary thinking: things are either good, or they are bad. There is no more grey possible. We collapse and oversimplify things. But people also have to take personal accountability, and family and community and professional accountability to how they are contributing to increasing the suffering to parts of the web, or how they are contributing to alleviating suffering, and we simultaneously really need to have an aspiration of how can we continue to make large scale long term change.” The solutions, it turns out, are complex and multi-layered. Is that really a surprise?
In spite of our field’s recent infatuation with stress-busting and self-care, it turns out that the suggestion that we should focus on the self, the system and the organization simultaneously was there all along: Laurie Anne Pearlman, one of the pioneers of this research, suggested as early as 1996 that we needed to address the problem at all three levels. But sometimes, when practitioners feel trapped working in a highly toxic workplace, it seems as though individual strategies are the only thing within their control, and that may, in some cases, be true. I have worked with some prison staff and hospital workers who were truly in survival mode – their management was so dysfunctional that all they could do is keep their head down and try to survive on a daily basis, or look for another job. A chilling example of this is described in a recent memoir by two child protection workers. “A culture of fear: an inside look at Los Angeles County’s department of Children & Family Services” by Julian Dominguez and Melinda Murphy reads like a modern day horror story. Whether LA County’s DCFS is truly as toxic as the authors argue is not for me to say, but this first person account provides stark examples of what can happen when the system is stretched way past its breaking point.
During a recent conversation, Kyle Killian suggested to me that one of the additional challenges we face in the helping professions is that many of us struggle with workaholism, and agencies enable and encourage that phenomenon: “The problem is, we get busy, and we get tunnel vision, and you don’t take personal days or vacations, or hang out with people at the local watering hole–you just don’t have time.” Killian suggested that it was important for people to work in a place where there are some feedback mechanisms in place, and some degree of predictability: approximately when you will be leaving the building: “That’s not what a lot of workaholics do, they plan to leave at 5:30, but they leave at 7. It’s a choice, in a way, but you are feeling pressured to stay for various reasons. Is someone tracking whether individual staff is truly taking their personal days and vacation days? Administrators are also there to help workers stay healthy. Role modeling is important. I worked with an institution that frequently had meetings that went until 4:30-5:00pm. Sometimes when people are a bit further along the life cycle, e.g. they don’t have kids to pickup from daycare, they don’t care, and you are left as the lone voice in the room.”
Deb Thompson is a clinical psychologist who was a self-confessed workaholic until she had a profound realization: “one Sunny Sunday, about 11 years ago, my blonde little 7 year old daughter asked me not to go into work that day, as was my habit, to write reports.” Thompson had been pushing herself hard in private practice, juggling a grueling schedule of assessments, medical-legal work and therapy, working about 55 hours a week. “I was well versed in keeping on trucking and ignoring how unhappy I was to be missing out on fun with my family and time for recharging and wellness for me. I was overweight, out of shape, stressed, and at risk for a heart attack.” But Thompson was also, as she says “very responsible and stoic”, and when her husband got laid off, leaving them with twin babies and a toddler to feed, she went into overdrive to keep them afloat.
When her daughter confronted her on that weekend morning, Thompson knew that she could no longer ignore the gnawing unhappiness that she had been experiencing: “the deep knowing that I was not spending my one and only life well was harder and harder to suppress, and with my sweet girl’s plaintive question, I had an epiphany.” So she went into work that day and blocked all new medical-legal referrals, a very lucrative source of work for a therapist. Although it took two years to close all of her cases, she had stemmed the tide. Thompson, a successful former high school athlete who was now 85 lbs. overweight, started exercising again. She also took a long hard look at her finances. Part of the motivation in carrying such a heavy workload had been to meet her significant financial needs. Her family lived in an expensive part of town, in a large house with a steep mortgage: “I was challenged to see that the deep and wide price of staying in a big house downtown was not wise given the toll on me. I was encouraged to see that my kids could adjust to moving and to a lifestyle based on a lower income. I wanted to have the energy to bake muffins in the evening with a kid.”
Deb Thompson now has a much smaller practice, a simpler office with no staff and much lower overhead: “I wanted to feel less spread thin, and continue to invest in my healthy lifestyle” Thompson explains. These changes also allowed her to drop the excess weight and maintain a regular fitness regime for over ten years now. “I absorbed a drop in income by downsizing at home and at work, which was not easy, but I have continued to make a living, and take most pleasure in activities that are very low cost like music, reading, writing, cooking, biking, hiking and visiting friends.” Thompson concludes: “Overall, it has been an evolving process of letting go, and letting come, and I am glad to be living a more spacious, rich, aligned and connected life, knowing that I am doing all I can to stay vibrant and happy.”
I think that many of us can relate to Deb Thompson’s dilemma: it’s hard to unpack the financial piece from the rest of the work that we do. We need to balance our need to earn a living and keep a roof over our heads with the equally important needs to have a healthy, realistic schedule, and a life outside of work. As a private practitioner, I always had to juggle with my schedule, trying to see enough clients to make a good income, and not so many that I would burn out. But here’s the question that few of us who are self-employed are comfortable answering: have you ever taken on a client because you needed the money rather than because you felt that you were the absolute best clinician for them? I once knew a therapist who saw 9-12 clients a day. This was not an exception, it was a regular regime for her – nine to twelve consecutive hours of therapy per day. I heard from clients that she sometimes fell asleep in sessions, which was not surprising. This therapist was a deeply caring person, with a practice specializing in sexual abuse and trauma. I think that she found it difficult to turn clients away. She had also made some bad investments and was struggling financially, which no doubt also influenced her decision to see so many clients.
To use Laurie Anne Pearlman’s model, then, we need to become personally and professionally accountable. That still leaves a burden of responsibility on the organizations, and the systems we work within.
Tomorrow: Part Four – Where are we headed?
Françoise Mathieu is a mental health professional and a compassion fatigue specialist. She is the author of The Compassion Fatigue Workbook (2012) and co-author with Leslie McLean of a book chapter entitled: Managing Compassion Fatigue, Moral Distress and Burnout in a context of patient-centered care in Walton, M., Barnsteiner, J., & Disch, J. (eds) Patient/Family Centered Care – Patient and Care Provider Considerations, Sigma Theta Tau International, 2014. She is also the author of several magazine articles.
Françoise is chair of the annual CARE4YOU Conference on Compassion Fatigue