Why Helpers Burnout Out So Quickly (& Deeply)

Posted on March 20, 2014

Welcome some new members from around the state of Arizona!  We had a great Medical Case Management Training last week and the weather was nearly perfect too!  Our community is approaching 500 members and I know some people read regularly that are not on our e-mail list (Hi Mom!).  Thanks for being part of this great and growing community!
Today I want to talk about us.  Recently, I have had the opportunity to do quite a few Thrive: Self-care Trainings around the country.  Besides discussing compassion fatigue, vicarious trauma and secondary trauma, Thrive spends time considering the process and impact of burnout on helpers.
It is not a secret that we have a high level of burnout in the helping professions. Historically we have labeled our condition as burnout when it was really compassion fatigue, vicarious trauma and secondary trauma. I think our work, and the nature of working with human beings, does expose us to burnout more than any other profession.  This post will explain why this happens and the importance of catching burnout in its initial phases so it does not permanently harm us physically, socially, emotionally and cognitively. 
Stress is our biological reaction to changes in the environment.  This can be a source of motivation that allows us to accomplish great things in life, this is often called eustress.  Stress can also be negative and exhausting and this is the stress that leads to burnout. Bad stress, also called distress or strain, is exacerbated by three intensifiers and this is where we’ll start our examination of burnout.
Stress gains power when the thing or problem causing the stress is important, uncertain or occurs over long periods of time (duration). Let’s look first at importance.  Think about our work with patients and clients.  We enter this profession because we care about the well-being of people and our communities.  The work we do is critical, both to the individuals we serve as well as to the overall health and safety of our communities.  In other words there might not be a more important job in our society than the one you are doing right now.  If you have not heard it today…Thank you for your dedication!
Next is uncertainty.  Do you have ANY ability to predict what will happen on any given day?  If your experience is like mine, just when you think you have seen it all something truly mindboggling walks through the door!  “Working with uncertainty” should be a line in all our job descriptions.
Finally, duration is an issue we all deal with in the helping professions.  Clients’ needs, e-mails, phone calls, paperwork and daily crises do not stop when we leave the office or take a vacation.  I have never had someone tell me “we have more resources than we know what to do with.” The reality of social services and public health is we work from a resource restricted position.  We do the miracles with what we have and use our creativity and passion to try to give our clients what they need to better their situation.  As long as this is our reality, we’ll always have too much on our plates and struggle to keep our heads above the constant demands of our work.
In other words, we work in high stress environments!  This reality means that exhaustion is a constant struggle.  Exhaustion is Stage 1 of burnout and something we have all experienced.  There exists a fine line between exhaustion from a bad day and the exhaustion associated with burnout. A bad day is something we can shake off by talking to a loved one or friend, having a great weekend, working out or practicing mindfulness.  Burnout is when we start waking up tired, driving to work tired, seeing clients/patients tired, and coming home tired. 
The good news about exhaustion is that we can recover with a long weekend, vacation or focusing on activities that improve our well-being.  The challenge is, it is a very small step from Stage 1: Exhaustion to Stage 2: Shame and Doubt.  Exhaustion means we are not able to give our best to our patients and clients.  Since they are important to us we can easily feel shame that we are not providing the level of services we know we are capable of providing when we are at our best. 
This shame can be a stress of its own. The additional stress can increase exhaustion, which increases our sense of shame, and a rapid cycle of stress can take over our lives.  In a matter of weeks we start to doubt our ability to provide great services we know our clients and patients need. 
Here is where our work differs from many other professions in society.  When your job is to create widgets, being exhausted might not impact anyone in a meaningful way.  In the helping professions, when we do not bring our best selves to work, people can suffer in very real and tangible ways.  Dealing with high levels of importance, duration and uncertainty requires us to bring our best to work every day, and at the same time it depletes our emotional, cognitive and physical energy.  This reality can accelerate our journey down the stages of burnout.
We cannot exist long in a state of exhaustion, shame and doubt.  This can lead quickly to Stage 3: Cynicism and Callousness.  We harden ourselves in order to survive the stress.  If we know we cannot give our best, we put up emotional walls to isolate our psyche from the knowledge that we are not giving our clients what they need.  No one wants to be cynical or callous, and these traits can be devastating in work that requires a superhuman level of empathy and patience. We disconnect with clients and often isolate ourselves from our co-workers and people in our personal lives. 
I have seen many people recover from Stage 1 and 2, but when a helper becomes cynical and callous they start to burn bridges with peers and clients.  I have yet to see someone stay in the same position in the same organization and recover from Stage 3.  It is possible, but it takes a lot of work and energy to rebuild relationships, and when one starts from a place of exhaustion and shame this can be a nearly impossible task. I have seen many people exist in this stage for years within an organization, leaving a path of destruction and pain in their wake.  One of the most damaging situations is when a leader is in Stage 3.  It can damage their staff and trickle down to how their staff treat clients and patients.
Stage 4: Failure, helplessness and crisis is rare to witness because most of the time the person leaves their job or is fired before they hit this stage.  When people hit this stage they are often alone and suffer in isolation.  The reality is that work can lead to broken relationships, mental illness, physical disease and a range of other problems.  Here is a slide from my research that lists all the consequence of burnout. 

want to leave you with this thought.  We should not suffer because we have dedicated our professional lives to the service of others and our communities.  Each of us have made the choice to forsake riches and luxury to follow a higher calling to serve those in pain and struggling with traumatic pasts.  We have to take care of ourselves first, if we don’t we cannot help others and are at risk of doing harm to those that come to us looking for hope.  I would love to hear from you all on how you keep yourselves health and recover from exhaustion, please feel free to share your experience in the comment section of this post.

2 responses to “Why Helpers Burnout Out So Quickly (& Deeply)”

  1. Thank You Matt, for that wonderful training in Phoenix, Arizona! Although it was not explicitly stated in your training, my brain made this connection between providing Trauma Informed Care to our clients and also providing Trauma Informed Care to ourselves. I had heard of burnout, of course, but in over 4 years of working as a case manager I had always heard of it as a normal thing that we were expected to live with, and I had never even heard the words Vicarious Trauma, Secondary Trauma, or Compassion Fatigue before – this curriculum really resonated with me. I’ve had trainings on providing Trauma Informed Care to clients before (and I feel that I accomplish this well on a good day) but it is a whole other thing to realize that I am experiencing Secondary and Vicarious Trauma (although I had long felt this way, no one had given me the language for it, or validated this experience), and that I need to treat myself with Trauma Informed Self-Care. Furthermore, your training helped me realize that myself (and social workers all over) also need to receive Trauma Informed Care from our co-workers, supervisors, and overseeing agencies, in order for us to be effective in our work and lead happy, productive lives.

    I have toggled between stage 1 and 2 of burnout for years, and, after the last day of your training, me and some co-workers were feeling really inspired to start implementing some of your self-care ideas. At that late afternoon moment, a supervisor (on instruction from our overseeing agency, ADHS), changed our schedule for the next day; we had planned for some self-care by the pool for the following morning before our final training that afternoon, but all of a sudden we were required to be in the training all day and we would not be getting to our homes over an hour away until late the next day. I was livid, I would never treat my traumatized clients that way – if there is a change of schedule or expectation I always go out of my way to give them as much choice as possible and I am mindful of the importance of their time – now I was overwhelmed by a feeling of helplessness and I gave up hope that any of my own plans for self-care could ever be effective when our supervisors are so inconsiderate. I could hardly believe that these supervisors (who just sat through he same wonderful training as I did) would be so insensitive to the delicate state of mind that most social workers are balanced in at any given moment. I hope that in your travels and trainings you get a chance to educate supervisors and administrators about the importance of providing Trauma Informed Care to their staff.

    So my co-workers and I have not implemented any of the self-care ideas that you proposed, although I still hope to. After that training I was in full exhaustion mode even, over the weekend due to other personal stressors, and I came to work Monday morning with a Very Full Cup – there were only 3 messages waiting for me but each one was a monumental crisis. I found that I could only accomplish a single phone call before I would have to close my door and cry for 15 minutes until I was able to attempt addressing the next problem. I took the next day off and I am now finishing a very long week and, although that day off was helpful, I am still struggling with regulating my affect. I plan to take a week off soon and I plan to start emailing a co-worker with 3 positive things that happened at the end of each work day, I also know that taking more breaks to go outside or stretch during the day would be helpful. I will let you know what else I come up with because I do love my job (mostly) and I know that, even if I don’t do case management, I am a helper and I need these self-care skills in order to be able to continue to do good work in my community. It would really help if the rest of the world practiced more awareness towards its fragile social workers.

  2. Matt Bennett says:

    Thanks so much for sharing. This work is tough and we have to be gentle with ourselves and realize that it should eat us up and spit us out! Please keep me updated on how your implementation goes…I love you dedication and openness to new ideas this flexibility shows you have the insight and energy to recover and Thrive! Matt

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