The Resilient Practitioner

Burnout and Compassion Fatigue Prevention and Self-Care Strategies for the Helping Professions

Thomas M. Skovholt, Michelle Trotter-Mathison

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317570073
• Edition: 3
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

The Resilient Practitioner, 3 rd edition, gives students and practitioners the tools they need to create their own personal balance between caring for themselves and caring for others. This new edition includes a new chapter on resiliency, an updated self-care action plan, self-reflection exercises in each chapter, and a revised resiliency inventory for practitioners. Readers will find, however, that the new edition keeps its strong focus on research and accessible writing style. The new edition also retains its focus on establishing working alliances and charting a hopeful path for practitioners, a path that allows them to work intensely with human suffering and also have a vibrant career in the process.

Part I

1 Caring for Others versus Self-Care: The Great Human Drama

DOI: 10.4324/9781315737447-1

I have always been better at caring for and looking after others than I have been at caring for myself. But in these later years, I have made progress.

– Carl Rogers at age 75 (Rogers, 1995, p. 80)

As a hospital chaplain, Walter Pitt once helped a little girl gather the strength to share parting words with her grandmother. Later, he received a letter saying it was one of the most important moments of the girl’s life.

– Ampel, 2013, p. B4

Teaching school is like having jumper cables hooked to your brain, draining all the juice out of you.

– Former teacher, now novelist Stephen King, (as cited by Grothe, 2008, p. 15)

Too often, we therapists neglect our personal relationships. Our work becomes our life. At the end of our workday, having given so much of ourselves, we feel drained of desire for more relationship.

– I. D. Yalom (2002, p. 252)

I tend to give my time away to others before I take it for myself.

– Junior high school teacher, 1996

Resilience, a word that is being used more and more during recent years, refers to a person’s ability to adapt in a positive way to difficult and trying situations. If you want to read in depth about the concept of resilience, Luthar et al. (2000) have written a scholarly review of the topic, one with 169 references! Or, as a short cut, you can just think of the term resilience in this way: The capacity to bounce back from a negative force – like a fishing bobber, pushed under water, pops back up.

Laura Hillenbrand (2010) describes Louie Zamperini this way in her bestseller book Unbroken: A World War II Story of Survival, Resilience, and Redemption. It is a story of a man who went through enormous suffering and pain, described in page after page of this book, and kept coming back. In the first page of the preface, we read of 1943. Louie was in the Pacific Ocean, where he “… lay across a small raft drifting westward… The men had been adrift for twenty-seven days… deep into Japanese controlled waters” (p. xvii). Louie was captured and spent many months in concentration camps where he was the special victim of a brutal guard… but, like the resilient bobber, he kept physically and emotionally bouncing back in the camp, and in the decades after, too. Then in 1998, fifty–five years later, he returned to the site of a concentration camp where he had been held in a cage decades before. Now in triumph, eighty-one-year-old Louie carried the Olympic torch while the local people watched in respect as they saw “the old and joyful man, running” (p. 398). The title Unbroken captures the life story of Louie Zamperini so well. Resilience and more resilience in action.

So many heroic stories of altruism reveal examples of balancing of other-care and self-care: Rosa Parks on the bus comes to mind, as do the Protestant reformer Martin Luther, social worker Jane Addams at Hull House in Chicago, Captain Chesley Sullenberger landing his plane on the Hudson and checking to see again and again that all were out as the plane filled with water. We will finish this section with one more example, this time about the Japanese civil servant who saved hundreds of Jews. Working as a Japanese civil servant in Lithuania in 1940, without asking for authorization, Chiune Sugihara spent 20 hours a day filling out exit visas for desperate Jews (Levine, 1996). In the teeter-totter of other-care vs. self-care, he swung to other-care because, he said, it was the right thing to do.

The resilience demanded of the helping professional is of another dimension; there is not the intensity where basic physical survival is the axis that one’s life revolves around. Yet, the helping professional often expresses the agonizing pull between other-care and self-care: There is a continual pull, constant strain, a tautness. It may not be intense. The common form is subtle, felt as body tension. Usually it doesn’t knock one over. It is more like a small wave rippling through – maybe a wave going in two directions or waves pulling in three directions. Or is it four? Sometimes it is a skirmish that quickly becomes war.

Exhausted when saying yes, guilty when saying no – this tension is between giving and taking, between other-care and self-care. This is a universal dilemma in the human drama. It is just more intense for those who are, by nature and inclination, emotionally attuned to the needs of others. It gets highly illuminated when intense human interaction – helping, teaching, guiding, advising, or healing – is the occupational core. Here, giving of oneself is the constant requirement for success. Caring for others is the precious commodity. It is caring for the Other, when by nature we are, as a species, geared to meet the needs of the self, that provides much of the strength of these caring fields.

The best ones who enter these helping fields have this natural lean toward the needs of others. They see, feel, smell, touch, and hear human need all around them and want to respond.

The best ones struggle the most and figure it out; or leave; or burn, from the inside to the outside, while hope dies. It is not natural to put the Other before the self. The human senses – smell, sight, taste, touch, hearing – are there to protect the me, to promote the me. To know the world through the senses of the Other is like swimming upstream, hard to do and easy to resist. How much should one work for the Other – this moment, this hour, this day, this week, this month, this year, this decade, this career? How much to give this hour to the one I am trying to help when there will be another day of many hours, and another week of many more hours, and another month of even more hours? How much to give of the self for the Other this hour?

In these three paragraphs, we are not talking about dipping into one’s own well of fortitude for Louie Zamperini-type resilience. However, to see human suffering and need all around oneself and to constantly be on the teeter-totter of other-care vs. self-care – do I give or pull back – demands its own kind of resilience. Hence, this book.

To be successful in the helping professions, we must continually maintain professional vitality and avoid depleted caring. For counselors, therapists, teachers, clergy, and health professionals, this can be a very difficult task. Since Freudenberger (1974) first used the term burnout, many authors have discussed the difficulty of professional vitality in the helping and related fields (Baker, 2003; Canfield, 2005; Larson, 1993; Linley & Joseph, 2007; Maslach, 1982; Mathieu, 2012; Papastylianou, Kaila, & Polychronopoulos, 2009; Robinson, 1992; Rothschild, 2006; Shirom, Oliver, & Stein, 2009; Sussman, 1995; van Dernoot Lipsky & Burk, 2009).

A central occupational strength in the caring professions – perspective taking – makes the boundary regulation between the needs of others and the needs of self a difficult task. Occupationally, we are trained to see life from the perspective of the Other, and perhaps we do this naturally by personality, as well. L. King (personal communication, February 1996) suggests that we often have a personal history of active caring for others: “We are often the great friend who listens, the ‘fixer’ in a relationship, the diplomatic person in a disagreement, and/or the ‘helper’ within the family of origin.” In another place, Skovholt (1988) wrote:

One of the most distinguished characteristics of our profession is our intense focusing on highly skilled perspective taking: a combination of empathy, perceptual flexibility, tolerance for ambiguity and affective sensitivity. When successful, all of this translates into a profound ability to understand the world as other people understand it. This well-honed ability, one of our occupational strengths, is not possessed by many people in other occupations.

(p. 283)

In the theater of life, the Other becomes the illuminated part of the stage; our I is often outside the illumination. The lives of others – their hopes, ideas, goals, aspirations, pains, fears, despair, anger – are in focus. Like a leaf under a microscope, we see all of this in highly illuminated detail. As a counselor, therapist, educator, clergy member, or health practitioner, the Other gets our attention. Out of the illuminated microscope, we can easily lose sight of our own needs. We even lose sight of the need to not respond to all needs around us.

In addition to perspective taking that focuses on the needs of the Other, we often are pulled to see things from multiple perspectives. That way we can naturally engage in activities such as family counseling in which we can see the issues from the viewpoint of each family member, as, for example, the mother, father, daughter, and son. Some people would hear of the Wallace Stevens (1923) poem, “Thirteen Ways of Looking at a Blackbird,” and say, “Wow, there are thirteen ways?” Those in the helping professions often use multiple lenses at the same time to understand others.

Being able to see the world of human need through multiple viewpoints can be valuable. Sometimes, though, those in the caring professions lose touch with their own viewpoint and their own needs.

Settings of intense human need can be very unsettling for those in the helping, teaching, and caring professions. This occurs because we are taught to assess, experience, and respond to human need at a much more intense level than the public. That is the goal of training. Nursing homes are an example of a difficult arena. With a honed ability to do perspective taking, one can easily feel the loneliness, fear, and despair of the residents. One practitioner struggled mightily to visit her client in such a place without being overwhelmed by all the other human need. She was caught in the option of exhaustion versus guilt while searching for boundaries of when to reach out and when to pull back. Here, the “shoemaker has no shoes” problem of low self-care can easily occur. Sussman (1995) comments:

Many therapists, for example, grew up playing the role of caretaker, go-between, parentified child or burden-bearer within their families of origin. Having learned at an early age to attune themselves to others, therapists often have great difficulty attending to their own emotional needs.

(p. 4)

Where in the practitioner’s life is self-preservation and self-care held and nurtured? Perhaps the answer can be found in the struggle between altruism and self-preservation within the bigger human drama. As a species, we have been remarkably able to increase our numbers. In recent years, it has been at an astonishing rate, from 2.5 billion in 1950 to 7.2 billion in 2014 (U.S. Census Bureau, 2014). We have accomplished this growth and domination of all other living species with an acute sense of species self-preservation.

Biologically, each of us is wired to preserve the self. The senses continually warn us of danger. The physical defense system fights disease and threat with white blood cells, energy pouring from the adrenal glands, and other miraculous processes. The desire to have children is often thought of as a biological self-preservation. The psychological defenses keep us from harm through the use of denial, rationalization, and projection.

Just as self-preservation seems to be an urgent human drive, we can also find evidence that altruism and self-sacrifice are central. In the winter of 2012 in Newtown, Connecticut, Sandy Hook Elementary School was tragically attacked by an armed gunman (Associated Press, 2012). While the school was under siege, teachers and administrators put the schoolchildren’s lives ahead of their own. Several accounts of heroism were reported in the aftermath of the shooting. Teacher Victoria Soto was said to have physically shielded the children in her first-grade class. Principal Dawn Hochsprung and psychologist Mary Sherlach literally put themselves between their students and the gunman by attempting to intervene, rushing toward the shooter. All three died in the shooting, offering the ultimate sacrifice as they worked to do what came naturally to them as individuals and as helping professionals: to protect and care for the children the...