Emotional Labor in Work with Patients and Clients

Effects and Recommendations for Recovery

Dorota Żołnierczyk-Zreda, Dorota Żołnierczyk-Zreda

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000092172
• Edition: 1
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

This book describes psychosocial working conditions that negatively impact the mental and physical well-being of employees of various "assistance-related" professional groups, as well as individuals whose work is related to contact with demanding clients. It offers concepts and research on the causes and effects of emotional burden (most often manifested as stress and burnout) when working with patients, children, and clients.

The book provides a detailed analysis of various aspects of emotional burden at work. It includes a description of studies carried out in 5 different professional groups that were exposed to emotional burden during emotional work and emotional labour. The book discusses the application of known and international diagnostic methods and provides an intercultural comparison. The current diagnosis of stress and burnout, as well as physical and mental health of individuals performing emotional work will be covered, as well as offering practical solutions on assistance for individuals based on the diagnosis of their health.

This book is for any professional or aspiring professional in the field, including postgraduate students. Scientists and practitioners in the field of work and health psychology, management, occupational health and safety, and HR will find this book of interest. Employers of assistance and services sectors, authorities formulating employment laws, lawyers, and occupational medicine physicians are also among this book's top audience.

1 Emotional Labor at Work with Patients and Customers

The Effects and Recommendations for Recovery

Dorota Żołnierczyk-Zreda

The tertiary sector, or services sector, has become the largest sector of the economy in the Western world, and is also the fastest-growing sector. The services economy currently contributes to approximately 70% of the gross domestic product (GDP) in the US and in European countries [The World Factbook 2017]. The work of a significant number of persons employed in this sector often requires intensive contact with customers or patients, where emotional labor is a job demand. It means that workers have to display certain emotions at work, while suppressing other feelings, according to the emotional display rules set by the employer [Hochschild 1983; Côté 2005]. Therefore, emotional labor encompasses a process that includes (a) explicit emotional demands (i.e. display rules) and (b) the effortful strategies needed to meet those demands (i.e. emotion regulation) [Diefendorff and Gosserand 2003; Grandey and Sayre 2019].

The research presented in this monograph covers two service sector branches: health care/social services and public administration, both of which are characterized by high emotional labor demands, and where display rules are explicitly communicated to motivate an effective interpersonal performance [Diefendorff, Richard, and Croyle 2006; Grandey and Sayre 2019]. The health care sector includes ‘social mission’ occupations that are based on the provision of physical and health security, satisfying the basic needs of other people, as well as providing basic skills or knowledge, enabling patients to function in society. The main motivation of workers employed in this sector should therefore be the willingness to help and care for others. The other sector employs tax, revenue, and private or social insurance workers. The main objective of the work performed in this sector is to satisfy the needs of customers by providing high-quality customer service and/or to persuade the customer to purchase the most profitable product from the organization’s point of view, i.e. “service with a smile” [Chua, Bakerb, and Murmann 2012].

An important part of the work of persons employed in both sectors is emotional regulation aimed at expression of certain emotions (e.g. sympathy, compassion, enthusiasm) or suppression of feelings (e.g. irritation, anger, hostility). However, interpersonal interactions with patients and customers induce a variety of both positive and negative emotions in workers [Dormann and Zapf 2004; Grandey, Diefendorff, and Rupp 2012; Grandey and Sayre 2019]. Being compassionate may be difficult when the patient (sometimes involuntarily) is offensive or even aggressive, or when a customer is overdemanding. Thus, there will be instances when workers experience emotions different in type or intensity from that prescribed by the emotional display rules. This discrepancy between the actual feeling and that required by the emotional display rules has been named ‘emotional dissonance’ by Holman, Iñigo, and Totterdell [2008]. Hochschild [1983] revealed that when the emotions and feelings of workers do not match the emotional display rules and the workers experience ‘emotional dissonance’, they often use one of two emotional regulation strategies to ensure that their actions are in line with the required emotional conduct. The first strategy is deep acting, which alters the emotion felt in order to change it and produce a genuine emotional display; the other is surface acting, which only modifies the outward expression of the emotion and produces a faked emotional display. According to Grandey and Sayre [2019], deep acting refers to modifying feelings, which can be done using cognitive strategies (e.g. refocusing attention, reappraisal) to proactively change how one feels (e.g. taking a difficult client’s perspective to genuinely show concern). Surface acting is a type of behavioral modulation (e.g. suppression, amplifying), often performed reactively to negative events (e.g. hiding irritation with a difficult customer).

Deep acting has been found to have a positive association with personal accomplishment and job satisfaction [Bono and Vey 2005; Hülsheger and Schewe 2011], whereas surface acting, accompanied by the lack of authenticity, or expressing emotions differently or in opposition to those actually felt, may constitute a source of stress, because it involves internal tension and suppression of feelings [Brotheridge and Grandey 2002). It is believed that surface acting requires more effort than deep acting [Richards and Gross 2000] and may with time lead to a disconnection from one’s true emotions and instead to feelings of others, and to emotional exhaustion, as well as reduced self-esteem [Brotheridge and Grandey 2002]. To explain this mechanism, particularly the negative effects of emotional labor, the demands and resources theory, such as the Conservation of Resources Theory [Hobfoll 1998; Brotheridge and Lee 2002] or demand–resource model of job burnout [Demerouti et al. 2001] are frequently used. According to these theories, an effort demanding surface acting results in depletion of personal resources, both physical and psychological. However, it has been suggested that, while surface acting may directly deplete effort, deep acting may positively affect well-being due to its role in promoting and obtaining resources [Holman, Iñigo, and Totterdell 2008]. Self-authenticity has been found to be a significant mechanism of the effects of deep acting on worker well-being [Brotheridge and Lee 2002].

Despite the significant knowledge of the different effects of emotional labor, much remains to be explored. The purpose of this monograph is to fill some of these gaps in the contemporary research. The research presented in the monograph demonstrates, for example, that levels of deep and surface acting vary considerably between occupations and contexts, and that contextual factors (such as hostile customer behaviors, or organization type: public or private) appear to play a significant role in the adoption of deep and surface strategies and their effects on worker well-being. The studies presented in the monograph reveal also certain individual factors, such as self-efficacy, that can mitigate the negative effects of emotional labor.

Much has been established on the impact of emotional labor on psychological well-being, such as job burnout and job satisfaction, however, there is still little data on these effects at the level of physical health or lifestyle. This monograph presents research that shows that long-term exposure to high emotional demands at work can lead to depression, and that it can result in excessive alcohol consumption and physical inactivity, which can also reduce the resilience to stress associated with caring for patients.

The monograph also covers methods that can increase this resilience and mitigate the negative effects of emotional labor, including solutions at the level of organizations, in which employees have intensive contacts with patients and customers.

In a study conducted by Mockałło carried out among public tax administration workers and described in Chapter 2, “Stress-Inducing Customer Behaviors and Wellbeing in Tax Administration Workers: What Is the Role of Emotional Labor?”, the author has investigated whether these persons, when confronted with stress-inducing customer behaviors (disproportionate customer expectations and hostile customer behaviors), would choose the deep or surface acting strategy (two aspects of surface acting were examined: hiding feelings and faking emotions). The study has also examined whether deep acting would result in a lower level of job burnout (disengagement from work and exhaustion) and improved physical health, examining symptoms such as headaches, nausea, weakness, stomach problems, etc. The study results have proven that the more workers are confronted with stress-inducing customer behaviors, the more exhausted they feel, the less engaged they are, and the poorer their physical health is. This data is yet further evidence of the negative relationship between stress-inducing customer behaviors and job burnout, and physical symptoms, the latter less frequently analyzed in the literature. Moreover, the study has revealed that deep acting is not associated with job burnout, but significant relationships have been observed with regard to physical health. The result may suggest that persons who perform deep acting emotional labor enjoy job satisfaction and personal accomplishment; however, handling difficult customers with the deep acting strategy continues to drain these workers of personal resources and energy. Contrary to the hypothesis, in conditions of stress-inducing customer behaviors, tax administration workers used both deep and surface acting strategies. Nevertheless, the effort of deep acting led to physical symptoms felt by these workers, which had not been reported in the literature so far. A further novelty of this research is a distinction between two surface acting aspects that are associated with physical symptoms in different ways. In terms of worker mental and physical well-being, hiding feelings has proven to be a weaker type of emotional regulation: it has been found to be associated with poorer physical and psychological health (burnout), while faking emotions has been positively related to job burnout only. In general, the results of this study indicate that even in emotionally difficult situations, workers apply all forms of emotional labor, and that the effects of this labor have various impacts on the mental and physical well-being of workers.

Interesting results with respect to the effects of deep and surface acting on physical and mental health, as well as on job burnout, have also been revealed in the Najmiec’s study carried out among private and public insurance workers who were confronted with excessive demands and hostile customer behaviors as presented in Chapter 3: “The Relationship between Intensification of Stress-Inducing Customer Behaviors, Job Burnout, and Well-Being of Customer Service Workers: The Role of Emotional Labor Types”. Namely, it has been found that among private insurance workers, in conditions of frequent exposure to hostile customer behaviors, the worst physical and mental well-being was experienced by those employees who performed the highest levels of deep acting, compared to those who used the surface acting strategy. Different results were obtained in the group of social insurance workers. In conditions of high-intensity hostile customer behaviors, those employees who performed deep acting emotional labor in customer interactions were characterized by a better physical and mental well-being than those using surface acting. Also, in conditions of disproportionate customer expectations, the greatest physical and mental well-being, as well as the lowest level of exhaustion, were observed among employees using the deep acting strategy. The overall effect of deep acting on job burnout was negative: the more often deep acting was used, the lower the level of job burnout was observed in the group of both private and public insurance workers.

Baka has conducted a cross-lagged study among workers of social rehabilitation centers – youth education centers, youth sociotherapy centers, youth hostels, and correctional facilities – which is described in Chapter 4: “Health Impairment Process in Human Service Work: The Role of Emotional Demands and Personal Resources”. The researcher has examined whether emotional and hiding emotions demands are associated with depression, and the role job burnout and self-efficacy play in this relationship. It has been found that job demands are directly related to depression measured after a year since the first measurement. However, a mediation effects analysis has shown that job burnout plays a key role in the development of depression. High job demands lead to an increase in the job burnout measured after a year, which also exacerbates depression. The author concludes that emotional demands occurring in the work environment affect the workers in a long-term manner, and their effects are postponed [Hockey 1997]. In the first phase of coping with these demands, the worker mobilizes the strength, commitment, and effort needed to perform professional tasks in order to maintain the required level of work quality. This gradually exhausts the worker’s resources to cope with stress, resulting in job burnout and then mental problems, such as depression. The beneficial function of personal resources, i.e. self-efficacy, has also been partially confirmed. A high self-efficacy mediated the negative effect of hiding emotions demands (but not emotional demands) on job burnout. The obtained study results, alongside the scientific value, carry important knowledge that can be used in psychological practice. The results reveal that strengthening the self-efficacy of employees facing high emotional demands in their work should be a necessary component of programs preventing job burnout and possible depression.

Najmiec has conducted a study among 200 employees of residential care establishments whose work is based on intensive and direct contact with the sick, elderly, and persons with chronic mental illnesses or intellectual disabilities, as presented in Chapter 5: “Determinants and Consequences of Work-Related Stress in Personnel of Residential Care Establishments”. The majority of the surveyed workers (over 70%) believed that their work always required addressing the problems of others, putting the workers in emotionally difficult situations. One third reported that their work did not give them the opportunity to develop their skills and learn new competences. They experienced unwanted conduct from patients, such as threats of physical violence or even violence itself, irritating behavior and unwelcome sexual interest. Most of the surveyed workers also reported musculoskeletal disorders resulting from the frequent lifting of chronically ill patients. Among the activities aimed at coping with such job demands, the author has mentioned relaxation training, aggression handling training, and reduction of contradictory job demands such as the need for empathy toward the sick while “not taking up” their complaints.

In Łuczak’s study carried out among medical staff of psychiatric and addiction treatment wards and described in Chapter 6:“Psychosocial Stressors at Work and Stress Prevention Methods among Medical Staff of Psychiatric and Addiction Treatment Wards”, the most important stressors have been found to be high emotional demands and patient aggression. At the lifestyle level, the surveyed workers also reported a lack of physical activity during leisure time as well as alcohol abuse, which could be a result of the stress induced by high emotional job demands, but which also potentially reduces the employees’ ability to cope with this stress. The author recommends that support programs addressed to this occupational group should include such methods of proven effectiveness as Mindful...