Best practice guidelines for burnout prevention for counselors

Research studies indicate that the rate of burnout and an increase risk of occupational related psychological problems among professional counselors are on the rise and are threatening the quality and safety of health care.

The nature of the work of counselors make them vulnerable to stress, poor self-care and other problems such as burnout, compassionate fatigue and vicarious traumatization

Administration and Policy in Mental Health and Mental Health Services Research published in a journal article in 2012 that as many as 2 out of every 3 mental health workers “may be experiencing high levels of burnout.”

Burnout 101

Burnout results of a long-term chronic stress state. Mental fatigue and emotional exhaustion, negative feelings and perceptions about clients and colleagues and a decrease in feelings of job satisfaction are part of burnout.  It is considered to be a “work related mental health impairment”. It’s often correlated with anxiety and depression and can manifest itself in many ways. Physical symptoms related to burnout are fatigue, increased health issues and chronic conditions, and inability to regulate the expression of emotions.

Other harmful effects are a decrease in the capacity of attention and concentration, impairment in decision making, absenteeism, increase number of clinical errors, depersonalization, withdrawal from others, exiting the counseling profession, negatively impacting the counselor profession, ethical violations, increase in the inequity between counselor and client, perception of clients as problems/objects, and decrease in job satisfaction.

It affects most counselors, psychotherapists or mental health workers at some point in their careers’ life. Therapists earlier in their careers are also affected.

According to Marini et al. (2017), in relation to burnout there are 3 types of counselors, those differ in self-esteem, job satisfaction and locus of control.  Well-Adjusted counselors are those with the second highest income and highest job satisfaction. Disconnected counselors are those that are moderately exhausted, perceive a negative work environment and a deterioration in their personal life, devalue clients, have poor self-esteem and the lowest income and job satisfaction. Finally, the preserving type of counselor has high levels of fatigue and exhaustion, negative work environment, are exhausted in their professional and personal lives but are attentive to their clients.

Counselors tend to neglect self-care, this might be due to lack of time and energy or to the belief that counselors do not deserve self-care as clients do.

Burnout Causes

There are multiple causes of burnout both personal and system/environmental factors are included.  Not engaging in good self-care practices, lack of career sustaining behaviors, malalignment with purpose and passion, and lack of healthy lifestyle behaviors such as poor sleep, and poor diet, are among some of the personal factors that may contribute to burnout.  Long shifts, big case load, ongoing challenges with health records and administration load, inadequate support, poor work culture, lack of supervision, lack of trust, bureaucracy and lack of resources, fraudulent policies, power differential, and lack of connection and support from coworkers, are among the multiple environmental/system factors that may contribute to burnout.

Professional Responsibility to prioritize self-care

  • The ACA Code of Ethics (ACA, 2014) states that counselors “engage in self-care activities to maintain and promote their own emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities,” (Section C).
  •  The Code of Ethics recognizes the importance of self-monitoring in this capacity by requiring that “Counselors monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired,” (Section C.2.g.).

Mindful Self-care plan

Self-care doesn’t have to be expensive or time-consuming. It shouldn’t feel like another item on the list. Regular small doses of self-care practices and adhering to career-sustaining behaviors are more effective than practicing self-care once or twice a week.

A multicomponent comprehensive strategy is required to build a culture of sustainable well-being in which the health care system provides the infrastructure and resources for fostering a culture of wellness and in which the counselor adheres to healthy choices and career-sustaining behaviors.

Self-care has been shown to be one of the most essential protective factors against occupational related psychological problems and is an ethical requirement for continued practice (ACA, 2014).

The complexity of the relationship between the emotionally demanding work and emotionally satisfying work of counselors, urge counselors to use Evidence base self- care innervations.

Evidence-based self-care practices:

Assess your self-care resources

Assess where you are in your self-care and career sustaining behaviors. There are many resources available for this, one option is the clinical version of the “Mindful Self-Care Scale” which is an 84-item scale that measures the self-reported regularity of behaviors and attitudes that measure self-care behavior. This evaluation will help you develop a self-care plan that is more personalized and specific to you. Find this evaluation here.

Try mindfulness

An emerging body of evidence suggests that mindfulness may protect mental health professionals at risk of burnout. Mindfulness can be practiced in many ways, it’s all about observing the present moment in a nonjudgmental and intentional way. You may do this by practicing breathing exercises, guided meditations, self-massage, painting mandalas, chanting mantras, etc.

Tap into resilience-building strategies

Create a plan for maintenance and prevention that includes the 4 domains or dimensions of yourself: Emotional, Mental, Physical and Spiritual wellness. Consider quick/easy strategies that can help you boost your wellness in all 4 domains. Find strategies to help you during stressful and challenging times. Become aware of stress-inducing triggers and anticipate those triggers by developing strategies that can help you deal with those triggers. The model for Creative Self Care can help you create a Mindful self-care plan.

Balance is key

Balance is key to practicing effectively and preventing burnout.

Seek social support.

Ongoing peer support and consultation can be very helpful in preventing burnout.

Practice Self-Compassion and Self-Kindness

Celebrate your successes and continuously look to find the gift of acceptance, love and self-compassion.

Practice Ethical Risk Management

Continuously update on changing laws and ethical guidelines. Seek consultation, extra documentation to support your practice.

Change the way you think about your work

Keep your job in perspective, identify your strengths and weaknesses and monitor your own reactions, body sensations, thoughts and emotions on an ongoing basis.

Get moving

Celebrate your successes and continuously look to find the gift of acceptance, love and self-compassion.

Personal Counseling

Your personal issues may be revealed in counseling relationships. Your own personal therapy is a very important assest to providing quality therapy

Nutrition and Hydration

Eating on the run and consuming caffeine and sugared drinks will cause your energy levels to be low. Eat small, healthy snacks throughout your day.

Supervision

Supervision will give you an enviroment to explore clinical issues. Using the Wellness model in supervision which takes into account the 5 aspects of wellness has been shown to foster balance and counselor's wellbeing

Construct hope and optimism

Set goals, develop strategies to achieve them and maintain motivation through pathway and agency thinking. According to Marini et al. (2017), persons with hope and optimisms can foster good coping skills, higher self-efficacy and internal locus of control, and increase effective problem solving skills.

Culture of Wellness

Evidence-based interventions must be targeted to counselors, the community of practice, the workplace culture and environment, and institutional policies. It’s is important to prioritize wellbeing within an organization, counselors should be offered the resources for the prevention of occupational related psychological problems.

References:

  • American Counseling Association. (2014). ACA Code of Ethics. Retrieved from http://www.counseling.org/docs/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=4
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