Is there a way around burnout?

Ideally, the enthusiasm that mental health and addictions counselors bring to their jobs and populations would never fade. But as Eileen O'Mara, EdD, core faculty at Capella University and professor emeritus at Hazelden Graduate School of Addiction Studies, and Thomas Durham, PhD, LADC, CCS, executive director of The Danya Institute, know too well, burnout is an eventual certainty for many counselors. O'Mara and Durham will lead two workshops at this year's inaugural National Conference on Addiction Disorders (NCAD). O'Mara will present “Burnout Prevention: An Individual and Management Challenge,” while Durham will present “Clinical Supervision: An Important Resource for Self-Care.”

When left unaddressed, burnout can result in anything from low morale to high staff turnover. Affected staff members may come in late or call off sick more than usual, find ways to spend less time with patients, make professional errors, develop cynical attitudes, or begin substance abuse themselves. And all of these things ultimately lead to a reduction in the quality of care that patients receive.

“It's an ongoing issue to be aware of,” says O'Mara, who has studied burnout and its effects for over 25 years. “Companies must be prepared to be on top of situations among staff as they arise.”

To effectively address the threat of burnout among staff members, organizations must provide three things:

• A supportive working environment that acknowledges staff stressors;

• Comforting and encouraging clinical supervisors; and

• Therapeutic resources for counselors.

Reduce staff stressors

Though burnout prevention and coping skills are essential for all counselors, O'Mara asserts that organizations also must address the on-the-job stressors that can lead to staff burnout.

“It's really pretty simple,” O'Mara says. “If the organization is committed to supporting staff and giving them the resources they need to do their jobs, that will reduce the level of burnout.” She recommends that organizations include burnout-prevention resources in their strategic plans, such as:

Ample, paid time off to recuperate from work stressors. Although it can be difficult to provide counselors-who typically have weekly obligations to clients and groups-with vacation time, O'Mara says that organizations should supply a substitute for a vacationing counselor. “And personally, I don't think a week is enough,” she says. “People need at least two weeks.”

Health and wellness initiatives. Along with vacation time, health initiatives encourage counselors to take care of their bodies so they are less prone to stress-related illnesses. O'Mara cites Hazelden's employee retention program-which awards employees $50 every time they complete a healthy activity, such as walking a certain distance or choosing a healthy meal from the cafeteria-as an ideal example.

“That kind of stuff really makes a big difference,” O'Mara says. “People like to know that their stress is acknowledged and is being helped.”

Professional growth and learning opportunities. Organizations should also be prepared to support counselors' professional needs as well. “Having the company's support of professional development is critical to a counselor's growth and competence,” O'Mara says. “Bringing in a national speaker, sending people to a conference-like NCAD-and supporting that growth is a major part of keeping people engaged in the organization.”

So, too, is career growth. Often, burnout can be remedied by challenging counselors with new roles or responsibilities. For example, O'Mara says the chance to “switch populations, do case management, work in admissions, or do something a little less intense” can help counselors to “get their balance back,” rather than exit the field altogether.

Vital relationships

A supportive environment is important, but counselors also need a safe relationship in which they can express needs, feelings, and frustrations. This relationship is often provided by their clinical supervisor.

Effective clinical supervision “requires the supervisor to develop a good collegial working relationship with the supervisee, which doesn't always happen,” says Durham. “Some organizations are more concerned with the bottom line and may not be staffed appropriately to provide good supervision.”

He says that effective clinical supervisors function as mentors and sources of support. “The supervisor relationship is key” in helping counselors develop a strong sense of self-confidence and deliver the best possible care.

Such support begins at the top, with an administration that understands what clinical supervision is, he says. Supervisors, in turn, “are responsible for developing a relationship with the counselor to ensure they grow as a clinician and have someone they feel comfortable discussing certain issues with.” These issues, such as compassion fatigue and secondary PTSD developed by working with traumatized patients, must be dealt with in clinical supervision, or they could lead to burnout. Durham suggests that clinical supervisors meet with counselors to address such issues at least one hour each week in a group or one-on-one setting, depending on the counselor's level of experience.

Warning signs

Clinical supervisors should watch for three warning signs of counselor burnout. If noted, these signs call for additional attention beyond the weekly meeting:

• Irritability and escape thinking;

• Reported feelings of countertransference; and

• Abandonment of a spiritual practice, such as meditation or church attendance.

“I usually counsel people that if you have countertransference that is similar in nature and occurs three times in a row, then you need to go to therapy and figure out what the root of it is,” O'Mara says. Because of this, O'Mara insists that all organizations need to provide their employees with an EAP that offers three to six free sessions.

Durham agrees. “A supervisor can suggest the counselor go to the EAP, and they'll do a confidential evaluation and refer them somewhere,” he says. “It makes it a lot easier because the EAP takes the referral away from the supervisor.”

In the event that an EAP is not available, Durham suggests that supervisors offer counselors a list of resources to choose from. Supervisors should not make referrals unless “it's the only thing and there is no other means available.”

While the organization and clinical supervisors can identify warning signs of burnout, it is up to the individual counselor to figure out what prevention strategies work and to maintain them over time.

NCAD 2010

NCAD, to be held Sept. 8-11 in Washington, D.C., is produced by Vendome Group, publisher of Behavioral Healthcare. The inaugural conference offers educational sessions on treatment, administration, design, and technology. Vendome founded the event in conjunction with NAADAC, the Association for Addiction Professionals and the National Association of Addiction Treatment Providers (NAATP).

To register for the conference, visit https://www.ncad10.com.

Behavioral Healthcare 2010 July-August;30(7):24-25