[acb-hsp] Workaholism

[Carmella D Broome]

The sipping point.  That was funny.
I think workaholism is alive and well in the  helping professions. Most 
community MHCs are overloaded.  Caseloads are huge and  the demands on the 
clinician can be ridiculous.  That's why so many people get out of that 
setting sooner or later.  They  know they're not providing the level of care 
they want to.  They know the stress is getting to them. They   know dreading 
going to work is not how they should feel.  Those getting a private practice 
started may  put in some long hours becoming established.  Those in rural 
areas or with  sought after specializations  might have a very hard time 
turning anyone away because they know  needs will not be met.   Those are 
all tough situations.   There are plenty of other settings where  the 
clinician is pushed to overextend him/herself. There are just as many where 
providers choose to do this, though.  It makes me concerned for all 
involved.

Why do we push so hard?  What are we trying to prove and who are we trying 
to prove it to?     Is it about us more than about our clients?    Why the 
need to be the world's best most dedicated therapist?  I get kind of tired 
of  the  mental health professional hero martyr complex.  We're allowed to 
be human and should be human, not superhuman.

Handle  your job that way if you want, but don't  look down on me if I 
don't.   Everyone has  different  energy levels and  we all differ in terms 
of how much stress we can, or want to,  deal with.  Some therapists are 
dealing with their own physical or  emotional limitations or have other 
family obligations or other interests that are  very important to them.  We 
all know what  feels healthy and balanced and when we're there vs when we're 
not.

I often get the feeling that, in order to show yourself to be a  "truly 
committed"  mental health professional, one must  basically demonstrate this 
commitment by being a workaholic.  If its not about  commitment, its about 
how many hours you have to  work a week to make ends meet financially, 
whether or not  you are  truly able to handle such a large caseload well and 
whether or not  you may not be as good a therapist to your clients.  If you 
don't/one doesn't, work  extra, sacrifice blocked off time, and  doesn't 
"give til it hurts,"   dedication level is suspect and there's  subtle guilt 
or pressure from colleagues  or supervisors to do more.

I know people that work  12 hour days on a regular basis, never take 
vacations,  are always doing some related professional something or other 
when   they're not at work, and   literally seem  to eat, sleep, and breathe 
this stuff.  They're going to talk about how hard they work, too, and how 
"that's just what you have to do when you go  into this kind of work." 
They're proud of their stamina, their dedication, their   willingness to 
extend themselves just a little more to save one more person, to intervene 
even though they were hungry and exhausted and had to  cancel other plans.

I've  seen interns in  situations where its almost like they're put through 
some  kind of therapy hazing experience to see if they can hack it.  They're 
given nightmare cases. New professionals are afraid to say "No" as more and 
more is put on them.  They're afraid to say "I don't think I can see that 
many people in a row without a break," or "I don't know if I should take on 
that case," or "No,  I can't work this weekend due to family obligations." 
"I'd rather not drive six hours each way to  go to that conference after 
working all week."  "I've had the after hours phone for a month straight and 
I need a couple  days without it."

Some people take on absolutely any and every case that comes their way. 
Not only do they not have time for so many clients, but they also  can't 
possibly be  skilled enough to address every possible  therapeutic need.  I 
don't care how gifted, skilled, talented, or spiritually called to this work 
you are, that's just not possible. Of course,  many people  seem to want to 
get certified in every niche and specialization known to God and man and 
spend all their extra time and money  pursuing  extra credentials.  I wonder 
why. Why the need to know how to help every  type of client when there are 
others around who  have specializations  and are appropriate referrals?  Why 
try and be thoroughly competent in every  treatment modality?   That's just 
not possible. Do some people think no one could do therapy  as well as they 
can? It seems that way sometimes.

I understand if you're the only provider in a very rural area.  Beyond that, 
though, there's just no reason to try to know everything about everything. 
I'm all about knowing which populations I don't  want to/am not qualified 
to, work with or what I don't specialize in and having a network of other 
medical and mental health people to refer to.  I trust these folks and am 
comfortable with them and   know that referrals I make are in good hands. 
Granted, there are plenty of therapists, or enough of them, near where I am 
to do this. I know that's not always the case. It may  be even less the case 
if you're working with low income clients without insurance and such.

I know people who regularly  stay late to see  clients who need to be seen 
that day.  They  come in early for the same reason.  They  come in  on days 
off to see clients or to do paperwork.  They make sure those around them 
know they  did these things, too. If someone chooses to work  marathon days, 
opens up  additional hours beyond their usual schedule for clients,  spends 
weekends doing paperwork, gives out their personal phone number, and takes 
on new  cases  even though they don't know how they'll fit everyone in, 
that's their choice.  If they think they can't leave their clients long 
enough to take a vacation  and  work extra before and after doing so, then 
that's their right.  I personally don't want  to  be the kind of therapist 
who's clients are truly that dependent on me all the time.   Back up for 
managing crisis situations should be sufficient. I think it is a little 
egotistical to think we can't  step away from our clients for five minutes 
without someone having a major life crisis.   Are we  making them  that way 
to meet our own needs?   Are we helping them or enabling them or what?  If 
someone is that unstable, they need a higher level of care involving a 
treatment team, not just one therapist.

Maybe  some people can just be that steady, have that much energy,  can 
truly be able to care for themselves and their clients, and they truly  do 
want to spend so much time on  career goals.  That's  up to them.  I don't 
want to judge, but I do get concerned for them and for their clients. I'm 
skeptical of how long people can do this well.  I also  resent the 
implication that anyone who doesn't do these things the same way is  not 
thought to be as dedicated or passionate about their work.

Personally, I've realized knowing my limits is crucial to professional and 
personal survival. I think it is ethically irresponsible to overextend 
ourselves.  Clients deserve our full attention and  being overwhelmed by a 
caseload that is too large is  a recipe for something important to get 
overlooked or for  service to be compromised somehow, even if it  is just 
because a person is distracted or tired or simply too busy with too many 
other people to take  appropriate action.  This work, to me, is about 
quality vs quantity. I'm not trying to break any records for how many 
sessions I can  cram into a week before collapsing.  I'm not  competing with 
anyone to  see   who had the most severe crisis case or   most difficult 
case this week,  and how much extra time was taken  beyond the time alotted 
for the session.  I'm not going to be guilt ridden if I didn't take on 10 
new pro bono cases or if  I charged a client for deciding  not to attend a 
session without an important reason.

I  also think it can be hypocritical to  preach self care to our clients, 
and to talk with them about "shoulds" and boundaries and differentiation, 
and then not  put those things in place for ourselves.  None of us can see 
every client with every issue at any time of day no matter how many hours 
we've already worked that week.  None of us are so special that we can't 
refer, delegate, or say "No" if its more than we  can or should take on.  We 
need to  practice  the balance we preach and  not be martyrs to our 
profession. We need personal lives, hobbies, and  to make  time for pursuits 
outside of work.

This doesn't mean we aren't dedicated.  It means we want to  do our  jobs 
well and  be able to continue in the profession for  a long time.  This is 
not a sprint; its a  marathon and pacing seems very important.  Use up all 
your energy too soon and you just fall behind and drop out sooner rather 
than maintaining a  pace that is  consistent and  reasonable. We all need to 
stretch and grow and challenge ourselves, but we need to be wise minded 
about this, too.  Join professional orgs and take part in meaningful 
committees or other groups.   Read and take  CEU courses and  other classes 
that interest you.   Take extra time now and then for particular clients if 
you choose to do so for particular reasons, but   do so because you  really 
do want to and freely choose to.

Counseling is draining work.   If we're not careful and self-aware, we'll 
all be burned out, vicariously traumatized, compassion fatigued, resentful 
that we've let our jobs drain the life out of us, and of no use to anyone, 
including ourselves.  And as we  so often tell our clients, if those things 
happen, they're due to our own choices entered  into for whatever 
subconscious or  psychologically complicated reasons.

Climbing down from soap box now.

Carmella Broome EdS LPC LMFT
Crossroads Counseling Center, Lexington SC
http://CounselorCarmella.WordPress.com
Author of Carmella's Quest:  Taking On College Sight Unseen (Red Letter 
Press 2009)
http://CarmellasQuest.LiveJournal.com


Carmella Broome EdS LPC LMFT
Crossroads Counseling Center, Lexington SC
http://CounselorCarmella.WordPress.com
Author of Carmella's Quest:  Taking On College Sight Unseen (Red Letter 
Press 2009)
http://CarmellasQuest.LiveJournal.com