[acb-hsp] Workaholism

[J.Rayl]

Well Carmella, you have brought up a lot of issues: probably too many for me 
to either remember or address here.  However, the whole issue of therapists 
and work-aholism is a serious one, and one that therapists and supervisors 
need to address.  For one thing it has many ethical implecations.
If therapists are, in fact, taking on too many cases and then cannot give 
the clients the time or attention they need, this could have serious, even 
detrimental, impact to the client, or therapist.  But the ethical codes are 
not, primarily, concerned with what is best for the therapist, it is "Do no 
Harm" to client.  However, by the time any professional reaches the level 
of, even Bachelors, but certainly Masters level, they also need to have 
reached a point in time in their lives where they have assumed enough 
personal responsibility to assess their own individual level of risk of 
safety.  I would question, if one cannot do that, how then can one assess 
me, or my child, as client adequately?  And if your inclination is to snap 
back something like: its easier to tell where someone else is, or tell 
someone else how to resolve problems, well all I can say is, look at that. 
But I'm not your supervisor <smiles>  I'll not engage the argument, however, 
would encourage some real reading / exploration on self-awareness for the 
interested learner / grower.

As to the reason many leave this profession, burn-out and low pay or among 
the top reasons.  For many it doesn't matter how much they work, their 
salary remains the same, very low pay, in comparison to most other fields 
out there.
And for the rest of us, we work much much more than are we ever paid to 
work.  So, unless we derive great internal reward from what it is we do, we 
burn out.
And either case poses serious ethical problems again.  Burn-out places the 
clients at risk because we dread going to work, have little regard for them 
when we are there, are often sick, succomb to illness or addiction, or are 
often absent thereby missing their appointments, are not in tune with them, 
etc.
Loving too much what we do makes us disregard the actual code of ethics 
because we'll do, or say, things out of "love", not that are based on what's 
best for the client.  We become entangled in dual-relationships and 
unhealthy relationships with clients.  We do not set appropriate boundaries. 
We are violating any number of other ethical violations because we "love" 
what we do and simply disregard that there is a proper code of ethics we're 
supposed to be following.  Some don't even know, or care, what it is because 
there bottom line is, more clients, more money, more to do because that is 
their "love".

As for why therapists keep training for this and that specialty / 
certification?  Many reasons.  Some do it out of general curiosity.  My 
coworker is simply a study addict.  <LOL>  He loves to learn, loves to 
study.  He always has--ever since he was a kid, and he's 70 now and is 
seeking a Doctorate.  He's got voocoos of Certifications, etc.  He just 
loves to learn and study.
Some of us, like me, know that therapists are a dime a dozen and compete 
like professional olympics trainers, and you better darn well compete with 
them or you're busted.  I don't happen to enjoy just one huge population 
(like kids only) as a couple of my colleagues do.  They thrive on just kids 
and could work with them all day.  In fact, if they never had to see an 
adult, they'd be happy.  <LOL>  I have another couple of colleagues who 
thrive on substance abusers and, if they never had to see a non-substance 
user, they'd be happy!  Well, I cannot just do that; I'd be bored stiff and 
burned out so quickly I'd have been a dog-catcher in three years after 
getting into this field.  <LOL>!
So, what am I going to do?  Marriage and family might get it, but I truly 
doubt it--not in this area.  While, granted, there are a lot of not happy 
couples, the show rate for them is just not that good or reliable and the 
insurance pay is worse.
So, all this plus, in the community mental health center, there was no 
choice: we had to see everyone who walked in the door, period, without 
question, didn't matter diagnosis, what you thought it was, wanted it to be, 
wanted your "specialty" to be, etc., etc.  You saw that person, you treated 
that person, and you better keep them coming back.  Yeah! that was your 
responsibility as a therapist, because that is what kep the MH Center going.
And the third factor for me, and I suspect other therapists, is I knew that 
if I didn't succeed as a therapist, it would not be a good thing for me 
because just what was I going to do then?  My choices were live on SSDI or 
figure out another career?  Well, I'd been down the "figure out another 
career thing" and this was the end result of that.  And, I'd pretty much 
been down the "I don't wanna live on SSDI" so starting my business was the 
end result of that, so making it succeed is the goal.  So, being as diverse 
as possible is the thing that works.
As to why therapists do not set boundaries--because that's what it is when 
we take the phones for a month at a stretch, or cancel family obligations, 
or cannot figure out how to do phones and the family obligation all-in-one, 
etc.?  Well, again, I'd encourage the interested learner to do some 
self-awareness.  I did, and it was quite enriching.  Not a thing happened 
when I began to set those much-needed boundaries, except I became happier 
and much healthier.  I actually had more money because I began to earn a 
little more, save a whole lot more too.  <smiles> And found I was incredibly 
more productive.  And, I started making the changes I wanted for me in my 
life versus blaming everyone else, living in fear and anxiety and denying 
problems that I had.

Do I consider myself a work-aholic?  No, I do not.  Do I work 60 hours a 
week?  Easy.  Do I have other balances, etc.?  I certainly do.
No, I don't hop on a plane and go spend weekends, or weeks, with my family 
in Chicago, Kansas, Texas, and everywhere else they so happen to live.  And 
when I get the opportunity, I do; and most of us are connected via FB, 
phone, email.
I, equally, don't plane-hop all the time to see my friends who are scattered 
around the US and the world; however, again, we're connected by FB, phone 
and email, and when we have opportunities, we spend time together in person.
I have other wonderful balances: take long relaxing walks on weekends, walk 
to & from work versus utilize the bus (on most days), meditate / pray before 
I sleep and first thing in the morning, spend time outside in the sunshine 
barefoot so that as much of me is exposed to the sun and earth as 
possible--until it is as cold that I cannot tolerate it; have grow lights 
throughout my house; keep doors & windows open as much as I can; take my 
books with me (non MH related) so that any down time I've got is spend 
reading non-MH books; go to enjoyable events--plays, movies, musicals, 
concerts, etc.; --many things.  And, of course I work on my dissertation.
How do I do all these things and work?  Well, there is no TV to take my time 
with idolness for one thing.  I don't spend a lot of useless time on phones 
for another, and when I do, I'm doing other things--folding clothes, things 
that I can do.
My cell phone is always with me for client / family and so, its on vibrate. 
If I'm at an event, I sit near a door, simply step out and take the call and 
return quietly to my event.  (I explain beforehand to the usher or whomever 
that I'm a MH counselor and this may well happen).  If I'm with family / 
friends, they know it, understand and life goes on.  In other words, I don't 
cancel or stop family / friends stuff because of my job--never did even when 
I worked crisis with Eastridge.  I decided long time ago that my job would 
not rule my life.  <smiles>  So even when I travel, my ole trusty c-phone 
and braillesense goes right along and I do the same thing.  Before I had a 
BS, I just had a slate & stylus and entered it in the computer later. 
Somehow, I've always made it work for me.
As for other people's response: I don't let it bother me ...this is my life 
...what I do.





Jessie Rayl
thedogmom63 at frontier.com
www.facebook.com/Eaglewings10
www.pathtogrowth.org

----- Original Message ----- 
From: "Carmella D Broome" <cdbroome at att.net>
To: "Discussion list for ACB human service professionals" <acb-hsp at acb.org>
Sent: Wednesday, October 03, 2012 10:24 PM
Subject: Re: [acb-hsp] Workaholism


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

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