[acb-hsp] Workaholism

[Karen Rose]

Carmela and All:  Well, I'm it--a therapist/workaholic who is proud of 
it.(smile)  However, I certainly hold no judgement against others who either 
have less energy, more of a personal life, desire greater balance, or have a 
second source of income, not to mention those who choose to live somewhere 
other than the paradise of the San Francisco Bay Area and therefore do not 
have to pay a minimum of a half million dollars simply to own a home.  I 
happen to come from a very high-energy family of workaholics, and to choose 
to live in the very most expensive part of the country.

But there are some things missing in your argument:  For one thing, the 
insurance companies have given therapists *no* increases for the past 
*thirty* years.  Yet the cost of living has gone up significantly in that 
time.  Do you know of any other profession or industry in which there have 
been no raises at all over the past thirty years?  Yet, we are not permitted 
to organize and bargain collectively since, as independent contractors, we 
would be violating laws that restrict restraint of trade.  So, we're caught.

Compounding this for me is my fear of leaving the insurance companies and 
charging only private pay rates.  First, I actually believe that people 
should be able to benefit from their hard-won benefits.  Second, I have been 
specifically told by sighted colleagues that they would not wish to risk 
their reputations and the comfort of their clients by refering to a blind 
therapist.  True, this was many years ago, but I am not at all sure that it 
wouldn't still apply, despite the fact that I now have a very full practice 
of about fifty client hours per week, devided between therapy with insurance 
clients and career counseling that is private pay.  Has anyone else dealt 
with these issues with colleagues?  I find it interesting that blindness is 
almost never raised by clients, but often by colleagues.

Karen
----- 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 7:24 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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