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Ethics and the Emotional Sick Day

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Isaac Hunter

on 11 December 2012

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Transcript of Ethics and the Emotional Sick Day

Isaac Hunter MS - August 2012 Ethics and Compassion Fatigue 2.03 Maintaining Competence

Psychologists undertake ongoing efforts to develop and maintain their competence. Ethical Considerations 2.06 Personal Problems and Conflicts

(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.
(b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance and determine whether they should limit, suspend or terminate their work-related duties. Why This Topic? - Reflecting on the year - Nature of college counseling centers - Important but not talked about * What are some reasons we might not talk about it? - Hopefully something we can all relate to Now that you're convinced that we should talk about it we had better define it. - Compassion Fatigue - fatigue, emotional distress, or apathy resulting from the constant demands of caring for others History - It was first diagnosed in nurses in the 1950s. Individual - Those in helping professions are often at the most risk. Compassion Fatigue can impact both the person and organization they belong to. Organization
• Bottled up emotions

• Isolation from others

• Voices excessive complaints about administrative functions

• Substance abuse used to mask feelings

• Compulsive behaviors such as overspending, overeating, gambling, sexual addictions

• Chronic physical ailments

• Apathy, sad, no longer finds activities pleasurable

• Difficulty concentrating

• Mentally and physically tired • High absenteeism

• Inability for teams to work well together

• Desire among staff members to break company rules

• Outbreaks of aggressive behaviors among staff

• Inability of staff to respect and meet deadlines

• Lack of flexibility among staff members

• Negativism towards management

• Strong reluctance toward change

• Inability of staff to believe improvement is possible

• Lack of a vision for the future Symptoms of Compassion Fatigue In traditional Native American philosophy it is told that each time you heal someone you give away a piece of yourself as well. Part of the journey to becoming a medicine man or woman is understanding that the healer will at some point become wounded and need healing themselves (Tafoya and Kouris, 2003). TaFoya, T., Kouris, N. (2003). Dancing the circle: Native American concepts of healing. In S.G. Mijares (Ed.), Modern psychology and ancient wisdom: Psychological healing practices from the world's religious traditions (pp. 125-156). New York: Haworth Integrative Healing Press. References Negash, S., & Sahin, S. (2011). Compassion fatigue in marriage and family therapy: Implications for therapists and clients. Journal Of Marital And Family Therapy, 37(1), 1-13. Donna has been a therapist for over 20 years. She began her profession in a mental health clinic and worked there 14 years. For the last 6 years Donna has worked alone as a private practitioner; her typical work day is around 10 hours. About a year ago Donna was divorced from her husband and gained legal custody of her 15-year-old daughter. Over the last year, Diana has suffered from regular headaches and some back pain. In only 6 months, she has lost 20 pounds and has become increasingly irritable and angry. Diana is feeling exhausted and sleeping fewer hours at night. During therapy she is not in contact with her patients and is unable to empathize. She has become isolated as work and complains of feeling overwhelmed. Recently, she has become less tolerant with clients and has little empathy for couples engaged in struggles similar to those of her own family. www.compassionfatigue.org Ethical concerns? Case Example "Engaging in lighthearted conversation, watching comedy entertainment, practicing religion, and participating in noncompetitive activities or hobbies may also reduce stress and increase happiness. The overall idea is to avoid stress, increase relaxation, and be part of a world that does not mirror that of the therapeutic setting. "Many of us have never really learned how to take the time to care and to nourish ourselves, having been trained to believe that this would be selfish... Nor have most psychologists taken the time to develop compassion for themselves, and compassion for their wounds." (Sapienza and Bugental, 2000) The Paradox of Self-Care Suppose you came upon a man in the woods working feverishly to saw down a tree. "What are you doing?" you ask. "Can't you see?" comes the impatient reply. "I'm sawing down this tree." You exclaim: "You look exhausted!" "How long have you been at it?" The man replies: "Over five hours, and I'm beat! This is hard work." You inquire: "Well, why don't you take a break for a few minutes and sharpen that saw? I'm sure it would go a lot better." The man replies emphatically: "I don't have time to sharpen the saw. I'm too busy sawing!"

... You see a psychologist working feverishly evaluating, treating and assisting client after client...

"Why don't you take a break and replenish yourself? I'm sure it would go a lot better."....

(Norcross and Barnett, 2008) How much does a sharp saw matter? Best statistical estimates are that the therapeutic relationship, including empathy, collaboration, the alliance, and so on, accounts for approximately 10% of psychotherapy outcome. That rivals or exceeds the proportion of outcome attributable to the particular treatment method. (Norcross, 2002; Norcross and Barnett, 2008) We talk about ESTs a lot in our programs but we rarely talk about the other EST - Empirically Supported Therapists.
(Hunter, 2012) (Negash and Sahin, 2011) We all hear tips of what to try but as a field we fail to actually embrace regular self-care. What are some of the barriers? In reality we are probably impaired long before we reach a place like Donna in this vignette.

Perhaps we read extreme cases like this and continue to tell ourselves that we are not in that place and don't need to make any adjustments. A study showed that almost 60% of mental health professionals reported "working when too distressed to be effective" even though many of them acknowledge knowing that doing so is unethical. (Pope, Tabachnick, & Keith-Spiegel, 1987) Another study showed that 74% of 300+ psychologists reported experiencing substantial personal distress during the previous three years.
(Guy et al., 1989) Personal level?

System level? So what can(should) we do about it? 1. Self Awareness and commitment - Make self care a priority not an indulgence - not something to be judged. We judge those who we think indulge. We need to get away from this mentality that more work is always better. As a mental health field we should especially know that quantity does not trump quality.

Having 500 Facebook friends doesn't usually feel as meaningful as a great face-to-face conversation with 1 close friend. 2. Remember and re-experience the privileges of the profession. "It is one of the most beautiful compensations of life that no man can sincerely try to help another without helping himself." - Ralph Waldo Emerson Translation guide:
man = person,
himself = themselves 3. Care for your body - All the things you know you should do. 4. Good relationships at work & at home. Not just one or the other. 5. Practice saying no because you care about yourself and practice getting used to caring. 6. Don't expect more of yourself just because you are a mental health professional. 7. Creating a flourishing Environment. How does your work place stack up? 1. Work load
2. Control
3. Reward
4. Sense of community
5. Respect
6. Having similar values to you 8. Be authentic and congruent with your values. Your intrinsic motivation depends on it! - SDT 9. Try to diversify your day to utilize more of your skills. 10. Support each other in self care. Practice what you preach with yourself and others day to day. This is your life not a weekend workshop. Norcross, J., Barnett, J. (2008) Adapted from "Leaving it at the Office: A guide to Psychotherapist Self-Care (2007) Norcross and Guy Discussion Personal Experiences? Barriers to this topic? Sick day vs emotional sick day. Which is more credible? Barriers to practicing self care? System level versus individual level? The therapist as someone naturally less or more adept at self care? So, what can we take from this and do differently? Self determination theory - Ed Deci, Richard Ryan Self Determination Theory Research When we help authentically and autonomously we are more effective helpers and get more out of it ourselves. When we help begrudgingly, we do little more than placebo for our clients and also don't reap the same rewards ourselves. Dr. Richard Ryan - Presentation INPM Conference (2012) Do we even know when we are not effective?
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