Why is self-care a critical social work survival skill?

Introduction

There is surmountable research indicating that self-care is vital to the effective practice of caring for others (e.g. Alkema, Linton & Davies, 2008; Weiss, 2004) in order to counteract burnout, compassion fatigue (Bride & Figley, 2007; Figley, 1995; Stamm, 2010) and secondary traumatic stress [STS] (Lloyd, King, & Chenoweth, 2002).  Social work practitioners in particular are placed at heightened risk for the psychological, emotional and physical impacts associated with high stress and burnout as they assist clients with complex needs and in a range of stressful work environments (Alkema, Linton & Davies, 2008; Cocker & Joss, 2016; Wagaman, Geiger, Shockley & Segal, 2015). Therefore, self-care strategies are of crucial value for social work practitioners to manage stress and potential burnout and, of equal significance, to ensure that their quality of client care is not compromised (Stamm, 2010).  However, despite being trained in self-care, the alarming prevalence of burn out experienced by social workers warrants serious concern (Smith, 2015).   Importantly, this report aims to shed light on the following topic: Why is self-care a critical social work survival skill?

Self-care defined

Prior to studying the importance of self-care in the context of social work, it is firstly necessary to define the concept.  Pioneered by a nurse practitioner in the 1950’s (Renpenning & Taylor, 2003; cited in Orem, 2001) self-care theory was initially described as an individual’s ability to simultaneously care for others whilst regulating their own functioning and development (Orem, 2001).  According to the theory, an individual needs to be aware of, and be in balance with, their physical and mental health needs in order to conduct effective social work practice (Denyes et al., 2001). To achieve this, the individual must identify and utilise mechanisms to protect and safe guard their self-care needs resulting in “deliberately produced care systems of therapeutic quality,” that “regulate human functioning and human development within norms” (Denyes et al., 2001, p.53).

Adaptive self-care strategies are encouraged in the existing social work research, as they are believed to provide practitioners with a nourishing life support to sustain their professional career (e.g. Alkema, Linton & Davies, 2008; Denyes et al., 2001; Lloyd, King & Chenoweth, 2002; Stamm, 2010; Weiss, 2004).  Healthy and constructive self-care actions are invaluable to a social worker’s capacity to achieve success, maintain positive well-being, and maximise longevity in their helping role (Orem, 2001).  On the contrary, if a social worker has a deficit in their ability to care for themselves, they expose themselves to burnout (Smith, 2015), secondary traumatic stress [STS] (Lloyd, King, & Chenoweth, 2002) and compassion fatigue (Figley, 1995; Stamm, 2010), ultimately impacting on their ability to provide adequate care for others (Smith, 2015; Wagaman et. al., 2015).

Burnout in relation to self-care

There are various definitions given for burnout in the literature, however there is consensus that burnout is experienced as an overpowering sense of emotional exhaustion, feelings of professional inadequacy, a loss of personal identity, and lowered self-worth (Hombrados-Mendieta & Cosano-Rivas, 2013; Sprang, Craig & Clark, 2011; Wagaman, et al., 2015). It is a cumulative response resulting from the demanding nature of social work and engagement with emotionally charged relationships with clients whereby (over time), the social worker’s adaptive defences become worn down by a range of individual-related, client-related, and organisation-related factors (Wagaman, et al., 2015).

The effect of burnout is so overwhelming that it impairs a worker’s ability to conduct their daily professional and personal duties and responsibilities (Boyas, Wind & Kang, 2012; Maslach & Schaufeli, 1993).  Burnout has been associated with physical and mental health problems such as depression (Kim & Stoner, 2008), insomnia, gastrointestinal issues (Lee & Ashforth, 1993), headaches, high blood pressure, chronic fatigue, and muscle tension (Maslach & Leiter, 1997).  Further, it has been linked to decreased job satisfaction and lowered performance in the workplace, an increase in absenteeism, a high staff turnover and decreased organisational commitment (Kahill, 1988).

Given that “the single largest risk factor for developing professional burnout is human service work in general” (Newell & MacNeil, 2010: p. 59) it is not surprising that the rates of burnout in the research of social work are devastatingly high (e.g. Cocker & Joss, 2016).  For example, McFadden’s (2015) study of 1,359 social workers across the UK found concerning levels of reported emotional exhaustion and depersonalisation, which is are associated with the experience of burnout. Precisely, 73% scored in the high category of emotional exhaustion (with an additional 18% scoring moderate levels) and greater than one in four participants (26%) scored in the high category of depersonalisation (in addition to the 35% who scored in the moderate category).

Secondary Traumatic Stress (STS) and self-care

Characterised by fatigue, STS typically arises from second-hand exposure to traumatic events, usually experienced from witnessing or listening to the accounts of others’ experiences and/or life stories (Bride, 2007; Kulkarni, Bell, Hartman & Herman-Smith, 2013; Pryce, Shackelford & Pryce, 2007; Sprang, Craig & Clark, 2011).  Consisting of symptoms that bear a strong resemblance to those of posttraumatic stress disorder (Bride, 2007; Kulkarni et al., 2013); a social worker experiencing STS may experience fatigue, hypervigilance, nightmares, sleep disturbance, and agitation (Newell & MacNeil, 2010).  Such vicarious trauma can influence feelings and experiences of burnout (Van Heugten, 2011) and cause significant interruption in the worker’s professional ability (Perkins & Sprang, 2013). 

The occurrence of STS has become so prevalent that is increasingly being viewed as a critical occupational hazard to social workers (Bride, 2007).  For example, in a study conducted by Bride (2007), 70% of social workers were found to experience at least one symptom of STS, whilst a considerable minority (15.2%) were found to potentially meet the diagnostic criteria for PTSD.   Additionally, a three year study undertaken by Kim, Ji and Kao (2011) reported that the health of social workers can be impacted upon within one year of exposure to secondary trauma due to mental fatigue.

Self-care approaches to reduce burnout and STS

A number of self-care strategies have been suggested for social workers to adopt on an individual level, in order prevent and manage the risks associated with burnout and STS (Alkema, Linton & Davies, 2008).  Human service practitioners are advised to proactively increase self-awareness and address their own personal needs; in terms of personal, emotional, familial, and spiritual (Figley, 2002; Stamm, 1999; Wagaman et al., 2015).  By doing this, social workers are more likely to be better equipped to cope with the daily demands of their clients and the work environment (Wagaman et al., 2015). The risk of burnout can also be reduced by the individual actively setting goals and boundaries within their day to day role, in terms of being aware of their own capabilities and limits (Wagaman et al., 2015).  For example, having clear parameters in regards to workload, client care and taking scheduled work breaks are noted (Maslach, 2003). 

A wealth of research espouses self-care strategies based on positive health and well-being (e.g. Killian, 2008; Wagaman et al., 2015). In general, the maintenance of an individual’s overall physical health can combat burn out and reduce susceptibility to STS by ensuring sufficient exercise (Killian, 2008), recreational activities, restorative sleep, and good nutrition (O’Halloran & O’Halloran, 2001; Wagaman et al., 2015; Zimering, Munroe & Gulliver, 2003).  Healthy social networks and the availability of social support have also been found to mediate and mitigate the effect of burnout and STS (Killian, 2008; Lakey & Cohen, 2000; Wagaman et al., 2015). 

Structured organisational approaches that promote and foster self-care of staff are known to have a positive role in targeting burnout and STS, with the availability of supervision and a meaningful supervisory relationship highlighted as particularly beneficial (Boyas, Wind & Kang, 2012; Killian, 2008; Kim & Lee, 2009; Siebert, 2005).  It is through the guidance of such a supervisory role model that a worker can build resilience and be encouraged to practice self-care (Boyas, Wind & Kang, 2012).  Further, the processing, debriefing, and support gained through the supervision process can help facilitate self-care and nurturing for the worker in relation to their practice (Killian, 2008).

It is believed that a blend of individual and organizational self-care approaches have the most positive effects in reducing burnout (Awa, Plaumann & Walter, 2010). However, it is suggested that there is a larger focus on developing self-care strategies and treating burnout after it occurs, rather than espousing practices to build resilience and self-care within practice.  Additionally, researchers such as Newell and MacNeil (2010) suggest a need for social work organisations to educate their staff, whereby raising awareness, on the importance of self-care practices that prevent burnout and STS.

Conclusion

In summary, the above review of literature on the role of self-care in the practice of social work raises several key points. Firstly, given the high level stressors and challenges of working in the caring profession, it is clear that self-care is imperative for social workers to ensure best practice.  Specifically, self-care is vital to mitigate the impacts of high level stress in terms of social worker’s performance and service delivery.  Secondly, it is imperative that social work agencies proactively adjust or adapt their modes of operating to the reality of the struggles experienced by their social work staff, given the high rates of burn out and STS in the field.  Thirdly, the adoption of methods at an organisation level is paramount to effectively enable social work employees to develop and practice self-care.  Lastly, it is imperative that social workers are proactive in setting boundaries to gear their work towards self-care practices and undertake steps to nurture their health and well-being on an individual level. Combined, individual and organisational approaches will help safe guard the well-being of practitioners in the field, whilst simultaneously preventing harm to both practitioners and their client care.

References

Alkema, K., Linton, J. M., & Davies, R. (2008) A Study of the Relationship Between Self-Care, Compassion Satisfaction, Compassion Fatigue, and Burnout Among Hospice Professionals. Journal of Social Work in End-of-Life & Palliative Care,4(2),101-119

Awa, W., Plaumann, M., & Walter, U. (2010). Burn-out prevention: A review of intervention programs. Patient Education and Counseling, 78, 184-190.

Boyas, J., Wind, L. H., & Suk-Young, K. (2012). Exploring the relationship between employment-based social capital, job stress, burnout, and intent to leave among child protection workers: An age-based path analysis model. Children and Youth Services Review, 34(10).

Bride, B. E. (2007). Prevalence of Secondary Traumatic Stress among Social Workers. Social Work, 52(1), 63–70.

Bride, B., & Figley, C. (2007). The fatigue of compassionate social workers: An introduction to the special issues of compassion fatigue. Clinical Social Work Journal, 35, 151-153.

Cocker, F. & Joss, N. (2016). Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. International Journal of Environmental Research and Public Health, 13(6), 618.

Denyes, M. J, Orem, D. E., & Bekel, G. (2001). Self-care: A foundational science. Nursing Science Quarterly, 14(1), 48-54.

Figley, C. R. (1995). Compassion fatigue: Secondary traumatic stress disorders from treating the traumatized.  New York: Brunner/Mazel.

Hombrados-Mendieta, I. & Cosano-Rivas, F. (2013). Burnout, workplace support, job satisfaction and life satisfaction among social workers in Spain: A structural equation model. International Social Work, 56(2), 228 – 246.

Kahill, S. (1988). Symptoms of professional burnout: A review of the empirical evidence. Canadian Psychology, 29(3), 284-297.

Killian, K. D. (2008). Helping till it hurts? A multi-method study of compassion fatigue, burnout, and self-care in clinicians working with trauma survivors. Traumatology, 14(2), 32-44.

Kim, H., Ji, J., & Kao, D. (2011). Burnout and physical health among social workers: A three-year longitudinal study. National Association of Social Workers, 56(3), 258-268.

Kim, H. & Lee, S. Y. (2009). Supervisory Communication, Burnout, and Turnover

Intention among Social Workers in Health Care Settings. Social Work in Health Care 48(4), 364-85.

Kim, H., & Stoner, M. (2008). Burnout and turnover intention among social workers: Effects of role stress, job autonomy, and social support. Social Work in Health Care, 32(3), 5-25.

Kulkarni, S., Bell, H., Hartman, J. L., & Herman-Smith, R. L. (2013). Exploring individual and organizational factors contributing to compassion satisfaction, secondary traumatic stress, and burnout in domestic violence service providers. Journal of the Society for Social Work and Research, 4(2), 114-130.

Lakey, B. & Cohen, S. (2000). Social support theory and measurement. In S. Cohen., L. G. Underwood & B. H. Gottlieb  (Eds.), Social support measurement and intervention: A guide for health and social scientists (pp. 29-52). New York: Oxford University Press.

Lee, R. T., & Ashforth, B. E. (1993). A meta-analytic examination of the correlates of the three dimen-sions of job burnout. Journal of Applied Psychology, 81, 123-133.

Lloyd, C., King, R., & Chenoweth, L. (2002). Social work, stress, and burnout: A review. Journal of Mental Health, 11, 255-265.

Maslach, C. (2003). Burnout: The cost of caring. Cambridge, MA: Malor Books.

Maslach, C., & Leiter, M. (1997). The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco, CA: Jossey-Bass.

Maslach, C., & Schaufeli, W. B. (1993). Historical and conceptual development of burnout. In C. Maslach, W. B. Schaufeli, & T. Marek (Eds.), Professional burnout: Recent developments in theory and research (pp. 1-18). Washington, DC: Taylor & Francis.

McFadden P. (2015). Measuring burnout among social workers: A community care study. [ONLINE] Available at:

http://www.qub.ac.uk/sites/media/Media,514081,en.pdf[Accessed 30 June 2018].

Newell, J. M. & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practice in Mental Health, 6(2), 57-68.

O’Halloran, M. S. & O’Halloran, T. (2001). Secondary traumatic stress in the classroom: Ameliorating stress in graduate students. Teaching in Psychology, 28(2), 92-97.

Orem, D. E. (2001). Nursing: Concepts and Practice (6th Ed.). St. Louis, MO: Mosby.

Perkins, E. & Sprang, G. (2013). Results from the Pro-QOL-IV for substance abuse counselors working with offenders. International Journal of Mental Health & Addiction, 11(2), 199-213.

Pryce, J. G., Shackelford, K. K. & Pryce, D. H. (2007). Secondary traumatic stress and the child welfare professional. Chicago: Lyceum Books

Smith, L. W. (2015). Compassion fatigue, burnout and self-care: What social work students need to know. Electronic Theses, Projects, and Dissertations, 206. [ONLINE] Available at: 

http://scholarworks.lib.csusb.edu/etd/206 [Accessed 30 June 2018].

Sprang, G., Craig, C., & Clark, J. (2011). Secondary traumatic stress and burnout in child welfare workers: A comparative analysis of occupational distress across professional groups. Child Welfare, 90(6), 149-168.

Stamm, B. H. (2010). The concise ProQOL manual (2nd Ed.). Pocatello, ID: ProQOL.org.

Van Heugten, K. (2011). Social work under pressure: How to overcome stress, fatigue and burnout in the workplace. London: Jessica Kingsley.

Wagaman, M. A., Geiger, J. M., Shockley, S. & Segal, E. A. (2015). The Role of Empathy in Burnout, Compassion Satisfaction, and Secondary Traumatic Stress among Social Workers. Social Work, 60(3), 201–209.

Weiss, L. (2004). Therapists guide to self-care. New York, NY: Brunner Routledge.

Zimering, R., Munroe, J. & Gulliver, S. B. (2003). Secondary traumatization in mental health care providers. Psychiatric Times, 20(4), 43-47.