Andrew Bernhardt is a Counsellor based in North London and a Senior Lecturer in Social Work at the University of Hertfordshire.
Before qualifying as a Counsellor he worked as a Probation Officer for 21 years. He is the UK coordinator of an Anglo-Russian training project teaching social work and counselling techniques to Russian Criminal Justice Staff. He also works for the Council of Europe training Probation staff in counselling theory and techniques in Georgia.
PRN spoke to him about burnout and how we can try to prevent it happening whilst working in a high-stress environment, such as the NHS.
PRN: What do you understand by the phrase 'burnout'?
AB: Burnout is not a specific medical condition. It's one of those loose catch all words but it's very handy for capturing an often unacknowledged issue. Burnout, like a lot common emotional issues – falling in love, anger, low mood- will manifest itself in different ways and will vary in intensity and duration according to the individual.
A loose collection of signs that tend to cluster together are loss of sleep, feelings of being overwhelmed, becoming excessively emotional, feeling inexplicably tearful, constant tiredness, drinking to excess and other signals that the physical and psychological system is beginning to crack under the strain.
It's important to remember that burnout isn’t an event, it’s a process - and a bit like having a wild night out with the wrong person - by the time you realise it's happening it’s usually too late.
PRN: As a counsellor, how do you recognise the signs and symptoms of someone who maybe burnt out, but who hasn't recognised it themselves?
AB: One of the distinguishing features of the onset of burnout is that, being a process, it happens over time and is not the result of one single bad day at work or one off trauma. It's a reaction to continuous stress which has not been managed or even acknowledged. Stress for a short period can be stimulating and make us stretch ourselves but if it is not relieved then our physical and psychological systems begin to react. Being a gradual process it creeps up on us and preach increasing stress we fool ourselves into believing that we can cope just a little longer.
Distinguishing burnout from other stressors isn't easy but a tell-tale sign in professionals is growing detachment from the core part of the job. In short we stop caring. However we can perceive this ourselves we continue to believe that we are coping and doing the best we can. In effect we become detached not only from our own emotional and physical well-being but from that of others too.
This is where professionals in healthcare, social services, teaching etc can become capable of committing acts of neglect or cruelty which should never be excused but they can sometimes be understood.
PRN: How can we begin to recognise burnout in ourselves?
AB: Although we must always take a close look at our own practice and personal behaviour it is crucial to understand that the last person perceive that they are becoming burned-out is the sufferer .
This points to the vital role of management and proper supervision.
I became briefly burned-out as a probation officer working with high-risk offenders and I remember reaching the point where I began ‘forgetting’ hugely important facts in the cases with which I was dealing. Inexplicable mental blanks would occur in cases I knew extremely well.
It wasn't until much later did I realise that this was simply my mind’s way of cutting out to avoid the more gruesome and distressing case notes. It was an informal means of psychological self protection.
I was lucky in that I had a manager who understood what was happening and supported me. The key thing I needed to do was simply stop.
PRN: How can we prevent burnout if there is a potential this may happen?
AB: Developing my point above it is extraordinary how in healthcare professions I notice that extremes of workload both in terms of size and emotional duress are sometimes imposed on staff with little or no corresponding supervision. By supervision I don't mean yet another management goon with a clipboard or iPad ticking off jobs completed, I'm specifically referring to building into the weekly schedule a time for staff to debrief about their concerns, take the time to consider their own feelings and be given the chance to express what they might need in terms of practical or emotional support.
PRN: What can we do if we are burnt out?
There will always be 101 demands being made on the burned-out person that they will feel must be met but the burnt out person is the worst judge of their own predicament. It is no coincidence that jobs with high stress levels have high sickness rates. This is a form of unsanctioned and informal self-care - people will check out for a day or two just to retain their sanity - but surely there has to be a better way.
PRN: Do you think workplaces where there is a high demand of 'emotional labour' should have more in place to acknowledge this, and therefore try and prevent it?
AB: Indeed but it begs the question of what is in place. Simply having a manager who slaps on his/her stick on frown of concern and nods sympathetically at the right moments is not enough. Sometimes the managers themselves are stressed out and responding to a chain of demands and targets being hammered down from above.
It requires skilled listening by people trained in this area together with an inbuilt policy to ensure that staff are either moved on or rested when they are experiencing extreme duress for too long a period
PRN: How can workplaces be better equipped to recognise and prevent burnout in their employees?
AB: I think there has been an unwelcome shift in what we now know as Human Resources - the usual name given for the part of the organisation responsible for the welfare of the employees - from the Human to the Resources.
Some institutions provide excellent counselling and staff support that are, and should be, separate from issues of promotion, payroll and administration but too often the human element is treated as a bolt-on or a luxury.
PRN: Do you think you need to be innately 'caring' to be in a caring profession?
AB: Innately, no, inherently yes.
You need to be able to make connections with others, to have empathy and a level of emotional awareness but this awareness should not only focus on the needs of others but on one's own emotional state.
As well as running my counselling practice I train staff both here and in Europe in the highly stressful field of Child Protection; one of the key skills we instil in all staff is ‘reflection and resilience’. The two go together.
There has been a trend recently to promote the idea of ‘resilience’ in staff working in stressful health care and related fields. However, without reflection I think this is a con as it creates the belief among the staff that if they are not coping they ‘lack resilience’ and are somehow unfit for the job.
This ‘staff blaming’ is an insidious nonsense. I know in my own life when I've had to cope with long periods of stress that what I needed was to be able to pull away from the demands of the job and be encouraged to take care of myself.
I train social work staff to observe their own reactions and feelings, and to do so on a daily basis so they don't lose sight of what is happening to them. This doesn't have to be deep and meaningful, it can just be making a brief mental note of how tired, interested, bored, up or down they are feeling. This helps create staff who can take better care of themselves and crucially of others.
If organisations manage staff stress well they perform better and cost less to run with the resultant high rates of staff retention, job satisfaction and lower levels of absenteeism. But aside from all this necessary bean counting let's just remember that destroying the psychological and emotional health of those in the healthcare professions is more than a little ironic not to mention self defeating.
Having the occasional ‘wild night with the wrong person’ is something that most of us have done or at least understand but it's important that we don't lose sight of the most precious and important person at the centre of events - ourselves.