Counselor Burnout and Wellness
Counselor Burnout and Wellness
Burnout was cited as a principal driver of employee turnover by three-quarters
of U.S. workers surveyed in 2006 by the online career site CareerBuilder.com.
Source: TrendWatcher: Addressing Worker Burnout, Institute for Corporate Productivity
This course addresses the important strengths of a substance abuse counselor
and how those strengths, when neglected, can cause burnout and fatigue. It
addresses both the issue and offers a guide to take the necessary steps toward
self-care and wellness. Portions of this course have been resourced from The
Addiction Technology Transfer Center, Kansas City, Missouri, and Center for
Mental Health Services, Substance Abuse and Mental Health Services,
Rockville, Maryland.
The National Institute on Drug Abuse website clarifies that an addiction
counselor must exhibit good professional judgment, be able to establish
rapport with most patients, be good listeners, be accepting of the patients (i.e.,
not have a negative attitude toward working with addicts), and use
confrontation in a helpful rather than an inappropriate or overly punitive
manner. Competent addiction counselors also must be personally well
organized enough to be prompt for all sessions and to maintain adequate and
appropriate documentation.
In 2006, Abt Associates, Inc., prepared a report entitled Strengthening
Professional Identity – The Challenges of the Addictions Treatment Workforce.
The report detailed a key issue facing the addiction’s workforce:
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Counselor Burnout and Wellness
 Insufficient workforce/treatment capacity to meet demand;
“Nationally, addictions treatment capacity is insufficient to accommodate all
those seeking services and is substantially inadequate to serve the total
population in need. Capacity issues vary by geographic area, population and the
type of treatment required. Per capita funding for treatment services also
differs by State. Some States are able to invest substantial State and local
resources into treatment, whereas others rely primarily on Federal funding.
Given limited resources, States and localities are faced with difficult decisions,
such as limiting the types or number of services individuals can receive and/or
limiting the number of individuals who can receive services. Moreover, in
recent years, many States have experienced severe revenue shortfalls that have
reduced treatment capacity, despite Federal budget increases.”
Additional highlights of the changing profile in treatment were:
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A shift to increased public financing of treatment
Challenges related to the adoption of best practices
Increased utilization of medications in treatment
A movement toward a recovery management model of care
Provision of services in generalist and specialist settings;
Use of performance and patient outcome measures; and
Discrimination associated with addictions.
The Abt discussion confirms what existing addiction counselors already know,
that is, as a career, workers in the field of addiction treatment are often faced
with an emotionally and professionally demanding job. When treatment
systems are required to provide additional services with less funding, providers
and the workforce experience enormous pressures.
Addiction counselors and clinicians are called upon to be empathic,
understanding and giving, yet they must control their own emotions and
responses in dealing with clients. When engaging with a client, clinicians are
often at risk of emotional, mental and physical exhaustion. Without good
boundaries and self-care, addiction counselors are vulnerable to fatigue and
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Counselor Burnout and Wellness
burnout. If not properly managed, stress can lead to many problems including
burnout, low morale, health problems, turnover, low productivity and much
more. Identifying stressors and learning ways to address these challenges can
help reduce stress and promote personal health and wellness.
Addiction counselors are treating a very challenging patient population. These
clients have complex medical issues, as well as legal, family, housing and
employment problems. Workers, whose intention is to help, can get overly
involved with (often very needy) patients. In addition, the job requires a huge
amount of empathy, yet counselors must face client relapse and ambiguous
success every day.
Other stressors occur because of an agency’s inability to implement measures
to support staff in their long hours of work, coupled with a lack of clear career
paths. In turn, counselors become completely drained (burned-out) and
dissatisfied with their job. Eventually, they may seek other employment
opportunities and unfortunately, end up leaving the remaining employees to
carry even larger caseloads, which piles on more work-related stress! The wellbeing of an organization, the professional team, the addiction treatment and
recovery field depends on how well the issues of stress, burnout, relapse, and
job turn-over can be addressed.
At the end of the day, it is ultimately the responsibility of each supervisor,
manager, and counselor to assume responsibility for self-management and
personal self-care.
Common stressors:
 Poor Management Practices – examples include lack of supervision,
unclear or no guidance on job performance, non-established processes
or procedures, and favoritism.
 Co-workers – dealing with multiple personalities types in a workplace
setting is often challenging and stressful.
 Bureaucracy/Red Tape – sometimes procedures and processes
complicate, lengthen, and don’t make sense. Employees have no input.
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 Performance demands – standards either become impossible to achieve
or are too low, creating another set of problems.
 Balance in Personal/Professional Life – overlapping of jobs with personal
lives can have a huge impact on health and personal relationships.
Addiction treatment professionals have a unique set of stressors and challenges
due to the complicated issues their clients face, in addition, to the overall
demands of the position, all of which lead to counselor burnout and turnover
rates.
Definitions
The following definitions will help to identify, more specifically, some of the
most common environmental factors contributing to addiction counselor
stress, burnout and poor job function.
Compassion Fatigue – state of exhaustion and dysfunction – biologically,
psychologically and socially – as a result of prolonged exposure to compassion
stress.
Burnout - generalized state of physical, emotional and mental exhaustion
counselors experience by long-term involvement in emotionally demanding
situations.
Primary traumatic stress reaction- the manifestation of posttraumatic
symptoms in clinicians who have been directly exposed to violence, threat of
violence, or violations/threat of violations of physical, emotional,
mental/psychological, spiritual boundaries/integrity and the ability to respond
effectively to the threat is overwhelmed.
Secondary trauma, also known as compassion fatigue, is the manifestation of
posttraumatic symptoms in clinicians (who may not necessarily have a history
of trauma) when exposed to clients’ stories of traumatic experiences.
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Vicarious traumatization – a change in the clinician’s inner experience, sense of
self, and/or worldview, as a result of empathic engagement with the traumatic
material of the client.
Countertransference - originally referred to an unconscious emotional reaction
to the client based on the clinician’s life experience, but more recently this
term has been used to describe all emotionally charged reactions of clinicians
to clients, whether or not those reactions are based on the clinician’s personal
history.
The American Counseling Association Task Force on Counselor Wellness and
Impairment has developed the following working definition of counselor
impairment:
“Therapeutic impairment occurs when there is a significant
negative impact on a counselor’s professional functioning which
compromises client care or poses the potential for harm to the
client. Impairment may be due to:
 Substance abuse or chemical dependency
 Mental illness
 Personal crisis (traumatic events or vicarious
trauma, burnout, life crisis) Physical illness or
debilitation
Impairment in and of itself does not imply unethical behavior.
Such behavior may occur as a symptom of impairment, or may occur in
counselors who are not impaired.
Counselors who are impaired are distinguished from stressed or distressed
counselors who are experiencing significant stressors, but whose work is not
significantly impacted. Similarly, it is assumed that an impaired counselor has
at some point had a sufficient level of clinical competence, which has become
diminished as described above.”
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The ACA’s definition highlights the reasoning behind the development of
their wellness education program. Estimates of the prevalence of mental
and emotional disorders in the American population cluster around 21%
(US Surgeon General, 1999) and it is believed that counselors may in fact be
more vulnerable for a number of reasons (Figley, 1995; Grosch & Olsen,
1994). As such, it would be useful for counselors to know what places them
at risk for progressing along the spectrum and to better equip them with
activities and strategies that promote health.
Counselor Vulnerability
Counselors are well educated about mental and emotional struggles, and
skilled at helping others address their concerns, leading to the misconception
that they are less susceptible to struggles of our own. Compounding this
belief is that when they do experience some sort of personal difficulty, that
they should be able to overcome them without outside help.
There are characteristics of counselors, and components of a counselor’s
work, which make them especially vulnerable (Yassen, 1995). Those who
practice in the helping field usually have a sense of empathy to the
experiences of others. It is not simply the empathy that counselors possess,
but empathy coupled with the intimate exposure to client struggles, that can
take a toll (Figley, 1995). Moreover, counselors are taught that the counselor
is the instrument of change, and that a successful therapeutic relationship
creates successful outcomes. This may serve to increase counselors’ strong
feelings of responsibility for positive outcomes and reinforce already
unrealistic expectations toward their own infallibility (Cerney, 1995).
Contextual factors can compromise the ability of individuals and systems to
practice effective self-care. Agencies may set unrealistic expectations for
clinicians to carry a large caseload, with many seriously troubled clients.
Real life expectations and commonly held myths about counselor
invulnerability create barriers to establishing and maintaining personal
wellness.
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Counselor Burnout and Wellness
Skovholt (2001) describes “high touch” hazards, those characteristics of
professionals in the helping fields, which make them more susceptible to
burnout. Those hazards include:
(1) Clients have an unsolvable problem that must be solved
(2) All clients may not have the skills or resources to meet their goals
(3) There is often a readiness gap between them and us
(4) Our inability to say no
(5) Constant empathy, interpersonal sensitivity, and one-way caring
(6) Elusive measures of success
(7) Normative failure
These hazards challenge counselors’ personal wellness and highlight the need
for supportive environments, and on-going assessment of our own wellness,
including positive strategies for resilience (Catherall, 1995; Cerney, 1995;
Saakvitne, Pearlman & Staff of TSI/CAAP, 1996).
Other factors that increase vulnerability include:
 ability to obtain quality supervision, the nature of our clientele (e.g.
vulnerable children, complexity of problems, safety concerns)
 nature of our workplace (e.g. insufficient resources or vacation time,
lack of input into the decision-making process of the organization,
current policies prohibit best practice treatment)
 our training, education and experience, current stressors and/or
changes in our life outside of work
 our natural coping style, a personal history of trauma, and beliefs that
limit our likelihood to seek support
One highlighted issue that contributes to counselor vulnerability is exposure to
primary and secondary trauma and violence. When counselors witness or
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experience violence firsthand (in the workplace or in their personal lives),
there is increased vulnerability to developing traumatic stress symptoms. The
concept of vicarious traumatization applies to all helping professionals even
without primary exposure to violence (Saakvitne, Pearlman & Staff of
TSI/CAAP, 1996). Vicarious traumatization is a cumulative process of personal
change in helpers that happens through empathic connection with clients.
The concept is applicable even when clients are not disclosing personal
histories of trauma. In the process of connecting with clients, counselors are
connecting empathy with client pain, which can have an impact on the
counselor. When issues of secondary traumatic stress are not addressed they
can result in high levels of absenteeism and turnover, rampant mistrust of
colleagues, feelings of anger and isolation, and incidents of ethical misconduct
(Catherall, 1995; Yassen, 1995).
Counselors must demonstrate the same level of commitment to selfawareness, self-care and balance for ourselves as they have for clients.
Intervention is possible when counselors assess the impact, speak openly as a
community, and take steps towards positive change.
Case Studies: Posttraumatic Stress and Burnout
Post-traumatic stress affected the healer as well as the healed.
Case #1: During the 1989 Phillips Petroleum plant explosions in Pasadena,
Texas, Lloyd, along with numerous medical, psychiatric and emergency
personnel worked around the clock for 90 days to provide counseling and
supportive measures to more than 100 employee and their families.
Six months to one year later, after lives were on track, depression set in for
many workers. Survivors returned for help, just when life was “supposed to be
normal.” And physicians and counselors reported a low-grade fatigue.
Case #2: Suzanne is a 51-year old counselor who specializes in working with
addicts in NYC. During her 11 years in corrections, she has become aware that
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most of the women in the facility have a history of sexual abuse and many have
used substances to numb out and block the memories of their abuse. Suzanne
believes treatment for many of the women inmates should be trauma-focused
with addictions treated as a condition. She has become increasingly
disillusioned with her job, and would have left the position years ago, if she was
not concerned about her retirement benefits. Suzanne has been in the system
long enough to have seen the relapse among her inmate clients and she has
grown bitter toward the corrections administration’s lack of support in
providing adequate funding for trauma-focused practice with the women in the
facility. She believes addiction services are underfunded and there needs to be
a major clinical shift toward including trauma-based treatment for the inmates.
She has little support for her concerns and has grown increasingly bitter and
frustrated by the placating attitude of the corrections administration. She feels
she is wasting her time and providing inadequate and misguided care for her
clients.
Case #3: A 34 year old single mom and addiction counselor, Melanie, worked
hard while raising her son and keeping a fairly busy social life. Recently, she
started feeling down and exhausted when at work. Every day she left her job
dreading coming back. She felt like all the tasks were weighing on her and she
couldn’t see an end of her ‘to do lists’. Her colleagues irritated her and her
responses sounded angrier than she’d like to let on. She couldn’t help but
comfort-eat. This didn’t help as it only fuelled her anxieties about her body
weight. In addition, she began suffering from tension headaches and couldn’t
fall asleep as she was feeling restless. She confessed that she felt very
frustrated about the fact that despite all the hard work she put in her job, she
wasn’t getting any closer to her desired position. It felt like everybody else was
getting ahead and she was stuck feeling like a failure. She thought that she was
personally targeted by the boss.
Case #4: A counselor started his career in 1998 with great anticipation and
encouragement. He later moved to a marginalized area where the level of need
was great and the resources were few. Even though the position was less pay
than he wanted, he felt he could make a real difference. He happily worked
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long hours, weekends, and even forfeited family vacations. He began to avoid
his family and friends, was irritable, unable to sleep and began to miss
important outside appointments. When his position became unstable and he
was moved to another department with less benefits, he felt emotionally
exhausted and physically drained. When his wife left and filed for a divorce, he
began to drink.
Case #5: Until three years ago, Anne had been very motivated and enthusiastic
in the treatment program where she worked due to her supervisor, who
lavished compliments and talked about promotions. She worked hard through
two restructurings in the next few years, certain to keep her job. She began to
receive less feedback and compliments and began to feel increasingly insecure
about her performance. Her workload has increased and overtime during the
week and on the weekend has become the norm. She had less and less time for
friends or hobbies. In the evenings she is often so exhausted that watching
television is all she is capable of doing. Over the past 8 months she has
increasingly experienced sleep disorders and difficulties concentrating; she has
the feeling that “it all gets too much”. She is repeatedly sick but doesn’t take
much time off to recover as she is convinced that “it is not possible right now.”
She tries to deal with headaches with medication. She feels empty and run
down, she doesn’t feel like doing anything and cries repeatedly on her way to
and from work. After a collapse she eventually quit her job and despite her
accreditations and past accomplishments, she has no energy to look for
another position in the addiction field.
Case #6: Jim, a clinical supervisor was at the worst point of the crisis. He felt as
if he was in a speeding car on the freeway with no brakes. He confided,
“I always had the feeling I was chasing everything. The difficulties I was facing
seemed insurmountable. I had to learn to try not to do everything by myself
and to clearly distinguish between important and unimportant matters utilizing
my team, but I stopped listening to my body. Jim was at the point of exhaustion
and the simplest tasks were daunting. He felt it was “all too much.” When his
health was in jeopardy, he finally took time to self-care and see a doctor.
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“Looking back it seems ridiculous to me; back then it was horrible. I felt
ashamed, wondering what people where thinking of me. I used to manage 50
staff – now I cannot even get daily things done on my own.”
Additional Case Studies regarding burnout and vicarious trauma are discussed
in the article, “Counselor Self-Care in Work with Traumatized Addicted People,”
written by Patricia A. Burke, MSW, Bruce Carruth, Ph.D., and David Prichard,
Ph.D. in the Journal of Chemical Dependency Treatment.™
Burnout and Stress: Signs, Symptoms, Causes, and Coping Strategies
When you’re burned out, problems seem insurmountable, everything looks
bleak, and it’s difficult to muster up the energy to care—let alone do something
about your situation. But burnout can be healed. You can regain your balance
by reassessing priorities, making time for yourself, and seeking support.
What is Burnout?
Burnout is a state of emotional, mental, and physical exhaustion caused by
excessive and prolonged stress. It occurs when you feel overwhelmed and
unable to meet constant demands. As the stress continues, you begin to lose
the interest or motivation that led you to take on a certain role in the first
place.
Burnout reduces your productivity and saps your energy, leaving you feeling
increasingly helpless, hopeless, cynical, and resentful. Eventually, you may feel
like you have nothing more to give.
Most of us have days when we feel bored, overloaded, or unappreciated; when
the dozen balls we keep in the air aren’t noticed, let alone rewarded; when
dragging ourselves out of bed requires more than determination.
You may be on the road to burnout if…
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Counselor Burnout and Wellness
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Every day is a bad day.
Caring about your work or home life seems like a total waste of energy.
You’re exhausted all the time.
The majority of your day is spent on tasks you find either mindnumbingly dull or overwhelming.
You feel like nothing you do makes a difference or is appreciated.
The negative effects of burnout spill over into every area of life – including your
home and social life. Burnout can also cause long-term changes to your body
that make you vulnerable to illnesses like colds and flu. Because of its many
consequences, it’s important to deal with burnout right away.
Burnout vs. Stress
Burnout may be the result of unrelenting stress, but burnout isn’t the same as
too much stress. Stress, by and large, involves too much: too many pressures
that demand too much of you physically and psychologically. Stressed people
can still imagine, though, that if they can just get everything under control,
they’ll feel better.
Burnout, on the other hand, is about not enough. Feeling burned out means
feeling empty, devoid of motivation, and beyond caring. People experiencing
burnout often don’t see any hope of positive change in their situations. If
excessive stress is like drowning in responsibilities, burnout is being all dried up.
One other difference between stress and burnout: While you’re usually aware
of being under a lot of stress, you don’t always notice burnout when it
happens.
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Stress vs. Burnout
Stress
Burnout
Characterized by over engagement
Emotions are over reactive
Produces urgency and hyperactivity
Loss of energy
Leads to anxiety disorders
Primary damage is physical
May kill you prematurely
Characterized by disengagement
Emotions are blunted
Produces helplessness and hopelessness
Loss of motivation, ideals, and hope
Leads to detachment and depression
Primary damage is emotional
May make life seem not worth living
Source: Stress and Burnout in Ministry
There are many causes of burnout. But anyone who feels overworked and
undervalued is at risk for burnout – from the hardworking office worker who
hasn’t had a vacation or a raise in two years to the frazzled stay-at-home mom
struggling with the heavy responsibility of taking care of three kids, the
housework, and her aging father.
However, burnout is not caused solely by stressful work or too many
responsibilities. Other factors contribute to burnout, including your lifestyle
and certain personality traits. What you do in your downtime and how you look
at the world can play just as big of a role in causing burnout as work or home
demands.
Work-related causes of burnout
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Feeling like you have little or no control over your work
Lack of recognition or rewards for good work
Unclear or overly demanding job expectations
Doing work that’s monotonous or unchallenging
Working in a chaotic or high-pressure environment
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Lifestyle causes of burnout
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Working too much, without enough time for relaxing and socializing
Being expected to be too many things to too many people
Taking on too many responsibilities, without enough help from others
Not getting enough sleep
Lack of close, supportive relationships
Personality traits can contribute to burnout
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Perfectionistic tendencies; nothing is ever good enough
Pessimistic view of yourself and the world
The need to be in control; reluctance to delegate to others
High-achieving, Type A personality
Warning signs and symptoms
Burnout is a gradual process that occurs over an extended period of time. It can
creep up on you if you’re not paying attention to the warning signals. The signs
and symptoms of burnout are subtle at first, but they get worse as time goes
on.
The early symptoms of burnout are warning signs or red flags that something is
wrong that needs to be addressed. If you pay attention to these early warning
signs, you can prevent a major breakdown. If you ignore them, burnout is
inevitable.
Physical signs and symptoms of burnout
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Feeling tired and drained most of
the time
Lowered immunity, feeling sick a
lot
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Frequent headaches, back pain,
muscle aches
Change in appetite or sleep
habits
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Emotional signs and symptoms of burnout
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Sense of failure and self-doubt
Feeling helpless, trapped, and
defeated
Detachment, feeling alone in the
world
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Loss of motivation
Increasingly cynical and negative
outlook
Decreased satisfaction and sense
of accomplishment
Behavioral signs and symptoms of burnout
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Withdrawing from
responsibilities
Isolating yourself from others
Procrastinating, taking longer to
get things done
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Using food, drugs, or alcohol to
cope
Taking out your frustrations on
others
Skipping work or coming in late
and leaving early
Professional Boundaries
Professional boundaries define our expectations for self-respect and show
respect for others. The lack of professional boundaries may ultimately
contribute to unnecessary stress and drama scenarios, depleting emotional
stamina.
In therapeutic relationships, our professional boundaries help to limit our
selfish inclination to control or manipulate others. Likewise, they protect us
from those who have no self-control and who wish to control us. A person with
clear, healthy boundaries communicates to others what is and is not
permissible. When people are being destructive, boundaries emphasize our
self-respect.
Counselors can be available for people in a therapeutic relationship, but
unavailable to indulgent, unrealistic or unethical demands. Being gracious is not
a blank check for others to continually drain our emotional account. Boundaries
teach us to accept one another as being different yet valuable. Boundaries help
us appreciate the differences in people rather than be upset by them.
Boundaries are not selfish when we use our freedom to serve others.
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Counselor Burnout and Wellness
Weak Boundaries
Counselors who don’t display professional boundaries lack definite lines of
personal responsibility vs. other people’s responsibility. If you have weak
boundaries you are a candidate for stress and burnout.
Signs of weak boundaries:
 Accepting responsibility for other people’s actions and responses
 Being over responsible or irresponsible
 Giving away your power or taking too much power
 Having no sense of privacy in a relationship
 Invading other's rights sexually
 Emotionally dependent
 Feeling confused about professional relationship protocol
Healthy Boundaries
If you have healthy boundaries you can regulate your own reality. This means
that you can choose what you want in your life and also what is not acceptable.
In addition, you are able to communicate these needs to those around you. You
will also take responsibility for your own behaviors and not take on other
people's problems beyond the therapeutic relationship.
It's also about you knowing what you want from others, what you will or will
not except from others, understand how you want to be treated. Our selfrespect as professional counselors dictates the standard to which we expect
respect from others. Once you have this priority in place, professional
boundaries will feel natural and protect both you and your client.
Rigid Walls are Not Boundaries
When healthy boundaries are not in place, walls of protection can easily
surface to help self-protect. Self-protective behavior limits our ability for
professional communication and therapeutic relationship.
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Ultimately, the lack of boundaries leading to protective behavior changes the
therapy session focus from helping others to protecting self. Some warning
signs:
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Unable to change views or perspectives
Same emotion surfaces every time
Unwilling to hear out others
Blaming others
Wanting to win at other’s detriment
Unable to accept that you are wrong
External Boundaries - External boundaries are about what you will accept from
others. They are the limits we set with those around us based on certain people,
times and places. They are about what behaviors we will accept from other
people and those which we will not accept.
Internal Boundaries - Internal boundaries are about what you will accept for
yourself. Internal boundaries include knowing your own beliefs, values,
thoughts, feelings and attitudes. They are about the decisions and choices you
make for yourself and the experiences you participate in.
Boundary gates are opened two ways.
Our external boundaries are breached when
we are not able to limit or stop an external
stimuli, for example, vicariously identifying
with the impact from a client’s trauma story
details.
Our internal boundaries are breached when
we do not employ self-control or manage our
strengths, for example, if we were to become
co-dependent to the needy client due to
their unresolved trauma experience.
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Counselor Burnout and Wellness
Countertransference
An addiction counselor's attunement to his/her own countertransference is
critical to a healthy therapeutic relationship. Countertransference adds a
source of stress and over activity that can lead to counselor (and client)
damage.
Counselors may have clients they like or “prefer” to deal with. Sometimes a
client’s motivation to change causes the counselor to feel empowered and
validates their treatment style. Other times, counselors are relieved that
certain clients have left treatment or been assigned to a different clinician.
Both these sides of these counselor/client relationships has to do with feelings
of countertransference.
Countertransference is defined as redirection of a counselor's feelings toward a
client, or more generally, a counselor's emotional entanglement with a client.
Countertransference often happens when the helping counselor doesn’t have
personal awareness and self-management. Countertransference is a reflection
of breaching a counselor’s internal, and sometimes ethical, boundaries.
Countertransference occurs when a counselor who is a recipient of a
transference activity, accepts this and engages with the client at an emotional
level, such as:
 Feelings aroused in the counselor by the client
 Feelings to do with a counselor’s unresolved conflict from past or present
relationships other than the professional relationship with this particular
client
Examples of countertransference:
 Over identifying with client through similar commonalities such as
personality, past difficulties, social standing, age
 Feeling parental towards client
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 Sexual attraction – Pope & Tabachnik, (1993) found that the vast majority
of counselors (87%) had been sexually attracted to at least one if not
more of their clients.
 Client reminds us of someone we have or had strong feelings for (positive
or negative)
Self-knowledge and personal awareness are the basic tools in dealing with
countertransference and establishing healthy professional boundaries. After
looking at the examples of countertransference, a counselor could ask their self
these questions:
 Do you find yourself responding to clients and/or individuals in your life
with any of the above reactions?
 If so, what does this reveal about you or your emotional needs and
internal self-management boundaries?
 What can you do either in counseling or in your personal relationships to
respond in a more effective way?
Re-establish the professional relationship by:
 Define personal internal boundaries that align with ethical standards.
 Discuss how you are affected by certain clients either within supervision
on with a colleague.
 Get other’s perspectives on whether you are maintaining unconditional
positive regard.
Recovering from Burnout
While the tips for preventing burnout are still helpful at this stage, recovery
requires additional steps.
 Slow down
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When you’ve reached the end stage of burnout, adjusting your attitude or
looking after your health isn’t going to solve the problem. You need to force
yourself to slow down or take a break. Cut back whatever commitments and
activities you can. Give yourself time to rest, reflect, and heal.
 Get support
When you’re burned out, the natural tendency is to protect what little energy
you have left by isolating yourself. But your friends and family are more
important than ever during difficult times. Turn to your loved ones for support.
Simply sharing your feelings with another person can relieve some of the
burden.
 Reevaluate your goals and priorities
Burnout is an undeniable sign that something important in your life is not
working. Take time to think about your hopes, goals, and dreams. Are you
neglecting something that is truly important to you? Burnout can be an
opportunity to rediscover what really makes you happy and to change course
accordingly.
 Acknowledge your losses
Burnout brings with it many losses, which can often go unrecognized.
Unrecognized losses trap a lot of your energy. It takes a tremendous amount of
emotional control to keep from feeling the pain of loss. When you recognize
these losses and allow yourself to grieve them, you release that trapped energy
and open yourself to healing. Ruth Luban, Keeping the Fire (1996) list these:






Loss of the idealism or dream with which you entered your career
Loss of the role or identity that originally came with your job
Loss of physical and emotional energy
Loss of friends, fun, and sense of community
Loss of esteem, self-worth, and sense of control and mastery
Loss of joy, meaning and purpose that make work – and life – worthwhile
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Considerations for Counselors in Recovery
Because stress and substance related cues are major factors contributing to
relapse, it is important that recovering counselors are able to speak openly
without fearing a backlash. The individual who approaches a co-worker or
supervisor to discuss concerns about feeling triggered should be commended
for their bravery in facing possible backlash and having the foresight to get
help.
Despite a counselor’s successful recovery from past substance abuse, they
must be aware of sensitivity to stress and cue-induced cravings. As an
addiction counselor, there is constant exposure to possible triggers from
clients who exhibit substance using behavior. In addition, recovering
counselors may come in contact with former using acquaintances or
partners who are now clients of the agency they work for, which triggers
a memory recall of former substance using days.
Source: The Recovering Counselor (2012)
Changes That Help
If you recognize the warning signs of impending burnout in yourself, remember
that it will only get worse if you ignore the symptoms. But if you take steps to
get your life back into balance, you can prevent burnout from becoming a fullblown breakdown.
Helpful tips:


Start the day with relaxing. Rather jumping out of bed as soon as you
wake up, spend at least fifteen minutes meditating, writing in your
journal, doing gentle stretches, or reading something that inspires you.
Adopt healthy eating, exercising, and sleeping habits. When you eat
right, engage in regular physical activity, and get plenty of rest, you have
the energy and resilience to deal with life’s hassles and demands.
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



Set boundaries. Don’t overextend yourself. Learn how to say “no” to
requests on your time. If you find this difficult, remind yourself that
saying “no” allows you to say “yes” to the things that you truly want to
do.
Take a daily break from technology. Set a time each day when you
completely disconnect. Put away your laptop, turn off your phone, and
stop checking email.
Nourish your creative side. Creativity is a powerful antidote to burnout.
Try something new, start a fun project, or resume a favorite hobby.
Choose activities that have nothing to do with work.
Manage stress. When you’re on the road to burnout, you may feel
helpless. But you have a lot more control over stress than you may think.
Learning how to manage stress can help you regain your balance.
The most effective way to combat job burnout is to quit doing what you’re
doing and do something else, whether that means changing jobs or changing
careers. But if that isn’t an option for you, there are still things you can do to
improve your situation, or at least your state of mind.




Actively address problems. Take a proactive approach – rather than a
passive one – to issues in your workplace. You’ll feel less helpless if you
assert yourself and express your needs. If you don’t have the authority or
resources to solve the problem, talk to a superior.
Clarify your job description. Ask your boss for an updated description of
your job duties and responsibilities. Point out things you’re expected to
do that are not part of your job description and gain a little leverage by
showing that you’ve been putting in work over and above the
parameters of your job.
Ask for new duties. If you’ve been doing the exact same work for a long
time, ask to try something new: a different grade level, a different sales
territory, a different machine.
Take time off. If burnout seems inevitable, take a complete break from
work. Go on vacation, use up your sick days, ask for a temporary leave-
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of-absence—anything to remove yourself from the situation. Use the
time away to recharge your batteries and take perspective.
Supervision
As addiction counselors, we have a vested interest in our role and want to
provide a valuable intervention. We have feelings for people that we have
professional relationships with. Those feelings can be positive or negative,
productive or damaging.
Community is a valuable tool in any environment. For addiction counselors,
having a supportive community is a healthy way to process feelings and sort
out perspective. Other’s “who have been there” are an essential part of
helping to keep our perspective on track. Knowing that stress, burnout and
fatigue are often an occupational hazard, addictions practitioners must learn
how to prevent and reduce workplace stressors.
Utilizing supervision and co-worker support is a healthy way to gain perspective
and realign ourselves with professional boundaries and ethical practice.
Research suggests appropriate clinical supervision can reduce staff stress and
increase motivation, in addition to providing ongoing skill evaluation.
Supervisors must sharpen their skills and take the time to supervise properly.
Ongoing communication and onboarding activities will help ensure a high level
of employee job satisfaction and engagement. The ways in which a supervisor
motivates employees can serve as a tool for stress reduction. When employees
are happy, their stress levels decrease.
Supervisors should watch their employees for signs indicating personal or
health-related problems such as mood swings, weight gain or loss, tardiness
and absenteeism. They should also address the following:
 Relationships between recovering staff and clients
 Professional credibility
 Cultural bias and unfair treatment
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 Staff performance evaluations
 Liability concerns
 Impaired counselors
Supervision can offer staff support and validation, an opportunity to debrief
and share reactions to clients’ trauma material. It is also an opportunity to
share positive coping strategies. Although there are tremendous pressures
today on clinical supervisors to focus on case management, administrative
issues and behavioral treatment planning, it is imperative for clinical
supervisors to include frequent supervision addressing compassion fatigue
issues as part of each staff member’s professional self-care plan. If neglected,
good clinicians will eventually experience burnout and inevitably walk away
from their jobs.
Wellness Approaches
There are individual, team and organizational strategies for addiction treatment
workers while working with traumatized, addicted clients. It is essential,
however, for each individual to take responsibility for developing their own
personal and professional self-care plans, including a relapse prevention plan
for those in recovery.
An important step in addressing this issue is the recognition that compassion
fatigue and other stress disorders are real and a common response of
compassion and empathy, without which, the counselor would not be
successful.
The Tennessee Medical Association in their article on secondary traumatic
stress in Mental Health professionals (The Journal, 2006), identifies key
balances between being vulnerable and being available to the client’s needs,
and taking steps toward protecting one’s own sense of integrity. The TMA
studies indicate that there are four important strategies to apply in prevention
efforts:
1. Professional strategies – balancing caseloads
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2. Organizational strategies – sufficient release time
3. Personal Strategies – respecting one’s own limits
4. General coping strategies – self nurture and care
Self-Evaluation
Try writing out a schedule for a typical work day including recognition of own
unique requirements for pacing, breaks for exercise, rest, and nourishment,
and a variety of tasks and self-care practices. Then, at the end of the day,
review schedule and ask:
 Did your day include an awareness of personal physical, emotional,
mental, and spiritual needs?
 Did it include a sense of balance?
 Did it include time for connection to self and others that is nourishing?
Developing a Wellness Lifestyle
Every aspect of your life — the place you live, the people you live with,
your friends and acquaintances, the things you do or don’t do, the
things you own, your work, even things like pets, music, and color,
affect how you feel. If you are concerned about your mental health or
the quality of your life, you can make changes in your life that will help
you to feel much better.
Creating Action
It is not always easy to create change. However, without taking some
action, you cannot make changes in your life that may help you feel
better. Every time you take positive steps in creating change in your
life, give yourself a pat on the back or reward yourself by doing
something nice for yourself like taking a warm bath, going for a walk, or
spending some time with a friend. You also may want to keep a written
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record of the change you are creating in your life in a notebook or
journal.
Change takes time and may be difficult. You may have to overcome
many obstacles. Take small steps. Don’t give up. Be persistent. Keep
working toward whatever it is that will help you to feel better and enjoy
your life more. Making change is being able to see beyond yourself to
what the solution might be.
Creating change is something you need to do for yourself. No one else
can do it for you. Others can help you and support you as you create
change but it is up to you to do what needs to be done. You will be the
one that benefits from successful change.
If you feel you have control over your own life, you have jumped over the
first hurdle to creating change in your circumstances. If you don’t feel
you have control over your life, it is important that you take back
control. It is very difficult to feel well when you are not in charge of your
own life. Make a list of the benefits of taking back control over your life.
Getting Good Health Care
You deserve good health care. If you have a good health insurance
plan, this won’t be a problem. If accessing health care is a problem, it is
worth making the effort to get what you need and deserve for yourself.
What can you do to be sure you take care of your body and emotions?
Lifestyle
What could you do to make your life more peaceful and calm? For
example, save time for yourself in the evening or set aside time every
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day to do things you enjoy. You need time to relax and to relieve
stress. Sometimes the events and circumstances of our lives make it
hard to do this. If you are unable to relax, you may notice physical and
emotional health problems. What can you do to take time to relax
every day?
Home
The space where you live, your home, can affect how you feel. Do you
look forward to going home or being at home? If not, what could you
change about your home that could make you want to go there and
feel comfortable there?
Employment or Career
There are difficult aspects of every job or career but, you should enjoy
your job or career that increases your life rather than draining it Does
your job or career enhance your life and wellness? If it doesn’t, what
needs to change? How can you make this happen?
Diet
The foods and other substances you put in your body may be affecting
the way you feel. Many people have found that they feel much better
when they pay close attention to what they put in their body,
eliminating some things and adding others. If you feel your diet might
be affecting you, notice how you feel half an hour or more after a snack
or meal. What can you do to make healthy changes?
Exercise
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If you are exercising regularly, you will enjoy the following benefits —





an overall feeling of well-being
enhanced ability to sleep restfully
improved memory and concentration
decreased irritability and anxiety
increased endurance
Do you exercise regularly to help reduce stress and increase
stamina? If not, how could you make that happen?
Light
You may notice that you have less energy than usual, feel less
productive and creative, feeling sad or depressed as the daylight time
gets shorter in the fall or when there is a series of cloudy days. If so,
you may have Seasonal Affective Disorder (more commonly known as
SAD). You may want to plan ahead, knowing that the fall and winter are
hard times for you and that you need to take care to get outdoor light
when possible.
Sleep
You will feel better if you sleep well. Your body needs time every day to
rest and heal.
According to the National Sleep Foundation in Washington, D.C.
65% of Americans are sleep deprived.
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If you often have trouble sleeping–either falling asleep, or waking during
the night and being unable to get back to sleep–one, several of the
following ideas might be helpful to you.

G
o to bed at the same time every night and get up at the same
time every morning.

E
stablish a bedtime “ritual” by doing the same things every night
for an hour or two before bed- time so your body knows when it is
time to go to sleep.
Spirituality
Just as trauma can result in a loss of meaning, hope, connection and a crushed
world view, secondary, or vicarious, trauma can have the same effects on the
addiction practitioner. Clinical literature suggests spirituality as a multidimensional human experience. As mentioned, working with addicted clients is
occupationally draining. Engaging in spiritually oriented activities can enhance a
balanced sense of well-being, and can serve as way to “refuel.”
Action Steps
Individuals can take steps toward their own health and wellness. These positive
personal strategies have helped professionals find balance to cope with stress:



Talking with colleagues about difficult clinical situations
Attending workshops, social activities with family and friends
Exercising
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



















Drinking plenty of water. Dehydration causes you to feel fatigued even if
you are eating healthy and getting enough rest.
Maintaining a healthy diet
Limiting client sessions
Maintaining mental wellness
Balancing caseloads with trauma and non-trauma clients
Taking breaks, vacations
Listening to music
Engaging in spiritually oriented activities: Walking in nature, meditating,
journaling, volunteer work, etc.
Engaging in personal psychotherapy
Keeping a “praise file” – This is a file of complimentary notes that you
read periodically to remind yourself of what a good job you are doing
Taking a one day vacation. – Take a day off to renew. It can be better
than spending an ineffective day at work
Expanding your horizons – do other kinds of activities
Reading. – It will get your mind off the “hamster wheel”
Taking a “fun” class
Taking the weekend off
Planning special activities - something to look forward to
Making a “pampering” appointment – Get a haircut, buy new clothes, a
pedicure or massage
Meditating
Laughing – use humor to recharge your batteries
Getting enough sleep. Try and get at least seven hours of sleep per night
The Humanities and Human Spirit program at the John P. McGovern, M.D.
Center for Health in Utah helps participants have a sense of balance. Health
professionals share and shed their burdens in a non-judgmental and supportive
atmosphere. “The object is not to solve each other’s problems,” explains Dr.
Thomas Cole, director of the McGovern Center, “but simply to listen and be
present with another colleague’s experiences.”
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Here are other publications to check out:
 Specific details for exercise, nutrition and mental wellness are outlined in
Self-Care, A Guide for Addiction Professionals. – booklet prepared by
Central East ATTC Regional Office addressing challenges in the
workplace, the agency role in supporting well-being and self-care
approaches.
 Humor can help! Education World™ offers a free, weekly Education
Humor Newsletter.
 BLR® offers a free newsletter, HR Strange But True!, bringing offbeat,
often hilarious, tales from the workplace.
Opt for a free newsletter from Colleen Kettenhofen, workplace expert
and contributing author of the book, Masters of Success. Newsletter
topics include: How to increase energy with top foods, easy exercise tips
and techniques; how to manage stress and achieve greater life balance,
and how to achieve personal, business and leadership success.
Following is a list of some very simple things you can do everyday
to feel better. Use these techniques whenever you are having a hard time or
as a special treat to yourself.
 Be present in the moment
 Use your spiritual resources
 Do something fun or creative
 Get some exercise
 Write something
 Do a relaxation exercise
 Do something routine
 Wear something that makes you feel good
 Get some little things done
 Learn something new
 Do a reality check
 Look at something pretty or that has special meaning for you
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 Play with children in your family or with a pet
 Take a warm bath
 Expose yourself to something that smells good to you
 Listen to music
 Make music
 Singing helps
 Make a gratitude list
What is the benefit of a wellness lifestyle? Being the best YOU! For instance,
you would —








feel better physically and emotionally
have less stress
have more time to do the things you enjoy
have time to take good care of yourself
feel more fulfilled
improve the quality of your life
laugh and have fun
be connected to life, people, and yourself
Why not start today!
Further Resources
Substance Abuse and Mental Health Services Administration (SAMHSA) Center for
Mental Health Services
Web site: www.samhsa.gov
SAMHSA’s National Mental Health Information Center P.O. Box 42557 Washington, D.C.
20015 Telephone (800) 789-2647 (voice) Web site: www.mentalhealth.samhsa.gov
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National Institute on Drug Abuse (NIDA) Office of Science Policy and Communications, Public
Information and Liaison Branch 6001 Executive Boulevard, Room 5213, MSC 9561, Bethesda,
Maryland 20892-9561
Consumer Organization and Networking Technical Assistance Center (CONTAC)
P.O. Box 1 000 Charleston, WV 25339 1 (888) 825-TECH (8324) (304) 346-9992 (fax)
Web site: www.contac.org
Depression and Bipolar Support Alliance (DBSA) (formerly the National Depressive and
Manic-Depressive Association) 730 N. Franklin Street, Suite 501 Chicago, IL 60610-3526
(800) 826-3632Web site: www.dbsalliance.org
National Alliance for the Mentally Ill (NAMI) (Special Support Center) Colonial Place Three
2107 Wilson Boulevard, Suite 300 Arlington, VA 22201-3042 (703) 524-7600
Web site: www.nami.org
National Empowerment Center 599 Canal Street, 5 East
Lawrence, MA 01840 1-800-power2u (800)TDD-POWER (TDD) (978)681-6426 (fax)
Web site: www.power2u.org
National Mental Health Consumers’ Self-Help Clearinghouse 121 Chestnut Street, Suite
1207 Philadelphia, PA 19107 1 (800) 553-4539 (voice) (215) 636-6312 (fax)
e-mail: [email protected] Web site: www.mhselfhelp.org Resources listed in this
document do not constitute an endorsement by CMHS/SAMHSA/HHS, nor are these
resources exhaustive. Nothing is implied by an organization not being referenced.
Strengthening Professional Identity – The Challenges of the Addictions Treatment Workforce, a
Framework for Discussion (2006) Acknowledgments Abt Associates Incorporated prepared this
report. The report also benefited from the input of A. Thomas McLellan, Leslie J. Scallet, and Joan
Zweben. This document was authored and produced by Melanie Whitter with support from E.
Lorraine Bell, Peter Gaumond, Margaret Gwaltney, Candy A. Magaña and Mirabelle Moreaux.
Linda Kaplan of Global KL, a subcontractor to Abt, organized and facilitated stakeholder meetings
and assisted with report development. Disclaimer The views, opinions, and content of this
publication are those of the authors and do not necessarily reflect the views, opinions, or policies
of SAMHSA or HHS.
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References: Wellness Lifestyle
A portion of this section resourced from:
U.S. Department of Health and Human Services (DHHS), Substance
Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health
Services (CMHS), and prepared by Mary Ellen Copeland, M.S., M.A., under contract
number 99M005957.
Center for Mental Health Services, Substance Abuse and Mental Health Services
Administratio,5600 Fishers Ln, Room 15-99, Rockville, MD 2085, SMA-3718, Updated 1/ 02
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