Health and Wellness – Ethics of Self-Care.

1. Terry E. Waldren, Ph.D. LMFT-S LPC-S NBCCLubbock Vet Center Health and Wellness – Ethics of Self-Care.

2. Why Wellness? • Wellness concepts are a holistic approach for working with individuals/couples and families. • Characteristics of healthy individuals and families are different from our clinical populations – important to know these differences. • Being physically and emotionally healthy are two key values for myself. • I see myself as a model for patients and clients – if I’m not healthy then I believe I lack creditability as a professional – the ethical connection. • Staying emotionally healthy working as therapist is a constant challenge – issue of burnout.

3. My Wellness Experiences: areas I’d be happy to comment about in more detail. • Eliminating Self Defeating Behaviors – working with health issues since 1974 – critical issue is transforming identity from self defeating to healthy patterns/behaviors. • Personal – going from smoker to smoke free person. • Research on Academic Procrastination. • Workshops on Burnout for Counselors. • Workshops on Narcissistic and Borderline personality disorders – estimate ½ of participants showing signs of burnout. • Interim Chair & Visiting Full Professor: Health Exercise and Sport Sciences (HESS). • Became number one degree granted at TTU in 2008. • Healthcare jobs are growing and are anticipated to grow in future. • Many courses were focusing on how to build healthy lifestyles with children and adults.

4. Wellness Experiences cont’d • TTU Honors College Honors Seminar– Comparative healthcare issues between US and other countries. • Critical issues for healthcare – going from procedures to wellness/prevention. • Smoking as number one health issue world wide. • Chronic diseases in the elderly increasing and the rapid increase of chronic diseases in young people as major sources of problems/healthcare costs – for younger people fast foods are a critical issue along with advertising. Diet/exercise/social support key ways to address issues of chronic illnesses.

5. Wellness Experiences cont’d • Grace Clinic – • Working on resources for health prevention/weight loss resources – • Issue is getting cost effective resources that work – • Could not afford coaches as insurance pays very little for wellness. • Dr. Bale – CME Ethics workshop about Heart Attack & Stroke prevention. • Many physicians leaving practice because of burnout – talking about alternative ways of practicing medicine. • Private medicine – concierge • Once give up smoking and addictions then wellness becomes number one set of factors for being healthy. • Physicians talking about not only physician assistants/nurse practitioners - health/exercise bachelor degree for nutrition/exercise awareness.

6. Compassion Fatigue • Emotional depletion • Mainly working long hours in isolation • Expected to give endlessly while expecting nothing in return except fee. • Isolation • Increasing numbers of laws, codes, and regulations regarding confidentiality. • Often work when others are not working. • Helplessness and sense of inefficiency • Often do not see immediate gains and/or sustained gains. • Have not found user friendly measure of psychotherapy successes. • Grandiosity and omnipotence • Therapist idealized and then devalued • Repeated distorted projections each 50 minutes • Depression, sadness and vicarious traumatization • Working with people in pain is draining and demanding • Confusion • Going from idealization to devaluation • Constant worry • Working with clients who maybe suicidal is draining

7. Compassion Fatigue cont’d • Grief Cycle • Endless cycle of new patients, hard work and then termination when patients are better. • One way Intimacy and voyeuristic Attitudes: • Therapist experiences deep intimacy from patients while not sharing about themselves. • Distraction • Focusing on others problems and losing track of our own needs/desires. • Inability to Shut off the Therapeutic Stance • Therapy is a way of relating and can bring this into family/friend situations. • Events that Affect Effectiveness • Our own life events (e.g. death, divorce, health provide challenges as these effect our effectiveness • Conflicting Clinical, Ethical, and Legal Considerations: • Codes of ethics grow each time new ones are released and more and more there are contradictions within these codes. • The threat of Lawsuits • Living in highly litigious society and working with disturbed people. • Split Personality – Public vs. Private • We have a very rigid separation between work and personal settings around issue of confidentiality.

8. Effects of burnout • Burn out leading cause psychotherapists high rate of depression, drug and alcohol abuse and suicide.

9. Symptoms of Burnout • Health Indicators • Fatigue and chronic exhaustion • Frequent and prolonged colds • Headaches • Sleep disturbances: insomnia, nightmares, excessive sleeping. • Ulcers • Gastrointestinal disorders • Sudden losses or gains in weight • Flare ups of preexisting medical disorders: diabetes HBP, asthma, etc. • Injuries from high-risk behaviors • Muscular pain, particularly in lower back and heck. • Increased premenstrual tension • Missed menstrual cycles.

10. Symptoms of Burnout con • Excessive Behavior Indicators • Increased consumption of caffeine, tobacco, alcohol, over-the –counter medications, psychoactive prescription drugs, illicit drugs. • High-risk-taking behavior: auto/cycle accidents, falls, “high-risk” hobbies, general proneness to accidents and injuries, gambling, extreme mood and behavior changes. • Increased propensity for violent and aggressive behavior. • Over and under eating. • Hyperactivity

11. Symptoms of Burnout con • Emotional Adjustment Indicators • Emotional distancing • Paranoia • Depression: loss of meaning, loss of hope. • Decreased emotional control. • Martyrdom. • Fear of “going crazy” • Increased daydreaming/fantasizing. • Constant feelings of being trapped. • Nervous ticks. • Undefined fears. • Inability to concentrate. • Intellectualization. • increased tension.

12. Symptoms of Burnout cont’d • Relationship Indicators Attitude Indicators • Isolation or over bonding with SO/friends. • Responding in mechanical manner. • Isolation from clients. • Increased expression of anger and or mistrust. • Increased interpersonal conflicts. • Increased problems in marital and other interpersonal relationships. • Social Isolation. • Over involvement with clients/patient using clients to meet social needs. • Value Indicators • Sudden and often dramatic changes in values and beliefs.

13. Wellness Resources: • http://www.zurinstitute.com/burnout.html • Site includes the aspects of counseling that influence burnout plus it talks about effects on therapist's family and ways to address burnout. • Site includes an extensive bibliography of stress/burnout books and articles. • http://helpguide.or/mental/burn_signs_wymptoms.htm • Additional resources for burnout.

14. Wellness Resources cont’d • The Wheel of Wellness Counseling for Wellness: a Holistic Model for Treatment Planning. • Good overview of utilizing a Wellness Counseling model with research support. • Wellness Counseling: The Evidence Base for Practice. • Reporting and describing research and ways to approach wellness research. • Wellness of Counselor Educators: an initial Look. • Study looking a wellness in Counselor Educators.