Merrill Main, Ph.D. Clinical Director DHS Special Treatment Unit Merrill.main@dhs.state.nj.us

1. BURNOUT Merrill Main, Ph.D. Clinical Director DHS Special Treatment Unit Merrill.main@dhs.state.nj.us

2. INTERNAL • Have, get, buy, borrow, or rent a life. • Lack of self-care. • Too much tendency to externalize. • Unmanaged general mental health issues. • Savior complex gone wrong. • Poor affect management.

3. EXTERNAL ? Answers in Organizational Psychology. For example, Herzberg's Motivation-Hygiene Theory ?

4. EXTERNAL • Lack of training • Unclear expectations • Lack of support • Lack of resources • Overutilization • Underutilization

5. NUMBERS • 20% to 25% show clinical burnout • Kadambi and Truscott, 2003 • 30% of the teachers • Rudow, 1999 • 50% of medical residents • Martini, S., Arfken, C., Churchill A., and Balon, R. (2004)

6. Sexual OffendingIs it contagious? • Were all sexual offenders once sexual victims? • Will all victims become offenders? • Do we begin to behave like the population that we work with.

7. PARALLEL PROCESS • Psychoanalytic idea that relationship between patient and therapist is reflected in relationship between therapist and supervisor. • Searles (1955) • See the world through the patient’s eyes too often and it may become habitual.

8. SYMPTOMS • Vicarious Tramatization • Hypervigilence • Distrust • Sexualization • Objectification of patients • Over-identification with patients • Stress • Exhaustion • Depression • Detachment from work • Over-investment in work

9. OVER-IDENTIFICATION

10. YOU’RE THE BEST • The high-school kid striving to be popular is still alive inside all of us. • Savior complex. • Misguided striving for personal safety. • Stockholm Syndrome.

11. YOU’RE THE WORST • I’ll prove that I’m worthy. • The beatings will continue until morale improves. • Effort justification • We like most what we’ve struggled to master

12. Divisive • Build one faction up, tear another down • ‘Shop’ for the best answer • Play one against the other • Highly attuned to existing differences/conflicts • Magnify and exacerbate real differences • Between individuals • Between groups • Instigate conflict for personal pleasure or gain

13. Manipulative • Starts with small things • Favors given or taken • I won’t tell • Progresses to big things • May seem reasonable at each step • Often starts with small quid-pro-quo

14. UNDER-IDENTIFICATION • Beyond gallows humor • Distain • Distrust • Disregard • Disrespect

15. THERAPIST STYLE • “Among the influential therapist behaviors, the most important appear to be: empathy, warmth, rewardingnes, and directiveness.” • Marshall (2005)

16. Effects and problems of working with sexual offenders • Excessive identification with offenders. • Excessive anger toward of offenders. • Parallel processes. • Effect on clinicians’ sexual functioning. • Work intruding into life. • Become used to talking about sex with patients.

17. ANTI-BURNOUT • Engagement • Vigor • Person-Environment Fit

18. Burnout Prevention • Communicate with colleagues • Commiserate with colleagues • Utilize supervision • HAVE A LIFE OUTSIDE OF WORK • Don’t worry more about patients’ problems than they do.

19. REFERENCES • Drapeau, M. (2005) Research on the Processes Involved in Treating Sexual Offenders. Sexual Abuse: A Journal of Research and Treatment. 17, 117 - 125. • Edmunds, S. (Ed.) 1997. Impact: Working with Sexual Abusers. Safer Society: Brandon, Vt. • Ennis, L. and Home, S., (2003). Predicting Psychological Distress in Sex Offender Therapists. Sexual Abuse: A Journal of Research and Treatment. 15, 149 - 157. • Farrenkopf, T. (1992) What Happens to Therapists who work with Sex Offenders? Journal of Offender Rehabilitation. 18(3/4), 217-223. • Kadambi, M., and Truscott, D., (2003) Vicarious Traumatization and Burnout Among Therapists Working with Sex Offenders. Traumatology. 9(4) 216-230. • Lea, S., Auburn, T., and Kibblewhite, K. (1999). Working with Sex Offenders: The Perceptions and Experiences of Professionals and Paraprofessionals. International Journal of Offender Therapy and Comparative Criminology. 43(1), 103-119. • Little, L. and Hamby, S. (2001). Memory of Childhood Sexual Abuse Among Clinicians: Characteristics, Outcomes, and Current Therapy Attitudes. Sexual Abuse:A Journal of Research and Treatment., 13, 233 - 248. • Moulden, H. and Firestone, P. (2007). Vicarious Traumatization: The Impact on Therapists Who Work With Sexual Offenders. Trauma Violence Abuse. 8, 67-83. • Nelson, M., Herlihy, B., and Oescher, J. (2002) A Survey of Counselor Attitudes Towards Sex Offenders. J of Mental Health Counseling. 24(1), 51-67. • Salter, A. (2003) Staff Seductions. In Predators: Pedophiles, Rapists and Other Sex Offenders. Basic Books:New York.Shelby, R., Stoddart, R., and Taylor, K. (2001) Factors Contributing to Levels of Burnout Among Sex Offender Treatment Providers. Journal of Interpersonal Violence. 16(11), 1205-1217. • Steed, L., and Bicknell, J. (2001). Trauma and the Therapist: The Experience of Therapists Working with the Perpetrators of Sexual Abuse. Australasian Journal of Disaster and Trauma Studies. 2001(1). • Thorpe, G., Righthand, S., and Kubik, E. (2001). Brief Report: Dimensions of Burnout in Professionals Working with Sex Offenders. Sexual Abuse: A Journal of Research and Treatmnet., 13, 197 - 203. • W.L. Marshall, W. (2005) Therapist Style in Sexual Offender Treatment: Influence on Indices of Change. Sexual Abuse: A Journal of Research and Treatmnet., 17; 109-116

20. BURNOUT Merrill.main@dhs.state.nj.us