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

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

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BURNOUT

Merrill Main, Ph.D.

Clinical Director

DHS Special Treatment Unit

Merrill.main@dhs.state.nj.us


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.


EXTERNAL

?

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


EXTERNAL

  • Lack of training

  • Unclear expectations

  • Lack of support

  • Lack of resources

  • Overutilization

  • Underutilization


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)


  • 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.


    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.


  • SYMPTOMS

    • Vicarious Tramatization

    • Hypervigilence

    • Distrust

    • Sexualization

    • Objectification of patients

    • Over-identification with patients

    • Stress

    • Exhaustion

    • Depression

    • Detachment from work

    • Over-investment in work


    OVER-IDENTIFICATION


    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.


    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


    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


    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


    UNDER-IDENTIFICATION

    • Beyond gallows humor

    • Distain

    • Distrust

    • Disregard

    • Disrespect


    THERAPIST STYLE

    • “Among the influential therapist behaviors, the most important appear to be: empathy, warmth, rewardingnes, and directiveness.”

      • Marshall (2005)


    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.


    ANTI-BURNOUT

    • Engagement

    • Vigor

    • Person-Environment Fit


    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.


    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


    BURNOUT

    Merrill.main@dhs.state.nj.us


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