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Sasha Kondrashov and Ani Dingamtar

Wikipedia defines patience as the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset. After reading such a definition, ask yourself a question, is it empowering? Internet is full of advice on how to be patient: “The Skill of Patience“, “The Quality of Patience“, “Compassionate Patience“, “5 Tips for Teaching Patience“, “The Importance of Patience in Every Area of Life“, “How To Master Patience – 20 Powerful Tips“, “The Three P’s to Success: Patience, Persistence and Positivity“, “Becoming a more patience leader“, “15 Tips for Becoming as Patient as Job“, “35 Inspirational Quotes On Patience” and even more quotes about patience.

One can also listen to the “Patience” song by American hard rock band Guns N’ Roses, which appears on the album G N’ R Lies and is released as a single in 1989 and then Chris Cornell’s tribute to Guns N’ Roses classic song “Patience“. When one study psychology, patience is seen as a decision-making problem involving either a small reward in the short-term versus a more valuable reward in the long-term. Religions all over the world will have some reminders on why patience is essential in life. Sandilya Upanishad of Hinduism identifies ten sources of patience and forbearances: Ahimsa, Satya, Asteya, Brahmacharya, Daya, Arjava, Kshama, Dhriti, Mitahara and Saucha. In each of these ten forbearances, the virtuous implicit belief is that our current spirit and the future for everyone, including oneself, will be stronger if these forbearances are one’s guide.

Motivational videos, speeches, TED talks remind us of the importance of being patient. However, is it such a fantastic skill, virtue, ability and capacity that we always need to practice? Let’s go back to patience’s original definition as the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset. Now let’s stop for a minute and think about bullying, harassment, violence, abuse, neglect, genocide, and many other suffering processes. Are we saying to the victim, please be patient and practice tolerance> It can be extremely disempowering.

Social workers need to be critical of using concept patience when working with their clients. We need to know what patience means to the person. Social workers do not offer advice, so saying please be patient to the victim of violence without explaining what we mean by patience can be perceived as keeping experience violence.

Patience has multiple meanings, and depending on someone’s experiences with patience, the use of the concept in social work practice needs to be adequately assessed. Saying be patient without discussing what it means to be patient and not learning about experiences people had with practicing patience can be damaging. Victims of violence can stay in violent relationships when they are reminded to be patient. Abuse and neglect will continue as a person is reminded that patience is a virtue and suffering needs to be tolerated.

Patience also can be seen as a way to move in a direction that can be positive as the change process can be slow with many ups and downs, setbacks and slow step by step progressions. In such a way, patience becomes the ability to assiduously wait out the change process, allowing time to bring the needed changes.

The process of practicing patience needs to come from within the person. Each person have their plan to navigate challenges. Saying to someone to be patient is not a solution. Asking someone to find ways to alleviate suffering can be an opportunity to discuss patience from inner-self. When people describe what they do to stop abuse, it allows them to uncover humility, strength, capacity and define patience. In such a way, patience can be empowering. If the social worker uses it without a proper assessment of the situation, patience can be very disempowering.

Patience is the ability to find a balance that only can be seen from the inner self. Social workers can explore the balance on individual, cultural and structural levels and ask clients about their capacity on each level. Patience is experienced very differently by many people. One learning journey about being patient is very different too. Many people learn about patience associated with childhood experiences. For some people, positive change can happen when they practice patience, while others are kept waiting for any positive changes to come.

The discussion on privilege and oppression is essential when the concept of patience is explored as a person might have a lot of individual capacity, but culturally and structurally, being patient is challenging. For example, a person who is unemployed, living in an abusive relationship might have more challenges in leaving the relationship than one who has stable employment and has the more structural and cultural capacity to stop tolerating abuse.

To practice patience, some people need to demonstrate impatience. It is more evident on structural and cultural levels. Protests are examples of when patience is not enough and impatience is critical to make positive changes. If they kept patiently waiting for including vacation benefits in their employment contract, workers might never get them from the employer. People who experience violence in abusive relationships might never be able to receive adequate services if the funding was not allocated to create such services.  Impatience is a much more critical concept for social workers to discuss with clients than being patient. Many abusers and those who want to maintain the status quo will use the phrase; please be patient to keep oppression going. Such ways of seeing patience should not be tolerated, and social workers need to question why patience is used to silence victims of abuse. Patiently experiencing harassment is not okay. Patiently being bullied, neglected should never be accepted.

Social workers need to promote critical patience when change is explained, and people are not forever waiting and tolerating their suffering. Patience needs to be appropriately taught when it is okay to tolerate suffering and how to do it. When suffering destroys your physical, emotional, spiritual and mental health it is not okay to be reminded to stay patient. Patience needs to be seen on different levels: individual, cultural and structural, and lenses of privilege and oppression need to be applied in practicing patience. Each person has a unique experience with patience on each level, and it needs to be explored, and proper actions are taken to be patient and achieve the change that is consistent with social work values.

Practice patience critically and explore when patience can be empowering and promote it. When patience is disempowering, practicing impatience is a better course of action.

Burnout

Oleksandr (Sasha) Kondrashov, and Ani Dingamtar. January 2020

What is burnout?

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Maslach and Jackson (1986) defined burnout as “ a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who do “people work” of some kind. . . .   Burnout can lead to a deterioration in the quality of care or service provided. . . . It appears to be a factor in job turnover, absenteeism, and low morale. …  It seems to be correlated with various self-reported indices of personal dysfunction, including physical exhaustion, insomnia, increased use of alcohol and drugs, and marital and family problems,   (pp. 1-2).

Maslach and Leiter (2016) state that burnout is a cronic problem. Muldary (1983) defined burnout as the “process by which a once-committed health professional becomes ineffective in managing the stress of frequent emotional contact with others in the helping context, experiences exhaustion, and, as a result, disengages from patients, colleagues, and the organization” (p. 12). Corcoran and Bryce (1983) defined burnout as the “loss of motivation for creative involvement with one’s client population and/or organizational setting” (p. 72). Brown (1984) reported that the problem of burnout among social service employees is “an increasing one” (p. 55).

All of the definitions, offered in the literature, involve negative reactions from and towards work. “Burnout is an individual experience that is specific to the work context” (Maslach, Schaufеli, & Lеitеr,  2001, p. 407; Maslach, 2017).

What does burnout mean for social work?

“Social workers are considered an occupational group at above-average risk for burnout.” (Soderfeldt & Soderfeldt, 1995, p. 638). Burnout not only affects the individual, but also can affect many others around that individual. In social work, burnout affects the quality of care, relationships, and effectiveness of care towards clientele (Wilson, 2016). Burnout also affects organizations by way of employment status, organizational reputation, and ultimately service provider numbers (i.e. having fewer employees to handle caseloads). This in turn indirectly affects clients as well. Although most of the research found that burnout is more a social or job situation than an individual issue (Soderfeldt, et al., 1995; Maslach et al. 2001; Maslach, 2017) there are some differences in who is susceptible and what type of burnout is experienced.

How you can recognize burnout (signs and symptoms)?

Certain demographic variables have been found to be related to the level of burnout. Marital status, age, level of education are some demographic factors identified in the literature as contributing to burnout in some form (Soderfeldt, et al., 1995; Maslach et al., 2001). Of all the demographic variables that have been studied, age is the one that has been most consistently related to burnout. Among younger employees the level of burnout is reported to be higher than it is among those over 30 or 40 years old. However, these findings should be viewed with caution because of the problem of survival bias—i.e. those who burn out early in their careers are likely to quit their jobs, leaving behind the survivors who consequently exhibit lower levels of burnout (Maslach et al. 2001).  

With regard to marital status, those who are unmarried (especially men) seem to be more prone to burnout compared with those who are married. Singles seem to experience even higher burnout levels than those who are divorced (Maslach et al. 2001).

Some studies have found that those with a higher level of education report higher levels of burnout than less educated employees. It is not clear how to interpret this finding, given that education is confounded with other variables, such as occupation and status. It is possible that people with higher education have jobs with greater responsibilities and higher stress. Or it may be that more highly educated people have higher expectations for their jobs, and are thus more distressed if these expectations are not realized (Maslach et al. 2001).

Avillion and Hamilton  (2018) from Wild Iris Medical Education lists physical, emotional and behavouiral signs and symptoms of burnout:

Physical

• Feeling tired and drained most of the time

• Lowered immunity, feeling sick a lot

• Frequent headaches, back pain, muscle aches

• Changes in appetite or sleep habits

Emotional

• Sense of failure and self-doubt

• Feeling helpless, trapped, and defeated

• Losing motivation

• Feeling alone in the world and detached from others

• Becoming increasingly cynical

• Decreased satisfaction and sense of accomplishment

Behavioral

• Withdrawing from responsibilities

• Isolating oneself from others

• Procrastinating, taking longer to get things done

• Using food, drugs, or alcohol to cope

• Taking out one’s frustrations on others

• Skipping work or coming in late and leaving early 

Maslach and Leiter (2016) provide some ideas on how to assess burnout by referencing Banishing Burnout: Six Strategies for Improving Your Relationship With Work book. For each item, think about how your current place employment matches up with your personal preferences using the following continuum: Just Right-Mismatch-Major Mismatch

Workload

The amount of work to complete in a day

The frequency of surprising, unexpected events

Control

My participation in decisions that affect my work

The quality of leadership from upper management

Reward

Recognition for achievements from my supervisor

Opportunities for bonuses or raises

Community

The frequency of supportive interactions at work

The closeness of personal friendships at work

Fairness

Management’s dedication to giving everyone equal consideration

Clear and open procedures for allocating rewards and promotions

Values

The potential of my work to contribute to the larger community

My confidence that the organization’s mission is meaningful

If everything is a match, you have found an excellent place of employment. However, if there is a lot of major mismatches that can lead to burnout.

What you can do to stay empowered (practical tips, strategies and tools)

Staying empowered can be difficult when you are facing with burnout. Maslach and Leiter (2016) suggest that when burnout is counteracted with engagement, exhaustion is replaced with enthusiasm, bitterness with compassion, and anxiety with efficacy” (p.44) there is a possibility to change.

Laura Biggart from The Centre for Research on Children and Families at the University of East Anglia in the Youtube video by Community Care (2017) offered the following tips for coping with burnout in social work

1. Use supervision opportunities

2. Aim to raise concerns with supervisors and team  leaders

3. Use your team as a resource for sympathy, advice and guidance

4. Remember that no social worker is invicible or all-knowing

5. Identify what you find emotionally rewarding at work and at home

Inspiration Quotes about Burnout

“Slowly you may have transformed from a helper to one in need of help. It’s important to talk about this, to identify the wounds you carry.”

― Jenn Bruer, Helping Effortlessly: A Book of Inspiration and Healing

“Dear Stress, I would like a divorce. Please understand it is not you, it is me.

–Thomas E. Rojo Aubrey”

― Thomas E. Rojo Aubrey, Unlocking the Code to Human ResiliencyMore quotes on Goodreads

Where you can learn more about burnout 

There are a number of resources available to learn about burnout. Below are resources that can help guide you move from burnout out back to engagement.

• Read Petra Durianova research Burnout Syndrome: A Disease of the Modern Age. Durianova (2012) suggest that burnout syndrome intervenes in every aspect of your life and is capable of destroying it both physically and mentally. In Petra’s work there is a good review of Freudenberger’s 12 stages of burnout (p.25-27): 

A Compulsion to Prove Oneself

Working Harder

Neglecting One’s Needs

Displacement of Conflicts

Revision of Values

Denial of Emerging Problems

Withdrawal From Social Contacts

Obvious Behavioral Changes

Depersonalization

Inner Emptiness

Depression

Burnout Syndrome

• Check Wild Iris Medical Education module on Burnout and Stress:Creating a Healthy Workplace

Upon completion of module, you will be able to identify the causes, symptoms, stages, management, and prevention of job-related stress andcomponents of a healthy workplace. Specific learning objectives include:

• Describe the effects of stress on the human body and how to relieve such stress.

• Explain the types of job stress common in healthcare workers.

• Discuss the presentation and causes of job-related stress in healthcare.

• Summarize actions for responding to different forms of job-related stress.

• Describe individual and organizational strategies to minimize job-related stress.

• Review Lauren’s video on 10 tips on how to stay well is social work. Lauren just celebrated 10 years of working in social work practices and the video is part of the social work scrapbook channel
• Read SaraKay Smullens article in the new social worker What I Wish I Had Known: Burnout and Self-Care in Our Social Work Profession that focuses on burnout, compassion fatigue Vicarious Trauma and Secondary Traumatic Stress and self care tips as antitode to the above concerns.
• Watch Ernst-Jan Pfauth and Frédéric Meuwly Ted Talks.  Ernst-Jan Pfauth shares ideas on how we can beat the burnout society. The video provides ideas on how to stay balanced while living in overachieving society. Frédéric Meuwly talk Burnout… A friend of a friend’s problem is based on a true story from a “burnout survivor”. This talk provides an overview how the exhaustion work and how to manage it effectively.

If you find any additional resources please share them in the comments.

Keep learning and sharing your knowledge.

Sasha and Ani.

References

Maslach, C, Jacksоn, S. Е. (1986). Thе Maslach Burnоut Invеntоry manual (2nd еd.). Palо Altо, CA, CоnsultingPsychоlоgists Prеss.

Muldary,  T. W.  (1983). Burnоut and hеalth prоfеssiоnals: Manifеstatiоns and managеmеnt. Nоrwalk, CT, ACapistranо Publicatiоn.

Cоrcоran, K.J., Brycе, A.K. (1983). Intеrvеntiоn in еxpеriеncе оf burnоut: Еffеcts оf skill dеvеlоpmеnt. Jоurnal оf Sоcial Sеrvicе Rеsеarch 7 (1),71–79.

Brоwn, L.N. (1984). Mutual hеlp staff grоups tо managе wоrk strеss. Sоcial Wоrk With Grоups 7 (2), 55–66.

Maslach, C., Schaufеli, W. B., & Lеitеr, M. P. (2001) Jоb burnоut. Annual Rеviеw оf Psychоlоgy, 52, 297-422.

Sоdеrfеldt, M., Sоdеrfеldt, B., & Warg, L. (1995). Burnоut in sоcial wоrk. Sоcial Wоrk, 40, 638-646.

Maslach, C., & Leiter, M. P. (2016). Burnout. In Stress: Concepts, cognition, emotion, and behavior (pp. 351-357). Academic Press.

Maslach, C. (2017). Burnout: A multidimensional perspective. In Professional burnout (pp. 19-32). Routledge.

Wilson, F. (2016). Identifying, preventing, and addressing job burnout and vicarious burnout for social work professionals. Journal of evidence-informed social work, 13(5), 479-483.