What is burn out and how to manage when it happens?

Do you find you’re trying to engage people in the office and getting nothing back? Are your workers slow to respond to your e-mails, or forgetting that they received them? Do you struggle to connect with people at work or feel exhausted after an attempt at interaction. Are you getting nothing back in meetings. You might be feeling the results of burnt out employees.

Burn out is extremely common with in the workplace, these past two years it has become even more of a concern with the added emotional toll of COVID. Burn out is the consequence of a psychological gap between somebody’s current functioning and the expectations or responsibilities they have. Many things can impact a person’s current functioning or capacity and a person with burn out however may not always present as you would expect.

Some common symptoms are apathy, absences at work or arriving late, being slow to complete tasks and a low mood. Personality plays a major part here; more conscientious people may “hide” their burn out better than more “laid-back” people. In complete contrast however, somebody who previously was the office cheerleader may become moody or irritable.

Burn out looks different for everybody and it can lead to more tense interactions. It can be upsetting discovering that your employees are struggling. It can be easy to take it personally when receiving feedback that about pressures experienced by staff if the staff feel these are due to poor management. Your reaction in these interactions is important. If you (a team leader) are about to approach a staff member who appears to be falling behind, it is particularly important to prepare yourself for some negative feedback. Ideally, you want to approaching staff at a time that you feel able to listen without judgment or defensive responding. This will help to provide a culture of psychological safety, help your workers to feel supported and help to reduce the symptoms of burnout.

Burn out may be experienced on a personal level, however it needs to be addressed at an organisational/cultural level.

If you have concerns about experiencing burn out or would like further information how to foster a workplace culture, contact AXIS today.

Change is a process.

Change is hard. Helping people to change is hard. This is the challenge we face as clinicians working with those who are engaging in maladaptive or harmful health behaviors knows. People learn powerful habits and coping skills in response to stimuli and life events. One conversation is not sufficient for meaningful change. Change that does occur under the guidance of a clinician is rarely linear or consistent. There is always the temptation to assume that the client “is not ready or not motivated” or that their noncompliance is an indication of a clinical failure, however its not that simple.

The science moves away from a deficit model and towards a process of precontemplation, contemplation, preparation, action, and maintenance. A deficit model puts the responsibility on the flaws of the client, the stages of change model aims to meet a client where they are. Crucially, when working with vulnerable populations, validating and acknowledging external barriers (such as socioeconomic factors) is often required. This supports for rapport and accurate formulation. Notably the research has found that repeated education around the uptake of a health behaviour, leads to poor rapport, disengagement, and feelings of disempowerment. Information does not create behaviour change. In contrast, reviewing points of decision making can enhance the patients innate ability for change. Each stage requires different approaches for long term success. The process of change often includes periods of recycling stages or regression, which does not indicate a failure.

During precontemplation the client is unaware or under evaluates their problems (i.e smoking, problem drinking, avoidance of activity post injury). These clients often present to allied health practitioners (such a physiotherapists or psychologists) due to pressure from loved ones, well meaning doctors or the workplace. These clients may be resigned or report feelings of no control, or experience denial. They often struggle believe any poor outcomes could happen to them. While this can come across argumentative it is crucial to explore the behavior requiring change with open questioning:

1. “What would have to happen for you to know that this is a problem?”
2. “What warming signs would let you know that this is a problem?”
3. “Have you tried to change in the past?”

Fig 1: Less than ideal clinical care.

A client in the contemplation of change stage will experience feelings of ambivalence and will start to assess barriers and benefits of change. There is also an acknowledgment of the future loss when cessation of the behavior does occur (e.g missing the positive factors of smoking like feeling “calmer”). The role of the clinician to explore the benefits and barriers of change equally, while not attempting to sway the client’s decision making, allowing the client to make the choice to change on their own. Open questioning must continue:

1. “Why do you want to change at this time?’
2. “What were the reasons for not changing?”

More active work occurs during the preparation stage, where both the client and the clinician explore specific behavioral change and engage in experimentation. This may look like a trial of certain feared movement for persistent pain clients, which is feared the least. In those who are attempting to quit smoking, cutting out one or two cigarettes a day. The preparation stage aims to build confidence and some psychological safety for the following action stage

The action stage is where the obvious changes can be seen, a smoker stops smoking and a patient with chronic pain begins an exercise program to regain function. This is the stage all clinicians aim for in the rehabilitation sector. The action stage is where we see change in key performance indicators, such as mobility and lower pain or distress. Going into the action stage without the prior stages can lead to premature recycling backwards. This can happen if the client made the changes abruptly and potentially without their own reasons to do so. Compliance in rehabilitation is rarely built by advice only, more often it comes from the clients own meaning making and values.

Maintenance and relapse prevention focuses in on incorporating the new behavior into the client’s lifestyle. However, relapse awareness crucial to empower people to recycle through steps again. Recycling or regressing through steps is common and normal, building anticipation for this can help facilitate ongoing rehabilitation. Life happens. A key point for clients is that even though they have relapsed, it has taught them something about themselves and what triggers they may need to avoid. The cyclic nature of the stages of change model helps patients to adopt a more flexible cognitive appraisal of their health behaviour. Rather than a black and white approach e.g. smoking or not smoking.

At all stages active listening and empathy is key. The sciences also support a person-centered approach. Studies have found clinician empathy to correlate with a reduction of problem drinking. In contrast confrontational styles have been found to predict ongoing issues. The stages of change model conceptualises change at an active, ongoing and non linear process. Change can be hard, yet crucial in the rehabilitation sector when delivering healthcare.

References

McPhail, S., & Schippers, M. (2012). An evolving perspective on physical activity counselling by medical professionals. BMC Family Practice, 13(1), 1-8.

Prochaska, J. O., DiClemente, C. C., Velicer, W. F., Ginpil, S., & Norcross, J. C. (1985). Predicting change in smoking status for self-changers. Addictive behaviors, 10(4), 395-406.

Prochaska, J. O., Norcross, J. C., & DiClemente, C. C. (2013). Applying the stages of change. Psychotherapy in Australia, 19(2), 10-15.

Zimmerman, G. L., Olsen, C. G., & Bosworth, M. F. (2000). A’stages of change’approach to helping patients change behavior. American family physician, 61(5), 1409-1416.

Why do I have to wait months to see a psychologist?

We are currently facing a national mental health crisis. Over the past decade we as health professionals in Australia have been tirelessly chipping away at challenging the stigma surrounding accessing mental health services.

However, we are now inundated, which has illuminated a system that is not working to support people or mental health clinicians.

People are being told they must wait months to speak with a qualified mental health professional. A recent ABC article for example ran with the headline; Nine-month waiting list for psychologists in Queensland as doctors forced to ‘pull favours’ (link to full article at the bottom).

There are many factors at play here which are contributing to this unacceptable lag time. The increase in Medicare funded sessions has meant that people who are in therapy are not being discharged as quickly. This is great for some, but a challenge for others trying to book in.

There are also much needed pools of funding via NDIS that were not previously available, the criteria for a psychological injury at work has also changed allowing injured workers to access more support. Another contributing factor is that phasing out of one of the training pathways to becoming a psychologist has meant less options for people wanting to pursue a career as a psychologist

Many articles at the moment are about treatment burnout, I have a different perspective. We need to zoom out and look at the systems that aren’t working. As a psychologist who has recently taken a new position and building my client load, it is frustrating to think that there are people needing to be seen, but who don’t know I am available. The ethics around advertising as psychologists makes this challenging.

It seems another contributor is the lack of a user friendly, shared referral database for GP’s to quickly search for mental health professionals with availability. I stress the word “quickly”, as GP’s are obviously inundated at the moment which leaves it, in many cases up to the individual to source their own help.

There is also a responsibility of us, the mental health professionals, psychologists, counsellors etc. to lean on each other during this difficult time. It seems to be us trying to triage our waitlists and contact our colleagues for appropriate referral pathways.

We have the technology to deliver confidential, secure, safe telehealth services to those that need it, we just need the tools to connect people and I feel that is where we are letting our profession and those that have the courage to seek help down.

I’m hopeful that someone in a position to drive change may read this and be inspired to reply with some suggestions as to how we can fix this problem, but if not, I hope it has given you food for thought.

“Nine-month waiting list for psychologists in Queensland as doctors forced to ‘pull favours’

National Pain Week

This week is National Pain Week. Chronic pain is a really big problem, affecting up to 40% of people at some point during their life. [1]

Chronic pain carries a large financial burden in Australia. A 2019 report from Deloitte estimated that the average cost for an Australian person living with chronic pain is AU$22,588-$42,979 per year when indirect costs were considered. [2]

The theme of Chronic Pain Australia’s National Pain Week this year is – CONNECTION.

And one thing we know at AXIS is that patients with chronic pain often lose connection with their workplace. This is one part of the big picture problem of the impact of chronic pain, and it is why at AXIS our pain management and rehabilitation programs have a laser focus on return to work.

Our expert clinicians work very hard to help our patient re-establish their meaningful life connections – including family, social and critically work connections. We know that being able to engage in good work is enormously beneficial for our patients physical and mental health.

At AXIS, 1 in 3 patients who start our program off work are able to return to work whilst completing their rehabilitation. We achieve this in five key ways:

1.  Allied health led by Highly experienced and qualified team

We provide an allied health led program. This means that our patients are active participants in their rehabilitation. It also means that they are able to maintain their CONNECTION with their existing care providers such as their GP or specialist.

2.  Run part-time fostering the goal of ‘return to work’

Our programs are run part-time and this allows our patients to remain at work OR return to work whilst engaging in rehabilitation. This allows them to remain CONNECTED with their employer and helps them discover that work IS rehabilitation.

3.  Comprehensive communication with all stakeholders to facilitate a positive RTW outcome

We don’t provide our rehabilitation in a silo. Coming to AXIS isn’t a holiday from the usual pressures and challenges that are present in day-to-day life. We work hard to CONNECT with our patients’ usual care team and communicate a rehabilitation plan that helps them stay on track with their recovery long after they have completed our program.

4.  Individual sessions (1:1) and tailored to the individual needs of client

We understand that every one of our patients is an individual and therefore needs an individualized recovery plan. We don’t believe in recipe approaches or that one size fits all and all of our sessions are run one on one. This ensures a strong CONNECTION between us and our patients.

5.  Flexible locations, hours and start dates

Finally, we know that having chronic pain doesn’t mean that all of the other demands on our time stops. That’s why we have positioned our clinics conveniently around South East Queensland, so that patients don’t have to commute for hours just to attend specialist care. And because we are part-time, patients can find a time that suits their schedule. That way, they stay CONNECTED with their usual life whilst they recover.

For more information on National Pain Week, visit https://www.nationalpainweek.org.au/

Source

[1] Cohen, S. P., Vase, L., & Hooten, W. M. (2021). Chronic pain: an update on burden, best practices, and new advances. The Lancet, 397(10289), 2082-2097.

[2] Deloitte Access Economics. The cost of pain in Australia. March, 2019. https://www2.deloitte.com/au/en/pages/economics/articles/cost-pain-australia.html (accessed 7 July, 2021).