Being part of the health care system involves facing stress, loneliness and the emotional toll of assisting, listening and caring for patients who come into the office or hospital, and seek or even demand assistance. Healthcare workers, like physicians, nurses and therapists, are trained, on assisting and healing others. They are less effective in taking care of themselves. This article, which aims to heighten clinicians' awareness of the need for self-care, especially now in the post-pandemic era, addresses the demanding nature of medicine and health work, and the resistance that clinicians commonly display in the face of suggestions that they engage in self-care. The consequences of neglecting to care for oneself are delineated. The demanding nature of medicine is reviewed, along with the loneliness and isolation felt by clinicians particularly those in private practice, the professional hazards faced by those caring for others, and the ways that are available to them (should they decide to care for themselves) for the benefit of their clients, their families and, obviously, themselves.
Citation: Ami Rokach. Healthcare workers: diminishing burnout symptoms through self-care[J]. AIMS Medical Science, 2023, 10(1): 55-68. doi: 10.3934/medsci.2023006
Being part of the health care system involves facing stress, loneliness and the emotional toll of assisting, listening and caring for patients who come into the office or hospital, and seek or even demand assistance. Healthcare workers, like physicians, nurses and therapists, are trained, on assisting and healing others. They are less effective in taking care of themselves. This article, which aims to heighten clinicians' awareness of the need for self-care, especially now in the post-pandemic era, addresses the demanding nature of medicine and health work, and the resistance that clinicians commonly display in the face of suggestions that they engage in self-care. The consequences of neglecting to care for oneself are delineated. The demanding nature of medicine is reviewed, along with the loneliness and isolation felt by clinicians particularly those in private practice, the professional hazards faced by those caring for others, and the ways that are available to them (should they decide to care for themselves) for the benefit of their clients, their families and, obviously, themselves.
[1] | Luther L, Gearhart T, Fukui S, et al. (2017) Working overtime in community mental health: associations with clinician burnout and perceived quality of care. Psychiatr Rehabil J 40: 252-259. https://doi.org/10.1037/prj0000234 |
[2] | Pope KS, Tabachnick BG (1993) Therapists' anger, hate, fear, and sexual feelings: national survey of therapist responses, client characteristics, critical events, formal complaints, and training. Prof Psychol Res Pr 24: 142-152. https://doi.org/10.1037/0735-7028.24.2.142 |
[3] | Hadjipavlou G, Halli P, Hernandez CAS, et al. (2016) Personal therapy in psychiatry residency training: A national survey of Canadian psychiatry residents. Acad Psychiatry 40: 30-37. https://doi.org/10.1007/s40596-015-0407-9 |
[4] | Woo T, Ho R, Tang A, et al. (2020) Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis. J Psychiatr Res 123: 9-20. https://doi.org/10.1016/j.jpsychires.2019.12.015 |
[5] | Salyers MP, Bonfils KA, Luther L, et al. (2017) The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. J Gen Intern Med 32: 475-482. https://doi.org/10.1007/s11606-016-3886-9 |
[6] | Skovholt TM, Trotter-Mathison M (2016) The resilient practitioner: Burnout and compassion fatigue prevention and self-care strategies for the helping professions. New York: Routledge. |
[7] | Segall A, Goldstein J (1989) Exploring the correlates of self-provided health care behaviour. Soc Sci Med 29: 153-161. https://doi.org/10.1016/0277-9536(89)90163-9 |
[8] | Norcross JC, VandenBos GR (2018) Leaving it at the office: A guide to therapist self-care. NY: Guilford Press. |
[9] | Kushnir T, Rabin S, Azulai S (1997) A descriptive study of stress management in a group of pediatric oncology nurses. Cancer Nurs 20: 414-421. https://doi.org/10.1097/00002820-199712000-00005 |
[10] | Di Martino V (1992) Preventing stress at work. Overview and analysis. Conditions of work digest. Geneva: International Labor Office (p. 11). |
[11] | Mosolova E, Chung S, Sosin D, et al. (2020) Stress and anxiety among healthcare workers associated with COVID-19 pandemic in Russia. Psychiatr Danub 32: 549-556. https://doi.org/10.24869/psyd.2020.549 |
[12] | CMPA (Canadian Medical Protective Association)Physician health: putting yourself first (2022). Available from: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2015/physician-health-putting-yourself-first |
[13] | Rokach A, Sha'ked A (2013) Together and lonely: Loneliness in intimate relationships—Causes and coping. NY: Nova Science Publishers. |
[14] | Rokach A (2019) The Psychological Journey to and from Loneliness: development, causes, and effects of social and emotional isolation. Cambridge, MA: Academic Press. |
[15] | Soler-Gonzalez J, San-Martín M, Delgado-Bolton R, et al. (2017) Human connections and their roles in the occupational well-being of healthcare professionals: A study on loneliness and empathy. Front Psychol 8: 1475. https://doi.org/10.3389/fpsyg.2017.01475 |
[16] | Karaoglu N, Pekcan S, Durduran Y, et al. (2015) A sample of paediatric residents' loneliness-anxiety-depression-burnout and job satisfaction with probable affecting factors. J Pak Med Assoc 65: 183-191. |
[17] | Gündoğan H Meaning-making process of psychotherapists on feelings of incompetence through the framework of the professional self-development: sources, consequences, and defense mechanisms (2017). (Doctoral dissertation, Middle East Technical University, Ankara, Turkey) |
[18] | Levitt DH, Jacques JD (2005) Promoting tolerance for ambiguity in counselor training programs. J Humanist Counse Educ Dev 44: 46-54. https://doi.org/10.1002/j.2164-490X.2005.tb00055.x |
[19] | Preti E, Di Mattei V, Perego G, et al. (2020) The psychological impact of epidemic and pandemic outbreaks on healthcare workers: rapid review of the evidence. Curr Psychiatry Rep 22: 43. https://doi.org/10.1007/s11920-020-01166-z |
[20] | Del Castillo DM Male Psychotherapists' Masculinities: A Narrative Inquiry into the Intersection Between Gender and Professional Identities (2010). (Doctoral dissertation, Miami University, Oxford, USA). |
[21] | Nelson W, Pomerantz A, Howard K, et al. (2007) A proposed rural healthcare ethics agenda. J Med Ethics 33: 136-139. https://doi.org/10.1136/jme.2006.015966 |
[22] | Simpson S, Simionato G, Smout M, et al. (2018) Burnout amongst clinical and counselling psychologists: the role of early maladaptive schemas and coping modes as vulnerability factors. Clin Psychol Psychother 26: 35-46. https://doi.org/10.1002/cpp.2328 |
[23] | Guy JD (1987) The personal life of the psychotherapist. New York: Wiley. |
[24] | Firew T, Sano ED, Lee JL, et al. (2020) Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers' infection and psychological distress during the COVID-19 pandemic in the USA. BMJ Open 10: e042752. https://doi.org/10.1136/bmjopen-2020-042752 |
[25] | Que J, Shi L, Deng J, et al. (2020) Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China. Gen Psychiatr 33: e100259. https://doi.org/10.1136/gpsych-2020-100259 |
[26] | García-Zamora S, Pulido L, Miranda-Arboleda AF, et al. (2022) Aggression, micro-aggression, and abuse against health care providers during the COVID-19 pandemic. A Latin American survey. Curr Probl Cardiol 47: 101296. https://doi.org/10.1016/j.cpcardiol.2022.101296 |
[27] | Maroda KJ (2010) Psychodynamic techniques: Working with Emotion in the Therapeutic Relationship. New York: Guilford Press. |
[28] | Walters M The client's explicit expression of anger towards their therapist: a grounded theory study of female trainee therapists (2018). (Doctoral dissertation, Middlesex University, London, England). Available from: http://eprints.mdx.ac.uk/25925/ |
[29] | Burns EM When patients attack: The experience of inpatient mental health counselors after a physical attack from a patient (2018). (Doctoral dissertation, University of Tennessee, Knoxville, USA). Available from: https://trace.tennessee.edu/utk_graddiss/5251/ |
[30] | Reuben A Secondary trauma: When PTSD is contagious. The Atlantic (2015). Available from: https://www.theatlantic.com/health/archive/2015/12/ptsd-secondary-trauma/420282/ |
[31] | Pearlman LA, Saakvitne KW (1995) Trauma and the therapist: Countertransference and vicarious traumatization in psychotherapy with incest survivors. New York: Norton. |
[32] | Trumello C, Bramanti SM, Ballarotto G, et al. (2020) Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 17: 8358. https://doi.org/10.3390/ijerph17228358 |
[33] | Thomas JT (2005) Licensing board complaints: minimizing the impact on the psychologist's defense and clinical practice. Prof Psychol Res Pr 36: 426-433. https://doi.org/10.1037/0735-7028.36.4.426 |
[34] | Rupert PA, Stevanovic P, Hunley HA (2009) Work-family conflict and burnout among practicing psychologists. Prof Psychol Res Pr 40: 54-61. https://doi.org/10.1037/a0012538 |
[35] | Lai CC, Shih TP, Ko WC, et al. (2020) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 55: 105924. https://doi.org/10.1016/j.ijantimicag.2020.105924 |
[36] | Miller RD, Giffin JA (2019) Parallel pregnancies: The impact on the supervisory relationship and art therapy practice. Arts Psychother 63: 94-101. https://doi.org/10.1016/j.aip.2018.12.007 |
[37] | Bienen M (1990) The pregnant therapist: Countertransference dilemmas and willingness to explore transference material. Psychother Theory Res Pract Train 27: 607-612. https://doi.org/10.1037/0033-3204.27.4.607 |
[38] | Locker-Forman A (2005) When real meets pretend: An exploration of the impact of the therapist's pregnancy on child psychotherapy.City University of New York. |
[39] | Zackson J The impact of primary maternal preoccupation on therapists' ability to work with patients (2012). (Doctoral dissertation, City University of New York) |
[40] | Das S, Singh T, Varma R, et al. (2021) Death and mourning process in frontline health care professionals and their families during COVID-19. Front Psychiatry 12: 624428. https://doi.org/10.3389/fpsyt.2021.624428 |
[41] | Norris DM, Gutheil TG, Strasburger LH (2003) This couldn't happen to me: boundary problems and sexual misconduct in the psychotherapy relationship. Psychiatr Serv 54: 517-522. https://doi.org/10.1176/appi.ps.54.4.517 |
[42] | Romero J Therapists' experiences with illness, injury, and disability: effects on the therapist's subjectivity and the therapeutic relationship (2018). (Doctoral dissertation, The State University of New Jersey) |
[43] | Myran DT, Cantor N, Rhodes E, et al. (2022) Physician health care visits for mental health and substance use during the COVID-19 pandemic in Ontario, Canada. JAMA Netw Open 5: e2143160. https://doi.org/10.1001/jamanetworkopen.2021.43160 |
[44] | Lasky R (2005) The training analysis in the mainstream Freudian model. The psychotherapist's own psychotherapy. Oxford: Oxford University Press. |
[45] | Goldfried MR (2001) Conclusion: A perspective on how therapists change. Washington, DC: American Psychological Association. https://doi.org/10.1037/10392-017 |
[46] | Freud S (1933) Fragment of an analysis of a case of hysteria. Collected papers of Sigmund Freud. London: Hogarth. (Original work published 1905) |
[47] | Chodron P (1994) Start where you are: A guide to compassionate living. Boston: Shambhala. |
[48] | Kazak AE, Noll RB (2004) Child death from pediatric illness: conceptualizing intervention from a family/systems and public health perspective. Prof Psychol Res Pract 35: 219-226. https://doi.org/10.1037/0735-7028.35.3.219 |
[49] | Skovholt TM, Jennings L (2004) Master therapists: Exploring expertise in therapy and counseling. Boston, MA: Allyn & Bacon. |
[50] | Florio Pipas C (2020) Caring for me is caring for you: the power of physician self-care and personal transformation. Fam Pract Manag 27: 17-22. |
[51] | Fjorback LO, Arendt M, Ornbøl E, et al. (2011) Mindfulness-based stress reduction and mindfulness-based cognitive therapy: A systematic review of randomized controlled trials. Acta Psychiatr Scand 124: 102-119. https://doi.org/10.1111/j.1600-0447.2011.01704.x |
[52] | Fessell DP, Goleman D (2020) How health care workers can take care of themselves.Harvard Business Reviw, Analytic Services. |
[53] | Irwin MR, Cole JC, Nicassio PM (2006) Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol 25: 3-14. https://doi.org/10.1037/0278-6133.25.1.3 |
[54] | Bush AD (2015) Simple self-care for therapists: Restorative practices to weave through your workday. New York: Norton. |
[55] | Field TM (1998) Massage therapy effects. Am Psychol 53: 1270-1281. https://doi.org/10.1037/0003-066X.53.12.1270 |
[56] | Hou W, Chiang P, Hsu T, et al. (2010) Treatment effects of massage therapy in depressed people: A meta-analysis. J Clin Psychiatry 71: 894-901. https://doi.org/10.4088/JCP.09r05009blu |
[57] | Pope KS Exercise's effects on psychological health, well-being, disorders, cognition, & quality of life (2017). Available from: https://kspope.com/ethics/exercise-meta-analyses.php |
[58] | Neuhaus M, Eakin EG, Straker L, et al. (2014) Reducing occupational sedentary time: a systematic review and meta-analysis of evidence on activity-permissive workstations. Obes Rev 15: 822-838. https://doi.org/10.1111/obr.12201 |
[59] | Augustin S, Morelli A (2017) Psychotherapy office designs that support treatment objectives. Handbook of private practice: keys to success for mental health practitioners. New York: Oxford University Press. |
[60] | Korn L (2014) How food improves mood: bringing nutrition into the consulting room. Psychotherapy Networker : pp. 30-32. Available from: https://www.psychotherapynetworker.org/magazine/article/146/in-consultation |
[61] | Knapp S, Sternlieb JL (2012) Stirring the “emotional soup.”. Pennsylvania Psychologist 76: 9-10. |
[62] | Johnson WB, Barnett JE, Elman NS, et al. (2013) The competence constellation model: A communitarian approach to support professional competence. Prof Psychol Res Pract 44: 343-354. https://doi.org/10.1037/a0033131 |
[63] | Turner JA, Edwards LM, Eicken IM, et al. (2005) Intern self-care: an exploratory study into strategy use and effectiveness. Prof Psychol Res Pract 36: 674-680. https://doi.org/10.1037/0735-7028.36.6.674 |
[64] | Norcross JC, Dryden W, DeMichele JT (1992) British clinical psychologists and personal therapy: What's good for the goose?. Clin Psychol Forum 44: 29-33. |
[65] | Orlinsky DE, Norcross JC, Rønnestad MH, et al. (2005) Outcomes and impacts of psychologists' personal therapy: A research review. The psychologist's own psychotherapy. Oxford: Oxford University Press. |
[66] | Gold SH, Hilsenroth MJ, Kuutmann K, et al. (2015) Therapeutic alliance in the personal therapy of graduate clinicians: relationship to the alliance and outcomes of their patients. Clin Psychol Psychother 22: 304-316. https://doi.org/10.1002/cpp.1888 |
[67] | Unadkat S, Farquhar M (2020) Doctors' wellbeing: self-care during the covid-19 pandemic. BMJ 368: m1150. https://doi.org/10.1136/bmj.m1150 |
[68] | Johnson WB, Barnett JE, Elman NS, et al. (2012) The competent community: toward a vital reformulation of professional ethics. Am Psychol 67: 557-569. https://doi.org/10.1037/a0027206 |
[69] | Welfel ER (2015) Ethics in counseling & psychotherapy. London: Cengage Learning. |
[70] | Gottlieb MC, Handelsman MM, Knapp SJ (2013) A model for integrated ethics consultation. Prof Psychol Res Pract 44: 307-313. https://doi.org/10.1037/a0033541 |
[71] | Wilcox MM, Franks DN, Taylor TO, et al. (2020) Who's multiculturally competent? Everybody and nobody: A multimethod examination. Couns Psychol 48: 466-497. https://doi.org/10.1177/0011000020904709 |
[72] | Welch ID (1998) The path of psychotherapy: Matters of the heart. New York: Brooks/Cole. |