Burnout is defined as a state of ineffectiveness comprising “emotional exhaustion, depersonalization, and reduced personal accomplishment.” (Maslach, 1982) It is a pervasive and frustrating state, accounting for a large portion of the turnover experienced in mental health services, including volunteer and paraprofessional organizations like crisis lines.
There are a number of models of burnout, but one stage model is presented below from Cherniss (1980) and reproduced in Kinzel & Nanson (2000):
Stage 1: Stress
Stress is the first stage of burnout, when an individual is functioning at a level that exceeds their optimal operating conditions. This could be because of internal factors (like wanting a promotion or being intensely devoted to work), external factors (like being given a larger caseload due to budget cuts) or interpersonal factors (like a negative relationship with a colleague or supervisor.)
Stage 2: Strain
When a person experiences strain, they have now operated in a state of stress long enough that they are reaching a point of emotional exhaustion. Their coping begins to be maldaptive and they often experience negative somatic or physical complaints like headaches.
Stage 3: Defensive Coping
In the final stage of burnout, an individual’s burnout begins negatively impacting their ability to take calls or otherwise perform their helpline work. There is a lack of empathy or concern for the callers and this may be accompanied by blaming the callers or detachment from the situation. At this stage
Causes of Burnout
There are a variety of causes of burnout. Some listed by Kinzel & Nanson (2000) include:
- Nature of crisis calls
- Negative emotions experienced during the calls like anger or guilt
- Countertransferrence (being triggered by one’s own experiences while supporting another)
- Repeat or regular callers creating a feeling of powerlessness or ineffectiveness
- A lack of effective coping skills
Additionally Kinzel & Nanson note studies that revealed the presence of magical thinking (assuming the situation would get better on its own) and escape-avoidance coping skills were associated with an increase in burnout, along with detachment and personality responsibility.
Paradoxically, workers who were too involved (taking personal responsibility for callers) were more likely to experience burnout as were volunteers who were detached. The least likely to experience burnout is the crisis line worker who stays emotionally connected to a caller but also recognizes that their life is their life and it is not the worker’s responsibility to change it. (Mishara & Giroux, 1993)
The Maslach Burnout Inventory (MBI; Maslach, C., Jackson, S.E., & Leiter, 1996) is the most common measure for assessing burnout. It is a 21-item scale that produces scores on three subscales: Emotional Exhaustion, Personal Accomplishment and Depersonalization.
Morse et. al. (2012) notes example cut-off scores for the three scales as follows “emotional exhaustion scores of at least 21, depersonalization scores of at least 8, and personal accomplishment scores of 28 or below” but with the caveat that those scores may be lower than necessary, artificially inflating the presence of burnout in mental health professionals.
Helpline managers will need to take the lead in determining whether their workers are experiencing symptoms of burnout. This may be witnessed in the quality of listened calls, in the comments made on call reports, or contacts that occur off the lines. For instance, volunteers who:
- Started giving more advice to callers
- Talked to staff about frustration with non-suicidal callers “wasting” distress line time
- Missed shifts because of not being emotionally capable
These may be situations where you would recommend burnout prevention activities. Potential treatments for burnout are discussed more in-depth below, but in the helpline environment a leave of absence (LOA) from the lines for a while, increased self-care or decreased activity (e.g. limiting hours weekly or monthly) can help avoid burnout.
Treatments for Burnout
Smullens (2013), writing for Social Worker magazine notes a number of strategies including:
- Stimulus control and counterconditioning. Stimulus control involves active decisions like not choosing to eat lunch at your desk or bringing a plant into the office while counterconditioning involves physical exercise, hobbies, or other diversions
- Mental health treatment. Therapists should seek their own therapy when their personal issues interfere, and someone who is experiencing or worried about experiencing burnout is certainly under that category
- Diversify. This refers to the idea of changing your responsibilities to give you non-clinical activities that help to refresh and restore you. For many social workers, this involves teaching, conferences, or other activities, but for heplline workers it can also involve becoming a leadership volunteer, serving on a non-profit Board or another form of volunteerism
Oser et. al. 2013) added to this with burnout prevention strategies including:
- Coworker support. Being able to vent to colleagues who have a sense of what you’re going through and understand your organizational culture can be very helpful. Feeling like (or being) isolated without anyone to discuss concerns with can exacerbate feelings of ineffectiveness. This applies to helpline workers as well, who can make frequent use of debriefing
- Clinical supervision. Supervision can also help reduce feelings of isolation and ineffectiveness by giving individuals an opportunity to identify maladaptive coping strategies or other issues that may lead to burnout
Research is continuing so hopefully in the future we have specific therapies designed for burnout and options; a number of individuals leave the helping professions each year because of burnout, which is obviously not ideal.
Bowden, G. E., Elizabeth Smith, J. C., Parker, P. A., & Christian Boxall, M. J. (2015). Working on the Edge: Stresses and Rewards of Work in a Front-line Mental Health Service. Clinical Psychology & Psychotherapy, 22(6), 488-501. doi:10.1002/cpp.1912
Cherniss (1980). Staff Burn-Out. Job Stress in the Human Services. Sage Publications.
Kinzel, A., & Nanson, J. (2000). Education and debriefing: Strategies for preventing crises in crisis-line volunteers. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 21(3), 126-134. doi:10.1027//0227-5910.21.3.126
Maslach, C. (1982). Burnout: The Cost of Caring. New Jersey: Prentice-Hall, Inc.
Mishara, B.L., Giroux, G. (1993). The relationship between coping strategies and perceived stress in telephone intervention volunteers at a suicide prevention center. Suicide and Life Threatening Behavior, 23(3).
Maslach, C., Jackson, S.E., & Leiter, M.P. (1996) Maslach Burnout Inventory (3rd ed.). Palo Alto, CA: Consulting Psychologists Press.
Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in Mental Health Services: A Review of the Problem and Its Remediation. Administration and Policy in Mental Health, 39(5), 341–352. http://doi.org/10.1007/s10488-011-0352-1
Smullens, S. (2013) What I Wish I Had Known: Burnout and Self-Care in Our Social Work Profession. Social Worker. Retrieved on December 28, 2016 from http://www.socialworker.com/feature-articles/field-placement/What_I_Wish_I_Had_Known_Burnout_and_Self-Care_in_Our_Social_Work_Profession/