Transcript for Episode 79: How Can Social Workers Avoid Job Burnout?

Announcer:
This episode is brought to you by the National Council for Mental Wellbeing.

Greg Wright:
Welcome to Social Work Talks. I am Greg Wright. Social work is a rewarding profession. Each day, social workers positively touch the lives of millions of people. But the profession can also cause burnout. In fact, some studies indicate that at any given moment, four out of 10 social workers report that they feel burned out about their jobs.

Here to talk about that is award-winning clinical social worker, SaraKay Smullens, who has a practice in the Philadelphia area. SaraKay is author of the best selling NASW press book, Burnout and Self-Care in Social Work. SaraKay is here to talk about burnout, how social workers can avoid it and why she decided to write a second edition of her book. Welcome to Social Work Talks, Sara. It's a pleasure having you here. Thank you.

SaraKay Smullens:
It's a pleasure to be with you, Greg. Wonderful to be here.

Greg Wright:
Yeah, thank you. At the top, there's a lot of confusion about what burnout is. I was wondering if you could define it for listeners.

SaraKay Smullens:
There is indeed a great deal of misinformation, confusion about what burnout is and how it differentiates from depression. Just let me give you a capsule comment. I'd like to really talk to those who are here today in a way that they can not just understand intellectually, but feel what I want to try to share in the context of their experience. Burnout is a state of mind where you're overwhelmed, overloaded, and feel like I just can't handle another thing.

It's an external force. It comes from too much pressure, from too many places and too much overload. Most of the work that has been done with burnout concentrates on professional burnout. But my research shows an interactive flow between personal, professional, physical, relational, and societal burnout. It can start in any of these arenas because of overload. I can't carry anymore. My back is breaking. One arena of burnout affects each of the others. It's a progressional state.

Many people who are burned out think that they're depressed. Depression is different, though there is a negativity in both and can be overlap. Depression is an internal force and as a social worker, I don't see most forms of depression as illnesses. Depression happens because of life events, because of life realities, because of loss and sadness, illness, death, job discord, being treated poorly, connivance, betrayal. Depression can also be, of course, a psychiatric illness when a black cloud descends and you don't know why.

When you wake up one morning and you say, "I'm not living a life I want and this is making me sick," or, of course, bipolar illness or a psychotic break. But burnout is much easier to address and prevent. Think of overload. The self-care strategies that I've researched address and prevent burnout as long as they're integrated in a life. Also, interestingly, the same self-care strategies that work with burnout work with depression, even if depression cannot immediately be alleviated makes it easier to live with depression when these strategies are a part of your life. [crosstalk 00:04:42].

Greg Wright:
A lot of social workers say that they experience a vicarious trauma from working with individuals with a lot of issues. Is that like burnout? Is it a cause of it? Is it a symptom of it? Could you delve into that?

SaraKay Smullens:
Absolutely. This is really important and you are pointing to ... Now we're specifically talking about burnout now. You are talking to a cause, a primary cause of burnout, vicarious trauma. We take on things. We feel them so deeply that our clients talk to us, share with us. There's also compassion fatigue that's a cause of burnout. I give and I give and I give, but the cup is empty. I have no more to give.

There's also countertransference which is a description that Sigmund Freud introduced, but more specifically to burnout, it means dealing with impossible situations and impossible people. I added, in the second edition, which we'll talk about, moral distress and injury. We as social workers view so many things in our society, in our work setting, in our lives, that are morally unacceptable to any ethics that we live and breathe. Moral distress and injury are also an enormous cause for burnout. We've illustrated four psychosocial causes for burnout that with awareness and self-care strategies we can address.

Greg Wright:
How does a social worker who has burnout behave? What is a sign that I have burnout?

SaraKay Smullens:
A sign that I have burnout is a feeling that I want to withdraw from everything and everybody, a feeling that nothing that I am doing or can envision is worth anything anymore, and absolute vehement turnoff to the people who love you that begin slowly and without attention, intensifies, numbing one's self with drugs and alcohol until one can fall through the cracks of life destroying everything that really keeps life meaningful personally and professionally.

Greg Wright:
I was wondering, how did you get interested in that? Did you have a burnout issue yourself or were you seeing it happening, and so you said, "Look, I want to investigate this a little bit further?"

SaraKay Smullens:
Right. You're getting to something really so important. Of course, I talked about physical burnout and that's related to this story. Well, this goes back to my first edition in 2015, when you so kindly interviewed me. I was blessed to work for President Kennedy. It was he who suggested social work for me. He suggested Catholic University. You don't say to the President of the United States, "Mr. President, what are you smoking?"

But I'm from an Orthodox Jewish family in Baltimore and I couldn't see myself at Catholic University, but it was one of the most extraordinary years of my life. I learned so much there. I was treated very respectfully, despite my difference with my fellow students. When he died, I didn't want to stay in. I worked there for the department, was then called the Department of Welfare. Again, to repeat, I just learned so much from my teachers, my supervisor. But when the president died, when president Kennedy died, I didn't want to stay in Washington any longer.

SaraKay Smullens:
I married very quickly and I married a law student at Penn and the University of Pennsylvania picked up my scholarship and stipend, and my placement was the society to protect children where we worked with neglect and abuse children. I learned from a rainbow coalition of devoted social workers how to help parents who got nothing, have hope and the ability to care for their children. They taught me how to do it, Greg. But I thought it was the job, but it was really what the job was touching in me.

I developed flu-like symptoms, and I had a committed year to work for them, and then I changed jobs and I went into therapy and I knew something wasn't right. What I learned there was it wasn't the job, it was what the job was touching in me, in my body and my physical arena about unfinished emotional business it was necessary to face. I faced it.

Then when Lynne Abraham was DA in Philadelphia, I had known Lynne from the time she was a young DA, she gave me an extraordinary pro bono opportunity to work with first offenders in domestic violence, where there was no fatality. To let me offer intensive therapy in lieu of incarceration. I called all my old mentors who I had worked with at the society to protect children, which then had been taken over by the city, and they said to me, "SaraKay, we are burned the hell out and we are leaving social work."

Greg, I had never heard the term burnout. I thought, "My goodness." Then I looked around me and others were leaving a profession they cared vehemently about, that they trained ardently for, and that they did not want to leave. You gave an alarming statistic in your intro, and it's worse now since the pandemic, obviously. I decided I'm going to do research into burnout. What is this? How is it different from depression? That's where I learned that it isn't just professional burnout. It's personal, professional, physical, relational, and societal, and they interact. That's a full response to your question. It was a progression that led to five years of research.

Greg Wright:
I have a question for you. Are some types of social work more prone to burnout than others? I've heard it a lot from our social workers who are in a child welfare [crosstalk 00:12:18] arena, but is it endemic across all sorts of social work?

SaraKay Smullens:
Yeah. Herbert [Fleinberger 00:12:28] who worked in the kind of setting I described in '74 and '75 published and introduced the term burnout. Yeah. Yeah. When we see men's inhumanity to man, when we see children used as living ashtrays, chained to beds, starved, yes, you're in a situation where you're more prone to burnout. But I do want to say that all of us are prone to burnout today, because 24/7 we see human violations of human beings all over the world.

We see a disregard for human beings that often begins in leadership positions, in families and in work settings, in communities, and of course, in society. All of us, every living person today because of the realities that are with us 24/7, can be prone to burnout. I have a pro bono practice and I also have a regular practice, and what you hear in your private regular practice is different than starving, usually, abused children, battered children, children's whose eyesight is ruined, children who starve until you can get in and do something.

It's different seeing that than ... How can I say? Deep intimacy and communication problems that are emotionally and often physically and sexually painful. That impacts on you too. There is vicarious trauma, countertransference, compassion, fatigue in that too. No matter what we do in a helping profession, we can ... One of the core self-care strategies is ask yourself what this is touching in you. Once I saw why I kept getting the flu, flu-like symptoms, when I wasn't sick, I knew that I had to do something about certain things in my personal life that had to change.

If we see in our work, wherever it takes us, what ... If you're in a community setting and you have an impossible board member or an impossible executive director or CEO, what is this disregard touching in you? Once you know, you can figure it out. It isn't the circumstance itself that overloads us. What overloads us is what's touched in us and our ability to work toward change.

Greg Wright:
Could you delve a bit more into what is touching us? Does that mean that the situation affects an unresolved thing within our own psyches that we need to deal with in order to address the burnout side of it?

SaraKay Smullens:
Yeah. Yeah. For instance, suppose you're dealing in a marital situation and the marriage is abusive. I've done research in arenas of emotional abuse that are always part of sexual and physical violence, but deserve their own codification. When you deal in a family situation and you see abuse going on, if you are abused in your present life or have been abused in your past life and you don't recognize it, you are going to be on overload and you're going to be burned the hell out.

Greg Wright:
Go you. Got you.

SaraKay Smullens:
In a parallel way, if you're dealing with clients who really have a quality of love that you yearn for and don't want to face this [inaudible 00:17:03] in your life, their having what you long for is going to also put you on overload. Basically, the bottom line is whatever the path of reality in your world and in society, regardless of how stony, face it and don't be passive and activate yourself toward the self respected mutual respect you and all deserve, toward attaining that.

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Greg Wright:
I want to talk about your book. But before that, I want to ask you, do our social work schools teach our students how to deal with this? Now, I have a daughter. She earned her masters in social work last year. She has a passion to be a forensic social worker who works with a lot of foster children. I am petrified that she'll get burnout from it. But are they teaching students about this, that it's a reality of the profession?

SaraKay Smullens:
I was really ... Yeah, that's such an essential question. As I've told you in personal conversation, I was blown away at the success of the 2015 book, NASW published. Because of that, before the pandemic, I was invited to meet with young social workers and newly minted social workers really all over the United States. I would go personally. I've been to Europe, I've been to Canada, and then once the pandemic hit, I've met with them through technology.

Here's what they tell me. They tell me, "We know about the injustices. We know about the pathologicisms, all of the hatred that drains you. We know about the immigration problems. We know about environment going to hell, and we want to work on that." That's essential to being a social worker. Children need love and children need respect. Through the ages, a community and a school compensate for what parents can't or don't or aren't able to give children, which was, of course, the job at society to protect children.

I told you where I was so blessed to be and learn from committed social workers who understood this, we start with the human heart in development. This shows that our schools must improve, and of course, our communities must have vital resources. A child needs, at birth, to begin to develop a state of dignity and a state of dignity begins with love. A child who is loved, develops internally, a feeling of pride. As one grows, I deserve good things and humility. I am not the center of the universe.

Those children who grow chronologically, but not with internal needs met, cannot grow into healthy parents, healthy community leaders. They may be even very bright and charming, but internally they're missing something. They can lead an organization where we work, but not understand how to really relate compassionately to others and they can be in elected office.

My research showed me also that rejection abandonment, rage, enmeshment where the family must be one big blob and people can't become who they really know in a ... How can I say? With an emotional sense of direction, which I know was so important, who they really need to grow to become in order to be satisfied and who they really need permission from parents who are so important, to become, severe neglect impedes development and extreme overprotection and over indulgence leads to people who don't understand the necessary give-take compromise in life.

These people have emotional deficits. I would ask anybody who is listening to our discussion, Greg, to think about people who are so impossible to deal with on any level, society, personally, professionally. If you study their backgrounds and developmental years, you will see often more than one of these grave limitations in how they grew to chronological adulthood.

Greg Wright:
Got you. Your first book was out in the year to 2015. Here we are, a second edition is out. We're seven years after that. We've had a pandemic, we've had a recession, we've had a lot of racial strife going on, we've had a political environment that is a divisive one. How did you weave all those things into a second edition that offers social workers advice on how to avoid burnout?

SaraKay Smullens:
You've covered why. I saw, from 2015 on, divisiveness, rage, pathological expression, pitting people against each other from those who were supposed leaders. I added another arena. I think we were the first to do this, societal burnout. 24/7 exposure to man's inhumanity to man, which was the societal overwhelming experiences that we're all sharing together, exacerbated burnout in the other arenas, because our energy was eaten up.

It's important to understand that in every healthy setting, personally, professionally, in our relationships and in our society, anxiety filters up. There is somebody to talk to who will respect you and cares about your concern. In dysfunctional settings, personally, professionally, societally, anxiety filters down as a control method to pit you against each other so you're burned the hell out, withdrawn, and the so-called leaders can control you.

Yeah. The proposal wrote itself. I wanted to do research into what's a dysfunctional, what's a functional leader in all aspects of life? I wanted to add more about internal healthy development. I wanted to add more about why social workers aren't as respected as we should be and why we are an impossible profession. I wanted to show that the personal is the professional, is the political, that that is an interactive chain. When we have societal leaders who don't care about our children, especially our children who are suffering so much, that is quintessential societal burnout.

I wanted to do my best to research what the hell we could do about it, together and with other people who I call natural social workers, those who, whatever their professions, share our values and our passion. That's why I did it. That's why I did it. That's why I did it. I'm so grateful that my proposal was accepted and I had an excellent editor, Rachel Myers. Yeah. Yeah. And Julie Gutin, who's the project manager, and of course, Cheryl Bradley for believing in my work from the first edition. I'm very grateful. I'm very grateful that people found my book because-

Greg Wright:
Oh, yeah. They have. I'm a PR person who works for social workers. What I've learned to avoid burnout is that I only watch the news for an hour or so. That's it. I can't have it on all day, every day. I get burnt out with it. We want people to actually read your book, but I was wondering if you could offer a few tips to social workers, to deal, not only with a professional burnout, but societal level as well. Just a few things.

SaraKay Smullens:
Right. Right. It's my pleasure. That is what I was asked to do recently when I was in Tucson at the Society of Social Work Leadership in Health Care conference. This is what they asked me to do as the keynote. Let me give you that capsule comment that I tried to give to them. We know that gratitude is important. We know that mindfulness is important. We know that journaling is important.

What a lot of people don't understand is bearing a caseload is important. But most important of all, in our professional settings, in our personal settings, and in our society and community, there must be self-respect that comes from a feeling of dignity and there must be mutual respect. Without that, we will be burned out. There are boundaries that can help us in our work. We must know we are not our clients. Our clients' lives are their lives. We have ours.

A relationship is essential. So many of our societal problems have exacerbated because many have forgotten how important it is to form relationships even with those we don't agree with. That leads to give, to take, to compromise, and to respect. Look at Uncle Tom's Cabin. That story awakened the world, awaken the United States. Led to the civil war, really, I think because we talked about real things and real suffering and horror, and we could get on a page to fix it.

We must also ask always, and this is what we said earlier, what is the situation in my society, in my home, in my work that is upsetting me so much? Let me face it and what can I do about it? This leads to the necessity sometimes even in a personal relationship with people who cherish each other. Sometimes we have to be able to say, "No. Personally, professionally, I wish I could, but right now I don't have the time or energy to do that."

We must face realities no matter how stony the path. Get involved with the social determinants of health. God bless us. We all know that. Listen as we work together to address what's necessary. Never demoralize a person. Be as kind as possible when you're dealing with someone with a character disorder, however who cannot love. Learn to be tough and hold your ground and process with people you trust and understand they don't have your best interest at heart, they don't have anyone's best interest at heart other than their own.

Listen to your bodies. Your bodies will speak to you. Always of course consult a medical expert if you're ill. But if your neck hurts and there's no medical reason, what is it you can't carry if your back ... Who's a pain in the neck if your back hurts? What's breaking your back? What can't you stomach? What can't you swallow? Your body talks to you. What are you itching for? We talked about the inner world development earlier.

Understand what in one's psychological makeup is overwhelming you. What are they missing? Maybe what you need to fill in for yourself, no matter what hell we are going through, no matter, we can rise above it. We have to remember. I love Amazing Grace. We all have such limitations and that's speaks to how much we need each other. Together, there's absolutely nothing we can't achieve. Robert Kennedy said, "We can break down the mighty mountains."

E. M. Forster wrote, "An aristocracy of the compassionate and the planky and those capable of caring for each other." This is the aristocracy I think that we, as social workers, are blessed to have together with the natural social workers who join us. John Lewis. Don't be passive. Get into good trouble with the issues that matter to you and save the soul of America and take pride. Take pride in our profession. Despair is never an option. We cannot afford to give up hope. There is always hope and we absolutely can't tell our children that hope is dead because it isn't.

We can learn from our mistakes. We can have grassroot efforts. We can get involved with the Brennan Center. United States is the only democracy in the earth, in the world, where voting districts are determined by the politicians who benefit from this manipulation. In every other democracy, these lines are decided by independent conditions of bipartisan citizen right. That's why involvement in the Brennan Center is essential.

We have to have a dream in our work life, and we have to have a dream in our professional life, and we need to think out of the box and the dream we have may not be with the dream that a person, parents would have, or even a person we're committed to in life. We're entitled to our own dreams. We must be creative and think out of the box and allow ourselves our dreams. If one dream doesn't come true, there's only one thing to do. Find another.

Greg Wright:
Thank you so much. Miss SaraKay Smullens, author of the second edition of Burnout and Self-Care in Social Work. That's an NASW Press, NASWpress.org. I want to thank you for all of your time. Once this pandemic is over with and easing, I hope to see you in person again.

SaraKay Smullens:
That'll be lovely, Greg. Thanks for this opportunity. Thanks very much.

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