Qual Sociol (2007) 30:153–169DOI 10.1007/s11133-006-9056-3

ORIGINAL PAPER

Helping Women and Protecting the Self: The Challengeof Emotional Labor in an Abortion Clinic

Michelle Wolkomir · Jennifer Powers

Published online: 25 January 2007C© Springer Science+Business Media, Inc. 2007

Abstract One of the central problems in the performance of emotional labor at workrevolves around how workers balance the needs of the job with those of the self. Drawingon data collected through participant observation and from in-depth, loosely structuredinterviews with nine clinic employees, this study analyzes how one group of abortion clinicworkers negotiated the difficulties associated with emotional labor in ways that allowed themto achieve this balance. More specifically, we examine the interactive processes by whichworkers categorized patients into distinct types and developed specific strategies, alonga continuum from investment to detachment, that enabled them to cope effectively witheach type of patient. The implications of these strategies for understanding the connectionsbetween self, emotion, and authenticity are also discussed.

Keywords Emotional labor . Abortion . Authenticity . Work . Coping strategies

In our increasingly service based economy, much of what is produced is a particular kind offeeling or emotional experience for customers. Workers in service oriented jobs are thereforeoften explicitly trained to evoke certain feelings, and their performances are evaluated, atleast to some degree, by how well they do so. Under such conditions, human emotion, oncea largely private matter, becomes public and subject to the control of an employer. In hernow classic study, The Managed Heart, Arlie Hochschild examined this commodification offeeling and conceptualized the work done to produce such feeling as “emotional labor,” or thework of “induc[ing] or suppress[ing] feeling in order to sustain the outward countenance thatproduces the proper state of mind in others” (1983, p. 7). Hochschild’s groundbreaking workcalled attention to a previously invisible facet of service work, highlighting both the “crucial

M. Wolkomir (�)Department of Sociology, Centenary College of Louisiana, 2911 Centenary Blvd.,Shreveport, LA 71134-1188e-mail: mwolkomi@centenary.edu

J. Powers8155 Southwestern Blvd., #132 Dallas, TX 75206e-mail: jpowers@pstrategies.com

Springer

154 Qual Sociol (2007) 30:153–169

steadying effect” of emotional labor in structuring workplace interactions to maintain a typeof civility and the potential human costs of manufacturing emotion, such as burnout anddistress (1983, p. 187).

These costs are related to the link between emotions and sense of an authentic self(Erickson & Wharton, 1997). Authenticity of self, in this case, refers to both a cognitiveand emotional aspect—who one wants and feels oneself to be—and a behavioral aspect,or whether one acts in accord with self-values. Erickson (1995, p. 127) explains how theseaspects interconnect to create a sense of (in)authenticity, pointing out that people use theiremotional responses to situations to gauge how well they adhere to a commitment to self-values, with adherence enabling feelings of relative authenticity of self and violation resultingin relative inauthenticity. The sustained performance of emotional labor—which requirespeople to display, and perhaps to feel, certain emotions—can muddle this process, leavingpeople to struggle for authenticity in interactions in which they have little control and creatingthe potential for worker duress. Hochschild (1983, pp. 187–189) suggests that such distressemerges from worker’s inability to distinguish self from job role in one of three ways. First,some workers can over-identify with the job and be unable to “depersonalize” client andwork related hostilities, thereby increasing stress and risking burnout. Second, others doseparate self from the job but feel badly about doing so, and such separation can createa sense of fraudulence and make work unrewarding. Finally, some workers so effectivelyseparate self and job role that they risk becoming too estranged from the work to be able toperform it well. In each case, the problem “is how to adjust one’s self to the role in a waythat allows some flow of self into the role but minimizes the stress the role puts on the self”(Hochschild, 1983, p. 188).

Building from Hochschild’s work, social scientists have examined this problem and theconsequences of worker’s emotional labor across a variety of occupational settings, such as inlaw firms (Pierce, 1995; Lively, 2000, 2001, 2002), in restaurants (Erickson, 2004; Leidner,1993; Paules, 1991), in nursing (Henderson, 2001), in the airline industry (Williams, 2003),in mental health professions (Scheid, 1999), and in social services (Clemans, 2004; Garot,2004; Karabanow, 1999; Marshall, Barnett, Baruch, & Pleck, 1990). These studies haveyielded mixed findings regarding the consequences of emotional labor, revealing that, whileworkers who perform emotional labor are more at risk for psychological duress, emotionallabor does not necessarily have a uniformly negative impact on workers. In fact, someresearch has shown that emotional labor can make work satisfying and rewarding (Erickson,2004; Karabanow, 1999; Stenross & Kleinman, 1989). These findings suggest that it is notthe performance of emotional labor per se that can result in worker distress, but rather thatthe consequences of this work—whether workers can successfully meet the needs of selfand job–depend on the conditions under which it is undertaken.

Much of existing research has focused on the human costs of emotional labor, examininga variety of work conditions (for a review, see Wharton, 1999) to assess how they impactworker’s abilities to strike a balance between the requirements of self and work. Two aspectsof work—level of worker identification with, or investment in, their jobs and job autonomy—have consistently emerged as critical influences on workers’ experiences of emotional labor.This finding is particularly relevant for workers in social and human services. People of-ten enter these fields because they believe the work is socially important and are thereforemore likely to have heavily invested in the work and infused it with valued self-meanings(Clemans, 2004; Garot, 2004; Stamm, 2002). Further, the rigid rules and bureaucratic settingsof some social service agencies can limit workers’ autonomy to decide who can be helpedand how, leaving workers to cope with the negative emotions of turning away clients in needbecause they do not “qualify” for assistance (Garot, 2004, p. 758). This limited autonomy,

Springer

Qual Sociol (2007) 30:153–169 155

in conjunction with high levels of investment, may leave social service workers most vul-nerable to the costs of emotional labor. Indeed, some scholars (Hochschild, 1983; Scheid,1999; Wharton, 1993) have posited that workers, regardless of profession, who are investedheavily in their jobs are more vulnerable to the negative consequences of emotional laborbecause their sense of self is so intertwined with their work identities that they cannot ade-quately distance themselves from client hostilities and failures. The result can be emotionaldissonance, exhaustion, stress and burnout. Such consequences have been well documentedamong social service providers. Clemans’ (2004) study of rape crisis workers, for instance,reveals that 15 of 21 workers suffered symptoms of secondary traumatic stress, and studiesof mental health case managers and professionals (Fox & Cooper, 1998; Meldrum, King, &Spooner, 2002) show that these workers are also prone to similar distress. Helping otherscan be a risky business.

Yet, other scholars (Ashforth & Humphrey, 1993; Erickson, 2004; Karabanow, 1999)assert that such investment in work makes emotional labor rewarding and can moderate thepsychic costs of emotional labor. Erickson’s (2004) study of servers in a family restaurant,for example, showed how women servers invested in their work and built relationshipswith customers that enabled them to find their jobs satisfying. Workers in social services andrelated fields, who are likely to highly value their work and to identify intensively with it, alsoreap these psychic and emotional rewards (Karabanow, 1999). These researchers do, however,agree that there is a risk of over-identification and subsequent negative feeling. These risksare exacerbated, and workers more likely to experience the psychic costs emotional labor caninduce, when they have little job autonomy, and cannot control how they meet the emotionaldemands of their jobs (Hochschild, 1983; Leidner, 1993, 1999; Scheid, 1999; Wharton,1993).

While scholars have thus discovered the conditions under which emotional labor is likelyto be problematic, little research has examined the processes by which workers can success-fully negotiate the complexities of emotional labor when they are motivated and have theautonomy to do so. In other words, how do workers, who are invested in their work and whohave the job autonomy to develop unique (e.g., unscripted) interactional strategies, balancethe needs of the self and of the job in ways that enable them to find their work rewarding,perform it well, and minimize the distress emotional labor can evoke?

To begin to address this question, this study explores how one group of human serviceworkers—who were both invested in their jobs and had relatively high levels of autonomy—managed the often competing demands of emotional labor. Drawing on data collected throughfieldwork at an abortion clinic, we analyze the processes by which workers labeled patients asdistinct types and developed specific interactional strategies for each type that enabled themto meet patient needs while simultaneously maximizing the rewards of emotional labor andminimizing its costs. Examining the processes by which workers in this case negotiated thedifficulties associated with emotional labor is likely to provide further insights into how workconditions enable and constrain the production of feeling, as well as to enhance sociologicalunderstanding of the connections between emotions, authenticity, and self.

The women’s center

To examine how clinic workers coped with the high demand for emotional labor that theirjobs required, the second author spent approximately 16 months participant observing in awomen’s healthcare clinic located in the Deep South. This clinic, referred to here as TheWomen’s Center (TWC), is a privately owned, for-profit enterprise and is one of two abortion

Springer

156 Qual Sociol (2007) 30:153–169

providers in a 200 mile radius. As such, TWC serves a large geographic area and can beextremely busy. The clinic provides varied services, including: emergency contraception,pregnancy testing, ultrasounds and abortions. Patients vary widely in terms of age, class,race and level of education, but most come to the clinic anxious, frightened, and some-times embarrassed. An important aspect of clinic work is helping patients deal with theseemotions.

There were approximately 13 employees on TWC’s entirely female staff, which consistedof an office manager, counseling director, receptionist, five counselors, two nurses, a labtechnician, and two back-staffers (who assist in the OR). Staff performed every facet ofpatient care (e.g., testing, counseling, emotional support, procedure preparation), while twomale doctors saw patients for the state mandated visit and actual procedure. The staff werebetween 20 and 45 years of age, and all had at least a high school diploma. There were sixwhites, six African Americans, and one Hispanic on staff at the time of this study.

The second author’s involvement with TWC began with a three month internship that wassubsequently converted to a part-time counselor position. Initially, this internship was under-taken to fulfill an academic requirement. However, as the second author became enmeshedin the daily activities of the clinic, she became intrigued by how staff coped with needy anddifficult patients, particularly as she struggled to manage her own sadness and anger sur-rounding some patient situations, and the occasional sense of being overwhelmed by patientcare. This study emerged as a result of this intrigue. At the conclusion of her internship, thesecond author secured both employment and permission from the clinic owner to examinehow workers dealt with the emotional demands of their jobs. She underwent TWC’s standardtraining to counsel patients, perform ultrasounds, and assist in abortion procedures. She readtraining materials and attended in-house workshops to train staff to interact with patients. Asa result, she was able to experience and observe most facets of clinic work and staff-patientinteraction. Extensive fieldnotes were recorded as soon as possible after each day of work,paying particular attention to how staff were instructed to manage patient care, how theyactually negotiated these interactions, and how they felt about them.

Data were also obtained through intensive interviews. Our goal was to interview all clinicworkers who had been at the clinic for at least three months, with the exception of thedoctors who interacted with patients minimally. Of the 13 staff workers (which included thesecond author), 11 had been employees for more than three months and one chose not toparticipate in an interview. We therefore conducted interviews with nine employees whosecharacteristics are summarized as follows:

Table 1 Descriptive characteristics of interviewees

Pseudonym Job title Duration Education Age Marital status Number of children

Kim Office manager 4 + years HS 33 Single 1Margie Counselor 2 years BA 23 Single 0Meg Counselor 6 months In college 20 Single 0Alexis Counselor 3 + years BA 23 Single 0Mandy Counselor 4 years BA 32 Married 2Susan Counselor 9 months In college 20 Single 0Cat Back staffer 4 + years Associate 27 Single 2Kendall Receptionist 5 years HS 39 Married 2Julie Counseling

director1 year BS 45 Divorced 1

Springer

Qual Sociol (2007) 30:153–169 157

All interviews were voluntary and included one counselor who quit a few weeks beforeher scheduled interview. The interviews were between an hour and an hour and a half inlength, with interview topics including questions about how workers felt about their jobs,their motivation for doing this work, what they perceived to be the rewards and difficulties ofit, what they found to be stressful at work and how they managed this stress. Interviews wereloosely structured to allow participants the opportunity to discuss issues that were importantto them. Each interview was recorded and transcribed in full.

We used a grounded theory approach to analyze these data (Charmaz, 1983; Glaser &Strauss, 1967). Consistent with this approach, we began analytic induction at the earliestphases of data collection, coding fieldnotes and interview transcripts for emerging themes,patterns, and processes. Writing analytic charts and memos on these themes helped us makesense of the challenges clinic employees faced and how they coped with them. As analysisprogressed, it became apparent that workers classified patients into different “types,” andconstructed varied interactional strategies to cope with the emotional labor required by eachtype of patient. Because our emergent analysis revealed the importance of initial counselingsessions with patients, we draw most heavily on data from workers who most frequently andextensively engaged in these interactions, including: five counselors, the counseling director,and the office manager.

Conducting fieldwork in this setting posed substantial, and sometimes unexpected, re-wards and challenges. Because of her internship, the second author did not have to struggleto gain access to the research site or to build the rapport that facilitates good data collection(Shaffir & Stebbins, 1991; Warren & Karner, 2005). Her co-workers regarded her as one of“them,” and she found the daily camaraderie enjoyable and shared staff’s sense of purposeand accomplishment as they worked to help women in difficult situations. In short, the work,as well as the research, became important and rewarding. This fully integrated participation,however, often made it difficult to manage the dual roles of worker and researcher, partic-ularly in such an emotionally charged atmosphere. Working with staff and patients meantcoping with a wide array of emotions almost constantly. Coping effectively, and being able tohelp, often demanded complete immersion in interactions. This immersion was illuminatingin that it enabled the experience of the emotional labor being studied, but it also made it verydifficult to “step back” from the work and analyze it. Further, examining how co-workersnegotiated their way through difficult cases often felt like a kind of betrayal of friends—asthough “talking behind their backs”—an uncomfortable feeling that persisted throughout theproject. The obligations of fieldwork, of course, extend beyond the immediate setting, andwe hope that this research contributes to a growing sociological understanding of how toenable workers to do such important work effectively.

TWC’s culture of choice and care

Working at any abortion clinic can be intensely stressful and potentially stigmatizing. Eachday, clinic staff care for patients who face difficult decisions and experience a host of tryingemotions, ranging from anxiety, fear, anger, and shame to relief (Simonds, 1996). Staff notonly must help patients deal with these emotions, enable them to choose how to handle anunwanted pregnancy, and support them through the abortion procedure if necessary, but theyalso must attend to their medical needs and be on guard for potential problems. This careoften takes place in a hostile environment, with protesters haranguing staff and patients.Further, workers can have concerns for their physical safety and feel stigmatized in theircommunities (Ginsberg, 1989). Given TWC’s location in the Deep South, part of the Bible

Springer

158 Qual Sociol (2007) 30:153–169

Belt, and its distance from any other abortion provider, this stress and stigma was heightened.The community that housed TWC was hostile to its existence, and the clinic provided carefor large numbers of women. For the most part, TWC’s staff knew aspects of their jobswould be difficult when they applied for them, but they were committed to providing care.To examine how the women developed and utilized strategies to cope with the emotionaldemands of their work, we must first understand the meaning that this work held for themand how they therefore learned to approach it.

All of the staff at TWC (with the exception of the receptionist who said she “just needed ajob”) came to the clinic with the specific goal of “helping others” or “helping women.” Thenotion of “helping” in this context had two interconnected meanings. First, clinic workersperceived that it was critical that women, if they were to build the lives they wanted, wereable to exert control over their reproductive capacities. This control, of course, requiredthe right of reproductive choice, and staff perceived that their job was to provide the spaceand opportunity for women to exert this choice. Kim, the office manager, best summed upworkers’ notions of helping in this way when she explained:

When you look at this particular field, you’re actually doing what other people talkabout. To us, I guess the main point is that it’s not just a job. We look at it as more thanjust going to work or just a job. . .we’re there for the patients, to ensure everyone hasthat option, that choice. If we were all to give up, to decide we couldn’t do it anymore,then what would happen to all these people?. . .They’re human beings in need of acertain service that wouldn’t be provided if there weren’t people who were dedicated toproviding. We are there to insure that anyone who needs to be there for help can get it.

As Kim indicates, clinic workers saw themselves as helping others by being, as Susan putit, “on the frontline of the battle to ensure choice.” In this sense, helping others meant beingwilling to work in this environment to keep the clinic doors open and make reproductivechoice a reality in people’s lives.

In addition, clinic workers felt that an important part of helping others was to guide themthrough the process of making reproductive choices by enabling women to explore options,make choices, and receive support for those choices. As one counselor, Meg, explained,clinic work was about “helping the clients make difficult decisions, whether that decisionwas to continue with the procedure or not, and making a difference in their lives by helpingthem come to terms with what they wanted to do.” Workers clearly saw their work asenabling reproductive choice in a supportive environment, and such work was important tothem because they truly cared about their patients and because it affirmed a valued aspectof themselves. When clinic staff enabled and supported women’s decisions, they felt theywere simultaneously helping individuals and engaging in important social work, activitiesthat they saw as critical to being a good person. Marge, a counselor, described this sharedconnection between work and self when she explained, “I feel like I am doing somethingpositive and helping women through a very difficult experience, making it less scary andeasier to deal with. I really do enjoy that about it. I’m, of course, strongly pro-choice, and Ifeel very strongly about abortion rights. So it’s a way to be active in something that I careabout, a way of being a good person and empowering people.” Helping others, while animportant goal, was also a way to signify and authenticate valued aspects of the self. In thisway, workers’ sense of self was intertwined with their jobs, and they invested in their work,in part, because it enabled them to enact important self-values, thereby enhancing feelingsof authenticity as a certain kind of person.

Clinic staff learned much about how to enact this goal of “helping others” throughTWC’s counselor training, which was required before staff could interact with patients

Springer

Qual Sociol (2007) 30:153–169 159

alone. While some aspects of training were purely educational–teaching staff about the bi-ology of pregnancy, available options for pregnant women, and the specifics of the abortionprocedure—much of the training focused on how workers should interact with patients. Intraining sessions, which consisted of both instruction and learning through observation ofother counselors, staff learned the two “rules” that were to guide all of their interaction withpatients. First, and most importantly, the counselor must always maintain the stance of a sup-portive, non-judgmental ally—meaning that the counselor must help a patient discover whatshe wants without inserting any negative assessment of the patient’s decision—regardlessof what a patient did or said. In one training session, for instance, counselors were taughtto “direct the question of whether to abort back to the patient.” In this session, Julie, thecounseling director, posed multiple scenarios of patients asking for help in their decision.She explained that:

Patients will ask you if they will go to hell if they have an abortion, if they are beingselfish by wanting an abortion, or what you would do in their situation. You cannot tellthem what to do because you do not know what is right for them. Instead, you mustexplain that you are there to help them figure out what they believe, want and feel, thatyou are on their side and will help them to think the decision through carefully. Yourjob is to ask the questions that will help them decide and to ask those questions in sucha way that they feel supported and comforted in their decisions.

While training offered suggestions about how to be supportive, staff had the autonomy tomaintain this stance any way they perceived was useful and, if a staff member felt she couldnot work with a patient and adhere to this rule, then she was allowed to remove herself fromthe situation and ask another counselor to take over. This rule was meant to ensure patientscould arrive at a choice that was right for them with respectful support, but it was also flexibleenough that staff retained a great deal of control over their interactions with patients.

During training sessions, staff were also instructed not to “take it [patient situations andinteractions] personally.” Often, the staff learned, patients will take out their anger and badfeelings on clinic workers. Instead of seeing this hostility as an attack, workers were toldto understand that the women are in a “very difficult place” and to “just let it go.” Thislesson was taught most vividly during counseling sessions. One day, for instance, during thesecond author’s training, Kim observed her as she counseled a hostile patient. The followingfieldnote excerpt illustrates how staff were generally taught to approach these patients:

I greeted her, handed her the clipboard with all the forms, and started to give herinstructions. She turned and walked away mid-sentence. I waited for her to finish andthen asked her to follow me. We walked to the video room, and I explained that shewould now watch a video that explained much about her next visit. She asked: “Do Ihave to?” I told her she did not but that it would help her know what was going on.She just shrugged and said “whatever” and told me to “get on with it.” I put her inthe counseling room and stood in the hall, angry at her and embarrassed that Kim hadwitnessed this exchange. Kim came over and put her hand on my shoulder and said,“Remember Jennifer, you can’t take this so personally. It is not about you. She is madabout the situation and wants it to go away. Your job is to help her through it, even ifshe is unpleasant, and then let all the anger go and move on.”

In much the same way, staff were warned that they would not be able to “fix” all of thesituations their patients faced and that they should not see this inability as a failure. Theywere to help as much as possible and not worry over what they could not fix. This advice

Springer

160 Qual Sociol (2007) 30:153–169

helped to structure how staff approached patients. “Letting it go” thus became a key part ofworker strategies for coping with the difficult emotions some situations evoked.

Finally, these training sessions also taught staff to divide patients into two groups, “easy”and “hard” patients, defining the varied needs of patients in these groups and giving staffgeneral guidelines for meeting these needs. “Easy” patients were those who had a previousabortion, had been pregnant before, were in the early stages of pregnancy and/or were certainabout what they wanted to do. These patients required only information and basic support(e.g., affirmation of choice, soothing of anxieties). By contrast, “hard” patients were definedas those who had one or more of the following characteristics: they did not know what theywanted, were in the second trimester of pregnancy, were in difficult or abusive relationships,were victims of sexual assault, and/or were minors. To learn how to best help these patients,staff read and discussed “Clients Who Pose A Challenge,” a chapter in their training manual(Baker, 1995) that provided strategies for approaching clients with particular issues. Theprimary goal in counseling across all cases was to enable the patient to arrive at a choice thatshe believed was right for her and could pursue without misgivings. Counselors strove notonly to facilitate choice but also to make the emotions surrounding that choice as positiveas possible. Doing so often required substantial emotional labor from workers; they had tosuppress their own anger, sadness, and frustration to evoke more positive feelings in patients.

Interactional strategies for coping with emotional labor

When staff first began work, they were enthusiastic about helping women and were preparedto invest in the emotional labor required to do so, believing that their investment wouldresult in clear patient choices, satisfactory resolutions, and some gratitude. When casesworked out this way, workers found them rewarding; that is, such cases created emotionsthat authenticated staff’s notions of themselves as good people who helped others. Overtime, however, staff discovered that only some cases worked this way and often initially hadtremendous difficulty coping with cases that did not, such as those involving hostile and/orambivalent patients or those involving minors or abusive situations. Marge, a counselor,explained this initial difficulty, shared by all clinic workers, as:

The most stress I ever felt was when I first started working there (TWC) because I wasn’tused to it. Your whole day can be hearing really awful stories, over and over from allthese different people. It’s just exhausting. It’s just really exhausting because you reallyfeel for these people and their situations. Often, the only thing we can help them withis the pregnancy, and they have a host of other issues that you worry about for them,especially when they are in abusive relationships or something like that. Sometimespatients are angry and take it out on you. It caused a lot of stress for me at first.

Clinic workers, as Marge indicates, quickly discovered that difficult cases posed unan-ticipated challenges. Investing in the emotional labor required to handle these cases oftencreated a sense of futility and of being unappreciated, undermining staff’s notions aboutthemselves and their jobs. These situations thus created a kind of dilemma for staff. If theystayed invested in their work, then they experienced a host of negative emotions that madework tiring and stressful. If they detached, then they felt they were not effectively providingcare. Both responses threatened worker’s abilities to see themselves as authentically goodpeople working to help others.

If clinic workers were to support patients emotionally and to find the work of caringmeaningful, then they had to find ways to cope with stress, negative feelings, and difficult

Springer

Qual Sociol (2007) 30:153–169 161

patients. To do so, staff innovatively built on their training, which taught them to respond topatients according to their divergent needs, learning also to divide patients into distinct groupsbased on the kind of response they were likely to require. Using their initial interactionswith patients, clinic staff categorized patients as “easy,” “ambivalent or hostile,” or “veryhard.” For each category, workers constructed and used different group-specific copingstrategies that enabled them to perform the emotional labor necessary to help patients andto maintain a positive sense of themselves. In what follows, we show how clinic staff usedinitial interactions with patients to assess attitudes, make these categorizations, and developstrategies. By doing so, workers were able to reap the emotional rewards of their labor insome cases and protect themselves, to some degree, from the costs involved in others.

Investing in “easy” patients

Given that clinic staff saw their work as helping women arrive at clear-cut reproductivechoices and as providing support for those choices, they generally defined “easy” patientsas those who were certain about what they wanted, comfortable with their decision, andappreciative of staff’s efforts. These patients were easily identified in counseling sessionswhen counselors asked about a patient’s decision and her emotions surrounding it. In thesecases, patients clearly stated what they wanted to do and why, and, while they were certainlynot happy about their predicament, they were comfortable with their decision and believed itwould provide relief. Their major concerns surrounded the procedure itself, the risks, and thepain involved. One of Alexis’ counseling sessions with a 20 year old college student who wasnine weeks pregnant provides a representative example of how such interactions unfolded:

When Alexis asked her if she knew what she wanted to do with her pregnancy, thepatient responded, “Yes, I want to have an abortion. I’m in school and this is not thetime to start a family. I need to have a life, a job first.” Alexis asked if she had support,and the patient explained, “my boyfriend agrees with the decision and is helping to payfor it. He’ll drive me and everything like that. We both know it is the right thing to do.It feels sort of unreal and scary, but I guess that’s normal.” Alexis nodded and told her,“Most people are scared, but it is really a simple procedure. It’s uncomfortable but it’squick. I’ll tell you exactly what to expect and stay with you the whole time if you’d like.”

Here, we see how a patient’s certainty about her choice and her openness in discussingher concerns led to the counselor’s reassuring response and an offer of continuous emotionalsupport. When patients were “easy” in this way, counselors reacted by working to diminish theanxiety surrounding the procedure and by offering any support possible to ease the situation.

These “easy” cases epitomized the way workers saw their jobs and helping, and theytherefore approached the emotional labor involved in these cases by fully investing in theprocess and patient. This investment strategy meant that staff built close emotional ties topatients, enabling them to take the positive reactions of these patients as evidence that theywere helping others and thus to find their work satisfying. The following two interviewexcerpts are representative of how workers used and experienced this investment strategy for“easy” patients:

You’re working with patients and getting emotionally invested in them, which can bevery tiring. But most of us try to only get really caught up in a patient if she knowswhat she wants or can make a decision and knows we are there to help her. Whenthat happens, you feel like you’re doing something that’s positive for people. It’s so

Springer

162 Qual Sociol (2007) 30:153–169

great when you get that feedback: “Thank you so much. I feel better so much betterabout this.” or “You really helped me to think about this.” That’s a pretty cool thingto be able to do, and I feel like I’ve really helped someone and been a good person.(Alexis—counselor)

A really good day for me is when patients come in and you speak with them and theyseem really sure of their decision. Sometimes, you talk to them and know you canhelp somebody come to the decision they wanted to—whether to terminate or keep thepregnancy—and whether they felt like they had a choice, made it and felt like a heavyload had been lifted off of them. When that happens, you let yourself get close becauseyou feel like you are helping people, and I like that. It forces me to be a different kindof person, focused on other’s needs. (Susan—counselor)

In these cases, when initial interaction with patients suggested that they had made clearchoices and would be appreciative of support, staff approached patient care with an openness,allowing themselves to “get close” or get “caught up” in the patient’s experiences. Patient’scomments about how much staff helped them make and carry out choices, and how muchbetter they felt, evoked positive emotions for clinic workers and provided evidence that theywere effectively helping others. By using the strategy of investing in these patients, staffwere able to authenticate a valued aspect of themselves, reap psychological rewards, andfind their work meaningful.

Detaching from “hostile” or “ambivalent” patients

Other patients, such as women who were angry about their situations or who could notget comfortable with any choice, posed problems for staff because they contradicted theirnotion of helping people, though for varied reasons. “Hostile” patients often had made achoice but took their anger out on workers, so while staff could help them enact choice,they often felt beat up and unappreciated by these patients. “Ambivalent” patients weretroublesome because they could not become comfortable with any option, making staff feellike they had failed to help. Because these patients challenged the women’s ideas abouthelping and work, staff, especially counselors, learned to use a strategy of detachment tocope with the emotional labor necessary to interact with these patients successfully. As astrategy, however, detachment was a tricky endeavor, particularly because workers believedin the social value of their work and in the primacy of helping others. Supporting andenabling reproductive choice was usually thought to require engagement, the act of listeningto and heeding women’s voices. Detachment seemed antithetical to such work. Too muchdetachment would thus threaten staff’s sense of themselves as helping women; yet, stayingentirely engaged created anger and a sense of futility that could get in the way of providingcare. To remedy this situation, staff learned how to detach emotionally from interactionswith these patients and to perceive this detachment as the best way to enable choice in suchcases. The redefinition of detachment—from not caring to a method of helping difficultpatients—allowed staff to detach without feeling like they were acting contrary to theirpurposes.

In counseling sessions, staff were able to discern which patients fit into this categoryquickly. “Hostile” patients usually responded to basic questions about choice and motivewith certainty about their decision but with anger and belligerence, often focusing theiranimosity on the counselor. Fieldnote excerpts, for instance, illustrate that typical responsesof angry patients to the introductory question “How are you today?” included a sarcastic

Springer

Qual Sociol (2007) 30:153–169 163

“How do you think I am?” or a “brush-off” answer like “I’m fine. Just give me the appointmentso I can leave.” Often, these patients lashed out and showed disdain for the counselor. In onesuch session, Julie tried reaching out to a patient, asking:

“Are you comfortable with your decision?” The patient just said, “yeah, whatever” androlled her eyes. Julie then asked if she had concerns, and the patient just shrugged andlooked down. Julie repeated the question, and patient told her she “needed to do her joband just mind her own business.” Julie was quiet for a moment and looked down at herfolder, said “okay, we’ll get you started. Please let me know if you have any questionsor need anything.” Then we left the room.

In this instance, Julie tried to discover how her patient felt and thus how she could bestsupport her. After her attempts were rejected, Julie simply stopped trying to elicit emotionsand moved on to the procedure. When efforts to help were repeatedly met with hostility,counselors withdrew their emotional assistance and just focused on completing the process.Angry reactions were treated as signals that emotional detachment was necessary.

In contrast to “hostile” patients, “ambivalent” patients often treated counselors politelybut were, in spite of counselors’ repeated efforts to help, entirely unable to make a choice.Routinely, sessions with these patients were circular, beginning with counselors askingpatients to explain their thoughts and feelings, which consisted of confusion and misgivings.Counselors then asked patients to think about the consequences of their choices. When theyhad done so, and counselors felt like they were making progress, patients returned to theinitial stance of “I’m just not sure either way” or “Whatever I choose seems like I will regretit later.” The following fieldnote excerpt, taken from a counseling session, reveals this typicalcycle:

Alexis asked her about her decision, and she said she wasn’t sure what to do. Sheexplained that, she “doesn’t want a baby now, though maybe it could work.” Alexisasked her to list the pros and cons. She explained that she’d have a new life to love, thather boyfriend wanted her to keep it, but that the timing was wrong, money was tight,and she was afraid of being a mother. Alexis asked which reasons felt most importantto her, and she shrugged and said, “I just don’t know, I really don’t know.” Alexis askedher to think about the pros and cons again. She replied: “I still don’t know, really.”Alexis responded, “Go home, clear your head, and write out a list of reasons for andagainst. You still have some time before you must make the decision. Call me whenyou are ready to make a choice.” After we left, Alexis remarked that, “There is justnothing I can do for her, so I had to leave her alone to make a choice.”

Here, when persistent patient indecision rendered Alexis unable to help, she decided thather only course of action was “to leave her alone to make a choice.” Helping in this case, andin similar others, thus became construed as detaching until patients could figure out whatthey wanted.

As a strategy for coping with “hostile” and “ambivalent” patients, detachment allowedstaff to protect themselves from negative feelings and yet still feel like they were helping.This detachment, described as “putting on an act,” “not letting true feelings show,” and just“getting the patient through,” allowed the emotional distance that would help them “getthrough” the process. Mandy, for example, described her reaction to hostile patients as:

The hardest thing for me is not letting my true feelings show. I’m not very good atputting on that fake smile and pulling through. When patients are angry towards meand are pissing me off, I kind of withdraw to keep that from showing. . . .I know she’s

Springer

164 Qual Sociol (2007) 30:153–169

mad at the world, at her situation, but I have to stop trying to connect with her. If it isreally bad, I’ve had to leave the room for a little or turn them over to another counselor.

In this description, Mandy explained how the nature of the interaction guided her strategyfor coping with the emotional labor required. In response to anger, she, like most TWC staff,“withdrew” and “stop[ped] trying to connect” with a patient. In severe instances, she reactedby creating a literal physical space from the patient and asking someone else to step in.

Staff also used this kind of disconnect to cope with “ambivalent” patients whose persistentindecision challenged the whole ideal of choice. When patients could or would not make achoice, staff often felt like they had to “step back” from the interaction. Meg explained that:“When patients don’t know which way to go, and we give them the options and present theadvantages and disadvantages, and they still can’t decide, you feel like you aren’t helpful.You can’t tell them what to do, and that is what they want, so you can’t give them what theywant. It bothers me a lot, so I step back from the patient and say, “I did all I can.” Here, Megexplained that staff felt that they had to detach from these patients because they perceivedthey were not able to be helpful. Given the staff’s shared definition of their work, indecisivepatients were frustrating and thwarted their notions about their abilities to help others. As aresult, they “do all they can” and then “step back” from the patient emotionally, protectingthemselves from the sense of failure such indecision might create.

In these cases, staff did not perceive detachment as a failure to provide effective carebut rather as the only way to offer care to patients who invoked such difficult emotions.“Angry” patients, despite their hostility and frequent outbursts, still needed staff to supportthem through the abortion procedure in a caring manner. “Ambivalent” patients needed staffto listen, to suggest, and ultimately to support a course of action that they were uncertain wasright for them. For staff to offer this kind of care and to maintain a supportive stance, in spiteof contrary feelings, they had to divest these patients’ reactions from their assessments oftheir work and themselves. In doing so, they could simultaneously provide care and insulatethemselves, at least to some degree, from negative feelings. In these cases, detachment wastransformed from a potential problem into a viable solution.

Building boundaries with “very hard” patients

By far, the most challenging patients for clinic staff were those experiencing painful andtraumatic life situations, such as: victims of sexual assault or domestic violence, plannedpregnancies that had to be terminated because the mother’s life was endangered or the fetuswas severely damaged, or very young minors (under age 15). In these situations, staff feltthat their ability to help was severely limited because no reproductive choice would remedypatient troubles entirely. Further, these patients were usually intensely emotional—hurt,confused, depressed, shamed, and grief stricken—and required a great deal of emotionallabor from staff, who, in addition to conveying compassion and empathy, had to portray anoptimism about the situation. With these patients, workers believed that they had to stayemotionally connected; detaching from these patients seemed callous and contradictory tostaff ideas about their work. Yet, staff also saw that their abilities to help were constrained,and these emotional connections could be a great source of pain and failure. In an effortto help and to insulate themselves, at least somewhat, from the hurt and futility they mightexperience in such situations, workers constructed boundaries around what they defined astheir “part” of the situation. To do so, staff looked at the entirety of a patient’s situation andsegmented the piece that they felt they could help with, focused on it intensely, and made a

Springer

Qual Sociol (2007) 30:153–169 165

commitment to “let the rest go.” By drawing this boundary, staff could invest emotionally,feel like good helpers, and simultaneously diminish their sense of futility.

The following example, drawn from fieldnotes, is representative of these very hard cases,illustrating the coping strategy staff utilized to negotiate the necessary emotional labor. Itwas during these sorts of interactions with patients that staff learned to draw boundariesaround a specific portion of the problem, to invest in interaction pertaining to this portion,and to disregard other facets. In one session, Julie was trying to reconcile a 15 year oldgirl’s desire to keep her pregnancy with her mother’s insistence she have an abortion. Themother believed their family could not sustain the extra expense of another child becauseshe, as a single parent, was barely making ends meet. The daughter believed she could workand go to school and generally “help out” enough to make up the difference. After manyconversations, the counselor knew the two would not come to an agreement and believedthat, no matter what she did, this family would endure great struggle. As she explainedlater in an informal conversation: “I knew I could not do anything about them not havingmoney, I can’t make a child finish school or help her get comfortable with an abortion ifshe does not want one. It’s a no win situation, so I decided to go in there and help themthink through the decision carefully. All I could do was help them make the best decisiontoday.” Through her interactions with this mother and daughter, this counselor recognizedthe myriad difficulties of this situation and redefined her helping role to include only makingan informed, immediate decision. In doing so, she drew boundaries around the part of thesituation in which she could help and “let go” of aspects she saw as out of her control.

This kind of boundary construction was common to staff’s descriptions of how theyhandled these cases. For example, during an interview, Kim recalled a situation in which ayoung teen had been impregnated by her brother. She remembered the counseling sessionand her persistent thought that: “No matter what we do here today, this child has to gothrough so much. What does she have to look forward to?” She remembered feeling “so sadand beaten.” Her response to these feelings was:

I have to get through this and help this poor child as much as I can. I can help her withthis pregnancy and send her in the right direction, and then I’ve got to let the rest of itgo. Being able to let go is really important around here, especially with these kinds ofcases; you can’t take on everybody’s problem as your own. You can feel for them andoffer them help and support, but then you have to think “I can only help with this part,that’s all I can do, and I have to let the rest go.”

Notice here that negative feelings are combated by Kim’s ability to construct boundariesaround the aspects of the situation that she can help with and those she will have to “let go.”Once this boundary was constructed, she could offer empathy and help with the pregnancyand yet detach from the rest of the situation. Mandy described this strategy similarly, notingthat “you have to separate it [what you can help with], and know that you have done the verybest that you can do, and move on from there.” In this way, staff felt like they provided aidand support by investing fully in interactions surrounding reproductive options. By definingother aspects of the situation as outside of their job, they could “let them go” without feelinglike failures. In doing so, they protected themselves from some of the emotional difficulty ofinvesting in “very hard” patients and preserved the valued sense of themselves as helpers.

Clearly, staff-patient interactions, particularly in the required counseling sessions, werecritical junctures from which staff’s strategies for coping with emotional labor emerged.Staff used patients’ initial emotional and substantive responses to a set of questions abouttheir choices to assess the meaning that their unwanted pregnancy held for them and thenused this assessed meaning to place patients in categories that suggested strategies of action

Springer

166 Qual Sociol (2007) 30:153–169

(Blumer, 1969). In other words, staff-patient interaction did more than inform and supportpatients; it provided cues to staff about how they could most effectively provide care. Theconstruction and use of these strategies enabled staff to feel authentic—both in the senseof being true to one’s self-values and enacting these values genuinely—in their efforts touphold reproductive choice and help others. Investing in “easy” patients provided positiveemotions that were taken as evidence of this authenticity. In other cases, detaching or buildingboundaries simultaneously protected workers from emotions that may have challenged theirvalued notions of self and allowed them to feel some satisfaction that they had helped in theways they deemed possible. In sum, these strategies worked to heighten the positive aspectsof emotional labor and mute the potentially negative ones.

For the most part, clinic workers used these strategies effectively and reported that theirwork, while sometimes highly stressful, was also “important” and “rewarding,” made themfeel like “good people,” and was even “enjoyable.” However, for two counselors thesestrategies were failing (or had failed) to mitigate the emotional costs of their jobs. Meg, whoquit after 5 months and later agreed to an interview, explained that she had to quit because:“It was the most high stress job I’ve ever had, and I did not know how hard it would be. It wasnever the abortion issue that was the problem; it was dealing with the people. SometimesI felt like I was helping but mostly I felt so stressed out and sad. I guess other peopleare better equipped to do this work than I am.” For Meg, these coping strategies providedneither protection from the negative feelings patient cases could induce nor ways to highlighthelping as rewarding work. As a result, her bad feelings became overwhelming, and she had toleave.

Similarly, Alexis voiced dissatisfaction with her job, again related to patient interaction.Unlike Meg, Alexis initially liked her work because she perceived that she “was doing what[she] wanted and helping people,” and she felt like a “different person who could reach outand do what was important for others.” This sense of helping, however, eroded over yearsof working with patients. She explained: “I don’t know if there is much I can say I likeabout it now. The negatives just starting outweighing the positives. It’s the patients. I’veseen thousands of women, and some are fine. But some are plain idiots or are angry or theylie. I get to the point where I’m like—I don’t want to talk to you, I’m tired of talking toyou. I do not care if you come back.” In Alexis’ situation, coping strategies did not mitigatethe negative feelings associated with work, and they gradually overshadowed the positivebenefits of helping people.

It is in these two cases that the importance of coping strategies for negotiating emotionallabor successfully becomes most visible. Meg could not find a balance between the demandsof work and self and therefore found clinic work unbearably stressful. Alexis’ example revealswhat can happen when staff are unable to invest much emotion in patient care. Put bluntly,she ceased to worry about helping others, thus finding difficult patients tiresome and eveneasy patients unrewarding. These negative cases highlight the costs of emotional labor thatis unmitigated by effective coping strategies, namely distress, burnout, and diminished workperformance. By contrast, when coping strategies worked, staff found the same demandingwork rewarding. Why similar coping strategies, utilized under shared working conditions,are effective for some workers and not others requires further empirical exploration.

Conclusions

Over two decades ago, Hochschild (1983) posed what is arguably the central problem in themanagement of emotional labor at work: that is, how do workers balance the often competing

Springer

Qual Sociol (2007) 30:153–169 167

demands of self and job in ways that enable them to find their labor rewarding, maintain asense of authenticity of self, and perform their work well? This balancing act is a complexand difficult task, one that can be impeded by rigidly structured working conditions, lowlevels of worker autonomy, long hours, and intense contact with clients (Wharton, 1993,1999). Failing to create this balance, as prior research has shown, can lead to worker distressand burnout (Scheid, 1999). While the findings of this study are consistent with this research,it also directs our attention to how one group of workers, who perceived that their work wasimportant socially and an integral part of themselves and who labored in a work environmentthat allowed worker flexibility in how patient needs were met, were able, to a considerableextent, to construct this balance.

This case study reveals that workers were largely able to accomplish this balance throughthe development of coping strategies that emerged from staff-patient interactions. By askinga fairly standard set of questions during initial interactions with patients, staff could gaugehow patients felt about their situations and their receptivity to the kind of help workerscould offer. Patients’ perceptions of and responses to their pregnancies laid the foundationfor subsequent interaction and provided the fodder staff used both to divide patients intocategories and to develop strategies specific to the needs and challenges posed by each. Indoing so, workers were able to invest heavily in interactions that were likely to be rewarding,detach from those that were not, and construct boundaries that enabled them to invest in someaspects of patient cases while “letting go” of the rest. These coping strategies helped staff toreap the psychic and emotional rewards of their labor while muting its more costly aspects.

These coping strategies were effective, at least in part, because they enabled staff tomaneuver between investing in and detaching from the emotional labor of their work,without threatening the authenticity of a valued sense of self. Previous research (Erickson,2004; Henderson, 2001) has shown that when workers take a global either/or approach totheir jobs; that is, they either entirely invest in or detach from the emotional labor involved,then they are more vulnerable to the costs of either strategy. By contrast, workers in thisstudy, while generally invested in their jobs, came to understand that they did not have toinvest in every interaction, or even every patient, to do their jobs well. Instead, the copingstrategies staff developed required that they detach from some hostile or ambivalent patientsand from some aspects of patient situations for which they could offer no aid. Without thisability to detach in certain cases, workers would likely have suffered greater emotional costsand been less able to create a supportive stance. It was clinic staff’s ability to utilize copingstrategies along a continuum of detachment to investment that enabled them to successfullycreate and maintain a balance between the needs of the job and the self. Clinic staff matchedstrategy to situation, using the dynamics of patient interaction as a guide, allowing for alarger, more flexible, and generally successful repertoire of responses to emotional labor.

The creation and application of this repertoire of responses also had important implicationsfor worker’s sense of themselves as authentically the kind of people they wanted to be,despite occasions when they pretended or detached. Because clinic staff began their jobsat TWC motivated by the opportunity to “help others” and to make reproductive choice areality, something they believed good people should do, the emotional labor they performedwas not only an effort to meet job requirements but was also a way to fulfill importantcommitments to self. Authenticity, as Erickson has asserted, is a “self-referential” conceptand should “be regarded as the extent to which one fulfills the expectations or commitmentsone has for self” (Erickson, 1995, p. 131). These self expectations and commitments establishcriteria for evaluating one’s performances, and feelings of authenticity are generated througha comparison of actions and emotions to these criteria. Clinic staff’s emergent strategiesfor performing and coping with emotional labor simultaneously provided a means to affirm

Springer

168 Qual Sociol (2007) 30:153–169

valued commitments to self and to discredit or disregard contrary actions or feelings. Like thecaseworkers in Garot’s (2004, p. 758) study of the Housing and Urban Development Section8 program, clinic staff felt less stress coping with difficult cases once they had labeled themas not meriting complete engagement or empathy. By redefining interactions with difficultpatients in ways that legitimated detachment and by building boundaries that specified whichpieces of a difficult patient situation fell under their domain and which could be justifiably“let go,” staff were able to overlook the aspects of their work that might otherwise challengevalued aspects of the self. As a result of this kind of redefining and of maneuvering along acontinuum from detachment to investment, staff constructed the emotional labor necessaryto fulfill their job demands as synonymous with the fulfillment of self-commitments, therebyfinding this work generally rewarding despite the difficult emotional labor it entailed.

Examining how the staff at TWC were able, to a considerable extent, to construct thisbalance between job and self suggests that the meaning work holds for workers has consid-erable influence over whether and how they are able to adapt to the emotional labor required.In this case, the importance clinic staff attributed to their work highly motivated them tostrike this balance and directed the kinds of strategies they could develop. Analyzing howworkers conceive of their work, in relation to themselves and others, may thus be a keypiece in formulating an understanding of what repertoires of responses to emotional laborare possible and likely to be effective. If, as Hochschild urged, part of the trick is to meet theneeds of the self, then an examination of self-meanings, in conjunction with assessments ofwork conditions, should play an integral role in subsequent research.

References

Ashforth, B. E., & Humphrey, R. H. (1993). Emotional labor in service roles: The influence of identity. TheAcademy of Management Review, 18, 88–115.

Baker, A. (1995). Abortion options and counseling. Granite City, IL.Blumer, H. (1969). Symbolic interactionism: Perspective and method. Berkeley: University of California

Press.Charmaz, K. (1983). The grounded theory method: An explication and interpretation. In R. M. Emerson (Ed.),

Contemporary field research: A collection of readings (pp. 109–126). Prospect Heights, IL: WavelandPress.

Clemans, S. (2004). Life changing: The experience of rape-crisis work. Affilia, 19, 146–159.Erickson, K. (2004). To invest or detach? Coping strategies and workplace culture in service work. Symbolic

Interaction, 27, 549–572.Erickson, R. J. (1995). The importance of authenticity for self and society. Symbolic Interaction, 18, 121–144.Erickson, R. J., & Wharton, A. S. (1997). Inauthenticity and depression: Assessing the consequences of

interactive service work. Work and Occupations, 24, 188–213.Fox, R., & Cooper, M. (1998). The effects of suicide on the private practitioner: A professional and personal

perspective. Clinical Social Work Journal, 26, 143–157.Garot, R. (2004). “You’re not a stone”: Emotional sensitivity in a bureaucratic setting. Symbolic Interaction,

33, 735–766.Ginsberg, F. D. (1989). Contested lives: The abortion debate in an American community. Berkeley: University

of California Press.Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research.

Chicago: Aldine.Henderson, A. (2001). Emotional labor and nursing: An under-appreciated aspect of caring work. Nursing

Inquiry, 8, 130–138.Hochschild, A. R. (1983). The managed heart: Commercialization of human feeling. Berkeley: University of

California Press.Karabanow, J. (1999). When caring is not enough: Emotional labor and youth shelter workers. The Social

Service Review, 73, 340–357.Leidner, R. (1993). Fast food, fast talk: Service work and the routinization of everyday life. Berkeley: University

of California Press.

Springer

Qual Sociol (2007) 30:153–169 169

Leidner, R. (1999). Emotional labor in service work. The Annals of the American Academy of Political andSocial Science, 561, 81–95.

Lively, K. (2002). Client contact and emotional labor: Upsetting the balance and evening the field. Work andOccupations, 29, 198–225.

Lively, K. (2001). Occupational claims to professionalism: The case of paralegals. Symbolic Interaction, 24,343–365.

Lively, K. (2000). Reciprocal emotion management: Working together to maintain stratification in private lawfirms. Work and Occupations, 27, 32–68.

Marshall, N. L., Barnett, R. C., Baruch, G. K., & Pleck, J. H. (1990). Double jeopardy: The costs of caring atwork and at home. In E. K. Abel & M. K. Nelson (Eds.), Circles of care: Work and identity in women’slives (pp. 266–277). Albany: State University of New York Press.

Meldrum, L., King, R., & Spooner, D. (2002). Secondary traumatic stress in case managers working incommunity mental health services. In C. Figley (Ed.), Treating compassion fatigue (pp. 85–106). NewYork: Brunner-Routledge.

Paules, G. F. (1991). Dishing it out: Power and resistance in among waitresses in a New Jersey restaurant.Philadelphia: Temple University Press.

Pierce, J. L. (1995). Gender trials: Emotional lives in contemporary law firms. Berkeley: University ofCalifornia Press.

Scheid, T. L. (1999). Emotional labor and burnout among health professionals. Social Problems, 11, 169–193.Shaffir, W., & Stebbins, R. (1991). Maintaining relations. In W. Shaffir & R. Stebbins (Eds.), Experiencing

fieldwork: An insider’s view of qualitative research (pp. 143–148). Newbury Park: Sage Publications.Simonds, W. (1996). Abortion at work: Ideology and practice in a feminist clinic. New Brunswick: Rutgers

University Press.Stamm, B. (2002). Measuring compassion satisfaction as well as fatigue: Developmental history of the

compassion satisfaction and fatigue test. In C. Figley (Ed.), Treating compassion fatigue (pp. 107–122).New York: Brunner-Routledge.

Stenross, B., & Kleinman, S. (1989). The high and lows of emotional labor: Detectives’ encounters withcriminals and victims. Journal of Contemporary Ethnography, 17, 435–452.

Warren, C., & Karner, T. (2005). Discovering qualitative methods: Field research, interviews, and analysis.Los Angeles: Roxbury Publishing Company.

Wharton, A. S. (1993). The affective consequences of service work: Managing emotions on the job. Work andOccupations, 20, 205–232.

Wharton, A. S. (1999). The psychosocial consequences of emotional labor. The Annals of The AmericanAcademy of Political and Social Science, 561, 158–176.

Williams, C. (2003). Sky service: The demands of emotional labour in the airline industry. Gender, Work andOrganizations, 10, 513–550.

Michelle Wolkomir is an Associate Professor of Sociology and Co-Director of Gender Studies at CentenaryCollege. Recent publications include Be not deceived: The sacred and sexual struggles of gay and ex-gayChristian men, which received the 2006 ASA Distinguished Book Award in Sexualities, and “Giving it up toGod: Negotiating femininity in support groups for wives of ex-gay Christian men” in Gender & Society.

Jennifer Powers received her Master of Public Policy degree from George Washington University in May2006. Her research interests focus on the intersection of disadvantaged groups, particularly women, andhealthcare. She is currently working for Public Strategies, Inc.

Springer