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Generational Resilience Conference University of South Alabama and

University of West Florida October 2014

Hazards of Practice and Tips for Professional Resiliency

Thomas Skovholt, Ph.D.Professor and Licensed Psychologist

University of Minnesota

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OutlineThe Professional ChallengeJoy and RewardsThe Cycle of CaringHazards of PracticeWhat is Resilience?The Eye in the Storm Model of

Practitioner ResilienceReferences

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The Professional Challenge

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The Professional Challenge: To Wade with Vitality into Ocean of Human Suffering…

and Be Intensively Present For the Suffering Other and Do it Again…and Again…and Again…

and Be Honored to Have Such Work

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Self Care in Other FieldsHow does the opera singer take care of the voice?

The rock climber, the arms?The woodcutter, the axe?The photographer, the eyes?The ballerina, the legs and feet? The counselor—therapist—health professional—teacher—lecturer, the self ? 

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The Difficulty of Self-Care…the transition from study to work appears

to be a particularly stressful period with higher rates of distress and burnout in younger Australian doctors…Doctors and medical students have been identified as a group at high risk of poor mental health…suicide, depression, anxiety disorders, substance abuse and self-prescribing. (National Mental Survey of Doctors and Medical Students in Australia (2013, p.6-7)

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Joy and Rewards

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The Joy and Rewards of Helping---Healing---Educating in the Relationship-

Intense Professions! The rewards of teaching is knowing that your life made a difference. (Ayers, 1993, p. 24)

Psychotherapy continues to prove its effectiveness…the large trial for aspirin as a prophylaxis for heart attacks produced as effect size of .03 (compared with .80 for psychotherapy as a treatment for mental health problems). It is interesting that the magnitude of the effect was thought to be so astonishing that the trial was stopped prematurely because it was decided that delivering the placebo was unethical. (Hubble et. al, 2009, p. 27-28)

Our goals of understanding others’ points of views, alleviating human suffering, and enhancing relationships are noble goals. (Pipher, 2003, p. 179)The successful student affairs professional is apt to enjoy people, taking pleasure in their diversity and individuality. He or she is often drawn to the subjective, experiential aspects of life, toward events and problems in their particularity, and accomplishing things through others…. (Jones, Harper & Schuh, 2011, p. 534)

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More Joy and RewardsWhat do we live for, if it is not to make life less difficult to each other? (Mary Ann Evans; Eliot, 1956, p. 537)

I rarely hear my therapist colleagues complain that their lives lack meaning. Life as a therapist is a life of service in which we daily transcend our personal wishes and turn our gaze towards the needs and growth of the other…There is extraordinary privilege here. And extraordinary satisfaction, too. (Yalom, 2002, p. 256)The great majority of therapists [M=11 years of experience] reported recently having high levels of Flow feelings: stimulated (80%), engrossed (80%), inspired (79%), and challenged (70%). (Orlinsky & Rønnestad, 2005, p.57) This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy. (George Bernard Shaw; cited in Larson, 1993, p. 2)A teacher affects eternity; he can never tell where his influence stops. (H. Adams, 1918, p. 300)

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The Cycle of Caring

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The Cycle of Caring

The most effective teaching approaches foster bonds of caring between teachers and their students (Kirp, 2014, p. 4)

the demand to be attuned, to be interested, to be energetic for the other--the other who is often in misery, anger, defiance, or hopelessness-- and to continue to do it over ad over again, defines the work of the therapy practitioner. (Skovholt et. al, 2004, p. 18)The basic meaning of care is: to grieve, to experience sorrow, to cry out with. (Nouwen, 2004, p.33)

[the] person of the therapist is the most robust predictor of any outcome of any factor ever studied. (Hubble et.at, 2009, p. 38)we tend to forget the complexity of the process [of being empathetic]. It is extraordinarily difficult to know really what the other feels; far too often we project our own feelings onto the other. (Yalom, 2002, p. 21)

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The Cycle of Caring

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Vigelund Sculpture. Oslo.

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Hazards of Practice

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Hazards of PracticeWhen I am affected by a woman’s story or someone tells me something about a domestic violence situation, I can’t stop thinking about it. I feel for that person. I think about them all day every day…I’ve taken on someone else’s trauma.... (Boyland cited in Lipsky & Burk, 2009, p. 124)    

 Being a psychotherapist is no Caribbean cruise with bonbons and bourbon. (Pipher, 2003, p.75)

Dwelling with the stories that haunt us: Building a meaningful nursing practice. (Rashotte, 2005, p.34)

If you are paying attention to the world you see a lot of pain… Francesca was in therapy after a

brutal date rape. Sue Anne came because her husband had just killed himself. (Pipher, 2003, p. 53)

The capacity for compassion and empathy seems to be at the core of our ability to be wounded by the work. (Stamm, 1995, p. ix)

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BurnoutAs general exhaustion

Hemorrhaging of the Professional Self

Compassion Fatigue – Emotional Depletion

As emotional exhaustion

Vicarious Traumatization

Being changed cognitively by the stories of human suffering

Ambiguous Professional Endings /

LossClients / Patients

disappear without closure

Professional Uncertainty

Ambiguity of the human condition

Method and outcome are unclear

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What is Resilience?

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What is Resilience?The word comes from the

Latin word resilre—to rebound… like a rubber band does

after it is stretched and then released….concept of resilience continues to refer generally to positive adaption in the context of risk or adversity. (Masten, 2014, p. 9) 

Simple definition…being able to bounce back from difficult challenges

An early use of the word resilience---Tredgold in 1818 described timber that would bend but not break. (Hou, 2014) 

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What is Resilience?The two pioneer longitudinal

studies of human resilience were done by Werner, Bierman & French

(1971) of immigrant children growing up in Hawaii and

Garmezy (1971) of poor children growing up in Minneapolis

Neither used the word resilience in their early writings, but did in time.

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Factors Associated With Resilient Young People

Positive relationships with parents-caregivers, other adults, friends and romantic partners 

Intellect and problem solving skills  Emotional regulation and planfulness Motivation to succeed and self-efficacy Being hopeful about life Having effective schools and

neighborhoods(Masten, 2014, p. 147)

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The Eye of the Storm Model of High Practitioner Resiliency

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The Eye of the Storm Model of High Practitioner Resiliency

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At the Eye Sits the Practitioner---Developing a High Vitality Index

Where Personal Vitality and Professional Vitality Greatly Exceed Personal Stress and Professional Stress

These are the four inventory domains

Developing Cycle of Caring Expertise 

Developing Master Therapist Expertise--- High on Cognitive / Relational / Emotional

Domains (Jennings, Skovholt, Goh & Lian, 2013)

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Suggested Resilient Practitioner Tasks First Essential Resilient Practitioner Task:

Losing One’s Innocence about the Need to Assertively Develop Resiliency and Self-Care Skills

Second Essential Resilient Practitioner Task: Developing Abundant Sources of Positive Energy

Third Essential Resilient Practitioner Task: Relish the Joy and Meaning of the Work as a

Positive Energy SourceFourth Essential Resilient Practitioner Task:

Searching for Empathy Balance and Boundaried

Generosity

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Suggested Resilient Practitioner Tasks Fifth Essential Resilient Practitioner Task:

Developing Sustaining Measures of Success and Satisfaction

Sixth Essential Resilient Practitioner Task: Creating a Greenhouse at Work

Eighth Essential Resilient Practitioner Task: Our Own Physical Health as a Source for Positive

Energy Ninth Essential Resilient Practitioner Task:

A Long-Term Continual Focus on the Development of the Self

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Suggested Resilient Practitioner Tasks

Tenth Essential Resilient Practitioner Task: Having Fun and Joy in One’s Life

Bellingrath Gardens

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ResilienceFinally, try imagining a favorite tree in

front of you…magnificent trees take in our carbon

dioxide and give off oxygen...but they need sunlight, rain and good soil.

Those in the relationship-intense professions do the sameThey take in the carbon dioxide of others and

give them oxygen…but they too need sunlight, rain, and good

soil…How is your supply?

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References

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ReferencesAdams, H. (1918). The education of Henry Adams. New York: Houghton Mifflin. Ayers, W. (1993). To teach: The journey of a teacher. New York: Teachers College Press. Eliot, G. (1956). Middlemarch (G. S. Haight, Ed.). Boston: Houghton Mifflin.Freudenberger, H. (1974). Staff burnout. Journal of Social Work, 30, 159-165.Garmezy, N. (1971). Vulnerability research and the issue of primary prevention. American Journal of Orthopsychiatry, 41, 101-116.Hubble, M.A., Duncan, B.L., Miller, S. D. & Wampold, B.E. (2009). Introduction. In B.L. Duncan, S. D. Miller, B.E. Wampold & M.A. Hubble (Eds.). The heart and soul of change: Delivering what works in therapy (pp.23-46). Washington, DC: American Psychological Association. Hou, J.M. (2014). Resilience: Review of the topic. Unpublished. University of Minnesota. Kent, M., Davis, M.C., Reich, J.W. (Eds. ) (2014). The resilience handbook: Approaches to stress and trauma. New York: Routledge.

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ReferencesJennings, L. , Skovholt, T.M., Goh, M. & Liam, F.(2013). In M.H. Ronnestad & T. M. Skovholt (Eds.) The developing practitioner: Growth and stagnation of therapists and counselors. (pp. 213-246). New York: Routledge.Jones, S. R., Harper, S. R. & Schuh, J.H. (2011). Shaping the future. In J.H. Schuh, S.R. Jones, S. R. Harper & Associates (Eds.) Student services: A handbook for the profession (pp. 534-546). San Francisco: Jossey-Bass. Kirp, D.L. (2014). Teaching is not a business. New York Times. Week in Review Section, August 14th, p. 4. Lambert, M. & Ogles, B. (2004). The efficacy and effectiveness of psychotherapy. In M. Lambert (Ed.), Bergin & Garfield’s handbook of psychotherapy and behavior change (pp.139-193). Hoboken, NJ: Wiley. Larson, D. G. (1993). The helper’s journey. Champaign, IL: Research Press.Lipsky, L. D. & Burk, C. (2009). Trauma stewardship: An everyday guide to caring for self while caring for others. San Francisco: Berrett- Koehler Publications.

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References Luthar, S., Cichetti, D., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543-562.Masten, A. S. (2014). Ordinary magic: Resilience in development. New York: Guilford.  National Mental Survey of Doctors and Medical Students in Australia (2013) www. beyondblue. org.auNorcross. J.C. & J. D. Guy (2007). Learning to leave it at the Office: A guide to psychotherapist self-care. New York: Guilford.Nouwen, J.M. (1974). Out of solitude. Notre Dame, IN: Ave Maria Press.Orlinsky, D. E., & Ronnestad, M.H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. Washington, D.C.: American Psychological Association.Palmer, P. J. (1998). The courage to teach: Exploring the inner landscape of a teacher’s life. San Francisco: Jossey-Bass. Pipher, M. (2003). Letters to a young therapist. New York: Basic Books.

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Rachotte, J.( 2005). Dwelling with the stories that haunt us: Building a meaningful nursing practice. Nursing Inquiry, 12(1), 34-42. Ronnestad, M.H. & Skovholt, T.M. (2013). The developing Practitioner: Growth and stagnation of therapists and counselors. New York: Routledge.Skovholt, T.M. (2005). The cycle of caring: A model of expertise in the helping professions. Journal of Mental Health Counseling, 27, 82-93.Skovholt, T.M. & Trotter-Mathison (2011) The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists, teachers and health professionals, 2nd edition, NY: Routledge.Skovholt, T.M. & Jennings, L. (2004) Master therapists: Exploring expertise in therapy and counseling. Boston: Allyn and Bacon.Skovholt, T. M., Goh, M., Upidi, S. and Grier, T. (2004). The resilient multicultural practitioner. The California Psychologist, 37 (6), 18-19. Skovholt, T.M. & Ronnestad, M.H. (1995). The evolving professional self. New York: Wiley.

References

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ReferencesStamm, B. H. (1985). Preface. In B.H. Stamm (Ed.), Secondary traumatic stress: Self-care for clinicians, researchers, and educators (pp. iv-xii). Luterville, MD: Sidran Books.Teater, M. & Ludgate, J. (2014). Overcoming compassion fatigue: A practical resilience workbook. Eau Claire, WI: PESI Publishing and Media.Werner, E., Bierman, J. & French, F. (1971). The children of Kauai: A longitudinal study from the prenatal period to age ten. Honolulu: University of Hawaii Press.Yalom, I.D. (2002). The gift of therapy: An open letter to a new generation of therapists and their patients. New York: Harper Perennial.

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Thank You