yaron ziv who takes care of the caretaker.pp · project on his/her clientproject on his/her client...

Who takes care of theWho takes care of thecaretaker?caretaker?

Burnout prevention for the helpingBurnout prevention for the helpingprofessionalsprofessionals

Dr. Yaron Ziv, MSW, Psy.DDr. Yaron Ziv, MSW, Psy.D

MaofMaof--center for human developmentcenter for human development

www.yaronziv.comwww.yaronziv.com

Burnout and stress at workBurnout and stress at work --difficulty and challengedifficulty and challenge

No person is immune againstNo person is immune againststressstress

No person is immune againstNo person is immune againstburnoutburnout

Stress and burnout areStress and burnout arenormative situations for thenormative situations for themodern working peoplemodern working people

Burnout and stress at workBurnout and stress at work --difficulty and challengedifficulty and challenge

Our task is:Our task is:

1.1. IdentifyIdentify

2.2. Take responsibilityTake responsibility

3.3. Take actionTake action

The ratio of burnout among theThe ratio of burnout among thetherapeutic profession, is one oftherapeutic profession, is one ofthe highest on the scale, 6the highest on the scale, 6thth

position out of 140 professions.position out of 140 professions.

What is stress?What is stress?

SituationSituation perceivedperceived as a threatas a threat(Selie,1961)(Selie,1961)

Situation in which a gap betweenSituation in which a gap betweenperceivedperceived selfself--expectation andexpectation andperceivedperceived environment expectationenvironment expectationoccurs (Ziv,1999)occurs (Ziv,1999)


Situation in which a gap betweenSituation in which a gap betweenperceivedperceived demands and existingdemands and existingresources occurs (Folkmanresources occurs (Folkman&Lazarus, 1984)&Lazarus, 1984)

Situation in which negative energySituation in which negative energyis invested at presenceis invested at presence( now( now) in) inregard ofregard of perceivedperceived thoughts aboutthoughts aboutthethe futurefuture (Ziv,2004)(Ziv,2004)


PerceptionPerception is the key word inis the key word inregard to stress.regard to stress.

““stressful situationstressful situation”” doesndoesn’’t existt exist

What is perceived as stress to oneWhat is perceived as stress to onewill not be perceived as stress towill not be perceived as stress toanotheranother

Stress is not good or bad , whatStress is not good or bad , whatcounts is the level of stresscounts is the level of stress

Negative ways to cope with stressNegative ways to cope with stress

DrugsDrugs

AlcoholAlcohol

SleepSleep

AvoidanceAvoidance

ProcrastinationProcrastination

EatingEating

AngerAnger

Positive ways to cope with stressPositive ways to cope with stress

SportSport

Good NutritionGood Nutrition

Meditation, Relaxation, Yoga,Meditation, Relaxation, Yoga,

Sharing and encountering withSharing and encountering withfriendsfriends

Good time managementGood time management

AssertivenessAssertiveness

Positive thinkingPositive thinking

What is Burnout?What is Burnout?

BurnoutBurnout is an accumulatedis an accumulatedprocess of physical and mentalprocess of physical and mentalfatigue as a result offatigue as a result ofaccumulated situations ofaccumulated situations offrustrations that have not beenfrustrations that have not beenresolved (Maslach,1998)resolved (Maslach,1998)

Physical symptoms of BurnoutPhysical symptoms of Burnout

Somatic complains about fatigue,Somatic complains about fatigue,dizziness, headaches, tensiondizziness, headaches, tension

Decline of the Immune systemDecline of the Immune systemfunctioningfunctioning

High exposure to heart and cancerHigh exposure to heart and cancerdiseases.diseases.

Cognitive symptoms of BurnoutCognitive symptoms of Burnout

Damage to the STM.Damage to the STM.

Forgetting the keys in carForgetting the keys in car

CanCan’’t find the keys in the morningt find the keys in the morning

Inability to invest energy inInability to invest energy inanythinganything

Cynicism and cynical humorCynicism and cynical humor

SarcasmSarcasm

Cognitive symptoms of BurnoutCognitive symptoms of Burnout

Setting appointments to differentSetting appointments to differentpeople on the same timepeople on the same time

Forgetting where you put yourForgetting where you put yourcalendar of appointmentscalendar of appointments

Loss of creativityLoss of creativity ––””working by theworking by thebookbook””

Social symptoms of BurnoutSocial symptoms of Burnout

IsolationIsolation and alienationand alienation

““the whole world is against methe whole world is against me””

Deliberate damaging the workDeliberate damaging the work

Low frustration tolerance to otherLow frustration tolerance to otherpeoplepeople’’s behaviors behavior

Negative attitude towards otherNegative attitude towards otherpeoplepeople

Putting down, ridicule other peoplePutting down, ridicule other people

Emotional symptoms of BurnoutEmotional symptoms of Burnout

DepressionDepression

AngerAnger

DepersonalizationDepersonalization

ImperviousnessImperviousness

Coping and preventing BurnoutCoping and preventing Burnout

Always learn something newAlways learn something new

Learn something which is notLearn something which is notconnected to your professionconnected to your profession

Create opportunities to share yourCreate opportunities to share yourfeelings and thoughts with othersfeelings and thoughts with others

Enrich your work, donEnrich your work, don’’t do thet do thesame thing for too long timesame thing for too long time

Coping and preventing BurnoutCoping and preventing Burnout

Balance between work and privateBalance between work and privatelifelife

Make physical exercise as a regularMake physical exercise as a regularhabithabit

Make time for relaxation and musicMake time for relaxation and music

Love what you do and do what youLove what you do and do what youlovelove

““if you are not there, quit!!!if you are not there, quit!!!””

Burnout among therapistsBurnout among therapists

The Therapeutic contract isThe Therapeutic contract isdifficultdifficult

The client is allowed to project onThe client is allowed to project onhis/her therapist (his/her therapist (transferencetransference), but), butthe therapist is not allowed tothe therapist is not allowed toproject on his/her clientproject on his/her client(countertransference(countertransference), it is), it isconsidered non professionalconsidered non professionalbehaviorbehavior

The therapeutic contractThe therapeutic contract

Every therapist serves as aEvery therapist serves as aprojected objectprojected object

Skills like empathy, activeSkills like empathy, activelistening, unconditional acceptancelistening, unconditional acceptanceare not natural and they requireare not natural and they requireenergy investment.energy investment.

TheThe ““savior symptomsavior symptom”” –– ““I willI willsucceed where everybody elsesucceed where everybody elsefailedfailed””

The therapeutic relationshipThe therapeutic relationship

We do it because we careWe do it because we care

We have to keep boundaries and toWe have to keep boundaries and todistinguish betweendistinguish between identificationidentificationandand empathyempathy

If you realize that youIf you realize that you ““take it intake it in””,,notice that there is annotice that there is an ““unfinishedunfinishedbusinessbusiness”” –– share it with yourshare it with yourtherapisttherapist

The energy bankThe energy bank

We do function in our life out of anWe do function in our life out of anenergy bank that operates like aenergy bank that operates like aregular bank.regular bank.

We have energy deposits and weWe have energy deposits and wehave energy withdrawalshave energy withdrawals

The only difference between theThe only difference between theenergy bank and the regular bankenergy bank and the regular bankthat we canthat we can’’t get loans!!!t get loans!!!


Burnout is defined as a continuousBurnout is defined as a continuousoverdraftoverdraft

It is very important to check regularlyIt is very important to check regularlyour balanceour balance

To maintain good balance in our energyTo maintain good balance in our energybank, we need to make sure that therebank, we need to make sure that thereare enough energy deposits in theare enough energy deposits in theaccount and we are in control of ouraccount and we are in control of ourenergy withdrawalsenergy withdrawals


What is an energy deposit?What is an energy deposit?

Energy deposit is any action we doEnergy deposit is any action we dototo ““charge batteriescharge batteries”” for fun andfor fun andpleasure: dancing, going to concertspleasure: dancing, going to concertsplaying cards, hanging out etc.playing cards, hanging out etc.

Notice that every energy deposit isNotice that every energy deposit isa time invested act, we need toa time invested act, we need toimplement it into our weeklyimplement it into our weeklyscheduleschedule


What is an energy withdrawal?What is an energy withdrawal?

An energy withdrawal is anAn energy withdrawal is aninvested energy in one of theinvested energy in one of thefollowing acts: Anger,following acts: Anger,Disappointment, Worry, Stress,Disappointment, Worry, Stress,Fear, Anxiety, Hurt, Tension, Guilt,Fear, Anxiety, Hurt, Tension, Guilt,Shame, etc.Shame, etc.

Some withdrawals are unavoidableSome withdrawals are unavoidable

Some withdrawals can beSome withdrawals can be ““savedsaved””


Make a list of energy deposits andMake a list of energy deposits andwithdrawals on a weekly basis atwithdrawals on a weekly basis athome and at workhome and at work

Notice which withdrawals areNotice which withdrawals areunavoidable and which can beunavoidable and which can besaved.saved.

Share with your partnerShare with your partner


Notice how many deposits you putNotice how many deposits you putin your accountin your account ––if any!!!if any!!!

If you are the last on the listIf you are the last on the list-- whatwhatdoes it say about yourself?does it say about yourself?

If your withdrawals are much moreIf your withdrawals are much morethan your depositsthan your deposits-- what does itwhat does itmean for you?mean for you?

Are you the captain of your energyAre you the captain of your energyship?ship?


What energy withdrawals can beWhat energy withdrawals can be““savedsaved””??

All the energy withdrawals thatAll the energy withdrawals thatrelate to Anger, Frustration, Hurt,relate to Anger, Frustration, Hurt,and Disappointmentand Disappointment

These invested energy have oneThese invested energy have onething in common :thing in common :EXPECTATIONEXPECTATION

Let us talk about expectationsLet us talk about expectations

Nobody can make us angry!Nobody can make us angry!

Nobody can disappoint us!Nobody can disappoint us!

Nobody can hurt us!Nobody can hurt us!

Nobody can frustrate us!Nobody can frustrate us!

We make ourselves angryWe make ourselves angry

We disappoint ourselvesWe disappoint ourselves

We make ourselves hurtWe make ourselves hurt

We make ourselves frustratedWe make ourselves frustrated


How do we do it?How do we do it?

We make ourselves angry or hurt orWe make ourselves angry or hurt ordisappointment not because peopledisappointment not because peopledid something or didndid something or didn’’t dot dosomething.something.

Our emotions is ours therefore weOur emotions is ours therefore weare responsible for their existanceare responsible for their existance


we get angry, hurt, disappointedwe get angry, hurt, disappointedbecause people do or donbecause people do or don’’t dot dosomething that doesnsomething that doesn’’t go alongt go alongwith our expectations.with our expectations.

TheyThey shouldshould have done this or theyhave done this or theyshould notshould not have done thathave done that

II cancan’’t standt stand that he/she does it thatthat he/she does it thatwayway


Common words about expectations:Common words about expectations:High/low, justified, minimal,High/low, justified, minimal,obvious, all these words areobvious, all these words arerelatively phrases and thereforerelatively phrases and thereforelead to nowhere!lead to nowhere!

What is obvious for me is notWhat is obvious for me is notobvious for youobvious for you

We need not toWe need not to ““lowerlower”” ourourexpectations ratherexpectations rather ““adjustadjust”” themthem

Two kinds of expectationsTwo kinds of expectations

We have two kinds of expectations:We have two kinds of expectations:legitimate and realistic.legitimate and realistic.

A legitimate expectation doesnA legitimate expectation doesn’’ttrelate to a certain individual or to arelate to a certain individual or to acertain time, legitimate expectationcertain time, legitimate expectationis manifested out of values, ethics,is manifested out of values, ethics,attitudes, norms and cultureattitudes, norms and culture

A realistic expectation relates toA realistic expectation relates topeople and time.people and time.


There are three options: expectationsThere are three options: expectationscould be non legitimate and non realisticcould be non legitimate and non realistic

Expectations could be legitimate andExpectations could be legitimate andrealisticrealistic

Expectations could be legitimate but notExpectations could be legitimate but notrealisticrealistic

I doesnI doesn’’t matter if the expectations aret matter if the expectations arelegitimate if they are not realistic itlegitimate if they are not realistic it’’s as awaste of energy. WOEwaste of energy. WOE-- Waste OfWaste OfEnergyEnergy


How do we know if an expectationHow do we know if an expectationis realistic or not? Can it beis realistic or not? Can it befulfilled in thefulfilled in the existing realityexisting reality??

Rational Vs Irrational thoughtsRational Vs Irrational thoughts

ABC moduleABC module ––(Albert Ellis, Ph.D)(Albert Ellis, Ph.D)

RationalRational ––Emotive BehavioralEmotive Behavioraltherapy, REBT.therapy, REBT.

Common Irrational thoughtsCommon Irrational thoughtsamong therapistsamong therapists

II shouldshould have known how to helphave known how to helpthis client, Ithis client, I shouldshould have donehave donebetter.better.

If I donIf I don’’t succeed to help this clientt succeed to help this clientthat meansthat means I am a lousy therapistI am a lousy therapist

If my client is not satisfied with myIf my client is not satisfied with mytherapy ittherapy it mustmust be my fault.be my fault.


If I set boundaries to my client I amIf I set boundaries to my client I amaa ““badbad”” therapisttherapist. Good therapist. Good therapistshouldshould be always to the service ofbe always to the service oftheir clientstheir clients

If I disagree with my client IIf I disagree with my client I am notam notreal empathetic, caring,real empathetic, caring,professional therapistprofessional therapist


II cancan’’tt take vacations , time off, it istake vacations , time off, it ison the account of my clientson the account of my clients’’ needs.needs.

My clients needsMy clients needs shouldshould be morebe moreimportant than my own needsimportant than my own needsbecause they arebecause they are ““weekweek”” and I amand I am““strongstrong””..

If my client is not satisfied thatIf my client is not satisfied thatshowsshows what a lousy university Iwhat a lousy university Iwent towent to

The 40 minutes formulaThe 40 minutes formula

Balance between work and privateBalance between work and privatelife.life.

40 minutes are 2/3 of an hour.40 minutes are 2/3 of an hour.

If we take 4 times 10 minutes ofIf we take 4 times 10 minutes oftimetime--out, it will change our day.out, it will change our day.

If we make it part of our regularIf we make it part of our regularenergy deposit, our energy bankenergy deposit, our energy bankwill look different.will look different.


11stst timetime--out: the morning time outout: the morning time out

22ndnd timetime--out: before wearing theout: before wearing theuniformuniform

33rdrd timetime--out: close the gate behindout: close the gate behindyouyou

44thth timetime--out:out:”” my home is mymy home is myfortressfortress ““


home work

t.o1 t.o2

t.o3t.o4

The magic of lifeThe magic of life

““Life is the longest loan thatLife is the longest loan thatdeath gave usdeath gave us””-- SocratesSocrates

Enjoy life and celebrate,Enjoy life and celebrate,Everyday that passes doesEveryday that passes doesnot return.not return.

The magic of lifeThe magic of life

Life is the show for itselfLife is the show for itself

There are no rehearsalsThere are no rehearsals

Thank you for attendingThank you for attendingyaronyaron

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