#dalelarson

A note on the text: I used The Helper’s Journey: Working with People Facing Grief, Loss, and Life Threatening Illness by Dale Larson as published by Research Press in 1993.

It’s very hard to be in the helping industry. Whether you are a social worker, a nurse, a therapist, or any other person working in this field, keeping up your morale is very important. People enter into the industry with the best of intentions and within a relatively short period of time can find themselves being burned out because of compassion fatigue. Dr. Dale Larson, in this seminal book, draws upon his wealth of experience to offer “helpers” advice on how to avoid getting burned out.

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. . . . Life is no brief candle to me. It is a sort of splendid torch which I have got hold of for the moment and I want to make it burn as brightly as possible before handing it to future generations (2).

Most people in the helping profession can strongly identify with the above statement made by George Bernard Shaw. It is why they entered into the field in the first place. They are driven by a need to serve others; to do more than simply “work for themselves”. They want to make a career out the adage that “the world should should be a better place because you were in it”. They want to make that kind of a positive impact on the lives of those around them. People in the helping profession tend to be more altruistic and therefore, “seeing other human beings grow and knowing that they are assisting in this growth is rewarding to them” (9). It’s natural for human beings to want to reach out and help each other- even animals are pre-disposed to help other members of the same species. In fact, “the weight of scientific evidence decidedly leans towards the conclusion that altruism and cooperation are innate and that the tendency to help others in distress is part of our biological inheritance” (12). 

As an example of this Dr. Larson talks about an experiment done with reheus monkeys. The fifteen monkeys were all rewarded with food when they pulled one chain when the red light flashed and the other chain when the blue light flashed. All fifteen monkeys were able to do this with ease, so the researchers changed the parameters to the experiment. Now on top of giving the monkeys some food,the pulling of the chain resulted in a small electric shock being given to the monkey in the next cage. The results were electrifying: “Ten of the 15 monkeys shifted [exclusively] to the non shock chain, and two refused to pull either chain. When the shock victim was a cage mate this altruistic behavior was much [even] more likely to occur [and] monkeys who had themselves been shocked in the past were [still] more likely to engage in [this] selfless behavior” (13). You see the same attitude with human beings: just look at how many people lined up to do things like donate blood after the shootings in Orlando and Las Vegas. Ask most people about why they do what they do and most of them will talk about how they survived something horrific and how this spurred them to dedicating themselves to helping others, and it is through helping others that they find meaning for their lives. This is what George Bach and Laura Torbet call the Caring Paradox: 

The Caring Paradox is that self-realization is only possible through caring for others. Caring for and about others is caring for ourselves. Caring for other accrues great benefits [for ourselves]: it increases our self esteem, attracts the care and concern of others, improves the environment, and enhances the quality of life. All caring is double edged, We have impact on others by acknowledging their impact on us, we grow by supporting others’ growth” (24).

However, the altruistic fire that fuels these workers is a double edged sword. At some point, the fire that fuels them will also cause them to burn out. This is what is commonly referred to as compassion fatigue. The challenge to any helper is to be emotionally involved in their work without burning out: 

The most idealistic, altruistic, and committed helpers are [often] the first to burn out. . . . One common theme in discussions of burnout is some sort of motivational erosion: dedication becomes apathy, altruism becomes contempt; insomnia replaces the impossible dream; and crusaders become kvetches. The implicit assumption is that [the] burnout must be preceded by commitment. . . . The process of burnout cannot begin unless the level of motivation is high. Metaphorically,one must be ‘fired up’  before one can burn out (29-30).

A good question that many people ask is, what does it mean to burn out? Well people who are burnt out share these three characteristics: emotional exhaustion, diminished caring, and demoralization. People who are emotionally exhausted are chronically tired, and feel emotionally drained and “used up”. Diminished caring is probably the most painful part of the burnout process, especially for the helper in question. It is where the helper feels so drained that he feels himself start to pull back emotionally- they “stop” caring, and this can happen in a way that is all encompassing. They stop caring “for the people [they] help, [their] co workers, and sometimes [their] friends and family” (33). If you’ve ever been pushed to say to someone: “you use up all of your sympathy at work”, this is the result of diminished caring. Demoralization happens when “the sense of efficacy and the intrinsic rewards that often accompany helping [are replaced with] feelings of hopelessness” (34). Most people don’t realize that helpers that are going through the burnout process are really struggling with their self esteem which can really complicate the situation: “I got into this work because [I thought I was] a caring person and [that] I wanted to make a difference. Now I don’t even want to see another hurting person, and I don’t think I’m doing much good” (35). If you, or someone you love, is in the helping profession and you see these qualities in yourself, realize that you are burning out and that you have fallen into what Dr. Larson calls the “Helper’s Pit”.

You fall into the Helper’s Pit by becoming so emotionally entangled with your client that you are unable to maintain the proper emotional distance. In order to protect yourself from burnout, and help your client most effectively, you have to have some emotional distance. You cannot identify with the person in the pit so strongly that you fall into it with them; you have to help them, but from the outside: 

identifying with the other person [too closely] and falling into the Helper’s Pit can also severely limit your [ability to help]. You [can’t] accurately perceive the other and you are unable to think objectively about what course of action [must]be taken for him or her. . . . You must find a way to reach into the Pit and helping the suffering person out- without falling in yourself (38-39).  

You have to work with your client in an emotionally balanced way. Otherwise you not only risk seriously harming yourself, but also you cannot be effective in helping the client. 

Now if you are in the process of burning out there are two things that you should know. The first is that 

finding a way to be empathetic and emotionally involved without falling into the Helper’s Pit is perhaps the central challenge for the caring helper. . . . [and] that [you] can have extremely strong emotional responses without falling into the Helper’s Pit. Strong emotions are a part of helping people cope with grief, loss, and life threatening illness [among other things]. You can be balanced even as tears roll down your cheeks as long as you are still focused on the other person and your own feelings don’t shift from caring to [personal] distress (46).

A quick aside: there is a difference between sympathy/empathy and personal distress. With sympathy/empathy, you are more inclined to help the other person because you “feel for them” in some way. With personal distress you are more inclined to help yourself because you are the one feeling distressed. When you fall into the Helper’s Pit your instinct quickly becomes to help yourself because you see yourself as being under attack and thus are not able to help others effectively which makes personal distress “a central feature of the burnout syndrome” (39). That’s why you want to stay out of Helper’s Pit and keeping yourself away from caring mode into personal distress mode. 

So the question remains: how do you achieve the emotional balance that is necessary to avoid burnout? The first step is to have an honest dialogue with yourself about what it is that stresses you out. This can be difficult to do because helpers often times have an unrealistic expectation of themselves. They think that they should always be able to help people, and when they hit a wall they tend to blame themselves. It results in the “if I were only” phrase that Dr. Larson calls “a burnout mantra” because if you say it to yourself enough then you will burn out (46). The problem is that “at its extreme this way of thinking goes beyond what we can reasonably expect from ourselves. It leads to [the] illusion of omnipotence [that is] reflected in such statements as ‘Maybe I could have prevented Mr. Smith’s death’ or [even] ‘I’m responsible for how he died’” (64). You are not a god. Let me say that again: YOU ARE NOT A GOD! You cannot  save everyone, and you shouldn’t expect yourself to. 

Once you’ve identified what your limits, aka stressors, are, don’t try to avoid them: 

the moment we choose avoidance we openly admit to ourselves (and any others who care to observe) that we have detected impulses that are so unacceptable that they cannot be faced realistically. . . . Obviously the prospects for personal growth are virtually non existent when the individual’s response to a perceived threat is to deny that which [he] has already glimpsed to be true” (70-71). 

The alternative is to openly acknowledge your limitations and find ways to cope with them: that is what growth is. You cannot grow if you cannot acknowledge what your weaknesses are. There are however some pretty important differences between those who cope successfully and those who don’t: 

Unsuccessful copers tend to blame themselves for their problems and engage in denial and avoidance- they feel helpless and out of control. They tend not to enlist the support of others and react without much planning and flexibility. Successful copers tend to take responsibility- without blaming themselves- for finding a solution to the problem they are facing. They tend to be flexible in their use of different coping strategies, enlist the help of others, and feel optimistic regarding the outcome of their efforts. They also usually view their difficulties as opportunities for personal growth, even though they would have preferred that life be otherwise (77).

The key to staying out of the Helper’s Pit is to maintain a balance “between the external and internal demands you confront and the resources [emotional and otherwise] that you have to meet them” (78). In short: do what you need to do to take care of yourself.

The first step in coping, is being proactive. Realize that your stress started somewhere upstream from where it is now, and go deal with it at the source. There is a story a man who is walking by a river and sees a man drowning. He quickly jumps into the river, saves the man, and resumes his journey. A few feet ahead he sees another man drowning, jumps in, saves him and as he’s getting out he hears a third man scream for help. At this point the man turns and starts to walk up stream, and a bystander asks him why he’s not trying to save the third man. He turns to the bystander and says: “because I’m going upstream to figure out who is throwing all of these guys into the river!”. The problem is that we usually only deal with problems when they’ve come “downstream”, when they’ve already become problems. If you actually want to change something about your life in a systemic way though, you have to go “upstream” to see where the problem started and see what you can change up there. Never fall into the trap of believing that your problems are simply unsolvable. It’s just a matter of going upstream enough that you’re able to see the problems before they develop into the problems that they are. Being able to anticipate a problem, and properly prepare yourself to face it, is half the battle. 

Once you’ve decided to be proactive in combating your burnout, there are many things you can do including learn how to set limits and compartmentalize. 

You have to set, and accept, limits on yourself, specifically limits concerning the amount of time and attention you give to every client: “you cannot be the number one psychosocial caregiver for everyone you work with. . . . If you don’t set limits, you will find that [the] emotional and physical overload will eventually” completely overwhelm you (82). 

Compartmentalizing is also important so that you can attend to all the different areas of your life without becoming overwhelmed. Don’t bring work problems home with you, and don’t bring home problems to work with you. When you’re at work, be at work. When you’re at home, be at home. It often helps to have a “small symbolic act or cue- [such as] listening to your favorite song or reading a note that [you’ve left yourself on your door]- [that] can remind you that you are leaving one world and entering another” (83). For me, I like listening to sports commentary when I’m leaving work. Something about hearing a conversation about something I like that isn’t that serious really calms me and puts my mind into “home” mode. 

People do other things as well to emotionally replenish themselves: some, like myself practice some form of prayer or meditation, while others do some form of exercise. 

It is also important that you create and maintain a strong social support system, especially with people that are also helpers and can understand what you’re going through: “sharing painful experiences and self doubts with others [who are] doing the same work can help in two ways: it helps [you] redefine these experiences as normal and human, and it leads to the identification of other coping mechanisms” (89). That isn’t to say that having other friends and family who are outside of your line of work can’t help, because they can, but having the support of people who do what you do is uniquely beneficial. I myself can attest to this; talking to people who are in the same field and know what I’m going through is vastly from talking to people on the outside. That’s why many people who are counselors and therapists have their own counselors and therapists!

Whatever you decide to do the most important thing is to know yourself: know what your limits are what you have to do to not fall into the Helper’s Pit and get burned out.