“First we make our habits, then our habits make us.”
- Charles C. Noble Most addiction counselors focus on helping their clients break their habits of addiction. In this article, we suggest that counselors need to pay attention to their own habits-habits of self-care.
As students, we had given little thought to the kinds of habits necessary to succeed in an addiction counseling career. But that changed last summer when one of us interned at a recovery center. There, the supervisor was adamant about helping staff develop good habits of self-care, or what some call career-sustaining behaviors (CSB). He demonstrated their importance by structuring our work so that it was refreshing and energizing. He consistently modeled how to integrate CSB into daily life. Sometimes we had staff meetings outside on a sunny day. Other times, he asked what we had done over the weekend. He wanted to be sure we practiced taking care of ourselves. This experience was formative, underscoring the importance of developing good habits of self-care so that we could better serve the needs of others.
Since then, we have learned a lot more about CSB. With the help of our professors, we reviewed research on stress, burnout and CSB, and then conducted a national study of the self-care habits of more than 700 addiction counselors. This article reviews some of the research on CSB and describes the results of our study.
Burnout among counselors
Addiction counseling involves heavy caseloads and clients prone to relapse, which can create high stress levels. The effects of stress on helping professionals can range from depression and emotional exhaustion to loneliness and decreased self-esteem. Moreover, stress can diminish counselors' effectiveness by disrupting decision-making skills, attention and concentration, as well as the ability to generate strong relationships with clients.1
Unattended stress can lead to burnout, a syndrome involving depersonalization, emotional exhaustion and a sense of low personal accomplishment.2 Counselors risk significant physical, emotional, spiritual and psychological harm if they force themselves to continue their work and ignore the stressors leading toward burnout.3 Furthermore, their effectiveness is significantly diminished.
The addiction counseling profession requires special attention to burnout. Alcoholics and addicts are noted for being “difficult clients,” often presenting with chronic difficulties, demonstrating slow progress, and regularly relapsing. Many times, addiction professionals are children of alcoholics or are in recovery themselves. While shared experience can initially assist counselors in empathizing and building rapport with clients, it also can increase burnout risk. “Empathy fatigue” occurs when counselors' own past problems resurface as they explore client issues.4 By continually revisiting their own suffering during counseling sessions, counselors often endure additional emotional turmoil and struggle to work effectively.
Of course, counselor stress is not limited to the office. Stress at home also may be related to burnout at work. When counselors do not set adequate boundaries between home and work, personal struggles can affect their work. Value attainment also might play an important role in job satisfaction and stress reduction.5 Counselors who are able to achieve their personal goals are more likely also to accomplish their professional goals. Yet when counselors feel hindered from achieving their personal ideals, they are likely to experience greater work conflict and frustration.
While little has been done to identify strategies to prevent burnout in addiction counselors, researchers such as Norcross have identified career-sustaining strategies for counselors in general.6
First, he suggests that professionals openly acknowledge the stress and hazards of their occupation and appreciate the rewards. Second, he recommends activities that are enjoyable and provide stress relief. Third, focusing specifically on the problems related to the stress is important. Often, working to modify the work environment or other procedural aspects of work can serve to reduce stress. Fourth, Norcross suggests that taking advantage of helping relationships, social supports and personal therapy can help to ease ongoing stress. Finally, he advises counselors to avoid wishful thinking and self-blame, and encourages them to diversify clients and counseling techniques.
In addition to these general recommendations about managing stress, we found additional practical recommendations from others,7 including maintaining a leisure mindset, leisure space and a connection to others, and using rewards as self-care strategies.
Clinicians' self-care strategies should not be event-based but a “lived experience.” That is, self-care should be an ongoing, rather than compartmentalized, practice. The point of career-sustaining behaviors is not to add another task to a checklist, but to turn them into habits of daily life. CSB are most helpful when they create space in counselors' lives to allow them to be more than clinicians and, consequently, to enrich and lengthen their careers.7,8