listening to our colleagues: 2009 practice survey ...€¦ · 13/08/2010 · burnout & career...

American Psychological Association

Listening to our colleagues: 2009 PracticeSurvey – Worries, Wellness, & Wisdom

Listening to our colleagues: 2009 PracticeSurvey – Worries, Wellness, & Wisdom

Diane L. Bridgeman, PhD,Chair APA Advisory Committee for Colleague Assistance (ACCA)

Independent Practice, Santa Cruz, CA

Daniel I. Galper, Ph.D.Director, Practice Research & Special Projects


Friday August 13, 2010


Agenda

• Acknowledgments

• Mission of ACCA & Colleague Assistance

• 2009 APA Colleague Assistance & Wellness Survey

• Wellness

• Wisdom

• Thank You – Questions?


• Len Tamura, Ph.D.

• Ray Hanbury, Ph.D.

• Missy Simpson, Ph.D.

• June Ching, Ph.D.

• Phil Kleespies, Ph.D.

• Scott Stacy, Ph.D.

• Tisha Dean, Ph.D.

• Earlier ACCA members

• Lynn Bufka, Ph.D.

• Omar Rehman

• Jessica Kohout, Ph.D.

• William Pate

• Ariel Finno

• Katherine Nordal, Ph.D.

• Dani Beckerman, Psy.D. &CLASP

ACCA Members & Other Collaborators


“Since 1980, APA has acknowledged the

existence of distress and impairment in

the profession, and the appropriateness

and importance of colleague assistance.”

Board of Professional Affairs’

Advisory Committee on Colleague Assistance (ACCA)

Statement of Purpose (2003)


1) Recognizing and investigating the uniqueoccupational vulnerabilities of psychologists andtheir need for colleague assistance (withemphasis on promoting wellness)

2) Promoting the development and continuation ofstate-level colleague assistance programs andpeer assistance networks

3) Developing proper, informed relationshipsbetween state ethics committees, boards ofexaminers, and colleague assistance programsfor the benefit of the professional and the public

ACCA’s Mission


Shared Missions & Responsibilities

•ColleagueSupport•Resources forSelf-help &Self-referrals

•Examination

•Licensing

•Regulation•Discipline

ColleagueAssistance

ASPPB &LicensingBoards

•Protecting thePublic•Education•Prevention•MaintainingCompetence &ProfessionalConduct

Ethics

•Assessment•Monitoring•Rehabilitation

•Consultation •Ethical Principles &Codes of Conduct

•Adjudicating EthicsComplaints


Current State of CAPs

• At least ½ of the 60 state and provincialpsychological associations have never provided orno longer have a colleague assistance committee(ACCA, 2003, 2008)

• Within last decade, many SPTAs discontinued theirCAPS, while a few others are starting (orrebuilding) one

• “Lack of use” was the most common reasonreported for discontinuation of colleague assistanceprogram (Barnett & Hilliard, 2001).


• Survey Methodology & Response


Stressors in Our Practices andPersonal Lives


As Psychologists: What We Know

o The practice of Psychology is a uniquelystressful career

o A balanced life enhances our personal andprofessional lives

o Self-care is an ethical mandate

o It’s beneficial to begin self-care practices early inour careers


As Psychologists: What we do

o Put our clients’ needs above our own

oOverextend ourselves

oMinimize the impact of our clients’ distress onourselves

o Take our work home with us

o View sleep as expendable

o Plan to begin exercising, tomorrow

o Engage in unhealthy coping strategies


Potential Consequences of IgnoringOccupational Stress

Damage to psychologists, including:

Depression Social/professional isolationJob dissatisfaction SuicideChemical abuse /dependence Relationship conflicts (e.g. divorce)Other addictions Unprofessional behaviorsEthical violations Stress-related illnesses

Damage to clients, including:

Malpractice SuicideBoundary violations Loss of faith in therapySymptom exacerbation GuiltIatrogenic symptoms Despair

Damage to the profession of psychology, including:

Loss of credibility LawsuitsAttrition Negative media attentionCynicism Disillusionment


“WORRIES” - Professional & Personal Challenges


Are you currently experiencing any ofthese challenges?


Many psychologists seek help,BUT others do not!

• 47% sought therapy for relationship issues (Deutsch, 1985)

• Between 56% and 86% reported they sought help for theirproblems (O’Conner, 1998)

• 70% of respondents who identified themselves asdepressed had sought treatment in the form ofpsychotherapy (Gilroy et al., 2002)

• Many psychologists experiencing distress and signs ofimpairment do not seek assistance when most needed!

• Little current information available on psychologists’ use ofself-help strategies and CAPs– General under utilization of self-care and CAPs


Perceived Barriers to Using Colleague Assistance or

Other Self-care Activities


Psychologists’ Lack Awareness of CAPs


WELLNESS


BURNOUT & CAREER SATISFACTION

• The ACCA findings on burnout (59%) areconsistent with most earlier studies (Rupert 07 &Smith 09), yet perhaps higher than actuallyreflected, as burnout was combined withcompassion fatigue as it has been in most studies.

• Examining this together with the fact that close to89% would choose psychology again as a career(Walfish et al, 1991).


Achieving Wellness: A Balancing Act


WORK SUPPORT = OVERALLSATISFACTION

• Consistent with importance of balance, Burke,Burgess, & Oberlaid (2004) that found malepsychologists who felt more supported at workwith work-personal life balance, reported morejoy in work, less job stress, less likely to quit,fewer psychosomatic symptoms, & more positiveemotional & physical well being.


YES, WE’VE GOT SATISFACTION!

Our engagement as psychologists, as it is

congruent with our values, may well inoculate

us to a degree so that less burnout develops

than might be expected given the inherent

stressors in the profession.


FINANCIAL TIES THAT BIND

• Finances are major negative threads woventhrough-out the replieso 6TH ranked barriers was “financial constraints” (33%)

o 4th greatest stress was debt (39%).

o “Financial security” - to enhance wellbeing (61%).

• 82% cited “economic uncertainty” as diminishingwellbeing.

• “Managed care/insurance” was 2nd highestchallenge (63%) … low reimbursement rates &inability to charge for insurance inquiries, etc; onlyadds to the economic woes.


Work – Family Balance


SERIOUS CONSIDERATIONS

Although colleagues need to be encouraged to reach out

earlier so that stressors can be better managed, perhaps

waiting to do so, as the data above suggests, contributes

to the low but serious concern of the18% of respondents

who replied they “experienced suicidal ideation while

dealing with challenges.” The actual incidence of

psychologists committing suicide is fortunately low (see

Kleespsies, et al, 2010).


Most Frequently Reported Coping Strategies


WORK /LIFE BALANCE: THE NEWWEAPON AGAINST STRESS

• Interestingly, respondents reported that “overlychallenging work-life balance” was the #1challenge/stressor for 72% of the sample.

• While 96% reported that “maintaining balancebetween personal & professional lives” was themost effective coping response.


WHY IS WORK/LIFE BALANCE IMPORTANT?

• Similar to these results, surveys by Stevanovic &Rupert’s (2004 & 2009) show that maintaining abalance between both environments was the 2ndhighest ranking strategy for maintaining wellness

• And, time with spouse/partner/family was #1ranked approach to achieving balance.

• The current ACCA survey was once againconsistent, with balance ranked slightly highero Seeking support from friends/peers at 95% was the 2nd.

highest method used to cope.


BALANCING TIME & WORK/HOME:WHAT WORKS BEST?

• These more contemporary colleague assistancemodels seems to be more effective, are beginningto see more calls come through, train & supportproviders and offer workshops.

• They also wisely emphasize the need to tailorongoing self-care, work from a grad std/earlycareer to retirement spectrum, include both thepersonal & professional spheres, & remindcolleagues how each environment influences theother, & our level of competence.


RELATIONSHIPS & ITS TRAJECTORIES

• The key to work/life balance appears to be thestrength of and time with meaningfulconnectedness with others.

• These protective factors tend to inoculate againststress & loneliness.

• As early as Deutsch (1985), Bernstein et al(1994), & again Stevanovic & Rupert (2004), &now in 2010 (ACCA), it is shown thatrelationships & how configured enhance andinhibit wellbeing personally & professionally.


BELIEVING IN WHAT WE DO• Earlier surveys reported that a low to moderate

rate of psychologists use psychotherapy as acoping strategy.

• This ACCA survey found that 64% receivedpsychotherapy or counseling to cope.

• Couple this with 94% stating they would talk witha colleague as a way to cope and we find a highdegree of value in psychologist to psychologistconnection.


STRESS/REACHING OUT• Our survey suggests that psychologists:

1. Handle low to moderate levels of stress without majornegative effects;

2. Aren’t bothered sufficiently to initiate a new self-carestrategy to cope with life stress unless it is quite serious;

3. Don’t appreciate the negative impact of “normal”occupational stressors may have on functioning.

• As depicted in the following graphs, the large majority ofparticipants report they would initiate a new self carestrategy under severe - very severe stress, while very fewreport they would do so under minimal-moderate stress.

• With the contemporary emphasis on balance and preventionearlier outreach needs to be encouraged.


Likelihood of initiating a New Coping StrategyWhen Under Very Severe Stress


Likelihood of initiating a New Coping Strategywhen under Mild Stress


GENDER CONSIDERATIONS

• Females & males report experiencing similarlevels of overall stress (on our stress scale), yetsimilar to other studies, women report reaching outfor support significantly more often, using morecoping strategies, and coping more effectively..

• These findings follow the national populationwhere women seem to feel more comfortable orgive themselves more permission, to reach out.

• Research by Stevanovic (2004) reports thatfemales reported greater use of “career sustainingbehaviors” consistent with the ACCA results.


Acknowledging & Accessing Support:From Weak to Wise

• How to move beyond the “old school” trifecta ofshame, embarrassment, guilt? It is less than inearlier studies but it is evident in several responses.

• We need to focus on reducing stigma. As a wholeour profession has greatly contributed to opening upseeking MH assistance for the public, we need tocontinue to normalize doing so for our selves &colleagues.

• It is hoped that the contemporary wellness modelthat states “it is wise not weak to seek assistance”will continue to assure & promote more outreach.


WISDOM


The Wisdom of Self-Care – New CAP Model

• Pope and Vasques (2005): “the goal is not simply tosurvive, but to thrive in practice and as psychotherapists”

– Achieving optimal wellness/functioning, not just avoiding burnout

• Current emphasis on promoting balance for our clients(and thus for ourselves):

– Importance of prevention

– Advent of positive psychology

– Awareness of benefits of resilient/ protective-like

qualities and mind/body connection

• These all point to maintaining wellness as not only

acceptable, but wise, & reaching out as not shameful,

but smart!


• Continued development of models for self-care &CAPs that lead the way to wellness, withemphasis on self-assessments, detecting earlywarning signs, & connecting with colleagues.

• Several State exemplars with prevention modelo Draw on the spectrum from maintaining

wellness/competence, & coping with early stressors todealing with serious challenges, while moving awayfrom the “impairment” model (e.g., North Carolina,Oregon, California, Tennessee & Colorado).

o Yet, we must not forget about significant concerns.

2010 Decade of Psychologists Wellness/Self-Care


FROM WELL BEING TO FLOURISHING

• When we listen to the voices of our

colleagues they indeed seem to heed

“lessons learned” for themselves.

• When asked for their perceptions of colleagues

who are thriving professionally they respond

60% are, and of those personally it is also 60%.


DIMINISHING WELLBEING


LINKING WELL BEING/SELFCARE


Seven Domains of Wellness/Wellbeing(Williams-Nickelson, 2006)

1) Physical

2) Emotional

3) Spiritual

4) Intellectual

5) Social

6) Relational

7) Safety and Security


Wellness & Self-Care: Moral & Ethical Imperatives

• APA Ethics Code – Principle A:o “Psychologists strive to be aware of the possible effect of [our]

own physical and mental health on [our] ability to help those withwhom [we] work.” (APA, 2002, p. 3)

o Awareness is an important first step towards wellness

• Pursuit of Wellness:o Wellness is “the enduring quality in one’s professional functioning

over time and in the face of professional and personal stressors”(Coster & Schwebel, 1997)

• Self-Care:o Self-care practices are necessary to maintain optimal wellness in

the face of occupational and personal stress

o If you don’t practice self-care, you risk harming clients

o “Moral Imperative” (Carroll et al., 1999)

o “Ethical Imperative” (Baker, 2007; Barnett et al., 2007)


PROTECTIVE FACTORSWELLBEING/RESILIENCE

• Our colleagues seem to get it right…. They reportdeveloping protective factors to aid in wellbeing &resilience.

• Taking time for oneself, time from work, financialindependence, time with family, friends, in nature,with partner, social time, reflect on positiveexperiences, all consistent with healthy self-care.


IS MARRIAGE A PROTECTIVE FACTOR?

• Married or in Long Term Committed relationshiprespondents handle stress better.

• Other studies (e.g., Holt-Lunstad, 2008) have alsoreported this.– Benefits are often both physical & mental, & overall

marrieds live longer.– These protective factors are thought to provide positive

social, economic, and & life-style support.

• More nuanced studies find men do a bit betterthan women & that women” may be a contributingfactor as mind/body “housekeepers (Kiecolt-Glaser).


COLLEAGUE ASSISTANCE PROGRAMS (CAPS)

• Prior to a recent “wellness” approach, studies onCAPs reported rather dismal results.o Floyd (1998) found a mere 1% from one state that

accessed a CAP, &

o Barnett & Hillard (2001) found 60% reported 1 to 5people sought such services.

o ACCA found slightly higher, yet still low use (4%), withawareness of CAPs at 15%.

o It has been well established that many such CAPsceased to exist due to underutilization, & probably aresult of worry about confidentiality, shame, fear ofprofessional censure, or feelings that psychologistsshould be able to handle it themselves.


Perceived support from CAPS, SPTA,License Board, & APA

• 40% of participants reported CAPs are very-extremely supportive of psychologists engaging inpreventive practices.

• 35% reported CAPs are very-extremely supportiveof psychologists engaging practices for wellbeing.

• 43% reported CAPs are very-extremely supportiveof psychologists obtaining help when distressed.

• For SPTAs, psychologists reported 22%, 18% &26% on the same factors.


PERCEPTIONS OF BOARD & APA

• Not surprisingly, for licensing boards, only 8% perceivedthem as very-extremely supportive of psychologistsengaging in practices for prevention purposes, 7% for wellbeing, & 14% for obtaining help when in distress.

• Higher than for boards, yet expected to be even higher wasAPA with 30% for prevention, 25% for well being & 36% fordistress.

• Clearly all groups/guilds need to do better & need to ask,listen & try to provide what psychologists need & value.


WHAT COLLEAGUES WANT FROM CAPS

The ACCA survey found that psychologists want;

• Referral to a therapist/clinic most helpful- 42%

• Referral to support group next with- 35%

• Referral to stress reduction program- 33%

• Resource materials on specific needs- 32%

• Referral to an attorney- 28%

• Referral to a financial planner- 18%


• The last several APA conventions includedACCA presentations on self-care, life spanneeds & work/life balance.

• ACCA has developed materials on informal self-assessments, self-care, how to start a CAP, tipsheet on “office safety”, a report on “suicide of acolleague”, is concluding a survey of status ofCAPs throughout the Country, & “meet/greets”are held at convention to encourage sharing ofideas & resources.

ACCA IS LISTENING & DOING


• It is at the heart of APA’s Advisory Committee forColleague Assistance (ACCA)’s goals thatmandated this survey be carried out & results bewidely disseminated.

• In 2007 a CAPs listserv was developed

• In 2010 a “Tools of Engagement” (Toolkit) wasdeveloped for how to begin & sustain a CAP, whichincludes 21 pages of references for psychologistsfrom grad std through retirement status on self-care/coping, personally & professionally, etc.


PSYCHOLOGISTS HELPINGPSYCHOLOGISTS

• In the ACCA survey when asked - “Did you talkwith a colleague when you were experiencingyour challenge?”95.5% responded yes.

• When also asked - if they “ever reached out tosupport other psychologists?”61% replied yes.


PSYCHOLOGISTS HELPING OTHERS

• Frequently psychologists are involved in theircommunities giving talks at schools, workplaces,newspaper interviews, etc.

• When specifically asked about providing pro bonodisaster mental health work, 15% replied positively.Also, 4% are part of APA’s Disaster ResponseNetwork (DRN). We encourage colleagues toconsider this effort as the training, rewards, &benefits to others are gratifying.


Colleagues Healthier, Needs Differ

• The ACCA survey tends to illustrate that colleagues ingeneral are healthier, wiser, than in earlier surveys, &access assistance when needed, yet some would benefit inearlier access & feeling wiser for doing so.

• Maintaining wellness, use of early warning signs/self-care &prevention need to be continually put forth as the keymessage for sustaining a healthy mind/body/spirit, & toprevent more serious incidents for those with challenges.Preference to seek their own individual therapy, not througha CAP is fine, yet more colleagues need support to accesscontemporary CAPS given the emerging higher level ofconfidentiality & overall Professionalism.


Thank YouDiane Bridgeman, PhD,Chair APA Advisory Committee for Colleague Assistance (ACCA)

Independent Practice, Santa Cruz, CA

[email protected]

(831) 420-1109

Dan Galper, Ph.D.Director, Practice Research & Special Projects

American Psychological [email protected](202) 335-5910

listening to our colleagues: 2009 practice survey ...€¦ · 13/08/2010 · burnout & career...

Documents