who takes care of the caretaker?

Who takes care of theWho takes care of the caretakercaretaker??

Burnout prevention for the helping Burnout prevention for the helping professionalsprofessionals

Dr. Yaron Ziv, MSW, Psy.DDr. Yaron Ziv, MSW, Psy.DMaof-center for human developmentMaof-center for human development

www.yaronziv.comwww.yaronziv.com

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

No person is immune against No person is immune against stressstress

No person is immune against No person is immune against burnoutburnout

Stress and burnout are Stress and burnout are normative situations for the normative situations for the modern working peoplemodern working people

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

Our task is:Our task is: 1.1. IdentifyIdentify2.2. Take responsibilityTake responsibility3.3. Take actionTake actionThe ratio of burnout among theThe ratio of burnout among the

therapeutic profession, is one of therapeutic profession, is one of the highest on the scale, 6the highest on the scale, 6thth position out of 140 professions. position out of 140 professions.

What is stressWhat is stress??

Situation Situation perceivedperceived as a threat as a threat (Selie,1961)(Selie,1961)

Situation in which a gap between Situation in which a gap between perceivedperceived self-expectation and self-expectation and perceivedperceived environment expectation environment expectation occurs (Ziv,1999)occurs (Ziv,1999)


Situation in which a gap between Situation in which a gap between perceived perceived demands and existing demands and existing resources occurs (Folkman resources occurs (Folkman &Lazarus, 1984)&Lazarus, 1984)

Situation in which negative energy Situation in which negative energy is invested at presenceis invested at presence( now( now) in ) in regard of regard of perceivedperceived thoughts thoughts about the about the future future (Ziv,2004)(Ziv,2004)


PerceptionPerception is the key word in is the key word in regard to stress.regard to stress.

““stressful situation” doesn’t existstressful situation” doesn’t exist What is perceived as stress to one What is perceived as stress to one

will not be perceived as stress to will not be perceived as stress to another another

Stress is not good or bad , what Stress is not good or bad , what counts is the level of stress counts is the level of stress

Negative ways to cope with stressNegative ways to cope with stress

DrugsDrugs Alcohol Alcohol 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 with Sharing and encountering with

friendsfriends Good time managementGood time management AssertivenessAssertiveness Positive thinkingPositive thinking

What is Burnout?What is Burnout?

BurnoutBurnout is an accumulated is an accumulated process of physical and mental process of physical and mental fatigue as a result of fatigue as a result of accumulated situations of accumulated situations of frustrations that have not been frustrations that have not been resolved (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 system Decline of the Immune system functioning functioning

High exposure to heart and cancer High exposure to heart and cancer diseases. 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 Can’t find the keys in the morningCan’t find the keys in the morning Inability to invest energy in Inability to invest energy in

anythinganything Cynicism and cynical humorCynicism and cynical humor Sarcasm Sarcasm

Cognitive symptoms of BurnoutCognitive symptoms of Burnout

Setting appointments to different Setting appointments to different people on the same timepeople on the same time

Forgetting where you put your Forgetting where you put your calendar of appointmentscalendar of appointments

Loss of creativity –”working by the Loss of creativity –”working by the book”book”

Social symptoms of BurnoutSocial symptoms of Burnout

IsolationIsolation and alienationand alienation ““the whole world is against me”the whole world is against me” Deliberate damaging the workDeliberate damaging the work Low frustration tolerance to other Low frustration tolerance to other

people’s behaviorpeople’s behavior Negative attitude towards other Negative attitude towards other

peoplepeople Putting down, ridicule other peoplePutting down, ridicule other people

Emotional symptoms of BurnoutEmotional symptoms of Burnout

DepressionDepressionAngerAngerDepersonalizationDepersonalizationImperviousnessImperviousness

Coping and preventing BurnoutCoping and preventing Burnout

Always learn something newAlways learn something new Learn something which is not Learn something which is not

connected to your professionconnected to your profession Create opportunities to share your Create opportunities to share your

feelings and thoughts with othersfeelings and thoughts with others Enrich your work, don’t do the Enrich your work, don’t do the

same thing for too long timesame thing for too long time

Coping and preventing BurnoutCoping and preventing Burnout

Balance between work and private Balance between work and private lifelife

Make physical exercise as a regular Make physical exercise as a regular habit habit

Make time for relaxation and musicMake time for relaxation and music Love what you do and do what you Love what you do and do what you

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

Burnout among therapistsBurnout among therapists

The Therapeutic contract isThe Therapeutic contract is difficultdifficult

The client is allowed to project on The client is allowed to project on his/her therapist (his/her therapist (transferencetransference), but ), but the therapist is not allowed to the therapist is not allowed to project on his/her client project on his/her client (countertransference(countertransference), it is ), it is considered non professional considered non professional behaviorbehavior

The therapeutic contractThe therapeutic contract

Every therapist serves as a Every therapist serves as a projected objectprojected object

Skills like empathy, active Skills like empathy, active listening, unconditional acceptance listening, unconditional acceptance are not natural and they require are not natural and they require energy investment.energy investment.

The “savior symptom” – “I will The “savior symptom” – “I will succeed where everybody else succeed where everybody else failed”failed”

The therapeutic relationshipThe therapeutic relationship

We do it because we careWe do it because we care We have to keep boundaries and to We have to keep boundaries and to

distinguish between distinguish between identification identification and and empathyempathy

If you realize that you “take it in”, If you realize that you “take it in”, notice that there is an “unfinished notice that there is an “unfinished business” – share it with your business” – share it with your therapist therapist

The energy bankThe energy bank

We do function in our life out of an We do function in our life out of an energy bank that operates like a energy bank that operates like a regular bank.regular bank.

We have energy deposits and we We have energy deposits and we have energy withdrawals have energy withdrawals

The only difference between the The only difference between the energy bank and the regular bank energy bank and the regular bank that we can’t get loans!!!that we can’t get loans!!!


Burnout is defined as a continuous Burnout is defined as a continuous overdraftoverdraft

It is very important to check regularly It is very important to check regularly our balanceour balance

To maintain good balance in our energy To maintain good balance in our energy bank, we need to make sure that there bank, we need to make sure that there are enough energy deposits in the are enough energy deposits in the account and we are in control of our account and we are in control of our energy withdrawals energy withdrawals


What is an energy deposit?What is an energy deposit? Energy deposit is any action we do Energy deposit is any action we do

to “charge batteries” for fun and to “charge batteries” for fun and pleasure: dancing, going to concerts pleasure: dancing, going to concerts playing cards, hanging out etc.playing cards, hanging out etc.

Notice that every energy deposit is a Notice that every energy deposit is a time invested act, we need to time invested act, we need to implement it into our weekly implement it into our weekly schedule schedule


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

invested energy in one of the invested energy in one of the following 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 be “saved”Some withdrawals can be “saved”


Make a list of energy deposits and Make a list of energy deposits and withdrawals on a weekly basis at withdrawals on a weekly basis at home and at workhome and at work

Notice which withdrawals are Notice which withdrawals are unavoidable and which can be unavoidable and which can be saved.saved.

Share with your partnerShare with your partner


Notice how many deposits you put Notice how many deposits you put in your account –if any!!!in your account –if any!!!

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

If your withdrawals are much more If your withdrawals are much more than your deposits- what does it than your deposits- what does it mean for you?mean for you?

Are you the captain of your energy Are you the captain of your energy ship?ship?


What energy withdrawals can be What energy withdrawals can be “saved”?“saved”?

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

These invested energy have one These invested energy have one thing 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 or We make ourselves angry or hurt or

disappointment not because people disappointment not because people did something or didn’t do did something or didn’t do something.something.

Our emotions is ours therefore we Our emotions is ours therefore we are responsible for their existanceare responsible for their existance


we get angry, hurt, disappointed we get angry, hurt, disappointed because people do or don’t do because people do or don’t do something that doesn’t go along something that doesn’t go along with our expectations.with our expectations.

They They shouldshould have done this or they have done this or they should notshould not have done that have done that

II can’t stand can’t stand that he/she does it that that he/she does it that wayway


Common words about Common words about expectations: High/low, justified, expectations: High/low, justified, minimal, obvious, all these words minimal, obvious, all these words are relatively phrases and therefore are relatively phrases and therefore lead to nowhere! lead to nowhere!

What is obvious for me is not What is obvious for me is not obvious for youobvious for you

We need not to “lower” our We need not to “lower” our expectations rather “adjust” themexpectations rather “adjust” them

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 doesn’t A legitimate expectation doesn’t relate to a certain individual or to a relate to a certain individual or to a certain time, legitimate expectation certain time, legitimate expectation is manifested out of values, ethics, is manifested out of values, ethics, attitudes, norms and cultureattitudes, norms and culture

A realistic expectation relates to A realistic expectation relates to people and time.people and time.


There are three options: expectations There are three options: expectations could be non legitimate and non realisticcould be non legitimate and non realistic

Expectations could be legitimate and Expectations could be legitimate and realisticrealistic

Expectations could be legitimate but not Expectations could be legitimate but not realisticrealistic

I doesn’t matter if the expectations are I doesn’t matter if the expectations are legitimate if they are not realistic it’s a legitimate if they are not realistic it’s a waste of energy. WOE- Waste Of waste of energy. WOE- Waste Of EnergyEnergy


How do we know if an expectation How do we know if an expectation is realistic or not? Can it be is realistic or not? Can it be fulfilled in the fulfilled in the existing realityexisting reality??

Rational Vs Irrational thoughtsRational Vs Irrational thoughts ABC module –(Albert Ellis, Ph.D)ABC module –(Albert Ellis, Ph.D) Rational –Emotive Behavioral Rational –Emotive Behavioral

therapy, REBT.therapy, REBT.

Common Irrational thoughts Common Irrational thoughts among therapistsamong therapists I I shouldshould have known how to help have known how to help

this client, I this client, I shouldshould have done have done better.better.

If I don’t succeed to help this client If I don’t succeed to help this client that means that means I am a lousy therapistI am a lousy therapist

If my client is not satisfied with my If my client is not satisfied with my therapy it therapy it mustmust be my fault. be my fault.

Common Irrational thoughts Common Irrational thoughts among therapistsamong therapists If I set boundaries to my client I am If I set boundaries to my client I am

a “bad” therapista “bad” therapist. Good therapist . Good therapist shouldshould be always to the service of be always to the service of their clientstheir clients

If I disagree with my client I If I disagree with my client I am am notnot real empathetic, caring, real empathetic, caring, professional therapistprofessional therapist

Common Irrational thoughts Common Irrational thoughts among therapistsamong therapists I I can’tcan’t take vacations , time off, it is take vacations , time off, it is

on the account of my clients’ needs.on the account of my clients’ needs. My clients needs My clients needs should should be more be more

important than my own needs important than my own needs because they are “week” and I am because they are “week” and I am “strong”.“strong”.

If my client is not satisfied that If my client is not satisfied that shows shows what a lousy university I went what a lousy university I went toto

The 40 minutes formulaThe 40 minutes formula

Balance between work and private Balance between work and private life.life.

40 minutes are 2/3 of an hour.40 minutes are 2/3 of an hour. If we take 4 times 10 minutes of If we take 4 times 10 minutes of

time-out, it will change our day.time-out, it will change our day. If we make it part of our regular If we make it part of our regular

energy deposit, our energy bank energy deposit, our energy bank will look different.will look different.


11stst time-out: the morning time out time-out: the morning time out 22ndnd time-out: before wearing the time-out: before wearing the

uniformuniform 33rdrd time-out: close the gate behind time-out: close the gate behind

youyou 44thth time-out:” my home is my time-out:” my home is my

fortress “ fortress “


home work

t.o1 t.o2

t.o3t.o4

The magic of lifeThe magic of life

““Life is the longest loan that Life is the longest loan that death gave us”- Socratesdeath gave us”- Socrates

Enjoy life and celebrate, Enjoy life and celebrate, Everyday that passes does Everyday that passes does not 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 attending Thank you for attending

yaronyaron

who takes care of the caretaker?

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