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    Derrick 
    Crim

    EdD, LADC, CPPR, MAPM

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  • Cultivating the Quality of Contentment, Part I

    As shall be demonstrated in this series, cultivating the quality of deep-seated contentment constitutes a key cornerstone in integrating a wellness mindset and lifestyle into recovery from alcoholism, drug addiction, and other addictive disorders. 

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  • National Perspective

    Over the past few years, the federal government has made a noticeable investment in fighting opioid abuse. Traditionally this subject was the purview of federal agencies such as the National Institute on Drug Abuse (NIDA) and the Substance Abuse and Mental Health Services Administration (SAMHSA), or even the Veteran’s Administration (VA).

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A Phenomenological Study of Stress and Burnout Experienced by Licensed Alcohol and Drug Counselors

Feature Articles

As a licensed alcohol and drug counselor (LADC), I have a growing concern about stress in the field of addiction counseling. Stress not only affects clients, as my personal experience suggests, but also organizations. This qualitative study examined the causes and coping strategies associated with personal and occupational stress experienced by fifteen LADCs in a Midwestern State. The study specifically addresses the factors creating stress, beyond the generalized concept of “stress management,” and identifies the specific sources of stress to move the alcohol and drug counseling field forward to a healthier state for both individual counselors and organizations. The following are my central findings, implications, and recommendations.

 

The Study

 

Participants

 

I adopted the phenomenological method and used a snowballing sampling technique. The fifteen participants were ethically and culturally diverse and were required to have at least one year of counseling experience. They also may have served in supervisor positions with previous counseling experience. The selection incorporated a range of experience from those engaged in the early stages of their careers to “seasoned” counselors.

 

Method

 

I used a warm-up phase to allow participants to feel comfortable and describe their professional work experience. I then asked for specific responses to their experiences to stress and burnout and finally asked participants to share several stories regarding “critical incidents” (Denzin & Lincoln, 2000) to capture a more complete picture of a stress experience and its impact.  

 

Personal Stress

 

Money

 

Participants claimed a lack of money caused them personal stress because of their inability to pay for personal expenses and costs associated with professional advancement. Money stress included an inadequate salary as well as a lack of sufficient resources to pay student loans, care for love ones, and save for retirement. Participants also identified low salaries and compensation for professional work as a related issue. The inability to meet financial needs created stress. Human resource departments should find ways to fairly compensate employees and offer benefits such as pay raise programs, education reimbursement for college, and financial literacy classes.  

 

The study revealed the need to address economic stress and its implications. According to Haley and Miller (2015), economic stresses are aspects of economic life that are potential stressors for employees and their families. It includes both objective factors such as the inability to meet current financial needs and subjective factors such as financial concerns and worries (Probst, 2005). Also, economic stresses have grave implications for families of affected employees. Research shows that a majority of Americans have inadequate knowledge about concepts related to personal finance and basic economics (Probst, 2005). A financial literacy program would focus on such topics as budgeting, personal finance, and record-keeping. The program can be delivered to LADCs through informational seminars, pamphlets or webinars.

 

Caring for Others

 

Participants described stress stemming from caring for primary and extended family members. This included caring for birth or origin family members such as parents and siblings, along with family created by birth and marriage, including spouses, children, and other relatives. Stress created by these circumstances was actual or anticipated, proved overwhelming, and at times left counselors feeling alone and powerless.  

 

The study revealed the health consequences of caring for others. Caring for family members presents a range of emotions—often guilt, anger, and resentment resurface as unresolved issues. Accordingly, stress stemming from family role environment includes mental and physical well-being outcomes. Research has shown family-work conflicts are related to worse physical health (Bellavia & Frone, 2005).  

 

I recommend family support that includes flexible work schedules, child care referrals, and leaves of absence. These programs reduce employee work-family conflict and enhance employee job attitudes and behaviors (Frone, 2003). Family support programs are a means for maintaining morale and attracting and retaining a dedicated workforce (Frone, 2003).

 

Aging

 

Aging as a cause of stress was accompanied by a variety of physical changes, reduced capacity for performing work, and preoccupation. Large bodies of work concerning the aging process have documented a variety of physical, cognitive, and emotional changes that accompany aging (Barnes-Farrell, 2005). Participants suggested these changes have the potential to disrupt fulfilling demands of work. 

 

Besides the physical changes, a dichotomy between older and younger counselors created a division between counselors and proved to be a significant cause stress for older counselors. The study revealed the need to understand the functionality of older workers and its stressful impacts on work and work environment (Barnes-Farrell, 2005). For example, ergonomic interventions aimed at redesigning work conditions, work tasks, and work tools show great promise for maintaining functioning and performance (Barnes-Farrell, 2005). For another example, older counselors completing required documentation could benefit from adaptive technology because of declining visual capabilities. Other opportunities for redesign regarding sensory, psychomotor, and cognitive changes with the human-computer interface are critical for older worker well-being (Barnes-Farrell, 2005). 

 

The study also revealed the need to understand conditions that create stress for aging counselors. It has been argued that older workers are more experienced at using cognitive strategies to regulate their emotions (Barnes-Farrell, 2005). Also, Randolph (2013) suggested older workers learn to take advantage of coping resources and are therefore able to manage considerable amounts of stress. Despite these acknowledgments, organizations should be familiar with conditions under which older counselors encounter difficulties in maintaining performance levels.  

 

I recommend professional development emphasizing the development of new skills and increased participation, involvement, and psychological support for older counselors within the organization. Also, professional development would elicit idea sharing between older and younger counselors. Older workers prefer experiential learning to conceptual learning approaches and enjoy using different strategies during the learning process (Randolph, 2013). Special attention to older counselors yields rewards since they often hold responsible positions and may be at increased risk for experiencing stress. 
  
 
Balancing Work and Family Demands

 

Counselors described stress in managing family relationships and work responsibilities. Work problems and demanding caseloads interfered with family life. One demand placed on counselors involved the use of time: time spent in one role is the time that cannot be spent in another (Judge & Colquitt, 2004). Counselors struggled to balance priorities between work and home.  

 

The study revealed the need to promote organizational justice by being responsive to work-family conflict. Judge and Colquitt (2004) argued justice literature pertains to understanding how family-friendly policies work. He maintains that organizations with unfair policies and practices contribute to the interference of work with family life. Thus, organizations should consider employee views and experiences regarding the work-family conflict. I recommend distributing employee surveys to provide an accurate picture of employee needs, thus creating procedures representative of all group concerns. Judge and Colquitt (2004). Also, leaders should adopt procedures responsive shared concerns. Bellavia and Frone (2005) noted an accurate needs analysis with organizational-wide participation serves a vital component of responsiveness to work-family issues. 

 

Next, I provide a summary of central findings, implications, and recommendations for causes of “occupational” (Ruotsalainen, Verbeek, Mariné, & Serra, 2014) or professional stress associated with performing work as an LADC.
 

 

Occupational Stress

 

LADCs described five sources of occupational stress, including the stress associated with documentation requirements and a lack of time to complete paperwork; experiencing difficulty with clients; managing relationships with coworkers; and organizational culture. Counselors experienced occupational stress in different ways and used a variety of coping strategies to manage stress.

 

Documentation Requirements and Paperwork

 

Considerable time and effort must be expended to meet documentation requirements associated with case management. The allotted time for these requirements presented challenges to counselors. Documentation standards compete with the face-to-face time available to meet with clients. Managing case files and providing the documentation served as a source of professional stress.  

 

The study revealed the need to consider how stress from documentation requirements affected the delivery of quality services. Federal and state documentation regulations ensure safety and standard of care for patients, a necessary component for counselors and organizations. However, high caseloads should be lessened, preserving quality patient care. Furthermore, learning effective case management skills supports employee growth and stress management. 
 

 

I recommend “case management coaching” (CMC), a term I devised. Changes in service delivery system, licensure rules, and practice settings challenge the profession and practice of rehabilitation counseling (Shaw, Leahy, Chan, & Catalano, 2006). These specific changes, in combination with anticipated societal and professional trends, have affected rehabilitation counseling (Knudsen, Ducharme, & Roman, 2008). CMC would assist counselors by pairing them up with coaches (i.e., coworkers) and helping them gain expertise in developing written reports regarding client progress, treatment plans, developing rapport/referral networks with other rehabilitation professionals, reporting to referral sources, and financial decisions. Coaching, through one-to-one learning, advising, and nurturing enhances personal and professional growth. Improved case management skills bring clarity of expectations, support to employees, and improved performance (Robbins & Judge, 2007).

 

Last, I recommend counselor professional development on managing time and resources. Participants made it clear they did not have enough time to complete assigned tasks. Large caseloads and demanding circumstances require effective time management skills. Staff training and development in time management may help to promote and maintain efficient and professional practices. Skagert, Dellve, Eklöf, Pousette, and Ahlborg (2008) found the lack of training and development causes time management and staff morale to suffer.  

 

Experiencing Difficulty with Clients

 

Experiencing difficulty with clients caused stress due the increased time and demands associated with clients in crisis. Concerns regarding chronic relapse; mental health issues beyond those associated with treatment and recovery for alcohol and drug addiction; and noncompliant behavioral issues about participation in treatment and recovery became a challenge for counselors.  

 

The study revealed drug addiction as a complex disorder, involving virtually every aspect of an individual’s functioning, including co-occurring addictive and mood disorders such as major depression, dysthymia, bipolar, and anxiety disorders (Brady, Myrick, & Sonne, 2003). This interface of mood disorders and substance use disorders acts as an important factor in improving treatment in the substance abuse field and has received a great deal of attention (Brady et al., 2003).  

 

I recommend a focus on clinical supervision. Two focuses of this supervision involve job performance and emotional support, creating a safe space to discuss emotionally challenging issues (Knudsen et al., 2008). The process of clinical supervision encourages counselors to engage in self-reflection. Research offered empirical support for the relationship between clinical supervision and decreased emotional exhaustion (Knudsen et al., 2008). It may be that supervisory relationship works to enrich the counselors’ ongoing experience on the job, thus moderating sensitivities to perceived stressors (Knudsen et al., 2008).

 

Managing Relationships with Coworkers

 

Counselors described how relationships with coworkers become strained due to workload. Excessive workplace demands proved detrimental to building relationships with colleagues due to the limited time available to get to know each other. Participants’ workloads impacted relationships with others in the work environment, thus weakening organizational commitment. Organizational commitment refers to the extent to which employees identify with an organization and feel committed to its goals (Sikorska-Simmons, 2005). A lack of organizational commitment has been identified as a strong predictor of staff turnover (Kirk-Brown & Wallace, 2004). Moreover, a strong positive relationship between job satisfaction and organizational commitment has been reported in numerous studies (Kirk-Brown & Wallace, 2004).

 

 
I recommend self-managing teams. Likert (1961) argued an organizational chart should depict not a hierarchy of individual jobs, but a set of interconnected teams. Each team would be highly effective in its right and linked to other teams via individuals who served as “linking pins” (Bolman & Deal, 2008, p. 154). The central idea in the autonomous team approach involves giving groups responsibility with autonomy and resources (Bolman & Deal, 2008). Teams meet regularly to determine work assignments and scheduling. Supervision typically rests with an appointed or emergent team leader (Bolman & Deal, 2008). 

 

I recommend autonomy-supportive environments to support feelings of being in control among LADCs. Counselors described the importance of having authority and flexibility to perform daily tasks at a quality level, whether accomplishing this as individuals or working with others in teams. 

 

Organizational Culture

 

The last cause for occupational stress involves organizational culture, which includes adapting to change and a lack of diversity in the work environment and racism.  

 

Counselors described stress associated with constant changes in case management. Change undermines existing structural arrangements, creating ambiguity, confusion, and distrust (Bolman & Deal, 2008). Counselors no longer knew what was expected of them. Clarity, predictability, and rationality gave way to confusion, loss of control, and a sense that “politics trumps policy” (Bolman & Deal, 2008, p. 383). To minimize difficulties, organizations must anticipate structural issues and work to redesign the existing architecture of roles and relationships (Bolman & Deal, 2008). Implementing such environmental characteristics produces subjective well-being (Warr, 2005). 
 

 

Next, participants maintained that a lack of diversity affected them. Clients and counselors of color interacted within a predominately white managerial environment. Counselors of color described this as racism and identified it as a cause of stress. Participants desired increase in diversity in managers. Organizations must recruit, support, and retain counselors and supervisors of color, reflective of the client base. 

 

To enhance culturally responsive services, staff members from marginalized or socially oppressed groups need to feel valued by individuals and organizations. The value may be demonstrated through processes allowing all members of the organization to compete on an even playing field, addressing factors within the organizational culture privileging some groups over others. Organizations overlooking the social and historical effects of race privilege and racism risk perpetuating inequity through practices emphasizing the achievements and strengths of white staff members without recognizing the cultural context supporting their success (Blitz & Kohl, 2012). To address organizational racism, formation and development of antiracist affinity groups are recommended.

 

Racial Affinity Groups

 

As a goal, white staff members of social work organizations understand institutionalized racism (Blitz & Kohl, 2012). Individuals of the same racial group meet on a regular basis to discuss the dynamics of institutional racism, oppression, and privilege within their organizations. Two or more groups (organized by common race identification) form and meet separately to identify and advance their organization’s racial equity goals. Race-based caucusing may be an effective method for social service agencies to highlight race as they address cultural responsiveness (Blitz & Kohl, 2012). Caucusing can function to promote the antiracist practices, advance organizational change, and support the personal and professional growth of the group members. It fosters accountability and validates perceptions of institutional racism within organizations, further supporting the organization’s members.
  

 

Despite these potential benefits, there is little evidence regarding the regular use of race-based caucusing by agencies (Blitz & Kohl, 2012). This may involve concerns about competing resources, difficulty envisioning concrete benefits, and lack of clarity on how to begin and manage the process over time. Antiracist work needs special attention because institutional racism downplays the role of white culture and privilege, advancing the supposed ideal of colorblind fairness, and discouraging talk about white racial identity. These practices tend to reinforce hidden privilege and maintain, rather than eliminate, inequity (D’Andrea, 2005; Perry & Shotwell, 2009; Spanierman, Poteat, Beer, & Armstrong, 2006). A race-based perspective moves organizations toward multicultural inclusiveness by stressing how racism and racial identity development shape the structure and performance of organizations (Shapiro, 2011).  Examining how institutional racism manifests may be particularly complex because each may define and experience racism uniquely. Some members of the organization may focus on the history of slavery, genocide, and colonization, while others may refer only to individual acts of prejudice or bigotry. Organizations moving toward the race-based perspective may, therefore, need to develop internal systems to support the staff members’ education and develop a common language and way of understanding structural racism and other forms of systemic inequities (Blitz & Kohl, 2012). 

 

Blitz and Kohl (2012) identified the following principles for effective implementation of racial affinity group: 

 

  • Clarify systems of accountability between the white antiracism caucus, people of color, the institution’s executive management group, consumers of community members, and other constituents
  • Work in harmony with, and contribute to, other organizational initiatives designed to address institutional and cultural bias, such as making the workplace LGBTQ-friendly, increasing access for people with disabilities, and supporting religious inclusiveness
  • Executive managers should operate with transparency, and discussion should remain open to all individuals and subgroups involved in the antiracism endeavor
  • White people involved in the caucusing process must be available for evaluative dialogue with people of color and others
  • Establish real avenues for critical feedback to reach the senior levels of management
  • Develop a shared mission or values statement between the white antiracist caucus and people of color caucus that clarifies the intent and goals of all the racial affinity caucuses
  • Clearly state the expectation that all white people within the organization will take an active role in confronting institutional racism as a function of their job, and offer the caucus as a means of support, education, and collaboration
  • Create forums, separate from caucuses, where employees who are uncertain that issues of race and racism are appropriate for the professional setting can discuss their concerns
  • When choosing members for caucuses, consider selecting participants from all levels of the agency’s hierarchy
  • Develop and maintain a regular dialogue about race and racism with key people within the organization and with outside consultants to stimulate continued personal and professional growth and enhance creative problem solving
  • Regularly disseminate relevant literature on institutional racism, white racial identity and culture, white privilege, and antiracist practices to all members of the organization
  • Look for ways to weave an analysis of power and race into other discussions of marginalization and bias, and develop partnerships that enhance the organization’s evolution toward genuine fairness, equity, and inclusion.

 

By implementing racial affinity groups, a healthy racial dialogue takes place within the agency; all staff members and organization leaders may become more adept at working within a multicultural, antiracist paradigm and enhance cultural responsiveness. 

 

Next, I present a point on leadership.

 

Leadership

 

For successful implementation of preceding organizational recommendations, an effective leadership structure must be in place. The large and growing literature dealing with leadership has not led to an obvious increase in either the quantity or quality of leaders (Lyons & Schneider, 2009).  Furthermore, leadership and burnout have mainly been examined as separate elements, and not enough attention has been paid to the relationship between these phenomena (Kanste, Kyngäs, & Nikkilä, 2007). Better administrative support has been shown to be related to less burnout and more satisfaction among substance abuse counselors (Garland, 2004). 

 

Compassion encompasses a transformation model. Northouse (2007) described transformational leadership as an exchange occurring between leaders and their followers, raising the level of motivation and morality in both leaders and followers. These leaders attend to the needs and motives of followers and try to help followers reach their fullest potential (Northouse, 2007).  Leadership development programs should focus on introducing and supporting a more compassionate leadership to help counselors and clients focused on the reduction of stress and a healthy and balanced lifestyle. 

 

Summary and Conclusion

 

My findings emphasized how the need for competence and an inability to control demanding roles and expectations caused stress among LADCs. Workloads, family-work conflict, and racism affected counselors’ confidence. Positive values and role models within the organization may help counselors become more proficient and gain new skills and competencies. I fear organizations may think of this ideology as utopian. However, organizations serve as competence builders, not only raising people’s beliefs in their capabilities but also modifying structures to ensure success and avoid placing people in situations leading to failure. Sharing the spotlight with personal self-care, new counselors, seasoned counselors, and leaders must appreciate the importance of healthy organizations in combating the degree and effects of stress and burnout on people. 

 

 

References

 

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