The Development of an Emotional Sense of Direction: A Clinical Approach to Alleviating and Preventing Burnout
by SaraKay Smullens, MSW, LCSW, CGP, CFLE, BCD
During the past two years, I have developed a new way of working with my clients who suffer from burnout. It is a short-term, highly focused interactive process based on the development of what can best be described as a trusted “emotional sense of direction.” I would like to share the developmental progression of this approach, one based on principles learned years ago.
Background
While a student at the University of Pennsylvania School of Social Work in the mid-1960s, I was introduced to a philosophy of practice and an implementation model that has proven effective through decades of practice. At Penn, I learned how essential the development of “the art of letting go” is to fulfillment and satisfaction in friendship, love, and work. Our professors and supervisors each stressed the importance of what I think of today as “positive autonomy”—“the letting go of” negative attitudes, depleting relationships, and debilitating patterns of interaction, as well as the fantasies that inhibit mature coping. My fellow students and I saw this truth substantiated through client involvement, study of the arts, and our own introspection. We saw that without this separation process, clear vision about future opportunities is impossible to achieve and promising opportunities are either invisible, or if seen, their value and potential are ignored or sabotaged.
Through excellent supervision, students also learned that the combination of time limits, interactive clinical process, and use of “contracts” enhanced insight and led to growth and change. The contract, either written or verbal, involved a client’s sharing what he or she hoped to achieve. It became the starting point of client-social worker concentration and interaction. At agreed upon times, each client evaluated how work together was progressing. Had goals been met? Was it time to conclude? Was there more work to be done on present goals? Had new goals evolved?
Letting Go Facilitates Reliable Direction
Soon after graduation, I began to define the “letting go process” as one that allowed the development of a reliable “emotional sense of direction,” a phrase I have continued to use throughout my professional life. The phrase connotes the ability to find satisfaction and fulfillment in love, friendship, and work by knowing whom to trust and build with and when it is necessary “to let go” and move on. However, in past years, I have used the concept as a descriptive term to illustrate the importance of separation from patterns, relationships, and attitudes that were depleting and defeating. I did not use it as a yardstick to indicate where and why a fulfilling path never developed or was lost. That is, until recently.
Times have changed vastly in the years since my graduation, and shockingly so in the past decade. Intensifying the myriad changes has been the increasingly fast pace insisted upon in our technologically advanced and advancing society. Do any readers remember when we got letters (snail mail!) and had time to think clearly before responding? Or when we received a phone call and could tell the caller that after thought we would reply? These vast changes have affected the nature and urgency of requests brought by clients.
Burnout, Self-Care, and a Yardstick To Measure What Went Wrong
Upon reflection, I realized that in the past, most clients consulted me about anxieties and feelings of hopelessness brought on by depression. Their depression was caused by loss of a loved one, or a job; by personal illness or illness of one dear to them; by the connivance of a dishonest friend or colleague; by betrayal or injustice. Sometimes there was the feeling of darkness and helplessness whose source was not understood.
Today, of course, the above losses and grave disappointments exist, and I continue to respond to clients who face them. A case example that follows involves depression heightened by the stress and exhaustion that accompany both burnout and depression. This said, however, presently I am consulted primarily because of the ramifications of burnout—that is, overload in our relentlessly fast paced society. The constant change and many pressures with little or no time for leisure, relaxation, connection with others, and nonexistent or exceedingly limited support or cushioning of our countless responsibilities is causing havoc in our society. Debilitating overload caused by personal, professional, and societal overload (or their combination) intensifies unresolved issues from personal, intra-psychic, and relational sources. Increasingly, I am told, “I am immobilized, falling apart.” “If I am not available 24/7, I will be fired.” “I do not know what to do first. As a result, I do nothing.” “I want direction, a how-to list. I have no time for lots of appointments.” “Manners are a thing of the past. Kindness is seen as weakness. I cannot cope.”
However, here is an optimistic note. Studies show that incorporating self-care opportunities in one’s day-to-day life eliminates and prevents burnout. Effectiveness is based on the ability to select—among the many self-care opportunities that exist—one, or a combination, that suit each individual.
Putting this research together with the changing times, needs, and requests of clients, I asked myself: In the midst of today’s overwhelming pressures, how can client and social worker pinpoint where and why emotional direction did not develop or somehow was lost? This question led to a realization that the term “emotional sense of direction” can become a yardstick to determine where and why one lost or never developed a fulfilling path in love, friendship, and work. For example, perhaps direction failed because one was never allowed to say “no” to a parent. Or perhaps one equated relaxation with “underachievement,” fearing this direction would cause parental rejection. On the other hand, direction loss can be rooted in the present, where numerous responsibilities and life realities cause exhaustion, confusion, and an inability to move forward. With specific understanding of where things went wrong and why, individualized self-care options can be selected to get back on track, or to find direction for the first time.
Clinical Approach
My clinical approach to address burnout is a short-term partnership of no more than three months (and frequently less) to identify where an emotional sense of direction has been impeded, to bring relief in presenting problems and their underlying causes. After taking a full history, each client and I “contract” for the number of sessions that we are comfortable with to address presented challenges. My goal is to offer the fastest possible relief and direction in a way that will not frighten or overwhelm, but will instead lead to insight and motivation. An agreed-upon number of sessions both calms and motivates, and anxieties lessen through awareness and development of a plan of action. Clients often successfully conclude our work in less time than they thought. Others require the full three months of concentration.
Following is an example of an eight-week clinical concentration: My client, whom I’ll call Cindy, was able to pinpoint the moment she lost her direction—the sudden death of her mother. Beyond that, she was able to see that she had never imagined that there would come a time in her life when she would no longer be able to depend “on a mom who was always loving and supportive—always there.” My first goal was to help Cindy face reality and let go of her wish for and dependence on what could no longer be. After Cindy’s selection of a self-care strategy, she was able to achieve a reliable emotional sense of direction and move on in a fulfilling, reality-based life.
Addressing Burnout With a Reality-Based Awareness and Self-Care
Cindy had been happily married for five years. She contacted me two years after her mother died. The death occurred one month following her mother’s diagnosis of pancreatic cancer and two weeks after the birth of Cindy’s first child, a son, whom she named for her mother. My client was depressed by her loss, and her family doctor provided her with medication, which she was continuing to use when her physician referred her to me. The primary cause of her ongoing upset, however, was that Cindy was on overload. She was burned out.
A graduate student in architecture working for a doctorate in a highly demanding university setting, my client had found a reliable nanny for her young son. But she was devastated that her mom was no longer there as a substitute when the nanny was ill, on vacation, or Cindy desired her help on evenings when she had to concentrate on the demands of her academic program, or when she and her husband, Jeff, hoped for an evening out. Jeff, a financial analyst whom Cindy described as “beyond frazzled in this crazy and unpredictable economy,” felt that his wife had become unavailable when he needed her the most. Cindy knew she had far too much to cope with and described herself as “devastated, overwhelmed, not knowing which way to turn.”
Cindy and her father had depended on each other during the initial months following their loss. She described this important period as one when they “mourned and cried together.” However, much to Cindy’s shock, before a year of mourning had concluded, her father remarried. Through condescension, silence, and overt rudeness, Jane, his wife, made it abundantly clear that she did not recognize Cindy, her husband, or their son as part of her world. Cindy, in her first session, was bereft about this brutal rejection.
Of the many self-care strategies we discussed, the one that excited my client was journaling. “I have always longed to write,” she enthusiastically told me. Cindy immediately began a pattern of morning and evening journaling that at first concentrated on her sadness and loss. A week later, Cindy decided to add photos and drawings to her journal, and a week after this, she began writing about plans for her future.
Sessions together focused on Cindy’s reality. She realized that the love of her mom would ever be with her, and in this way their relationship would never end. By her fifth session, Cindy was able to accept a painful truth. Her father would continue to stonewall any discussion of his daughter’s pain and disappointment, and he refused to address his wife’s unpleasantness or lack of courtesy. Nevertheless, after consideration of possible options, Cindy determined that it would be wise that they continue to maintain a relationship that was as pleasant as possible. When together, Cindy ignored Jane’s rudeness, and although his visits were infrequent, her dad began to spend time alone with his daughter and her family.
Cindy continued to journal about truths she now accepted, highlighting these sentences: I was fortunate to have a wonderful mother. I do not need my dad’s wife as a friend. My husband and child are my first priorities. I cannot change another person. I will handle my reality like an adult. By our sixth session, the need for medication had become, in Cindy’s words, “a distant memory.”
Prior to our seventh session, Cindy met with her Dean, requesting an additional year for degree completion. This request was granted. By our concluding session, Cindy and Jeff were in the midst of planning a holiday for their family of three. In Cindy’s words: “We are the important ones now.” And there is more. Cindy enjoyed writing and diagramming her words so much that a friend she shared her journal with directed her to a literary agent, who accepted her as a client, and believes that with refinement, her journal is publishable.
Conclusion
Whereas depression is usually associated with grave loss and crushing disappointment, burnout results from debilitating overload caused by personal, professional, and societal factors. The clinical approach described is well suited for those with demonstrated ego strength who are overwhelmed, muddled, confused—on overload—and wish to unravel and clarify their issues and achieve direction. When one family member finds relief and satisfaction, others often follow suit.
SaraKay Smullens, MSW, LCSW, CGP, CFLE, BCD, whose private and pro bono clinical social work practice is in Philadelphia, PA, is a certified group psychotherapist and family life educator. She is a recipient of a Lifetime Achievement Award from the Pennsylvania chapter of NASW, which recognized her longstanding community organization, advocacy, and activism, as well as the codification of patterns of emotional abuse and the development of the model to address it. SaraKay is the best-selling author of Whoever Said Life Is Fair: A Guide to Growing Through Life’s Injustices and Setting YourSelf Free: Breaking the Cycle of Emotional Abuse in Family, Friendships, Work, and Love. Her latest book is Burnout and Self-Care in Social Work: A Guidebook for Students and Those in Mental Health and Related Professions.