One of the missing pieces in any conversation about burnout is the need for professionals to keep examining where we’re coming from: how invested are we in outcomes? Do we truly view our clients as being in process of change, even when that change is barely perceptible to us? Can we appreciate that our clients are doing the best they can with what they’ve got right now, even if the scope and limits of their processing aren’t (we believe) optimal? Bottom line: If our clients see us again, that means they’ve managed to stay alive – congratulations! That’s a measurable achievement right there.
The is where the Stages of Change model is so helpful. Originally published in the late 70s, co-authors James Prochaska (since deceased) and Carlo Di Clemente forensically analyzed how change happens and is implemented. Speaking to his model, Prochaska confirmed that the model is good for any change from buying a gift to an automobile, from relocating to managing illness; the potential impact of the change is not so much the point as the process. The process (and its multiple applications) is what interests these authors.
On the same occasion – Syracuse Behavioral Health Conference in NY pre-Covid – Prochaska spoke about how those of us in the “helping professions” are particularly vulnerable to wanting our clients to be “in action.” (Preferably action that’s pre-approved by us.) But, Prochaska pointed out, “action” is the 4th Stage in their change model, and we can’t lose the three preceding steps in the process – the change just won’t take. Thus, when a client arrives in the ER strapped to a gurney with a needle hanging out of his arm, we cannot assume that the gravity of his condition means that he’s ready to make a change, and certainly not a change as enormous as sobering up.
It’s that optimistic assumption of ours that sabotages us, leaving us invested in an outcome not yet adopted by the client, and morally scuppered when our client (predictably) fails to reach this benchmark. Our clients keep failing us? We become burned out – “all my efforts are for nothing.” More accurate to say, “all my efforts have been misdirected.”
But who wants to face up to this reality? We professionals must look to our own courage.
In my conversations with treatment and recovery professionals, and in the thread here, there’s little reference to the Stages of Change model, for all its salience. Rather we talk about “relapse.” But whose plan was “abstinence?” Clients will often acquiesce to the authority in the room – that’s us! – but without deeply committing to a plan of action which seems unrealistic to them for whatever reason. A client who’s in any stage before “action” is not guaranteed to stay substance-free; it’s not a realistic proposition, whatever that client says to me in the moment. Accordingly, I have no business being shocked or annoyed when she uses again.
Rather, if I’m true to my recovery mission, it’s my job to find out where on the spectrum of change my client is locating herself today: adamant that no change is necessary despite all external evidence (1-precontemplation)? acknowledging that her life and outcomes could be improved – and by her! (2-contemplation)? interested in researching detox and treatment (3-preparation)? Each of these stages offers fertile ground for purposeful and respectful conversation. Voluntary action undertaken as a result is far more likely to be successful.
For professionals like us, the satisfaction lies in the process. A purposeful conversation skillfully undertaken is a true measure of our service. But don’t take it from me – you’ll hear it direct from your clients who value your interest in what’s really going on for them (not what they think you want to hear) and your personalized invitation to the solution. For yourself, there’s no greater defense against burnout than staying away from investing in outcomes: other people are gonna do what other people are gonna do and I’m not in charge.
‘Hope this helps!
I discuss these issues in “Good Behavior Ethics in Theory & Practice” (a 9-hour training for professionals). One social worker participant noted, “I appreciate having the connection between burnout, boundaries, and the stages of change, and letting go of outcomes as an ethical practice.” Next dates in June. Please email me for details – ruth@sobriety-together.com.
