HOLISTIC BURNOUT SUPERVISION MODEL (HBSM)

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CHAPTER THREE LITERATURE REVIEW

Introduction

This chapter focusses on burnout phenomenon and its dynamics. The main components of clinical supervision are examined. Other themes related to counsellor pathology and wellness are discussed. These are self-awareness, motivation, ethical and legal issues in counsellor supervision.

Burnout and its Seriousness

Studies carried out amongst different groups of people reveal the seriousness of burnout as well as coping mechanism strategies. Teacher stress and burnout are reportedly a cause for serious concern. The 1980s studies of victims found that 160 teachers each year were supervised on the grounds of ill-health. Their average age was between 44 to 45 years. Two-thirds of these teachers were retired early because of psychological ill-health, while another one-tenth retired because of stress- related cardiovascular disorders (Otto, 1986). Another study found that 10% to 20% of the 2138 respondents were experiencing psychological distress, while 99% were severely suffering from the same.
According to an extensive survey by the Independent Education Union (IEU) in Victoria (1996), teachers reported experiencing stress in workload pressure, difficulties with management and poor-student relationships. This stress manifested itself through irritability at home (50%), in class (55%), anxiety (64%) and feelings of powerlessness (45%). Psychosomatic complaints (like chronic fatigue, headaches, shingles and heart palpitations) were reported by 18% of the respondents.
Pithers and Soden (1998) and Kyriacou (2001) report that the causes of teachers’ burnout are teacher perceptions of poor student-relationships, time pressure, role conflict, poor working conditions, lack of control and decision-making power due to bureaucratic structures and autocratic leadership. Others causes are: Poor-colleague relationships, feelings of personal inadequacy and extra-organizational stressors. Teachers who suffered burnout were reported to be ineffective in key areas such as lesson organization and student behaviour management (Sinclair, 1992).
The cost of burnout to the individual teachers was even greater. They had impaired health, reduced self-confidence, low self-esteem, and damaged personal relationships. Dinham (1993) reports that teachers who opted for early retirement reduced symptoms of burnout. The Call Centres study in Australia focussed on the reality of worker’s emotional exhaustion and resultant worker withdrawal (Deary et al., 2002). Call Centres engage staff to work interactively with customers. These employees perform an important role in the management of customer relations. The manner in which they display their feelings towards customers has a critical effect on the quality of service transactions (Ashforth & Humphrey, 1993). These demands create role conflict for employees and impede their ability to provide high quality service (Knights & McCabe, 1988). Their study shows that employees coped with their emotional exhaustion through massive absenteeism. This was seen as a temporary form of escape from a stressful and unpleasant work situation (Hackett, 1989; Moore, 2000).
Another study in Australia examined the psychological well-being of case managers working with the unemployed (Goddard et al., 2001). Using longitudinal survey methodology, 86 managers completed the 12-item general health questionnaire (Goldenberg, 1978) on two occasions in 1999. In comparison with other studies investigating the psychological well-being of both employed and unemployed individuals, case manager respondents significantly reported higher levels of psychological morbidity among the employed and the unemployed Australians.
In a follow-up study, Goldberg (1998) compared burnout levels between case managers and non- case managers working with unemployed Australians in shared working environments. The researchers found significantly higher levels of burnout in staff using a personalized case management approach to assist clients than in staffs that were assisting their unemployed clients by providing over the counter services. This study has a lot to offer the current study where caseworkers or counsellors invest emotionally in their work with clients.
Dunbar, Mckelvey and Armstrong (1980) studied burnout effects among psychotherapists working in public agencies such as community mental health centres. This group of helpers was categorized as working in high stress working environments. Studies show that those employed in public settings are more dissatisfied and prone to occupational stress and burnout than those in private practice (Ackeley, Burnell, Holder & Kurderk, 1988; Cherniss & Egnatios, 1978; Raquepaw & Miller, 1989).
Rural mental health counsellors are subjected not only to the stress of working in a public setting, but also face an unusual array of common stressful conditions that include ethical issues related to limits of competence and dual relationships (Berry & Davis, 1978; Flax, Wagonfeld, Ivens & Weiss, 1979; Hargrove, 1982, 1986; Horst, 1989; Jennings, 1992; Schank & Skovholt, 1997), impact of a deteriorating economic base on the funding of mental health services (Dyer, 1997; Human & Wasem, 1991; Murray & Keller, 1991; Paulsen, 1988), geographical barriers to the delivery of social services (Cohen, 1992), and professional isolation (Richards & Gottfredson, 1989; Sladen & Mozdrierz, 1989; Wagonfield & Buffum, 1983).
The potential for burnout in counselling practice has been well –documented by Farber and Heifetz (1982) who investigated prevalence of burnout in 71% of the psychologists, 43% of the psychiatrists, and 73% of social workers. Another study by Farber (1985) discovered that 36% of the sample of mental health professionals reported moderate levels of burnout and only 6.3% indicated a high degree of burnout. The results indicate that more than a third of the psychologists reported experiencing high levels of both emotional exhaustion and depersonalization. Raquepaw and Miller (1989) completed a study of 68 Texas psychotherapists using the Maslach Burnout Inventory (MBI). The psychotherapists in this study reported low to moderate levels of burnout.
Maslach (1982) avers that the literature regarding prevalence of burnout in many of the human service professions has been extensive. Apparently, research on prevalence of burnout in particular groups has been limited. Maslach (1993) suggests that studies on burnout should focus on specific work settings. The current research has explored the seriousness of burnout in Kenyan psychotherapists/ counsellors.

Sources of Burnout

Researchers  on  burnout  concur  that  burnout  develops from workplace challenges (Cedoline, 1982; Freudenberger, 1974; Maslach, 1976; Pines, 1993). This section focusses on administration and operational characteristics, post-traumatic stress disorder, masked narcissism, nature of work, contact overload, role conflict/ambiguity, personality, and training deficits.

Administration and Operational Characteristics

The study on work-stress burnout in emergency technicians and early recollections offers a lot on the role of administrative factors in worker burnout (Vettor et al., 2000). Other studies regarding occupational stress and emergency medical technicians (EMTs) have pointed out that administrative and operational characteristics of EMT organizations are important determinants of stress (Allison, Whitley, Revicki & Landis, 1987; Graham, 1981).
The stress that EMTs undergo is not only limited to what they experience in the field but is also compounded by the regular monotonous routine of paperwork, lack of administrative support, low wages, long working hours, irregular shifts and the cynical attitudes of hospital personnel and law enforcement officials (Boudreaux et al., 1998; Grigbsy & Mcknew, 1988; Spitzer & Neely, 1992). Lack of control over one’s destiny can compound the worker situation (Cedoline, 1982).
Smith and Maslach (1995) advice that workers want to know the expectations of the organization, behaviours that will be successful or unsuccessful in satisfying job requirements, any physical and psychological dangers that might exist and security of the job. Cedoline (1982) adds that workers need feedback to develop job values, aspirations, objectives, and accomplishments. Lack of clear and consistent information can result in distress. Regarding communication, organizational structures that foster open, honest, cathartic expression in a positive and constructive way earn big dividends for employees. When management only reacts to open communication on a crisis basis, it reinforces negative communication.

Post-traumatic Stress Disorder

The study of work stress burnout within EMTs shows that working with traumatized clients could induce PTSD on the healer. This study revealed that EMTs are constantly at risk of developing symptoms of PTSD because of their exposure to traumatic stressors. Research on the effects of disasters has usually focussed on the immediate victim of the disaster (Fullerton, McCaroll, Ursano & Wright, 1992). Rescue workers are also exposed to both self – stress and their role as therapists. It was found that EMTs had higher levels of exposure than civilian victims to the experiences that are implicated in the development of PTSD and other post-trauma psychological difficulties (Weiss, Marmar, Metzler RonFeldt, 1995). PTSD has the ability to disable the helpers through their being overwhelmed (Linton, Kammor Webb, 1993). This relates more to the counsellor who exposes selfness to the client as a therapeutic tool. This has personal implications on the practitioners and the care they provide to their patients (Grevin, 1996).

TABLE OF CONTENTS
Declaration 
Dedication 
Acknowledgements 
Summary 
CHAPTER ONE: INTRODUCTION
Thesis Background
Thesis Focus
Statement of the Problem
Basic Assumptions
Rationale
Plan for the Thesis
CHAPTER TWO: THEORETICAL FRAMEWORK
Psychotherapists’ Burnout
Definition of Burnout
Work Stress
Theories of Burnout
Cherniss’s Model of Burnout
Golembiewski’s Phase Model
Leiter and Maslach’s Model
Conservation of Resources Theory (COR)
Burnout Assumptions
Psychotherapeutic Supervision
Historical Background
Definition of Counselling Supervision
The Supervisory Relationship
Categorization of Supervisory Models
Supervisory Models
Psychotherapeutic Supervision
Developmental Models
Social Role Models
Eclectic or Integrationist Models
Constructivist Approaches
Professional Issues in Counsellor Supervision
Theoretical Implications
Legal Aspects of Supervision
CHAPTER THREE: LITERATURE REVIEW
Burnout and its Seriousness
Sources of Burnout
Administration and Operational Characteristics
Posttraumatic Stress Disorder
Masked Narcissism
Nature of Work
Contact Overload
Personality
Role Conflicts and Ambiguity
Training Deficits
Contributions to Worker Burnout
Intrapsychic Contributions
Workplace Contribution to Burnout
Systemic Contributions
Effects of Burnout
Coping and Management
Primary Prevention of Burnout
Secondary Prevention of Burnout
Tertiary Prevention of Burnout
Counsellor Supervision
Institutionalized Supervision
Program Management
Supervisor Styles
Qualities of an Effective Supervisor
Supervisory Tasks
Supervisory Formats
Individual Supervision
Group Supervision
Peer Supervision
Effects of Supervision
Legal and Ethical Issues in Counsellor Supervision
Roles and Responsibilities
Frequency of Supervision
Methods of Supervision
Combining Supervision and Counseling
Competence to Supervisee
Dual Relationships
Confidentiality and Supervision
Supervisor’s Independence
Personal Awareness and Development
Definition
Importance of Self-awareness
Self-concept
Psychological Maladjustment
Resourcing Oneself
The Fully Functioning Therapist
Motivation
The Role of Emotions in Motivation
Theories of Emotions
CHAPTER FOUR: METHODOLOGY
Research Design
Sampling Design
Sample Population
Sample and Sampling Procedure
Instrumentation
Focus Group Discussions
FGD Interview Procedure
Precautions
Questionnaires
Precautions
In-depth Interviews
Advantages of Semi-structured Interviews
Precautions
Ethical Considerations
Informed Consent
Confidentiality
Data Analysis
CHAPTER FIVE: RESULTS PRESENTATION
Section A: FGD Results
Section B: Counsellor Respondents Questionnaire Results
Section C: Counsellor Supervisors’ in-depth Interview
CHAPTER SIX: DISCUSSION AND INTERPRETATION
Subjects’ Demographic Data
Gender Distribution
Age Ranges
Marital Status
Practitioners’ Training Level and Competence
Definition of Burnout
Personality and Burnout
Extent of Burnout Condition Among Kenyan Counsellors
Physiological Symptoms
Behavioural Symptoms
Psychological Symptoms
Spiritual Symptoms
Clinical Symptoms
Impact of Burnout on Subject Performance
Intervention Strategies for Burnout
Utilized Strategies
Ways of Enhancing Burnout Supervision
Requirements of a Burnout Supervision Burnout Model
Advantages of Supervisory Support
Choice of Either Individual or Group Supervision
Advantages of Group Supervision
Advantages of Individual Supervision
Utilized Supervision Models
Rationale for Intervening Using a Supervision Model
CHAPTER SEVEN: HOLISTIC BURNOUT SUPERVISION MODEL (HBSM)
A Supervision Model
Rationale of the HBSM
Focus of HBSM
Multi-faceted Care Service
Attends to the Whole Person
Provides an Experience of Care in a Lifecycle
The Preventative and Curative Component of HBSM
Aims and Goals of HBSM
Core Assumptions of HBSM
Assumptions from Other Theories
Concept of Wholeness
Human Beings are Self-regulatory
Redundancy Principle
Source of Unhealth
Supervisee as the Expert
Supervision in a psychotherapist’s Lifecycle
Assumptions from Current Study Findings
Diminished Personal Resources
Personality and Burnout
Sources of Burnout
Burnout – A State of Loss
Supervision Formats of HBSM
Individual Supervision
Group supervision
Method of Supervision
Post-hoc Supervision
Modes of Presentation in Burnout Supervision
Personal Logs and Journals
Reflective Process Method
Institutionalized Burnout Supervision
Supervision Contract
Frequency of HBSM
Burnout Supervision Qualities
Clinical Knowlegeability and Expertness
Reflective Stance
Providing Constructive Feedback
Persistent Commitment
Model and Mentor
High Level of Awareness
Forming Secure Attachments
Respects Structures
Possessing Rich Strategies and Methodologies
Supervisor – Supervisee Relationship
Supervisory Work: Level One and Two
Level One: Preventative Burnout Supervision
Practitioner’s Personality
Current Burnout External Sources
Competence Level
Performance Level
Level Two: Curative Burnout Supervision
Strategies and Techniques
Supervisor Strategies
Personal Strategies
Organizational Strategies
CHAPTER EIGHT: RECOMMENDATIONS AND CONCLUSION
Recommendations
Practicing Counsellors and Counsellor Supervision
People Care Agencies, Organizations, and Institutions
Counsellor Training Institutions
Kenya Counseling Association
Further Research
Conclusion
BIBLIOGRAPHY
GET THE COMPLETE PROJECT
THE ROLE OF SUPERVISION IN THE MANAGEMENT OF COUNSELLOR BURNOUT

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