Career-sustaining behaviors of addiction counselors

“First we make our habits, then our habits make us.”
- Charles C. Noble Most addiction counselors focus on helping their clients break their habits of addiction. In this article, we suggest that counselors need to pay attention to their own habits-habits of self-care.

As students, we had given little thought to the kinds of habits necessary to succeed in an addiction counseling career. But that changed last summer when one of us interned at a recovery center. There, the supervisor was adamant about helping staff develop good habits of self-care, or what some call career-sustaining behaviors (CSB). He demonstrated their importance by structuring our work so that it was refreshing and energizing. He consistently modeled how to integrate CSB into daily life. Sometimes we had staff meetings outside on a sunny day. Other times, he asked what we had done over the weekend. He wanted to be sure we practiced taking care of ourselves. This experience was formative, underscoring the importance of developing good habits of self-care so that we could better serve the needs of others.

Since then, we have learned a lot more about CSB. With the help of our professors, we reviewed research on stress, burnout and CSB, and then conducted a national study of the self-care habits of more than 700 addiction counselors. This article reviews some of the research on CSB and describes the results of our study.

Burnout among counselors

Addiction counseling involves heavy caseloads and clients prone to relapse, which can create high stress levels. The effects of stress on helping professionals can range from depression and emotional exhaustion to loneliness and decreased self-esteem. Moreover, stress can diminish counselors' effectiveness by disrupting decision-making skills, attention and concentration, as well as the ability to generate strong relationships with clients.1

Unattended stress can lead to burnout, a syndrome involving depersonalization, emotional exhaustion and a sense of low personal accomplishment.2 Counselors risk significant physical, emotional, spiritual and psychological harm if they force themselves to continue their work and ignore the stressors leading toward burnout.3 Furthermore, their effectiveness is significantly diminished.

The addiction counseling profession requires special attention to burnout. Alcoholics and addicts are noted for being “difficult clients,” often presenting with chronic difficulties, demonstrating slow progress, and regularly relapsing. Many times, addiction professionals are children of alcoholics or are in recovery themselves. While shared experience can initially assist counselors in empathizing and building rapport with clients, it also can increase burnout risk. “Empathy fatigue” occurs when counselors' own past problems resurface as they explore client issues.4 By continually revisiting their own suffering during counseling sessions, counselors often endure additional emotional turmoil and struggle to work effectively.

Of course, counselor stress is not limited to the office. Stress at home also may be related to burnout at work. When counselors do not set adequate boundaries between home and work, personal struggles can affect their work. Value attainment also might play an important role in job satisfaction and stress reduction.5 Counselors who are able to achieve their personal goals are more likely also to accomplish their professional goals. Yet when counselors feel hindered from achieving their personal ideals, they are likely to experience greater work conflict and frustration.

Career-sustaining strategies

While little has been done to identify strategies to prevent burnout in addiction counselors, researchers such as Norcross have identified career-sustaining strategies for counselors in general.6

First, he suggests that professionals openly acknowledge the stress and hazards of their occupation and appreciate the rewards. Second, he recommends activities that are enjoyable and provide stress relief. Third, focusing specifically on the problems related to the stress is important. Often, working to modify the work environment or other procedural aspects of work can serve to reduce stress. Fourth, Norcross suggests that taking advantage of helping relationships, social supports and personal therapy can help to ease ongoing stress. Finally, he advises counselors to avoid wishful thinking and self-blame, and encourages them to diversify clients and counseling techniques.

In addition to these general recommendations about managing stress, we found additional practical recommendations from others,7 including maintaining a leisure mindset, leisure space and a connection to others, and using rewards as self-care strategies.

Clinicians' self-care strategies should not be event-based but a “lived experience.” That is, self-care should be an ongoing, rather than compartmentalized, practice. The point of career-sustaining behaviors is not to add another task to a checklist, but to turn them into habits of daily life. CSB are most helpful when they create space in counselors' lives to allow them to be more than clinicians and, consequently, to enrich and lengthen their careers.7,8

Religion and religious practices also have been found to enhance counselors' well-being. Steger and Frazier found that “meaning in life” mediates between religiosity and well-being.9 When counselors engage in religious practices, such as going to worship services, praying and reading religious texts, they find meaning in their lives that they may not be able to find elsewhere. This meaning may transfer into one's counseling practice, providing a greater sense of purpose in daily work and in turn contributing to greater well-being.

Study background

While it is clear that career-sustaining behaviors are important for promoting effective counseling practice, little is known about their use among addiction professionals in particular. Therefore, we invited more than 5,000 members of NAADAC, the Association for Addiction Professionals to complete an online survey of their CSB.10

A total of 709 members participated. The majority of the sample was female (about 61 percent) and the average age was 50. Geographically, the Southern U.S. had the highest representation with 35 percent of participants. Approximately 68 percent of participants were married or in a significant relationship. In the paragraphs that follow, we explain which addiction counselors are most likely to use CSB and we identify which CSB counselors are practicing.

Results

We used a variety of statistical analyses to determine what factors were related to the practice of CSB among addiction counselors. We found that certain demographic groups were more or less likely to practice CSB. For example, those who were married or currently divorced reported more frequent practice of CSB. Perhaps it is not surprising that those who had never been married reported lower rates of CSB. It might be that, in order to meet the demands and needs of family and romantic relationships, some counselors intentionally utilize CSB to structure their relational and vocational priorities. We suspect that single individuals might be more prone to focus on their work, and as a result end up maintaining fewer boundaries between work and personal life.

Addiction counselors who lived in the West, Northeast or South had similar CSB scores; however, their scores were consistently higher than those reported by counselors from the Midwest. These differences suggest that the practice of CSB might be affected by place. Cultural as well as climate factors might contribute to the different levels of CSB practice across geographic locations. For example, some find an afternoon walk enjoyable and stress-relieving. While those in the South may be able to step outside to practice this CSB, January's weather in the Midwest is less conducive to such activities. Those in colder climates might have to be more creative and intentional to integrate CSB into their daily life.

We expected that those who had more years of education, as well as those who had greater work experience, would more frequently practice CSB. While the data did demonstrate positive relationships between CSB and both years of education and years of work experience, the relationships were weak. These weak correlations (r =.12 and .19, respectively) suggest that counselors with more training and education use CSB only marginally more than counselors with less training and education. This might reflect a lack of CSB instruction in addictions counseling academic programs.

CSB were unrelated to other demographic factors. Men and women did not differ on CSB scores. Likewise, we found no difference in CSB among those who worked in different practice settings (urban vs. suburban vs. rural).

We asked participants to indicate the frequency with which they used a variety of CSB. The most commonly used CSB are listed in Table 1 and those that were used least frequently are reported in Table 2.

Cultivating habits of self-care

Addiction counselors' training is predominately other-focused, with less attention given to self-care. Studies on burnout urge educators to alter their curriculum to include career-sustaining behaviors.11 Yet the novelty of standardized curriculum, limited faculty and scarce resources may interfere with teaching self-care methods. However, in the same way that students learn Motivational Interviewing techniques, students should learn self-care-by practicing.

Good habits, whether they are related to counseling skills or self-care, require practice. Educational institutions strive to equip students with the counseling skills necessary to be successful in the addiction field. Yet by neglecting to cultivate good habits of self-care, or CSB, training programs could be missing an essential ingredient for sustained effectiveness.

Our addiction counseling faculty have acknowledged the difficulty of adding “one more thing” such as self-care strategies to the addictions counseling curriculum. Faculty members feel pressure to streamline curriculum, and students-responding to financial and other life pressures-move as quickly as they are able through training. These factors challenge the implementation of CSB into the training curriculum. As a result, students do not develop CSB habits, and instead cultivate unhealthy habits that they carry with them into their counseling work.

Charles C. Noble reminds us, “First we make our habits, then our habits make us.” Given the demands of addiction counseling, we are reminded of the importance of developing good habits in these formative years. Studying addictive behaviors has taught us that, over time, habits have a way of shaping individuals into certain kinds of people. Likewise, we are realizing that the habits we cultivate now will shape us into certain kinds of professionals.

More Online

For another perspective on avoiding burnout, visit https://www.addictionpro.com/shulman1207.
Michelle Sobon (pictured above), Ashley Davison and Lauren Bogear are undergraduate students at Indiana Wesleyan University. Sobon is completing her undergraduate majors in psychology and addiction counseling and will be pursuing doctoral training in clinical psychology in the fall. Davison is a psychology major and a member of the John Wesley Honors College; she plans on finishing her undergraduate work in 2011 and pursuing a career in Student Development. Bogear is graduating with majors in psychology and adolescent ministry; she plans to work in a local church with her husband. Tim Steenbergh is Associate Professor of Psychology at Indiana Wesleyan University, and Katti Sneed is Social Work Department Chair and Associate Professor of Addiction Counseling at Indiana Wesleyan University. Steenbergh's e-mail address is Tim.Steenbergh@indwes.edu.

References

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Addiction Professional 2010 July-August;8(4):25-30