How social workers experience stress and burnout at the workplace. Article 1: The Battered Helper? Article 2: Burnout, Informal Social Support and Psychological Distress among Soci

The Battered Helper

HAROLD LEWIS

Social workers face so many pressures that they warrant the description "battered." Growing needs

of clients and the shortage of resources ctM for constant difficult and exhausting decision making'.

Caught between the tight fists of the economy-minded altruists and the grasping hands of desperate clientele, the social work helper is punched and pulled whichever way she turns. Contracting resources and escalat- ing needs squeeze the worker, whose functions and roles ask her to mediate the impossible. The same economic forces that reduce what money will buy affect what can be provided and what is required. It is not surprising that a disturbing syndrome that once shaped the behavior of an occasional helper now threatens to become a prevalent disease.

What heat is to fire, anger is to the battered helper. Anger, fueled by no-win circumstances in which she finds herself, burns her up till she burns out. Even the balm of client satisfaction and personal reward that in the past helped rationalize the failed cases and unhappy denials of service is rarely available to the helper in these infiation-ridden times.

The burnout is manifest in many ways. Irritability, exhaustion, des- perate measures to deal with routine problems, impatience and distrust, resignation and withdrawal—all contribute to a cool, defensive facade in an unfeeling presentation of self. To the client, even an automatic phone-answering service can seem more human than the burned-out worker confronted by a pressing request for help.

Harold Lewis. B.S., M.S. W., D.S. W., ACSW, is Dean and Professor. School of Social Work, Hunter College, City University of New York.

0009-4021/80/040195-07 $01,25 © Child Welfare League of America

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196 CHILD WELFARE / Volume LIX Number 4 April 1980

There is much more to this syndrome than can be measured by absentee rates, worker error, and cost-efficiency figures. Recent research suggests high burnout rates occur:

1) among younger, inexperienced workers with little supervisory responsibility;

2) in large caseloads and more formal organizational structures; 3) where leadership-provided structure and support are lacking; 4) when workers do not know what is expected of them, and com-

munication of rules and regulations is unclear; and 5) in work environments with little autonomy, opportunity for inno-

vation and low staff support. [2.2]

Employment Rewards

Yet turnover rates for burned-out workers do not follow an expected separation pattern. This is a disturbing finding, since it could indicate that lacking other job opportunities, burned-out workers may remain on a job when in heart and spirit they have already gone elsewhere [2.2]. A variety of studies indicate that persons seeking employment in the helping professions do so for nonmaterial as well as material reasons. If one is seeking wealth and status, employment in the helping profes- sions is counterproductive. The nonmaterial rewards are more likely to be realized. Thus, human service workers seek to satisfy personal beliefs about caring for others; they wish to lead socially useful lives, want to use their talents in human relationships to achieve social justice and promote individual, group and community well-being. They seek out health, education and welfare programs that profess similar intentions. They are encouraged by those who recruit them to believe that if they perform their assigned functions well, not only will their clients benefit, but they will derive considerable satisfaction in their work.

Evidence also suggests that workers quickly discover how far reality departs from these expectations. The process workers experience as they are forced to shed one illusion after another when confronted with impossible assignments has been likened to the stages Kubler-Ross identifies for the terminal patient: shock, denial, anger, bargaining, depression and acceptance (1:195-208). In my research on parental neglect, these sequential reactions also appeared to describe the reactions of parents confronted with charges of neglect of their children. If the

Lewis / The Battered Helper 197

underlying fear of loss of control that is present in the dying and in neglect situations reflects a similar fear in the burned-out worker, the process experienced suggests a helper in need of help, not one available to provide it for others. It is not too useful to learn that some workers manage to avoid the syndrome. These appear to be workers who escape to supervisory slots, who ferret out and utilize strong agency support networks, who manage to gain a differential caseload giving them relief from certain persistent stresses, who are eligible for sabbaticals, vaca- tions, special leaves and other rest times that can be strategically spaced, etc. For most workers, these options are not available, and when available are of such limited scope that they fail to stem the burnout process.

This discussion does not pursue the line of inquiry suggested by current research and autobiographical reports on burnout. Instead, it focuses on a more encompassing concern inherent in a broader category, the battered helper, of which the burned-out worker is but one byprod- uct.

The Moral Dilemma

In the usual practice situation requiring worker judgments, the worker must reconcile means and ends in choosing what is right and good for the client. This choice is the most difficult one the worker has to make. In those situations where clear and controlling rules govern the range and manner in which alternative actions can be considered, less choice is available, or none at all. Of course, where choice is eliminated and judgment unnecessary, there is no need for the worker.

For our purposes, it is assumed that helping situations involve complex judgments, where there is need for a human interface that can be provided only through worker-client interactions. In recruiting per- sons to carry out these interpersonal assignments, the importance of motivation and skill is recognized, but equally important are attributes such as physical stamina, psychic resiliency and emotional maturity. What kind of worker she will be is clearly as important as what she will know and do. Unhappily, where work assignments allow for little use of what she knows and limits what she can do, they syphon off motivation and diminish opportunity to improve skill. These obvious byproducts of inappropriate employment of professional helpers are not

198 CHILD WELFARE / Volume LIX Number 4 April 1980

the central concern in this discussion, though they are relevant to it. What is central is the damage done to the worker's physical health and psychic well-being when constantly confronted with moral dilemmas in her effort to be helpful. It is this emotional and intellectually draining confrontation resulting from the mediating role the helper is expected to play, that produces the battering.

An extreme instance of worker burnout , one unrelated to social service provision, can place in stark relief the moral dilemmas inherent in problems addressed here. It is generally recognized that demanding work, physical or mental, burns up energy and depletes a worker 's resources. Where the depletion exceeds replenishment, burnout will occur. The most flagrant example in recent history of a system deliber- ately designed to exploit worker burnout occurred under the Nazi government in Germany. An analysis of the shortened work-life span, increased rate of illness, etc., documents this pattern in the employment of German workers in heavy industry during that period. Its ultimate expression was achieved during World War II, when Polish, Russian, Yugoslavian and other laborers were worked to complete exhaustion under German-controlled management.

Pertinent Assumptions

From the experience under the Nazi regime it is possible to abstract assumptions that helped justify the policies followed:

1) The products produced by the labor involved could meet necessary standards.

2)The labor supply was expendable and could be replaced at lower cost than would be required to sustain the same labor pool at non- burnout standards.

3) The welfare of the laborers themselves was not a critical consider- ation in view of higher priorities in the allocation of resources.

4) The work force could be coerced and controlled so that protest and outright revolt could be suppressed at acceptable cost.

If these four assumptions are applied to the current situation in the human services manpower pool, the moral dilemma is sharply defined.

1) The product in the human services is the condition of life of people, particularly children, the aged, dependent and handicapped. Standards of acceptability for their condition of life define what the worker would consider "good" for these clients.

Lewis / The Battered Helper 199

2) The labor supply consists of persons engaged in helping services who are usually better situated than their clients, but not so distant in standards that they cannot identify with and appreciate what would be the impact of standards set so low as to seriously threaten the health and well-being of their clients.

3) The welfare of these human services workers is a concern, but not a critical consideration in terms of national priorities. Their right to higher priority ranking as judged by resources allocated for their support and training suggests a relatively low status in the national, regional, state and city labor market.

4) To the degree that these workers have the right to organize and can be organized to pressure on their own behalf, to that extent will their own efforts determine the degree of control they will have over their conditions of employment. Acceptable costs will be determined by political and economic negotiations based on the utilization of this right.

"Good" vs. "Right"

Items 1 and 2 make clear that what is "good" for the client may be judged differently by the worker, the client, the agency employing the worker, and funding sources. Items 3 and 4, on the other hand, specify rights and determine priorities in resource allocations that affect the scope and quality of labor employed and services rendered. Thus, in situations where the helper must use judgment in choosing among alternatives to achieve what is right and good for the client, it is almost certain she will face confiicting views about what is good and right for herself as well. Ordinarily, in a situation free of conflicting valuations of good and right, right ought to take precedence over good. Where what is judged good for the client and worker is to be given precedence over what is right for them, provision should be made to assure that rights that may be sacrificed are yielded because such sacrifice is clearly in the worker's and the client's interests. Conflicting valuations are inherent in such a situation, and such conflicts are central to worker performance. This leads to a moral dilemma in practice—one that batters the helper, keeps her awake nights, anxious and tense while on the job, and preoccupied with ethical doubts that kill job satisfaction and produce chronic depressions.

Clients reveal by word, deed and condition when the defined good falls far short of humane treatment. An inadequate level of help offered

200 CHILD WELFARE / Volume LIX Number 4 April 1980

promotes serious distrust on the client's part, in that he sees his worth valued at less than minimal conditions of life. When clients protest, individually and in organized groups, the worker knows only too well how real is the basis for their protest. If the agency's resources dictate such deficient definitions of "good," the worker must in practice support a standard she considers inadequate. Such dilemmas produce intolerable internalized confiicts and inner-directed anger. Add to this that the worker's salary often appears to be in competition with the client's needs, since both are included in the same program budget, which is always short of what is needed to cover adequate standards for either client or worker.

If this ethical dilemma were the only pressure on the worker's psyche, it would be damaging enough, but to this is added the equally draining ethical dilemma affecting her "rights." Although prompted to enter the helping profession by expectations of a high order, and expecting to exercise a benign influence on those who seek her agency's help, she quickly discovers that her methods are not so powerful as she thought, nor can she apply them as need dictates because program resources are deficient. She then learns that her work is not highly valued in the circles that distribute resources; that her efforts are demeaned, as are the clients she serves. In short, what she assumes to be her rights in prior allocation are not seen as rights by crucial others. Further, should she seek to organize and exercise pressure in order to realize these rights, the right to organize is also placed in question. As with salary, so with organi- zation; her efforts in her own behalf are purported to be unprofessional, and self-aggrandizing, at the cost of service to clients. Thus, as was true with the judging of what is good, determining what is right serves to turn the worker's doubts inward, deepening the self-critical anxiety and producing uncertainties that deny the body rest.

Worker Organization Is Not Enough

What has to be done if this battering is to be ended? As a rule, the author would accept the premise contained in the old adage: God helps those who help themselves. The battered helper must find ways to assert her right to organize in her own behalf, and to use such organization to press for the other right—the right to a higher priority in the distribution of shares. Such organization may take many forms and all need to be explored.

Lewis / The Battered Helper 201

But such organization will in the long run not significantly alter the pressures on the helper unless the help she renders is more highly valued. This requires that clients organize in their own behalf to press for a quality standard of "good" that the worker can also accept as humane. Given the interrelationship of resources to support workers and their well-being and resources to meet client need, unless the good of both advance together they are not likely to advance for either.

Although agencies can infiuence the battering somewhat by seeking more funds, reducing caseloads, arranging variations in assignments, providing other support services, etc., so long as their budgets are determined by unacceptable definitions of good all such measures can provide only temporary relief. Moreover, agency administrators will frequently be put in the situation of having to defend an inadequate definition of good, and participate in a denial of what are here described as rights.

A change in the long run can only occur with a broader change in national priorities, and in the self-image of workers that often is shaped by the status given their efforts in such priority rankings. Unless a change occurs in the current infiationary economy, one could add to worker burnout the demise of programs and an undermining of trust in the economy as a whole. What must be fought for is removal of food, housing, energy and health care from the impact of inflation, coupled with a publicly supported supplement to assure minimally adequate standards for the most disadvantaged. Seeking this goal, the battered helper would find a constructive outlet for the anger generated by these moral dilemmas. •

References

1. Lee, Dalton S. "Staying Alive in Child Protective Services: Survival Skills for Worker and Supervisor: Part 1—A Preliminary Examination of Worker Trauma," Arete, V, 4 (Spring 1979).

2. Schneiger, Frank. "The Worker Burnout Phenomenon: Implications of Current Research for the Child Protective System," Community Council of Greater New York, Newsletter supplement, Nov. 1, 1978.

Burnout, Informal Social Support and Psychological Distress among Social Workers

Esteban Sánchez-Moreno1,*, Iria-Noa de La Fuente Roldán2, Lorena P. Gallardo-Peralta3, and Ana Barrón López de Roda4

1Department of Sociology, Faculty of Social Work, Complutense University of Madrid, Madrid, Spain 2Department of Social Work, Faculty of Social Work, Complutense University of Madrid, Madrid,

Spain 3Department of Philosophy and Psychology, Faculty of Social Sciences, University of Tarapacá, Arica, Chile 4Department of Social Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain

*Correspondence to Esteban Sánchez Moreno, Ph.D., Department of Sociology, Faculty of Social Work, Complutense University of Madrid, Campus de Somosaguas, 28223 Pozuelo, Madrid, Spain. E-mail: [email protected]

Abstract

Previous research has shown that social workers are a profession at risk of suffering a high

incidence of so-called burnout syndrome. Burnout is in turn related to psychological dis-

tress. Social support from informal sources is a factor with potential to reduce the psycho-

logical distress caused by burnout. However, the previous research has not considered

informal social support in sufficient detail. This article, using a cross-sectional study, ana-

lyses the relationship between burnout, informal social support and psychological distress

in a sample of social workers in Spain (n ¼ 189). The results show a high incidence of

psychological distress and burnout, above all in terms of Emotional Exhaustion (EE). The

results of the hierarchical regression analysis confirm the importance of informal social

support as a variable negatively related to distress, even in the presence of burnout.

Surprisingly, organisational variables were not associated with distress. Longitudinal

and qualitative research is necessary to examine the nature of this relationship in detail.

Keywords: Burnout, social workers, distress, social support

Accepted: June 2014

# The Author 2014. Published by Oxford University Press on behalf of

The British Association of Social Workers. All rights reserved.

British Journal of Social Work (2015) 45, 2368–2386 doi:10.1093/bjsw/bcu084 Advance Access publication September 2, 2014

Background

Burnout syndrome relates to professions whose daily work has to do with systematic and direct contact with people in need of care (Pines et al., 1981). Maslach and Jackson (1982; Maslach, 1976), working on Freudenber- ger’s (1974) proposals, established the grounds for psycho-social research on burnout. The authors define the syndrome as a response to chronic work stress, mainly related to those professions and services characterised by con- stant, systematic and intense attention paid to people in need of care. Faced with this situation, workers frequently develop a sense of professional failure, in addition to a series of negative attitudes towards those people. It is import- ant to emphasise that burnout is not a form of psychological stress. Rather, it is a response to chronic work stress resulting from the relationships estab- lished between professional and client/user on the one hand, and profession- al and institution on the other. Burnout is, moreover, a tri-dimensional process composed of Emotional Exhaustion (EE), Depersonalisation (DP) and reduced sense of Personal Accomplishment (PA), being defined by the presence of feelings of EE, attitudes of DP towards clients and reduced feelings of PA.

Bearing this definition in mind, social workers constitute an at-risk group for burnout, since these professionals must cope with complex situations where distress and suffering are characteristics of target groups for profes- sional intervention on a constant and systematic basis. There is a body of international literature establishing social workers as an at-risk group and analysing the incidence of burnout for this group (Barak et al., 2001; Cohen and Gagin, 2005; Kim et al., 2011; Yürür and Sarikaya, 2012). Research con- ducted by Gibson et al. (1989) focusing on social workers in Northern Ireland found that 47 per cent of respondents showed DP and an even higher percent- age reported high levels of reduced PA. In New York, Martin and Schinke (1998) found that social workers in the mental health and family fields frequently developed burnout. Specifically, 57 per cent of mental health and 71 per cent of family social workers presented high burnout levels. In Chile, Barrı́a (2002) found a burnout prevalence of 30.8 per cent among social workers, and almost every respondent showed high levels of at least one of its dimensions. Thus, social workers have a strong tendency to suffer the phenomena studied. The same conclusion is valid for the study conducted by Evans et al. (2006) in England and Wales, in which they found high levels of EE and stress and that 19 per cent of respondents had low job satisfaction levels. In Spain, research conducted to assess the prevalence of burnout is scant (Lázaro, 2004; Grau and Suñer, 2008; Hombrados and Cosano, 2013). In spite of this, some articles do state the importance of the syndrome for social workers. Research designed by Morales et al. (2004) for crisis interven- tion and social services professionals found that half of respondents showed high levels for at least one dimension of burnout, 23 per cent for two

Burnout, Informal Social Support, and Psychological Distress 2369

dimensions and 11.5 per cent for all three dimensions. Along the same lines, a study completed by Jenaro et al. (2007) found that 20.4 per cent of workers in human services were at risk of suffering burnout.

In summary, previous research has shown that social workers perform their professional duties in a stressful social and organisational context (Pines and Kafry, 1978; Acker, 1999; Kim and Stoner, 2008; Pasupuleti et al., 2009). For this reason, burnout usually becomes a key dimension of professional inter- vention. Some determinants in the emergence and development of burnout among social workers are the constant social, demographic and political changes affecting and modifying both client/user problems and professional competences (Lloyd et al., 2002), scant social status and recognition for social work, low salaries and resources for social intervention (Rupert and Morgan, 2005; Acker, 2008), and problems related to organisational structure and en- vironment determining role conflict and role ambiguity, lack of supervision and coordination for work groups, and high staff turnover (Bennet et al., 1993; Bradley and Sutherland, 1995).

In general terms, previous research is reasonably supportive of the idea that burnout plays a role in the development of psychological distress and emergence of psychological disorders (Pillay et al., 2005; Milfont et al., 2008; Shanafelt and Dyrbye, 2012; Kozaka et al., 2013). Results from several studies focusing on social workers indicate that the incidence of mental disor- ders associated with burnout is considerably higher for social workers than for other professions (Bennet et al., 1993; Lloyd et al., 2002). In this vein, Caughey (1996) found that 72 per cent of social workers surveyed could be defined as possible psychiatric cases, given the high levels of psychological distress reported in relation to their professional performance. These findings are very similar to those of Balloch et al. (1998) for the same professional group and those of Collins and Parry-Jones (2000), who also noted that psychological distress was associated with high levels of anxiety and depression. In summary, previous research shows that burnout has significant negative consequences for social workers’ mental health.

Given this relationship, a number of studies have focused on those variables that may play a moderating role in the appearance of psychological distress fol- lowing the development of burnout. In this sense, one of the most important variables is social support. There is abundant research considering social support as a mediating variable between burnout processes and mental health (Bennet et al., 1993; Pines et al., 2002; Collins, 2008; Yildirim, 2008). Moreover, perceptions of both availability and lack of social support are related to the development of burnout (Acker, 1999; Hamama, 2012a). Most studies have focused on the formal social support networks maintained by workers. These networks usually include co-workers, peers and supervisors (Leiter and Maslach, 1988; Farber, 2000; Thomas and Rose, 2010; Hamama, 2012b). However, Baruch-Feldman et al. (2002) have pointed to the import- ance of close personal relationships (family and friends). A few studies (Maslach and Jackson, 1985; Greenglass et al., 1994; Huynh et al., 2013) have

2370 Esteban Sánchez-Moreno et al.

in fact shown that informal networks and relationships have important impli- cations for the development of burnout, and could even offer more effective help than formal social support systems in alleviating this phenomenon (Broadhead et al., 1983; House et al., 1988; House, 1991).

Informal social support focuses on a level of intimacy constructed within the context of an interpersonal help system that shapes an ecological daily help process in which people usually play complementary and interrelated roles (Umberson and Montez, 2010). This level of social support involves feelings of commitment and mutual exchanges and relationships with shared responsi- bility for one another’s well-being. The level of social support is thus beneficial preciselybecauseofthefunctions it fulfils.Asaresult, informal social support is widely accepted as a key variable for health and well-being (Sánchez-Moreno and Barrón, 2003).

As reported by Collins (2008), social support becomes a major coping strat- egy, since it enables the individual to deal with both instrumental (seeking information, advice, etc.) and emotional (seeking affection, moral support, etc.) issues, the latter relating to qualitative aspects of informal support. In the context of formal systems and groups, support is based on an exchange of resources aimed at satisfying the specific needs that can be met within the most intimate relationships with family and friends. We therefore see the importance of informal social support as a potential work–stress reducing variable.

The general aim of this study consists specifically of examining the relation- shipbetweeninformalsocialsupport,burnoutandpsychologicaldistressamong social workers in Madrid (Spain). Given the scarcity of existing research in Spain, one of the specific aims is to evaluate the incidence of burnout and psy- chological distress in a sample reflective of the socio-demographic composition of the profession in the aforementioned city. We also seek to analyse the roles played by burnout and by social support emanating from informal sources in psychological distress in the case of social workers. In this respect, it is worth stressing the importance of considering the potential of informal social support to reduce the negative consequences of burnout and thus addressing one of the more notable gaps in the literature, as outlined in preceding paragraphs.

Method Participants and procedure

Two hundred social workers from public social services in Madrid were con- tacted by telephone to participate in our study, of whom 189 ultimately parti- cipated inourcross-sectional research (94.5per centresponserate).Self-report questionnaires were distributed by mail to the social workers that voluntarily agreed to participate. The participants answered the questionnaires and

Burnout, Informal Social Support, and Psychological Distress 2371

returned them by mail. To present the research, a letter was enclosed with each questionnaire that introduced the research team, the context and purpose of the research, and the structure of the questionnaire, and also guaranteed participant anonymity.

The sample was predominantly female (87.3 per cent, n ¼ 165). The average age was 41.8 years, ranging from twenty-three to sixty years. The ma- jority of the professionals were married or living with a partner (70.4 per cent, n ¼ 133) and 51.9 per cent (n ¼ 98) had children.

With respect to employment, the average duration of occupation as a social worker was eight years and more than half of participants (56.6 per cent, n ¼ 107) had working experience of between sixteen and thirty years. Participants had spent an average of seven years in their current position. Approximately one-third of respondents (32.3 per cent, n ¼ 61) had been in their current pos- ition for fifteen to thirty years, 32.8 per cent (n ¼ 62) for six to fifteen years and, finally, 33.9 per cent (n ¼ 64) for one to five years. Only 1 per cent (n ¼ 2) had spent over thirty years in their current position.

Regarding agency size, the average was thirty-five workers per agency. Institutions with one to fifteen workers accounted for 34.4 per cent (n ¼ 65) of the sample, with 23.3 per cent (n ¼ 44) employing sixteen to thirty workers, 15.9 per cent (n ¼ 30) employing thirty-one to sixty workers and 21.7 per cent (n ¼ 41) with more than sixty workers. Finally, subjects reported an average of thirty-five clients per week, distributed in intervals from one to twenty-five clients (44.4 per cent, n ¼ 8

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