How to avoid activist burnout

Lately I have been thinking about activist burnout, that state you get in when you have been stretched too thin serving others or serving a cause. I decided to ask my colleague, psychologist Dr. Harry Dudley the following questions:
  1. How can people working or volunteering in fields where they are exposed to physical and psychological trauma take better care of themselves and avoid burn out ? These situations include but are not limited to war zones, hospitals, refugee camps, addiction clinics, or helping homeless populations.
  2. People in these fields sometimes have trouble saying no and take on more burdens than they can handle. What advise do you have for people who repeatedly find themselves in these situations ? How can they learn to say "no".
  3. Why is the concept that is common in activist circles of "sacrificing for the cause" unhelpful to the helper and the people he or she is trying to help in the long run ?

Harry's answers:

There is an emerging literature on burnout in human rights workers which shows that the prevalence rate mirrors that seen in other helping professions, such as physicians and mental health professional. In those groups, the rates seem to vary between 25% to 50% , depending on the study. First, let's define burnout as being a state of emotional and physical exhaustion which involved reduced effectiveness and loss of perceived identity. This can include a number of symptoms related to clinical depression, anxiety, and somatization disorders. for example, one study of human rights workers found base rates of depression at 14.7%, burnout at 19%, PTSD at 19.4%, and "sub-threshold PTSD" at 18%. These prevalence rates are much higher than what is seen in the general population. In my work as a forensic and clinical psychologist, I myself experienced periods of burnout and secondary PTSD due to vicarious traumatization when I conducted forensic evaluations of perpetrators and victims.

I would like to note that although there is an emerging literature on the mental health needs of human rights workers, it is astonishingly limited, and that is not just my opinion, rather, it was expressed in the articles that I reviewed. Clearly, as is often said, "more research is needed", and I would urge all of you reading this who are involved in academia or who are pursuing degrees to consider the community of human rights workers to be population that needs to be better studied.

Approaches to address burnout involve implementing various self-care strategies that include various relaxation and anxiety management methods and setting limits on how much one is will to take on. This is often difficult for all of us in the helping professions, as we work in overwhelmed and underfunded systems where the needs continually outpace the capacity of the organization or professional. In short, there is always one more case to take on or one more patient to treat. The literature would indicate that the same dynamic exists for human rights workers (and I also include animal rights workers as well), and in addition, there is either a implicit or explicit message that workers need to be "tough" and to focusing on their own needs might be viewed or experienced as being weak or selfish. One article I reviewed made reference to a "martyr" culture as being present is some organizations. Saying "no" in these situations is a challenge. Although I have not worked so much with human rights workers, what I advise my clients who are educational, health care, or legal professionals (where is also a great deal of burnout and related difficulties) is that when they take better care of themselves they are then better able to care their clients. In essence, your first duty really is to yourself.

I was fortunate enough as a fledgling psychotherapist in the 1980s to have had a number of supervisors who used the phrase, "you have to nurture the nurturer" when working with complex family therapy cases significant for multi-generational layers of mental illness, addiction, complex trauma, and oppression. However, they also extended this maxim to the psychotherapist themselves, as we were part of the family system and were impacted by it, as well as the organization that delivered the service, in this case a community mental health program embedded in a day treatment school in the South Bronx. I would literally be stepping on crack vials as I walked from my car to the building, and it was one of the the most rewarding, but also the most emotionally draining positions I have ever had. I was fortunate to have come away with an understanding that the worker is part of an broader system that includes demands from the clients and from the organization.

Any organization in and of itself is a subculture, and if one of the norms is that "one must sacrifice for the cause", then this is a set-up for burnout. As such, it is critical to set limits for oneself, to be able to say "no" to certain situations and to not take on that one additional case even though your supervisors thinks you are the perfect worker or it. It is important to listen to and honor the signals that your are receiving from your own physical body and to heed feelings of malaise, fatigue, and difficulty sleeping. These are signals delivering a message that something is wrong and out of balance.

One concept I have found very useful is that of Compassion Fatigue (CF). This refers to the reduced capacity or interest of a professional or worker to be empathic or to "bear the suffering" of their clients, and is the natural behaviors and emotions that result from knowing about a traumatizing event experienced or suffered by another person. CF is the result of the demands of client care (or, if one is working at a systemic level, care for an organization) overwhelms the ability of the professional or worker to care for themselves. In these situations, the worker experiences decreased empathy and compassion for their clients, who are increasing objectified. I actually view CF as the the experiential core to burnout, and I believe it is better defined from a scientific and clinical perspective, but regardless, it is my professional opinion that in essence CF is the heart of burnout.

To address CF, one can look to the emerging but rich research and clinical literature of what has been termed "Compassion Science". On the clinical end of things, I recommend the works of American educational psychologist Kristin Neff, PhD, and British clinical psychologist Paul Gilbert, PhD. Dr. Neff's focus is Self-Compassion and Dr. Gilbert's is Compassion Focused Therapy (CFT). In my practice with clients and meditation students, I incorporate aspects of both of their respective work, and although I am personally drawn more to Dr. Gilbert's CFT, which involved self-compassion, I tend to first recommend the work of Dr. Neff. Dr. Neff's writings are highly accessible and make easier reading than Dr. Gilbert's and his associates, but regardless, both are empirically derived and evidence based. Dr. Neff's book and materials are readily available via her website.

Let me first comment on self-compassion in and of itself. There is often a resistance to this based on a perception that self-compassion is feeling sorry for oneself. Let me assure you that it is not, and in fact, it takes strength to practice self-compassion as you must honestly meet and acknowledge your own foibles, shortcomings, and failures. Just as compassion means to "suffer with" and to understand the pain of others without disconnecting or avoiding it, self-compassion is directing that towards oneself, and you do then meet where you feel that you have missed the mark, and this is difficult for those of us in the helping professions. However, this also allows us to meet and accept the universality of our experience. As such, I teach clients and students to meditate on self-compassion, often by starting with directing compassion to another being, human or animal, and then directing that same felt perceptual process toward themselves.

A related practice involved cultivating a sense of gratitude. Research has shown that gratitude practices at night can improve sleep quality and mood the next day. This simply involved identifying and focusing on three to five things that one is grateful for. Aim small, and it could include one or two items that are the same everyday, such as being grateful that your car starts (one of mine) or you relationship with someone you love. It should also include small things we would otherwise take for granted, such as that nourishing lunch that you had, hearing a favorite song on the radio. I recommend that you start with a commitment to write down three to five things each evening for a period of time, such as two weeks to a month, and for most people it often becomes an automatic process that manifests itself throughout the day. Oh, no one really does it every night, or at least it is rarely the case. Rather, this is just an intention and I'm happy if people do it most of the nights, which seems to be sufficient for clients to internalize the process and for there to be shift in their negative perceptual bias. I was trained in part as a cognitive behavioral therapist, and we love to give homework to clients, but compliance and follow-through is often a challenge. However, I have been amazed by how I have experienced very little difficulties with compliance on gratitude practices.

The research would also indicate that in spite of the significant distress experienced by human rights workers, little attention is given to promoting self-care within their organization, and surprisingly few seem to seek out mental health treatment that would be useful to address their suffering. Barriers include the culture of placing the needs of others before their own and financial constraints. I believe that human rights workers perform an incredibly valuable service, and they themselves need to be valued, and part of that should involve funds or support for self-care and mental health services.

Harry Dudley, PsyD, received his doctorate in school psychology in 1988, at which time he focused on pediatric and clinical child psychology. Dr. Dudley maintains a practice in forensic, clinical, and consulting psychology. He is also a meditation teacher and has been involved in the development of trauma informed yoga classes for marginalized populations through his work with the nonprofit, Living Yoga

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