HHS 201 Introduction to Human Services Wk5

Chapter 15 Staying Current and Avoiding Burnout

The word crispy may not refer to crackers when human service workers use it; it may describe a burned-out worker. One of the authors first heard it at a college human service career day:

I had invited two of my former students to talk about their human service jobs. The first, Kathie, was all fired up and spoke energetically about her work in child protection and foster care. Sure, she said, her job had its hard moments, but that did not stop her from doing a good job or figuring out ways to solve the problems.

The second speaker, Brian, whom the teacher remembered as a bright and enthusiastic student, talked in a depressed monotone about the problems of his job that he felt were insurmountable. He droned on about his work as a probation officer in a juvenile court, complaining about large caseloads, ungrateful and manipulative clients, inadequate resources, coworkers who goofed off, other agencies that refused referrals, insensitive judges, and mountains of paperwork.

After the speeches were over, I commented to Kathie about Brian’s lack of enthusiasm. Kathie replied, “He’s not just burnt out, he’s crispy—for sure!”

Human service work draws on our deepest impulses to form important relationships and on our curiosity about what makes us think, feel, and act the way we do. It gives us a chance to laugh and play with people, to solve problems with them, to cry and grieve with them, to share the joy of their successes, to share their anger at injustice, and to work with them to change unjust systems. What job can be more important than that?

In fact, there is evidence that by helping others, people improve their mental health, their physical well-being, and even their longevity. A University of Michigan study of 423 elderly couples followed for five years found that the people who reported helping others—even if it was just giving emotional support to a spouse—were only about half as likely to die within those five years as those who did not. Another study of 2,000 Presbyterians found that improved mental health seemed to be more closely linked to giving help than to receiving it. A study of older people who volunteered in the Experience Corps to mentor elementary school pupils found that tutoring lead to measurable benefits for the volunteers, who showed improved physical activity and health compared with adults of similar age and demographics (Associated Press, 2010). However, when helping involves constant or exhausting demands, the toll it takes clearly outweighs any good it does (Goldberg, 2003).

Any work is exciting only as long as we are growing in it—expanding our self-awareness, learning more about the job, feeling good about our ability to do it, gaining more power over the conditions of work, and getting some measure of success from it. In order to grow, we need the following supports from our environment:

Working conditions that make it possible to do our best

Support and respect from our peers and supervisors

Freedom from unconstructive criticism and control

Ability to share in decision making

Some stability

It is the same with flowers: They grow luxuriously only when they have the right conditions of sun, soil, and water; if those are lacking, they wilt and die. Continual change in the human service field brings excitement and adventure as well as tension. When the change is too rapid or when it brings a political climate that is unsympathetic, it is hard for workers to do their best work.

15.1 Burnout

The term burnout and the slang terms for its varying degrees of intensity have been coined to describe the mood that human service workers sink into when they have lost their spark. The concept has—to coin a pun—caught fire. Newspapers print articles about it, workshops and conferences are held on it, teachers’ unions devote entire issues of their professional journals to it, books are written about it, and there are now “burnout experts.” On January 3, 2011, there were about 13,600,000 references for “burnout” on Google.

Reed (1979) says that burnout “disproportionately strikes those in the helping professions—teachers, counselors, social workers. It’s related to stress and can last for years. It’s harmful physically to the individual and psychologically to all those around him” (p. 12).

Two terms that are related to and sometimes used interchangeably with burnout are vicarious traumatization and compassion fatigue. Vicarious traumatization is specific to trauma and results from empathic engagement with traumatized clients, and their reports of traumatic experiences. A worker may experience both vicarious traumatization and burnout, and each has its own remedies. Compassion fatigue, also known as a Secondary Traumatic Stress Disorder, is a term that refers to a gradual lessening of compassion over time. It is common among victims of trauma and individuals who work directly with victims of trauma (LPAC, 2006).

Symptoms of Burnout

Grey (1979) says these five symptoms of stress are common:

Difficulty in sleeping

Irritability

Upset stomach

Headaches

Shortness of breath

Burnout may lead human service workers to stop caring about the people they work with, perhaps to sneer at them, laugh at them, label them, or treat them in derogatory ways. It causes workers to exaggerate differences between clients and themselves, seeing clients as “less good, less capable, and more blameworthy than themselves” (Maslach, 1978, p. 113).

Some workers escape their job by drinking or taking drugs or staying away from work—calling in sick or pretending to be at work when they are not. In place of enthusiasm, a sense of futility sets in. Some workers develop a callousness and cynicism to protect them from feeling anything. Behind this callousness may be an idealist who became overwhelmed by the job and stopped caring. Starting out with empathy for victims, the worker ends up being a victim blamer.

One woman who worked for the Save the Children agency during the war in Vietnam watched this process happen in herself. She said that when she went to Vietnam, she was fired up with enthusiasm about saving the victims of the war. But there was never enough medical staff, supplies, or equipment, and the destruction of war was too devastating for the staff to handle. In order to get even a few hours of sleep so they could start again the next day, they had to push the doors shut against the bodies of people screaming and pressing to get in for emergency medical treatment. She began to resent the people for their insatiable demands and for making her act like that. She never in her life dreamed that she would be slamming a door on people in such desperate straits. She had to go home to rebuild her sense of self.

15.2 Causes of Burnout

There are at least two ways to analyze the phenomenon of burnout. One, based on individual psychology, emphasizes the emotional stress of working with problems that can reactivate the worker’s unconscious childhood conflicts (Littner, 1957). The other approach, based on sociological theory, examines the social system in which human services are embedded and claims that the system itself creates the stresses. Karger (1981) argues that the very term burnout is misleading because it focuses on the subjective state of the individual. He would substitute the term alienation, a sociological term used to describe the way that the structure of a job distances people from their work, from each other, and from themselves. This would put the focus on the organization and the larger society. Both the psychological and the sociological points of view are correct, but they often ignore each other’s insights.

alienation

A sociological term used to describe the way the structure of a job or an organization distances people from their work, from each other, and from themselves.

Karl Marx used the term alienation to describe the process that happens to workers under the system of capitalism. His description matches closely the descriptions of burnout experts:

What constitutes the alienation of labor? The fact that labor is external to the worker, i.e., it does not belong to his essential being; that in his work, therefore, he does not affirm himself but denies himself, does not feel content but unhappy. Does not develop freely his physical and mental energy but mortifies his body and ruins his mind. The worker therefore only feels himself outside his work, and in his work feels outside himself. He is at home when he is not working, and when he is working he is not at home. His labor is therefore not voluntary, but coerced; it is forced labor. It is therefore not the satisfaction of a need; it is merely a means to satisfy needs external to it. Its alien character emerges clearly in the fact that as soon as no physical or other compulsion exists, labor is shunned like the plague. External labor, labor in which man alienates himself, is a labor of self-sacrifice, of mortification. (Tucker, 1972, p. 60)

Marx does not distinguish between skilled and unskilled workers. However, a worker who takes pride in her or his work because of its high quality is probably less likely to burn out than is an unskilled worker.

Alienation can affect anyone in any kind of work and with any status. One of the earliest researchers on it, Christina Maslach, says that today hedge fund managers are as likely to be burned out as any do-gooders. “In 21st-century New York, the 60-hour week is considered normal. In some professions, it’s a status symbol. But burnout, for the most part, is considered a sign of weakness, a career killer” (Senior, 2007).

Psychological Conflicts

The powerful emotional stress and thorny problems that human service workers deal with daily often touch deep responsive chords in them: A worker who was neglected as a child may impute neglect when parents are merely casual in their parenting style; one whose parents were extremely strict may see the with fury at seemingly overdemanding parents. Many beginning workers are still dealing with their own issues of dependence and independence from family, mate, religion, and cultural group. Often it is difficult for them to sort out when their own struggles and those of their clients begin and end. For young workers, identification with the problems of teenagers or young adults can easily cross the line into overidentification.

overidentification

The process of relating so completely to another person’s feelings and/or experiences that one cannot separate oneself from the other person.

Sometimes the goals of the work itself cause ambivalence and anxiety, even when the worker basically agrees with the agency’s mission. You can feel strongly about the importance of protecting children from abuse, but accusing parents of perpetrating that abuse, and even removing children from their homes, can cause intense anxiety.

Workers in abortion clinics are also under emotional stress because of the nature of the work. Carol Joffe (1983) studied workers in one clinic and found that, even though the workers supported a woman’s right to choose an abortion, they did not believe that abortion should be done as a method of contraception. They loved babies, were happy when a client decided to go through with her pregnancy, and were joyous when one of their own staff had a baby. They were more pro-choice than pro-abortion. Yet, in the embattled political atmosphere that surrounds abortion, they were forced to “cling, at least publicly, to a rhetorical pro-abortion position” (p. 318). The politics of abortion rights forced them into a rigidity they did not really feel, and this created stress.

Conflicting Social Values

Combined with these very personal stresses are the even more serious strains induced by the ambivalent values of our social system, which gives only grudging support to universal social services. Welfare workers are in the front line of this conflict. To illustrate how one worker deals with these conflicts, following is an interview with Rick Colbath Hess.

Interview Rick Colbath Hess, Director of MassSERVE

Rick Colbath Hess is the founder of MassSERVE, an organization dedicated to improving the working conditions of human service workers. We present here an interview with him, conducted by a staff member of the Mass Human Services Coalition in October 2001 (Mass Human Services Coalition, 2001).

hsc:

We’d like to talk to you about the whole direct care worker crisis that’s rampant throughout human services and in particular, what MassSERVE has been doing about it. So perhaps we could start by you giving a little background on the founding of MassSERVE.

rc:

Well, there were essentially a bunch of human service workers who came together who didn’t feel like they had a voice in any other place. Their organizations were not unionized and they felt like they should have a voice in the political process and they came together and people were very upset about the working conditions and what was going on in the field and out of that came MassSERVE. That’s the short version.

hsc:

Could you tell us a little bit about your own experience as a direct care worker? Or how you became involved in this cause and effort?

rc:

Sure. I’ve been in human services now for seventeen or eighteen years, I’ve worked with homeless people, I’ve worked with people with drug addictions, I’ve worked with people in food pantries, I’ve worked with program creation, and my last job was at Catholic Charities, and when I went around interviewing for that job, I went to many many different agencies and they were all dropping their personnel policies and going to “worker at will” provisions and I realized at the time that there was really a power shift in the dynamics of what was happening in the field and that people really didn’t have much say at work because providers were also losing their say and it was trickling down to the workers. After working at Catholic Charities for three years I had children and—let me see how to say this—I was essentially demoted for trying to negotiate a child-friendly work schedule and there was really nowhere for me to turn for help, and out of that experience really came my organization. I ended up being laid off from that job and I started organizing MassSERVE and putting together a lot of people who had been talking around these issues.

Also in my internships at social work school, I saw how depressed everybody was. People were essentially responding the way they would respond to crisis, fight or flight. Half the staff was depressed in my internships and the other half was angry as hell and the energy was very misdirected. People did not seem to be able to respond to the political crisis at the time: the crisis of privatization, the degradation of human services, both at the service level and at the employee level.

hsc:

Well now MassSERVE has put forward a possible solution to the direct care worker crisis; the Human Services Worker Living Wage Bill. Could you tell us a little bit more about the genesis of the bill and what coalition has emerged in support of it?

rc:

Well, the bill came out of looking at the whole field, who was suffering the most, looking at research and seeing that when you push the bottom up, everybody else goes up too. And also following the Living Wage movement nationally and seeing what a success it’s had and we had a number of goals at MassSERVE but we decided that wages were the most pressing at the time and we started working on developing a strategy around the living wage bill. And from that we were able to try to pull together—one of the advantages of the organizing that we’re doing is that being a worker organization, we don’t go directly after providers, we essentially view the state as the provider. Without moving the state you can’t change much of the conditions in the work field. We were able to pull providers, unions and recipient groups together which has been a very hard thing and phenomenal kind of thing that came together.

hsc:

Well now there is a very large dollar amount attached to the Living Wage Bill, in the range of $100 million, what’s it going to take to get the state to be willing to make that kind of investment? What do YOU think it’s going to take to get that bill passed?

rc:

Well clearly … all salaries need to be upgraded, not just people at the bottom, there needs to be more training and possibly some kind of career ladder, [where] salary is tied to education and experience, that world view—I think there are many places in other parts of the world where it’s a very professional field where you actually get trained and people get paid much higher. I think if it was looked at more professionally, then salaries would go up and that quality of care would go up. And I think that another one of the long-term strategies is essentially for the union providers and recipient groups to work together and to find their common ground to push for legislation to improve all their lots.

The Bind of the Double Message

As we discussed in Chapter 2, powerful forces are trying to dismantle most, if not all, government support for social welfare. As a result, “social workers are caught between the privatization of profits and the socialization of the costs from that profit making” (O’Connor, 1973, cited by Arches, 1991).

The human service profession is built on a humanitarian ethos, but everyone in our society does not fully subscribe to it. And therein lies the conflict. Communities rarely provide the full resources of money, time, and caring to allow the human service worker to do the kind of job that needs to be done. One writer says that the modern welfare state has converted the ideal of service into cynicism or self-serving careerism (building your career at the expense of other values). This has made some committed and idealistic workers so disillusioned that they leave public service. This in turn makes it less likely that agencies will change, because the most idealistic workers often leave.

humanitarian ethos

A dedication to promoting the welfare of humanity, especially through the elimination of pain and suffering.

careerism

A single-minded preoccupation with getting ahead in a career to the exclusion of other interests or values.

Workers face many double messages in this country. They are continually in conflict about whether to help clients summon their energies for change or to make the client more obedient in order to fit better into the agency’s way of “helping.” They may want to advocate for their clients to get more services, but the agency, with an eye on the budget, probably wants to limit services. Workers may want to work with clients as allies in shaping the policies and practices of the agency, but the agency does not encourage input from clients or alliances between workers and clients. Although the agency proclaims its desire to “help,” that help may merely mean manipulation. All of these contradictions mirror the ambivalence society has about its poor.

It is the front-line worker who is called upon to broker these contradictions and rationalize them to the client and to her or himself…. Public defenders committed to the ideal of providing the indigent with legal representation find themselves in court without time even to interview the client, let alone prepare adequately. Teachers find that the more pressing the need for creative classroom instruction, the more likely is the school to be overcrowded, and the more inundated the teacher is with disciplinary and housekeeping chores. When welfare workers in Massachusetts are assigned the statutory maximum of 180 cases (and others stack up, uncovered), or when judges have dozens of cases to dispose of daily, the possibility of personalized assessment becomes submerged in the need to process the work.

Although public agencies empowered under various legislative acts are required to serve everyone who is eligible, they often cannot do so with their limited resources. Some react to this imbalance by devising ways to keep people from applying for service and by delivering an inaccessible or inferior product. Public programs often cannot charge fees, but they can set “prices” by inflicting indignities such as requiring long waits or limiting information.

Obviously, these techniques contradict the ostensible program goals. Yet a worker who provides superior service will be rewarded only with additional clients. Greater availability or quality of services like health care, or greater accessibility of effective counseling to families in crisis, simply attracts more customers and harder cases. Adding capacity fails to solve the worker’s perennial problem of inadequate resources (although it may in fact extend mediocre service to more people).

The worker in public welfare programs confronts the dilemma of the fabled highway planner of the congested Long Island Expressway. The engineers kept adding additional lanes on the theory that this would alleviate traffic jams. However, the increased capacity only attracted more drivers, so that congestion was perpetuated, albeit at higher traffic levels. (Lipsky, 1980a, pp. 33–34)

Agencies respond to this pressure by following the Peter Principle (which suggests that services expand until they reach the point of mediocrity). More people may be served, but they are not served well. Agencies often sacrifice their original service goals in order to meet their bureaucratic needs. For example, when the job market shrinks, vocational placement agencies change their objectives from finding people jobs to “job counseling.”

The recession has resulted in cutbacks in human service programs. Many services have been eliminated completely, and some have had severe cutbacks in staff. A medical social worker in a hospital says that the most frustrating part of her job is the fact that there are so few services to refer people to when they are ready for discharge from the hospital.

Increased Bureaucratization

Bureaucracy has become pervasive within the past few decades, and social agencies too have followed that trend. Increased bureaucratization means more centralization, more hierarchical control, larger workplaces, and decreased autonomy for workers. “Authority and discipline imposed by sponsors undermine autonomous input. Rigidly enforced and scheduled work hours and quotas are common” (Arches, 1991, p. 202).

Butler studied 404 members of the Virginia National Association of Social Workers in 1986 to assess job satisfaction. Not surprisingly, she found that workers who had high levels of daily frustration and emotional intensity, excessive bureaucratic demand, and too much paperwork were less likely to be satisfied (Butler, 1990). Those who worked in large agencies were also less satisfied. Thirteen percent of the workers studied had a full-time private practice, and 17 percent had a part-time private practice. Butler says that small groups give better support to coworkers and have less bureaucratic red tape. Social work managers in large bureaucratic organizations need to find ways to organize their work units into smaller groups (p. 25).

Low Salaries and Decreased Satisfaction

A factor that caused discontent among some workers in Butler’s study was low salaries, which was apparently one reason that some workers left agency work to go into private practice. Other studies show that in social work, men are more satisfied with their jobs than women. Men’s salaries are consistently higher than those of women in both service and administration positions.

Insurance and Government Reimbursement

When insurance companies dictate the kind of treatment to be given and the way of giving it, workers no longer decide how the work gets done. This affects social workers in private practice as well as in agencies. Private insurance companies reimburse only for psychotherapy, diagnosis, and evaluation. They do not reimburse for marital counseling unless the client is given a diagnosis from what has become the “bible” of diagnosis, the DSM-IV—the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (Text Revision) (American Psychiatric Association, 2000). Every request for reimbursement in any field of practice must be accompanied by a diagnosis from DSM-IV. This means that much of our work is not reimbursable, including nursing-home placements, foster care, client-related meetings, and advocacy.

Even when a practice is reimbursable, the insurance company sets the time limits. Workers make cynical jokes about “sixty-day miracle cures” for psychiatric patients. They are discharged as “cured” from the hospital when the insurance runs out, whether or not they act or feel cured. However, the Health Care Reform bill of 2010 includes a provision that people will no longer have a lifetime limit or “cap” on insurance coverage.

Workers may not be able to choose the treatment of choice because of insurance requirements. “For example, if only 12 visits are reimbursable, then planned short-term therapy is likely to be used whether or not it is deemed clinically the best treatment by the social worker” (Ortiz & Bassoff, 1988, p. 116). Medicare establishes time limits for treatment of each diagnosis under its system of diagnosis-related groups (DRGs). Ethical dilemmas abound:

In some agencies, social workers are encouraged to double-book clients so that the outside coverage will still pay for the worker’s time if one of the clients does not show up. If both show up, someone is forced to cool their heels in the waiting room. In other settings, social workers are pressured to drop clients who do not show up for two consecutive appointments. (Arches, 1991)

Arches (1991) studied 275 registered social workers in Massachusetts in 1988 to assess their level of job satisfaction and burnout and found that one source of stress was that agencies have several financial sponsors, and each sponsor has different demands. The workers in her study “reported working in agencies with an average of five external sponsors” (p. 203). For example, a family agency might receive money from several insurance companies, Medicaid, Medicare, state contracts, and the federal government. The agency is responsible to each of these sources of money, and the worker must comply with their demands as well as the agency’s demands.

Time Pressures

When there is not enough time, the helping impulse may become extinguished. Careful listening takes time and patience. In fact, according to a Princeton University study, time is one of the most important reinforcers of the helping impulse (Shenker, 1971).

In the study, three groups of theological seminary students were given a speech to read at a nearby building. On the way to the building, they encountered a man lying on the ground acting as if he were suffering (this was arranged by the researchers). One group of seminarians was told they had plenty of time; another, just enough time; and another, that they were already late. The ones who stopped to help most often were the ones with the most time (63 percent of “low hurry,” 45 percent of “intermediate hurry,” and 10 percent of “high hurry” men stopped). The researchers speculated that in the biblical parable of the Good Samaritan, the Samaritan, being a man of low public status, had little important business to attend to, so that he had the time to help. One could imagine the priest and Levite, “prominent public figures, hurrying along with little black books full of meetings and appointments, glancing furtively at their sun dials as they go” (Shenker, 1971, p. 25).

“I’d like to schedule a time management seminar on my calendar…as soon as I find time to buy a calendar.”

Lack of Resources Outside the Agency

Even if workers are lucky enough to be at an agency with enough money to hire competent staff, keep caseloads to a manageable size, and provide good supervision and a supportive environment, they are not home free. As long as other agencies are not as lucky, the impact is still felt by the clients and workers of all agencies. In the following narrative, Priscilla Shade (1981) tells of how state cutbacks in medical benefits to General Relief recipients affected her work in the welfare department:

What this left workers like me to cope with were cases like the man who’d had surgery of the colon, who, with medical benefits cut, couldn’t afford colostomy bags—life-sustaining medical supplies—because he got so little money on General Relief. He’d come in the office and get sick right there. Of course I was hysterically dumping him and clients like him back on City Hospital. At the hospital they went crazy from the patient overload. It also put the doctors there in the position of seeing a patient who may not have been disabled for the minimum of thirty days that was required for eligibility, but the doctor knew the patient would have nothing to eat if he didn’t say he or she was disabled for thirty days. So all of a sudden, doctors were put in a position of having to lie for the client: they were caught right in the middle. (p. 28)

Shade goes on to describe how her work was affected when the state eliminated General Relief for the unemployed:

Those clients who were merely unemployed and now cut off from General Relief began to reappear with a variety of illnesses related to their mental state. This meant an additional burden for caseworkers. In the end, clients got no “stopgap” assistance for unemployment, caseworkers were saddled with heavier “crisis” caseloads, the state footed a higher bill—and no one was helped. (p. 30)

Shade also describes how the housing shortage forced workers to do “shelter shuffling,” sending deinstitutionalized mentally ill homeless people from one shelter to another because of the differing eligibility criteria of shelters, and how workers are caught in the middle of contradictory agency policies. She tells how at one point the state provided professional services to clients while ignoring their basic needs for food and shelter:

When I worked in the services division I learned to beg, borrow, and steal. I got to know a lot of people and I got to know where I could beg this, where I could borrow that, and where I could get $5 for groceries. I depended on the private agencies. I went outside the system. It strained every resource I could ever think of—even my own pocketbook. I was broke every week. (p. 30)

Lack of Support from the Agency

A worker’s frustrations in the face of inadequate resources can be eased when the agency goes to bat for its workers, helping them do the job despite problems. But if the agency blames the workers for its own inadequacies (as sometimes happens), workers are likely to feel angry, guilty, and depressed. Some government funding sources and agency bureaucracies have tried to deal with their workload problems by introducing management methods that stress accountability and speeded-up work.

accountability

A requirement, usually imposed by a funding source, that an agency perform according to a certain set of standards.

Agencies are increasingly under the gun for accountability and effectiveness. This can cause anxiety that sometimes interferes with doing quality work because of the new concern with quantity and numbers. Although workers should always be concerned about their effectiveness, attempts to prove effectiveness in narrowly conceived mechanical ways can be useless at best and intimidating at worst. Workers may have to write down the way they spend every minute of the day in an efficiency study. New managers and management techniques come and go. The concern with numbers and quantification can lead people to adopt techniques they are not comfortable with and use them in absurd ways.

Buckholdt and Gubrium (1979) studied a children’s residential treatment institution that had adopted behavior modification as its treatment method because its funding sources insisted on some numerical proof of effectiveness. Behavioral modification offered more precision than the psychodynamic strategies the institution had previously used. The actual treatment seemed to continue more or less as it had before—loving and caring and time-consuming, the days filled with activities. It was probably one of the best-run institutions in the area, perhaps the nation. Yet the workers, anxious to prove their effectiveness, became preoccupied with quantifying the children’s behavior—how many temper tantrums, how many refusals to do homework, how many small thefts—in an effort to prove that they had solved these problems.

We return to Priscilla Shade’s (1981) account of her work in the welfare department to illustrate how an agency can subvert a worker’s desire to help people:

The worst thing was that the worker was caught in the middle—caught in the contradictions of programs that provided, for instance, job counseling to clients when there was little hope of employment. Then, too, workers were faced daily with programs that provided preventive health screening for children; while other policies cut down on the amount and quality of food that could be purchased by the family. In effect, well-intentioned programs were being established while other policies undermined them. Those of us whose job was to help people found ourselves working in a system that did not allow it. (p. 30)

Pressures Exerted by Clients

Workers are not the only ones who become angry and frustrated when resources are inadequate or rules are restrictive. Clients feel the same but often express their negative reactions to the worker because that is the person who face-to-face denies them the resources they need. The legislators who voted the inadequate funding are shadowy figures. Today, the worker not only has to face clients’ anger but also has to face continual value dilemmas. In an effort to help their clients find the resources they need for survival, workers often devise their own methods of playing the system, or they look the other way as their clients do so. One British author describes the kinds of dilemmas that workers face daily:

How many social workers, for example, ignore the illegal fiddling of some of their clients against the Department of Health and Social Security, an organization which social workers surely see as being unkind to themselves as well as to their clients? How many probation officers turn a blind eye to the breaches of the probation order by offenses of their clients? How many social workers simply do not care about the fact that a client earns a pound or so more than social security regulations permit by working behind a pub bar at night? These are questions to which we do not know the answers, and perhaps nothing more than discretion will prevent us from ever knowing. But our commonsense knowledge tells us, as insiders to the codes and signals of the profession, that the social worker sometimes serves the function of a … Robin Hood who, if he is not actually robbing the rich to feed the poor, is aiding and abetting the offense. (Pearson, 1975, p. 21)

A few welfare workers, on the other hand, regard bureaucratic rules with almost religious reverence and are on the lookout even during their leisure time for clients who are working part time without reporting their wages.

Involuntary Clients

Some clients are angry because they never asked to be clients, and they fight their client status every step of the way. Such involuntary clients include parents accused of child abuse and neglect, juvenile or adult offenders who are imprisoned or on probation, involuntarily committed mental patients, some old people in rest homes or nursing homes, children in treatment programs, and people caught driving under the influence of alcohol. Through patient and empathetic work, many of these people can be encouraged to participate, and some end up being genuinely grateful for the worker’s intervention. Some continue to resist even the most patient and caring of workers.

involuntary clients

Clients who are forced to use a social service, usually by a court.

T. S. Szasz (1965), a psychiatrist who thought and wrote a great deal about the involuntary status of clients, argued that when the power differential inherent in the relationship is made clear and explicit, both you and the client can deal more honestly with each other. Some human service work is used for social control, so it is important to distinguish between social control and social service, both for theoretical clarity and to help us understand our relationships with clients. Clients of probation officers or parole officers may regard their workers as police officers who are not to be trusted. Child-protection workers investigating an abuse complaint should not be surprised if they are also regarded as police officers, because they are symbolically entering a client’s home with the long arm of the law.

Stigma, Discrimination, and Status Ranking

The poor, the physically disabled, the retarded, the mentally ill, and the prisoner are often stigmatized by the larger society. People who work with them find that some of that stigma rubs off on them. Workers may often discover this when telling their friends or relatives about the nature of their jobs. Perhaps they have just gone on a home visit in a very poor section of town, or they have just gone to court with a youthful offender accused of a violent crime. People may say, “Aren’t they dirty?” “Why do you want to help him?” Some people can brush off these remarks, which only reinforce their commitment. Yet such constant reminders of the low social esteem in which their daily tasks are held can be demoralizing.

The public often makes distinctions between and within groups of people, continuing the age-old stereotypes of “deserving” and “undeserving” clients. Among the least stigmatized are the more affluent clients who take their interpersonal problems to the offices of private psychiatrists. Among the most stigmatized are the drug addicts and alcoholics who live and socialize on the local skid row. Because human service workers are part of the same society that creates these stigmas, they also sometimes measure their clientele by the same yardstick.

A stigma is effective only if you believe it. Rick Colbath Hess and many other workers refuse to accept the stigma that society puts on clients and the people who work with them. Rick sees all people as equally valuable and does not divide his clients into “deserving” and “undeserving.” Nor does he consider his social status diminished because he works with stigmatized clients.

Added to the stigma problem is the status problem. There are often sharp and painful status differences between professionals within an agency. A worker with an associate’s degree from a community college may be doing exactly the same work and doing it just as competently as a worker with a Bachelor of Social Work (BSW) degree from a four-year college; yet the pay for the associate’s degree worker will probably be less, the possibility of being promoted without further credentials may be nil, and—to rub even more salt into the wound—the BSW worker might even be insensitive enough to remind the worker with the associate’s degree of the supposed superiority of the BSW degree.

Dealing with Danger

Human service workers usually work with poor people, and some of them live in neighborhoods that contain some violence. Naturally, a worker wants to avoid violence, yet needs to work in those neighborhoods. When a worker shows excessive anxiety about it, disproportionate to the reality, clients can interpret that as contempt or hostility toward all the people who live in the neighborhood. Yet some caution is realistic, and clients know that better than anyone else. They can give you good advice about taking precautionary steps. It is important to establish collegial relationships with neighborhood people so they trust you and show concern for your safety, just as you are concerned for their safety.

Human service workers have sometimes been assaulted by their clients, and even murdered. Health care and social services workers have a high incidence of assault injuries. Definitions of violence vary, depending on the person doing the defining. Some people consider a verbal threat to be violence, while others do not. The most prevalent form of violence is verbal threat (Kadushin, 1992). Physical assaults are not as prevalent. Research shows that young and relatively inexperienced staff are at greatest risk of client assault in community residential mental health programs (Flannery, Fisher, & Walker, 2000; Flannery et al., 2001).

Child-protection work is especially dangerous because parents sometimes react violently when a worker threatens to take away their children. In 2007 in Massachusetts, nineteen Department of Social Service workers reported that they had been physically assaulted on the job, and five of those assaults resulted in injuries: for example, when a client punched a social worker in the face in a courtroom, or when someone hit a social worker in the side of the head with a rock while that worker was knocking on a client’s door (Badkhen, 2008).

Most agencies offer their staff strategies to stay safe. The Massachusetts Department of Social Services has installed fortified glass in the reception areas at most field offices. In one office, a police officer sits in the lobby once a week. Social workers schedule meetings with potentially threatening clients for the day the police officer is on duty. The department also instructs its workers to always go in pairs when they investigate reports of child abuse or neglect. If the workers believe that they are at risk, they can ask police officers to accompany them (Badkhen, 2008).

Workers often deny that they can become victims at the hands of their clients, thereby overlooking the potential for danger (Maier, 1996). This leaves them more vulnerable because they do not take realistic steps to protect themselves, and it also denies the agency information that they could use to help protect workers. Your agency has a responsibility to keep you safe and you should expect, even demand, practices that protect you from possible danger and that give you support when you encounter a threatening situation. You should expect support from your supervisor and from your colleagues. Sometimes colleagues are not as supportive as they should be because they want to deny that the same thing could happen to them. None of us is invulnerable, and we all need support.

Hazards of the Work

Most human service workers go into the field because they have ideals and a vision about helping people and optimism about the possibilities of change. This is an absolute requirement for the work; when ideals die and turn to cynicism, that is burnout. Yet an occupational hazard for human service workers is that the desire to be of help can turn into a rescue fantasy—a belief that they have to do it all, and if clients don’t change in a desired way, the worker has failed:

No matter how much you care, show concern, or even love, students will quit, inmates will mess up, patients will die, depressives will commit suicide, and parolees will violate the conditions of their paroles. It’s natural to feel that a portion of the failure is your responsibility. Maybe you really did the best you could. If you had to do it over again, perhaps you would do some things differently. Perhaps that will help you with the next challenge. Failure is especially hard on the new staff member who is fired up with humanitarian zeal to help, to give, and to serve. Your own well being and sanity may be at stake if you accept more than your portion of any failures. (Russo, 1980, pp. 157–158)

Even workers who do not succumb to rescue fantasies or the need to be omnipotent in clients’ lives can be dragged under by the sheer weight of people’s problems, many of which may be essentially unsolvable. Sometimes the feelings of helplessness and of being overwhelmed come from the simple fact that life is often painful and that some pain cannot be removed, some problems cannot be solved, and the best you can do is simply reach out and show that you care. Here is an account of one student’s feelings about the pain of the human drama in her fieldwork:

Sometimes when I go into the home and I haven’t been there for a while, I’m almost afraid to ask, “Well, how are things with you, Mrs. J.?” I know that she’ll begin to catalogue all the things that are wrong with her. Her health is really in a terrible state, and it’s hard for her to get used to all the tubes and bags and the feelings that she can’t do anything by herself. And then she’ll tell me that her son didn’t show up after he swore he would. And, damn him, why can’t he visit once in a while? She seems like she’s such a decent person and she really cares about him. A visit would make such a difference in her morale, but I can’t drag him in, and what can I say to her to make it okay—that he is just too busy with his own life to visit a sick old lady, the person who raised him and looked after him when he needed it?

For all of us, there is often a wide gap between what we wish we could do and what we can do. As human service workers, this gap can be particularly painful when we feel we are behaving differently with our clients than we were taught to behave in our college classes. Human service workers can lament, along with doctors, that no one comes to see them when they are feeling good. In some ways that is true. We often encounter people at their worst, when they are the most abusive, discouraged, depressed, overwhelmed, and angry. Frequently they have already had their problems for many years. Inadequate housing, poor schools, bad marriages, and destructive parenting patterns did not appear overnight and will not disappear overnight; so several things happen. Our clients often slip back into destructive patterns of behavior even after they see other possibilities. An alcoholic adult may make a hundred vows that will probably be broken and cover each with a hundred excuses—the same ones we ourselves use when we explain why we have abandoned our exercise program again or have broken our diets:

I’m not really hooked.

I’ll just do it one more time to get me through this hard stretch.

When things calm down, I’ll stop drinking (overeating, taking dope, being beaten or beating).

Just one more binge, and then I’ll quit!

The parent council that quite justifiably complained that no one ever listened to their opinions before still has barely a quorum even though you are committed to not submitting the next budget without their approval. You really, really mean to share the power with them yet they still don’t show up in any significant numbers. So here you sit, making the decisions for them!

Often when our clients are feeling better about their lives and possibilities, they take off, and we never know just how well they are doing and how well we did with them. Sometimes they even need to deny that we were of any help to them at all. Sometimes we encourage them to feel their own sense of power by minimizing the contributions we may have made. But being human and having our own needs for stroking, we can at times get angry at them when they fall back into old behaviors or seem to be rejecting us or putting down the help we have given them.

Living life fully as a handicapped person and as the parents or caregivers of handicapped young adults takes genuine courage. An array of tennis stars at a tournament celebrate two young people they dubbed, “the True Champions.” The tennis players are McEnroe, Martin, Cash, Courier, lvanisevic, and Wilander.

Some days being a human service worker can be a thankless task. You have to look in the mirror and say, “Hey, I just did a damn good piece of work!” You’ll probably have a supervisor, coworker, or good friend who gives you strokes for your good work just in case you don’t get them from anyone else. We shouldn’t need to be constantly thanked and fussed over, but we are all human and need a small pat on the back from time to time.

15.3 Some Less-Than-Ideal Reactions to Stressful Conditions

Some ways of reacting perpetuate feelings of powerlessness, and others help workers to gain power and autonomy for themselves and their clients. The following five common reactions illustrate the least creative ways of coping with job stress; they do not involve an active struggle to take charge and master one’s work environment (Wenocur & Sherman, 1980).

Total Capitulation

A patient in the hospital where she worked asked Ginny, a social service aide, if he could look at his medical records. Ginny said she’d ask her supervisor, who promptly said, “No. Patients have never been allowed to look at their records. That’s our policy. We’ve always done it this way.” That made sense to Ginny. If things had always been done that way, that’s the way she wanted to do them, too. All her life she had tried hard to do things the way other people did them. She had only to pick up a slight cue from her parents, her teachers, her minister to set her on the straight and narrow path; she never rocked the boat. Needless to say, Ginny never went out on a limb to fight for patients’ rights to read their records or for anything else. She simply closed off whatever empathy she had brought to the job and spent a lot of time shuffling papers. She lasted a long time.

Total Noncapitulation

In the course of his twenty-two years, Rafael had variously been described as a “maverick,” an “agitator,” a “radical,” “unrealistic,” and “immature.” In his job at the Department of Welfare, he was constantly furious at the bureaucracy, “the stupid regs,” “the dumb supervisor,” “the crummy welfare grants,” and “the stupid, greedy, and corrupt legislators” (and he used other, less printable terms). He always agreed with his clients when they railed against the system; yet he never controlled his anger long enough to analyze the system or to help his clients understand it or work to change staff attitudes or regulations. His radical friends described him as a “rebel without a cause,” not the kind of radical who got to the roots of problems. Rafael was fired after six months on the job; he had achieved little positive change but was well on the way to his first heart attack.

Niche Finding

After Bisi finished college, she got a job at the county Department of Child Welfare, where she was given a caseload of eighty foster children, plus their foster and birth parents. The workload overwhelmed her; she could never get on top of it. In the morning, she reached in her box to take out the telephone messages written on pink memo slips that had piled up when she was out in the field the day before. She held her breath as she read them, hoping she wouldn’t find the dreaded message from a foster parent—“Take Johnny out today. I can’t stand him a minute longer!” or “Susie’s run away. Call the police!” As she reached the point of being unable to stand it anymore, the agency offered her a special intake job, with a lower caseload. One can certainly understand Bisi’s finding a safe niche for herself—any one of us might do the same. Workers like Bisi find an area of expertise or a special position in the organization.

If workers concentrate only on their particular niche, they gain real but limited power in one small segment of an agency, but they have opted out of trying to change the entire agency. However, it is also possible that, having found a job that uses her full talents, Bisi will have more energy to devote to changing the agency.

Becoming a Victim Martyr

Following is a narrative by one worker who tried to do too much:

We were so terribly understaffed when I first went to work at the recreation center that I found myself doing everything from running the dance to cleaning up afterwards. It killed me to have to keep saying “no” to the kids every time they’d come up with something they wanted to do. So, little by little, I’d give in—one weekend it would be a camping trip, another a disco party, and soon I realized I’d worked seven Saturday nights in a row. Well, my boyfriend was getting really annoyed. He’s a computer programmer who works very hard but doesn’t take his work home with him, so on the weekends he’s ready to play. I dragged him with me when I took the kids places, and he was terrific with them, but he began resenting the fact that we were never alone.

After a while I also began to miss the closeness we used to have. I got flak from other friends, too—they’d want to talk with me and I’d be falling asleep from sheer physical exhaustion. Suddenly I realized that at 23 I didn’t have the stamina of my 14-year-old group members. I also realized that I still had to clean my apartment and do the laundry, and my world was getting messier and messier. Somehow I got through that summer, but in the fall I told the director that this center absolutely had to have more staff if it was really going to respond to the neighborhood kids. I knew I was falling apart and couldn’t keep up the one-handed tennis match much longer.

This worker quickly fell into the trap of being a “victim martyr,” believing that she had to fulfill totally all the tasks the agency claimed it was doing. The job was impossible to do by herself, but she believed the implicit message of the agency that she had to do it. This is sometimes called a double bind—a person is given two contradictory messages. She obeyed the part of the message that said, “You must do it because we say that’s what we do” but was continually facing the other message: “But you can’t do it—no one can alone.” Until she faced that issue with the agency, she was unable to lead a well-balanced life of her own.

Some victim martyrs have the additional burden of working in agencies where the clients are angry and powerless. The victimized workers identify with the clients’ anger and powerlessness, feeling the same themselves, but then get stuck in a powerless position and feel unable to change the system (Wenocur & Sherman, 1980).

It is easy to be sucked into the role of victim martyr, because most workers genuinely want to help and place high demands on themselves. Knowing our limits helps both us and the agency to face reality in a constructive way.

Withdrawal

Many workers withdraw from the overwhelming pressures of their jobs by quitting. This may sometimes be a move that is essential for the worker’s mental health, yet, it doesn’t change anything for the agency or the workers (Wenocur & Sherman, 1980).

Mixed Reactions

Although we have described these five reactions as “pure types,” people are more complex than that and generally react in various ways to their jobs. Priscilla Shade, for example, fought valiantly for her clients for a time but finally felt that it was hopeless and quit the job to be a full-time mother. Here is her description of that process:

I dealt with the welfare department’s Wonderland-like working conditions by venting my anger. I raved a lot. I screamed. I called Legal Aid. I exerted political pressure. I went and testified in district and federal courts against rulings that affected clients. In the instance where medical benefits were cut from General Relief, I and a group of coworkers went to our state legislator. His assistant, who also had contacts in the human services department, had been told that people were dying for lack of medical benefits. So in six weeks the legislature—without going through the usual public hearings—restored medical benefits to people who were on General Relief…. In the end, though, the workers and clients were driven apart. This is what happened to me. Slowly I was going down. And no matter what I did, the policy makers were going to come up with some beaut tomorrow that would put me three feet behind where I was the day before. So when the baby sitter who was taking care of my child suddenly got sick, I decided I’d be a full-time mother again…. Even with the best of intentions, programs don’t work when they’re erratic, underfunded, and understaffed. And starting new programs while crippling others will not help. Ultimately, client advocacy is not an option for the line worker: it is a requirement. For only advocacy will enable workers to obtain the means to do their job, hopefully in a decent and humane way. (Shade, 1981, p. 31)

15.4 Staying Alive—Positive Adjustments

The major responsibility for avoiding staff burnout rests with the administration: this is what administrators are paid to deal with (Weissman, Epstein, & Savage, 1983, p. 301). Just as workers are held accountable for their work, agencies too should be held accountable. Weissman (1973) believes that agencies avoid examining their own efficiency and effectiveness by focusing on the efficiency and effectiveness of their employees, and he recommends “bottom up” evaluations, that is, having workers evaluate their supervisors and directors as well as the other way around. We would add to this that clients should also be routinely asked to evaluate both their workers and the agency.

Combating Stress

The welfare department is particularly vulnerable to shifts and contradictions in social policy, and those of course are reflected in the workplace. However, even within the constraints imposed on them by the legislature, courts, and governor’s office, managers of welfare offices have some options. They do not have to operate according to the “dixie cup—use them up and throw them away—school of management” (Bramhall & Ezell, 1991, p. 33). There are many things they can do:

They can take principled stands with the legislature and governor against policies that limit their ability to help people.

They can enlist workers in advocacy for clients and encourage alliances between workers and clients.

They can go to bat for higher pay and better working conditions for workers.

They can set up support groups in which workers can share their feelings and frustrations with each other and brainstorm to solve problems in the agency.

support groups

Groups in which members help each other to clarify or act on certain issues.

They can recognize the pressure that workers are under and give them encouragement and support.

They can involve the frontline staff as partners in decision making and create smaller and more intimate work groups.

They can pay attention to workers’ stress levels and do whatever is necessary to keep them from burning out, including:

Varying a worker’s tasks

Instituting flex time

Limiting a person’s work hours

Keeping a roster of on-call workers to maintain client–staff ratios during periods of absenteeism

Providing carefully graduated levels of responsibility for new staff Streamlining paperwork

They can make the workplace surroundings as pleasant and clean as possible. (Bramhall & Ezell, 1991)

They can set up child care space in the waiting room and enlist volunteers to care for children of waiting clients.

They can involve clients in decision-making bodies.

According to one study by psychologists, political activism can even make you happier. Two university psychologists, Malte Klar and Tim Kasser, interviewed two sets of around 350 college students, both about their degree of political engagement and their levels of happiness and optimism. They found that those most inclined to go on a demo were also the cheeriest. “The study flies in the face of the popular wisdom that happiness resides in creature comforts and relative affluence. Perhaps activism gives people a sense of purpose, or of agency, or just a chance to hang out with other people. Most likely it does all of the above” (Charkrabortty, 2010).

Problem Solving

Administrators are under the gun to save money and are responding to pressure. They often lose sight of both workers’ and clients’ needs. Everyone in an agency needs to be involved in solving its problems.

Many of the skills involved in solving work problems in an agency are the same analytical and change skills that workers have learned in dealing with clients. Workers who do certain kinds of work, such as in rape crisis or battered women’s centers, no longer see these problems as just individual troubles. They involve their clients in a social and political analysis of their problems. It is a relief to clients to realize they are not alone. Using the same skills, workers can involve their colleagues in analyzing agency problems. This gets workers beyond incessant criticism of the agency that goes nowhere, and it helps them gain mastery of agency problems (Bramhall & Ezell, 1991).

If workers feel powerless and helpless, how can they help clients feel less so? Workers cannot provide models for growth for clients or help them gain mastery over their lives unless they are taking some control over their own work lives. How is that done? We have pointed out that when people analyze the reasons for their burnout, they tend to overemphasize either the personal or the organizational reasons, rarely balancing the two. The same dichotomy happens when people prescribe remedies. Although some can look at both personal and political issues as all of a piece, many prescribe only individual remedies (biofeedback, meditation, relaxation techniques, job rotation). Others insist that the only solution to worker stress is to change the whole agency and even the whole social system. Both sets of remedies have utility but they need to be combined. Certainly, a rigid and an authoritarian agency working with a stigmatized clientele on a shoestring budget can literally producea pain in the neck, stomach, head, or gut of the worker, but even in a “good” agency, with a low caseload and lots of support, we still find ourselves under occasional stress simply because we are dealing with people’s emotions and unmet needs.

Meeting family responsibilities while working is stressful, and can contribute to burnout.

Gaining Power through Knowledge

In order to get power in an agency, you need to understand the social and political economy of the agency and how it fits into society. As one sociologist put it, you need to break out of “occupationally trained incapacity to rise above a series of cases” (Mills, 1943, p. 171) in order to figure out what society really wants you to do with these clients, what society really expects of you, what is really known about the kinds of problems your clients have.

Your study of your own agency should begin with close observation, perhaps using your journal to document your observations and thoughts. Notice who does what and why, who is especially rewarded and why, what kind of behavior in both workers and clients is valued. Supplement your own observations by studying what others have said about these issues in books or at workshops, conferences, visits to other agencies, formal courses, and your own informal support group. Remember that knowledge is power, and if you do not understand what is coming down, you will be buffeted about by mysterious forces.

In order to understand our own position in an agency and intervene helpfully in people’s lives, we need to see them and their environments as clearly as possible. For example, some of the “whys” that might occur to you in a foster care agency are:

Why are so many children being moved so often from one home to another?

Why do children stay so long in foster care?

Why is it so hard to find foster homes for adolescents?

Why don’t some social workers and foster parents want the biological parents to see more of their children?

Why is my caseload so high and my pay so low?

In child-protection work, an area with a high rate of burnout, a study of the job should include an analysis of the structure of the worker’s job. One expert on the child-welfare system maintains that high burnout is at least partly caused by the fact that the worker is asked to perform the two incompatible roles of policing and providing supportive help to families (Pelton, 1989). Pelton argues that, in order to develop the trust necessary to provide the supportive help that families need, families must voluntarily choose the help. Because workers often meet families with a real or an implied threat to invoke the state’s power to remove their children, it is impossible for families to trust the workers. Pelton believes that the two roles should be separated, creating special police units to handle the coercive functions and freeing social workers to give help that families genuinely need and want.

Along with your independent study, you will need to join with others, both coworkers and clients, in seeking answers. One person working alone can conceivably change an organization, but that is rare, and it is a lonely road. We stress, again, that change comes about through people working together.

Getting Support

Supervision

Social agencies have traditionally relied on supervision to train workers and to give them support in their work. The profession of social work has probably relied more than any other profession or trade on long-term, one-to-one supervision. Although it can have its benefits, not all human service workers are happy with the kind of supervision they interpret as enforced dependence for their entire career.

There are good and bad aspects to traditional supervision. The best part is that a supportive supervisor can help human service workers function at their full potential, often helping them discover creativity and strength they never knew they had. Such a supervisor can help prevent burnout and poor-quality service.

One research project (Berkeley Planning Associates, 1978) that evaluated child abuse and neglect programs concluded that the most important factor in keeping workers actively engaged was supportive program leadership. This was especially important to younger and more inexperienced workers. Workers functioned best when they were:

Active participants in supervision

Encouraged to be innovative

Given clear communication and expectations from supervisors

Not required to follow formalized rules rigidly when it was more helpful to the clients to bend the rules

Good supervisors:

Took the work seriously

Emphasized its importance

Encouraged workers to get the job done

Were neither passive nor authoritarian

Provided support and structure

Conveyed a sense of trust in staff

Gave direct feedback to workers on their performance

Helped workers find resources in the community

Provided strong advocacy on behalf of the clients and workers within the agency

The same research report showed that workers who had poor supervision burned out at a much greater rate than did workers with good leadership.

Ideal Supervision

One of the most important qualities of a good supervisor is the ability to allow workers freedom and responsibility for their own work. An overcontrolling supervisor encourages dependence and childish subservience. Workers under the tutelage of such a person never develop their own creativity. The study on child abuse and neglect demonstrated that workers became seriously demoralized when they were not given autonomy.

Most of us would agree that we can, and need to, learn from more experienced and knowledgeable people both in our professional and our personal lives. In any job, a worker should expect good supervision at a regularly scheduled time—perhaps an hour or two a week set aside to talk about work-related problems and plan for future activities. Supervision need not be done only on a one-to-one basis. Informal peer supervision and formal group sessions, which are regularly scheduled discussion groups of agency workers and selected consultants, can replace or supplement it. In many human service agencies, most of the staff supervision is done through groups. Some people think this is better than one-to-one supervision because “the group has a way of maintaining honesty; the supervisor shares power with the group members, and they add their power to his. One result can be a lessening of the threat of the conference held behind closed doors” (Abels, 1979, p. 174).

Other Forms of Supervision

Other forms of group supervision are case conferences, core evaluations, and staffings, in which the workers concentrate on one particular client’s problem or on one key issue affecting groups of clients. A study of child abuse and neglect programs (Berkeley Planning Associates, 1978) concluded that work was more likely to be successful when the workers used multidisciplinary teams to review more serious or complex cases at intake and at some other point in the treatment process (at least once every six months). Using such teams, which might include teachers, homemakers, lay therapists, social workers, psychologists, nurses, and doctors, helped workers learn how to handle a particular case and similar cases in the future. Workers also did better in these projects when they had case conferences in which two or more workers reviewed their progress on a case once every three months and when they used outside consultants from different disciplines on more complex cases.

case conferences

Conferences about a particular client in which staff members pool their information and share resources.

Supervision As a Problem-Solving Process

A supervisor’s broadly ranging knowledge is not enough, however, if he or she does not know how to pass the knowledge along. Supervision is a problem-solving relationship. A worker must feel safe in supervisory relationships before he or she will risk honestly admitting insecurities, mistakes, and ignorance. A supervisor who acts like a “snoopervisor,” always checking up and looking over the worker’s shoulder for mistakes, ready to mark them down on an evaluation sheet, is not someone with whom subordinates will willingly discuss problems. In fact, many will respond to this assault by playing games, telling the supervisor what he or she wants to hear while shoving their real problems under the rug.

If supervisors are secure, they can invite workers to tell what helps or hinders the workers about their way of working. Open discussion is the best way to work out problems in supervision. If the supervisor feels too threatened by this, or if it is impossible to change supervisors, one must look around for support elsewhere.

Supervisors and Workers’ Self-Esteem

Because human service workers “as a rule, are easily convinced that they are doing a poor job” (Feldman, 1979, p. 118), one of the supervisor’s most important jobs is to help workers gain confidence in the effective work they are actually doing, often without being aware of it. For example, there are times in a working relationship with a client when he or she needs to express anger and be critical of a worker. Such an expression may be a sign that the worker has helped a client feel free enough to express anger. Yet anger is hard to take, and a worker may feel that he or she has failed. A supervisor, understanding the relationship more objectively, can help the worker understand the anger as a sign of progress and can also show the worker points at which the worker “felt empathy and was able to perceive her client’s need and respond constructively—without herself being aware of it…. (Analyzing with workers their intuitively correct responses is the best way of teaching)” (Feldman, 1979, p. 124).

Formal and Informal Groups

Another study of worker effectiveness and morale showed that workers needed informal peer support (Maslach, 1966). In high-morale agencies, workers were encouraged to choose a consultant on their own, either a fellow worker whom they respected and trusted or someone outside the agency. Human service students or trainees in fieldwork placements often turn to a field supervisor from their college in addition to the one appointed at their field agency. This doubling up of supervisors can be an asset or a liability, of course, according to the skill and commitment of all involved.

Informal Networks

The informal conversations we have with our friends and coworkers are the most common way of sharing experiences. These take place during coffee breaks, over lunch, after work on the telephone, at each other’s homes, and during shared entertainment. These conversations give us the emotional support to keep at our demanding jobs. They are one way to check out, add to, and revise our store of knowledge about our work. Sometimes they can improve our practice. We may share innovative ideas; but we may also share ignorance, prejudice, and stereotypes. If the conversation stays on the level of griping, it can increase anxiety and keep people mired in helplessness. One needs to gripe, but if one never moves on to analysis and action, complaining can be counterproductive.

Informal networks are essential for survival on the job. Sociologist Howard Polsky (1962) studied a residential treatment center for delinquent youths and found that the live-in cottage parents felt, and in fact, were the most isolated and vulnerable of all the staff members because they did not have a reference group—friends they could go home to and share ideas and feelings with. The social workers, on the other hand, commuting together back to New York City and spending evenings with family and friends, returned to work the next day emotionally replenished for their bouts with the rage, wisecracks, con games, and sadness of these youngsters who had been taken from their homes by the state. The cottage parents’ lack of an alternative status reference group had a negative impact on the treatment they gave to the teenagers in their care:

Lacking an alternative status reference group, the cottage parent becomes dependent upon, and conforming to, the boys’ delinquent orientation and eventually adjusts to it by taking over and utilizing modified delinquent techniques. The extreme concern with cottage loyalty and the violent condemnation of “ratting” cement the cottage parent to the boys’ subculture and perpetuate a vicious circle, which insulates the cottage from the rest of the therapeutic milieu. (Polsky, 1962, p. 135)

Formally Organized Support Groups

A formally organized support group may or may not include one’s friends. It may consist only of colleagues on the job, or it may be an explicitly political group that is open to people from other agencies who want to clarify their thinking about their work. They may be a study group that meets regularly, chooses readings to discuss, and perhaps invites specialists to discuss certain issues. A study group is most effective when people give it a high priority in their lives, meet regularly, and use the group to analyze the workplace: how it is affecting each member and how members can individually and collectively deal with their work-related frustrations. It can become quite an effective tool for collectively tackling problems in the workplace, and it can give enormous psychological support to its members. Wenocur and Sherman (1980) suggest a few important items to discuss:

How the organization heightens the guilt of the workers

The role of dependency in keeping workers in patterns of victimization

How workers identify with the powerlessness of their clients

The forms of accommodation the members have adopted in order to survive in the agency

Most of the literature on burnout emphasizes the crucial importance of support groups. One child-welfare agency held a support group for child abuse workers to deal with the severe stresses of the job (Copans et al., 1979). The group met for one and one-half hours once a week for six months to “examine the feelings aroused in workers by their work and to discuss how these feelings aided or interfered with effective delivery of care” (p. 302). During these meetings, ten major sets of feelings that often interfere with effective delivery of care were identified:

Anxiety about the effects of a decision

Need for emotional gratification from clients

Lack of professional support

Denial and inhibition of anger

Feelings of incompetence

Denial and projection of responsibility

Difficulty in separating personal from professional responsibility

Feelings of being victimized

Ambivalent feelings toward clients and about one’s professional role

The need to be in control

In all these areas, workers got emotional support and helpful suggestions for dealing with the problem. Every group member suffered from feelings of incompetence:

One very competent worker said that she felt professionally inadequate most of the time. Since she rarely received comments on her work, she assumed it was not good. It was a great relief to her to discover that others shared these feelings of failure. As a result of recognizing this problem in the group, many workers returned to their agencies and asked for critical feedback on their work. Most of them also felt much less incompetent, as they could see from case discussions that there is generally no “best way” or “right answer” in such work. (Copans et al., 1979, p. 305)

One of the reasons for this widespread feeling of incompetence among human service workers is that they are not sure whether their work is effective. Most researchers on burnout assume that when workers’ morale is high, their work is effective and productive. Weissman and his colleagues (1973), however, believe that this is the wrong way to look at it. They assert that worker morale will improve when the agency is effective. They would shift the focus from the individual worker to the agency:

There is nothing more satisfying to professionals than spending their work lives in an organization that they feel is effective…. The competence of the agency should be as high a priority to the profession as the competence of individual practitioners. If agencies are not effective, clients suffer, and workers suffer. (Copans et al., 1979, p. 331)

Researchers at the Wellesley Center for Research on Women studied stress in the service sector of the economy and found that “regardless of how demanding their jobs were, workers who felt they weren’t making a contribution to the lives of others were more distressed.” Their advice to employers in the service sector was to design jobs that permit individuals to be effective service providers, to make a difference to others. “This won’t make the stress of a demanding service job any easier to bear, but it may prevent job-related distress from worsening” (Center for Research on Women, 1999/2000).

Professional Organizations

A professional organization forges links between people in the same field. Collectively, these people share their values and their knowledge and support each other in job searching and other concrete ways. Most organizations have at least one professional journal that provides a platform for workers to carry on their professional debates and to share their research and practice experiences. Most human service organizations have a code of ethical practice. Workers often derive support by holding on to their professional values, even though these may at times be in conflict with those practiced in the agency. The profession often uses the clout afforded by its numbers to improve agency practice and to lobby for better social services.

Unions

There is often no sharp distinction between a professional organization and a union; some professional organizations, such as the National Education Association (NEA) and the American Association of University Professors (AAUP), started as professional associations but have gradually taken on the traditional functions of a trade union. Generally, professional organizations do not engage in contract negotiations or in job actions such as slowdowns or strikes.

As the country’s workforce has increasingly moved into service occupations, professionals such as teachers and human service workers are unionizing much more now than in the past. The greatest increase in unionization recently has been among professionals in education, government service, and nonprofit organizations. Public social agencies generally pay workers more than private agencies because they are more unionized.

Turning their pain into positive energy, AIDS activists organize fund-raising long-distance bike rides all around the country. They provide money for medical research while increasing their own fitness.

One of the most important reasons workers give for leaving human service agencies is their lack of control over their working conditions. Unions are often perceived as the most powerful tool to wrest some of that control from management. Some social service unions have a limited vision of their task, bargaining mainly for wages, hours, and fringe benefits, while others struggle for a greater worker role in decision making and for changes in systems. A spokesperson for the American Federation of State, County, and Municipal Employees (AFSCME), which has organized many human service workers, tells of his union’s concern for those broader issues. Professionals often want representation at the planning or policy level. For example, social caseworkers, who are often overburdened with high caseloads, work for policies that lower their caseloads (Curtin, 1970, pp. 12, 15).

The organization that Rick Colbath Hess founded is one model for human service workers to improve their working conditions. This is especially important for direct care workers, who often have lower salaries and worse working conditions than others in the field.

If your agency is not unionized and the workers want a union, a group of you can work on it. Study all the unions that could represent you. Find out their track record on organizing and bargaining; check out what salaries their staff earn. (There’s no reason union bureaucrats should be living in luxury while human service workers scrimp.) See what issues they are willing to take a stand on; ask how elitist or hierarchical they are in their own decision making. Do they believe the membership or the union staff should call the shots? How much are the dues? Do they have a fund to tide you over if it comes to a strike? Can they give you legal assistance and help in bargaining? Give ample time for everyone to share his or her concerns about what might happen to the clients if there was a work stoppage and what he or she is prepared to do if the organizing or contract negotiation gets sticky. Don’t be surprised if the agency management is not happy about the prospect of workers organizing. Even human service supervisors can have serious misgivings and fears of turmoil and conflict.

Some organizations play on workers’ fears in order to reduce union activity—fear of being fired, not promoted, or disapproved of. Sometimes the fears are justified. One reason for the recent decline in union membership is that employers have fired union organizers, which has made people more afraid to organize. Find out from the union leaders in your area whether this has been happening in the human service field and what you can do about it.

Often there will be resistance from some agency colleagues, who believe that it is unprofessional to organize. As the economic crunch hits more middle-class people, however, they tend to look for a union’s protection. Finally, if workers are in a small private agency that contracts out work from the state, they may find they need to form coalitions with fellow workers in similar small agencies before unionizing in order to grow large enough to influence management.

Service Employees International Union (SEIU) has organized workers often considered “unorganizable,” especially low-wage service sector workers, in what is often called “social movement organizing.” Many of these service sector workers are minorities, immigrants, and women. Some of the union’s organizing campaigns include:

Justice for Janitors (janitors),

Stand for Security (security officers),

Invisible No More (home care workers),

Clean Up Sodexo (outsourced services),

National Health Care Workers Union (healthcare providers),

SEIU Kids First (childcare),

Quality Public Services (public workers), and

Everybody Wins (public workers) (SEIU, Local 503).

A particularly significant organizing campaign for welfare recipients occurred in Milwaukee, Wisconsin, when SEIU organized 604 people who cared for their parents, employed by the nonprofit agency New Health Services (NHS). This was the first large-scale organizing in Milwaukee at the low end of the wage scale since the 1997 launch of “W-2,” Wisconsin’s welfare reform system initiated by then-governor Tommy Thompson. Many former welfare recipients are employed by NHS. These workers were paid at the rate of $7.10 per hour, with no benefits of any kind. After their union was certified, they went on to negotiate a contract for higher wages, improved training, health insurance, and pension benefits (Glenn, 2001b). Many feminists have long argued for paying wages to caregivers. This campaign is the first to organize people who care for their own parents.

Choosing Your Fights

After analyzing your situation and setting up your support groups, you then need to set priorities on what you want to change in your work situation. You can’t change everything at once, so decide what it is that you simply can’t live with any more. Say that your gripes include having to punch a time clock at 8:30 and carrying a caseload of 800 food stamp clients*—with inadequate secretarial staff to prepare documents, write letters, and do publicity. Which of these is most important? You will probably decide that the clock punching is least important, so you won’t take on that fight just yet. There is no point in risking a major confrontation on a minor issue, especially one that doesn’t compromise any basic principles, when there are other things much more crucial to your effectiveness or job satisfaction.

* In 2010, Massachusetts food stamp workers had 800 cases. Even after more workers were hired, they had 600 cases. Obviously, clients weren’t served well and workers were burned out.

Make a cost–benefit analysis of your issue. How much might it cost you in terms of job risk, disapproval from the boss, and so on, and what are the possible benefits? Which side of the scale tips—risks or benefits? Don’t overestimate the risks, especially if you have substantial support from your colleagues and advocacy groups. People tend to err on the side of caution when some risk might actually reap large benefits. The more people you have with you, the more you reduce your risks. It is harder to reprimand or even fire ten people than one. Watch out for divide-and-conquer tactics. Agency management may lay off the people with the least formal training first, and the others may assume that they have escaped. Later, management may pick off the trained workers or lower their salaries. The more people and advocacy organizations you include in your struggle, the better your chance of success.

Creative Ways of Working

One way of keeping the spark alive on the job is to experiment with new ideas. It may be hard to think of new ways to do your work when so many people are telling you, “but we’ve always done it this way.” Yet well-thought-out experimentation is often worth the risks it might entail. Clearly, it keeps people enthusiastic.

Working with people in groups rather than as individuals can sometimes save time. You might make an overly large caseload more manageable through such devices as conducting group intakes for adoption applicants. Foster parents can be trained in groups to care for children; they can also help the worker to recruit other foster parents. Group counseling for unemployed people and support groups for parents, teens, families of alcoholics, and others can all be both time-saving and sometimes more effective than individual work. One study found that treatment of abusive and neglectful parents was most effective when parents were involved in mutual support groups such as Parents Anonymous and when parent aides were used (Berkeley Planning Associates, 1978). Encouraging and supporting clients to help themselves and each other cuts down on your caseload and pressures while strengthening your clients’ abilities.

If you can get enough support from your colleagues, clients, and community, you might persuade your agency to change the way it does the work. One staff member of a sheltered workshop for retarded people said this in her letter of protest to the agency board:

While I was told that teaching clients would be at least a part of my job, this has not been the case so far. In the weeks I’ve been at [the workshop], I’ve spent a total of half an hour working on money skills with a client, and that was only because I put other things aside and took initiative to do so. In reality, my job consists of fixing and counting chess pieces and mascara brushes, inspecting bathrooms, opening boxes of calculators. How about if I spend two hours a day teaching clients to do these tasks? I understand they must be done but think it is a ridiculous use of my skills. From 10:00–12:00 I could work on routine sorting tasks and from 1:00–3:00 hold a money management workshop. I’d like six weeks to stick with this schedule and then I’ll report back on how it’s working.

Programs that allow scope for creativity make space for workers and clients to grow. The ultimate goal of any human service work is the mutual empowerment of clients, workers, and the community. Workers can reach out to clients and the community to explore and discuss alternative modes of service.

Varying the Work

A good way to survive on the job is to vary the work by rotating duties with other workers, alternating between intense involvement with clients and less emotionally draining administrative work, or taking time out from regular tasks to do a special project or attend a course or conference. Workers often break a cycle of defeat by figuring out which clients are the most draining on them and making trade-offs with other workers who have different kinds of tolerances and bring a new insight to a stalled group or individual case process.

Sharing Ideas

One of the most important ways of enjoying your work is to know you are doing a good job. That is a good reason to continue to sharpen your skills throughout your career. It is stimulating to share ideas with others, both verbally and in writing. You can be part of the “community of scholars” at work, in the community, and in your profession by writing letters to the editor of your local newspaper, composing practice notes and accounts for your professional journal, and, if you have a bent for more formal research and theoretical speculation, producing articles that present your thinking and research.

Clarity of Thought and Writing

Most human service concepts can be expressed in clear language. The beginning student should be wary of articles or lectures that are overly abstract or filled with labels, jargon, categories, and excessive complexity.

English writer George Orwell (famous for his political novel 1984) warned us about pretentious diction in his classic essay, “Politics and the English Language” (1950). He illustrates his point by translating a passage from the Bible into “modern English of the worst sort.” Here is the original passage from Ecclesiastes:

I returned and saw under the sun, that the race is not to the swift nor the battle to the strong, neither yet bread to the wise, nor yet riches to men of understanding, nor yet favour to men of skill; but time and chance happeneth to them all.

Here it is in modern “jargonese” English:

Objective consideration of contemporary phenomena compels the conclusion that success or failure in competitive activities exhibits no tendency to be commensurate with innate capacity, but that a considerable element of the unpredictable must invariably be taken into account. (Orwell, 1950, p. 92)

Clear thinking demands honesty, not pretentiousness, and in studying the field of human services, students should demand clarity of teachers and supervisors and should strive for honest expression in their own writing. Orwell’s guidelines for writing can be helpful to all of us:

Never use a metaphor, simile or other figure of speech which you are used to seeing in print.

Never use a long word where a short one will do.

If it is possible to cut a word out, always cut it out.

Never use the passive where you can use the active.

Never use a foreign phrase, a scientific word, or a jargon word if you can think of an everyday English equivalent.

Break any of these rules sooner than say anything outright barbarous. (Orwell, 1950, p. 100)

Orwell tells us that our writing style will be clearer and more forceful if we speak in the active rather than passive voice. An active style forces us to take responsibility for our thoughts. When I say, “I think …,” I announce that I am the author of that thought and am willing to take both the praise and the blame for it. If, on the other hand, I want to duck responsibility for the thought, I might say, “It has been thought …” A person who thinks and writes in the active voice is more likely to be actively engaged in dialogue that shapes practice.

Avoiding Abbreviations

In addition to avoiding pretentiousness in our speaking and writing, we need to avoid the casual drift into speaking in human service abbreviations—the secret code of our field. It is very easy to say to a parent, “After your child has been cored, we’ll apply to OCD for CHINS or Title XX money, and we’ll find a less restrictive setting for your child,” when what you want them to know is, “After the study and evaluation of your child’s special needs are completed, we can apply to the Office of Child Development for money from the Children in Need of Service fund or the Supplementary Security Act. We’ll also find a school that will provide him with the best, most normal education.”

If you are sure that the parent knows the jargon, then speaking in abbreviations or professional terms is, of course, acceptable. But we must always check to make sure we aren’t speaking in a “foreign language.” One of the authors [Schram] recalls an example of this in the 1960s, the time of the War on Poverty:

When I was on the board of a poverty program funded by the Office of Economic Opportunity (fondly known as O.E.O.), we were always having one or another crisis with our funding and must have mentioned O.E.O.—cursing or praising it—at least twenty times in the course of one board meeting. At the close of one particularly dramatic meeting, I realized that one of the new board members, known for her militancy in neighborhood politics, was remarkably quiet, and in fact she had abstained from voting on several important issues. When I took her aside after the meeting and asked her why she was acting in this untypically laid-back manner, she explained that much of the meeting had been a jumble to her. “What,” she asked me, “did oleo (the local word for oleomargarine, the butter substitute) have to do with the poverty program?” My heart sank when I realized that we unwittingly excluded through our use of “insider’s” abbreviations the very person we most wanted to involve. It taught me a lesson I will not soon forget.

Of course, no matter how conscious we are, code words and initials will creep into our writing and speaking. If you as a new worker are plunged into a bowl of alphabet soup, the only way to keep from drowning is to interrupt the action politely and ask for an explanation.

Setting Limits on Self and Others

Finally, you need to know how to protect yourself from the unrealistic demands that people make on you. You need to learn to recognize your limits and let others know when you have reached them. Learn to say “no” without feeling guilty. Take time out when you’re feeling drained. If you’ve just had a nerve-wracking experience with a client and your knees are shaking, let your supervisor know that you need to take a walk or talk it out. If you’re exhausted after a few years on the job, try to take a leave of absence, if you can afford it. You may come back refreshed, with new ideas.

You need to learn how not to take your work home with you, and you need to take good care of yourself outside the job. There are lots of ways to do this. Our list would include good nutrition, regular exercise, rest, recreation, reading, and friendships. Some people find meditation, relaxation techniques, or biofeedback helpful. One psychologist in a teachers’ stress counseling program talks of how some people neglect their health: “Many teachers subsist on coffee and nicotine. They don’t eat breakfast, but they might drink coffee with sugar, or a Coke, with a doughnut. They get sugared up. It makes them sleepy, cranky, and inefficient” (Grey, 1979, p. 6).

However we manage to do it, we must keep our spontaneity and spirit of play alive. If we lose our joy, how can we bring joy and hope to our clients?

Summary

Human service work can be one of the most exciting careers in the world, but only as long as one can grow in the job and feel successful in it.

Growth requires support from peers, supervisors, and the society that sponsors your agency.

If support is not forthcoming, a human service job can create stress, which leads to burnout.

Symptoms of burnout can include sleep problems, irritability, upset stomach, headaches, and shortness of breath. Workers may become cynical and hardhearted, stop caring about the clients, and treat clients with contempt.

Burnout can be caused by both psychological and environmental stress.

The human service profession is built on a humanitarian ethos, but in practice that ideal sometimes turns into cynicism or careerism.

When insurance companies dictate the kind of treatment to be given and the way to give it, human service workers are restricted in their choices.

When there is not enough time, the helping impulse may become extinguished.

Government cutbacks in services restrict the kind of help that workers can give.

Agencies that serve the poor seldom have enough resources.

Pressure for accountability can cause agencies to take refuge in sorting and counting behavior, which may not reflect the true quality of their work.

Clients exert pressures on the worker when resources are restricted.

Work stress is increased when the client has not chosen to come to the agency, as in child-protection work.

Clients of agencies are often stigmatized by society. Those who work with them are sometimes included in this stigmatization.

Some human service work is dangerous, and workers need help from their agencies to protect themselves.

Hazards of human service work include workers’ rescue fantasies, the fact that some problems cannot be solved, and the enormity of the problems.

Some of the less creative reactions to the pressures of work include capitulation, total noncapitulation, niche finding, withdrawal, and becoming a victim martyr.

Taking control of one’s work situation involves understanding the social and political structure of the agency and its relationship to the larger society.

Support groups, professional organizations, and unions are important sources of support.

A supportive supervisor can help workers function at their full potential.

One of the most important qualities of a good supervisor is the ability to allow workers freedom and responsibility for their own work.

Individual methods of change include finding more creative ways of doing the work, varying the work, improving one’s competence, and joining the “community of scholars” by contributing to the dialogue of the profession.

Unions can give workers more control over the conditions of their work.

Clarity of thought and writing help one to maintain a forceful presence in the human service profession.

Workers need to protect themselves from impossible demands and learn how to say no without feeling guilty.

Taking care of oneself includes good nutrition, regular exercise, rest, recreation, reading, and friendships.

Discussion Questions

If you were in charge of a social agency, how would you structure it to avoid worker burnout?

Imagine that you are a worker who wants to form a union to improve wages and working conditions. The administrator of your agency calls a meeting to warn workers about the dangers of unions and makes a veiled threat that workers might be fired if they try to form a union. How would you respond to this?

What are some examples of federal and state laws that might contribute to worker burnout?

What are some examples of agency regulations that might contribute to worker burnout?

Describe what you would consider to be the ideal supervisor and the ideal method of supervision.

Web Resources for Further Study

American Federation of State, County, and Municipal Employees (AFSCME)

www.afscme.org

AFSCME is the largest union for workers in the public service. AFSCME organizes for social and economic justice in the workplace and through political action and legislative advocacy. AFSCME represents a diverse group of service and health care workers in the public and private sectors, including nurses, EMTs, sanitation workers, bus drivers, child care providers, corrections officers, child care providers, human service workers, custodians, and librarians.

U.S. Department of Labor

www.dol.gov

This site provides information on government programs affecting workers, and on occupations.

Service Employees International Union (SEIU)

www.seiu.org

SEIU’S membership includes 2.2 million working people and retirees in North America. Counterparts around the world help ensure that workers, not just corporations and CEOs, benefit from today’s global economy. SEIU includes the largest health care union, the largest property services union, and the second largest public services union. Some of the groups it organizes include human service workers, health care and mental health workers, home care workers, cafeteria workers, janitors, and security officers.

Employee Assistance Plans

http://www.dol.gov/odep/documents/employeeassistance.pdf (Employee Assistance Programs for a New Generation of Employees, U.S. Department of Labor 2009-01-01)

Employee Assistance Programs (EAPs) are employee benefit programs offered by many employers, typically in conjunction with a health insurance plan. EAPs are intended to help employees deal with personal problems that might adversely impact their work performance, health, and well-being.