Merrill Main, Ph.D.

1
BURNOUT

• Merrill Main, Ph.D.
• Clinical Director
• DHS Special Treatment Unit
• Merrill.main_at_dhs.state.nj.us

2
INTERNAL

• Have, get, buy, borrow, or rent a life.
• Lack of self-care.
• Too much tendency to externalize.
• Unmanaged general mental health issues.
• Savior complex gone wrong.
• Poor affect management.

3
EXTERNAL

• ?
• Answers in Organizational Psychology. For
  example, Herzberg's Motivation-Hygiene Theory ?

4
EXTERNAL

• Lack of training
• Unclear expectations
• Lack of support
• Lack of resources
• Overutilization
• Underutilization

5
NUMBERS

• 20 to 25 show clinical burnout
• Kadambi and Truscott, 2003
• 30 of the teachers
• Rudow, 1999
• 50 of medical residents
• Martini, S., Arfken, C., Churchill A., and Balon,
  R. (2004)

6
Sexual Offending Is it contagious?

• Were all sexual offenders once sexual victims?
• Will all victims become offenders?
• Do we begin to behave like the population that we
  work with.

7
PARALLEL PROCESS

• Psychoanalytic idea that relationship between
  patient and therapist is reflected in
  relationship between therapist and supervisor.
• Searles (1955)
• See the world through the patients eyes too
  often and it may become habitual.

8
SYMPTOMS

• Vicarious Tramatization
• Hypervigilence
• Distrust
• Sexualization
• Objectification of patients
• Over-identification with patients
• Stress
• Exhaustion
• Depression
• Detachment from work
• Over-investment in work

9
OVER-IDENTIFICATION
10
YOURE THE BEST

• The high-school kid striving to be popular is
  still alive inside all of us.
• Savior complex.
• Misguided striving for personal safety.
• Stockholm Syndrome.

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YOURE THE WORST

• Ill prove that Im worthy.
• The beatings will continue until morale improves.
• Effort justification
• We like most what weve struggled to master

12
Divisive

• Build one faction up, tear another down
• Shop for the best answer
• Play one against the other
• Highly attuned to existing differences/conflicts
• Magnify and exacerbate real differences
• Between individuals
• Between groups
• Instigate conflict for personal pleasure or gain

13
Manipulative

• Starts with small things
• Favors given or taken
• I wont tell
• Progresses to big things
• May seem reasonable at each step
• Often starts with small quid-pro-quo

14
UNDER-IDENTIFICATION

• Beyond gallows humor
• Distain
• Distrust
• Disregard
• Disrespect

15
THERAPIST STYLE

• Among the influential therapist behaviors, the
  most important appear to be empathy, warmth,
  rewardingnes, and directiveness.
• Marshall (2005)

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Effects and problems of working with sexual
offenders

• Excessive identification with offenders.
• Excessive anger toward of offenders.
• Parallel processes.
• Effect on clinicians sexual functioning.
• Work intruding into life.
• Become used to talking about sex with patients.

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ANTI-BURNOUT

• Engagement
• Vigor
• Person-Environment Fit

18
Burnout Prevention

• Communicate with colleagues
• Commiserate with colleagues
• Utilize supervision
• HAVE A LIFE OUTSIDE OF WORK
• Dont worry more about patients problems than
  they do.

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REFERENCES

• Drapeau, M. (2005) Research on the Processes
  Involved in Treating Sexual Offenders. Sexual
  Abuse A Journal of Research and Treatment. 17,
  117 - 125.
• Edmunds, S. (Ed.) 1997. Impact Working with
  Sexual Abusers. Safer Society Brandon, Vt.
• Ennis, L. and Home, S., (2003). Predicting
  Psychological Distress in Sex Offender
  Therapists. Sexual Abuse A Journal of Research
  and Treatment. 15, 149 - 157.
• Farrenkopf, T. (1992) What Happens to Therapists
  who work with Sex Offenders? Journal of Offender
  Rehabilitation. 18(3/4), 217-223.
• Kadambi, M., and Truscott, D., (2003) Vicarious
  Traumatization and Burnout Among Therapists
  Working with Sex Offenders. Traumatology. 9(4)
  216-230.
• Lea, S., Auburn, T., and Kibblewhite, K. (1999).
  Working with Sex Offenders The Perceptions and
  Experiences of Professionals and
  Paraprofessionals. International Journal of
  Offender Therapy and Comparative Criminology.
  43(1), 103-119.
• Little, L. and Hamby, S. (2001). Memory of
  Childhood Sexual Abuse Among Clinicians
  Characteristics, Outcomes, and Current Therapy
  Attitudes. Sexual Abuse A Journal of Research
  and Treatment., 13, 233 - 248.
• Moulden, H. and Firestone, P. (2007). Vicarious
  Traumatization The Impact on Therapists Who Work
  With Sexual Offenders. Trauma Violence Abuse. 8,
  67-83.
• Nelson, M., Herlihy, B., and Oescher, J. (2002) A
  Survey of Counselor Attitudes Towards Sex
  Offenders. J of Mental Health Counseling. 24(1),
  51-67.
• Salter, A. (2003) Staff Seductions. In
  Predators Pedophiles, Rapists and Other Sex
  Offenders. Basic BooksNew York.Shelby, R.,
  Stoddart, R., and Taylor, K. (2001) Factors
  Contributing to Levels of Burnout Among Sex
  Offender Treatment Providers. Journal of
  Interpersonal Violence. 16(11), 1205-1217.
• Steed, L., and Bicknell, J. (2001). Trauma and
  the Therapist The Experience of Therapists
  Working with the Perpetrators of Sexual Abuse.
  Australasian Journal of Disaster and Trauma
  Studies. 2001(1).
• Thorpe, G., Righthand, S., and Kubik, E. (2001).
  Brief Report Dimensions of Burnout in
  Professionals Working with Sex Offenders. Sexual
  Abuse A Journal of Research and Treatmnet., 13,
  197 - 203.
• W.L. Marshall, W. (2005) Therapist Style in
  Sexual Offender Treatment Influence on Indices
  of Change. Sexual Abuse A Journal of Research
  and Treatmnet., 17 109-116

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BURNOUT

• Merrill.main_at_dhs.state.nj.us