Burnout in Christian Perspective Thomas V. Frederick ...

Running head: BURNOUT IN CHRISTIAN PERSPECTIVE

Burnout in Christian Perspective Thomas V. Frederick, Scott Dunbar, and Yvonne Thai California Baptist University – Online and Professional Studies

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BURNOUT IN CHRISTIAN PERSPECTIVE

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Abstract Mindfulness and Christian spirituality are useful tools in preventing and coping with burnout and compassion fatigue. As these practices are tied into managing loss of personal accomplishment, emotional exhaustion, and depersonalization, human service workers are able to stave off burnout and actually be revitalized in their work. As Christians, a better way to conceptualize burnout and compassion fatigue are the categories of calling, apathy and indifference. In this way, preventing and coping with burnout becomes a project of spiritual revitalization – reconnecting with the empowering, living spirit of God. The practices of the Jesus Prayer, the daily examen, and the prayer of consideration are useful tools to accomplish this. Keywords: burnout, compassion fatigue, mindfulness, Christian spirituality, Jesus prayer, daily examine, prayer of consideration


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Mindfulness and Christian spirituality are useful tools in preventing and coping with burnout and compassion fatigue. As these practices are tied into managing loss of personal accomplishment, emotional exhaustion, and depersonalization, human service workers are able to stave off burnout and actually be revitalized in their work. As Christians, a better way to conceptualize burnout and compassion fatigue are the categories of calling, apathy and indifference. In this way, preventing and coping with burnout becomes a project of spiritual revitalization – reconnecting with the empowering, living spirit of God. The practices of the Jesus Prayer, the daily examen, and the prayer of consideration are useful tools to accomplish this. This paper will describe the overlap between burnout or compassion fatigue as characterized by lack of personal accomplishment, emotional exhaustion, and depersonalization. This will be followed by proposing that a Christian understanding of compassion fatigue corresponds with a Christian perspective of calling, apathy, and indifference. Next, the paper will discuss the role mindfulness, differentiation of self (DoS) and Christian spiritual practices play in preventing and coping with burnout. The paper will end discussing three Christian practices that may aid the reader in coping with or preventing compassion fatigue. Burnout “Burnout is a prolonged response to chronic emotional and interpersonal stressors on the job” (Maslach, Schaufeli, & Leiter, 2001, p. 397). Burnout is an international problem and has been attributed to perceived high workloads, inadequate communication, demanding physical conditions, lack of managerial support, conflicting values, absence of fairness, breakdown of community, decline of available workforce, and low financial rewards (Maslach & Leiter, 1997; Reid, et al., 2010; Swensen, Kabcenell, & Shanafelt, 2016; van der Doef, Mbazzi, & Verhoeven,


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2012). For human service professionals, burnout is discussed as compassion fatigue (Figley, 2002) or vicarious traumatization (McCann & Pearlman, 1990). The main difference between compassion fatigue and burnout is the focus on psychological factors (compassion fatigue) and workplace environment (burnout) (see Newall, Nelson-Gardell, & MacNeil, 2016). However, there is a high degree of overlap in some research (see Beebe, 2007). For the purposes of this paper, burnout, compassion fatigue, and vicarious traumatization will be treated as synonyms. Due to the demands of being with and for others, service providers are at a high risk for experiencing emotional exhaustion, depersonalization, and lessened personal accomplishment (McCollum, 2015). As measured by the Maslach Burnout Inventory – Human Services Survey (MBI-HSS), the gold standard for measuring burnout among human service professionals, burnout is comprised of three distinct dimensions - emotional exhaustion, depersonalization, and lack of personal accomplishment. The MBI-HSS describes emotional exhaustion (EE) as, “feelings of being emotionally overextended and exhausted by one’s work” (Maslach, Jackson, & Leiter, 1996, p. 10). An individual experiencing exhaustion may feel drained and experience a lack of energy, causing the individual the inability to unwind or recover (Maslach & Leiter, 1997). Individuals may employ depersonalization, the second dimension of burnout, to distance themselves from disappointment and exhaustion. Depersonalization is characterized by, “an unfeeling and impersonal response toward recipients of one’s services, care, treatment, or instruction” (Maslach, Jackson, & Leiter, 1996, p. 4). In other words, depersonalization is a defensive response or disengagement with one’s clients or patients who are making demands on the service provider who is experiencing burnout. The final component of burnout, lack of personal accomplishment, revolves around one’s, “feelings of competence and successful achievement in one’s work with people” (Maslach, Jackson, & Leiter, 1996, p. 4). In other


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words, human service professionals experiencing burnout, more specifically personal accomplishment, are generally dissatisfied with their jobs, and they have a lessened sense of “positively influencing people’s lives through work” (Maslach, Jackson, & Leiter, 1996, p. 43). Numerous research studies have applied the construct of burnout to the healthcare field, mostly with similar findings. The components of burnout have been associated with nursing job satisfaction, intent to turnover, absenteeism, low morale, deterioration of the quality of care provided, and nurse-reported quality of care variables (Maslach, Jackson, & Leiter, 1996; Van Bogaert, et al., 2013). Individuals experiencing burnout may also experience physical and psychological conditions such as depression, diabetes, hypertension, and irritable bowel syndrome (de Beer L. , Pienaar, Jr., & Sebastiaan, 2016). According to Shanafelt et al., more than half of physicians practicing in the United Stated are experiencing professional burnout (2015). From a patient perspective, physicians experiencing burnout are less productive, are more likely to make medical errors, and are less likely to motivate patients to comply with the recommended medical treatments (Dewa, Loong, Bonato, Thanh, & Jacobs, 2014; Schuman, 2016). As such, physicians experiencing burnout are at an increased risk for malpractice and often earn low patient satisfaction scores (Dewa, Loong, Bonato, Thanh, & Jacobs, 2014; Schuman, 2016). Among therapists, burnout or compassion fatigue is a critical concern. As the name suggests, compassion fatigue results in a diminished ability to have empathy for one’s clients (McCollum, 2015). This limits one’s effectiveness in providing a healing therapeutic relationship. McCollum theorizes that compassion fatigue results in emotional dissonance. Due to the demands of providing services to many others during one’s work day, one’s emotional experiences override from one client to the next. Emotional dissonance occurs when there is a


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mismatch between one’s feeling state and one’s expression. In other words, carrying the sentiment from one session to the next. Therapists may end up faking interest or compassion. In this way, emotional dissonance results in increased emotional exhaustion and depersonalization. These culminate in decreased personal accomplishment. Turgoose and Maddox (2017) identify the following predictors of compassion fatigue for therapists: personal trauma history, lower levels of dispositional mindfulness, depth of empathy provided to one’s clients (higher levels of empathy associated with increased compassion fatigue), increased caseload, and maladaptive coping strategies. These therapist predictors could result in lower client care and higher levels of dropout. Burnout and compassion fatigue have been crucial to pastors and ministers. For example, Evers and Tomic (2003) discovered that Dutch Reformed pastors had higher levels of emotional exhaustion compared to other social service workers, while depersonalization and lowered personal accomplishment were lower than the social service comparison group. Further, Spencer, Winston, and Bocarnea (2012) surveyed 285 evangelical pastors. Spencer et al. identified vision conflict – discrepancies between the pastor’s and the congregations’ ministry expectations – and compassion fatigue as the two crucial components in the process for pastors exiting the ministry. Beebe (2007) illuminated the connections between a pastor’s inability to differentiate between the self and pastoral roles and burnout, while others have identified the correlations between congregants’ intrusiveness and burnout and stress (Lee, 2010; Han & Lee, 2004). The concept of role and self-differentiation will be discussed at length below. Burnout is a serious concern due to its effects of emotional exhaustion, depersonalization, and depleted sense of personal accomplishment on employees. This is especially concerning in the helping professions like psychology, counseling and pastoral ministry. The main concern is


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the personal effects of burnout in the helping professions, as the person of the counselor is crucial to process of counseling. Burnout in Christian Perspective Three categories emerge when reflecting on burnout or compassion fatigue from a Christian worldview perspective. First, calling corresponds to the personal accomplishment dimension of burnout. Next is apathy as emotional exhaustion. Finally, indifference represents the depersonalizing aspects of burnout. Deriving meaning from work is a crucial developmental task for adults (Capps, 2000; Erikson, 1980). The developmental context for deriving meaning from work and other aspects of life occurs in the 4th decade of life and is based in the dynamics of generativity versus stagnation (Capps, 2008; Erikson, 1980). Generativity more generally refers to investment in the future. By mentoring others, giving back to society, by rearing one’s offspring, and by investing in one’s creative, vocational endeavors, one develops a sense of generativity – living out a sense of caring for the world and the future. Care, in this sense, is “a widening commitment to take care of the persons, the products, and the ideas one has learned to care for” (Erikson, 1997, p. 67, emphasis in original). A Christian understanding of work or vocation as calling entails: Vocation derives from that profound sense that we are called into existence in this time and this place and among these people for the sake of investing our gifts and potentials in furthering some cause that is of transcending importance. (Fowler, 1987, p.32) In this regard, Christian work is a divine or transcendent orientation toward purpose in pursuing one’s work. Vocation or calling provides meaning in relation to the “summons of a good God”


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(Stevens, 1999, p. 72). There are at least three ways to understand calling and vocation in the Christian perspective (Stevens, 1999). First, callings are personal. In the personal sense, Christ calls individuals to himself as disciples: this is known as an effectual calling. Further, God ordains some to professional ministry (pastors, priests). Also, the spirit empowers via charisms to perform certain tasks, and finally, individuals have passion or desire to serve others in specific ways (Ogden, 1990; Stevens, 1999). This first understanding of vocation provides the meaning for work adopted in this paper. The second aspect of calling is the Christian calling which takes one toward salvation through discipleship to Christ (Stevens, 1999). The final theological understanding of calling or vocation is the general human vocation – the cultural or creative mandate and the Great Commission (general discipleship making). Callings or vocation as intensely personal speaks directly to burnout. One’s sense of meaning and value relate to personal satisfaction – valuing one’s contributions at work. When one derives meaning about vocation from a transcendent source, personal accomplishment is tied into a faith-based meaning-making system creating a spiritual framework for understanding work. Ray Anderson writes about psychotherapy as a sacred calling fostering a spiritual understanding of work for those Christian individuals working in the counseling professions (1990). Being called to counsel, for Anderson, is fulfilling God’s call to be a Christian in the counseling room. There is a congruence between one’s inner life – one’s desires, skills, talents, motivations, etc., - and one’s outer life – the specific tasks or roles one performs develop the sense of congruence. That is, my identity as a Christian is being expressed in my vocation as a counselor. In this sense, calling is discovered as one identifies one’s desires and discovers tasks that fulfill these desires. As the highest sense of calling is being Christian, one fulfills this calling of counseling by embodying Christ’s love for others. Calling in this sense helps Christian


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counselors to continually examine and evaluate one’s motivations for counseling. This offers a corrective and preventive for burnout. If one is embodying Christ’s love to hurting and suffering individuals, ultimately, Christ owns them and the counselor and is ultimate responsible for the entire process. The counselor is responsible to embody Christ’s love and be with and for the other in the counseling process; however, fulfillment as a counselor is not based on the outcomes of the counseling process. Burnout becomes “a sense of loss of interest, respect or sympathy for those whom we are responsible” (Capps, 2000, p. 59). Here the connections between emotional exhaustion, depersonalization, and personal accomplishment become clear. Developmentally, when individuals experience stagnation – the opposite pole in the developmental crisis of generativity versus stagnation – a sense of care is lost. If care is the defining characteristic as a positive outcome or virtue for this developmental crisis, Capps (2000) identifies acedia as the vice. Acedia is often translated as apathy in English, which captures an important motivational, experiential dimension of acedia. Namely, apathy describes the affective, motivational condition of the individual experiencing burnout. However, acedia is also directed outward. The individuals and products one cares for are also impacted by acedia through indifference. Indifference entails lack of care regarding distressing situations and individual suffering. In other words, individuals are uninterested in the concerns of others. The vice of acedia is a form of selfbondage. Individuals suffering from acedia are trapped in their own apathy unable to escape it, and this results in social isolation and alienation. If viewing one’s vocation as a counselor relates to a Christian understanding of calling which corresponds to personal accomplishment, then acedia corresponds with both the emotional exhaustion and depersonalization aspects of burnout. Emotional exhaustion resembles the apathy


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dimension of acedia. Apathy as demotivational represents the emotional exhaustion because emotional exhaustion entails a loss or emptying of the motivational and compassionate aspects of the individual engaged in helping others. It could be characterized by numbness or depletion of psychic resources to provide care for others. Apathy in this sense is self-eviscerating and emptying: It is a lack of desire (Capps, 2000). Acedia as indifference corresponds with depersonalization. Depersonalization results in a callous and cynical outlook on one’s clients (Maslach, Jackson, & Leiter, 1996). Like depersonalization, indifference reveals itself in disregarding the experiences of others – not working to ameliorate the suffering and pain of others (Capps, 2000). Depersonalization expresses itself in “faking it” or only “going through the motions” of being with individuals that suffer. Sufferers and needs become objectified in this process. There are significant areas of overlap between the dimensions of burnout as emotional exhaustion, depersonalization, and personal accomplishment with the Christian principles of apathy, indifference, and calling. Emotional exhaustion and apathy alongside depersonalization and indifference directly connect with the provision of helping services. Personal accomplishment and calling relate to one’s purpose based on work. The paper now turns to understanding two important buffers for preventing and coping with burnout – mindfulness and differentiation of self. Mindfulness and Coping with Burnout or Compassion Fatigue “Mindfulness is recommended as a tool to decrease stress and burnout in health professionals, and may also increase practitioner compassion and improve patient interactions” (Hunter, 2016, p. 918). Multiple definitions of the mindfulness construct exist in current and past research literature. A study of 33 definitions of mindfulness was conducted by Nilsson and


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Kazemi in 2016. The authors determined the concept of mindfulness was comprised of four elements – awareness and attention, present-centeredness, external events, and cultivation. To these four elements, the authors added the concept of ethical-mindedness, which is often absent in the Western definitions of mindfulness (Nilsson & Kazemi, 2016). Nilsson and Kazemi define mindfulness as “a particular type of social practice that leads the practitioner to an ethically minded awareness, intentionally situated in the here and now” (Nilsson & Kazemi, 2016, p. 190). Practicing mindfulness has been found to alleviate and reduce burnout despite high job demands, enhance employees’ problem-focused coping styles and feelings of selfefficacy, lessen employees’ emotion-based coping styles, and increase employee job satisfaction (Charoensukmongkol, 2013). “Mindfulness is a significant concept for the discipline of nursing with practical applications for nurse well-being, the development and sustainability of therapeutic nursing qualities and holistic health promotion” (White, 2014, p. 282). Specific to nurses and healthcare professionals, practicing mindfulness has been shown to decrease stress, burnout, and anxiety, while increasing empathy, focus, and mood (Smith, 2014). As such, research shows that the construct of mindfulness can be used to prevent burnout or help individuals cope with burnout. A study conducted by Pflugeisen, Drummond, Ebersole, Mundell, and Chen (2016) evaluated the effectiveness of a video-module-based mindfulness training program. Physicians participating in this study showed significant increases in mindfulness skills and reported decreased stress, personal accomplishment, and emotional exhaustion (Pflugeisen, et al., 2016). Likewise, a study involving psychologists conducted by Benedetto and Swadling found a strong negative correlation between mindfulness and burnout (2014). Specifically, the study revealed “four mindfulness facets, non-reactivity to inner experience, acting with awareness, describing


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and non-judging of inner experience were significantly negatively correlated with burnout” (Benedetto & Swadling, 2014, p. 712). This led the authors to the conclusion that mindfulnessbased techniques may be effective at preventing burnout (Benedetto & Swadling, 2014). In addition, a negative relationship between the constructs of mindfulness and burnout was revealed in a study of 380 counseling interns (Testa & Sangganjanavanich, 2016). The Acting With Awareness facet of mindfulness was significantly related to both the Emotional Exhaustion and the Depersonalization subscales of the MBI-HSS, which suggests that attending to moment-to-moment experiences helps facilitate greater awareness of one’s own emotions and feelings toward others. Consequently, this ability can support counseling interns’ understanding of their emotions, and this understanding may result in their being more equipped to regulate their emotions and develop emotional coping skills, which would prevent a strain on their emotional resources—a key factor in the development of burnout (Testa & Sangganjanavanich, 2016, pp. 103-104). Mindfulness has been a practice encouraged among human service providers (McCollum, 2015). There has been an increasing desire to study burnout for therapists and other human service professionals. If compassion fatigue results in decreased personal presence and empathy for human service professionals, mindfulness could be used to increase these dimensions. Increasing openness and acceptance for therapists and other human service professionals combats the tendencies of emotional exhaustion and depersonalization. Further, mindfulness practice may also aid practitioners to ward off reactivity to traumatizing experiences. Differentiation of Self and Coping with Burnout or Compassion Fatigue Stress researchers have found that people’s coping resources can act as a buffer to or reduce the impacts of stress (Thoits, 2010). During times of stress, individuals draw on both


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personal and social assets. Of these assets, social support has emerged as an efficacious stressbuffer (Thoits, 2010). Social support is considered a coping resource, or a social “fund” from which people draw on when dealing with stressors such as burnout (Thoits, 1995). Social support usually refers to the functions performed for the individual by significant others, such as family members. Family members can provide instrumental, informational, and/or emotional assistance (House and Kahn 1985). Further, the more family members can strive to maintain a positive outlook, the more it helps a person or a family during highly stressful events (Burns 2010; Thomason 2005). Specifically, research has found that families who work together by developing open communication, having an accepting attitude, and focusing on the positives have been found to help individuals cope with stress better (Bluth et al., 2013). The importance of family as a source of social support to weaken burnout or compassion fatigue is well aligned with Differentiation of Self (DoS) in marriage and family therapy. Differentiation of Self (DoS) is one of the most well established constructs in marriage and family therapy. DoS is one of the eight concepts in Bowen family theory, and it is the central focus in clinical work (Bowen, 1978; Hall, 1991; Papero, 1990; Titleman, 1998, 2014). DoS is essentially the relationship processes that are characterized by individuals’ abilities to balance the drive for individuality and togetherness. That is, individual values, ideas, and beliefs are maintained in one’s relationships, despite intense efforts from relational partners to change those values and beliefs. Persons with higher levels of DoS have the ability to be true to his or her beliefs despite relationship pressure to change these beliefs. Another aspect of DoS is the ability to recognize one’s emotional experiences and yet not become overwhelmed by that experience in order to take values-based actions (Bowen, 1978; Hall, 1991; Papero, 1990; Titleman, 1998, 2014).


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One important aspect of human relationships is coping with stress and anxiety (Bowen, 1978; Hall, 1991; Papero, 1990; Titleman, 1998, 2014). As stressors increase, so does anxiety toward coping with the stressors. DoS allows families and individuals to cope with stressors and manage anxiety. On the lower levels of DoS, anxiety drives humans to establish and maintain relationships to cope with stressors (Roberto, 1992). Lower levels of DoS are displayed in increased dependency, emotionality, lessened autonomy, and in sever instances psychosis (Bowen, 1978; Roberto, 1992). Anxiety in this sense is survival oriented – prompting humans to create relationships and communities in order to raise offspring or meet other survival needs. As a result, humans experience intense pressure to maintain relationships with others, even when these relationships make inappropriate demands on the relational partners. As families draw closer together in order to rally their resources, pressure is put on individual members to assume specific, rigid familial roles on the lower ends of DoS. Higher levels of DoS provide the ability to withstand this pressure in order to maintain relationships. Over time, maintaining one’s values and commitments AND relationships facilitate relational change. A critical aspect of DoS, in this sense, is to recognize one’s experiences and feelings and maintain the ability to take valuesbased actions instead of reacting emotionally to one’s feelings, all the while maintaining these relationships. There have been few attempts to conduct research on DoS, and anxiety let alone burnout. For example, DoS has been applied to pastoral burnout. In one study, DoS was shown as a protective factor and allowed pastors to remain in the churches while enduring job stress. Beebe (2007) relied on DoS to understand the relational processes involved with burnout and exiting the ministry. It was hypothesized that the ability to maintain a unique sense of self that was separate from one’s role as pastor would aid in lowering both burnout and exiting the ministry.


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In this sense, DoS entails remaining a self-separate from one’s profession. Beebe discovered that DoS does in fact provide a buffer against burnout as it facilitated a clergy’s ability to remain connected with parishioners yet be a change agent for them as well, which inherently increases anxiety and stress for those being transformed. Those pastors with higher levels of DoS could respond with compassion to their parishioners and maintain relationships despite experiencing conflict with them due to pastoral challenges to be transformed. There has been only one study that has specifically investigated the relative impact of both mindfulness and DoS on burnout (Author, in press). In this investigation, the authors purposefully compared DoS and mindfulness as contributors to the prevention of burnout. In a Christian sample of working adult students, there were significant inverse correlations between mindfulness and DoS with emotional exhaustion. Lower levels of emotional exhaustion were correlated with higher levels of mindfulness and DoS. However, mindfulness was an overall better predictor of burnout compared with DoS for this sample, making trait mindfulness a more salient psychological resource in coping with burnout. Needless to say, more research is needed in this area. Techniques to prevent and cope with burnout – mindfulness McCollum (2015) identifies two broad types of mindfulness practice. First, concentration practices are used to develop one’s ability to concentrate and focus on the present moment. Second, insight practice allows one to attend to the actual experience. That is, insight practice allows one to broaden attention to any experiences that arise while focusing on one’s present moment experiences. Breath meditation is an easily used mindfulness technique that develops one’s concentration and focus (McCollum, 2015). This practice is intentionally experiencing


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one’s breathing – noticing in the body (nostrils, belly, chest) where the air fills and empties, any smells and other sensation that arise with the breath. Insight practice, on the other hand, allows one to (1) attend more fully to the present moment, and (2) hold the present moment compassionately. “Compassion is the ability to feel the suffering of another being along with the wish to lesson or eliminate that suffering” (McCollum, 2015, p. 50). This sense arises as one gains insight into the fact that all beings are connected, thus one individual’s suffering is everyone’s suffering. This duality of compassion – connection with all humanity and being present in one’s experience – challenges therapists, counselors, and pastors to know his or her personal suffering. Part of the present moment is the counselors suffering in addition to being present with the client in suffering. Segal, Williams, and Teasdale (2013) outline multiple mindfulness-based strategies in their text Mindfulness-Based Cognitive Therapy for Depression. One of these strategies, referred to as the Raisin Exercise, provides an experiential problem-solving base through providing a new way of relating to the experience of eating a raisin. In this exercise, each participant is given a raisin and is guided through a new way to experience eating the raisin. First, participants are asked to see the raisin as an object they have never seen before by exploring the texture of the raisin, examining the folds of the raisin, and smelling the raisin. Participants are then guided through slowly taking the raisins to their mouths and are asked to explore the sensations of the raisins in their mouths, such as consistency and shape, prior to chewing the raisin. Next, participants are asked to slowly chew the raisin and pay attention to change in consistency of the raisin. Participants are then encouraged to detect their readiness or intention to swallow the raisin, paying special attention to the process of swallowing, the aftertaste, and the absence of the raisin their mouths. This exercise is designed to take participants off automatic pilot mode,


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which occurs when the body is doing one thing and the mind is done something else (Segal, Williams, & Teasdale, 2013). A second technique, used to bring mindfulness into everyday life, is the 3-Minute Breathing Space exercise (Segal, Williams, & Teasdale, 2013). In this exercise, participants are asked to complete the exercise, consisting of three steps, at three predetermined times throughout the day. However, participants may use this exercise more than the three predetermined times. The first step, acknowledging one’s experiences at that very moment in time, is designed to have the participant leave automatic pilot mode. Participants may ask themselves questions such as, “Where am I? What’s going on?” during this step. “The second step involves bringing the attention to the breath, gathering the scattered mind to focus on this single object – the breath” (Segal, Williams, & Teasdale, 2013, p. 196). In this step, participants redirect their focus to the physical sensations of breathing. Examples include the participants sensing breath in their abdomens, and feeling the expansion and contraction of their abdomens as breath goes in and out of their bodies. In the final step, participants are asked to expand their awareness to include breathing and a sense of their entire bodies. This may include becoming intentionally aware of body posture and facial expressions. At the close of the 3-Minute Breathing Space exercise, participants are asked to bring this expanded awareness to the next moments they experience (Segal, Williams, & Teasdale, 2013). A third mindfulness technique contained in the text Mindfulness-Based Cognitive Therapy for Depression by Segal, Williams, and Teasdale (2013) is the Body Scan. The goal of the Body Scan technique is bring a detailed awareness to each part of a participant’s body, and it affords participants the opportunity to learn to keep their attention focused over a sustained period of time. Individuals participating in the Body Scan technique are asked to lie on their


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backs and focus on their breathing. Next, participants intentionally bring awareness to individual parts of their bodies and focus on the physical sensations occurring in that specific region, at that moment. For example, participants may be instructed to be aware of the sensations of touch and pressure, based upon where their bodies make contact with the ground. Participants are asked to focus on a specific body part for a short time and then are instructed to release that body part and shift their attention to the next body part. As with the Raisin Exercise, the Body Scan exercise allows participants to experience a new way to experience physical sensations and relate mindfully to an experience (Segal, Williams, & Teasdale, 2013). Techniques to prevent and cope with burnout – Christian spiritual practices If acedia is at the heart of burnout and compassion fatigue, reconnecting with God through the spirit will enliven the person struggling with compassion fatigue. In fact, a recent study has shown that Christian spiritual practices may lower anxiety and worry for Christians (Knabb, Frederick, Cummings, 2017). Some research among Christian pastors indicates that personal renewal and rest-taking strategies are important ways in which pastors may prevent or cope with emotional exhaustion (Chandler, 2009). That is, connecting with God using personal renewal strategies (Bible reading, prayer) help to deal with the demands of ministry – apathy towards one’s congregation. Further, Chandler (2010) identifies the crucial role personal devotion time and prayer time have in preventing and coping with burnout in the ministry. Taken together, there is an emerging connection between Christian spiritual practices and coping with stress, worry, and burnout. Three important spiritual practices that are useful in coping with burnout are (1) the Jesus Prayer, (2) the daily examen, and (3) using the prayer of consideration. The Jesus Prayer is an ancient spiritual practice coming out of the Christian contemplative tradition (Talbot, 2013). The


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Jesus Prayer simply is, “Lord Jesus Christ, Son of God, have mercy on me, a sinner.” As Talbot describes the practice of connecting the breath with the prayer: “Breathing in fills us up, and breathing out empties us. Breathing in causes us to hold on, and breathing out causes us to let go” (2013, p. 17). By connecting “Lord Jesus Christ, Son of God” with inhaling, one experiences the breath (or spirit, in Biblical vernacular). Exhaling on “have mercy on me, sinner” allows for the release of guilt, shame, and anxiety. Recent research suggests that practicing the Jesus Prayer positively impacts mood (Rubinart, Fornieles, & Deus, 2017). Further, some practitioners have reported a deepened sense of peace and calm furthering a relationship with the transcendent other (Rubinart, Moynihan, & Deus, 2016). St. Ignatius’ Spiritual Exercises contain the core features of the “daily examen” (Ignatian Spirituality, n.d.). This Christian spiritual practice is useful in helping one to identify God’s loving, active presence throughout the day, during one’s mundane life. This practice entails prayerful reflection, typically twice a day, facilitating the recognition of God’s active, loving presence. There are five main aspects to this type of prayer. First, notice God’s presence in one’s experience. Next, reflect on the day’s events with gratitude and thankfulness. Third, notice one’s subjective experience. Fourth, pick one prominent aspect of the day and pray from that experience. Finally, ask God to prepare the practitioner for tomorrow, taking what was learned from today’s experience. The final spiritual exercise is the prayer of consideration (Ignatian Spirituality, n.d.). The heart of Ignatian spirituality is “seeing God in all things” which prompts us to be actively engaged in finding where God is working in the world and partnering with God to accomplish divine purposes (Tetlow, 2008). In the prayer of consideration, one thoughtfully and imaginatively reflects on the world and experiences. Four categories to consider could be


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(Ignatian Spirituality, n.d.): (1) creation by finding in God in the beauty of nature, (2) people by reflecting on encounters experienced throughout one’s day, (3) work by focusing on colleagues, tasks and projects, as well as skills as reflecting God’s image, and (4) children by focusing on what they teach us about entering God’s kingdom (Luke 18:15-17). The prayer of consideration allows one to enter into a text or experience paying attention or considering where God’s active presence is and what it means for the believer. For example, one may consider the splendor of creation and reflect on the creator. One may begin reflecting on the innocence of childhood and reflect on what that means for being a child of God. Or, as Tetlow (2008) suggests, one could reflect on the idea of extravagance as described in the story of the Prodigal Son in Luke 15. Who is acting in a prodigal fashion? The younger son? The father? What kinds of people are described in this story? What would it be like to live in their family? How does one experience the prodigal love of God now? In one’s current experiences? Conclusions Mindfulness and Christian spirituality are useful tools in preventing and coping with burnout and compassion fatigue. As these practices are tied into managing loss of personal accomplishment, emotional exhaustion, and depersonalization, human service workers are able to stave off burnout and actually be revitalized in their work. As Christians, a better way to conceptualize burnout and compassion fatigue are the categories of calling, apathy and indifference. In this way, preventing and coping with burnout becomes a project of spiritual revitalization – reconnecting with the empowering, living spirit of God. The practices of the Jesus Prayer, the daily examen, and the prayer of consideration are useful tools to accomplish this.


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References Anderson, R. S. (1990). Christians who counsel: The vocation of wholistic therapy. Pasadena, CA: Fuller Seminary Press. Beebe, R. S. (2007). Predicting burnout, conflict management style, and turnover among clergy. Journal of Career Assessment, 15, 257-275. doi: 10.1177/1069072706298157. Benedetto, M., & Swadling, M. (2014). Burnout in Australian psychologists: Correlations with work-setting, mindfulness and self-care behaviours. Psychology, Health & Medicine, 19(6), 705-715. doi:10.1080/13548506.2013.861602 Bluth, K., Roberson, P., Billen, R., and Sams, J. (2013). A stress model for couples parenting children with Autism Spectrum Disorders and the introduction of a mindfulness intervention. Journal of Family Theory and Review 5(3):194-213. Bowen, M. (1978). Family therapy and clinical practice. New York: Jason Aronson. Burns, G. W. (2010). Happiness, healing, enhancement: Your casebook collection for applying positive psychology in therapy. Hoboken, NJ: Wiley. Capps, D. (2000). Deadly sins and saving virtues. Eugene, OR: Wipf and Stock Publishers. Capps, D. (2008). The decades of life: A guide to human development. Louisville, KY: Westminster John Know Press. Chandler, D. (2009). Pastoral burnout and the impact of personal spiritual renewal, rest-taking, and support system practices. Pastoral Psychology, 58, 273-287. doi:10.1007/s11089008-0184-4.


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Chandler, D. (2010). The impact of pastors' spiritual practices on burnout. Journal of Pastoral Care and Counseling, 64, no. 2, 1-9. Charoensukmongkol, P. (2013). The contributions of mindfulness meditation on burnout, coping strategy, and job satisfaction: Evidence from Thailand. Journal of Management & Organization, 19(5). doi:10.1017/jmo.2014.8 Converso, D., Loera, B., Viotti, S., & Martini, M. (2015). Do positive relations with patients play a protective role for healthcare employees? Effects of patients' gratitude and support on nurses' burnout. Frontiers in Psychology, 6, 1-11. doi:10.3389/fpsyg.2015.00470 de Beer, L., Pienaar, J., & Rothmann Jr., S. (2013). Linking employee burnout to medical aid provider expenditure. South African Medical Journal, 103(2), 89-93. doi:10.7196/SAMJ.6060 de Beer, L., Pienaar, J., Jr., R., & Sebastiaan. (2016). Job burnout, work engagement and self reported treatment for health conditions in South Africa. Stress & Health, 32(1), 36-46. doi:10.1002/smi.2576 Dewa, C., Loong, D., Bonato, S., Thanh, N., & Jacobs, P. (2014). How does burnout affect physician productivity? A systematic literature review. BMC Health Services Research, 14(325), 1-10. doi:10.1186/1472-6963-14-325 Erikson, E. H. (1980). Identity and the life cycle. New York: W. W. Norton. Erikson, J. M. (1997). The life cycle completed (Extended Version). New York: W. W. Norton. Evans, W., & Tomic, W. (2003). Burnout among Dutch Reformed pastors. Journal of Psychology and Theology, 31, 329-338.


23

Figley, C. R. (Ed.). (2002). Treating compassion fatigue. New York, NY: Routledge. Fowler, J. W. (1987). Faith development and pastoral care. Philadelphia, PA: Fortress. Author. (In press). Exploring the relative contributions of differentiation of self and mindfulness for predicting burnout. In Meditation: Practice, Techniques, and Health Benefits. Nova Science Press. Hall, C. M. (1991). Bowen family theory and its uses. New York: Jason Aronson. Han, J., & Lee, C. (2004). Ministry demand and stress among Korean American pastors: A brief report. Pastoral Psychology, 52, 473-478. Hunter, L. (2016). Making time and space: the impact of mindfulness training on nursing and midwifery practice. A critical interpretative synthesis. Journal of Clinical Nursing, 25(7 8), 918-929. doi:10.1111/jocn.13164 House, J. S., and Kahn, R. L. (1985). Measures and concepts of social support. In S. Cohen and S. L. Syme (Eds.). Social Support and Health (pp. 83-108). Orlando, FL: Academic Press. Ignatian Spirituality. (n.d.). The daily examen. Retrieved July 19, 2017, from http://www.ignatianspirituality.com/ignatian-prayer/the-examen. Knabb, J., Frederick, T. V., and Cummings, G. (2017). Surrendering to God’s providence: A three-part study on Providence-Focused Therapy for recurrent worry (PFT-RW). Psychology of Religion and Spirituality, 9, 180-196. Lee, C. (2010). Dispositional resiliency and adjustment in protestant pastors: A pilot study. Pastoral Psychology, 59, 631-640. DOI 10.1007/s11089-010-0283-x.


24

Maslach, C., & Leiter, M. (1997). The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco: Jossey-Bass Inc. Maslach, C., Jackson, S., & Leiter, M. (1996). Maslach Burnout Inventory Manual. (3rd), 1-45. Maslach, C., Schaufeli, W., & Leiter, M. (2001). Job burnout. Annual Review of Psychology, 52, 397-422. McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131-149. McCollum, E. (2015). Mindfulness for therapists: Practice for the heart. New York: Routledge. Newall, J. M., Nelson-Gardell, D., & MacNeil, G. (2016). Clinician responses to client traumas: A chronological review of constructs and terminology. Trauma, Violence, and Abuse, 17, 306-313. DOI: 10.1177/1524838015584365 Nilsson, H., & Kazemi, A. (2016). Reconciling and thematizing definitions of mindfulness: The big five of mindfulness. Review of General Psychology, 20(2), 183-193. doi:10.1037/gpr0000074 Ogden, G. (1990). The new reformation: Returning the ministry to the people of God. Grand Rapids, MI: Zondervan. Papero, D. V. (1990). Bowen family systems theory. Boston: Allyn and Bacon. Pflugeisen, B., Drummond, D., Ebersole, D., Mundell, K., & Chen, D. (2016). Brief video module administered mindfulness program for physicians: A pilot study. Explore, 12(1), 50-54. doi:10.1016/j.explore.2015.10.005


25

Reid, R. J., Coleman, K., Johnson, E., Fishman, P., Hsu, C., Soman, M., . . . Larson, E. (2010). The group health medical home at year two: Cost savings, higher patient satisfaction, and less burnout for providers. Health Affairs, 29(5), 835-843. doi:10.1377/hithaff.2010.0158 Rubinart, M., Fornieles, A., & Deus, J. (2017). The psychological impact of the Jesus Prayer among non-conventional Catholics. Pastoral Psychology, 66, 487-504. DOI: 10.1007/s11089-017-0762-4. Rubinart, M., Moynihan, T., & Deus, J. (2016). Using Collaborative Inquiry method to explore the Jesus Prayer. Spirituality in Clinical Practice, 3, 139-151. DOI: http://dx.doi.org/10.1037/scp0000104 Schuman, A. (2016). Preventing (and treating) physician burnout. Contemporary Pediatrics, 33(11), 39-41. Segal, Z., Williams, M., & Teasdale, J. (2013). Mindfulness-based cognitive therapy for depression. New York, New York: The Guilford Press. Shanafelt, T., Hasan, O., Dyrbye, L., Sinsky, C., Satele, D., Sloan, J., & West, C. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Foundation for Medical Education and Research, 90(12), 1600–1613. doi:10.1016/j.mayocp.2015.08.023 Spencer, J. L., Winston, B. E., & Bocarnea, M. C. (2012). Predicting the level of pastors’ risk of termination/exit from the church. Pastoral Psychology, 61, 85-98. DOI 10.1007/s11089011-0410-3.


26

Stevens, R. P. (1999). The other six days: Vocation, work, and ministry in biblical perspective. Grand Rapids, MI: Eerdman’s Publications. Smith, S. (2014). Mindfulness-based stress reduction: An intervention to enhance the effectiveness of nurses' coping with work-related stress. International Journal of Nursing Knowledge, 25(2), 119-130. doi:10.1111/2047-3095.12025 Swensen, S., Kabcenell, A., & Shanafelt, T. (2016). Physician-organization collaboration reduces physician burnout and promotes engagement: The Mayo Clinic experience. Journal of Healthcare Management, 61(2), 105-127. Talbot, J. (2013). The Jesus Prayer: A cry for mercy, a path of renewal. Downers Grove, IL: InterVarsity Press. Tetlow, J. A. (2008). Making choices in Christ: The foundations of Ignatian Spirituality. Loyola Press. Tetsa, D., & Faii Sangganjanavanich, V. (2016). Contribution of mindfulness and emotional intelligence to burnout among counseling interns. Counselor Education & Supervision, 55, 95-108. DOI: 10.1002/ceas.12035. Testa, D., & Sangganjanavanich, V. (2016). Contribution of mindfulness and emotional intelligence to burnout among counseling interns. Counselor Education & Supervision, 55, 95-108. doi:10.1002/ceas.12035 Thoits, P. (1995). Stress, coping and social support processes: Where are we? What’s next? Journal of Health and Social Behavior 35:53-79.


27

Thoits, P. (2010). Stress and health: Major findings and policy implications. Journal of Health and Social Behavior 51: S41-S53. Thomason, D. J. (2005). Natural disasters: Opportunity to build and reinforce family strengths. Family Focus on..Family Strengths and Resilience FF28:F11. Minneapolis: National Council on Family Relations. Titelman, P. (1998). Overview of the Bowen theoretical-therapeutic system. In P. Titelman (Ed.). Clinical applications of Bowen family systems theory (pp. 7-49). New York: Haworth Press. Titelman, P. (2014). The concept of differentiation of self in Bowen theory. In P. Titelman (Ed.), Differentiation of self: Bowen family systems perspectives (pp. 3-64). New York: Routledge. Turgoose, D., and Maddox, L. (2017). Predictors of compassion fatigue in mental health professionals: A narrative review. Traumatology, 23, 172-185. Doi: 10.1037/trm0000116. Van Bogaert, P., Clarke, S., Wouters, K., Franck, E., Willems, R., & Mondelaers, M. (2013). Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: a multilevel modelling approach. International Journal of Nursing Studies, 50, 357-365. doi:10.1111/j.1365-2702.2009.03128.x van der Doef, M., Mbazzi, F., & Verhoeven, C. (2012). Job conditions, job satisfaction, somatic complaints and burnout among East African nurses. Journal of Clinical Nursing, 21, 1763-1775. doi: 10.1111/j.1365-2702.2011.03995.x


White, L. (2014). Mindfulness in nursing: An evolutionary concept analysis. Journal of Advanced Nursing, 70(2), 282-294. doi:10.111/jan.12182

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