Pastoral Psychol https://doi.org/10.1007/s11089-017-0799-4
Burnout in Christian Perspective Thomas V. Frederick 1
1
& Scott Dunbar & Yvonne Thai
1
# Springer Science+Business Media, LLC, part of Springer Nature 2017
Abstract Mindfulness and Christian spirituality are useful tools in preventing and coping with burnout and compassion fatigue. Christian human services workers who engage in these practices are able to stave off burnout and actually be revitalized in their work because mindfulness and Christian spirituality are tied to managing loss of personal accomplishment, emotional exhaustion, and depersonalization. For Christians, a better way to conceptualize burnout and compassion fatigue is to consider them within 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 for accomplishing this. Keywords Burnout . Compassion fatigue . Mindfulness . Christian spirituality . Jesus prayer . Daily examen . Prayer of consideration The Christian spiritual practices of the Jesus Prayer, the daily examen, and the prayer of consideration are useful tools in assisting Christian human service workers prevent and cope with burnout or compassion fatigue. A Christian perspective on compassion fatigue conceptualizes it using the categories of calling, apathy and indifference. As burnout is experienced as a diminished sense of personal accomplishment, emotional exhaustion, and depersonalization, Christian spiritual practices enable reconnecting with the empowering, living spirit of God. This paper describes the overlap between burnout and compassion fatigue as characterized by lack of personal accomplishment, emotional exhaustion, and depersonalization. This is followed by the proposal that a Christian understanding of compassion fatigue corresponds with a Christian perspective on calling, apathy, and indifference. Next, the paper discusses the role that mindfulness, differentiation of self, and Christian spiritual practices may play in preventing and coping with burnout. The paper ends by discussing three Christian practices that may aid the reader in coping with or preventing compassion fatigue.
* Thomas V. Frederick
[email protected] 1
Online and Professional Studies, California Baptist University, 10300 Hemet St., Suite 200, Riverside, CA 92503, USA
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Burnout BBurnout is a prolonged response to chronic emotional and interpersonal stressors on the job^ (Maslach et al. 2001, p. 397). Burnout is an international problem that 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 and Leiter 1997; Reid et al. 2010; Swensen et al. 2016; van der Doef et al. 2012). For human services professionals, burnout is discussed as compassion fatigue (Figley 2002) or vicarious traumatization (McCann and Pearlman 1990). The main difference between compassion fatigue and burnout is whether the focus is on psychological factors (compassion fatigue) or workplace environment (burnout) (see Newall et al. 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. Burnout is comprised of three distinct dimensions—emotional exhaustion, depersonalization, and lack of personal accomplishment (Maslach et al. 1996). Emotional exhaustion consists of Bfeelings of being emotionally overextended and exhausted by one’s work^ (Maslach et al. 1996, p. 10). An individual experiencing exhaustion may feel drained and experience a lack of energy, causing the individual to be unable to unwind or recover (Maslach and Leiter 1997). Individuals may employ depersonalization, the second dimension of burnout, to distance themselves from disappointment and exhaustion. Depersonalization is characterized by Ban unfeeling and impersonal response toward recipients of one’s services, care, treatment, or instruction^ (Maslach et al. 1996, p. 4). In other words, depersonalization is a defensive response to or disengagement with the 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 Bfeelings of competence and successful achievement in one’s work with people^ (Maslach et al. 1996, p. 4). 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). In other words, human services professionals experiencing burnout, more specifically the lack of a sense of personal accomplishment, are generally dissatisfied with their jobs, and they have a lessened sense of Bpositively influencing people’s lives through work^ (Maslach et al. 1996, p. 43). 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 nursereported quality of care variables (Maslach et al. 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 et al. 2016). According to Shanafelt et al. (2015), more than half of the physicians practicing in the United Stated are experiencing professional burnout. From the patient’s perspective, physicians experiencing burnout are less productive, more likely to make medical errors, and less likely to motivate patients to comply with the recommended medical treatments (Dewa et al. 2014; Schuman 2016). As such, physicians experiencing burnout are at an increased risk for malpractice and often earn low patient satisfaction scores (Dewa et al. 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 limit one’s effectiveness in providing a healing, therapeutic
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relationship. McCollum theorizes that compassion fatigue results in emotional dissonance. Due to the demands of providing services to many people during one’s work day, one’s emotional experiences override from one client to the next. Emotional dissonance occurs when there is a mismatch between one’s feeling state and one’s expression, or a carrying of sentiments 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. Burnout and compassion fatigue are common experiences among pastors and ministers. For example, Evers and Tomic (2003) discovered that Dutch Reformed pastors had higher levels of emotional exhaustion compared to the social services comparison group but that the levels of depersonalization and lowered personal accomplishment were lower than in the comparison group. Further, Spencer et al. (2012) surveyed 285 evangelical pastors. They identified vision conflict—discrepancies between the pastor’s and the congregation’s ministry expectations— and compassion fatigue as the two critical components in the process of pastors exiting the ministry. Beebe (2007) illuminated the connections between a pastor’s inability to differentiate between the self and pastoral roles and burnout, and others have identified the correlations between congregants’ intrusiveness and burnout and stress (Han and Lee 2004; Lee 2010). This provides evidence that pastors and ministers are at risk due to the human service aspects of carrying out the vocation of professional Christian ministry. Taken together, burnout’s effects of emotional exhaustion, depersonalization, and a depleted sense of personal accomplishment on employees leads to a sense of stagnation. When one’s sense of meaning in one’s work is diminished due to burnout or compassion fatigue, stagnation or lack of caring takes hold. In other words, one’s psychological resources to meaningfully engage in work are depleted, leading to lower levels of job satisfaction, higher levels of intent to turnover, higher absenteeism, lower morale, and a deterioration in the quality of care provided. This is especially concerning in the helping professions, such as psychology, counseling, and pastoral ministry. The main concern is the personal effects of burnout in the helping professions because the person of the counselor is crucial to the process of counseling.
Burnout from a Christian perspective Because compassion fatigue depletes psychological resources along the dimensions of lowered levels of personal accomplishment, emotional exhaustion, and depersonalization, a Christian perspective on burnout necessarily incorporates the three categories of calling, apathy, and indifference. First, calling corresponds to the personal accomplishment dimension of burnout. Next, apathy is 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 fourth 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, rearing one’s offspring, and investing in creative and vocational endeavors, one develops a sense of generativity—of living out a sense of caring for the world and the future. Care, in this sense, is Ba widening commitment to take care of the persons, the products, and the ideas one has learned to care for^ (Erikson 1997, p. 67).
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A Christian understanding of work as calling entails a sense of vocation. As James Fowler (1987, p. 32) reminds about vocation as developing from a profound understanding that humans are investing in their current context, in the here and now Bfor the sake of investing our gifts and potentials in furthering some cause that is of transcending importance.^ 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 Bsummons of a good God^ (Stevens 1999, p. 72). The concept of calling as an intensely personal, purpose-driven understanding of one’s work speaks directly to burnout. One’s sense of meaning and value relates to one’s personal satisfaction—valuing one’s contributions at work. When one derives meaning about vocation from a transcendent source, personal accomplishment is tied to a faith-based meaning-making system, creating a spiritual framework for understanding work. Ray Anderson (1990) writes about psychotherapy as a sacred calling, fostering a spiritual understanding of work for those Christian individuals working in the counseling professions. 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, and thus the specific tasks or roles one performs develop the sense of congruence. That is, one’s identity as a Christian is expressed in one’s vocation, in this example, 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. The notion of calling in this sense helps Christian counselors to continually examine and evaluate their motivations for counseling. This offers a corrective and preventive for burnout. If one is embodying Christ’s love to hurting and suffering individuals, Christ owns them and the counselor and is ultimately 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 Ba sense of loss of interest, respect or sympathy for those for 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 self-bondage. 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 that corresponds to personal accomplishment, then acedia corresponds with both the emotional exhaustion and depersonalization aspects of burnout. Emotional exhaustion resembles the apathy 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 the psychic resources to provide care for others. Apathy in this sense is self-
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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 et al. 1996). Like depersonalization, indifference reveals itself by disregarding the experiences of others—not working to ameliorate the suffering and pain of others (Capps 2000). Depersonalization expresses itself in Bfaking it^ or only Bgoing through the motions^ of being with individuals who are suffering. Sufferers and their 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 the purpose of one’s work. The next section addresses the understanding of two important buffers for preventing and coping with burnout—mindfulness and differentiation of self.
Mindfulness and coping with burnout or compassion fatigue BMindfulness 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). 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). 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; White 2014). In short, the research shows that mindfulness can be used to prevent burnout or help individuals cope with burnout. A study conducted by Pflugeisen et al. (2016) evaluated the effectiveness of a videomodule-based mindfulness training program. Physicians participating in this study showed significant increases in mindfulness skills and reported decreased stress, increased sense of personal accomplishment, and decreased emotional exhaustion (Pflugeisen et al. 2016). Likewise, a study of psychologists conducted by Benedetto and Swadling (2014) found a strong negative correlation between mindfulness and burnout. Specifically, the study revealed that Bfour mindfulness facets, non-reactivity to inner experience, acting with awareness, describing and non-judging of inner experience were significantly negatively correlated with burnout^ (Benedetto and Swadling 2014, p. 712). This led the authors to the conclusion that mindfulness-based techniques may be effective in preventing burnout (Benedetto and Swadling 2014). In addition, a negative relationship between the constructs of mindfulness and burnout was revealed in a study of 380 counseling interns (Testa and Sangganjanavanich 2016). The acting with awareness aspect of mindfulness was significantly related to both emotional exhaustion and depersonalization, suggesting 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, which may result in their being more equipped to regulate their emotions and develop emotional coping skills and therefore prevent a strain on their emotional resources—a key factor in the development of burnout (Testa and Sangganjanavanich 2016).
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The practice of mindfulness has been encouraged among human services providers (McCollum 2015). There has been an increasing desire to study burnout among therapists and other human services professionals. If compassion fatigue results in decreased personal presence and empathy among human services professionals, mindfulness could be used to increase these dimensions. Increasing openness and acceptance among therapists and other human services professionals combats the tendencies to emotional exhaustion and depersonalization. Further, mindfulness practice may also aid practitioners to ward off reactivity to traumatizing experiences.
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 experience. Breath meditation is an easily used mindfulness technique that develops one’s concentration and focus (McCollum 2015). This practice involves intentionally experiencing one’s breathing—noticing in the body (nostrils, belly, and chest) where the air fills and empties and any smells or other sensations 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. BCompassion is the ability to feel the suffering of another being along with the wish to lessen or eliminate that suffering^ (McCollum 2015, p. 50). This sense arises as one gains insight into the fact that all beings are connected and 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 their personal suffering. Part of the present moment is the counselor’s suffering in addition to their being present with the client in suffering. Segal et al. (2013) outline multiple mindfulness-based strategies in their text MindfulnessBased Cognitive Therapy for Depression. One of these strategies, referred to as the raisin exercise, provides an experiential problem-solving base through 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 raisin to their mouths and are asked to explore the sensations of the raisin in their mouths, such as its consistency and shape, prior to chewing the raisin. Next, participants are asked to slowly chew the raisin and to pay attention to changes in the 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, which occurs when the body is doing one thing and the mind is done something else (Segal et al. 2013). A second technique, used to bring mindfulness into everyday life, is the 3-min breathing space exercise (Segal et al. 2013). In this exercise, participants are asked to complete the threestep exercise 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 experience at that very moment in time, is designed to have the participant leave automatic
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pilot mode. Participants may ask themselves questions such as, BWhere am I?^ and BWhat’s going on?^ during this step. BThe second step involves bringing the attention to the breath, gathering the scattered mind to focus on this single object—the breath^ (Segal et al. 2013, p. 196). In this step, participants redirect their focus to the physical sensations of breathing. Examples include the participants sensing their 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-min breathing space exercise, participants are asked to bring this expanded awareness to the next moments they experience (Segal et al. 2013). A third mindfulness technique contained in the text Mindfulness-Based Cognitive Therapy for Depression by Segal et al. (2013) is the body scan. The goal of the body scan technique is to bring 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 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 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 teaches participants a new way to experience physical sensations and to relate mindfully to an experience (Segal et al. 2013).
Techniques to prevent and cope with burnout—Christian spiritual practices There is a growing literature connecting mindfulness and Christian spiritual practices as important values accommodative approaches for Christians (Blanton 2011; Garzon 2013; Knabb 2012; Knabb et al. 2017). In other words, mindfulness is being appropriated and tailored for Christian clients in social services. Developing a specifically Christian accommodative understanding of compassion fatigue is important for Christians due to the Buddhist underpinnings of mindfulness (Grabovac et al. 2011). If acedia is at the heart of burnout and compassion fatigue, then 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 among Christians (Knabb et al. 2017). Some research among Christian pastors indicates that personal renewal and rest-taking strategies are important ways by which pastors may prevent or cope with emotional exhaustion (Chandler 2009). That is, connecting with God using personal renewal strategies (Bible reading, prayer) helps pastors deal with the demands of ministry and with apathy toward one’s congregation. Further, Chandler (2010) identifies the crucial role that personal devotion time and prayer time play 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) the prayer of consideration. These three spiritual exercises are intended to rekindle one’s spiritual connection to the divine. The Jesus Prayer is an ancient spiritual practice coming out of the Christian contemplative tradition (Talbot
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2013). The simple Jesus Prayer is as follows: BLord Jesus Christ, Son of God, have mercy on me, a sinner.^ Talbot (2013) describes the practice of connecting the breath with the prayer: BBreathing in fills us up, and breathing out empties us. Breathing in causes us to hold on, and breathing out causes us to let go^ (p. 17). By connecting BLord Jesus Christ, Son of God^ with inhaling, one experiences the breath (or spirit, in biblical terminology). Exhaling on the phrase Bhave mercy on me, a sinner^ allows for the release of guilt, shame, and anxiety. Recent research suggests that practicing the Jesus Prayer positively impacts mood (Rubinart et al. 2017). Further, some practitioners have reported a deepened sense of peace and calm, furthering their relationship with the transcendent other (Rubinart et al. 2016). In other words, the Jesus Prayer rekindles one’s connection to God through attending to one’s breath or spirit (pneuma in the New Testament; see John 3:8). St. Ignatius’s Spiritual Exercises contain the core features of the Bdaily 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. That is, the daily examen invigorates one’s lived experience through noticing the active, loving presence of God in everyday 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 one 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 Bseeing 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. This active attention enlivens one’s spiritual connection to God. Four categories to consider could be: (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) (Ignatian Spirituality n.d.). 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 oneself. 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 in relation to 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? The three spiritual exercises of the Jesus Prayer, the daily examen, and the prayer of consideration speak directly to the spiritual depletion of apathy, indifference, and lack of purpose or calling associated with compassion fatigue. Focusing on the breath enlivens the spirit. Disciplined reflection on one’s daily experiences, as in the daily examen, provides a basis for seeing God at work in one’s life. Finally, the prayer of consideration helps one identify where God’s active presence is and its meaning for oneself, thus providing a sense of purpose and meaning to one’s work.
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Conclusions Mindfulness and Christian spirituality are useful tools in preventing and coping with burnout and compassion fatigue. Christian human services workers who engage in these practices are able to stave off burnout and actually be revitalized in their work because they help increase one’s sense of personal accomplishment and decrease emotional exhaustion and depersonalization. For Christians, a better way to conceptualize burnout and compassion fatigue is to consider them within 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 for accomplishing this.
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