The impact of clients' mental illness on social workers' job satisfaction and burnout.

Author:Acker, Gila M.
 
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During the past two decades, there has been considerable interest and research on the phenomena of job satisfaction and burnout in the social work profession (Farber, 1983a; Harrison, 1980; Jayaratne & Chess, 1984; Johnson & Rubin, 1983; Lecroy & Rank, 1987; Maslach, 1986). The direct contact with clients in clinical practice and the continual responsibilities of meeting their emotional as well as their physical needs offer both intrinsic satisfaction and stresses for the providers of the services (Father & Heifetz, 1981; Maslach & Jackson, 1982; Pines & Kafry, 1978).

Job satisfaction is defined as a positive emotional state resulting from the appraisal of one's job situation and is linked with the characteristics and demands of one's work (Arches, 1991; Butler, 1990; Dressel, 1982; Krislef, 1981; Locke, 1976; Smith, Kendall, & Hulin, 1967). The work-related satisfaction of helping people, achieving change and improvement, and promoting their growth has important implications for social workers' behaviors at work, their desire to continue in their work, and their involvement in the job and with their clients (Beemsterboer & Baum, 1984; Daley, 1979; Deutsch, 1984; Farber & Heifetz, 1981; Maslach, 1976, 1978, 1982; Ratlif, 1988; Streepy, 1981).

The literature links job satisfaction with role conflict. It is not uncommon for social workers who work in formal organizations to have different perceptions and expectations of their roles than those of the organization (Harrison, 1980; Olsen & Olsen, 1967; Rosenbaum, 1992). Studies suggest that role conflict has a negative effect on the individual and the organization; it includes job-related tension, conflict and anxiety, and dissatisfaction with the job (Gross, Mason, & McEacherr, 1958; Harrison, 1980; Jayaratne & Chess, 1984; Rosenbaum, 1992). Butler (1990) found that task significance and task variety were positively associated with job satisfaction. Jayaratne and Chess (1984) developed a multidimensional model of job satisfaction that incorporated several job facets that included comfort, challenge, financial rewards, role conflict, role ambiguity, and workload.

Burnout is defined as a negative psychological experience that is a reaction of workers to job-related stress (Daley, 1979; Deutsch, 1984; Maslach, 1978, 1982; Ratlif, 1988). Burnout refers to a cluster of physical, emotional, and interactional symptoms, including emotional exhaustion, a sense of lacking personal accomplishment, and depersonalization of clients (Maslach & Jackson, 1982). Burnout symptoms also can include recurrent bouts of flu, headaches, fatigue, poor self-esteem, difficulty in interpersonal relationships, substance abuse, inability to concentrate, rigidity, and tendency to blame clients for their problems (Cherniss, 1980; Pines & Maslach, 1978).

In a profession that is client centered and requires emotional involvement that puts stress on service providers, it is not uncommon to have emotionally drained and chronically frustrated workers (Beemsterboer & Baum, 1984; Maslach, 1982). These workers are likely to be unable to deal with the inevitable stresses of their job, and this failure to cope can result in a number of negative consequences, including impaired performance, low morale, absenteeism, and high turnover (Beemsterboer & Baum, 1984; Daley, 1979; Maslach, 1976, 1978, 1982; Streepy, 1981).

The literature offers a complex etiological model of burnout, emphasizing the interaction of individual, organizational, and societal factors (Cherniss, 1980; Farber, 1983a; Schaufeli, Maslach, & Marek, 1993). The nature of human services occupations often attracts people who are empathetic and sensitive and who tend to be people oriented but who are also anxious, introverted, and overenthusiastic (Farber, 1983a; Freudenberger & Richelson, 1980; Pines & Aronson, 1981). Often the need to help others is exaggerated and is based on low self-esteem and unrealistic goals, factors associated with the burnout phenomenon (Farber, 1983a; Poulin & Walter, 1993). Certain demographic variables, including age, marital status, and gender also were found to be related to burnout (Maslach, 1982; Poulin & Walter, 1993).

Koeske and Kirk (1995) found that internal locus of control was associated with less burnout and higher job satisfaction. Those with internal locus of control, who attributed behavioral outcomes to effort or skill and who had a sense of personal control were able to handle stress and appraised difficult situations as controllable.

The nature of the work setting produces numerous work-related stresses that can lead to workers' burnout (Poulin & Walter, 1993; Schaufeli et al., 1993). Organizational factors found to affect burnout included lack of autonomy (Arches, 1991; Burisch, 1993; Cherniss, 1980; Farber, 1983a; Lecroy & Rank, 1987), role conflict (Harrison, 1980; Kahn, Wolfe, Quinn, Smoek, & Rosenthal, 1964; Winnibust, 1993), inadequacy of organizational resources (Poulin & Walter, 1993), and lack of social support (Pines & Maslach, 1978; Poulin & Walter, 1993; Winnibust, 1993).

CLIENTS WITH SEVERE MENTAL ILLNESS

The major cause of burnout has been attributed to the emotionally demanding interpersonal relationships of professional caregivers with their clients (Beemsterboer & Baum, 1984; Edelwich & Brodsky, 1983; Farber, 1983a; Maslach & Jackson, 1982, 1986; Ratlif, 1988). Certain types of clients - especially those with more chronic and complex problems - are perceived to be more stressful and less desirable to work with than others (Farber, 1983b; Maslach, 1978).

Clients with severe mental illness (SMI) have great difficulty maintaining the therapeutic relationship. The ability to engage these clients in treatment is limited because of their regressive and inappropriate behavior (Cancro, 1983; Coyle, 1978). These clients' progress in treatment is especially slow, and signs of change and improvement can be very minimal and insignificant (Kestenbaum, 1984; Maslach, 1978; Raquepaw & Miller, 1986). Their problems are often so severe and chronic that they are not amenable to most therapeutic interventions (Intagliata & Baker, 1983; Lamb, 1979; Rubin, 1978).

Social workers who have traditional training often expect evidence of insight, progress, and change, which are often the outcomes of the work with clients with mild emotional disorders and life adjustment reactions (Bland & O'Neill, 1990; Walsh, 1984). The lack of feedback regarding the progress and improvement of clients with severe mental illness reinforces clinicians' own sense of failure, a major factor leading to burnout (Maslach, 1978; Raquepaw & Miller, 1986; Ratlif, 1988).

CONCRETE SERVICES

People with SMI need help in living successfully in their communities. The elements of work necessary to serve this population include the provision of concrete services. Social workers who manage the care of these clients perform various activities that include help with the management of simple life activities, advocacy, referral, and mediation between the client and social organizations such...

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