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1997-98 Academy Text Supplement

Chapter 21-14

Coping With Stress and Preventing Burnout

Abstract: Numerous training programs have been developed that address stress and burnout related to work in general and certain professions in particular. In addition, there are countless schools of thought on how to intervene with employees who experience stress-related symptoms. This chapter discusses the unique stressors experienced by victim service providers, including the stress of working with issues related to crime victimization and advocacy and dealing with the limitations of the criminal justice and community service systems. Techniques for recognizing and managing stress and preventing burnout are also presented.

Learning Objectives: Upon completion of this chapter, students will understand the following concepts:

1. Recognition of the unique stressors involved in handling crime victims' issues.

2. Understanding of the stressors that are typically a part of working environments.

3. Recognition of important and early signs of stress before the stress becomes overwhelming for the individual.

4. Suggested methods for relieving stress, including relaxation techniques.

Statistical Overview

• The cost of occupational stress to business and industry in monetary terms has become increasingly well documented. Annually, US industry loses approximately 550 million working days due to absenteeism. It is estimated that 54 percent of these absences are in some way stress-related. (Elkin, A. & Rosch, P. (1990). "Promoting Mental Health at Work." Occupational Medicine: State of the Art Review, Vol. 5, p. 739-54.)
• According to a 1994 Gallup Poll survey of a representative sample of Americans from all walks of life, roughly four in ten of all American adults, and more than half of those age 35 - 54, report that stress is a frequent part of their daily lives. Respondents gave the following answers to Gallup Poll's question: How often do you experience stress in your daily life?

Frequently 40%

Sometimes 39%

Rarely 17%

Never 4%

(Paulsen, B. (1994, October). "Work and Play, a Nation Out of Balance." Health, Vol. 8., no. 6., p. 44.)

• Prolonged stress of police commanders and supervisors causes 90 percent of physiological and psychological diseases. ("The Police Survivor and Stress." (1996, May). The FBI Law Enforcement Bulletin, Vol. 65, No. 5., p. 7.)

• Researchers at the American Institute for Stress, a non-profit organization based in New York, suggest that 75 to 90 percent of patient's visits to physicians are for ailments that have some kind of link with stress and that controlling stress could be instrumental in controlling rising health care costs. (Nowroozi, C. (1994, December). "How Stress Can Make You Sick." Nation's Business, Vol. 82, No. 12, p. 82(1).)
• Medical researchers have found evidence that stress influences the immune system, weakening the body's defenses against many viral disorders. Preliminary research conducted by Carnegie Mellon University in Pittsburgh, Pennsylvania found that of 400 people intentionally exposed to common-cold viruses, those who scored highest on a test of stressful life events were more than twice as likely to develop colds after this exposure than people who scored the lowest. (Ibid.)
• Dr. Paul Rosch, Professor of Medicine and Psychiatry at New York Medical College, believes that stress is more powerful than diet in influencing cholesterol levels. He cites several studies -- including one of medical students around exam time and another of accountants during tax season -- that have shown significant increases in cholesterol levels during stressful events, when there was little change in diet. (Ibid.)

Unique Sources of Stress in Working with Crime Victims

Professionals who assist crime victims face several unique sources of stress that go beyond the typical stressors experienced by those in other work environments. Victim service providers are expected to provide comforting, compassionate support for crime victims, while at the same time they are expected to be outspoken advocates to ensure that victims are extended their rights within the justice system and that they receive necessary services. In addition, many crime victim professionals work within the very system they are trying to impact and know all to well its limitations. The responsibility of serving in sometimes conflicting roles can be a major source of stress.

Another source of stress that often affects those in the helping professions relates to the desire to help those in need. How do you know when enough is really enough? This question plagues the victim service profession and often arises in trainings conducted on stress and burnout for victim service providers. Without accepted standards for the field, with varying organizational policies on how far the role of the victim service provider extends, and without a "manual" on what it takes to provide reasonable and appropriate victim assistance, most victim service providers find they must set their own limits. This, too, can cause stress.

Finally, the nature of the work causes many crime victim advocates to be in regular contact with people who have suffered severe trauma and loss. To assist victims of crime effectively requires tremendous emotional energy and resilience and is a near-constant source of stress. Stressful situations that the victim-serving community may encounter include:

• Working with victims and witnesses who have experienced or witnessed acts of indescribable human cruelty.

• Working with children who have suffered repeated inhumane acts of sexual, physical, or other abuse.

• Dealing with grieving family members of deceased victims -- immediately after a homicide when providing death notification or in the days or weeks that follow.

• Assisting scores of victims and survivors in the aftermath of mass murder or terrorism.

• Working with victims who, for a variety of reasons, continue to be at risk for further abuse.

These represent work-related stressors that are quite different from most job settings and may affect an individual victim advocate in profound ways.

Understanding Your Ability to Tolerate Stress

An individual's ability to tolerate stress often depends on the frequency, severity, and types of stressors confronted. It also depends on many intrinsic or personal characteristics, including:

• Past experiences

• Personal values and attitudes

• Sense of control

• Personality

• Residual stress level

• General state of health.

In addition, several external or organizational factors can contribute to stress. A brief list of these stressors includes:

• Work overload

• Family conflict

• Threat of job loss

• Job conflict or job ambiguity

• Interpersonal conflicts

• External agency conflicts

• Organizational culture and environment

• Insufficient resources

• Inadequate job training

• Over qualification for current position

• Supervisor's attitudes

• Changes in organizational structure

Manifestations of Stress: Recognizing the Signs

Stress has an effect on all aspects of an individual's emotions and behavior, as well as his/her physical health. Researchers generally divide the manifestations of stress into three general categories: psychological, behavioral, and physical. Most training programs on stress begin with an overview of psychological indicators of stress. The symptoms of psychological stress can include the following:

• Anxiety

• Irritability

• Mood swings

• Sadness and depression

• Low self-esteem

• Emotional withdrawal

• Hypersensitivity

There are also behavioral symptoms associated with stress. These symptoms can affect an individual's work performance, such as:

• Inability to make decisions

• Increased interpersonal conflicts

• Blocked creativity or judgment

• Poor memory

• Lowered productivity

• Difficulty concentrating

Finally, the physical manifestations of stress are often ignored by the individual experiencing long periods of stress until they reach the point of critical consequences. Common signs of the physical impact of stress include:

• Changes in sleeping patterns, such as insomnia

• Headaches

• Backaches

• Gastrointestinal disturbances

• Fatigue

• High blood pressure
• Changes in eating patterns

• Shortness of breath

• Susceptibility to illness

Additional Signs of Stress

Other signs of being highly stressed include the following observations expressed by victim service providers who have attended stress workshops throughout the field. These signs include the following:

• Loss of concentration on work.

• Inability to feel empathy with all or some crime victims.

• Inability to meet deadlines.

• A constant frustration with the lack of adequate monetary compensation.

• Uncharacteristic forgetfulness, such as leaving a wallet or purse behind.

• Fighting with friends and family over insignificant events.

• Feeling overwhelmed with his/her job and a sense that it is consuming one's life.

• A lack of being able to put current stressor into perspective.

• A feeling of inadequate reward and recognition from the agency for constant sacrifices.

• Being overwhelmed with the desire to seek other employment, but feeling there are few options to do so.

Recognizing Stress in Your Working Environment

In addition to the inherent stress involved in responding to crime victims, victim service providers also face many other circumstances that add to their stress in the working environment. While criminal justice-based victim service professionals may face different stressors than professionals in community-based agencies, there are common stressors experienced by most victim service providers.

In March of 1997, the National Institute of Justice (NIJ) released a comprehensive report entitled Developing a Law Enforcement Stress Program for Officers and Their Families. NIJ's Report provides a list of psychological stressors facing law enforcement officers. Developed by Dr. Terry Eisenberg, the report has been used by the International Association of Chiefs of Police in their law enforcement training programs. The following overview of stressors facing victim services professionals has been adapted from Dr. Eisenberg's work as reported in the NIJ Report.

Common Sources of Victim Service Provider Stress

• Isolation: Victim service providers often experience a sense of isolation if they feel they are the only victim serving agency in the community.
• Funding pressures: Most victim services agencies face funding pressures and must seek financial support for their agency from a variety of local, state, and federal sources. This can give staff a sense of insecurity in not always knowing if their position will be funded for the following year.
• Irregular work schedule: Many victim services agencies offer 24-hour assistance to victims of crime; thus staff must rotate their schedules to provide coverage. Even in agencies that have "regular" business hours, staff often have to work overtime to meet the needs of crime victims -- from emergency funeral arrangements, to preparing victims for trials, to providing crisis intervention and counseling, etc.
• Sense of helplessness or hopelessness: The inability to resolve completely victims' problems confronts victim services providers on a daily basis.
• Absence of closure: Much of the work of victim service providers is fragmented -- making a referral, assisting the victim in filling out a compensation claim, or providing short-term crisis intervention. For example, very few victim service providers assist the victim through the entire criminal justice process. The crisis counselor on call when the victim first contacts the agency may not be the same advocate as the one who is the court advocate. Thus, opportunities for feedback on the outcome of a case is minimal.
• Role conflict: It has long been said that an effective victim services provider must be able to wear several hats. One moment being a kind, sensitive, supportive counselor, and

the next moment, being a strong, outspoken advocate on behalf of the victim to ensure their rights are accorded.

• On-going human suffering and cruelty: On a daily basis, victim service providers are exposed to the inequalities and brutalities of life. Over time, the exposure to human suffering, and the daily outpouring of empathy by victim service providers to each victim, may take its toll.
• Lack of referral agencies: Often, the lack of other agencies to help victims -- whether they are other criminal justice-based or community-based agencies -- can often frustrate the victim services provider and may add to the already overburdened workload.
• Frustration with the criminal justice system: Victim service providers, both within and without the criminal justice system, are often frustrated with many aspects of the criminal justice system -- finding out the hard way that many victims' rights are simply not implemented due to a lack of education and knowledge of criminal justice professionals about victims' rights, a lack of funding for victim assistance programs across the criminal justice continuum, and often, because the system is simply overloaded.
• Poor equipment: The lack of current technology that makes the demands of the workplace easier, such as computers for entering client reports and reporting data to funding agencies, or automated notification systems, adds to the workload of victim service providers.
• Frustration with supervisors: The actions and attitudes of supervisors can either increase or help alleviate the stress of the job.
• Lack of career opportunities: Opportunities for promotion are viewed by staff as being limited or unfair. This is a particular problem in victim services agencies that have a few or small staff and few opportunities for advancement exist within the agency.
• Inadequate rewards: Recognition for a job well done is rare; however criticism for mistakes is frequent.
• Extensive paperwork: The need for extensive or duplicate reporting on client case loads to meet the reporting requirements of different federal and state grants that support agency activities is viewed as burdensome.

Techniques to Help Prevent Stress

from Becoming Burnout

Burnout is a severe reaction to stress that results in a state of physical and emotional depletion from the conditions of one's occupation (Public Service Commission, 1991). Because of the

intense nature of the work required by the field of victim assistance -- dealing on a daily basis with issues involving injury and death, frustrations faced with each new case requiring renewed advocacy, compassion, and vigor, and often low pay and a lack of job security -- burnout can occur. In addition to reducing the number of stressors, the following techniques are suggested for program directors to help to try and prevent staff burnout. This information is not only for program directors, it also can serve a useful purpose for program staff to assess whether their agency is taking necessary steps to prevent staff burnout.

(The following information has been adapted from Developing a Law Enforcement Stress Program for Officers and Their Families, National Institute of Justice, March 1997.)

To prevent burnout of victim services staff, program directors should:

• Warn new victim assistance staff about not over-identifying with the job. Let them know about the possibility, nature, and symptoms of burnout, and encourage them to monitor their own vulnerability.

• Meet regularly with staff to discuss and resolve problems of work overload.

• Arrange for scheduled staff meetings at which experienced and inexperienced victim service providers discuss the impact of their work on their own emotions and lives.

• Help victim service providers set limits on how much time they will spend on the job and give them an opportunity (without guilt) to refuse on occasion to accept certain assignments, especially if the individual is responding to emergencies too often.

• Help victim service providers understand the limits of what they can expect to accomplish in their work in terms of helping victims as well as in achieving organizational or system-wide change.

• Assist victim service providers to tolerate some stress by helping them to develop an awareness that they are doing important work that affects people's lives. This obvious, but critical information, is often forgotten or minimized by overworked staff.

• Encourage victim service providers to take vacation time -- without their work and their beepers.

• Promote a work environment that encourages victim service providers to get regular exercise before, during, and after work. Explore agency discounts for group health club memberships.

• Encourage your agency to provide training opportunities for staff to increase their knowledge, skills, and confidence level in their daily work, as well as to foster opportunities to promote career advancement.

Tips for Helping to Relieve Stress

The following information is provided by Dodi Christiano, M.A., a licensed professional counselor who specializes in not only treating individual patients with stress-related problems, but also in conducting community education on stress management.

Time Management

It is important to have balance in your life: balance between work and play; between adult social time and alone time; between family time, physical activity time and spiritual expression. Assess your priorities; make time for each category. Look at how you establish your priorities. Do you only do things you "have to" or do you include things you "want to" do. Try to turn the "have-to's" into "want-to's'.

Attitude

How you think can have a profound affect on your emotional and physical well-being. Each time you think a negative thought about yourself, your body reacts as if it were in the throes of a tension-filled situation. If you see good things about yourself, you are more likely to feel good -- the reverse is also true. Eliminate words such as "always," "never," "should," and "must." These are telltale marks of self-defeating thoughts. Talk to yourself, switch negative self statements to positive statements. For example, "I can do....(whatever it is you are setting out to do)" or, "I made a mistake, but I can do....(whatever it is you are setting out to do)" or, "I made a mistake, but I do a lot of things right."

Relaxation, Meditation, Guided Imagery

Physiologically relaxing your body brings down heart rate, blood pressure and slows breathing. These are all manifestations of stress release in your body. Work up to at least once per day (20-30 minutes) to center yourself with meditation, relaxation exercises, or guided imagery tapes.

Exercise

Our bodies were designed to move. Built up stress can be difficult by physical activity. Walk if you cannot do anything else. Aerobic activity, on a regular basis, plays a significant role in boosting the immune system. Work up to incorporating some form of physical exercise three times per week.

Fun and Laughter

There is a measured effect of the relaxation response after a good laugh. Laughing reduces stress! Do something playful at least once per week, if not once per day. Have fun in your life!

Relaxation Exercises for Relieving Stress

Stress can be relieved in a number of ways. The same method may not work each time an individual attempts to relieve stress -- so you must try different things. One way to reduce stress is to employ relaxation techniques. The following overview provides some exercises victim service providers can use to relax. Each exercise usually takes 15 to 20 minutes, but "mini" sessions can always be tried in situations where one is pressed for time and in desperate need of some stress relief. (Sharp, 1996).

• Deep breathing: Take a deep, slow breath. Let the air come in through your nose and move deep into your lower stomach. Then breathe out through your mouth. Repeat this for several minutes. Imagine that the air coming in carries peace and calm, and the air you exhale contains your tension.
• Body scan: Close you eyes and do some deep breathing exercises. Then, in your mind, do a scan of your entire body, beginning with the top of your head and moving down to your feet. With each breath, focus on a different part of your body. As you breathe in, notice any muscle tension in the various parts of your body. As you breathe out, let go of that tension.
• Progressive muscle relaxation (PMR): As you perform a body scan, tighten the muscles in each area to increase the tension. Then slowly release the tension. Do this for each part of your body, from head to toe. You will find that you feel much more relaxed after letting go of the tension.
• Meditation: Find a comfortable place to sit or lie down, and close your eyes. As you breathe deeply, repeat a word or sound over and over again either to yourself or softly aloud. Concentrating on your breathing or on the repeated word helps you to focus your attention. Meditation can help you to slow down your breathing and heart rate, ease muscular tension, and to respond calmly to stressful situations. Once you are used to meditating, you can use it to relieve stress while you stand, walk, or jog. Some people even meditate while doing everyday things such as waiting for the bus, doing the dishes, etc.
• Guided imagery: Find a quiet, comfortable place to sit. Then close your eyes and take a few slow, deep breaths. Now imagine you are in a place where you know you can relax, such as on the beach or in your bed. Now visualize yourself at this one spot. Take in the sounds, smells, and scenery around you. Savor them one by one. As you become

more experienced with imagery, you can use it anywhere. For example, if stress takes over your mind while you are waiting for someone to show up for an appointment, take a couple of minutes to use imagery to relax so you can focus.

• Yoga: This is one of the oldest relaxation techniques. There are many different kinds of yoga, but all involve physical poses, meditation, and deep breathing. Everything you do as you practice yoga helps to strengthen, stretch, and relax both your mind and body. There are many classes, books, and videos available to help teach you how to practice this ancient relaxation technique.
• Aerobic exercise: Finally, any kind of physical exercise, whether it is a team sport or a simple walk at lunch time, can help reduce stress. Remember, if you can release pent-up energy, your body will benefit in the long run.

Self Examination Chapter 21, Section 14

Coping With Stress and Preventing Burnout

1) What are three symptoms of psychological stress?

2) What are three physical manifestations of stress?

3) What are four common organizational stressors?

4) There are many ways for organizations to help reduce stress on employees; list at least three.

5) What techniques can you use to reduce stress?

References

Canadian Public Service Commission. (1992). "Stress and Executive Burnout." Focus on Staff, 4 (1).

Elkin, A. & Rosch, P. (1990). "Promoting Mental Health at Work." Occupational Medicine State of the Art Review, 5, 739-54.

Finn, P. & Tomz, J. (1997). "Developing a Law Enforcement Stress Program for Officers and Their Families." National Institute of Justice, Issues and Practices, 8-9, 56.

Nowroozi, C. (1994). "How Stress Can Make You Sick." Nation's Business, 82 (12), 82.

Palmer, S. & Drydan, W. (1996). Stress Management and Counseling: Theory, Practice, Research, and Methodology. New York: Cassel Publishers.

Paulsen, B. (1994). "Work and Play, A Nation out of Balance." Health, 8, (6), 44.

Sharp, K. (1996). "Ready....Get Set....Relax!" Current Health 2, 23, (4), 21.

Standfest, S. (1996). "The Police Survivor and Stress." The FBI Law Enforcement Bulletin, 65, 7.

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