Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Self-Care. Show all posts
Showing posts with label Self-Care. Show all posts

Monday, June 12, 2023

Why some mental health professionals avoid self-care

Dattilio, F. M. (2023).
Journal of Consulting and Clinical Psychology, 
91(5), 251–253.


This article briefly discusses reasons why some mental health professionals are resistant to self-care. These reasons include the savior complex, avoidance, and lack of collegial assiduity. Several proposed solutions are offered.

Here is an excerpt:

Savior Complex

One hypothesis used to explain professionals’ resistance is what some refer to as a “savior complex.” Certain MHPs may be engaging in the cognitive distortion that it is their duty to save as many people from suffering and demise as they can and in turn need to sacrifice their own psychological welfare for those facing distress. MHPs may be skewed in their thinking that they are also invulnerable to psychological and other stressors. Inherent in this distortion is their fear of being viewed as weak or ineffective, and as a result, they overcompensate by attempting to be stronger than others. This type of thinking may also involve a defense mechanism that develops early in their professional lives and emerges during the course of their work in the field. This may stem from preexisting components of their personality dynamics. 

Another reason may be that the extreme rewards that professionals experience from helping others in such a desperate state of need serve as a euphoric experience for them that can be addictive. In essence, the “high” that they obtain from helping others often spurs them on.

Another less complicated explanation for MHPs’ blindness to their own vulnerabilities may be their strong desire to avoid admitting to their own weaknesses and sense of vulnerability. The defense mechanism of rationalization that they are stronger and healthier than everyone else may embolden them to push on even when there are visible signs to others of the stress in their lives that is compromising their functioning. 

Avoidance is also a way of sidestepping the obvious and putting it off until later. This may be coupled with the need that has increased, particularly with the recent pandemic that has intensified the demand for mental health services.


The dismissal of MHPs’ own needs or what some may term as, “denial” is a deeper aspect that goes hand-in-hand with cognitive distortions that develop with MHPs, but involve a more complex level of blindness to the obvious (Bearse et al., 2013). It may also serve as a way for professionals to devalue their own emotional and psychological challenges. 

Denial may also stem from an underlying fear of being determined as incapacitated or not up to the challenge by their colleagues and thus prohibited from returning to their work or having to face limitations or restrictions. It can sometimes emanate from the fear of being reported as having engaged in unethical behavior by not seeking assistance sooner. This is particularly so with cases of MHPs who have become involved with illicit drug or alcohol abuse or addiction. 

Most ethical principles mandate that MHPs strive to remain cognizant of the potential effects that their work has on their own physical and mental health status while they are in the process of treating others and to recognize when their ability to be effective has been compromised. 

Last, in some cases, MHPs’ denial can even be a response to genuine and accurately perceived expectations in a variety of work contexts where they do not have control over their schedules. This may occur more commonly with facilities or institutions that do not support the disclosure of vulnerability and stress. It is for the aforementioned reasons that the American and Canadian Psychological Associations as well as other mental health organizations have mandated special education on this topic in graduate training programs (American Psychiatric Association, 2013; Maranzan et al., 2018).

Lack of Collegial Assiduity

A final reason may involve a lack of collegial assiduity, where fellow MHPs observe their colleagues enduring signs of stress but fail to confront the individual of concern and alert them to the obvious. It is often very awkward and uncomfortable for a colleague to address this issue and risk rebuke or a negative outcome. As a result, they simply avoid it altogether, thus leaving the issue of concern unaddressed.

The article is paywalled here, which is a complete shame.  We need more access to self-care resources.

Thursday, March 16, 2023

Drowning in Debris: A Daughter Faces Her Mother’s Hoarding

Deborah Derrickson Kossmann
Psychotherapy Networker
March/April 2023

Here is an excerpt:

My job as a psychologist is to salvage things, to use the stories people tell me in therapy and help them understand themselves and others better. I make meaning out of the joy and wreckage of my own life, too. Sure, I could’ve just hired somebody to shovel all my mother’s mess into a dumpster, but I needed to be my family’s archaeologist, excavating and preserving what was beautiful and meaningful. My mother isn’t wrong to say that holding on to some things is important. Like her, I appreciate connections to the past. During the cleaning, I found photographs, jewelry passed down over generations, and my bronzed baby shoes. I treasure these things.

“Maybe I failed by not following anything the psychology books say to do with a hoarding client,” I tell my sister over the phone. “Sometimes I still feel like I wasn’t compassionate enough.”

“You handled it as best you could as her daughter,” my sister says. “You’re not her therapist.”

After six years, my mother has finally stopped saying she’s a “prisoner” at assisted living. She tells me she’s part of a “posse” of women who eat dinner together. My sister decorated her studio apartment beautifully, but the cluttering has begun again. Piles of magazines and newspapers sit in corners of her room. Sometimes, I feel the rage and despair these behaviors trigger in me. I still have nightmares where I drive to my mother’s house, open the door, and see only darkness, black and terrifying, like I’m looking into a deep cave. Then, I’m fleeing while trying to wipe feces off my arm. I wake up feeling sadness and shame, but I know it isn’t my own.

A few weeks ago, I pulled up in front of my mother’s building after taking her to the cardiologist. We turned toward each other and hugged goodbye. She opened the car door with some effort and determinedly waved off my help before grabbing the bag of books I’d brought for her.

“I can do it, Deborah,” she snapped. But after taking a few steps toward the building entrance, she turned around to look at me and smiled. “Thank you,” she said. “I really appreciate all you do for me.” She added, softly, “I know it’s a lot.”

The article is an important reminder that practicing psychologists cope with their own stressors, family dynamics, and unpleasant emotional experiences.  Psychologists are humans with families, value systems, emotions, beliefs, and shortcomings.

Saturday, February 18, 2023

More Physicians Are Experiencing Burnout and Depression

Christine Lehmann
Originally poste 1 FEB 23

More than half of physicians reported feeling burned out this year and nearly 1 in 4 doctors reported feeling depressed — the highest percentages in 5 years, according to the 'I Cry but No One Cares': Physician Burnout & Depression Report 2023.

"Burnout leaves you feeling like someone you're not," said Amaryllis Sánchez, MD, a board-certified family physician and certified physician coach.

"When someone is burned out, they experience extreme exhaustion in the workplace, depersonalization, and a sense that their best is no longer good enough. Over time, this may spill into the rest of their lives, affecting their relationships as well as their general health and well-being," said Sánchez.

When feelings of burnout continue without effective interventions, they can lead to depression, anxiety, and more, she said.

Burnout can persist for months to even years — nearly two thirds of doctors surveyed said their burnout lasted for at least 13 months, and another 30% said it lasted for more than 2 years.

The majority of doctors attributed their burnout to too many bureaucratic tasks, although more than one third said it was because their co-workers treated them with a lack of respect.

"This disrespect can take many forms from demeaning comments toward physicians in training to the undermining of a physicians' decade-long education and training to instances of rudeness or incivility in the exam room. Unfortunately, medical professionals can be the source of bad behavior and disrespect. They may be burned out too, and doing their best to work in a broken healthcare system during an extremely difficult time," said Sánchez.

Tuesday, September 6, 2022

Confronting Health Worker Burnout and Well-Being

V. Murthy
NEJM, July 13, 2022
DOI: 10.1056/NEJMp2207252

Here is an excerpt:

Burnout manifests in individuals, but it’s fundamentally rooted in systems. And health worker burnout was a crisis long before Covid-19 arrived. Causes include inadequate support, escalating workloads and administrative burdens, chronic underinvestment in public health infrastructure, and moral injury from being unable to provide the care patients need. Burnout is not only about long hours. It’s about the fundamental disconnect between health workers and the mission to serve that motivates them.

These systemic shortfalls have pushed millions of health workers to the brink. Some 52% of nurses (according to the American Nurses Foundation) and 20% of doctors (Mayo Clinic Proceedings) say they are planning to leave their clinical practice. Shortages of more than 1 million nurses are projected by the end of the year (U.S. Bureau of Labor Statistics); a gap of 3 million low-wage health workers is anticipated over the next 3 years (Mercer). And we face a significant shortage of public health workers precisely when we need to strengthen our defenses against future public health threats. Health worker burnout is a serious threat to the nation’s health and economic security.

The time for incremental change has passed. We need bold, fundamental change that gets at the roots of the burnout crisis. We need to take care of our health workers and the rising generation of trainees.

On May 23, 2022, I issued a Surgeon General’s Advisory on health worker burnout and well-being, declaring this crisis a national priority and calling the nation to action with specific directives for health systems, insurers, government, training institutions, and other stakeholders. The advisory is also intended to broaden awareness of the threat that health worker burnout poses to the nation’s health. Public awareness and support will be essential to ensuring sustained action.

Addressing health worker well-being requires first valuing and protecting health workers. That means ensuring that they receive a living wage, access to health insurance, and adequate sick leave. It also means health workers should never again go without adequate personal protective equipment (PPE) as they have during the pandemic. Current Biden administration efforts to enhance domestic manufacturing of PPE and maintain adequate supplies in the Strategic National Stockpile will continue to be essential. Furthermore, we need strict workplace policies to protect staff from violence: according to National Nurses United, 8 in 10 health workers report having been subjected to physical or verbal abuse during the pandemic.

Second, we must reduce administrative burdens that stand between health workers and their patients and communities. One study found that in addition to spending 1 to 2 hours each night doing administrative work, outpatient physicians spend nearly 2 hours on the electronic health record and desk work during the day for every 1 hour spent with patients — a trend widely lamented by clinicians and patients alike. The goal set by the 25×5 initiative of reducing clinicians’ documentation burden by 75% by 2025 is a key target. To help reach this goal, health insurers should reduce requirements for prior authorizations, streamline paperwork requirements, and develop simplified, common billing forms. Our electronic health record systems need human-centered design approaches that optimize usability, workflow, and communication across systems. Health systems should regularly review internal processes to reduce duplicative, inefficient work. One such effort, Hawaii Pacific Health’s “Getting Rid of Stupid Stuff” program, has saved 1700 nursing hours per month across the health system.

Tuesday, April 26, 2022

Ethical considerations for psychotherapists participating in Alcoholics Anonymous

Kohen, Casey B.,Conlin, William E.
Practice Innovations, Vol 7(1), Mar 2022, 40-52.


Because the demands of professional psychology can be taxing, psychotherapists are not immune to the development of mental health and substance use disorders. One estimate indicates that roughly 30% to 40% of psychologists know of a colleague with a current substance abuse problem (Good et al., 1995). Twelve-step mutual self-help groups, particularly Alcoholics Anonymous (AA), are the most widely used form of treatment for addiction in the United States. AA has empirically demonstrated effectiveness at fostering long-term treatment success and is widely accessible throughout the world. However, psychotherapist participation in AA raises a number of ethical concerns, particularly regarding the potential for extratherapy contact with clients and the development of multiple relationships. This article attempts to review the precarious ethical and practical situations that psychotherapists, either in long-term recovery or newly sober, may find themselves in during AA involvement. Moreover, this article provides suggestions for psychotherapists in AA regarding how to best adhere to both the principles of AA (i.e., the 12 steps and 12 traditions) and the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct

Here is an excerpt:

Recent literature regarding the use of AA or other mutual self-help groups by psychotherapists is scant, but earlier studies suggest its effectiveness. A 1986 survey of 108 members of Psychologists Helping Psychologists (a seemingly defunct support group exclusively for substance dependent doctoral-level psychologists and students) shows that of the 94% of respondents maintaining abstinence, 86% attended AA (Thoreson et al., 1986). A separate study of 70 psychologists in recovery who were members of AA revealed the majority attained sobriety outside of formal treatment or intervention programs (Skorina et al., 1990). 

Because AA appears to be a vital resource for psychotherapists struggling with substance misuse, it is important to consider how to address ethical dilemmas that one might encounter while participating in AA.


Psychotherapists participating in AA may, at times, find that their professional responsibility of adhering to the APA Code of Ethics hinders some aspects of their categorical involvement in AA as defined by AA’s 12 steps and 12 traditions. The psychotherapist in AA may need to adjust their personal AA “program” in comparison with the typical AA member in a manner that attempts to meet the requirements of the profession yet still provides them with enough support to maintain their professional competence. This article discusses reasonable compromises, specifically tailored to the length of the psychotherapist’s sobriety, that minimize the potential for client harm. Ultimately, if the psychotherapist is unable to find an appropriate middle-ground, where the personal needs of recovery can be met without damaging client welfare and respecting the client’s rights, the psychotherapist should refer the client elsewhere. With these recommendations, psychotherapists should feel more comfortable participating in AA (or other mutual self-help groups) while also adhering to the ethical principles of our profession.

Friday, April 8, 2022

What predicts suicidality among psychologists? An examination of risk and resilience

S. Zuckerman, O. R. Lightsey Jr. & J. White
Death Studies (2022)
DOI: 10.1080/07481187.2022.2042753


Psychologists may have a uniquely high risk for suicide. We examined whether, among 172 psychologists, factors predicting suicide risk among the general population (e.g., gender and mental illness), occupational factors (e.g., burnout and secondary traumatic stress), and past trauma predicted suicidality. We also tested whether resilience and meaning in life were negatively related to suicidality and whether resilience buffered relationships between risk factors and suicidality. Family history of mental illness, number of traumas, and lifetime depression/anxiety predicted higher suicidality, whereas resilience predicted lower suicidality. At higher levels of resilience, the relationship between family history of suicide and suicidality was stronger.

From the Discussion section:

Contrary to hypotheses, however, resilience did not consistently buffer the relationship between vulnerability factors and suicidality. Indeed, resilience appeared to strengthen the relationships between having a family history of suicide and suicidality. It is plausible that psychologists may overestimate their resilience or believe that they “should” be resilient given their training or their helping role (paralleling burnout-related themes identified in the culture of medicine, “show no weakness” and “patients come first;” see Williams et al., 2020, p. 820). Similarly, persons who believe that they are generally resilient may be demoralized by their inability to prevent family history of suicide from negatively affecting them, and this demoralization may result in family history of suicide being a particularly strong predictor among these individuals. Alternatively, this result could stem from the BRS, which may not measure components of resilience that protect against suicidality, or it could be an artifact of small sample size and low power for detecting moderation (Frazier et al., 2004). Of course, interaction terms are symmetric, and the resilience x family history of suicide interaction can also be interpreted to mean that family history of suicide strengthens the relationship between resilience and suicidality: When there is a family history of suicide, resilience has a positive relationship with suicidality whereas, when there is no family history of suicide, resilience has a negative relationship with suicidality.

Thursday, March 17, 2022

High rates of burnout among college mental health counselors is compromising quality of care, survey says

Brooke Migdon
Originally posted 17 FEB 22

College counselors and clinicians are reporting increasingly high levels of burnout and stress as the pandemic enters its third year. Experts say it’s going to get worse before it gets better.

Just under 93 percent of clinicians on college campuses reported feeling burned out and stressed during the fall semester this year, according to a survey by Mantra Health, a digital mental health clinic geared at young adults. More than 65 percent of respondents reported a heavier workload and longer hours worked compared to the fall semester in 2020. 

Another 60 percent said their workload had compromised the quality of care they were able to provide to students in the fall.

Caseloads aren’t expected to fall anytime soon, as overworked clinicians are leaving the field at a rate similar to that of students asking for help, according to David Walden, the director of Hamilton College’s counseling center. Qualified candidates are also hard to come by.

“Over the last year college counseling centers have seen an uptick in professionals leaving the field and a smaller pool of applicants to refill their positions while the demand from students seeking treatment continues to rise,” he said Thursday in a statement.

Walden noted that, importantly, clinicians are also contending with their own pandemic anxieties that impact their ability to care for themselves, let alone others.

It is “increasingly difficult for directors and clinicians to avoid burnout while institutions of higher education are having increasing trouble hiring and retaining quality mental health staff,” he said.

With college-aged students reporting alarming rates of depression, anxiety and substance abuse, providing quality on- and off-campus care is critical.

Friday, January 15, 2021

Association of Physician Burnout With Suicidal Ideation and Medical Errors

Menon NK, Shanafelt TD, Sinsky CA, et al. 
JAMA Netw Open. 2020;3(12):e2028780. 

Key Points

Question  Is burnout associated with increased suicidal ideation and self-reported medical errors among physicians after accounting for depression?

Findings  In this cross-sectional study of 1354 US physicians, burnout was significantly associated with increased odds of suicidal ideation before but not after adjusting for depression and with increased odds of self-reported medical errors before and after adjusting for depression. In adjusted models, depression was significantly associated with increased odds of suicidal ideation but not self-reported medical errors.

Meaning  The findings suggest that depression but not burnout is directly associated with suicidal ideation among physicians.

Conclusions and Relevance  The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.

Monday, December 14, 2020

The COVID-19 era: How therapists can diminish burnout symptoms through self-care

Rokach, A., & Boulazreg, S. (2020). 
Current psychology,1–18. 
Advance online publication. 


COVID-19 is a frightening, stress-inducing, and unchartered territory for all. It is suggested that stress, loneliness, and the emotional toll of the pandemic will result in increased numbers of those who will seek psychological intervention, need support, and guidance on how to cope with a time period that none of us were prepared for. Psychologists, in general, are trained in and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others. The article, which aims to heighten clinicians’ awareness of the need for self-care, especially now in the post-pandemic era, describes the demanding nature of psychotherapy and the initial resistance by therapists to engage in self-care, and outlines the consequences of neglecting to care for themselves. We covered the demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, the professional hazards faced by those caring for others, and the creative and insightful ways that mental health practitioners can care for themselves for the good of their clients, their families, and obviously, themselves.

Here is an excerpt:

Navigating Ethical Dilemmas

An important impact of competence constellations is its aid to clinicians facing challenging dilemmas in the therapy room. While numerous guidelines and recommendations based on a code of ethics exist, real-life situations often blur the line between what the professional wishes to do, rather than what the recommended ethical action is most optimal to the sovereignty of the client. Simply put, “no code of ethics provides a blueprint for resolving all ethical issues, nor does the avoidance of violations always equate with ideal ethical practice, but codes represent the best judgment of one’s peers about common problems and shared professional values.” (Welfel, 2015, p. 10).

As the literature asserts—even in the face of colleagues acting unethically, or below thresholds of competence, psychologists don’t feel comfortable directly approaching their coworkers as they feel concerned about harming their colleagues’ reputation, concerned that the regulatory board may punish their colleague too harshly, or concerned that by reporting a colleague to the regulatory board they will be ostracized by their colleagues (Barnett, 2008; Bernard, Murphy, & Little, 1987; Johnson et al., 2012; Smith & Moss, 2009).

Thus, a constellation network allows a mental health professional to provide feedback without fear of these potential repercussions. Whether it is guised under friendly advice or outright anonymous, these peer networks would allow therapists to exchange information knowingly and allow for constructive criticism to be taken non-judgmentally.

Saturday, October 3, 2020

Well-Being, Burnout, and Depression Among North American Psychiatrists: The State of Our Profession

R. F. Summers
American Journal of Psychiatry
Published 14 July 2020


The authors examined the prevalence of burnout and depressive symptoms among North American psychiatrists, determined demographic and practice characteristics that increase the risk for these symptoms, and assessed the correlation between burnout and depression.


A total of 2,084 North American psychiatrists participated in an online survey, completed the Oldenburg Burnout Inventory (OLBI) and the Patient Health Questionnaire–9 (PHQ-9), and provided demographic data and practice information. Linear regression analysis was used to determine factors associated with higher burnout and depression scores.


Participants’ mean OLBI score was 40.4 (SD=7.9) and mean PHQ-9 score was 5.1 (SD=4.9). A total of 78% (N=1,625) of participants had an OLBI score ≥35, suggestive of high levels of burnout, and 16.1% (N=336) of participants had PHQ-9 scores ≥10, suggesting a diagnosis of major depression. Presence of depressive symptoms, female gender, inability to control one’s schedule, and work setting were significantly associated with higher OLBI scores. Burnout, female gender, resident or early-career stage, and nonacademic setting practice were significantly associated with higher PHQ-9 scores. A total of 98% of psychiatrists who had PHQ-9 scores ≥10 also had OLBI scores >35. Suicidal ideation was not significantly associated with burnout in a partially adjusted linear regression model.


Psychiatrists experience burnout and depression at a substantial rate. This study advances the understanding of factors that increase the risk for burnout and depression among psychiatrists and has implications for the development of targeted interventions to reduce the high rates of burnout and depression among psychiatrists. These findings have significance for future work aimed at workforce retention and improving quality of care for psychiatric patients.

The info is here.

Thursday, August 6, 2020

Five tips for transitioning your practice to telehealth

Five tips for transitioning your practice to telehealthRebecca Clay
American Psychological Association
Originally posted 19 June 20

When COVID-19 forced Boston private practitioner Luana Bessa, PhD, to take her practice Bela Luz Health online in March, she was worried about whether she could still have deep, meaningful connections with patients through a screen.

To her surprise, Bessa’s intimacy with patients increased instead of diminished. While she is still mindful of maintaining the therapeutic “frame,” it can be easier for everyday life to intrude on that frame while working virtually. But that’s OK, says Bessa. “I’ve had clients tell me, ‘It makes you more human when I see your cat jump on your lap,’” she laughs. “It has really enriched my relationships with some clients.”

Bessa and others recommend several ways to ensure that the transition to telehealth is a positive experience for both you and your patients.

Protect your practice’s financial health

Make sure your practice will be viable so that you continue serving patients over the long haul. If you have an office sitting idle, for example, see if your landlord will renegotiate or suspend lease payments, suggests Kimberly Y. Campbell, PhD, of Campbell Psychological Services, LLC, in Silver Spring, Maryland. Also renegotiate agreements with other vendors, such as parking lot owners, cleaning services, and the like.

And since patients can’t just hand you or your receptionist a credit card, you’ll need to set up an alternate payment system. Campbell turned to a credit card processing company called Clover. Other practitioners use the payment system that’s part of their electronic health record system. Natasha Holmes, PsyD, uses SimplePractice to handle payment for her Boston practice And Still We Rise, LLC. Although there’s a fee for processing payments, an integrated program makes payment as easy as clicking a button after a patient’s session and watching the payment show up at your bank the next day.

The info is here.

Wednesday, August 5, 2020

How to Combat Zoom Fatigue

Liz Fosslien and Mollie West Duffy
Harvard Business Review
Originally posted 29 April 20

If you’re finding that you’re more exhausted at the end of your workday than you used to be, you’re not alone. Over the past few weeks, mentions of “Zoom fatigue” have popped up more and more on social media, and Google searches for the same phrase have steadily increased since early March.

Why do we find video calls so draining? There are a few reasons.

In part, it’s because they force us to focus more intently on conversations in order to absorb information. Think of it this way: when you’re sitting in a conference room, you can rely on whispered side exchanges to catch you up if you get distracted or answer quick, clarifying questions. During a video call, however, it’s impossible to do this unless you use the private chat feature or awkwardly try to find a moment to unmute and ask a colleague to repeat themselves.

The problem isn’t helped by the fact that video calls make it easier than ever to lose focus. We’ve all done it: decided that, why yes, we absolutely can listen intently, check our email, text a friend, and post a smiley face on Slack within the same thirty seconds. Except, of course, we don’t end up doing much listening at all when we’re distracted. Adding fuel to the fire is many of our work-from-home situations. We’re no longer just dialing into one or two virtual meetings. We’re also continuously finding polite new ways to ask our loved ones not to disturb us, or tuning them out as they army crawl across the floor to grab their headphones off the dining table. For those who don’t have a private space to work, it is especially challenging.

Finally, “Zoom fatigue” stems from how we process information over video. On a video call the only way to show we’re paying attention is to look at the camera. But, in real life, how often do you stand within three feet of a colleague and stare at their face? Probably never. This is because having to engage in a “constant gaze” makes us uncomfortable — and tired. In person, we are able to use our peripheral vision to glance out the window or look at others in the room. On a video call, because we are all sitting in different homes, if we turn to look out the window, we worry it might seem like we’re not paying attention.

The info is here.

Tuesday, August 4, 2020

A Psychological Exploration of Zoom Fatigue

Jena Lee
Psychiatric Times
Originally published 27 July 20

Here is an excerpt:

This neuropathophysiology may explain other proposed reasons for Zoom fatigue. For example, if the audio delays inherent in Zoom technology are associated with more negative perceptions and distrust between people, there is likely decreased reward perceived when those people are videoconferencing with each other. Another example is direct mutual gaze. There is robust evidence on how eye contact improves connection—faster responses, more memorization of faces, and increased likeability and attractiveness. These tools of social bonding that make interactions organically rewarding are all compromised over video. On video, gaze must be directed at the camera to appear as if you are making eye contact with an observer, and during conferences with 3 or more people, it can be impossible to distinguish mutual gaze between any 2 people.

Not only are rewards lessened via these social disconnections during videoconferencing compared to in-person interactions, but there are also elevated costs in the form of cognitive effort. Much of communication is actually unconscious and nonverbal, as emotional content is rapidly processed through social cues like touch, joint attention, and body posture. These nonverbal cues are not only used to acquire information about others, but are also directly used to prepare an adaptive response and engage in reciprocal communication, all in a matter of milliseconds. However, on video, most of these cues are difficult to visualize, since the same environment is not shared (limiting joint attention) and both subtle facial expressions and full bodily gestures may not be captured. Without the help of these unconscious cues on which we have relied since infancy to socioemotionally assess each other and bond, compensatory cognitive and emotional effort is required. In addition, this increased cost competes for people’s attention with acutely elevated distractions such as multitasking, the home environment (eg, family, lack of privacy), and their mirror image on the screen. Simply put, videoconferences can be associated with low reward and high cost.

The info is here.

Thursday, June 11, 2020

Personal Therapy and Self-Care in the Making of Psychologists

Jake S. Ziede & John C. Norcross (2020)
The Journal of Psychology
DOI: 10.1080/00223980.2020.1757596


Psychologists are skilled in assessing, researching, and treating patients’ distress, but frequently experience difficulty in applying these talents to themselves. The authors offer 13 research-supported and theoretically neutral self-care strategies catered to psychologists and those in training: valuing the person of the psychologist, refocusing on the rewards, recognizing the hazards, minding the body, nurturing relationships, setting boundaries, restructuring cognitions, sustaining healthy escapes, maintaining mindfulness, creating a flourishing environment, cultivating spirituality and mission, fostering creativity and growth, and profiting from personal therapy. The latter deserves special emphasis in the making of health care psychologists. These strategies are recommended both during training and throughout the career span. Recommendations are offered for enhancing and publicizing systems of self-care throughout the profession.

The article is here.

Tuesday, June 9, 2020

A third of Americans report anxiety or depression symptoms during the pandemic

Brian Resnick
Originally posted 29 May 20

Here is an excerpt:

The pandemic is not over. The virus still has a great potential to infect millions more. It’s unclear what’s going to happen next, especially as different communities enact different precautions and as federal officials and ordinary citizens grow fatigued with pandemic life.

The uncertainty of this era is likely contributing to the mental health strain on the nation. As the pandemic wears on into the summer, some people may grow resilient to the grim reality they face, while others may see their mental health deteriorate more.

What’s also concerning is that, even pre-pandemic, there were already huge gaps in mental health care in America. Clinicians have been in short supply, many do not take insurance, and it can be hard to tell the difference between a clinician who uses evidence-based treatments and one who does not.

If you’re reading this and need help, know there are free online mental health resources that can be a good place to start. (Clinical psychologist Kathryn Gordon lists 11 of them on her website.)

The Covid-19 pandemic has a knack for exacerbating underlying problems in the United States. The disease is hitting the poor and communities of color harder than white communities. And that’s also reflected here in the data on mental health strain.

As the pandemic continues, it will be important to recognize the growing mental health impacts for such a large portion of Americans — and to uncover who is being disproportionately impacted. Hospitalizations and infection rates are critical to note. But the mental health fallout — from not just the virus but from all of its ramifications — will be essential to keep tracking, too.

The info is here.

Tuesday, April 7, 2020

Four pieces of ethical advice for practitioners during COVID-19

Four pieces of ethical advice for practitioners during COVID-19Rebecca Schwartz-Mette
Originally posted 2 April 20

Are you transitioning to full-time telepsychology? Launching a virtual classroom? Want to expand your competence in the use of technology in practice? You can look to APA’s Ethics Committee for support in transforming your practice. Even in times of crisis, the Ethical Principles of Psychologists and Code of Conduct (hereafter “Ethics Code” or “Code;” 2002, Amended June 1, 2010 and Jan. 1, 2017) continues to guide psychologists’ actions based on our shared values. Here are four ways to practice in good faith while meeting the imminent needs of your community:

Lean in

Across the nation, rather than closing their practices and referring out, psychologists are accepting the challenge to diligently obtain training and expand their competence in telepsychology. Standard 2.02, “Providing Services in Emergencies,” allows psychologists to provide services for individuals for whom other services aren’t available through the duration of such emergencies, even if they have not obtained the necessary training. The Ethics Committee supports those psychologists working in good faith to meet the needs of patients, clients, supervisees and students.

Get training and support

Take advantage of the APA’s new (and often free) resources to develop and expand your competence, in line with Standard 2.03, “Maintaining Competence.” Expand your network by connecting with colleagues who can provide peer consultation and supervision to support your efforts.

Consider referrals

The decision to transition to telepsychology may not be for everyone. Competency concerns, lack of access to technology, and specific needs of particular clients may reflect good reasons to refer to practitioners who can provide telepsychology. Psychologists should assess each client’s needs in light of their own professional capacities and refer to others who can provide needed services in line with Standard 10.10(c), “Terminating Therapy.”

Take care of yourself

Psychologists are human and can feel lost in the ambiguity of this unprecedented time. It is your ethical mandate to also care for yourself. Practicing accurate self-assessment, leaning on colleagues when needed, and taking time to unplug from the news and practice to recharge helps to prevent burnout and is entirely consistent with 2.06, “Personal Problems and Conflicts.” Make self-care a verb and connect with your community of psychologists today.

Monday, February 24, 2020

Physician Burnout Is Widespread, Especially Among Those in Midcareer

Brianna Abbott
The Wall Street Journal
Originally posted 15 Jan 20

Burnout is particularly pervasive among health-care workers, such as physicians or nurses, researchers say. Risk for burnout among physicians is significantly greater than that of general U.S. working adults, and physicians also report being less satisfied with their work-life balance, according to a 2019 study published in Mayo Clinic Proceedings.

Overall, 42% of the physicians in the new survey, across 29 specialties, reported feeling some sense of burnout, down slightly from 46% in 2015.

The report, published on Wednesday by medical-information platform Medscape, breaks down the generational differences in burnout and how doctors cope with the symptoms that are widespread throughout the profession.

“There are a lot more similarities than differences, and what that highlights is that burnout in medicine right now is really an entire-profession problem,” said Colin West, a professor of medicine at the Mayo Clinic who researches physician well-being. “There’s really no age group, career stage, gender or specialty that’s immune from these issues.”

In recent years, hospitals, health systems and advocacy groups have tried to curb the problem by starting wellness programs, hiring chief wellness officers or attempting to reduce administrative tasks for nurses and physicians.

Still, high rates of burnout persist among the medical community, from medical-school students to seasoned professionals, and more than two-thirds of all physicians surveyed in the Medscape report said that burnout had an impact on their personal relationships.

Nearly one in five physicians also reported that they are depressed, with the highest rate, 18%, reported by Gen Xers.

The info is here.

Sunday, February 23, 2020

Burnout as an ethical issue in psychotherapy.

Simionato, G., Simpson, S., & Reid, C.
Psychotherapy, 56(4), 470–482.


Recent studies highlight a range of factors that place psychotherapists at risk of burnout. The aim of this study was to investigate the ethics issues linked to burnout among psychotherapists and to describe potentially effective ways of reducing vulnerability and preventing collateral damage. A purposive critical review of the literature was conducted to inform a narrative analysis. Differing burnout presentations elicit a wide range of ethics issues. High rates of burnout in the sector suggest systemic factors and the need for an ethics review of standard workplace practice. Burnout costs employers and taxpayers billions of dollars annually in heightened presenteeism and absenteeism. At a personal level, burnout has been linked to poorer physical and mental health outcomes for psychotherapists. Burnout has also been shown to interfere with clinical effectiveness and even contribute to misconduct. Hence, the ethical impact of burnout extends to our duty of care to clients and responsibilities to employers. A range of occupational and personal variables have been identified as vulnerability factors. A new 5-P model of prevention is proposed, which combines systemic and individually tailored responses as a means of offering the greatest potential for effective prevention, identification, and remediation. In addition to the significant economic impact and the impact on personal well-being, burnout in psychotherapists has the potential to directly and indirectly affect client care and standards of professional practice. Attending to the ethical risks associated with burnout is a priority for the profession, for service managers, and for each individual psychotherapist.

From the Conclusion:

Burnout is a common feature of unintentional misconduct among psychotherapists, often at the expense of client well-being, therapeutic progress, and successful client outcomes. Clinicians working in spite of burnout also incur personal and economic costs that compromise the principles of competence and beneficence outlined in ethical guidelines. This article has focused on a communitarian approach to identifying, understanding, and responding to the signs, symptoms, and risk factors in an attempt to harness ethical practice and foster successful careers in psychotherapy. The 5-P strength-based model illuminates the positive potential of workplaces that support wellbeing and prioritize ethical practice through providing an individualized responsiveness to the training, professional development, and support needs of staff. Further, in contrast to the majority of the literature that explores organizational factors leading to burnout and ethical missteps, the 5-P model also considers the personal characteristics that may contribute to burnout and the personal action that
psychotherapists can take to avoid burnout and unintentional misconduct.

The info is here.

Tuesday, January 28, 2020

Examining clinician burnout in health industries

Cynda Hylton Rushton
Cynda Hylton Rushton
Danielle Kress
Johns Hopkins Magazine
Originally posted 26 Dec 19

Here is an excerpt from the interview with Cynda Hylton Rushton:

How much is burnout really affecting clinicians?

Among nurses, 35-45% experience some form of burnout, with comparable rates among other providers and higher rates among physicians. It's important to note that burnout has been viewed as an occupational hazard rather than a mental health diagnosis. It is not a few days or even weeks of depletion or exhaustion. It is the cumulative, long-term distress and suffering that is slowly eroding the workforce and leading to significant job dissatisfaction and many leaving their professions. In some instances, serious health concerns and suicide can result.

What about the impact on patients?

Patient care can suffer when clinicians withdraw or are not fully engaged in their work. Moral distress, long hours, negative work environments, or organizational inefficiencies can all impact a clinician's ability to provide what they feel is quality, safe patient care. Likewise, patients are impacted when health care organizations are unable to attract and retain competent and compassionate clinicians.

What does this mean for nurses?

As the largest sector of the health care professions, nurses have the most patient interaction and are at the center of the health care team. Nurses are integral to helping patients to holistically respond to their health conditions, illness, or injury. If nurses are suffering from burnout and moral distress, the whole care team and the patient will experience serious consequences when nurses' capacities to adapt to the organizational and external pressures are eventually exceeded.

The info is here.

Thursday, November 7, 2019

Are We Causing Moral Injury to Our Physician Workforce?

Carolyn Meltzer
Originally posted November 5, 2019

Here is an excerpt:

The term moral injury was coined by psychiatrist Jonathan Shay, MD PhD, who, while working at a Veterans Affairs hospital, noted that moral injury is present when 1) there is a betrayal of what is considered morally correct, 2) by someone who holds legitimate authority (conceptualized by Shay as “leadership malpractice”), and 3) in a high-stakes situation (Shay and Monroe 1998). Nash and Little (2013) went on to propose a model that identified the types of war-zone events that contributed to moral injury as witnessing events that are morally wrong (or strongly contradicted one’s own moral code), acting in ways that violate moral values, or feeling betrayed by those who were once trusted. In a fascinating study using the Moral Injury Event Scale and resting-state functional magnetic resonance imaging (fMRI), Sun and colleagues (2019) were able to discern a distinct pattern of altered functional neural connectivity in soldiers exposed to morally injurious events. In fact, functional connectivity between the left inferior parietal lobule and bilateral precuneus was positively related with the soldiers’ post-traumatic stress disorder (PTSD) symptoms and negatively related with scores on the Moral Injury Event Scale.

Moral injury has been recently applied as a construct for physician burnout. Those who argue for this framework propose that structural and cultural factors have contributed to physician burden by undervaluing physicians and over-relying on financial metrics (such as relative value units, RVUs) as the primary surrogate of physician productivity (Nurok and Gewertz 2019). Turner (2019) recently compared the military experience to that of physician providers. While one may draw similarities between the front line of healthcare delivery and that experienced by soldiers, Turner argues that a fundamental tenet of military leadership - that leaders eat last – provides effective support for the health of the workforce. In increasingly large healthcare organizations managed by administrators who may be distant from the front line and reliant on metrics of productivity, the necessary sense of empathy and support from leadership can seem lacking.

The info is here.