1. DHS Special Treatment Unit
BURNOUT
Merrill Main, Ph.D.
Clinical Director
DHS Special Treatment Unit

2. INTERNAL Have, get, buy, borrow, or rent a life. Lack of self-care.
Too much tendency to externalize.
Unmanaged general mental health issues.
Savior complex gone wrong.
Poor affect management.

3. EXTERNAL ?
Answers in Organizational Psychology. For example, Herzberg's Motivation-Hygiene Theory ?

4. EXTERNAL Lack of training Unclear expectations Lack of support
Lack of resources
Overutilization
Underutilization

5. NUMBERS 20% to 25% show clinical burnout 30% of the teachers
Kadambi and Truscott, 2003
30% of the teachers
Rudow, 1999
50% of medical residents
Martini, S., Arfken, C., Churchill A., and Balon, R. (2004)

6. Sexual Offending Is it contagious?
Were all sexual offenders once sexual victims?
Will all victims become offenders?
Do we begin to behave like the population that we work with.

7. PARALLEL PROCESS
Psychoanalytic idea that relationship between patient and therapist is reflected in relationship between therapist and supervisor.
Searles (1955)
See the world through the patient’s eyes too often and it may become habitual.

8. SYMPTOMS Vicarious Tramatization Hypervigilence Distrust Sexualization
Objectification of patients
Over-identification with patients
Stress
Exhaustion
Depression
Detachment from work
Over-investment in work
Italicized are unique to sex offender treatment, second two unique to therapists, latter sx common to all burnout

9. OVER-IDENTIFICATION

10. YOU’RE THE BEST
The high-school kid striving to be popular is still alive inside all of us.
Savior complex.
Misguided striving for personal safety.
Stockholm Syndrome.

11. YOU’RE THE WORST I’ll prove that I’m worthy.
The beatings will continue until morale improves.
Effort justification
We like most what we’ve struggled to master

12. Divisive Build one faction up, tear another down
‘Shop’ for the best answer
Play one against the other
Highly attuned to existing differences/conflicts
Magnify and exacerbate real differences
Between individuals
Between groups
Instigate conflict for personal pleasure or gain

13. Manipulative Starts with small things Progresses to big things
Favors given or taken
I won’t tell
Progresses to big things
May seem reasonable at each step
Often starts with small quid-pro-quo

14. UNDER-IDENTIFICATION
Beyond gallows humor
Distain
Distrust
Disregard
Disrespect

15. THERAPIST STYLE
“Among the influential therapist behaviors, the most important appear to be: empathy, warmth, rewardingnes, and directiveness.”
Marshall (2005)

16. Effects and problems of working with sexual offenders
Excessive identification with offenders.
Excessive anger toward of offenders.
Parallel processes.
Effect on clinicians’ sexual functioning.
Work intruding into life.
Become used to talking about sex with patients.

17. ANTI-BURNOUT
Engagement
Vigor
Person-Environment Fit

18. Burnout Prevention Communicate with colleagues
Commiserate with colleagues
Utilize supervision
HAVE A LIFE OUTSIDE OF WORK
Don’t worry more about patients’ problems than they do.

19. REFERENCES
Drapeau, M. (2005) Research on the Processes Involved in Treating Sexual Offenders. Sexual Abuse: A Journal of Research and Treatment. 17,
Edmunds, S. (Ed.) Impact: Working with Sexual Abusers. Safer Society: Brandon, Vt.
Ennis, L. and Home, S., (2003). Predicting Psychological Distress in Sex Offender Therapists. Sexual Abuse: A Journal of Research and Treatment. 15,
Farrenkopf, T. (1992) What Happens to Therapists who work with Sex Offenders? Journal of Offender Rehabilitation. 18(3/4),
Kadambi, M., and Truscott, D., (2003) Vicarious Traumatization and Burnout Among Therapists Working with Sex Offenders. Traumatology. 9(4)
Lea, S., Auburn, T., and Kibblewhite, K. (1999). Working with Sex Offenders: The Perceptions and Experiences of Professionals and Paraprofessionals. International Journal of Offender Therapy and Comparative Criminology. 43(1),
Little, L. and Hamby, S. (2001). Memory of Childhood Sexual Abuse Among Clinicians: Characteristics, Outcomes, and Current Therapy Attitudes. Sexual Abuse: A Journal of Research and Treatment., 13,
Moulden, H. and Firestone, P. (2007). Vicarious Traumatization: The Impact on Therapists Who Work With Sexual Offenders. Trauma Violence Abuse. 8,
Nelson, M., Herlihy, B., and Oescher, J. (2002) A Survey of Counselor Attitudes Towards Sex Offenders. J of Mental Health Counseling. 24(1),
Salter, A. (2003) Staff Seductions. In Predators: Pedophiles, Rapists and Other Sex Offenders. Basic Books:New York.Shelby, R., Stoddart, R., and Taylor, K. (2001) Factors Contributing to Levels of Burnout Among Sex Offender Treatment Providers. Journal of Interpersonal Violence. 16(11),
Steed, L., and Bicknell, J. (2001). Trauma and the Therapist: The Experience of Therapists Working with the Perpetrators of Sexual Abuse. Australasian Journal of Disaster and Trauma Studies. 2001(1).
Thorpe, G., Righthand, S., and Kubik, E. (2001). Brief Report: Dimensions of Burnout in Professionals Working with Sex Offenders. Sexual Abuse: A Journal of Research and Treatmnet., 13,
W.L. Marshall, W. (2005) Therapist Style in Sexual Offender Treatment: Influence on Indices of Change. Sexual Abuse: A Journal of Research and Treatmnet., 17;

20. BURNOUT