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Vacuous Spleens and Swampy Livers: Burnout in the Acupuncture Profession
By Katherine Kahn
Laura, an acupuncturist and single woman in her late thirties, begins her day by waking up in dread. She feels a wave of exhaustion mixed with anxiety as she heads into the kitchen for a cup of coffee.
She thinks of the patients awaiting her at her office today, all of them in varying degrees of discomfort: from angry Mrs. Bankhead, with her livery skin rash, to dying Mr. Engel, nearing the terminal stages of lung cancer. It's a sparkling June morning, and she entertains a nagging compulsion to cancel all her appointments and run off to the beach. On some days, she seriously considers quitting altogether and going back to her more lucrative job as a computer programmer, but she feels trapped by her commitment to her patients and to her career.
Laura ended up studying acupuncture because of the monotony of her career and because she herself had been helped by an acupuncturist. She thought she could fashion a meaningful, satisfying career helping people understand the benefits of Chinese medicine. She didn't count on people not always appreciating her efforts, or that the majority would expect a quick fix from acupuncture. She didn't realize most of her patients would have chronic long-term illnesses from deeply imbedded imbalances. And, being highly intelligent and intellectual, she found herself growing bored needling Spleen 6 for the 20th time that week. Laura also didn't consider that she would feel as isolated in her solo practice as she does.
Laura exhibits the typical symptoms of burnout, but doesn't understand the root causes of her dissatisfaction and what went wrong. So she keeps doing the same thing, day in and day out, developing chronic neck pain, temporal headaches, and experiencing complete exhaustion by the end of the day.
In acupuncture practice, we rarely talk about the phenomenon of burnout, yet being in a helping profession, we are at risk. Indeed, some aspects of Chinese medicine may even predispose us to it. For many of us, Chinese medicine was our chosen dream career: we looked forward to living a lifestyle that embraced our personal and spiritual values, that offered us a great deal of freedom and let us express who we are while still making a living. Yet, our high ideals and expectations may in fact be our saboteurs.
The feelings of burnout are a signal for us to pay attention, an opportunity to learn something profound about ourselves. If we pay attention, we often gain a greater understanding and appreciation for who we are as healers. Burnout is a problem involving negative (and sometimes dysfunctional) attitudes about our work solution, but where do these attitudes come from?
Healing the Unhealable. Although acupuncture school prepared us for treating imbalances in our patients, it did not encourage us to contemplate our own initial calling to the healing profession. It is common knowledge among mental health professionals that people who choose medicine, psychology, ministry and social work as careers frequently have childhood backgrounds of abuse, family alcoholism or psychiatric illness, and other examples of chaotic family dynamics.
Often, we were involved in our families as the child "caretaker," longing desperately to soothe emotional and psychic wounds of the adults in our lives and actually being encouraged in this psychological role as "little parents." We become good listeners, despite the fact that we also become watchful and overanxious. In Dr. Anthony Storr's book Solitude, he says that this "same temperament is not infrequently found in psychoanalysts and doctors, who invite confidences but who are not called upon to reveal themselves."
Many of us witnessed severe illness and disease in our families as children and wanted desperately to find a way to alleviate inevitable suffering, to find a way to control the situation.
Some of us experienced unpleasant or even damaging consequences from Western medical procedures. In our frustration and anger, we vowed to find a better way through alternative medicine and share this with the rest of the world. Among those of us attracted to the healing professions, a strong psychological need to gain and maintain control of feelings and situations is often an underlying personality trait. This may come as a surprise to those who have always thought their desire to be healers as a purely altruistic calling.
Crash and Burn. Burnout arises from this initial draw to the healing professions in several ways, and paradoxically, it is a sign of positive growth. Usually within 1-2 years after being in private practice, it becomes evident to most health care practitioners that they have brought with them an erroneous set of assumptions and inflated expectations about their abilities to effect change and control their patients' illnesses and actions. Most of us then adjust our expectations accordingly, but if we are prone to burnout, we can't adjust.
Almost unconsciously, we continue to expect certain responses from our patients because we are giving so much of ourselves. We expect them to be thankful and appreciative of our efforts, and to be nice to us when they walk through the office door. We expect certain clinical outcomes and are disappointed if that doesn't occur. We become overly attached to the changing feelings and perceptions of our patients. We become attached to results. We hold the irrational belief that if we design the best possible treatment and carry it out, all our patients will recover and heal. When Mrs. Curtis' sciatica vanishes after an electroacupuncture treatment, we are secretly ecstatic. It must have been the treatment. When she comes in the following week saying the pain in her leg is worse than ever, we feel like failures, even when we know intellectually we are not. Again, it must have been something we've done or neglected to do. In our own minds, we have made ourselves too important. We start to resent our patients and their never-ending problems because we realize we have less control over health and disease than we thought.
This can lead to a crisis not only of career but of spirit. Perhaps we become disillusioned with Chinese medicine, blaming it rather than recognizing our own contributions to our attitudes. We are uncomfortable accepting the general ambiguity associated with any type of healing. Are we really helping, or are we just putting a Band-Aid on the problem? Who's to say? What constitutes healing, anyway? These questions form a pathway of spiritual discovery about ourselves and the ambiguous nature of all healing actions.
As an outgrowth of questioning our career, we may also begin to notice that we are being the "caretaker" in other areas of our lives as well. We give to others in our work and in our social and family lives what we, deep down, want to receive. Strangely, we find that even as we begin to realize this, we recognize we have always had difficulties accepting from others that which we want the most. Over a period of time, usually about 3-4 years, we become sick and tired of healing in every aspect of our lives.
Phoenix Rising. If we pay attention, this time can be one of growth and fruition. Recovery from burnout does not happen overnight. It is not simply a matter of taking more bubble baths and going for more walks. It takes time, contemplation, and both physical and mental rest. Chances are you will not be able to do this exclusively on your own, even though it is the tendency of healers not to ask for guidance. Find a counselor or therapist who has helped others with this problem. Your first task is to identify your original calling to medicine. This almost always invokes exploring your childhood, family dynamics, and the past. It is here that you will find the keys to your current attitudes about your work. Once these are elucidated, your possible choices will become clearer.
In addition to exploring how you arrived at Chinese medicine in the first place, you can also take practical steps to help ease your feelings of burden regarding your practice. These also take effort and commitment to implement, but they are useful in feeling more in control of your work in the here and now.
Limit Patient Contact. If you are experiencing sever burnout, one of the first steps you can take to reassert some control in your practice and get some breathing space is to limit patient contact, at least temporarily. This can be accomplished in a variety of ways, and you must decide what feels most comfortable to you. Perhaps an immediate vacation is necessary for your sanity. It is also vital that you schedule routine vacations whether you feel you need them or not. A week or two off every three or four months can help tremendously. Your patients will survive without you and may even admire that you make such healthy choices for yourself!
Many healthcare professionals routinely work a four-day week. It is not uncommon for some to work only three days a week. Whether you create a long weekend for yourself or give yourself a day off in the middle of the week, this extra time can be revitalizing. Examine your work schedule and make concrete decisions as to how to open up extra personal time in your week and on a daily basis, then stick firmly to this new schedule.
Another aspect that can sometimes afford some "trimming" is the actual time you spend actively talking with patients. Although many acupuncturists consider elaborately detailed intakes and thorough client education a vital part of their practice, trying to convince clients that Chinese medicine works or making lengthy lifestyle suggestions can be counterproductive. Have you ever noticed how many clients actually take your suggestions? Of those who do, how many quickly find something wrong with those suggestions? Shorten both your initial intake and the length of time you talk to clients before treating them. You will find you have more energy and won't get so wrapped up in their personal dynamics.
Sharing Feelings. As mentioned earlier, healers often have difficulty sharing feelings, especially negative ones, with others. Finding other practitioners to talk to can often alleviate some of the burdens of our profession. Find other practitioners that you can trust. Talking about your work with someone who may be critical of you, or who is unaware of these issues in the healing professions, can be counterproductive. Choose your confidantes with care. In Western medicine, support groups for burnt out physicians and nurses are commonplace; why not in acupuncture? If you don't have the energy to start your own group, approach a psychotherapist who is experienced in group therapy and request that they start one for healthcare professionals.
Cultivating Detachment. Striving for detachment does not mean becoming callous to the needs of your patients or adopting a "who cares?" attitude. Detachment means to develop an awareness of your self and to observe you are reacting and feeling in your dealings with patients without automatically reacting. Are you feeling anxious about seeing a new client? Do you find yourself plagued by doubts that undermine your sense of self? Are you angry or exhausted? Do you notice how and when these feelings tend to come and go? Detachment is a powerful step toward self-knowledge, and it is a loving step. We can just watch ourselves doing our job and feeling whatever feelings come up, but not holding onto them, or we acknowledge that we do hold onto them. This awareness gives us the capacity to watch others and notice how their feelings may have nothing to do with us at all, even though we can take them so personally. Detachment teaches us we don't have to react defensively when Mrs. Snodgrass comes into our office in a snit. It reminds us not to take ourselves too seriously - we aren't the only healing force in anyone's life.
Another aspect of detachment involves the acupuncture treatment itself. Do you find yourself always striving to perform miracles, or to have Mr. Beidel praise you on how relaxing your treatment is? B.J. Palmer, the founder of chiropractic, taught his students to "take no credit" for positive outcomes of treatment, but to also "take no blame" for patients' continuing symptoms. His reasoning was that practitioners who get caught up in results impair their own abilities as healers, becoming slaves to outcomes. Just doing your acupuncture treatment and letting go of the results can lift an enormous burden from your shoulders. After all, can we really control all factors affecting another person's health? Sometimes patients almost unconsciously desire us to act as though we can. Be careful not to act in collusion with your patient's irrational need for you to "fix" them.
A Lot Going Out, A Little Coming In. Sometimes, the very structure of how your practice is set up can add to feelings of burnout. Are you a solo practitioner who works eight hours a day, five days a week, then goes home to fix dinner for the family; put the kids to bed; and give your husband a foot massage? At the opposite end of the spectrum, do you come home every night to an empty apartment, stick a frozen bean burrito in the microwave, and plop down in front of Seinfeld reruns with a jumbo glass of red wine?
As healers, we spend our days listening to tales of pain and suffering. Unlike a conventional friendly relationship, we don't offer back to our patients what's on our minds unless it has to do with constructive ideas for them. Ethically, we can't turn to our client-practitioner relationships for support or friendship even though we may spend the majority of our days with these individuals.
What are your sources for emotional and creative sustenance in the rest of your life? Sometimes it may seem that our work is the problem when it's actually a lack of balance in another aspect.
Dr. Christiane Northrup, in her book Women's Bodies, Women's Wisdom, describes the areas of everyone's existence that need nurturance: work; friendships; family; nutrition; exercise; community; finances; and creativity. How satisfying is each area of your life? Which areas call out for attention? Because we give so much of our qi in our work, it's critical for our happiness and health that we take the time to maintain other aspects of our life, and that we allow others to give to us. Sometimes, before we make changes in our practice, we must make changes in other areas of our lives.
Working for Pittance. As alternative practitioners, we often remain squeamish about money matters or feel access to health care of any kind should not depend upon a person's ability to afford it. However, if you are suffering from burnout, you must ask yourself, "Does my practice support me financially?"
We hear and know of acupuncturists who have three or four treatment rooms going at once, but most of us are in smaller practices averaging 15-30 patients a week. If we cannot find ways to make our work self-supporting by educating ourselves in (and implementing) business and marketing strategies, we will find ourselves in the burnout-prone position of more going out, not enough coming in. Certain situations in the health care industry set us up for tough financial times. Most of us keep our fees low, charging less than many massage therapists, so patients can afford to come more frequently for the treatments they need. Insurance companies that offer acupuncture to their customers often expect us to discount our services rather than reimburse us the 50-80% that is standard for other licensed health care providers. Hospitals are encouraged in bringing us on board - but only if we're willing to volunteer.
These problems do not mean we can't make a decent living, but they are real obstacles. Therefore, we must be more aggressive in our business strategies if we want to be appropriately compensated for our healing efforts.
Developing Gratitude. When we are stuck in just seeing the negatives of our work situation, we drain our own energy through demoralizing thoughts. These thoughts are also not true reality, but are tainted by our personal perception of the situation. One technique, developed by Dr. John Demartini and described in the book Count Your Blessings, can be used to reawaken a more balanced view of our practice and develop feelings of gratitude and thankfulness for where we are right now and what our practice provides us. Take your time doing the following exercise: First, make a list of 10 things you actually like about your work. Then, create a list of 10 things you hate about it. Next, with the list of things you hate, take each of those statements and write down how that particular aspect has had a positive effect on you. This may be difficult at first. How, you might ask, can I find anything positive in something I dislike? Sometimes the answers that come up may surprise you. In life, no situation is 100% negative, even in the worst set of circumstances you can imagine (including instances of abuse, violence and social injustice). Recall the Taoist theory of yin and yang, in which yin resides in yang (and yang within yin). This most basic of Chinese theories is applicable to our own lives and careers! Let yourself deeply experience the positive aspects you've discovered. By finding the positive in the negative, you will find some of your emotional energy is freed.
As an example of how this works, let's say your first negative item was, "I hate it when I have to deal with toxic, angry clients." How could dealing with difficult people be positive? Perhaps it is an opportunity to watch the feelings an interaction like that brings up within yourself without reacting. Perhaps it enables you to feel better about yourself when you address the situation successfully, or gives you an opportunity to learn how to be assertive without defensiveness. These situations can be true gifts of self-exploration for which we can be thankful.
Take your time and be thoughtful in your consideration of the above exercise. You may find yourself experiencing a new appreciation of how your career as an acupuncturist serves you. This in turn will give you the perspective you need to make choices about your career and where you want to explore the future.
Other Paths. Few of us ever imagined becoming bored with the rich tapestry of philosophy that underlies Chinese medicine, yet once in practice, we find our scope of what we do may be more narrow than we'd originally considered. I remember, when working as an acupuncture assistant, one of my mentors mentioning to me that I may eventually become tired of private practice. I could barely fathom what she was talking about. Now I understand all too well, having done my 400th treatment of lower back pain.
If this is a component of your burnout tendencies, some simple remedies await. Sign up for more continuing education courses. If you have been in practice long enough, teaching is a possibility, as is taking on a student assistant. Writing articles for local newspapers or acupuncture publications can also reawaken your interest in Chinese medicine. Recall that there are many aspects of Chinese medicine - historical perspectives; Taoist religious thought; tui na; qi gong; the martial arts - the subject matter is endless. Step outside of the treatment room and pursue some of your original interests.
What Next. Sometimes we do all we can to remedy the feelings of burnout, but to no avail. Perhaps we've struggled with it for months or years with varying degrees of success. We've let go of our unrealistic expectations surrounding our work; found ways to vent our emotions and nurture the rest of our lives; and yet we still end up feeling uneasy about our work as acupuncturists.
It is okay to ask yourself questions. Is this where I really can give what I have to offer? Are my energies well spent in this career, or perhaps in another? Do I need a break?
Typically, no easy answers await, but by now, it should be clear that your range of options is much greater than what you originally considered. Consider also the statistic that, on average, an individual can expect to change careers - not just jobs - five times during his or her lifetime. Perhaps Chinese medicine will continue to be a part of your professional life, or perhaps you will choose a new endeavor. Whatever your next well-considered choice may be, the wisdom of Chinese medicine will have most certainly permeated and enriched your life. Good luck!
Blevins C. Overcoming professional burnout. The Optimum Institute website, 1998-2000.
Demartini J. Count Your Blessings. Boston: Element, 1997, pp. 20-27.
Demartini J. Sacred Healings videotapes. 1994.
Farmer S. Adult Children of Abusive Parents. New York: Ballantine Books, 1989, pp. 64-67.
Nelson VJ. Nurses and burnout. Newsweek website.
Northrup C. Women's Bodies, Women's Wisdom. New York: Doubleday, 1998, pp. 577-641.
Novack D. Physician's personal awareness may influence patient interaction. Journal of the American Medical Association 1997;278:502-509.
Ram D. How Can I Help? New York: Alfred A. Knopf, 1988, pp. 184-216.
Storr A. Solitude: A Return to the Self. New York: Ballantine Books, 1988, p. 115.
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