Cultivating Professional Resilience in Direct Practice A Guide

for Human Service Professionals

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Columbia University Press
Publishers Since 1893
New York Chichester, West Sussex
cup.columbia.edu
Copyright © 2017 Columbia University Press
All rights reserved

Library of Congress Cataloging-in-Publication Data

Names: Newell, Jason M., author.
Title: Cultivating professional resilience in direct practice :
a guide for human service professionals / Jason M. Newell.
Description: New York : Columbia University Press, [2017] |
Includes bibliographical references and index.
Identifiers: LCCN 2016055339 (print) | LCCN 2017014118 (ebook) |
ISBN 9780231544900 (electronic) | ISBN 9780231176583 (cloth : alk. paper) |
ISBN 9780231176590 (pbk.)
Subjects: LCSH: Social workers—Job stress. | Social service—Practice. |
Burn out (Psychology)—Prevention.
Classification: LCC HV40.35 (ebook) | LCC HV40.35 N49 2017 (print) |
DDC 361.301/9—dc23
LC record available at https:// lccn.loc.gov/2016055339

Columbia University Press books are printed on permanent

and durable acid-free paper.

Printed in the United States of America

Cover design: Jordan Wannemacher

Cover image: © Carmen Spitznagel / Trevillion Images
To my wife, Dora, and our daughter, Eliza, for all of your loving kindness,
support, and laughter. Thank you for allowing me the time
and the space to write this book. To all those who selflessly choose
human service work as a way of life, I challenge you to actively pursue
your own personal and professional well-being as you attend to the
needs of others. This ongoing practice is essential to staying on the path
to resilience.
CONTENTS

Preface ix
Acknowledgments xiii

1. AN INTRODUCTION TO CULTIVATING PROFESSIONAL RESILIENCE

IN DIRECT PRACTICE 1

SECTION 1: THEORY, CONCEPTUALIZATION,

AND MEASUREMENT
2. UNDERSTANDING THE CONNECTION BETWEEN STRESS
AND TRAUMA 17

3. CHRONIC EMPATHY AND TRAUMA IN HUMAN SERVICE WORK:

IMPLICATIONS FOR SOCIAL SERVICE PROFESSIONALS 38

4. UNDERSTANDING AND PREVENTING THE EFFECTS

OF PROFESSIONAL BURNOUT AND INDIRECT TRAUMA:
AN INDIVIDUAL AND ORGANIZATIONAL CHALLENGE 56

5. ASSESSMENT AND MEASUREMENT OF OCCUPATIONAL STRESS

AND TRAUMA 72

SECTION 2: A HOLISTIC FRAMEWORK FOR THE

APPLICATION OF SELF-CARE PRACTICES
6. THE ESSENTIAL PRACTICE OF PROFESSIONAL SELF-CARE:
CULTIVATING AND SUSTAINING PROFESSIONAL RESILIENCE 87

7. PRESERVING PROFESSIONAL RESILIENCE:

THE ONGOING PRACTICE OF HOLISTIC SELF-CARE 102
viii CONTENTS

8. THE ETHICAL OBLIGATION OF PROFESSIONAL SELF-CARE 120

WITH JAMES L. JACKSON JR.

9. TRAUMA-INFORMED EDUCATION, TRAINING, AND PROFESSIONAL

DEVELOPMENT 142

10. THE USE OF MINDFULNESS PRACTICE AS A FUNCTION

OF SELF-CARE 159

EPILOGUE: FINDING BALANCE IN SOCIAL WORK PRACTICE:

SELF-CARE AS PRACTICE WISDOM 173

WORKSHEETS
PERSONAL REFLECTION EXERCISE:
RESILIENCE AND SELF-APPRECIATION 181

SELF-REFLECTION EXERCISE:
ENGAGING GROUP DISCUSSION ON TRAUMA 183

SAMPLE ASSIGNMENT: DEEP BREATHING EXERCISE 185

SAMPLE ASSESSMENT OF ORGANIZATIONAL

AND INDIVIDUAL CHALLENGES 187

SELF-CARE PROCESS: SETTING ORGANIZATIONAL GOALS 189

SELF-CARE PROCESS: SETTING PERSONAL GOALS 191

PROFESSIONAL DEVELOPMENT ASSIGNMENT: CONSTRUCT A PLAN

OF PERSONAL AND PROFESSIONAL SELF-CARE 193

SUGGESTIONS FOR DEVELOPING A COMPREHENSIVE PLAN

OF SELF-CARE 195

SAMPLE GOALS AND OBJECTIVES FOR A PLAN OF SELF-CARE 197

BLANK TEMPLATE FOR A COMPREHENSIVE PLAN OF SELF-CARE 199

SAMPLE SELF-CARE PLAN: PERSONAL TABLE 201

SAMPLE ASSIGNMENT: JOURNALING MINDFULLY 203

Bibliography of Recommended Readings 205

Bibliography of Suggested Internet Resources 209
Glossary 215
References 227
Index 247
PREFACE

The capacity for compassion and empathy seems to be at the core of our abil-
ity to do the work and at the core of our ability to be wounded by the work.
—CHARLES FIGLEY

THIS BOOK evolved over a decade of academic research, scholarship, and profes-
sional training. My interest in the well-being of social workers and other human
service professionals began nearly two decades ago after the completion of my
undergraduate degree. My first professional job was as a direct care provider
for a state funded inpatient and outpatient mental health agency. I provided
services for elementary-aged children diagnosed with comorbid psychological
diagnoses and psychosocial conditions in a therapeutic day program. The pro-
gram was designed to improve treatment outcomes for children with “problem-
behaviors” over the summer break. This was my first direct exposure to the per-
vasive challenges of parental drug use, poverty, poor education, neglect, physical
abuse, sexual abuse, mental illness, and innumerable psychosocial challenges
all too common to the practice of social work. In the most unfortunate cases,
I witnessed children affected by the compounding effects of these conditions as
they occurred simultaneously. I quickly realized the impact of these behaviors
on the emotional health and well-being of these very young children, most of
them under the age of 10. Many of the children were historically, generationally,
and currently involved with the child welfare system. Some had experienced
removals from their biological homes due to the severity of their parental abuse
and neglect. I still vividly recall my initial reactions of shock, disbelief, and some-
times horror. I remember thinking to myself “no wonder these kids are men-
tally ill” and “how in the world can I help them?” I felt compelled to choose a
career path that would allow me to make a “real difference” in the lives of peo-
ple, especially those affected by trauma in the form of child abuse and neglect.
x PREFACE

Witnessing the conditions of these children could have easily turned me away
from the profession of social work. Instead, their struggles and narratives fueled
my spirit to embrace a career with meaning, purpose, and reward beyond finan-
cial gain.
As a professional social worker for almost 20 years, I have provided therapeu-
tic and case management services for children in public child welfare, in a res-
idential facility for psychiatric care, in a faith-based group home, in a nonprofit
family counseling agency, and at the Veterans Administration with veterans and
military families. Over the years, I have knowingly and willingly encountered
countless stories of pain and human suffering, but I have remained resilient
and committed to the spirit of the work. Too often well-trained, earnest, and
dedicated social workers leave the profession because the organizational and
emotional challenges of the work simply become overwhelming. More than
in any other practice setting, social workers in public child welfare experience
what they described as “burnout,” which too often resulted in resignation as a
form of personal and professional self-preservation. Sadly, this left many of our
most vulnerable children abandoned by a caregiver once again. Until vacancies
were filled, other social workers carried higher caseloads, which meant addi-
tional stress on already limited resources and diminished services due to the
overwhelming demands of the high caseloads. It seemed like a never-ending
cycle. Fifteen years later, I observe students in their field placements and some-
times find myself thinking, “things have changed, but not that much.”
When I began my doctoral program, I knew I wanted to find a way to keep
social workers resilient and thriving in the workforce. The overarching goal of
my research is to preserve our human service workforce by cultivating resil-
ience for all social workers through meaningful practice experiences with those
who are poor, vulnerable, traumatized, or otherwise suffering in some way. Part
of my commitment to the social work profession is to educate students and
other professionals on the potentially deleterious effects of the emotionally chal-
lenging aspects of direct practice described in the literature by terms such as
vicarious traumatization, secondary traumatic stress, compassion fatigue, and
burnout. My theoretical and empirical work with these constructs and how to
address them, both personally and professionally, are weaved into every fabric
of this book.
Generationally, my professional career coincided with the global effects of
the terrorist attacks on the World Trade Center and the official declaration of
war shortly thereafter. Watching the effects of the September 11, 2001, terrorist
attacks, and more recently the increase in school violence, terrorism, extreme
racism, and other forms of mass interpersonal violence, it is clear that the
emotional effects of trauma, grief, anger, suffering, and other forms of human
emotion are indeed “transferable.” Through my work I have learned that people
 PREFACE xi

have the ability to “bounce back,” to overcome even the most traumatizing and
horrific life experiences, a quality I have seen many times as children, families,
soldiers, and communities recover from personal trauma, terrorism, natural
disaster, and other forms of human suffering. I believe there is no greater pro-
fessional reward than to be a part of someone’s recovery process.
As a social worker, it is my great privilege to serve those who are experienc-
ing personal distress and trauma and an even greater privilege to educate the
professional social workers of the future. I feel it is my ethical obligation to stu-
dents, their families, and to the clients they serve to provide a resource on what
I call the “essential practice” of self-care. As a social work educator, I feel an
even greater sense of ethical responsibility to provide a thorough and adequate
education to neophyte social workers who self-select to do this work. I want to
preserve the energy, drive, and spirit of humanity that I see in the classroom as
my students enter their field placements and later our workforce.
I have reviewed countless textbooks on social work theory, practice, and field
education. It is rare to find a book that includes any substantial content on the
practice of self-care. On the uncommon occasion that self-care is included, it
is often minimally discussed in the context of other “more important” infor-
mation. Despite years of empirical evidence suggesting that the emotionally
challenging aspects of social work practice contribute to professional burn-
out and compassion fatigue, there is no mention in the newly revised CSWE
Educational Policy and Accreditation Standards for content on self-care to be
included in social work curriculum, course content, or field education.
There is overwhelming agreement in the empirical literature that new social
workers, particularly those going into child welfare or other areas of trauma-
related care, are the most vulnerable to the indirect effects of the trauma work
itself. This book provides a comprehensive treatment of the psychosocial effects
of trauma-related care, professional burnout, and compassion fatigue through
the holistic practice of self-care. I describe the ongoing practice of self-care as
“the key to professional resilience.” Using an ecological systems perspective,
I propose a holistic framework for self-care as a comprehensive series of prac-
tice behaviors from the physical, interpersonal, organizational, familial, and
spiritual domains of the psychosocial self. The practice of self-care involves
regulating empathy resources, which must be maintained over time to cultivate
and sustain personal and professional resilience. I use the word “cultivating” in
the book title to refer to the great potential for personal growth that can occur
through social work practice, training, and education. The practice of self-care
must be cultivated across one’s professional career to be effective.
My hope is that students will learn from this material and begin to develop
their self-care practices before entering the workforce, so they may remain resil-
ient and committed to the values, mission, and spirit of the social work profession.
xii PREFACE

Teaching students, fellow social workers, and other human service professionals
to be professionally resilient is my life’s work. I hope this book reflects my deep
commitment to the education and professional development of social work prac-
titioners, particularly those in trauma-related care, and to their personal and
professional health and well-being.
ACKNOWLEDGMENTS

TAKING ON a project of this size has been a challenging yet invigorating phase
of my professional development and of my scholarly work. This book would
not have been possible without the support of many mentors across my pro-
fessional career. For nearly two decades, I have cultivated their wise counsel
to collectively inform my practice, research, and teaching abilities. I would
like to thank the University of Montevallo, particularly Dean Mary Beth Arm-
strong of the College of Arts and Sciences, for supporting my research through
internal and external funding opportunities, travel allocations, and sabbatical
leave. Thanks to Ruth Truss, my mentor and now chair, for her sage advice,
patience, wisdom, and support of my sabbatical to complete this work. More
than you know, I have gleaned valuable insights from your diplomatic leader-
ship style and your genuine nature. My sincere gratitude goes to Jeannie Duke
and Meredith Tetloff, my loyal colleagues and companions in social work, for
assuming my job duties without complaint to allow me the rare opportunity to
write without distraction.
Thanks to my mentor and colleague Deb Nelson-Gardell for always believ-
ing in the value and meaning of my work to our profession and for her constant
encouragement and mentorship of my professional career.
My sincere thanks to Will Hasenbein who supported our program as a grad-
uate student worker for two years and made considerable contributions to this
book by assisting with research, editing, and bibliographic entries, not to men-
tion his daily contributions to the functioning of our program and to the faculty.
Thanks to James L. Jackson Jr., the graduate counseling program coordinator at
the University of Montevallo for his contributions to chapter 8.
Thank you to my parents, family, and friends who bring joy, laughter, and
resilience to my life every day. Words simply cannot express how much grat-
itude I owe my wife Dora for her constant love and support, both personally
and professionally. Thank you to our beautiful daughter Eliza for being the
xiv ACKNOWLEDGMENTS

source of our joy and our resilience, for inspiring my creativity every morning,
and for reminding me when I need to seek the balance and equanimity that is
the subject of my research. Finally, thank you to Columbia University Press,
Stephen Wesley, and to my editor Jennifer Perillo for taking time to review
my initial book proposal and for her enthusiasm and support of this project.
Working with your guidance has been my great pleasure.
CULTIVATING PROFESSIONAL RESILIENCE
IN DIRECT PRACTICE
1
AN INTRODUCTION TO CULTIVATING PROFESSIONAL
RESILIENCE IN DIRECT PRACTICE

I learned a long time ago that those who are the happiest are those who do
the most for others.
—BOOKER T. WASHINGTON

CHAPTER GOALS AND OBJECTIVES

1. Describe social work and other human service professions as career paths equally rich
with emotional challenges and with opportunities for professional growth and resilience.
2. Introduce the importance of personal and professional self-care as an essential compo-
nent of daily practice with human service populations.
3. Identify the need in social work education for curriculum and course content on the
utilization of professional self-care by social workers and other human service profes-
sionals to cultivate professional resilience.
4. Briefly introduce the terms stress, empathy, resilience, and self-care as the four core con-
structs essential to understanding the material in this book.
5. Conceptualize self-care from an ecological systems perspective as a holistic practice
with components from various domains of the psychosocial self.
6. Provide an outline and a rationale for the presentation of the chapter content, materials,
and book features so that they may be utilized efficaciously by students, faculty, and
other interested professionals.

As future professionals, many students who self-select the pursuit of a profes-

sional social work education feel that human service work is more to them than
a career path: it is the call to embrace a professional life of deep, meaningful,
and rewarding service. Congruent with the mission, values, and humanitar-
ian spirit of the social work profession (National Association of Social Workers
[NASW], 2008), social work students willingly dedicate their college lives and
future professional careers to providing services to those members of our society