So quite a lot then ... and theres more, not to mention the battle with bureaucracy, scarcity of resources and Brexit uncertainty ...
Its World Social Work day today this week. I personally think it should be a week long to celebrate all the amazing work in the UK and around the world that Social Workers do, and more often than not against the tide.
Yes we know from research that social workers are feeling under a huge amount of workplace stress. I recently delivered a workshop 'Letting go of Stress and Building your Resilience as a Social Worker' at the Emotional Resilience and Wellbeing Conference, 15th March 19, organised and hosted by the South West London Teaching Partnership. The general consensus by 60 odd Social Workers was that social work as a profession is under chronic stress as are the social workers themselves. The average length of post masters social work career is 7.5 years, which is a shame since they may have taken near enough 5-7 years to become one; when including the degree and experience and pre-qualifications they needed to get on the degree. One might say Social Work is an impossible task yet social workers still do amazing things every day and make a positive difference to the lives of many people around the country and the world, despite the challenges. The signs indicate that things are not getting easier for the profession with greater levels of complexity and less funding. So a step change is required. Not just in the working conditions, in the way we support our social workers to sustain achieving great things, but also in the way we as social workers take habitual daily action to optimise our resilience and wellbeing.
There has been a great deal of research into stress and social work, here are two recent ones:
BASW/Bath University 2018 UK Social Workers: Working Conditions and Wellbeing; (1) 1600 social workers responded
60% attended work whilst ill at least twice in the last 12 months (presenteeism)
50% of social workers were looking to leave the job
52% want to leave the profession within 15 months
40% are dissatisfied with their job due to:
Lack of autonomy and control
Lack of quality managerial support
Strained team relationships
Poor understanding of role in organisational change
Blame culture
Lack of positive recognition
Institutional discrimination re: race and disability
The conclusion: High workload demands was the most consistent negative influencer upon the perception of stress, job satisfaction, and turnover intentions.
Plymouth University (2017) How stress impacts social workers – and how they’re trying to cope (2); 427 social workers employed in England across 88 local authorities as well in the private and third sectors.
57% - emotional eating to cope with work-related stress, which concurs with Community Care research
35%-55% using alcohol to cope with work-related stress
63% - difficulties sleeping
56% - emotionally exhausted
75% - concerned about burnout
35% - felt unable to cope at work
15% currently take, or taken within prior 12 months, anti-depressant medication ‘as a result of their social work role’
A brief critique of these would highlight that there is a chance that social workers with such issues were more likely to complete this survey, thereby squeeing the data, which must be taken into consideration. When presenting these research findings in the 15th March workshops not one social worker in the room was surprised about these findings and even thought that the alcohol consumption figures would be higher from their experience. The audience also shared their concern about professional isolation when social workers become so focused and absorbed in the excessive demands of their caseload that they become an island within a team; many teams now operate a hot desking arrangement compounding this further. There was also reference to management who become critical and micro manage social workers.
The list of chronic health conditions linked to workplace stress is endless. From a health perspective, people with chronic stress are more susceptible to but not limited to:
1. getting ill with infections and viruses
2. autoimmune conditions
3. physical pain ie headaches and muscular pain
4. energy and sleep issues
5. Digestive issues
6. Depression and anxiety linked to 40% of workplace stress and 49% of sick days 16/17
7. Metabolic syndrome associated with high cholesterol, obesity, increased risk of choronary heart disease, stroke and diabetes
Long term these kind of conditions are increasingly being associated with increased risk of Dementia in later life, according to Dr Amen (3). Dr Amen (2017) has completed more than 126,000 spect scans and he refers to stress being a big factor on the increase in Dementia, as well as toxins from excessive and persistent stress hormones/ neurochemicals like adrenalin and cortisol as well as from associated lifestyle behaviours like poor diet, alcohol and substances, being sedentary.
If these kind of chronic stress symptoms become a feature of ones practice as a social work its no wonder that the average career length is 7-8 years, despite having taken 6-8 years in total preparing to become a social worker (including previous to degree work experience)
“The ‘life expectancy’ of a qualified social worker is a meagre eight years. As a group they are more prone to burnout and experience above average levels of sickness absence. Emotional exhaustion is highly distressing and potentially life changing for the sufferer but it is also likely to have a negative impact on service users.
“We need emotionally resilient social workers who are able to relate empathically and appropriately with their service users in order to maintain service standards and continuity of care.”
What is resilience?
The capacity to deploy and sustain a range of personal resources and strengths, including hope, optimism, and self-efficacy, despite the tough adverse conditions. We're more likely to learn from mis-takes, in a way that supports the upward spiral of confident and capable social work practice, we have the personal resources to experience more pressure and promptly address and learn from challenges, we’re able to perform better in our lives and work. Desert flowers are a useful metaphor for resilience, they keep blossoming, despite the adverse weather conditions. Resilience is the capacity to weather the storm over the long haul and bearing in mind in Social Work every day is near enough a storm.
What is Wellbeing?
The World Health Organization defines health as “a state of complete physical, mental, and social well-being” (4). Put simply its state of being comfortable, healthy and happy. Having a positive state of wellbeing means to have the aspiration to and have capacity to be comfortable, healthy and happy in any given situation, night and day. We feel more elevated in mood, connected, present, able to communicate with empathy and with mindful compassion, we wake up every day feeling invigorated, stress is experienced as positive stress (eustress) and our physical health and mental wellbeing is more likely protected and optimised (in the short, medium and long term). The risk of burn out is minimised.
So how do we achieve this? Do we need to consider innovative and unusual approaches for unusual times?
In my view, yes we do!
Flourishing
Flourishing is a wellbeing framework, originally introduced by the father of Positive Psychology, Martin Seligman (5) having extended his notion of authentic happiness. It includes 5 dimensions of wellbeing; positive emotions, positive relationships, meaning, engagement, accomplishments. He sought to find a counterbalance to the mental and physical illness model, which focuses on mind and body deficits that require treatment, in an effort to give human beings something to work towards, to prevent deficits coming to light. By having the intention to flourish we practice the 5 domains of flourishing and seek to grow each one of them in our lives and work. Vanderweele (2017) (6) broadened this notion of flourishing to include mental and physical health, happiness and life satisfaction, meaning and purpose, character and virtue, and close social relationships. There has now been a significant amount of research into flourishing, evidencing the following benefits:
Fewer missed days of works
Fewer half-days and work cutbacks
Lower helplessness
More clear life goals
Higher resilience
Higher intimacy
Lower risk of cardiovascular disease
Lower number of chronic physical diseases with age
Fewer health limitations of daily living activities
Lower health care utilization (Keyes, 2007) (7)
One the reasons why flourishing works so well is because when we're flourishing our autonomic nervous system is in a state of homeostatis. We have a greater level of balance and we feel consciously and unconsciously safer and have a greater level of control in our lives.
Biofeedback
Biofeedback is a term which relates to listening to the mind and body for signals that indicate our state of wellbeing through real time information on whether we are in a positive or negative state of well-being. Pain, discomfort or illness is some form of biofeedback (biological feedback) - the body is giving a message that there is a dis-ease that requires resolution. It therefore gives us the opportunity to respond to those signals and take actions to get back into a state of ease, to feel better. Many people ignore or mask this bio-feedback, ie with anti-pain medication, for too long without addressing the root cause which over time can result in the dis-ease worsening.
Bio-feedback technology gives us the opportunity to listen to body and brain signals which communicate a state of dis-ease before symptoms manifest and therefore giving us the opportunity to respond and control some of our body's functions, such as your heart rate and brain waves. During biofeedback, you're connected to electrical sensors that help you receive information about your body. This is made possible because the body and brain together are an electrochemical multi-cellular organism.
Bio-feedback in the form of Neurofeedfback or Brainwave training basically posits that people who endure high stress workplaces, in addition to their already busy modern lifestyles, could have a high incidence of chronic levels of stress causing our autonomic nervous system to be in fight flight freeze mode. As mentioned previously, Social Work specifically is known for its high levels of stress due to the complexity of the social problems they are working with combined with ever decreasing resources in many cases giving rise to poor working conditions; the challenges and level of demands can exceed the level of support.
Neurofeedfback/Brainwave training should be considered as an effective tool in Social Worker to support our resilience and wellbeing, both of which may be associated with better client outcomes (win win win): 1. to help measure and improve our resilience so we can be a more effective and productive employee despite the challenging conditions; 2. to help respond to our health signs in real time to support our wellbeing in the short, medium and long term; and 3. when we have resilience and wellbeing we are more likely to see better outcomes in our clients.
What is happening in the body that turns workplace stress into physical, mental and social dis-ease and increasingly the likelihood of poor performance?
Porges (2017) Ployvagal Theory (9) refers to an unconscious feeling of being unsafe that is running the through bodily system via the vagal nerve. This is both in response to the environment combined with what we personally bring to that situation; ie our emotional landscape stemming from our own resolved/unresolved trauma, beliefs and expectations.
The image above illustrates Porges Model of Social Engagement in which he refers to the bodys lack of safety being the driving factor that creates the fight flight mode; this relates to one side of the autonomic nervous system, a feature of the sympathetic nervous system. When we are in a dangerous situation the brain and body involuntarily respond to the environment by mobilising enough resources to effectively respond to that danger. This is called fight flight or in extreme cases freeze. When the danger happens key organs of the body are instantly flooded with neurochemicals/ hormones like adrenalin and cortisol in an effort to inform the body its time to either run away from the danger, or fight away the danger, or freeze ie acting dead in a survival situation (in the recent shooting in New Zealand the survivors were those who acted dead) but this can also include apathy, depression and suicide ideation. Certain key organs are suppressed in an effort to save resources, to send more resources to the extremities, ie increase blood flow to the hands and feet, to focus energy on resolving the danger; the digestive system is curbed, the immune system is suppressed, the eyes narrow, the heart beats faster to bump blood further to fill muscular extremities with resources to address the danger.
The new day to day danger is modern day living which is compounded further by high stress jobs. Even without the stress of social work modern day living is already far more stressful than pre-modern times. This is due to the lack of downtime, always on culture, sedentary lifestyles and multi-tasking through life to get essential things done, then using the New, TV or technology to wind down which serves to overwhelm us further. When our range of human needs are not being adequately met because of such lifestyle behaviours our unconscious system feels unsafe. In this sense stress is the new danger. Indeed, stress is harming us every day if we do not let it go. It is harming us by generating toxic neurochemicals /hormones, like adrenalin and cortisol, that build up in the system. That toxicity then becomes the danger which signals fight flight freeze.
An additional factor that may impact on the systemic feeling of safety links to ones own past. Its not unreasonable to assume that many social workers became a social worker due to having experienced some degree of trauma themselves. Its easy to assume that social workers have addressed and recovered from all of their own traumas. In reality some social workers will have have engaged in some form of therapy and fully resolved them, others may have had some form of therapy and not fully resolved them and others may have had little to none. It follows then that there could be a relatively high incidence of social workers with at least residual unresolved emotions stemming from their own life and/or workplace trauma's. Unresolved emotions creates an inner landscape of the brain which increases vulnerability to buckling under stress or to enduring health problems when under stress, either experienced in real time or deferred to later in life. It can make what was previously a usual activity fall into the distressing range when there is too much of it. It is for all these varying factors that can make peoples perception of stress differ from one another despite engaging in what appears to be the same activity.
Porges point about social disengagement is that when people are enduring fight flight they are less social, compassionate and empathic, more likely to experience frustration, worry, anxiety and anger. Given that social work is inherently a people business requiring empathy, compassion and clear thinking through complexity, it is a concern if social workers are experiencing a low level of unconscious safety in part due to mismanagement of the body-brain system.
The objective of brainwave training is help people get into brainwave states that get them out of the habitual pattern fight flight mode and into brainwave states that get them into pattern of homeostasis. Brainwaves are a root of all our emotions, thoughts and therefore our behaviour and they represent the electrical impulses that carry information between the community of 100 billion neurons in our brain. It has been uncovered that there are also neurons in the gut (10) and other also believe there are neurons in the heart and spinal cord. When we do activities that impact positively on our brainwaves it follows then that we can impact positively on our heart, gut and spinal cord.
By measuring our brainwaves, e.g. using Focusband, we get to find out the current status of our brainwaves. Beta brainwaves are the normal adult waking conscious brainwaves. High Beta is associated with fight flight and overwhelm. Higher levels of Theta, Alpha and Delta waves tend to be linked to the relaxation response, otherwise none as Rest and Digest.
The Focusband also helps us read the status of our autonomic nervous system; whether we're in flight flight (red zone), or moving in that direction, or whether in homeostasis (green zone). The preferred state is homeostasis. In this zone, as Porge highlights, we are more compassionate, mindful, empathic, socially engaged, we are more present and experience more joy. We can empower human relationships when we spend more time in homeostasis.
In homeostasis we generate greater levels of delta waves which help to release hormones that support our wellbeing, including serotonin, dopamine and oxytocin. Accessing greater levels of delta waves engages the parasympathetic autonomic nervous system along with rest and recovery/relaxation response. It necessarily puts the breaks on the fight flight mode and and engages, what Porge refers to, as social engagement. Which can empower our relationships with our clients and colleagues.
Delta waves are slow deep brain waves that we experience 3 times per night (if we sleep well through night) when we're in deep dreamless sleep and are also generated in abundance during certain activities in waking state, including certain exercise, like high intensity interval training and trampolining, dancing, experienced meditation, Havening Techniques. In short, by spending more time in these positive brainwave wave states we give our brain a boost and we increase the likelihood of empowering our human relationships and sustaining win win win outcomes: good for our wellbeing, good for personal and professional resilience both of which are associated with better service user outcomes, more effective working relationships with our colleagues and better leadership.
In unusual times we need unusual and uncommon effective tools to help us adjust to the increasingly stressful and changing environmental conditions in which we find ourselves in. Flourishing, Biofeedback technology and Havening Techniques can help us rise to this for a step change in the way we operate our wellbeing.
Click here to find out more about Havening Techniques and how it can help to let go of unresolved and unwanted emotions and scroll down the home page of the website for testimonies.
Keep an eye out for more blogs that will expand your awareness on this and related topics.
References
(1) https://www.basw.co.uk/resources/uk-social-workers-working-conditions-and-wellbeing-0
(2) https://www.plymouth.ac.uk/news/pr-opinion/opinion-how-stress-impacts-social-workers-nil-and-how-theyre-trying-to-cope
(3) Daniel G.Amen (2017) Memory Rescue; Tyndale Momentum
(4) World Health Association (1948) Preamble to the Constitution of the World Health Organization.International Health Conference (World Health Association, New York), Official Records of the World Health Organization, No 2, p 100.
(5) Martin Seligman (2011) Flourish: A new understanding of happiness and wellbeing - and to achieve them; Nicholas Brealey Pubishing, London
(6) Tyler J. VanderWeele; PNAS August 1, 2017 114 (31) 8148-8156; published ahead of print July 13, 2017 https://doi.org/10.1073/pnas.1702996114 Edited by Kenneth W. Wachter, University of California, Berkeley, CA, and approved June 16, 2017 (received for review February 21, 2017)
(7) https://positivepsychologyprogram.com/flourishing/#definition-flourishing
(8) https://www.beds.ac.uk/news/2013/january/social-workers-life-expectancy-just-eight-years
(9) Stephen W.Porges (2017) The Pocket Guide of The Polyvagal Theory: the Transformative Power of Feeling Safe; W.W. Norton, New York
(10) Richard E. Cytowic M.D. (Jan 17,2017) The Fallible Mind: Emotion, perception, and other tricks of the brain https://www.psychologytoday.com/intl/blog/the-fallible-mind/201701/the-pit-in-your-stomach-is-actually-your-second-brain
Author: Jan Carpenter
(Bsc, DipSW, PGDipMS, DipCoaching, Havening Techniques Practitioner)
Jan is a certified Havening Techniques® Practitioner and a student of neurofeedback. It complements a decade of certified coaching, NLP and training delivery and 2 decades as a qualified social worker, specialising in safeguarding adults, adult mental health and senior practitioner roles through to interim team management.