The challenges which mental health professionals face highlight the importance of effective self-care practices to reduce occupational stress.. To date, however, there is no specific res
Introduction
Mental health professionals face a vast array of demands in the workplace Not only must they manage the typical responsibilities of employment including organization of tasks, effective communication, and maintaining current training certifications, they are also required to manage the emotional burdens that are inevitable in their respective field For the purposes of this dissertation,ƚheODEHO³mental health professional´ represents Clinical Psychologists, Licensed Marriage and Family Therapists, Licensed Clinical Social Workers͕ and Psychology-interns and practicum trainees (Psy.D.) who provide therapeutic services For these individuals, the stressful and often traumatic cases they see do not simply vanish once they clock out Given the nature of their work, mental health professionals are vulnerable to stressors that challenge them emotionally, physically, spiritually, and can impact their cognitive resources and psychological well-being (Portnoy, 2011)
When conscious efforts are not made to manage work-related stress for mental health practitioners, research has found that such practitioners are highly vulnerable to experiencing distress that has a negative impact on their daily functioning The term commonly used to describe the negative impact of work-UHODWHGVWUHVVLVàRFFXSDWLRQDOEXUQRXWả7KLVWHUP encompasses a wide variety of symptoms that can potentially cause significant distress
Occupational burnout can lead to depression, anxiety, compassion fatigue, distraction and decreased self-awareness, and the risk of such consequences may increase with a lack of social- support (Carter, 2013)
Over the course of their career, many mental health professionals will be tasked with treating individuals who present a wide variety of traumatic experiences Mental health Ϯ professionals who face such challenging cases are at risk of experiencing some level of secondary trauma as a result Secondary trauma is a term that describes the emotional distress experienced by an individual who hears about the firsthand traumatic experience of another person (Baum, 2016) The symptoms of secondary trauma mimic the symptoms of post- traumatic stress disorder (PTSD)
It is commonly accepted that mental health professionals can expect to experience a significant amount of emotional activation given the often painful and distressing material their clients share with, and sometime direct toward them Psychotherapists are often exposed to stories of trauma, complex and highly negatively charged interpersonal interactions, tragic stories, and complicated ethical issues and mandated reporting questions A psychotherapist must absorb much painful affect and still be able to approach delicate issues with equanimity and competence if they are able to develop and implement treatment plans to target maladaptive behaviors and reduce the severity of the clientVảVXIIHULQJ Much research indicates that to provide effective psychotherapy, mental health professionals should engage in effective self-care practices to alleviate the occupational stress that they experience (Portnoy, 2011; Figley, 2002)
Under Principal II: Responsible Caring of the Canadian Code of Ethics of Psychotherapy; 3ULQFLSDO,,VWDWHVWKDWSV\FKRORJLVWV³(QJDJHLQVHOI-care activities that help to avoid conditions that could result in impaired judgment and interfere with their ability to benefit and QRWKDUPRWKHUV´3RSH 9DVTXH]TKH$PHULFDQ3V\FKRORJLFDO$VVRFLDWLRQảV*HQHUDO3ULQFLSOHV3ULQFLSDO$%HQHILFHQFHDQG1RQPDOHILFHQFHVWDWHVWKDW³3V\FKRORJLVWVVWULYHWREH aware of the possible effect of their own physical and mental health on their ability to help those ZLWKZKRPWKH\ZRUN´3RSH 9DVTXH]7KHVH statements reflect the mental health SURIHVVLRQDOVảHWKLFDOGXW\WRDFWLYHO\HQJDJHLQDFWLYLWLHVWKDWPD\UHGXFHWKHULVNRI ϯ occupational burnout, sHFRQGDU\WUDXPDRURWKHUULVNIDFWRUVWKDWPD\LPSDLUDFOLQLFLDQảVDELOLW\ to effectively care for their clients
Numerous studies have been published which support a variety of martial arts styles in reducing stress For example, researchers have demonstrated a positive association between Tai Chi training and stress reduction (Birdee, et al., 2009) Researchers have also argued that martial arts, notably Aikido, can be effective in stress reduction, emotional regulation and improving memory (Hakan, Kassab & Lothes, 2013)
This dissertation attempts to answer the following question: Are martial arts an effective form of self-care for mental health professionals? For the purposes of this dissertation, the term martial arts encompasses a variety of styles including but not limited Karate, Brazilian Jiu Jitsu and Aikido This investigation first explores the literature to: 1) address mental health
SURIHVVLRQDOVảVXVFHSWibility to occupational burnout; and 2) explores the efficacy of martial arts as a self-care strategy Two primary elements of martial arts are believed to be related to self- care including physical exercise and mindfulness After discussing exercise and mindfulness based strategies involved in martial arts training, relevant martial arts styles are discussed to determine any benefits unique to a specific style
For this phenomenological dissertation, the theoretical perspective is based on the
Humanistic model (Giorgi, 2009) It is assumed that mental health professionals are aware of the psychological and emotional impacts of working in their respective fields The Humanistic model assumes that: 1) Individuals have the innate desire to reduce stress and reach their full potential,&RQVWUXFWLQJRQHảVRZQLGHQWLW\DQGUHDFKLQJRQHảVIXOOSRWHQWLDOPD\UHTXLUHVRFLDO support that martial arts may naturally provide in the dojo-setting ϰ
1) Occupational stress: Symptoms include weariness, decreased frustration tolerance, decreased empathy for clients (Portnoy, 2011), or any additional negative symptoms that the participants associate with their occupation
2) Mental health professionals: Licensed Marriage and Family Therapists (LMFT) and LMFT interns, Licensed Clinical Social Workers (LCSW) and LCSW interns, School Psychologists, Clinical Psychologists, and PsyD trainees and interns.
3) Self-care effect sizes: How significant, if at all, is martial arts as a self-care activity?
4) Martial arts training: Including description of style, frequency and intensity of training
5) Mindfulness: The process of bringing one's attention to the present moment
The hypothesis in the context of this dissertation is: Martial arts are an effective form of self-care for mental health professionals It is common among martial arts enthusiasts to assume that training promotes well-being including self-confidence, physical health, emotional regulation, and improved cognitive functioning ;Boudreau, Koznak, 1984) While many people may agree that martial arts offer a wide range of benefits, the statement does not take into consideration certain factors that may diminish the benefits of practicing martial arts Some individuals may endure notable distress from their martial arts training Stressors may include difficulty understanding techniques, physical injuries, negative interactions with peers, rigid instructors, or financial strain at martial arts studios with high tuition costs ϱ
Given that this is a qualitative study, much of the data obtained was subjective and personal bias may be a factor to consider Additionally, it was essential to address and control for confounding variables so that the impact of martial arts training can be teased apart from the benefits the participants may have received from any other self-care practices Also, selecting martial artists who fit the criteria as an LMFT, LCSW, School Psychologist, Psychological trainees, interns, or Licensed Clinical Psychologist was a daunting task The selection criterion for participants also pertained to the delimitations of this study The scope of research is limited to participants who practice martial arts and are able to reflect on how their professional performance and overall well-being has been impacted by their martial arts training
The significance of this study is determined by the results Generally speaking, the data supports martial arts as an effective self-care practice for mental health professionals This is a significant finding because martial arts are growing as an extra-curricular activity, arguably due to its glorification through the entertainment industry and as a means of physical fitness One can see the promotion of martial arts through action movies which typically have a high volume of hand to hand combat-scenes, and combat sports like mixed martial arts (MMA) Although the health benefits have been reported across the data sets of this dissertation, problems due to martial arts training were also revealed in the results including increased psychological stress, interpersonal conflict and physical injury ϲ
Literature Review
Burnout is a term commonly used to describe a state of physical, mental and emotional exhaustion DWWULEXWHGWRRQHảVRFFXSDWLRQ (Mayo Clinic, 2015) Burnout attributed to occupational demands FDQQHJDWLYHO\LPSDFWRQHảVSURIHVVLRQDOH[SHULHQFH The term burnout may include job dissatisfaction, fatigue, and absent mindedness at work (Gupta, Paterson,
Lysaght, & Von Zweck, 2012) For those who serve populations in significant distress, appropriate forms of self-care have been found to be essential in inoculating people from burnout For example, therapists who work with individuals with trauma may be susceptible to occupational burnout as well as secondary trauma or compassion fatigue (Baird & Jenkins,
2002) Secondary trauma is a term used to describe an emotional reaction therapists may experience as a result of exposure or repeated exposures in therapy to trauma survivorsả descriptions of their experiences (Baird, & Jenkins, 2002) Psychotherapists who work with traumatized or significantly mentally ill populations must cope with both the general demands of work as well as the intensely emotional and sometimes tragic stories they hear from their patients Whether serving populations with problems that are moderate or severe, mental health professionals are often required to absorb and process significant amounts of information empathetically while maintaining composure and emotional stability This is often a difficult task, as the need to metabolize much painful affect makes mental health professionals highly susceptible to experiencing significant levels of work-related stress Therefore, it is essential for mental health practitioners to find effective strategies to process the stress they experience to lessen their risk of burnout
In a study examining the effects of secondary trauma on psychotherapists, 188 participants who regularly treated trauma survivors completed questionnaires to evaluate their ϳ psychological well-being (Mac Ian & Pearlman, 1995) Participants were administered the Symptom Checklist-90²Revised (SCL-90-R), the Traumatic Stress Institute Belief Scale (TSI Belief Scale), and an independent questionnaire The independent questionnaire asked questions regarding personal histories of trauma and work related stress
The participants presented a wide range of professional experience and personal histories of trauma Forty percent of the participants did not report a traumatic history Of the participants without traumatic histories, only those with less training and experience exhibited notable levels of work-related stress Sixty percent of the total sample (32 men and 80 women) reported personal histories of trauma Participants with histories of trauma exhibited greater negative effects from their occupation than participants without personal traumatic histories Participants with both histories of trauma and low levels of experience showed the greatest levels of occupational stress (Mac Ian & Pearlman, 1995)
The results of this study suggest that experienced clinicians exhibit greater levels of resiliency than new clinicians when working with trauma survivors The results also reflect that when psychotherapists are exposed to stories of trauma, they are vulnerable to mental health problems This study demonstrates the risk of vicarious traumatization that clinicians face in the workplace (Mac Ian & Pearlman, 1995)
Norcross (2000) emphasizes the importance of tailored self-care activities for psychotherapists, and presents a compilation of research informed strategies that are recommended by clinicians Norcross notes that clinicians may have specific preferences and varying limitations or access to resources when it comes to self-care activities Therefore a careful exploration of strategies must be done to find the best fit for each individual clinician ϴ
Self-care activities should promote a broad range of benefits including but not limited to relaxation, improved cognitive functioning, and physical exercise (Norcross, 2000) The author emphasizes that clinicians begin exploring self-FDUHVWUDWHJLHVE\DFNQRZOHGJLQJRQHảV vulnerability to burnout-related symptoms in practice, and be open-minded to different forms of self-care
In a longitudinal study examining the significance and preceding factors to burnout among school psychologists, data was FROOHFWHGRQWZRVHSDUDWHRFFDVLRQVWRDVVHVVSDUWLFLSDQWVả symptoms of burnout;Huebner & Mills, 1998) Three symptoms of burnout were measured using three scales These scales included: emotional exhaustion, depersonalization, and reduced personal accomplishment The first data collection took place in October 1993, with 225 participants The second data collection was completed in May 1994, using 173 participants from the original sample (n"5) Data was assessed and measured by using the following tools: a demographic questionnaire,ƚŚĞMaslach Burnout Inventory (MBI) to measure levels of exhaustion or reduced occupational interest, a NEO Five-Factor Inventory to measure
SDUWLFLSDQWảVSHUVRQDOLW\WUDLWV, and a School Psychologist Stress Inventory Following the third data assessment, the results demonstrated that 40% of participants documented significant levels of emotional exhaustion, and 19% of participants reported a notably reduced sense of accomplishment due to the nature of the work.
In a study examining occupational stressors and levels of stress among psychological trainees in the United Kingdom, researchers administered a Counselling Psychology Trainee Stress Survey (CPTSS) and General Health Questionnaire 12 (GHQ12) to 109 participants (Baker & Kumary, 2007) The CPTSS consists of subtests that assess four domains including academic, personal and professional development, placements, and support Researchers stated ϵ that overall, participants demonstrated high stress scores on three of four domains of the CPTSS including academic, placements, and personal and professional development
The GHQ12 is a 12-item screening tool designed to measure levels of stress among people in medical and community settings (Baker & Kumary, 2007) Items on the GHQ12 rate WKHSDUWLFLSDQWảVmost recent experience with specific symptoms and behavior on a four-point scale The GHQ12 can be scored for level of stress and can also be XVHGWRLQGLFDWHààFDVHQHVVảả 6FRUHVPHHWLQJWKHFULWHULDIRU³FDVHQHVV´VXJJHVWWKHSRVVLELOLW\RIDSV\FKLDWULFGLDJQRVLV Researchers found a significant positive correlation between CPTSS subscales and GHQ12 scores for the psychological trainees (Baker & Kumary, 2007) For example, 54 participants ZHUHLGHQWLILHGDV³FDVHV´SHUWKHLU*+4VFRUHV 7KH*+4³FDVHV´GHPRQVWUDWHG significantly higher CPTSS VFRUHVWKDQWKH³QRQ-FDVHV´The results of this study strongly suggest that mental health professionals are susceptible to occupational stress This study also reflects the importance of exploring effective strategies to reduce the likelihood of such symptoms (Baker & Kkumary, 2007)
In a study examining the psychological impact of crisis-counseling responders to victims of the Oklahoma City bombing (Wee, Myers & Figley, 2002), researchers administered multiple tests to evaluate for vicarious trauma including the Frederick Reaction Index -A (FRI ±A), the Symptom Checklist-90 Revised (SCL-90-R), and a Alfred P Murrah Federal Building Bombing Reaction Questionnaire nine months after the incident The FRI-A results demonstratedthe disaster mental health workers-group presented symptoms that placed them within the disorder range for posttraumatic stress disorder The SCL-90-R GSI scores were below the cut-off T score of 63, establishing clinical significance Overall, the scores strongly suggested that all ϭϬ participants were at risk of experiencing vicarious trauma and burnout (Wee, Myers & Figley, 2002).
,WLVORJLFDOWRDUJXHWKDWWKHV\PSWRPVRIWKHWKHUDSLVWảVFRPSDVVLRQIDWLJXHDQ[LHW\ numbing or avoidance might negatively impact the therapeutic alliance In an article discussing the signs of burnout and compassion fatigue, Portnoy (2011) lists the common symptoms of burnout under five categories including cognitive, emotional, behavioral, spiritual, and somatic Portnoy notes that the cognitive effects of burnout commonly include difficulty with concentration and preoccupation with secondary trauma Regarding emotional symptoms,
Portnoy explains that one may experience symptoms of anxiety and either elevated or flat affect Behavioral impacts of burnout often include irritability and changes in appetite and sleep
Portnoy describes a spiritual response to burnout as well Assuming that one subscribes to spirituality or has a religious affiliation, spiritual burnout may result in a loss of purpose or feelings of hopelessness, or lead to a questioning of RQHảs religious beliefs (Portnoy, 2011) Lastly, Portnoy describes the somatic impacts of burnout that commonly include chronic perspiration, aches and pains, and weakening of the immune system
Research Methods
Mental health professionals face a wide variety of demands in the workplace Managing client schedules and documentation, communicating effectively, maintaining current training certifications, and managing emotional burdens are just some of the tasks that mental health professionals face in their respective fields For the purposes of this paper, the mental health professional represents Clinical Psychologists, doctoral level trainees and interns in Clinical Psychology, and Licensed Marriage and Family Therapists who provide psychotherapy for their clients For these individuals, the stressful and often traumatic cases they see do not simply vanish once the clinician clocks out Given the nature of their work, mental health professionals are vulnerable to stressors that may jeopardize their emotional, physical, spiritual, and cognitive well-being (Portnoy, 2011) This research is designed to explore the relationship between martial arts and self-care
For this dissertation, eight male and or female persons were selected to participate in semi structured interviews in an attempt to capture the individualVảH[SHULHQFHZLWKPDUWLDODUWV in the context of a self-care activity The interviews attempted to address the question: Are martial arts an effective self-care practice for mental health professionals? Creswell (2014) emphasizes that during the interview process, effective data-collection can be improved by developing an observational protocol to enhance the content obtained through the interview protocol The participants were one of the following: A licensed Marriage Family Therapist, a licensed Clinical Social Worker, a School Psychologist, a Clinical Psychologists, a doctoral level practicum trainee, and a doctoral intern All participants have been providing psychotherapeutic services to clients in a variety of settings including private practice, schools, or for clinics ϯϯ
Participants reported no significant mental illness Additionally, participants have all been practicing martial arts on a weekly basis Martial arts training was not be restricted to one style Additionally, one Participant was not providing psychotherapeutic services during the time of the interview however; KHKDVRYHU\HDUVảH[SHULHQFHWUHDWLQJFOLHQWVDVDpsychotherapist while training martial arts
Subject selection began by reaching out to martial arts school-instructors nation-wide via e-mail and by telephone to state the purpose of the research A document stating the nature of the research and requesting for volunteers was sent to the schools that are willing to participate The instructors were asked to distribute the documents to students in hopes that potential participants who fit the criteria would make contact with this researcher
In addition to the martial arts school-search, participants were sought out through
QHWZRUNLQJDWWKH9HQWXUD&RXQW\3V\FKRORJLFDO$VVRFLDWLRQảVPHPEHUảVZHEVLWHIncentives for participation emphasized an opportunity for the respondent to gain a deeper understanding into how his or her training has impacted overall well-being
Subject selection required that mental health professionals must be over age 18
Participants must also be licensed therapists at the masters or doctoral levels, or students currently enrolled at the doctoral level and providing therapy through practicum or internship Participants who KDYHQảWEHHQproviding therapeutic services, but who have done so in the past, may be interviewed so long as these participants have extensive experience as psychotherapists and were practicing martial arts during their career ϯϰ
Given the variety of clinical experience and martial arts backgrounds presented throughout this study, there were contrasting subjective experiences among participants Because of this, a qualitative, phenomenological method implementing a semi-structured interview process was optimal in capturing the experiential data
There was one interview per participant (n=8) The interviews were audio-recorded with two electronic devices to ensure that all data was collected and nothing lost due to mechanical failure or human error This researcher traveled to locations convenient for participants to conduct interviews For participants living beyond the reasonable range of travel (beyond 50 miles), interviews were conducted by telephone and through skype
The semi-structured interview protocol was designed to identify basic demographic information about the individual Demographic information included gender, age, the nature of their clinical work, level of experience as a clinician, and in martial arts, how they decided to participate in martial arts training, and if they considered this activity as a form of self-care The protocol began with specific demographic-identifying questions then transition to broad, general questions to facilitate space for individual exploration as the interviews unfolded Because this research does not restrict martial arts to one specific style, the semi-structured interviews facilitated space for the interviewee to reflect on his or her own style Once data was collected, it required considerable interpretation in order to extract the significance and implications of the content.
During the interviews the examiner documented the particLSDQWVảtone, body language and physical presentation relevant to the content of the interview protocol For those interviewed ϯϱ by SKRQHLWZDVQảWSRVVLEOHWRREVHUYHERG\ODQJXDJHWKLVUHVHDUFKHUQRWHGWKLVGLVDGYDQWDJH and continued to make note of tone during telephone responses Verbatim transcription of each interview was be completed Transcriptions were analyzed manually and with NVIVO software Welsh (2002) emphasizes the importance of utilizing software to improve the validity of qualitative data analysis Through qualitative analysis, this researcher examined the language and grammar that participants used and interpreted each account to gain meaning from their experiences NVIVO was a useful tool in this process Transcripts were imported directly to NVIVO software where they were coded Coding the data helped this researcher identify specific themes, and organize notable content across transcriptions Welsh (2002) notes that in addition to WKHLPSRUWDQFHRIYDOLGDWLQJRQHảVGDWD19,92LVXVHIXOLQWKHRU\-development through
DVVHVVLQJWKHPHVIUHTXHQFLHVDQGLQWHUSUHWLQJSDUWLFLSDQWVảH[SHULHQFHVThis analyzation was a process of examining the transcripts, identifying significantly relevant content, making
FRPSDULVRQVDQGFRQWUDVWLQJWKHSDUWLFLSDQWVảUHVSRQVHV)UHTXHQFLHVwere measured through NVIVO to assess for associations or common experiences shared by the participants Themes also explored similar or contrasting content to provide a clear picture and address the question: Is Martial Arts an effective self-care practice? And if so, in what ways does the chosen martial art serve as a self-care practice for the participant?
The interviews for this study were conducted in a variety of quiet settings including the park and at the participantVả residences Participants who did not reside within 50 miles of this researcher were interviewed through Skype video-chat and by telephone The study includes five male and three female participants (n=8) who are from a wide range of professional and martial arts backgrounds This researcher designed a protocol that encouraged participants to engage in ϯϲ an exploration of their occupational experiences, and how martial arts practice has influenced their clinical performance, and overall well-being There are diverse levels of experience in both mental health and martial arts in this dissertation The results of this study may therefore be considered applicable to mental health professionals in diverse fields who train in different styles of martial arts
Eight participants were interviewed for this study Participant 1 is a male PsyD student and practicum trainee who is in his early twenties Participant 1 works at a local elementary school He provides therapeutic services for children who are typically from low income, Latino families This participant trains in Brazilian Jiu Jitsu ZLWKRYHUWKUHH\HDUVảH[SHULHQFH He reports training roughly three to five days per week with peers of varying levels of experience
Participant 2 is a male PsyD pre-doctoral intern This participant is in his early thirties
He provides individual therapy, assessment and forensic services in a variety of settings This participant trains in Cajun Ryu Karate with URXJKO\ILYH\HDUVảH[SHULHQFH
Participant 3 is male, in his mid-fifties with a PhD in clinical psychology He has over
\HDUVảH[SHULHQFHSURYLGLQJtherapeutic services in a mental health hospital and private practice This participant has been training for over 30 years in Kung Fu, Tai Chi, Goju Ryu Karate and Shotokan Karate Participant 3 is currently a psychology professor at university
Participant 4 is a female school psychologist in her early forties with an MA in clinical psychology She has been providing therapeutic services in public schools for over ten years Participant 4 generally serves populations with intellectual disabilities, often from low income families This participant trains in Muay Thai, with roughly one year of martial arts experience ϯϳ
Participant 5 is a male LMFT He has over six years of experience providing individual therapy for families and couples from middle to higher income households This participant has been training in Aikido for roughly 20 years
Participant 6 is a female LMFT She has been providing therapeutic services in private practice for over ten years This participant has 35 years of experience training in Aikido
Participant 7 is a female LMFT This participant has been working as a therapist for fourteen years She has over 30 years of experience training in Aikido
Participant 8 is a male with a PhD in clinical psychology He has RYHU\HDUVả experience providing therapeutic services, primarily for deaf clients This participant has over WZHQW\\HDUVảH[SHULHQFHWUDLQLQJLQ$LNLGR
Procedures for this qualitative, phenomenological study were approved by the
Results
For this study, eight participants were interviewed All participants identified as martial artists, with varying levels of experience Participants came from different occupational backgrounds including three Licensed Marriage and Family Therapists, one School Psychologist, one PsyD intern, one PsyD Practicum trainee, and two Clinical Psychologists Participants ranged in age from 23-65 years Each participant was administered the same 18-item interview protocol The objective of this dissertation was to understand the lived experience of mental health practitioners who practice martial arts The results of these interviews identified converging themes related to occupational stress, and themes to determine if the martial arts are an effective self-care practice In addition, the emergent themes also identified factors of martial DUWVWUDLQLQJWKDWPD\FRPSRXQGDSDUWLFLSDQWảVRFFXSDWLRQDOVWUHVVVXFKDVSHUVRQDOLQMXU\RU interpersonal conflict at their respective schools or dojos
Themes refer to response-patterns across the different participants interviews which are significant to the research question Occupational stress is an emergent theme that is central to this dissertation because it reflects the challenges of this occupation, and the importance of self- care
For this study, occupational stress is defined as any symptoms that the participants associate with the demands of work Symptoms include excessive worry, fatigue, decreased frustration tolerance, decreased empathy for clients, or any additional cognitive, emotional, or physical symptoms that the participants associate with their occupation.The levels of ϰϬ occupational stress were measured by the length and detail of relevant responses, content, tone, and body language for those interviewed in person NVIVO was used to organize the interview data, to measure word frequencies and to connect themes Questions within the interview protocol that relate to occupational stress were utilized to understand the stressors that mental health professionals experience, and the degree to which martial arts impact that experience
Some participants reflected on occupational stress even when items on the interview protocol did not ask them to do so For example, Question 5 asks³:RXOG\RXVD\WKDW\RX enjoy
\RXUZRUN"´)RUWKLVTXHVWLRQ, participants 1 and 2 reflected on stressful experiences at work before noting any occupational enjoyment Participant 1 began his response by saying: ³,GR>HQMR\KLVZRUN@XPP\ELJJHVWLPSHdiment so far has been kind of my
Participant 1 has limited experience as a practicum trainee 3HUWKLVSDUWLFLSDQWảV responses, it would be reasonable to argue that his occupational stress is largely attributed to limited experience and working in a multicultural environment that feels unfamiliar
Additionally, iWLVSUREDEOHWKDWSDUWLFLSDQWảVIHHOLQJVRILnadequacy are associated with high levels of stress and high self-expectations, which are common among trainees and interns (Alam, Inam & Saqib, 2003)
Participant 2 explained that although he enjoyed the challenge of working with hospital patients who had significant mental illness, he worked long shifts and had minimal support from management Participants 1 and 2 represent two different work environments and population demographics These demographics include the school campuses that serve low income Latino majorities and mental health hospitals which serve the severely mentally ill These responses to ϰϭ
Question 5 suggest that there are times when occupational stress outweighs occupational satisfaction for some mental health professionals
Generally speaking, the interviews presented notable degree of overlap regarding the areas of work where occupational stress is experienced.On the interview protocol, Question 7 DVNV³:KDWDUHWKHPRVWFKDOOHQJLQJDVSHFWVRI\RXUMRE"´ For this question, participants 1, 2, 3,
5 and 8 associated occupational stress with co-workers and working in multi-disciplinary environments For example, participant 1 and 5 work in the school system and both note that it is challenging to work with school faculty who generally hold academic priorities over mental health, and are not always amenable to facilitating space for treatment
Participant 1 responded to Question 7 by stating that working in a multi-disciplinary environment resulted in occupational stress This was the second time he reflected on occupational stress during the interview Participant 1 explained that as a practicum trainee providing services at a public school, the environment facilitates academic success as the
SULPDU\JRDODQG³7KDWảVNLQGRIDFKDOOHQJHWRILJXUHRXWZKDWRXUUROHLVH[DFWO\KRZZHILWLQ with the mechanism of the VFKRROV\VWHP´3HUWKLVZULWHUảVREVHUYDWLRQVRIWRQH, body language and response to Question 7, Participant 1 feels that his position as a mental health professional is not valued to the degree that faculty members are valued in this work environment As a result, Participant 1 experiences feelings of inadequacy and interpersonal strain between himself and school staff Although occupational stress is apparent in his responses to Question 5 and
Question 7, Participant 1 is able to meet the occupational demands of his practicum and engage in martial arts ϰϮ
Participant 2 reflected on the most challenging aspects of his work, noting problems with management and fatigue associated with long hours at work He stated: ³7KHUHZDVDYHU\ZHLUGXQSrofessional way of kind oIKD]LQJWKHHPSOR\HHV´
Participant 2 emphasized that getting along with co-workers could be frustrating, especially when dealing with the hierarchy of management For example, Participant 2 remembered times when he was assigned the toughest cases at the in-patient facility Participant
2 noted that he frequently treated physically aggressive patients Although three of the participants reported feeling a greater sense of confidence when working with dangerous patients, Participant 2 emphasized that martial arts cannot be used against aggressive patients in the way one might defend oneself in the street because of liability issues He said: ³,I\RXXVHDQ\RILW>GDQJHURXVWHFKQLTXHV@\RXJHWWDNHQRIIDQd thrown in jail you NQRZ´
This statement reveals the weight of responsibility that Participant 2 held regarding the matter of personal safety, patient safety and liability
For Question 7, Participant 3 attributed occupational stress to interpersonal challenges and self-expectation While serving multiple clinics in his area with a multi-disciplinary staff, this participant stated: ³&R-workers can be kinda stressful at times.´
Participant 3 did not elaborate on this response Instead, he reflected on having high self- expectations and expressed difficulty in accepting that at times he does not have the answer to ϰϯ challenging clinical questions Participants 1 and 3 attribute occupational stress to high self- expectations on performance