If you are asking yourself how burnout is related to ethics, consider this. Ethics is not only about ensuring proper conduct with our clients. It is also about ensuring our own safety, expressing our values, and providing a positive experience of touch. None of these things are possible if we are experiencing burnout. The AMTA code of Ethics states that “Massage therapists shall accept the responsibility to self, clients and associates to maintain physical, mental and emotional well being.” This means that we have an ethical obligation to take care of ourselves.

What is Burnout and Who Gets It?

Burnout is a painful process which results in a deteriorated state of being. Normal functioning may become impaired due to unhappiness, excess stress, and lack of recreation. It is an insidious malaise of the spirit that has adverse affects on every aspect of our lives. A term that was once used to describe the bottomed-out street addict, burnout is now a commonly used word for the phenomenon which is ravaging the stress-filled final decades of the twentieth century. Psychologist Herbert Freudenberger, who claims credit for the term, describes burnout as a depletion of energy and a feeling of being overwhelmed by others’ problems.¹ It is an experience which includes feeling unmotivated, “used up”, bored, frustrated and dissatisfied. It is different from simply being over-stressed; you can be stressed and still feel motivated. Burnout is when you dread going to work in the morning.

Although no one is immune, those in helping professions tend to be particularly prone to burnout. Hardest hit are the ‘people who help people’, and they are closely followed by those who have left other jobs or professions because they felt burned out.² Unfortunately, burnout does not simply go away when you leave the adverse situation; you must properly recover, or it will follow you .

Burnout in Massage Therapy

Considering these facts, massage therapists appear to be at a statistical disadvantage for becoming a target for burnout. Many of us have chosen this profession because we were wearied from the stresses of our former work, and we expected to find reprieve in the field of massage therapy. Chances are high that we did not conscientiously recover before we began facing the aspects of massage therapy which make us all vulnerable to the very phenomenon we may have sought to remedy. Even if we entered this field feeling energetic and enthusiastic, we may be at high risk Let’s examine some of the aspects of our work which may put even the most motivated massage therapist in jeopardy:

1. The intimate nature of our work. Touch is a very intimate act. Being fully present to another human being for the duration of a massage session takes touch to an even more intense level. Perhaps we work in a home setting, or we have friends and family as our clients; this means we have the additional challenges of maintaining privacy and setting limits. Intimacy, as wonderful and healing as it may be, can also be very stressful.
2. Working with people in pain – physically, emotionally, or both. As sensitive, caring massage therapists, we may find ourselves dealing with the complexity of people in pain. This can be a draining experience, especially for those who work with chronic pain situations, as many of us do. In addition to this, clients often come to us as a last resort, desperate for relief. Spoken or unspoken, there are often expectations from ourselves and our clients to “fix” their pain. Think of the pressure this puts on us!
3. Feeling unappreciated or unrecognized. This may be the result of several factors. Massage therapists tend to be endless givers – we are apt to expend much of our energy on the behalf of our family, friends, and clients. This tendency in and of itself can be a precursor to burnout. If we additionally face situations where, for example, a new client does not call again, a regular client does not return, or perhaps a client does not benefit from massage, we may feel personally responsible and attempt to increase our efforts to be helpful. When we lack a balanced return from our energy investments, we become depleted and discouraged, and are a candidate for burnout.
4. Disappointment in career progress. If we expected to have a “turn-key operation” waiting for us when we graduated from massage school, we may be experiencing disappointment, disillusionment, and fear of failure. Or perhaps our career change placed us in a financial crunch which is not yet remedied by a slow-starting massage practice. Self employment may have brought on stresses of its own, such as lack of health care coverage, and continual time and monetary investment with an imbalance in financial return. Stress, stress, stress… the very thing we left our former careers to eliminate.
5. Overload. Success, on the other hand, can also be very stressful. A lot of work will not necessarily cause us to burn out, as long as we feel we can control what happens to us and we receive adequate return for our investments. If, however, time management is a problem and we face conflicting demands on a regular basis, we can become overwhelmed. Without intervention, our lives can become chaotic, causing fatigue and lack of motivation. As our stamina wanes, our potential for burnout increases.
6. Isolation. As I mentioned earlier, some of us lack the opportunity to have regular contact with other massage therapists. Despite its appeal, autonomy can lead to alienation from the vital support systems we may need when faced with difficult situations, both clinically and ethically. Furthermore, without regular peer contact, we are may be unaware of symptoms we are having that indicate we are burning out.
7. Perfectionism. Sometimes our own perfectionism sets us up for burnout. Being stuck with a critical boss inside of our heads can tend to be very de-motivating and draining. It can cause us to feel defeated before we even begin our day.

These factors, either alone or in combination with each other, accommodate the potential for the onset of the burnout syndrome.

Warning: Downward Spiral Ahead!

Fortunately, there are signs that can warn us to take better care of ourselves so that we can avoid the downward spiral into burnout. If we recognize them and take them seriously, chances are good that they will serve to motivate us to take better care of ourselves. They include:

1. Exhaustion. This first warning sign of burnout is that lack of energy we have all experienced from time to time. If we find ourselves feeling tired all the time and are having trouble keeping up with our usual activities, we may be headed for trouble.
2. Increased impatience and irritability. We find ourselves having more frequent flare-ups with others over insignificant things.
3. Boredom and cynicism. In this vicious cycle, one begets the other, until we find ourselves thinking negatively about life in general.
4. Feelings of being unappreciated. When our added efforts go unrecognized or unrewarded, anger and resentment set in.
5. Detachment. Lacking energy, we withdraw from people, interests, and activities.
6. Victim mentality. When we start to believe that we are prone to bad luck or are doomed to misery. We may think someone is “out to get me,” or, “I can’t have what everyone else has.”
7. Psychosomatic complaints. While we may well understand that physical symptoms can be induced or prolonged by emotional stress, we may be hesitant to consider that our headaches, lingering colds, backaches, insomnia or digestive problems are warning us of impending burnout.

We all experience these things from time to time, but if you find yourself nodding frequently as you read the lists above, you are likely to benefit by reading on.

How to Beat Burnout

Whether you identify somewhat, very much, or not at all, the following measures can help you return to and maintain a right relationship with your world. These are simple ways in which you can heed Nature’s advice and take care of yourself first, which is the ideal antidote to burnout.

1. Get massaged regularly. Schedule it, regularly. And don’t be afraid to pay for it; you’re worth it! If you find yourself avoiding getting a massage because it is too much trouble to schedule a barter appointment with a peer, take the pressure off yourself and pay for a session.
2. Schedule time off. Take your appointment book and X through two days per week. Be strong and don’t schedule work appointments on those days, no matter how badly a client needs to get massaged.
3. Refer out to other massage therapists. Find another massage therapist who works similar to you and suggest that your clients see them on those occasions when they call you and you are off or are booked solid. Have a therapist who covers for you while you are on vacation. Instead of compromising your strength and endurance, have a backup. If you let your clients know in advance that you work with another therapist in this manner, it will flow easier if the situation arises.
4. Attend your local AMTA chapter meetings. The peer support, educational opportunities and networking that is available at chapter meetings can be extremely helpful. You can talk about difficult clients, get ideas to market yourself, and socialize with other massage therapists.
5. Get a mentor. We all know massage therapists who have great clientele and successful practices or businesses. Find someone who has what you want and ask them to coach you. It can be nurturing and rewarding for both the mentor and the mentored.
6. Get feedback on difficult cases. Whether you find a clinical supervisor, peer, or simply another person who knows more about a condition or situation than you do, talk about your difficult cases and get other perspectives. When in doubt, check it out…with someone else.
7. Find restful recreation. If exercise is your primary means of relaxation, you may be lacking the rejuvenation that results from more peaceful methods of self renewal. Find a restful way to enjoy a reprieve from your hurried, stress-filled day. If your recreation involves gear, equipment or running shoes, it’s probably not restful.
8. Simplify your life. Find small ways to make your life easier. For example, consider these ideas: cancel call waiting; hire someone to clean your house or office once a month; eliminate the word “should” from your vocabulary – instead, determine what you “need and want”; delegate chores and responsibilities both at home and at work.

Summary

In order to successfully meet the ethical challenges of our profession, we must first meet the responsibility we have to ourselves to maintain physical, mental, and emotional well-being. Central to meeting this responsibility is self management and self care. Burnout will never be an issue if we approach our personal and professional lives from a viewpoint of “living to stay well”. Nature teaches us to take care of ourselves first. Let us take heed!

— by Dianne Polseno, President of Cortiva Institute – Boston massage school

¹Frank Minirth, MD, How To Beat Burnout (Moody Press, Chicago 1986) p. 14.
²Dr. Beverly Potter, Beating Job Burnout (Ronin Publishing, Inc., CA) p. 5.

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