More and more people suffer from mental illness and have to leave their professional life prematurely. This is especially true for social workers, who are exposed to multiple stresses in their daily work. Psychohygienic measures can counteract stress and strain and prevent mental illness.
What are the causes of mental stress? What are the health consequences of mental stress? And how can social workers concretely protect themselves from stress and strain?
The author Nicole Scherm gives an overview of the possible causes of mental stress among social workers. Based on this, she presents various coping strategies and tests their effectiveness. She also derives concrete recommendations for action to prevent mental stress.
From the contents:
- Social work
- Stress perception
- Burnout
- Depression
- Stress management measures
Table of contents
Abstract
List of abbreviations
1 Introduction
1.1 Problem definition and relevance for social work
1.2 Structure of the paper
2 Part I: Theoretical foundations of psychohygiene
2.1 definition
2.2 Origin of the term
2.3 History of Psychohygiene
2.4 Psychohygiene in the Context of Racial Hygiene in the Third Reich
2.5 Social professions with a particular risk of high psychological stress
2.6 Possible causes of psychological stress on social workers
2.7 Psychohygiene measures for the prevention of psychological stress
2.8 Possible consequences of non-use of psychohygienic measures
2.9 Interim conclusion
3 Part II: Empirical study on the spread of occupational overload and offers to protect against overload
3.1 Interest in knowledge and question
3.2 Justification of the choice of research method
3.3 performance
3.4 Survey
3.5 Evaluation and interpretation
4 Conclusion and discussion
5 Recommendations
Bibliography
Appendix
List of abbreviations
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Abstract
The present work deals with the methods of psychohygiene and therefore first tries to give an insight into the diverse stresses to which social workers are exposed in the profession and then to present a collection of methods that can help to counteract these stresses. For this purpose, psychohygiene and its historical development are first presented. It then discusses the factors that can cause psychological distress in social workers and presents various theories and concepts to explain and illustrate these stresses. In the following section, the methods of psychohygiene, their effects on everyday professional life and the current state of research on the respective methods are presented. In doing so, the feasibility and possible problems are also addressed. In the last section of the theoretical part, the consequences of psychological stress are also dealt with, their dissemination among social workers is discussed and their social and personal consequences are shown.
In the second section of the present work, an attempt is made to use a recognized instrument for measuring the perception of stress to find out the extent of psychological stress currently assumed in social workers and the importance of methods for the prevention of these stresses, i.e. their spread is examined and analyzed. In the course of this, the correlation between selected stress management measures and the individual stress perception is also presented in order to answer the research questions and to develop recommendations for action for social workers on the basis of this information.
1 Introduction
1.1 Problem definition and relevance for social work
For a long time now, the profession in Germany - as well as in most European countries - has by no means taken on the sole function of securing one's livelihood. For a growing number of people - especially in social professions - aspects such as self-realization and the development of the personality are increasingly coming to the fore. In addition to school education and social aspects, one's own interests and talents are therefore included in the choice of career. All the more surprising is therefore the frightening development that more and more people are suffering from mental illness and have to leave working life prematurely. Especially the profession of social work brings with it a variety of requirements, which not every social worker seems to be able to cope with. The correct handling of clients and one's own person is crucial for professional success, because results must also be visible in social work so that an intervention can be regarded as a success. Professional action therefore requires competencies that go far beyond empathy and caring, because even these character traits, which are usually rated as very positive in social workers, can be a hindrance to the relationship between the professional helper and the client in many situations if they are too strongly represented. In order to avoid stress and professional problems, those skills must be learned that help to maintain a relationship with the clients appropriate to the respective situation, taking into account the helper's own personal needs. This includes in particular a good balance between closeness and distance to the client, but also the constant reflection of one's own actions.
During my studies of social work, I often heard from my fellow students the statement that the decision to study arose from the fact that they wanted to do "something with people" or simply "help others", although sometimes the choice of study seemed to have been made due to an ideological or political attitude and was less oriented towards personal interests and talents. In my opinion, this entails the danger that social work will be used less as a profession and more as a way of expressing one's own political and social points of view, for example as a protest against social injustice or capitalism. The demands of the profession and the need to learn skills take a back seat. However, this may also lead to an underestimation of the requirements and, as a result, to psychological stress or overloads in everyday working life. But even exaggerated motivation and excessive focus on the needs of the client can carry such a danger. In the present work, therefore, I am by no means interested in criticizing social work itself, but in strengthening and expanding the understanding of the profession.
The importance of psychohygienic measures for professional action in social work, as well as in other social professions, should not be underestimated, which also resulted in my interest in this topic. Therefore, this bachelor thesis deals with how social workers can protect themselves from stressful situations and excessive stress at work by using targeted measures that are essential for social work in a professional context and should be applied by every social worker.
Based on the assumption that social workers can only practice their profession professionally if they themselves are largely free of stress, I will answer the question of how professional helpers can protect themselves from psychological stress in order to skillfully bear the burden of everyday professional life.
In order to ensure optimal readability, the use of gender-neutral language was dispensed with. Nevertheless, the female form is always included in the naming of occupational or other groups, the exclusive mention of the male language form has no evaluative character.
1.2 Structure of the paper
The work is divided into two parts. The first part deals with the theoretical foundations of psychohygiene. This is divided into seven sections. In the first section, it is clarified what is meant by psychohygiene and a definition is developed. The second section deals with the origin and history of psychohygiene. In the third section, the possible factors that are causative in the development of psychological stress in social workers are examined. The fourth section deals with the social professions that entail a particularly high risk of getting into psychologically stressful situations. The fifth section deals with the measures of psychohygiene that are intended to counteract these stresses. The sixth section describes the factors that have a protective influence on mental health. The seventh section deals with the consequences that can occur if protective measures are not taken.
The second part is an empirical study that gives an insight into the spread of psychological stress among social workers as well as offers for relief. At the end, some recommendations for action based on the theoretical part and the study results are presented, which every social worker should consider, and a final conclusion is drawn.
This work is only intended to give an overview of the possible causes of psychological stress in social workers and the methods of psychohygiene for the prevention of the same, it therefore by no means claims to be complete.
2 Part I: Theoretical foundations of psychohygiene
2.1 definition
In 1893, Isaac Ray, a co-founder of the American Psychiatric Association, which still exists today, first defined psychological hygiene as "the art of protecting the mind from all incidents and influences that can lead to deteriorating its qualities, impairing its energies, or disrupting its movements. The management of physical forces in relation to movement, rest, food, clothing and climate, the laws of reproduction, the government of passions, sympathy with current emotions and opinions, the discipline of intellect - all this comes into the field of mental hygiene" (Rossi 1962, page 79).
Another definition refers to psychohygiene as "[...] a complex event that can lead to inner conflicts and inner healing on different levels. This, in turn, can lead to a change in attitude in dealing with the outside world" (Reddemann 2003, page 85). It is primarily about the mindful and loving handling of oneself and about the perception and seriousness of one's own needs. According to this definition, psychohygiene is nothing more than self-care and - in most cases - must be learned.
The term psychohygiene or mental hygiene unites all measures that serve to promote and maintain mental health (Kulbe 2017, page 175). Psychohygiene is therefore not an independent method, but rather a collective term for a variety of methods and measures. These should help to cope better with the stresses of professional (and also private) everyday life and to relieve or reduce stress.
Although there is no clear definition, all definitions have in common that they describe psychological hygiene as conducive to mental stability and mental health. Consequently, all methods that promote mental health and prevent mental illness are methods of psychohygiene. Psychohygiene therefore combines the concepts of prevention and health promotion.
2.2 Origin of the term
The term psychohygiene is derived from the Greek word for psyche, which translates as soul or mind, and the Greek word for hygiene, which means "serving health". Literally translated, psychohygiene means "serving mental health".
2.3 History of Psychohygiene
Between 1910 and 1960, psychohygiene, including psychological hygiene, was a very influential movement within psychiatry, the so-called Mental Hygiene Movement, especially in the USA, but also in Germany and other countries. Nowadays, the term psychohygiene is hardly used, but the methods and teachings are still relevant and their influence continues to exist in many areas, including Antonovsky's concept of salutogenesis (see Chapter 9.4.1).
Psychohygiene began in the USA under the term "mental hygiene". There the term was first used in 1843 by William Sweetser (Mandell 1995, online). However, the basic idea of psychohygiene came from the Swiss-American psychiatrist Adolf Meyer. He saw mental illness and disorders as a result of individuals' interactions with their environment; a similar view can also be found in systemic therapy. From this, he concluded that mental illness or disorder suggested an imbalance between individuals and their environment, and that preventive measures and treatments could prevent serious problems (Parry 2010, page 2356 f.).
In 1909, the National Committee for Mental Hygiene was founded in the United States, a non-profit organization now known as Mental Health America. One of the founding members was Clifford W. Beers, who in his 1908 autobiography A Mind That Found Itself described the miserable conditions in the psychiatric hospitals in which he himself was a patient. For this reason, he pursued the goal with the Committee to improve psychiatric education and conditions in psychiatric hospitals and to invest in research to prevent the development of mental illness; the idea of preventing mental illness was born. Despite the focus on psychiatry, social workers, teachers, psychologists, sociologists and members of other professions also showed interest in and were inspired by psychohygiene, so that psychological hygiene soon became interdisciplinary (Cohen 1983, pages 123-149; Franklin 1994, 11 et seq.; Pols 2004, page 595 f.; Warren 1998, 537-555).
During the 1920s, Sigmund Freud's theory of psychoanalysis became very popular. This also had an influence on the Mental Hygiene Movement. Freud's teaching that mental illness originates in childhood has been applied to psychohygiene. The representatives of the Mental Hygiene Movement were subsequently of the opinion that psychohygiene should be applied in particular to children and persons who are in particularly close contact with children - teachers and parents - in order to counteract the development of mental illnesses already in childhood. The focus on children's everyday problems continued to increase over time, so that in the 1930s, leaders of the Mental Hygiene Movement even designed educational programs for schoolchildren aimed at promoting mental health and reaching as many children as possible. As a result, during the 1930s, the training of teachers was expanded to include developmental psychology. Educational reformists were also increasingly interested in psychohygiene, as the educational methods at that time were still partly very repressive and consisted mainly of punishments that should lead to obedience and "right", i.e. desired behavior. When educational reform finally took hold, the development of personality became one of the main tasks of education (Cohen 1983, 123–148).
2.4 Psychohygiene in the Context of Racial Hygiene in the Third Reich
On July 16, 1933, the board of the German Association for Mental Hygiene, which was founded in 1925 by the German psychiatrist Robert Sommer, was taken over by the Swiss-German psychiatrist and eugenicist or race hygienist Ernst Rüdin. Robert Sommer, who had previously held the board seat, was forced to leave his post. At the same time, the association was renamed the German Association for Mental Hygiene and Racial Hygiene and thus its function was changed (Gerrens 1996, page 67 ff.). In the course of the Gleichschaltung, psychohygiene thus became an instrument of the National Socialists that served to spread their world views. The rise of National Socialism and the subsequent Second World War thus heralded the end of the heyday of psychohygiene.
After the Second World War, the idea of psychohygiene was particularly determined by the interest of parents, especially mothers, in parenting guides. Critics saw this as a danger that mothers would unjustifiably become overly concerned about the mental health of their children. At the same time, the influence of psychohygiene on the education of children decreased, as it was increasingly replaced by the teaching of academic skills. Gradually, the term mental hygiene was replaced by the term mental health , which is still common today (Bertolote 2008, page 115 f.).
2.5 Social professions with a particular risk of high psychological stress
Social professions are all professions that are social and accordingly "serve the common good, the general public[...]; regulate human relations in the community[...] and promote[...] and protect the (economically) weaker[...]" (Duden 2017, online). Social professions therefore require a high degree of commitment to fellow human beings and society.
However, the results of a study by the University of St. Gallen show that people who practice social professions are themselves exposed to a high psychological burden. For example, people in the occupational group "social and cultural service occupations", to which social workers can also be counted, experience stress comparatively frequently (see Fig. 1).
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Figure Perception of stress by occupational group
Taken from Böhm et al. 2017, page 26
In addition, 57 percent of this professional group stated that their work demands a lot emotionally. In addition, more than a third (37.7 percent) said the amount of tasks to be done was too high (Böhm et al. 2017, page 37). Only 43.1 percent of the employees of this occupational group were able to forget their work in their free time, almost two-thirds of the respondents (64.5 percent) also used information and communication tools in their free time, i.e. there is only a low ability to distinguish between work and leisure (Böhm et al. 2017, page 43).
An American study from 2014 examined differences in the prevalence rate of depression in various industries in western Pennsylvania from 2002 to 2005. According to the study, social workers are around 14.6 percent more likely to develop depression (diagnosed after the clinical modification of ICD-9). This puts this occupational group in third place among the occupations studied with the highest risk of developing depression. Other social occupations with an increased likelihood of developing depression include health care occupations with 11.42 percent. Both occupational groups were assigned to the category Health care and social assistance. A total of 56 occupational groups were examined, the average of all occupational groups was 10.45 percent (Wulsin, Alterman, Bushnell, Li & Shen 2014, pages 1805-1821).
On the basis of these data, it is reasonable to assume that social workers are exposed to a very high degree of psychological stress when practising their profession, which manifests itself, among other things, in a high number of depressions; the causes of the high psychological stress in social workers can be very diverse, as the following chapter will show. It is therefore obvious that measures to maintain mental health are of great importance for social workers and people in social professions.
Alice Salomon, a pioneer of social work as an academic discipline, already recognized this at the beginning of the 20th century and wrote about it in her book "Guide to Welfare": "The social worker must create a fulfilled life for himself, [...] develop, become richer if he is to constantly transfer power to others. He has to budget with his strength, not do more than he can handle. This is not only necessary for his own sake, but is part of his professional duty to the whole, precisely because he is constantly dealing with people whose strength fails" (Salomon 1928b, page 183).
2.6 Possible causes of psychological stress on social workers
As a psychological burden, the "The totality of all comprehensible influences that come from the outside on the human being and have a psychological effect on him", understood (Richter 2000, page 2). This stress can result in psychological stress, the consequences of which can be both positive and negative. The positive consequences are expressed by a stimulating effect. The negative consequences include both under- and overstrain (ibid., page 2 f.). In this context, stress is also often spoken of when the psychological stress resulting from the influences of the environment cannot be managed with the existing individual resources and leads to negative consequences (Folkman 2013, page 1913). The causes of psychological stress in social work can be manifold; the following chapter explains the main causes.
2.6.1 The "helper syndrome"
The so-called helper syndrome is not an empirically proven and medically or psychologically recognized symptom group, but rather a model or a theory that tries to describe and explain the mental problems that occur more frequently in social professions. It is therefore not to be found in any classification system. The term goes back to the German psychoanalyst Wolfgang Schmidbauer, who used it for the first time in 1977 in his book Die hilflosen Helfer, which is still relevant today and is constantly being reprinted.
The model assumes a certain personality structure that makes a person susceptible to helper syndrome. First and foremost, this includes a low self-confidence, which leads to the fact that the person concerned uses all his attention and energy to fulfill a helper role and to be absolutely needed; helping thus serves to suppress one's own problems (Schmidbauer 2013b, page 19 f.). There is a behavior that has the symptoms of addiction; the client is abused as an "addictive substance" (ibid., page 58). The cause of this is considered to be unresolved conflicts in childhood, which led to low self-confidence and self-esteem and were thus carried into adulthood (Schmidbauer 2013a, page 57). By being used, the self-esteem is not really increased, but the person concerned perceives it as self-affirmation and thus acquires an "artificial" self-esteem. Since behaviors such as the deferral of one's own person in favor of others (especially in favor of family members), caring, protecting and passive, indirect expression of aggression generally correspond to the classic female understanding of roles of bourgeois social classes, the helper syndrome is far less obvious in women than in men (ibid., page 204).
This constellation leads to the fact that people who have this personality structure align their career choice according to the extent to which they can help other people in the respective profession and obtain confirmation for it. This is the case in (almost) all social professions, especially social workers and caring professions such as nurses or geriatric nurses, but also psychotherapists, psychologists, doctors, etc. People with the helper syndrome therefore tend to choose these or related professions. In the worst case, this leads to overmotivated help, which does not correspond to the professional understanding of help for self-help, but completely denies the person in need of help independence and takes over all tasks. In this way, the helper creates a relationship of dependency (ibid., page 126). However, this only helps the person in need of help in the short term or even not at all, since he is not given any problem-solving strategies for future problems, but only "served" ready-made solutions (Thomas 2006, page 52 ff.). The person concerned can also impose his help on others without it being necessary or desired. The helper syndrome and the associated disregard for a professional way of working damages not only the person seeking help, but also the affected helper himself and the entire profession (Heiner 2004, pages 92-111). The person concerned neglects or ignores his own needs as well as those of his partner, family and other social contacts; this leads to states of exhaustion, burnouts and depression (Fengler 2008, page 47).
In the case of helper syndrome, the relationship between helpers and those in need of help can be described using the so-called drama triangle (see Fig. 2). The drama triangle is a concept that was designed in 1968 by Stephan Karpman and comes from transactional analysis. The concept is based on a triangular relationship between helper, person in need of help (victim) and perpetrator (persecutor) (Karpman 1968, page 40). The helper all too quickly takes on the role of the savior, so that a love triangle arises from the initially existing victim-persecutor relationship and the victim is thus denied any chance to help himself (Thomas 2006, page 52 ff.). People with helper syndrome find themselves strikingly often in such relationship patterns. Within such triangular relationships, abuse often occurs (LâAbate, Cusinato, Maino, Colesso & Scilletta 2010, page 213). In the case of professional help, the two-person relationship between victim (V) and persecutor (P) remains and the helper (R) is merely a counsellor who supports the victim and gives him help for self-help.
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2.6.2 empathy
Empathy is not an emotion, but the ability to recognize, understand, and empathize with the emotions of our fellow human beings (Ekman 2003, 67). Empathy is therefore a quality that is generally desired or expected of all social workers and persons in social professions and for this reason plays an elementary role in the self-image of social work. The importance of empathy in social work is so high that it has been included in the Ethics in Social Work Code of Ethics, Statement of Principles of the International Federation of Social Workers, IFSW for short, and the International Association of Schools of Social Work, IASSW for short. It says: "Social workers should act in relation to the people using their services with compassion, empathy and care", to German: 'Social workers should act with compassion, empathy and care in relation to the people who use their services'.IFSW & IASSW 2004, online).
However, an Illinois study suggests that an excess of empathy can also make you sick — at least with regard to the parents of children between the ages of 13 and 16. According to the study, levels of inflammation in parents' blood increase proportionally to the level of empathy they had for their children. This indicates a weakened immune system and increased stress levels (Manczak, DeLongis & Chen 2015, pages 211-218). Empathy can also have downsides. Although the study cannot, of course, be readily transferred to social work, it is reasonable to suspect that these findings apply in a similar way to social workers.
2.6.3 Feeling of powerlessness
In social work, there are no "power sterile relationships" - although the existence of power structures in social work is generally condemned or even denied - because everywhere social orders are formed, power structures exist (Kraus & Krieger 2013, page 29 ff.). As a result, power structures are also present in social work – between social workers and offices, social workers and clients, institutions and clients, etc.
Structural powerlessness, for example, can have a problematic effect if social work interventions prove to be only partially effective against social injustice, exclusion, repression and oppression. Individual case assistance and social group work, which make up a large part of social work interventions, are largely uninfluential in relation to social structures.Knopp 2007 page 101 f.). For example, unemployment and the associated existential fears cannot be remedied by individual aid alone if an entire district or an entire region suffers from a lack of infrastructure and an undersupply of jobs.
Again and again it happens that social work interventions miss their goals or clients apparently do not want to know anything about their help, especially if they do not (have to) use their services voluntarily, but under duress. This is the case, for example, when it comes to correcting socially undesirable behavior. Of course, this can be very sobering - for both parties - and often leads to the interventions becoming ineffective, since productive work is only possible if the social worker can count on the participation and motivation of the client (Gehrmann & Müller 2010, page 16). If such constellations are the rule, they soon lead to the fact that the social worker concerned experiences himself as powerless. The result is often frustration.
Social work is also particularly subject to political power structures. These can lead to structural framework conditions such as insecure working conditions, severely limited financial resources, high time pressure and increased bureaucratisation, which exacerbate the predicament of social work and intensify a feeling of powerlessness (Keller, Gojová & Baum 2013, page 212). The same applies to a high workload of tasks to be completed at the same time, as is the case with a large number of case responsibilities (Richter 2000, page 5). However, this problem is by no means new. Alice Salomon already commented on this in 1928 as follows: "The enormous overload of many civil servants lies in the nature of the task. It arises from the fact that many social welfare officers have to provide for too large a number of individuals, through long distances that they have to travel every day, through too short vacation periods, which are probably sufficient for officials of the office service, but not for carers in the field service for relaxation and strengthening. It is the task of professional organisations to work for change; Task of the authorities to understand and take into account the requirements of the new profession" (Salomon 1928a, page 199).
The Job Demand-Control Model of the US sociologist Robert Karasek can be used to assess stress and stress factors of the working environment as well as to promote the health of the working person. Karasek assumes that a heavy workload is caused by a combination of the two factors job demands and job decision latitude; if the work requirements are high and associated with little room for manoeuvre (low autonomy), heavy burdens occur (Karasek 1979, page 289 ff.).
According to Karasek, the potential energy generated by high work requirements is transformed or released into work motivation to the extent that the worker can make decisions independently. On the other hand, stress symptoms occur due to psychological stress when the room for manoeuvre is limited and the energy of action cannot be released in the form of actions as a result. According to Karasek, this can then have a beneficial effect on depression (ibid. 1979, page 287).
In 1988, Johnson and Hall expanded the model to the Job Demand Control Support (JDCS) model. Here, a lack of social support and isolation are identified as factors that can further increase the extent of psychological risk. Other factors, such as social support, have a positive effect and can reduce psychological distress (Johnson & Hall 1988, 1341).
The relationship between requirements and control has already been empirically investigated. By means of so-called structural equation analyses, it has already been proven that high demands in the profession coupled with high control lead to the fact that productivity and competence were strengthened in the examined persons and coping strategies were promoted. Little control, on the other hand, leads to reduced productivity and dissatisfaction (Dollard, Winefeld, Winefeld & De Jonge 2000, page 506 ff.).
2.6.4 Lack of appreciation and recognition
Especially in social professions, a lack of appreciation and recognition for professional commitment is a significant factor for professional stress. In 1996, the Swiss medical sociologist Johannes Siegrist developed the so-called effort-reward imbalance model. Here, the work-related requirements resulting from extrinsic conditions (requirements) and intrinsic performance motivation are compared with rewards in the form of recognition, status, career opportunities, salary and job security. If the rewarding factors are subjectively perceived to be less than the requirements, an imbalance arises, which manifests itself in the form of a gratification crisis (Siegrist 1996, page. 29 ff.). On the basis of this model, Sigrist developed a standardized questionnaire in which not only the two factors "utilization" and "reward" are recorded on the basis of 22 items, but also the dispositional, intrapsychic factor "excessive willingness to spend professionally" (Rödel, Siegrist, Hessel & Brähler 2004, page 229).
This empirically well-studied model found an almost six-fold higher risk of developing depressive symptoms in employees who experienced a gratification crisis (Larisch, Joksimovic, Knesebeck, Starke & Siegrist 2003, page 227). Correlations to emotional exhaustion, psychosomatic complaints and coronary heart disease are also documented (de Jonge, Bosma, Peter & Siegrist 2000, page 1321 ff.).
In this model, the extrinsic burden ("job strain") is compared with the employee's scope for control and decision-making, similar to the Job Demand-Control model of Karasek (1979). Both models are apparently suitable for predicting the risk of cardiovascular disease. The effort-reward imbalance model, on the other hand, seems to be slightly better suited for predicting mental illness than the JDC model (Wahrendorf et al. 2012, page 471).
2.6.5 Disturbance of the balance of proximity and distance to clients
One thing is certain: The success of the balancing act between closeness and distance is of great importance for most social work interventions and therefore a pervasive problem that needs to be solved. If the proximity to the client is too great, there is a risk that no workable and actionable relationship arises and the help is doomed to failure in advance. However, if too much distance is maintained, the client may close himself to the helper and not allow support, as he can not build a trusting relationship with him. How much closeness and how much distance is necessary for professional social work, however, is not precisely defined, is difficult to measure and also depends on the respective field of work.
With regard to psychohygiene, the aspect of the lack of distance to the client should be examined in more detail. To do this, however, it must first be clarified what the terms "proximity" and "distance" mean in detail with regard to social work. The term proximity is described as follows: "A bond is usually sought, the need for interpersonal, social interests, security, tenderness, as well as for confirmation and harmony, compassion and compassion, self-abandonment" (Thomann & Schulz von Thun 2000, page 149). Such closeness therefore usually exists only between family members, partners or long-term friends. Distance, on the other hand, manifests itself in the "[...] Desire to differentiate from other people [...]. The emphasis is on uniqueness, freedom and independence, disconnection and autonomy." (ibid.). However, such a pronounced distance would not be conducive to a trusting relationship between social worker and client.
These two definitions reveal the dichotomy underlying the pair of concepts of proximity and distance; absolute proximity and absolute distance are the "poles" of a continuum. If the proximity gains too much weight, there is a risk that a relationship of dependence between client and helper will arise; this applies in particular to the work with children and adolescents, if a "mothering" of the client by the helper takes place. In the most extreme case, seduction, coercion and abuse of trust can occur (Thiersch 2012, page 38). A demarcation is then no longer possible or available.
This shows the great dilemma of social work, because especially working with drug addicts requires a high degree of closeness and empathy in order to reach the target group; this also includes revealing something more about oneself than is considered appropriate by professional understanding. In this particular case, it might even be detrimental to the success of the intervention if the social worker in question were to pay particular attention to creating or maintaining a balance between proximity and distance. This also applies to many social workers in other fields of activity, such as street workers.
2.6.5.1 Clients as personal contacts in social networks
Social networks such as Facebook, Twitter, Instagram and Co. are now an integral part of the everyday life of many people and enjoy increasing popularity due to the simplicity of independent exchange with friends, family members and other people, even over long distances. As a rule, however, social networks belong to privacy, so personal accounts are rarely used professionally. However, it also happens that social workers come into contact with clients through such networks; such contact can come either from the client himself or - in rare cases - also from the social worker. However, this means that the boundaries between previously privately used space and the world of work are becoming blurred; there is no longer a clear demarcation between professional and private contact (Harbeck Voshel & Wesala 2015, pages 67-76). It is the responsibility of the social worker to establish and maintain a professional relationship, which also includes a certain degree of distance, with the client (Halabuza 2014, page 27). Of course, the same applies to so-called messenger services such as Whatsapp or the storage of professional contacts on the private mobile phone or smartphone.
If such a merger occurs, it is difficult not to mentally deal with everyday working life and professional problems in your free time, as you are constantly confronted with them. As an example: A social worker is on vacation and wants to send vacation pictures to his friends through social networks. It cannot be avoided that he also reads the contributions and messages of clients; as a result, the recreational value of the holiday sometimes drops drastically. In addition, there are data protection concerns that make the use of social networks and messenger services for professional purposes not recommendable.
2.6.5.2 Proximity to the workplace
A workplace close to home or even living directly at the workplace is initially something positive, because both are associated with many advantages: short or no travel times, less mobility costs or even complete elimination of the same, greater flexibility, less stress, more free time, etc. Especially for students who are about to move after completing their studies, it is more than obvious to choose an apartment that is as close as possible to the future workplace. However, especially in social professions, too little distance to the workplace can also have a detrimental effect, especially if the workplace is an inpatient residential facility. In this case, encounters with clients in their free time can occur, for example when shopping or going for a walk. The social worker is repeatedly confronted with his everyday working life. At this point, the client may not be aware that the social worker is traveling privately and contact him; they may even see him as a constantly available contact person, come to him with their concerns and talk to him about acute problems.
If this is rarely the case, there are no concerns about psychological stress, but if this becomes the norm, there may be difficulties in distinguishing between work and leisure, because the apartment and its surroundings are by definition the "place of a large part of extra-professional life." Their ground plan, their equipment and their location in the socio-spatial fabric of the settlement more or less directly organize this life" (Häußermann & Siebel 2000, page 11). The apartment as such and its location thus act as a retreat whose function can be impaired if this place is in the immediate vicinity of the workplace. In addition, the way home from the workplace can also be used to get in the mood for leisure time and "switch off" if this is omitted, it is more difficult to draw a line between private and professional time.
2.7 Psychohygiene measures for the prevention of psychological stress
The measures of psychohygiene are divided into three superordinate areas: individual (personal) psychohygiene, professional psychohygiene and social psychohygiene (Reddemann 2001, online). However, not considering just one of the areas could severely affect the effectiveness of psychohygiene.
For each of these areas, there are several methods that target the respective areas of life:
Abbildung in dieser Leseprobe nicht enthalten
table : Areas of psychohygiene
Taken from Reddemann 2001, online
The following chapter outlines those measures and methods that are most important for social work; however, this is not a complete list of all existing methods.
2.7.1 Support from the institution and colleagues
The collegial support or support of the institution is to be located in the field of social psychohygiene (see above). An essential factor for the prevention of psychological stress is the success of cooperation between colleagues and management staff. As a result, the development of stressful situations can be prevented and in the case of great psychological stress, a (suitable) contact person can be found quickly. The quality of team collaboration can be improved through intervision and reflection methods such as supervision.
The reflection methods presented in this chapter are an important and at the same time essential achievement of the professionalization of social work, because it was only through the professionalization of social work and the newly added advisory character that social work was now also made accessible to the reflection methods and offers necessary by additional tasks (Buchinger & Klinkhammer 2007, page 17).
2.7.1.1 Collegial advice or intervision
A central way to receive support from colleagues is collegial advice or intervision. This has its origin in systemic therapy. The aim of collegial advice is the exchange of ideas and solutions for professional practice that can also be implemented at short notice (Herwig-Lempp 2016, page 8 ff.). Such an exchange can be particularly helpful when a social worker despairs of a seemingly hopeless and hopeless situation and therefore cannot gain an objective view of the situation. In such a situation, it is quite possible that by considering the case by outsiders - i.e. colleagues - helpful suggestions can be collected and the social worker in question is relieved in the best possible way.
An important criterion for collegial counseling is the equality of the participants, which means that, in contrast to supervision, there should be no hierarchy in the group and each participant is given the opportunity to express himself and contribute. In addition, participation in collegial consultation should always be voluntary, but a commitment should be binding and based on personal responsibility. The absolute discretion with regard to the processed case is substantial here. For the topics that are dealt with in a collegial consultation, the participants develop targeted problem-solving strategies for a specific case or a concrete problem through joint reflection (Lippmann 2013, pages 12-16).
Collegial advice is a form of advice in which no fees are paid, as is the case, for example, with supervision. The participants of a collegial consultation support each other in problems and conflicts and can benefit from them themselves by receiving valuable suggestions for their own work. Collegial counseling can therefore be described as a self-help group for professionals; the principle is: "Teaching in learning, learning in teaching" (ibid., page 17). The course of the consultation is determined by the participants themselves, but it is advisable to agree on some rules in advance in order to avoid conflicts and to create a clear structure so that the best possible results can be achieved and the consultation proceeds to the full satisfaction of all participants (Balz & Spieß 2009, page 171 f.).
2.7.1.2 Individual supervision
Individual supervision is the advice of a single supervisor by a supervisor. It is particularly recommended if the supervisand is in a particularly stressful situation. Since this type of supervision is very intensive and intimate and the supervisand with his individual problem is the focus, the selection of the supervisor should be made with caution (Heyse & Metzler 1995, page 64). It should also be ensured that the individual supervision takes place in a protected setting - other persons or disturbing factors should therefore not be in the same room if possible (Pühl 2000, page 260 ff.).
In individual supervision, conflicts in dealing with colleagues, superiors or clients are usually in the foreground. The first of the four main objectives of supervision is - similar to collegial advice - the relief of the supervisand. Since the supervision takes place in a protected setting, the supervisand can express without fear of criticism or consequences, which burdens him, frustrates or overwhelms him and in the future meets colleagues and clients more relaxed. This is a great advantage over collegial consulting and team supervision, as the inhibition threshold to make certain statements is significantly higher with these two methods than with individual supervision. The second goal of the individual supervision is self-clarification. This means the clarification and reflection of attitudes and attitudes, thoughts and desires, hopes and doubts, crises and successes. Through continuous reflection, conflicts and escalations can be avoided. A third goal is the development of options for action that enable situation-appropriate and constructive solutions to problems. The supervisor pays attention to the ethical and moral justifiability of the problem solutions. The fourth goal is to increase the quality of life in both professional and non-professional everyday life, which leads to an improved working atmosphere and greater satisfaction (Fengler & Sanz 2011, page 156 f.).
2.7.1.3 Team supervision
In contrast to individual supervision, team supervision does not focus on the problems of a single person, but on those of the entire team. This form of supervision occupies a special position, since the participants not only form a group during the session, but also belong to this group outside the meetings (Heyse & Metzler 1995, page 66). It is therefore only natural that the content of team supervision is often the relationships between team members and relationship disorders. Topics such as competition, power and hierarchy, differentiation of tasks, information processing and the different biographical backgrounds and experiences of the team members are given great importance. The aim is to support team building and team development and to achieve an increase in the effectiveness and professionalism of teamwork (ibid., page 66 f.). This benefits not least the clients, because "the client or the client group can only develop as far as the helpers can allow it" (Pühl 1998, page 20).
The supervisor has a special role to play in team supervision: he becomes - mostly unconsciously - a mirror of institutional dynamics (Pühl 1998, page 20). This means that the supervisor is not only a distanced observer, but "rather a co-creator of the scene involved at every moment and an interested designer[...] of the jointly generated reality in the advisory system" (Pühl & Obermeyer 2015, page 16).
Before one or more supervision sessions take place, a so-called contract is concluded in a preliminary discussion, but at the latest after the first supervision session, in which information is exchanged and agreements are concluded. Such a contract is binding for all parties involved. A contract can exist either as a two-sided (between supervisand and supervisor) or three-sided (between supervisand, institution and supervisor) contract (Boeckh 2008, page 29). The supervision session as such can be understood as a process, which can be divided into twelve phases or steps (according to Boeckh 2008, pages 32-46):
1. Arriving and contacting us
2. Collection of concerns
3. Evaluation of the results of the last supervision (if available)
4. Selection of items
5. Determining the question
6. Presentation of case or concern
7. Confirmation or correction of the question
8. Method Selection
9. Methodical processing of the request
10. Solution testing and solution transfer
11. graduation
12. Reflection of the supervision process and contract review
The procedure shown here applies to all supervision settings. However, it only serves as orientation and not as a rigid pattern, so it does not have to be strictly adhered to. Rather, a deviation from the orientation pattern is the rule in most supervision processes (ibid. 2008, page 32).
As a session frequency for supervision, a period of three to six weeks is recommended. It is therefore advisable to conduct an average of one session per month. There is no clear recommendation for the duration of the session, a session can theoretically take any duration, but this should be limited in time and structured in advance (Schumacher 2006, page 296).
However, by far not all social institutions and organisations use this method of counselling and reflection. A regional survey carried out in the summer of 2008 used concrete figures to demonstrate for the first time how widespread supervision is in commercial enterprises and in socio-economic organisations. The survey was addressed to a total of 1,000 organizations and companies within the Bavarian administrative district of Lower Franconia. The German Society for Supervision e.V. (DGSv) initiated and supported the preparation and evaluation of the survey, the Bamberg Institute for Applied Economic and Social Research, Methods and Analyses MODUS was responsible for the evaluation of the results (Fellermann & Rosenkranz 2009, page 191 ff.).
According to the survey, in the past three years, 58 percent of socio-economic organizations have used supervision in particular, sometimes in combination with coaching, less often coaching as the sole support offer. The majority of them (58 percent) see supervision as an opportunity to improve the competencies of their employees. Almost half of the respondents (46 percent) stated that they use supervision to resolve conflicts. For 41 percent of the organizations, the clarification of tasks and roles is a topic in supervision. Only just under a third (30 percent) use supervision to improve cooperation, only 28 percent to maintain motivation among employees and just under a quarter (24 percent) use supervision as support in the development of concepts (ibid. 2009, page 191). This means that most socio-economic organisations use supervision to improve skills and resolve conflicts.
Most organizations (77 percent) measure whether supervision is successful by whether there is an improvement in employee collaboration. Almost three-quarters of the organizations (74 percent) consider the supervision to be successful if it has led to the question of the employees being clarified. For 68 percent of those surveyed, the clarification of a conflict is considered a success criterion, after all, 66 percent already see the application of a conflict resolution model as a success. On the other hand, only 18 percent of the organizations monitor success (ibid. 2009, page 192). Two years later, in the summer of 2010, a similar survey was also conducted by the DGSv in Berlin. The results were comparable to the results of the survey in Lower Franconia, with the difference that supervision, but also other support services, were less common (Görtler 2011, page 3).
Both reflection methods, both individual supervision and team supervision, are assigned to professional psychohygiene. They are by no means competing methods, but rather complement each other in a meaningful way. In addition to group and team supervision, there are other forms of supervision, e.B group supervision. However, team supervision in particular has the highest priority in social work, so the idea of other forms of supervision is dispensed with (Belardi 2015, pages 119-120).
It is advisable to contact an external, i.e. external supervisor for supervision, as the willingness to be open among internal supervisors, i.e. those employed in the same institution, is comparatively low and the supervision could lose its effectiveness. Furthermore, it should be avoided that there are personal contacts of the supervisands to the supervisor (Boeckh 2008, page 31).
2.7.1.4 Coaching
Coaching is the professional advice of individuals or teams by a trained coach. The aim should be to identify strategies together with the consultant that are helpful for him in achieving his goals. In order to ensure effective coaching, the coach must possess professional and leadership skills, have the ethical justifiability of solution strategies in mind, have social competence and engage in self-reflection (Mandl, Kopp & Dvorak 2004, page 53).
Coaching takes place mainly in the professional, but occasionally also in the private sector. During coaching, private matters can also be discussed, especially if they have an influence on everyday professional life (Müller-Commichau 2002, pages 28-29). Since coaching usually manifests itself as a problem- and solution-oriented form of consulting, this usually only takes place if there is a concern or a question or problem. Individual coaching usually focuses on the professional role that the coachee plays in the environment of the organization and the associated conflicts (Lippmann 2013, pages 16-23). Especially in the management area, but not only there, coaching is not only used to overcome conflicts, but also, for example, to learn and optimize job-specific skills and to improve performance (Segers, Vloeberghs & Henderickx 2011, page 204).
The term coaching originally comes from the USA and England. There he established himself at the end of the 19th century in the (high-performance) sports sector. The aim of coaching was to offer individual support by means of motivation, advice and training measures and thus to improve athletic performance (Lippmann 2013, page 14). But it was not until the 1970s that the idea of coaching spread to management and thus outside the sports industry. Initially, coaching meant a goal-oriented and development-oriented leadership style. In the following years, coaching also expanded into europe and quickly led to a sharp increase in external consulting services (Böning & Fritschle 2005, page 26 ff). Despite the strong change, the term coaching is still associated with the idea of performance, as it comes from high-performance sports.
Coaching is therefore in great demand, especially in the management sector (Birgmeier 2010, pages 15-17). But social economy companies are also increasingly relying on coaching as a form of consulting (Birgmeier 2006, page 13). However, the requirements of social work for coaching differ from those of management, so coaching must respond to these changed requirements. This means that social work takes place in the intermediate field of the two poles economy ("Only what pays off is feasible") and Caritas ("People must be helped"). In order to be able to overcome these contradictions, the teaching of new skills for social work employees is indispensable. Both the individual personality of the employees and their experience are taken into account. Coaching has proven to be an efficient method in this regard (Müller-Commichau 2002, page 28). After supervision, coaching is the most common instrument for reflection in socio-economic organizations, but is often only used in combination with supervision or as a supplement to supervision (Fellermann & Rosenkranz 2009, page 191).
Coaching ideally takes place in five phases ("five-phase model"). In the first phase, the entry and contact phase, a basis of trust between employee and coach is built up and the topic of coaching is limited. This is followed by the agreement phase. Here, contractual agreements are made with regard to the objectives and target agreements. In the subsequent work phase, the actual coaching work begins. This phase is therefore the main phase of coaching. Diagnostic, development, problem-solving and implementation preparation work is carried out in the work phase on the basis of several coaching discussions. When the goals of the coaching are met, the final phase is reached. This phase serves the necessary emotional and factual separation between coach and employee. About three months after completion of the coaching, the evaluation phase follows, in which the maturity and effective state of this form of counseling is reflected (Vogelauer 2003, page 187 ff.).
The coached are helped to develop their own solution strategies instead of being "presented" with ready-made solutions by the coach. Discretion and trust are the sustainable basis on which a mutually accepted relationship between coach and coach can take place. As with supervision, there should be no relationships between coach and coachee outside of coaching (Lippmann 2013, page 19). The "promotion of self-reflection and self-perception, awareness and responsibility" is another goal of the coaching, whereby the coached person is helped to help himself. The promotion of the self-management skills of the coached person is to be improved by promotion and advice in such a way that help from the coach is no longer needed in the end. The coach's approach is described in an elaborated coaching concept, which thus functions as a framework for interventions, methods and processes and creates the prerequisites for professional coaching (Birgmeier 2010, page 15 ff.). Compared to other forms of counselling, coaching is a very limited consulting process, which is an innovative measure of (social) management consulting. People of all hierarchical levels who are employed in service institutions, companies or administrative systems with management tasks as well as freelancers in individual crises are the target group to whom the coaching is addressed. The coach takes on the role of the reflection partner who gives feedback to the coached person, regardless of which topics are dealt with (ibid., page 18). All other, specific forms of coaching are based on the "classical" coaching model, whose assumptions and specifications thus form the basis of the specific coaching method of socio-pedagogical coaching (ibid., page 16 f.).
Positive effects such as emotional relief, stress reduction, change of perspective and increased self-reflection ability were found by Künzli (2005) in 22 empirical studies examined. However, the effects of coaching seem to be delayed, i.e. not to unfold immediately after the coaching process (Künzli 2005, page 239 ff). The relationship of trust between coach and client as well as the commitment on the part of the client are considered key factors for positive results (Künzli 2009, pages 3-5).
2.7.2 Reflection of professional action
The reflection, or self-evaluation, serves the self-evaluation of professional action. The self-evaluation is carried out by the social worker himself and on his own, which makes it fundamentally different from other methods of reflection. In self-evaluation, "on the basis of systematically collected and evaluated information [...] documents, analyzes and evaluates one's own actions with their consequences, [...] which ranges from the systematic, empirically founded reflection of professional action to the implementation of smaller social science studies on the performance of one's own organization or organizational unit" (Heiner 2000, page 590). Ethical and moral principles should also be repeatedly questioned in self-evaluation (Stimmer 2006, page 212 f.). Self-evaluation is therefore a process that should be permanently integrated into professional activities.
In doing so, it should not be proceeded without plan and system, but methods for reflection should be used, because "In addition to principles of action, methods also provide categories for the interpretation of phenomena and results of social work action, which can serve the specialists for reflection" (Michel-Schwartze 2009, page 18). These methods should be based on social science theories (Trabandt 2009, page 30).
In the self-evaluation, the following six points should always be taken into account (according to Stimmer 2006, page 212 f.):
- Are or have the goals agreed with the clients been achieved?
- Are or were appropriate methods chosen during planning to solve the problem?
- Is or was the quality guaranteed by methodological competence for the implementation of the methods?
- Is or has it been acted according to ethical principles?
- Is or was the problem-solving process perceived as circular?
- Can or could social work have the right skills for the case? Has any necessary cooperation with other institutions and professions been established?
It is absolutely necessary to carry out self-evaluation at all stages of an intervention, as this is the only way to decide on the benefits or harms of an intervention and to establish a clear structure with regard to professional action (Trabandt 2009, page 37).
However, self-evaluation has another existential benefit for social work: It serves to legitimize one's own work. With the help of self-evaluation, outsiders, e.B payers, can understand the social work activities and their quality, which leads to more transparency (König 2007, page 56).
2.7.3 Methods of demarcation
Demarcation or distancing techniques belong to the field of individual personal psychohygiene. Although a certain degree of empathy and closeness towards clients is important for social work, it is part of professional help to be able to differentiate oneself in order to maintain the balance between closeness and distance and thus one's own mental health (see Chapter 8.4). This is particularly important when confronted with severe strokes of fate; a highly topical example from practice is the work with severely traumatized refugees, whose fates can have a very stressful effect on the professional helper if there is a lack of demarcation. This is one of the reasons why in the recent past there have been repeated cases of more and more refugee helpers being pushed to the edge of their strength due to overload and overstrain, developing burnout syndrome or even suffering secondary traumatization (Chatzea, Sifaki-Pistolla, Vlachaki, Melidoniotis & Georgia 2017, online). However, there are always border crossings by clients, so that a demarcation is necessary. In addition to reflection methods such as supervision and self-evaluation, social workers have a number of methods available that they can use to counteract occupational stress.
2.7.3.1 Mindfulness exercises
Mindfulness exercises are an effective and at the same time easy-to-use method of coping with stress. Mindfulness also makes an important contribution to the relationship between professional helper and client. In order to understand this, it is first necessary to define what is understood by the term mindfulness. Mindfulness is a state of focused, unbiased attention and present-centered awareness in which every thought, feeling, and sensory impression is acknowledged and accepted (Hick 2010, page 5). This state can be achieved, for example, through formal or informal meditation, but also through non-meditative exercises. Formal meditation involves intense introspection, in which attention is focused on an object (for example, one's own body) or a process (for example, breathing or sensory perceptions, but also emotions); however, attention can also be focused on all other perceptions. Subsequently, attention is turned back to the present everyday life, without drifting into worries about the future or the past. Informal meditation involves the application of mindful attention in everyday situations, such as mindful eating or walking; this type of meditation can be applied to all everyday activities (ibid., page 6). Furthermore, there is a wide range of non-meditative exercises in which perception and thinking are trained. An example of this is the so-called raisin exercise, in which a raisin is viewed closely with all the senses. The raisin exercise can of course also be carried out with other objects (Michalak, Heidenreich & Williams 2012, page 32 ff.).
The use of such mindfulness exercises leads to significantly improved attention and more conscious decisions in both professional and private everyday life; frivolous or even negligent decisions can be prevented and the efficiency of social work interventions can be increased.
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