Battling BCBA Burnout

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Originally posted on https://bsci21.org/battling-bcba-burnout/

In our field, we are all aware of the high-turnover rate for direct Applied Behavior Analysis (ABA) therapists and Registered Behavioral Technicians (RBTs). It is a reality that Board Certified Behavior Analysts (BCBAs) are also susceptible to these issues. We may stay in our position longer due to the salary, benefits, job perks, and a feeling of responsibility to our clients, but in the end, those benefits can only go so far to compensate for unhappiness or dissatisfaction in the workplace. Burnout is not simply being overworked, it is a syndrome of emotional exhaustion, depersonalization, and reduced inner accomplishment (Maslach, Jackson, & Leiter, 1996, p4). Symptoms of burnout may include questioning your career choice, dreading going to work, becoming irritable with your co-workers or clients, having a decrease in productivity, and having an increase in health problems such as headaches, upset stomach, and body aches (Mayo Clinic, 2018).

Contributing Factors to BCBA Burnout

While feeling burnt out might seem like a personal problem of the employee, and there are individuals that are more susceptible to burnout, the root of the problem is with the company (Garton, 2017). The model proposed by Maslach, Schaufeli, and Leiter (2001) suggest this syndrome is due to a mismatch of the expected vs actual interaction of the person in their work environment covering six main areas:

● Workload: According to the most recent report of the US Employment Demand for Behavior Analysts, annual demand for BCBAs has increased about 800% from 2010 to 2017. This is a great thing for job security in our field, but it also means employers are under a great deal of stress to provide services to significantly more clients than they have supervisors for, leading to either turning away business and money, or pressuring staff to take on more than they can handle. This may include a caseload that is too large or taking on cases that are outside of your area of competence. In any case, this excessive demand can cause physical and mental exhaustion.

● Control: This area relates to the lack of resources, authority, or support to do their job effectively. This may include a simple monetary issue such as having a budget for therapy materials or access to assessments. However, this control also extends to the backing and support of your company. If you have specific client recommendations or need the time and ability to re-staff or re-train your direct therapy staff, you should have the authority and ability to make those decision. When your clinical recommendations are ignored or overruled, then the matter of control is negatively impacted.

● Reward: As BCBAs we are all aware of the importance of reinforcement, whether that come in the form of verbal praise, tangibles, or other types of recognition. We do our job because we love it, but lack of reward or recognition for our achievements can greatly affect our motivation and morale. Companies may use employee reinforcement strategies for direct therapy staff by using token-based systems or other forms of reinforcement, but if this is not extended to the work of the BCBA it can lead to feelings of inadequacy. This reinforcement does not need to come in the form of a huge monetary bonus, in fact money may not even be a reinforcer for some of your employees, but a simple acknowledgement or thank you for maintaining excellent standards or going above the call of duty may be sufficient. We often deal with severe behaviors, unrealistic expectations from parents, and demanding work requirements. These continuous unreasonable expectations without appreciation or acknowledgement can lead to a lack of fulfillment and feelings of apathy.

● Community: Whether you’re in a clinic surrounded by people or working on your own in home-health, loss of positive connection with others in your workplace can occur. Having a connections with others that you respect, can share ideas with, and create a community with are vital for satisfaction in your job. Many things have the potential to derail this, including micromanaging, isolation, and negative interactions with co-workers. Regardless of your work setting, a strong company culture with an emphasis on creating a positive team environment is needed to reduce the possibility of a mismatch in this area. Companies should reinforce collaboration and positive social interactions, while extinguishing egocentric and negative interactions such as gossiping, complaining, and venting. Complaints should be taken seriously, but should be directed to the correct person like HR or a clinical director instead of to a group of co-workers or subordinates.

● Fairness: A mismatch in this area can come from a wide range of issues. Unfairness can come in the form of favoritism or discrimination from management, inequality of workload or pay, mismanaged evaluations or promotions, or even allowing others to continue sub-par performance without consequence. Neuroscience research have used game theory to study the impact of fairness on the brain. When a fair offer was presented to participants there was activation in the reward regions of the brain while unfair offers showed reaction in regions of the brain associated with contempt and disgust. We all know life is not fair, but allowing these injustices into a company can damage employee motivation and performance (Jacobs, 2018). When there is an instance of perceived injustice, there should be procedures to resolve disputes without fear of revenge or retribution.

● Values: One of the great things about the field of ABA is that we are all guided by, and expected to uphold, the Professional and Ethical Compliance Code. This should minimize conflicts of values and clarify the right thing to do if issues arise. However, it may be difficult to determine how the ethics code applies to specific real-life situations or you may be asked to do things that are unethical by non-BCBA staff who are not familiar with the code. If there are any issues involving ethics, we must hold to the ethics code as our ethical responsibilities come before any organization policies (1.04e). Aside from ethics, a mismatch in this area may also occur between personal goals and the values of the company or between a company’s advertised mission statement and their actual practice. Everyone promotes high quality service with the best interest of the client in mind, but the reality of having a profitable business does not always match up with that goal.

How to Battle the Burnout

● Maintain a positive work environment: Don’t contribute to the gossip or unconstructive complaining. While it may feel good to vent, especially in the presence of others dealing with the same frustrations as you, it does not lead to improvement and can create a toxic work environment.

● Create boundaries and stick to them: These boundaries can be related to your values, work/life balance, or any area that you feel is contributing to your burnout.

● Ask for the support you are lacking: If you don’t ask for help, people may not know that you need it. Remember that it is our responsibility to follow the ethics code which states we may not accept clients we are not competent with (2.01) and that we refrain from taking on more work than we can handle (1.04c). If you find yourself in one of those situations, it is imperative that the issue is resolved.

● Seek professional growth: Our field spans so much more than providing therapy to children with Autism. Moving into a new areas such as Organizational Behavior Management (OBM), Acceptance & Commitment Therapy (ACT), animal training, distance supervision, teaching ABA, etc.. may reignite your passion. Even if you stay in your current area, you can get excited about your career again by attending conferences or Continuing Education events (McMillin, 2016).

Should you quit your job? Maybe. If you are working in a hostile work environment or if there are ethical concerns, then you may want to consider leaving if they can’t be resolved. If not, you have to consider if changing jobs is really going to provide the permanent change you’re looking for. While your employer likely has a real interest in improving clients’ lives, they are also running a business and their goals of profit and growth could be leading to many of the issues that cause burnout. We’re in the business of changing behavior, so let’s bring those skills into the interactions with co-workers, management, and staff to improve job satisfaction and reduce burnout.

References

Garton, Eric. (April 6, 2017). Employee burnout is a problem with the company, not the person. Harvard Business Review. Retrieved February 1, 2019 from https://hbr.org/2017/04/employee-burnout-is-a-problem-with-the-company-not-the-person

Jacobs, Susanne. (April 5, 2018). Why employers shouldn’t ignore unfairness at work. People Management. Retrieved February 1, 2019 from https://www.peoplemanagement.co.uk/voices/comment/employers-should-not-ignore-unfairness

Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). Maslach burnout inventory manual. Palo Alto, CA (577 College Ave., Palo Alto 94306): Consulting Psychologists Press.

Maslach, C., Schaufeli, W.B., and Leiter, M.P. (2001) Job Burnout, Annual Review of Psychology, 52:397-422. Retrieved December 10, 2018 from https://www.wilmarschaufeli.nl/publications/Schaufeli/154.pdf

Mayo Clinic Staff. (November 21, 2018). Job burnout: Hour to spot it and take action. Mayo Clinic. Retrieved December 10, 2018 from https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642

McMillin, Trina. (June 30, 2016). Increased stress in the ABA workplace calls for reform. Relias. Retrieved February 1, 2019 from https://www.relias.com/blog/increased-stress-in-the-aba-workplace-calls-for-reform

Plantiveau, C., Dounavi, K., & Virués-Ortega, J. (2018) High levels of burnout among early-career board-certified behavior analysts with low collegial support in the work environment, European Journal of Behavior Analysis, 19:2, 195-207. Retrieved December 10, 2018 from https://www.tandfonline.com/doi/full/10.1080/15021149.2018.1438339

Professional and Ethical Compliance Code for Behavior Analysts. Ver. December 1, 2018. Behavior Analyst Certification Board. Retrieved February 1, 2019 from https://www.bacb.com/ethics/ethics-code/

US Employment Demand for Behavior Analysts: 2010-2017. (2018) Behavior Analyst Certification Board. Retrieved December 10, 2018 from https://www.bacb.com/wp-content/uploads/Burning_Glass_20180614.pdf