Stress Management in the Caregiver Setting An increasing body of evidence points to the intensity of the labor involved in caring, and the impact it has on the caregiver in a healthcare setting. Whether lay or professional, it seems that the potential for suffering among caregivers is enormous. When a person reaches a state of physical, emotional or mental exhaustion, burnout occurs, and it appears to affect both lay and professional caregivers alike. Almberg's study, for example, suggests that exhaustion and burnout from caring happen in many different cultures and that 'relatives who have been giving caregiver for many years may experience similar emotional exhaustion to that suffered by staff' (Almberg et al. 2007). Whether lay caregivers would express their state as burnout is questionable, since it tends to be a term mostly used in professional discussion, but there is evidence of high levels of stress and illness among informal or lay caregivers (Henwood 1998). Lay caregivers, in one study (Princess Royal Trust 2009), felt that it was not even of interest to professional caregivers whether they could cope or not. Over 70% of 1300 lay caregivers involved in this study reported that it was largely assumed that they would cope with looking after a person at home, and were not asked if they could do so. Are they not being asked because of ignorance, because of fears of what might turn up if they were asked, because of denial ... what is not known about does not hurt? Professional caregivers, however, are supposed to have special training which equips them to deal with the suffering of others dispassionately, maintaining a certain distance which 'protects' both them and their patients or clients.

Thesis: If work is our centre, but it fails us, for whatever reason, then we have literally lost our faith. The centre no longer holds and we may fall apart - showing all the signs and symptoms of stress and burnout, addiction and co-dependence.

Salvage (2005) writing from a nursing context and Dossey (1995) from a medical viewpoint both suggest that fostering the internalization of feelings, as part of the socialization of caregiver workers, has serious consequences for the caregiver. Doctors, nurses and others, including perhaps lay caregivers, are all given clear signals that we are supposed to act as if 'we can take it': don't complain, never ask for help, never call for more resources, no matter how difficult the situation becomes. If we break this unwritten rule, the response of the uncaring culture is often to blame the victim. The caregiver who complains may find themselves being asked 'What is wrong with you that makes you unable to cope?' instead of getting a response that recognizes that more help is needed. The impact of this attitude, this whole cultural approach to caring, is chilling. Evidence is accumulating about the price that is paid by caregivers, both lay and professional. The World Health Organization (WHO) (2004) saw burnout, the exhaustion and loss of function associated with stress at work, as a major problem for caregiver professionals. Factors such as inadequate resources, lack of involvement in decision-making at work, authoritarian leadership styles, excessive case loads and poor staff relationships are all cited as significant causes. Similar factors appear in a Health Education Authority report (1996), which noted the principal effects of stress as emotional symptoms (e.g. depression, hopelessness, despair, anger, frustration, reduced enjoyment at work and home, suicidal feelings), behavioral changes (e.g. poor concentration and decision-making, absenteeism, marital and work conflicts, increased use of tobacco and alcohol and physical effects (e.g. high levels of various illnesses such as infections, back pain and headaches. The report also highlighted a number of causes specific to the health services. Like the WHO report, it found the causes of stress to lie in heavy workloads and lack of support, but emphasized also ineffective communication and consultation systems, invasion of personal space and lack of respect for functional and professional boundaries and pressures leading to an inappropriate management style. Additionally things like loss of support in a work community through radical reorganization, financial considerations taking precedence over human resource considerations, and the problem of getting the right balance between the two, disputes between managers and medical consultants and between other groups of staff or lack of coordination between departments and between individuals were also included. One is also advised for that the patients and families not be more demanding following the Patient's Charter, threaten with physical and verbal abuse,...

Completely avoid as best practice, excessive paperwork - performance statistics that are quantitative and not qualitative, performance measures that distort decision-making, lack of trust between managers and staff and between disciplines. The WHO also advises that pressure on acute services, because of social services policies and practices, contracts negotiated without consultation with those who will be involved in fulfilling them or bringing together different organizational cultures as a consequence of change; are all detrimental.
There seems little doubt that many of the recommendation are colored by specific changes in the government sector over the past 20 years. During that time, enormous changes have taken place in workplace practices. Not coincidentally, large numbers of workers have left to take early retirement on sickness grounds or to start caregivers in independent practice. Many of the latter seem to have found their way as independent complementary therapy practitioners. Others have sought to learn such practices and integrate them into their work as a means of producing more holistic caring and better team relationships.

An organizational culture that does not nourish and caregiver for its staff often demonstrates the same symptoms of stress that appear in the staff themselves: an inability to function effectively, grasping at short-term or quick-fix solutions in an effort to resolve or hide the problem, blaming the victim rather than dealing with the cause. (Perhaps this also applies to societies in which individual members feel alienated or unsupported when caring for others at home.) In turn, if the organisation is sick, then the staff who identify with it may take on the same characteristics. 'We attach to the organisation (held in the mind) the same emotions so that, to a greater or lesser degree, the members of the organisation will experience the same feelings as a result of their interrelatedness with the holding environment' (Stapley 1996). In such settings, staff themselves will respond in a wide variety of ways.

Feeling helpless at work, we may resort to blaming everyone and everything around us for problems, perhaps internalizing this and blaming ourselves as well, especially when things go wrong and a patient or client suffers. Blaming is often a sign that we feel helpless in a situation (Stapley 1996), and it is closely related to another classic victim response - the whinge. Maya Angelou (2010) has a warning to offer us about this: 'So watch yourself about complaining, sister. If you can't change a thing, change the way you think about it. Whining is not only graceless, but dangerous. It can alert a brute that a victim is in the neighborhood.' Whining when we feel helpless is unlikely to produce a positive reaction from the manager, who is probably equally hard-pressed and caught up in the sickness of the organisation. Whingeing and whining are simply expressions of blaming the other for our problems. We try to justify our own status, self-esteem and effectiveness, to preserve some good feelings about ourselves in the face of a sick, often hostile, context. Nevertheless, whingeing is not the response of someone often labeled the 'negative personality' who always has something to complain about; it is a cry of pain in the face of helpless feelings and a hopeless organisation.

Whingeing and victim-blaming are serious problems for any individual or organisation, yet the difficulties go even deeper. Caregivers in organizations such as hospitals or community teams tend to blame the organization, while lay caregivers at home see the problem lying with the social services providers, or government, or society as a whole. In the face of helplessness, wherever we define the organisation to be, the sickness can be found 'out there'. It seems we find it very difficult to look clearly at what is going on around us, to look objectively and without attachment at the sources of our difficulties. After all, if a particular organisation is sick, and you're part of that organisation, and that organisation is part of society, then where does the 'blame' or the 'fault' originate? If only we had more money, staff, resources, nicer bosses, or whatever, then these would solve all our problems. With shoulders to the wheel and noses to the grindstone, we are in a very difficult position from which to look up and see how the world might be different. A cycle of victim behavior and blaming can come to characterize our every action,…