Treating career burnout: a psychodynamic existential perspective

This article presents an approach for treating career burnout based on a psychodynamic existential perspective. Psychodynamic theory contributes the idea that people choose an occupation that enables them to replicate significant childhood experiences. Existential theory contributes the idea that people attempt to find existential significance through their work. It is suggested that when treating career burnout it is essential to address three questions: Why, psychodynamically, did this person choose this particular career, and how was it expected to provide existential significance? Why does this individual feel a sense of failure in the existential quest, and how is the sense of failure related to burnout? What changes need to take place for this individual to derive a sense of existential significance from work? A case illustration is presented that demonstrates the application of this approach.     

Use of an educational computer program before genetic counseling for breast cancer susceptibility: effects on duration and content of counseling sessions.

PURPOSE: Patients seeking genetic testing for inherited breast cancer risk are typically educated by genetic counselors; however, the growing demand for cancer genetic testing will likely exceed the availability of counselors trained in this area. We compared the effectiveness of counseling alone versus counseling preceded by use of a computer-based decision aid among women referred to genetic counseling for a family or personal history of breast cancer. METHODS: We developed and evaluated an interactive computer program that educates women about breast cancer, heredity, and genetic testing. Between May 2000 and September 2002, women at six study sites were randomized into either: Counselor Group (n = 105), who received standard genetic counseling, or Computer Group (n = 106), who used the interactive computer program before counseling. Clients and counselors both evaluated the effectiveness of counseling sessions, and counselors completed additional measures for the Computer Group. Counselors also recorded the duration of each session. RESULTS: Baseline characteristics did not differ significantly between groups. Participants and counselors both rated the counseling sessions as highly effective, whether or not the sessions were preceded by computer use. Computer use resulted in significantly shorter counseling sessions among women at low risk for carrying BRCA1/2 mutations. In approximately half of the sessions preceded by clients' computer use, counselors indicated that clients' use of the computer program affected the way they used the time, shifting the focus away from basic education toward personal risk and decision-making. CONCLUSION: This study shows that the interactive computer program "Breast Cancer Risk and Genetic Testing" is a valuable adjunct to genetic counseling. Its use before counseling can shorten counseling sessions and allow counselors to focus more on the clients' individual risks and specific psychological concerns. As the demand for counseling services increases, a program such as this can play a valuable role in enhancing counseling efficiency.     

You're entitled: the benefits counseling program

Marty Kraushar and his experiences in providing benefits counseling for PWAC for the past year are described. The program is part of the Advocacy Counseling for Entitlement Services (ACES), which is part of the Retired and Senior Volunteer Program (RSVP). Volunteers go through an extensive six-week training program to learn about various entitlement services and how to obtain them. ACES volunteers are placed in hospitals, nursing homes, and social service agencies, and act as advocates for patients who may not understand the bureaucratic process involved in entitlement. Contact information for the program is provided, along with a summary of AIDS-related benefits and programs.     

Job strain, burnout, and depressive symptoms: a prospective study among dentists

BACKGROUND: Burnout has been presented as an antecedent of depression, but longitudinal data are lacking. We investigated whether burnout mediates the association between job strain and depressive symptoms. METHODS: Two surveys were conducted. In 2003, 71% of Finnish dentists were reached, and the response rate of the 3-year follow-up was 84% (n=2555). Burnout was measured with the Maslach Burnout Inventory and depressive symptoms with the Beck Depression Inventory. The sequences 'job strain-burnout-depressive symptoms' and 'job strain-depressive symptoms-burnout' were investigated with logistic regression analyses. RESULTS: Of the burnout sufferers without depressive symptoms at baseline, 23% reported depressive symptoms at follow-up. The adjusted odds ratio of burnout for depressive symptoms was 2.6 (95% CI 2.0-3.5). The effect of job strain on depressive symptoms had an OR of 3.4 (95% CI 2.0-5.7), but it disappeared when adjusted for burnout. Of those who had depressive symptoms without burnout at baseline, 63% had burnout at follow-up. The adjusted odds ratio of depressive symptoms for burnout was 2.2 (95% CI 1.4-3.4). The effect of job strain on burnout had an OR of 27.9 (95% CI 6.5-120.2) for the men and 4.9 (95% CI 2.5-9.6) for the women. These effects remained significant after adjustment for depressive symptoms. LIMITATIONS: The study was conducted among one occupational group. CONCLUSIONS: There is a reciprocal relationship between burnout and depressive symptoms. Job strain predisposes to depression through burnout. In comparison, job strain predisposes to burnout directly and via depression.     

Prisoners of liberation: a psychoanalytic perspective on disenchantment and burnout among career women lawyers

Using a psychoanalytic perspective, this article addresses the roots and treatment of disillusionment and incipient burnout in female corporate lawyers. It suggests that one of the primary issues that needs to be addressed in therapy with this group is the tendency to be self-punishing, a characteristic that often may be traced back to insensitive parenting. This formulation, combined with the penchant of law firms to regard as "good and expected" the inclination of their workers (especially women) to work without respite and with little regard for their own needs, places individuals at high risk for burnout. A case example is used to illustrate this phenomenon. It is concluded that whereas psychoanalytic treatment greatly may help overstressed professionals, society at large must address the values that foster the attitude of high career achievement at any cost.     

Evaluation of a counseling training program for nursing staff

One of the essential issues in nurses' daily work is interaction with patients, patients' families, and co-workers. However, in the Spanish academic programs for Nursing Schools, social interaction skills do not receive adequate attention and nurses often report communication problems. In order to diminish these difficulties and to train nursing staff to better manage interaction, an intensive counseling training program was designed and implemented in a General University Hospital. The main aim of this study was to evaluate the effects of a counseling training program and assessing the evolution of difficulties that professionals perceived in their work in three different periods: before the training, after the training, and at follow-up, 2 months after the program was delivered. According to the results, we can maintain the hypothesis that the counseling training program reduces perceived interaction difficulties in nursing staff. Consequently, we can expect a further improvement in the interaction performance with patients and their families after the training. These findings suggest that counseling training has to be taken into account to improve quality of care in health care providers, and it may also help to prevent professional burnout by increasing competence level at minimum personal cost.     

Concurrent validity of the MMPI-A in a counseling program for juvenile offenders

This study was conducted to examine the concurrent validity of the MMPI-A (Minnesota Multiphasic Personality Inventory-Adolescent) in an adolescent offender setting. From a sample of 50 court-adjudicated youths participating in an outpatient counseling program, 42 valid MMPI-A profiles were obtained, 33 of which were accompanied by counselor ratings of behavior problems. The highest mean elevations on the MMPI-A were on scales MAC-R (MacAndrew Alcoholism Scale-Revised), A-Con (Adolescent Conduct Problems), A-Sch (Adolescent School Problems), Pd (Psychopathic Deviate), and IMM (Adolescent Immaturity). Counselor ratings of behavior problems correlated highly with scales ACK (Alcohol and Drug Acknowledgment Scale), A-Sch, A-Ang (Adolescent Anger Problems), Ma (Hypomania), and PRO (Alcohol/Drug Problem Proneness). This pattern of results supports the concurrent validity of the MMPI-A for use in this setting. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 395–399, 1998.     

The effects of lay counseling on medication adherence and blood pressure: adjunctive treatment for hypertension

Ten noncompliant hypertensive patients were monitored and received counseling from trained aides. Monitoring and lay counseling was associated with a reduction of -10 mmHg in systolic blood pressure and of -7 mmHg in diastolic pressure (P less than 0.05). Medication adherence increased from 69% to 84%. Counseling resulted in pressure decreases equal to those obtained by usual care for similar but compliant patients. This analysis provides a model for paraprofessional adjunctive counseling of patients thought to be adhering poorly to their medication regimen, which may improve control of hypertension.     

The advisory dean program: a personalized approach to academic and career advising for medical students.

Advising and mentoring programs for medical students vary in their official names, scope, and structures. Catalyzed by negative student feedback regarding career advising and a perceived disconnection between faculty and students, in academic year 2003-2004, Columbia University College of Physicians and Surgeons implemented its formal Advisory Dean (AD) Program and disbanded its former advising system that used faculty volunteers. The AD Program has become a key element for enhancing the students' professional development throughout their student training, focusing on topics including, but not limited to, career counseling, professionalism, humanism, and wellness resources. Advisory deans and the dean for student affairs, familiar with resources for academic development, student support, and extracurricular activities, operate at the nexus of the program, providing personalized mentoring and advising for each student. Fully supported by administration and faculty, the program has shown early success according to student feedback. Early feedback from the Class of 2006, who had been involved in our AD Program for three years, has been encouraging. Out of 152 students, 104 (68%) provided feedback, with 93 (89%) of the respondents reporting the AD Program as a valuable initiative. Expecting to further improve on this early positive response, the AD Program will continue to foster an environment conducive to a seamless transition from student to physician.     

Disclosing genetic risk for coronary heart disease: effects on perceived personal control and genetic counseling satisfaction

We investigated whether disclosure of coronary heart disease (CHD) genetic risk influences perceived personal control (PPC) and genetic counseling satisfaction (GCS). Participants (n = 207, age: 45–65 years) were randomized to receive estimated 10‐year risk of CHD based on a conventional risk score (CRS) with or without a genetic risk score (GRS). Risk estimates were disclosed by a genetic counselor who also reviewed how GRS altered risk in those randomized to CRS+GRS. Each participant subsequently met with a physician and then completed surveys to assess PPC and GCS. Participants who received CRS+GRS had higher PPC than those who received CRS alone although the absolute difference was small (25.2 ± 2.7 vs 24.1 ± 3.8, p = 0.04). A greater proportion of CRS+GRS participants had higher GCS scores (17.3 ± 5.3 vs 15.9 ± 6.3, p = 0.06). In the CRS+GRS group, PPC and GCS scores were not correlated with GRS. Within both groups, PPC and GCS scores were similar in patients with or without family history (p = NS). In conclusion, patients who received their genetic risk of CHD had higher PPC and tended to have higher GCS. Our findings suggest that disclosure of genetic risk of CHD together with conventional risk estimates is appreciated by patients. Whether this results in improved outcomes needs additional investigation.     

Update knowledge of dry mouth- A guideline for dentists

Background

Dry mouth is usually caused by a reduced salivary flow or by changes in the biochemical composition of saliva.

Objective

The aim of this paper is a review of the update literature of dry mouth.

Methods

We search in pubmed in the past 10 years using the words «dry mouth», «causes», «symptoms», «treatment» and «dentistry». A large number of papers have been identified. Papers not relevant to the issue were removed reducing the entries to 56 only.

Results

There are no clearly established protocols for the treatment of dry mouth in the literature. Most of identified papers were systematic reviews, non-systematic reviews, and observational studies. The most studied patients were Sjögren''s syndrome and the irradiated patients. Treatments are focused on the etiology, prevention, symptomatic, local salivary stimulation and systemic treatments.

Conclusion

It can be concluded that there is no clear evidence for the causes and treatment of dry mouth, therefore the majority of the general dental practitioners refer most of the cases to appropriate specialist. Treatment must be individualized, salivary substitutes and mechanical stimulation techniques can be applied.     

Psychiatric genetic counseling: A mapping exercise

Psychiatric genetic counseling (PGC) is gradually developing globally, with countries in various stages of development. In some, PGC is established as a service or as part of research projects while in others, it is just emerging as a concept. In this article, we describe the current global landscape of this genetic counseling specialty and this field's professional development. Drawing on information provided by expert representatives from 16 countries, we highlight the following: (a) current understanding of PGC; (b) availability of services for patients; (c) availability of training; (d) healthcare system disparities and cultural differences impacting practice; and (e) anticipated challenges going forward.     

大学生毅力与职业使命感:生涯建构理论的视角

目的:运用生涯建构理论探讨大学生毅力对职业使命感的影响及作用机制.方法:采用毅力量表、生涯适应力量表、职业使命感量表以及社会支持感量表对257名大学生进行两阶段问卷调查.结果:①毅力与职业使命感存在显著正相关(r=0.27,P＜0.01);与生涯适应力存在显著正相关(r = 0.36,P＜0.01);②生涯适应力在毅力...     

A self-referral preventive intervention for burnout among Norwegian nurses: One-year follow-up study

Objective

Burnout among nurses is an issue of concern, and preventive interventions are important to implement and evaluate. This study investigated levels and predictors of change in burnout dimensions after an intervention for help-seeking nurses.

Methods

Nurses participating in a self-referral, counseling intervention, from 2004 to 2006 in Norway, were followed with self-reporting assessments. One-year follow-up was completed by 160/172 (93%, 155 women and 5 men).

Results

Mean level of emotional exhaustion (one dimension of burnout, scale 1–5) was significantly reduced from 2.87 (SD 0.79) to 2.52 (SD 0.8), t = 5.3, p < 0.001, to the level found in a representative sample of Norwegian nurses. The proportion of nurses seeking psychotherapy increased after the intervention, from 17.0% (25/147) to 34% (50/147), p < 0.001. Less reduction in emotional exhaustion was independently predicted by reporting a work-related conflict (β −0.53 (SE 0.13), p < 0.001) or by getting a period of sick leave (β −0.28 (SE 0.12), p < 0.05) after the intervention.

Conclusions

A short-term preventive intervention could contribute to reduction of emotional exhaustion in nurses. Work-related conflict and sick leave after the intervention were negatively associated with this reduction.

Practice implications

Preventive interventions to reduce burnout for nurses should be considered, as well as programs for preventing or handling conflicts at work.     

PediDraw: A web-based tool for drawing a pedigree in genetic counseling

Background  

Drawing a pedigree is a prerequisite in genetic counseling. In medical records, a pedigree is useful to document the family history of the patient. Drawing a pedigree is also necessary in collecting genetic resources for medical research such as positional cloning. Currently, most pedigrees are drawn by hand or by drawing software. Due to the special requirements in a standardized pedigree, generating a pedigree by these methods is usually time-consuming and requires professionals. This limits the usage of a pedigree as demanded in remote diagnosis or online counseling from the counselees to send an electronic pedigree.     

Pseudodeficiency of arylsulfatase A: a counseling dilemma

Arylsulfatase A (ASA) deficiency is the cause of early and late onset metachromatic leukodystrophy (MLD). Low ASA levels are detected in some healthy individuals who are pseudodeficient (PD). PD individuals can be distinguished, because PD fibroblasts hydrolyze 14C-sulfatide at similar rates to normal fibroblasts. This has also been demonstrated in amniocytes and chorionic villi (CV). The genetic basis for PD is not clearly understood and is most likely heterogeneous with respect to allelic mutations of the ASA gene. It is hypothesized that the PD phenotype can either be due to PD/PD or PD/MLD genotypes, only the latter representing a potential risk to offspring. We report an unusual family where two siblings, both carriers of the classic late infantile MLD allele, are married to unrelated PD individuals. One couple has two PD offspring; their "at risk" status, due to the lack of an affected offspring is in question. The other couple terminated a fetus determined to be affected with a "MLD variant", most likely a compound heterozygote. Cautions prenatal counseling of PD families is essential. The population frequency of the PD phenotype is unknown.     

A survey of primary-care physician preventive services: implications for smoking-cessation counseling

We surveyed office-based preventive procedures among a random sample of primary-care physicians. The completed response rate was 60%, with no discernible bias between respondents and nonrespondents. Of the ten preventive procedures inquired about, seven were offered by more than 70% of the respondents. Further detail was obtained for a "tracer" procedure, smoking-cessation counseling. While 73.5% of respondents reported offering this, the majority desired additional support in their counseling efforts in the form of patient materials, physician guides, or continuing medical education workshops. Additionally, 79% felt that feedback provided to them concerning their patients' cessation efforts would improve their ability to help patients stop smoking.