Clinician Care: Expectations and Growth
Expectations and Growth in Regards to the Clinician and the Clients
According to Kestnbaum (1984) therapist's unrealistic expectations of their client's growth and progress will interfere with therapy and lead to burnout because the therapist will often blame him/herself. This section highlights some of these expectations as discussed by Kestnbaum (1984). Refer to article for detailed explanation.
Burnout cannot be viewed as a causal linear model, as has been done with much of the research regarding this topic. Rather, burnout needs to be viewed as an interaction between factors. For example, imperfect training or extremely difficult clients will not cause burnout by themselves, but an interaction between these two can cause burnout.
From time to time, all therapists, especially beginners, hold unrealistic and clinically unfounded goals, attitudes, and daydreams about what ought to be taking place in the therapy session. These expectations will greatly affect their perceptions and feelings. The dissonance between these unrealistic expectations and the actual or perceived results will lead from frustration and anxiety to disappointment, blame, and eventually burnout. Therefore, burnout can be self-made, based on perceived rather than actual failure.
There is no absolute level of truth in formulating therapeutic expectations. But therapists often possess expectations that are not well thought-out, not based on clinically observed data, or based on the needs and wishes of the therapist. Positive change is in the eye of the beholder. The recognition of growth and progress may not be as simple as it may seem. Each therapist differs in their views on defining growth and progress and how much is occurring. These differences in perspectives will certainly affect how each views his/her effectiveness and ability, and ultimately, job satisfaction.
Even if some agreement on definitions of growth and progress are assumed, there still remain difficulties in getting the therapist to recognize these milestones when they occur. The ability to identify client growth and progress is not intuitive but is rather learned through skill and experience. The therapist that consistently holds unrealistically high expectations for client growth will consistently feel that his/her clients do not make satisfactory progress. Such a therapist will be unaware of or will dismiss small steps of growth. This leads to the blaming of the clients or self, either of which will pave the way to chronic disappointment and eventually a sense of failure. The therapist will believe that he/she is unable to help their clients, which will prevent professional satisfaction and lead to burnout.
For all kinds of burnout, there are a number of strategies that you can utilize to reduce the harmful effects. It is critical to maintain consistency between expectations for therapeutic growth and actual diagnostic findings. As a home therapist it is also useful to consider progress in development in trust, clarity of focus, and other non-tactile building blocks just as important as the more concrete accomplishments.