Practical Ways of Sustaining the Spiritual Energy Required for Care

We conclude by bringing together five of the more important practical applications that can be derived from an approach based on 'spiritual nutrition':

  • 1. The importance of supervision as emotional processing: Supervision is often thought of as the teaching of skills or competence, whereas in fact its primary value is emotional nutrition and processing. This means that when toxic and difficult emotions are shared between supervisee and supervisor, the supervisee is able to process the emotional impact of their care work and this enables them to become mentally refreshed and spiritually re-energised so that there is a renewed capacity to carry on similar work. The risks and dangers of a lack of supervision are great. A lack of supervision can much more quickly lead to emotional and spiritual burn-out. It is helpful therefore to think of supervision as an issue of spiritual as well as of technical competence. Without a nurturing and empathic link with the mind of a supervisor, any empathic link between a care worker and those that they care for will become depleted. This means that the attitude across some care organisations that regular supervision for all professionals in caring roles is a luxury rather than a necessity is in itself dangerous and self-defeating.
  • 2. The concept of a ‘psychologically safe’ working environment: In relation to public mental health services, Seager (15) examined from a psychoanalytic and attachment theory perspective, following Winnicott (16), the factors that reduce the risk of suicide and keep all of us safe in terms of our mental and spiritual well-being. He concluded that care environments needed not just to be physically but also 'psychologically safe'. For example, he states:

Just as the individual patient needs the containment of 'good enough' attachments to a care-giving system, so also do clinicians need the containment provided by good quality attachments to skilled supervisors, supportive managers and meaningful policies. To be 'good enough' parents or carers, professional or otherwise, we all need the support of grandparent figures (p.272).

In the same paper Martin argues that a psychologically safe work environment requires a healthy 'professional family' where everyone feels a sense of involvement, and he continues:

The greatest risk to psychological safety for all human beings is to be forgotten, lost from view and not 'held in mind. This is arguably worse even than having a negative identity in the minds of others' (p.276).

A psychologically safe care environment is therefore one where not only the clients feel remembered and held in mind but also the staff does. One of the most practical steps therefore in ensuring good quality care is to care for the care practitioners as human beings too. However, as we have already seen, standards of care and support for care practitioners are rarely made a priority or explicitly spelled out in policies. For the sake of our collective well-being, however, it is now vital that this policy and practice deficiency in our care services culture is remedied by government, employing organisations and also professional bodies, including trade unions. In the absence of explicit standards of staff protection there will always be room for negligent and toxic work environments for our care practitioners.

3. Looking at caseloads and workloads from a mental and spiritual perspective: In our care services, particularly those in the public sector, the caseload allocation to any individual care practitioner is usually based upon only the physical dimensions of space, number and time: space in the diary, number of cases waiting for a service, and hours in the working day. This takes no account of the mental and spiritual energy and capacity of the practitioner. Martin (9) describes how effective care practitioners must 'tune in' with the distress of their clients and explains that this process of identification must inevitably cause vicarious distress or compassion fatigue as described by Figley (17). Martin points out that beyond the technical competence and capacity of the care practitioner as an individual, the following qualitative 'burden factors' must also be taken into account if a caseload is to be allocated in a way that is psychologically and spiritually safe: [1]

The more blind and emotionally illiterate we remain as a society in relation to these common-sense factors that clearly impact on mental and spiritual energy, the more likely we are to perpetuate or exacerbate toxic and neglectful public care cultures where care practitioners are overloaded and drained of the energy needed to continue healthily with the tasks that they usually are highly motivated to perform. Loading care practitioners with heavy and complex caseloads without reference to spiritual and emotional energy levels is ultimately dangerous and self-defeating for all of us.

  • 4. Broadening our definition of occupational health and human resources: Traditional models of occupational health are highly medicalised and highly reactive. Usually occupational health services only get involved once a practitioner is already sick, and the aim of such services is to treat the sick individual with the aim of restoring their capacity to function at work. Our occupational health culture is therefore largely blind to the wider, systemic psychological and spiritual causes in the workplace of ill health, depletion, stress, fatigue and burn-out. This seems to be part of a wider mind-blindness in our science and in our society. However, if occupational health is to live up to its title, there has to be a paradigm shift involving an inclusion of psychological and spiritual factors alongside the biological. Even in organisations whose core business is care, to this day only lip service is paid to the psychological aspects of work environments and systems along with the morale and spiritual health of practitioners. The management practices and policy of care organisations are therefore not tied in with occupational health in a proactive way. This is a massive opportunity missed. The mental and spiritual health of workers should be the starting-point for all organisations but in particular those whose purpose is compassion and care. Occupational health, rather than operating as an isolated department taking individual referrals, should therefore be involved proactively and systemically in the design of work environments and the support of care practitioners. Such a culture of ongoing staff support would prevent health problems developing rather than reacting to them when it is too late. Occupational health could also provide a base from which to deliver ongoing staff support programmes. In the same way, Human Resources (HR) departments have a beguiling title that invites possibilities that go beyond traditional and current models. HR departments potentially could become less bureaucratic and provide some of the ongoing i nterpersonal back-up and spiritual support that care practitioners and their managers need.
  • 5. Beyond the organisation: the potential role of helplines and the internet: The online community and the internet provide a whole new dimension in connecting care practitioners with support. We have already mentioned the on-line resources and materials developed by Mike. Organisations are increasingly using the internet and intranets to support their staff, but the problem with websites and written materials is that they can lack the interpersonal touch that is required to process live emotions fully between people. For this reason, Mike and Martin (10) also have advocated the possibility of a national helpline for public sector care practitioners, recognising that there might be an added value in terms of confidentiality in being able to seek help outside one's own organisation, especially if that organisation is the primary source of distress. Such a helpline should be funded collectively by government, employing organisations and professional bodies. As yet, however, our attempts to stimulate the development of such a facility have fallen on stony ground.

  • [1] The emotional attachment between care-giver and care recipient • The level and complexity of distress in the cared for person • The reversibility and changeability of the cared-for person's problems • The availability of other receptive minds to share the emotional burden with • Distractions upon the care practitioner including 'top down' pressure to achieve targets • The degree of freedom or control that the care practitioner has to escape from or get relief fromthe care-giving role
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