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Identifying risk factors and difficulties that can lead to problems in professional careers is important. Prevention always saves time, energy and resources. Being able to identify behavior changes in one’s self, staff, and colleagues helps prevent more serious problems from developing in the future, which can leave individuals, consumers and organizations vulnerable to risk and liability.

There are many factors that contribute to work stress. Some are adjustable and some not. However, problems don’t generally, “go-away” or change without intervention.

When feeling stressed and worn down, it can be confusing as to why. It is always important to step back and look at what might be going on a daily basis to identify contributing factors.  Tracking health habits, food, exercise and sleep, recreation, etc., for a short period can be helpful to be able to see what may be impacting stress levels, behavior and overall health.

Changing the perception of  stressors and releasing the need for control or reevaluating expectations of one’s self can also be helpful. This is a cognitive- behavioral skill which can make a big difference in perceiving an issue and dealing with it more constructively giving the person back control.

Looking at habits and mindset is a way of taking care of the internal conditions impacting health, well-being and behavior.

The outside environment, meaning the conditions under which we operate and function is of critical importance – People, physical space, processes, demands/ requirements, etc. We are deeply affected by the environmental conditions whether or not we are aware of it – They impact our thinking, emotions and behavior as we are wired to naturally adapt to meet environmental demands.

When outer conditions overwhelm a person’s ability to sustain the demands of the environment over a period of time, there is likely to be a crisis.

Professionals are usually smart, goal oriented, and skilled people and tend to push themselves. They may be more vulnerable to over-functioning and feeling highly responsible in the work they do.  This can put them at additional risk for stress and burnout potentially leading to health and behavioral problems as their ability to self- manage becomes more difficult.

Personal control is important for human beings to feel stable, focused and safe.

Less flexible personal traits and behavioral tendencies in combination with challenging workplace conditions can give rise to the development of misconduct and unprofessional behavior.

Over many years of counseling professionals dealing with occupational conflicts, behavioral challenges and impairments our clients have voiced some common workplace difficulties which have been tough for them to manage over the long term. However, with some willingness on part of the professional and his or her employer, concerns can be addressed and in many cases improvements can be made in the benefit of both parties. Much of the time improvements may include the fine-tuning of communication, revisiting expectations, guidelines and other accommodations without too much disturbance to work processes. The importance of boundaries is highlighted.

Something else we have learned is that many professionals have a hard time saying “no.”

This can be especially true of people in human service oriented roles, including healthcare, law and areas of consulting, where there is a focus on being helpful to others. Setting limits and boundaries becomes paramount in making healthy changes.

Professionals have also achieved their success through working hard and can be competitive (often self-competitive). It takes commitment to excellence to get to the top. After years of diligence and drive it can often be hard for professionals to establish the balance needed to maintain their health, energy and positive mindset. You can see how the inner and outer conditions start to inter-weave and make for difficulties as tension grows.

Neither the employer nor the professional employee is wrong or at fault. Macro and micro changes shape situations over time.  Changes can go unnoticed until crisis hits and there is an incident of sorts.

At the end of the day, everyone is just trying to move forward in the best way possible.

In working with professionals the effort to resolve problem issues, we have noted some themes concerning what they have found difficult in their respective work environments.

• Lack of communication between professional and his or her direct report.
• Responsibility without authority.
• Lack of control or input over pace of work.
• Frequent distractions (including too many meetings) – Not being able to finish work.
• Excessive workload demands – Never being able to be “caught up.”
• Ongoing difficulty with work – life balance.
• Combination of high-demands and decreased rewards.
• Unrealistic work expectations-Especially in light of a change in work processes.
• Inequitable work environments- Including oversight of a team member’s under-performance or misconduct.
• Rusting out – Low workload, lack of challenge or opportunities for growth, lack of intellectual engagement (opposite of “excessive”) – Underemployment.
• Negative mindset from “spinning one’s wheels” and lack of support and above noted issues.

Technology can be stressful, too. The expectation of immediate access of 24/7 devices can take its’ toll on the personal boundaries needed to be effective. Being constantly “plugged – in” can be like always being on alert and “on call” with little to no opportunity for release.

The bottom line is that most professionals need increased awareness and skills to be effective in today’s work world. Change is constant and rapid fire. Professionals need to reflect and reconsider how to navigate the new work landscape and to perhaps make new choices.

A thorough assessment of all the dimensions of functioning can help in planning for improvement.

At Integrated Treatment Solutions we help professionals focus on getting back to the basics of self –care, including moving away from over-functioning and operating out of fear.  We help professionals form a structured routine supporting their needs and performance requirements, along with training on skills to self- manage in order to navigate the work setting more effectively.

Self- management skills help professionals advocate for themselves, their teams and to collaborate with other colleagues in their organizations’ more effectively. They also help with coping with emotions and stress.

The ultimate goal is to provide greater awareness, confidence, balance and personal control in work and life.

The world of work has changed dramatically over the years due to macro shifts in the way business is conducted as well as micro shifts in terms of structure and process.  According to the National Institute for Occupational Safety and Health (NIOSH), problems at work are more strongly associated with health problems and complaints than any other life stressor – Even more so than financial difficulties and-or family problems. 25% of employees perceive their jobs as being the #1 stressor in their lives – 75% of employees believe that workers now have more on-the-job stresses and demands than they did a generation ago.

These statistics may come as no surprise to any of us in light of the challenges of today’s economy and business climate.  It is more important to be extra mindful of self-care and to attend to personal health as stressful job conditions and or lack of coping and self-management skills can lead to increased risk of injury and illness.

Flexibility and adaptation have become requisite skills for professionals to successfully navigate this new work terrain all while maintaining optimal performance. Just as in nature, “Adaptation is key to survival ” – Always.  Such requirements can be very challenging for most as change often happens so rapidly that there is not often ample time to understand and integrate.

Rapid – fire change has become the new normal.

The professional who is not as flexible with change or who does not have the behavioral skills to accommodate major shifts is at most risk for negative consequences. We often see professionals who are struggling (often unknowingly) with significant changes in their respective industries and or work processes.  Another group we see includes high performing “turn-around” or start-up executives and entrepreneurs who have been operating on over-drive for extended periods of time  and hit crisis when there is no longer an outlet for such energies. The stress can pile up and compound over the course of time leading to problems with health and or behavior.  Unmanaged  energy and behavior can escalate in the form of misplaced attempts at control in and outside of the workplace.

As a Behavior Therapist, I see this repeatedly in my counseling work with professionals (in my offices in Chestnut Hill, Philadelphia and West Chester, PA). Stress, fear and rigidity compounds over the course of time leading to confusion and negative consequences.

It is not uncommon for professionals to get into “behavioral ruts” and spiral downward with negative thinking, non-collaborative behavior, impulse control problems with alcohol, food and other self-defeating behaviors.   Problems tend to then migrate to relationships with spouses and children – The boundaries become blurred.  That’s how most professionals end up in my office.  Counseling is often mandated by the spouse in order to stay married.

In order to approach unprofessional behavior in a comprehensive, preventative and solutions focused manner it is critical to understand that accommodating change takes mental, emotional and physical energy.

People have different capacities when it comes to flexibility, skill and energy – Perhaps this is another form of diversity.

Professionals often need help in identifying the issues at hand, understanding them and developing new skills in order to make new choices. Life can get so busy that personal reflection and the possibility of new choices and creativity become less apparent.

In a nutshell, constant change often pulls on less flexible personality traits, taking energy, challenging tolerance and individual capacities. Understanding this behavioral equation and how the pieces come together is necessary to accurately appraise people and situations.  This is another conversation which we will have in future blog posts.

Occupational facts to consider about what constitutes a highly stressful job and what may become difficult for professionals as they move through constant change is the topic of the next Living Well Weekly Blog entry.

Tips and tools in the interest of remaining stress hardy in navigating the new occupational landscape will follow.

If you found this information helpful, feel free to forward it to a colleague or friend.

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Our world is a 24/7 almost 365-day place that is ever evolving and dynamic. Rapid and sudden change has become the “new normal.” These changes sunk in for me last year when I was getting emails on Thanksgiving morning and LinkedIn invitations on Christmas Day. On some level, I found it mildly entertaining and on another quite concerning. Regardless, it became apparent to me that there has been a shift in the way we are navigating life, not to mention the erosion of boundaries that have historically protected out down-time.

There is more, however. We are all aware that our world is in a state of flux. World-wide shift in weather patterns, competitive business climate, mergers, acquisitions, the turbulent economy, and fragile international politics are requiring us to adapt and live differently in order to function.  The problem with that is we just don’t change that quickly.  In fact, did you know that it takes many hundreds of years for humans’ and animals to adapt to a change in their food source? If that’s the case what do, we do in the face of constantly changing conditions in our lives? After all, for some of us getting a new Smart Phone is a big change! Read More

While it can be sad to leave summer behind, autumn brings with it gifts of its’ own; it’s vibrant tapestry of color, comforting foods, soups, chili and pumpkin pie, and the smell of fireplaces burning on a crisp evening.  Autumn, however, can be challenging on a health and energy level for many people.  As the days grow shorter, and there is less daylight, many people start to feel “down”, depressed or depleted of energy.  The transition into the colder months can be especially hard for people with mood problems, addictions, chronic pain and other persistent medical and mental health conditions. I hear this each year from clients and callers in my counseling practice in Chester County and Philadelphia, PA.

While season change can be tough, one doesn’t have to suffer. There are skills that we can use to reduce the likelihood of negative emotions and mood states – To prevent emotions from controlling our thoughts and actions.

Our ability to self-manage plays a key role in our physical and mental well-being; hence self-management skills are very important to our functioning. While some of these skills may seem like common sense or perhaps you are already doing them, you more than likely will find that you need to tend to a couple of them.

I use the Dialectical Behavior Therapy, Emotion Regulation skill for Reducing Emotional Vulnerability in my work with people with depression, anxiety, and other difficulties.

Marsha Linehan, Ph.D. pioneer of DBT uses the acronym of “PLEASE MASTER”  as a way of remembering these skills.

treat PhysicaL illness

balance Eating

avoid mood-Altering drugs

balance Sleep

get Exercise

build M A S T E R y

If we are feeling unwell, hungry and undernourished, fatigued, drinking too much alcohol, don’t move around or get much exercise or aren’t doing something in our day that gives us a sense of mastery or accomplishment, we are more likely to be vulnerable to negative emotions including low energy. We are also more apt to experience or see the negative rather than the positive in situations, less able to cope and manage interactions in a skillful manner.

Tips:

• If you are prescribed medication, take it as directed. Many people don’t. Symptoms tend to resurface under stress including season change. Issues that are persistent require ongoing treatment.
• Stay away from sugar, caffeine, excess carbs and processed foods. Try to eat organic and whole foods. It takes the body a lot of energies to metabolize unnatural foods and to work through the overstimulation and insulin spike ignited by sugars, caffeine and carbs.
• Don’t drink alcohol. Alcohol is a depressant. It also affects sleep.
• Build in an extra half hour of sleep at night – Get to bed earlier.
• Get outside and take a walk each day in the sunshine; even if its’ during lunchtime during the workday. Movement boosts endorphins and vitamin D (from sunlight) is related to mood, outlook and energy.
• Make sure you do something each day that makes you feel competent and in control of your life – Something that feeds your future. Taking care of the business of your life supports self-esteem and confidence.

Everything we do for ourselves counts – A lot. Through taking care of ourselves, we inoculate ourselves from negativity, ill health as well as being non-productive.

“It’s not selfish to love yourself, take care of yourself, and to make your happiness a priority. It’s necessary.” – Mandy Hale

When I started my practice Integrated Treatment Solutions in 2009, I did so out of professional conviction. My experience working in a variety of healthcare and drug and alcohol treatment settings led me to rethink my approach as a behavioral health professional. I could no longer only treat symptoms at the expense of being complete and addressing underlying issues. I realized that I was at a critical choice point and that working within a traditional clinical framework was preventing many clients from getting help – That was not going to work for me. I wanted to collaborate with clients in the exploration of their problems and see what made sense for them in their respective recoveries.

These are some things about addiction and recovery that I have learned along the way and implement in my daily practice as an addictions specialist and behavior therapist…

Understanding addiction and moving into recovery is a process, not an event. Addiction recovery takes willingness, honesty, openness and time. Recovery is not linear. In fact, it can vary person to person.

The decision about one’s relationship with substances is personal. Individuals use substances and engage in addictive behaviors for different reasons – Essentially, all behavior is purposeful. As human beings, we are always trying to accomplish something. Each person has his or her perspective and goals concerning their use, lifestyle and level of wellness desired.

As a co-occurring disorders specialist (previously referred to as dual diagnosis – addiction and mental health together) I counsel and treat clients presenting “clinical complexity.” Many have been trying to gain clarity about their conditions and make progress for many years having been through many courses of treatment but continue to struggle with relapse or are “white knuckling” it through tough symptoms. Despite previous attempts at recovery and disappointments incurred along the way, they have stepped up again! I applaud their courage and determination.

I also believe that there is hope. Even after several attempts have been made.

It has become apparent to me that there are no failed clients only failed treatment. While addiction, depression, bipolar disorder, etc. tend to be fairly standard in their presentations, each person affected is different within the issue at hand. Each brings unique strengths, vulnerabilities and life experiences which need to be taken into account when planning treatment.

Treatment must be tailored to the individual – always.

People want to get well – not only sober. To feel at home in their bodies and positive about themselves, others and their relationships – To be able to trust themselves – their thinking, abilities and choices.

Many clients who approach treatment with me had been sober before – for long periods of time and yet continued to be in physical and or emotional pain. Many have made attempts at sobriety in traditional drug and alcohol rehabs and attended daily Alcohol Anonymous (AA) or Narcotics Anonymous (NA) meetings – Worked with a sponsor through the 12 Steps of AA or NA.

Symptoms from chronic pain, mood disorder, trauma, attention deficit (ADD) or chronic physical conditions/ diseases involving the autoimmune system, or unresolved post-surgical complications can surface when the person stops using substances – “breakthrough” symptoms can result in powerful triggers fueling drinking and drug use again. Inflexible personality traits or personality disorders can also serve as barriers to effective therapy and treatment. Trying to manage what is not known or understood is confusing and painful for people.

Unfortunately, situations presenting this level of complexity are not uncommon. There are often multiple problems occurring at the same time, playing off one another. The idea that addiction is a singular issue is often a false construct – An incomplete, inaccurate or an ill-founded psychological concept.

Addiction often travels with other issues – It is critical that all of the problem issues are identified, understood and addressed in order to move towards stabilization and recovery. Expecting a person to reduce their drinking or substance use or to completely abstain (depending on risk) is not realistic without a comprehensive and holistic approach offering precise diagnosis and a personalized plan.

No problem is about “one thing and one thing only.”

Clients need and have the right to know exactly what the issues are and to be educated about them. Identification of the issues and a conversation about them needs to happen even if it means talking about conditions like borderline personality disorder (BPD), narcissistic personality disorder, Asperger’s or anything that is tough to accept.

If difficult issues are NOT talked about, they will sabotage treatment and leave clients confused and defeated yet again, resulting in an increased sense of hopelessness and helplessness. When people are not informed they are deprived of the opportunity to move through their own process of “self-diagnosis”, which means “Do I agree with this?” and “What does this mean to me?”

Knowledge is power.

Engagement and commit to change can only happen when clients are clear about what they are dealing with and have a sense of what to expect moving forward.

Effective treatment starts with a thorough bio- psychosocial assessment to obtain information about the major physical (bio), psychological, and social issues. A holistic approach posits that separate issues are often related. – No stone is left unturned in the interest of getting the “bigger picture” of what is going on.

Assumptions are dangerous.  Illnesses presented as being “treated” such as autoimmune disease, diabetes, depression or conditions that tend to be minimized like, Lyme disease, premenstrual dysphoric disorder (PMDD), or sleep problems can fuel addiction and its ‘problem behavior. Medical treatments often need to be reevaluated to determine if they continue to be effective.

People are not always consistent with or misuse medications. Many do not have a trusted primary care physician. There are oversights and misunderstandings that can happen which have the impact on any health problem.

So, the solution to the problem is only as good as it’s’ conceptualization. To be inaccurate or incomplete is time, energy and resource draining.

An integrative approach to addictions treatment and its’ co-occurring disorders is collaborative, thorough, health and well- being oriented – Not just about “one thing” or symptom oriented.