An Autoethnographic Exploration of Burnout Suffering Supported Through Spiritual Direction

by Dr Marlene Marburg PhD

Web-Exclusive Interview with Marlene Marburg

Preface

Writing a personal narrative of burnout is personally challenging. I am writing this to offer some autoethnographic input to the experience of burnout, to examine some questions which emerge from that experience, and to wonder why so many people suffer from it. This essay is ‘autoethnographic’ in that it includes personal narrative, research and commentary on a cultural and personal phenomenon, in this case, ‘burnout’. The process of writing asks me as the ‘researched’ to recall the experience of ‘burnout’ by immersing myself in what I think, feel and desire, almost as if I am reliving the story ‘now’. The writing is not only helpful as research data, but as personal consciousness-raising. When researching my own narratives, I try to maintain a degree of objectivity and be honest as far as I am able. I want to research any questions which emerge for me in the writing and reading, so that you, the reader, and I, the researched and researcher, have greater understanding through one story of burnout, and so discover useful ways to accompany a person suffering burnout. Through the process of writing this essay, I expect increased personal transformation and integration.

In writing both narrative and theory, this essay emerges from me as an inculturated individual; as an Australian female, having been educated in Catholic primary and secondary schools, divinity and secular universities in Melbourne. I was raised as the youngest of three daughters in the 1950s and 1960s in a working class Catholic family. At the time I suffered burnout, around 1980, I had been married for nine years and had two children.

The first section of this essay focusses on the theory of burnout and the second focusses on the way in which a person suffering burnout might be accompanied. As I write this essay, I have an audience in mind: sufferers of burnout, those who have an interest in it and want to learn from it for the future, caring professionals, spiritual directors and companions and professional supervisors.

Note about terminology: ‘Divine’ in this essay is the Source who or which is greater than all things and yet present in all things. There are many words used to describe the divine reality. I have mostly but not exclusively chosen ‘God’. Please replace the word with your preferred designation.

Introduction

The American Psychological Association dictionary (2020) describes burnout as:

Physical, emotional, or mental exhaustion accompanied by decreased motivation, lowered performance, and negative attitudes to oneself and others. It results from performing at a high level until stress and tension, especially from extreme and prolonged physical or mental exertion or an overburdening workload, take their toll. The word [burnout] was first used in this sense in 1975 by US psychologist Herbert Freudenberger (1926-1999) in referring to workers in clinics with heavy caseloads. Burnout is most often observed in professionals who work in service-oriented vocations … and experience high levels of stress. It can be particularly acute in therapists or counselors doing trauma work, who feel overwhelmed by the cumulative secondary trauma of witnessing the effects.

During the global COVID-19 pandemic (late 2019–), symptoms of burnout have emerged on a global scale. ‘Stress’ is cited as the cause. Queen and Harding (2020, 873) writing about widespread burnout in the ‘International Wound Journal’ (IWJ), define it as: “a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress.” ‘Excessive stress’ is key to this definition, and yet a person might only begin to know that the stress is excessive when symptoms present themselves. A third definition (Calmer, 2020) importantly states, “Burnout is the loss of meaning in one’s work, coupled with mental, emotional or physical exhaustion as the result of long-term, unresolved stress”. ‘Loss of meaning’ is serious content in spiritual direction, as directors and directees are particularly interested in meaning-making1 and how it affects a directee’s relationship with themselves, others, and the divine.

Burnout Research Studies and Findings

After months of appointments with my doctor, I asked him what was wrong with me. He replied, ‘burnout’. I didn’t know what that term meant. I knew I felt trapped in a lost place.

I suffered burnout in the early 1980s, five or so years after the term was first coined. A diagnosis can both clarif y and ‘box’ a person without due attention to their unique experience and symptoms. In seeking to find clear descriptors applied to ‘burnout’ I found most ‘burnout’ questionnaires are job specific2. At best, the diagnosis of burnout is a generalised statement about symptoms without uniform criteria for its assessment except that symptoms occur due to unmanageable stress loads leading to a loss of the ability to function normally.3

Burnout was a confusing, slow ‘burning’ of my body, mind and spirit. It coincided with two years of relentless back pain.

Stress can find its origin in imposed exterior or integrated interior ‘ideals’. For me, ideals were centred on moral ‘perfection’ according to my understanding of Catholic morality. Meeting these ideals became impossible, but firstly, I had to bring them into consciousness. Burnout was not only about my ideal-driven work as a stay-at-home mum, it was more concretely about negative thought processes, ingrained defaults left unchallenged during my life to that point in time. It made a large difference to my recovery when I discovered that my negative frameworks for thinking could be deconstructed and reconstructed with positive patterns of thought and belief which gave me purpose and hope.

Initially in burnout, physical symptoms are common. A study “Burnout in Healthcare Workers” found that “burnout seems to be associated with musculoskeletal diseases among women and with cardiovascular diseases among men.” (De Hert, 2020, 8) Physical symptoms are helped through various medical modalities but the psychological and spiritual symptoms which manifest in later stages of burnout become more difficult to address due to their uncertain causation. The effects of burnout are clear, and I expect that some urgency for pinpointing causes in relation to the global Covid-19 pandemic crisis will ensue.

The consequences of workplace burnout to healthcare workers in the De Hert study were grouped in two categories, work effects and personal life effects.

Consequences were … decreased job satisfaction, absenteeism, turnover in personnel, and cynicism. These effects at work frequently have repercussions on personal life such as feeling unhappy, anxiety, depression, isolation, substance abuse, frictional and broken relationships and divorce. 

De Hert, 2020, 8

Risk Factors for Burnout: Systemic and Intrapersonal

The article ‘Clergy Burnout’ (Grosch & Olsen, 2000) made progress in finding the causes for burnout in a clerical group. The abstract suggests that burnout can have a systemic origin:

Understanding how clergy, who begin their careers with high idealism, optimism, and compassion, burn out is difficult. One body of research suggests that clergy, among others, burn out because of the systems in which they work. From this perspective, burnout is the result of external systemic factors such as bureaucracy, poor administrative support, and difficult work conditions.

Grosch & Olsen, 2000

The authors also state that burnout has a personal predispositional profile:

[B]urnout is the result of intrapersonal factors such as high idealism, Type-A personality, narcissism, and perfectionism.

Grosch & Olsen, 2000

In a study of 676 nursing professionals in Spain, researchers attempted to identify the variables related to burnout and to propose a personnel risk profile for this syndrome. The researchers concluded:

The prevalence of burnout among nursing professionals is high. Gender, age, marital status, level of healthcare, work shift and healthcare service areas predicted at least one of the three dimensions or dependent variables4 1. emotional exhaustion, 2. depersonalization5 (Anxiety UK, 2021) and 3. personal accomplishment, of the syndrome. Neuroticism, agreeability, extraversion and conscientiousness are personality traits that predict at least two of the dimensions of burnout syndrome in nurses. Therefore, personality factors should be considered in any theory of risk profiles for developing burnout syndrome in the nursing profession.

Fuente et al., 2015

If there is a personnel risk profile for nurses, perhaps there might also be one for workers in allied fields of care such as in spiritual direction. In the Heart Wisdom6 spiritual direction formation program, spiritual directors in formation do not undergo personality assessment at preliminary interview or fill out any questionnaires other than for self-assessment during the course of formation. Other programs may require applicants to complete personality assessments including those for the purpose of information or assessment to ascertain a prospective participant’s disposition to burnout.

Queen and Harding write that a COVID legacy is societal pandemic burnout in which we are stressed, ‘feeling overwhelmed, emotionally drained, lacking energy, empty and unmotivated, and unable to meet daily demands’. (Queen & Harding, 2020, 873) Further symptoms of pandemic burnout, are, ‘an increase in irritability, … increased conflict in your relationships, or feel[ing] like you want to crawl into your bed and never get out. You feel stuck, exhausted and hopeless.’ (Queen & Harding, 2020, 873). Understandably the global community has taken time to absorb the far-reaching consequences of managing ordinary family and work commitments. Perhaps employers and employees alike ought to consider that trying to work from home during the COVID-19 is secondary to trying to cope with the new experience of a global pandemic crisis.

Why is Burnout Widespread?

Researchers endeavour to give reasons why burnout is widespread globally. There is medical evidence that the body’s chemical reaction to stress helps a person manage gainfully in a given situation. However, that response can contribute to burnout when there is a frequent oversupply of generally helpful hormones. Michaela Cimberle in 2019, comments on Hans Selye’s research and quotes Bayerle-Eder:

In his general adaptation to stress model, Hans Selye clarified this double, positive or negative, outcome of stress. The alarm reaction to a stimulus leads to the release of cortisol, adrenaline, testosterone, oxytocin and dopamine and consequent activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system.

“This is a good, adaptive reaction. Typically, … these hormones help to focus on the task and enhance your potential. However, overactivation of these stress adaptation reactions leads to burnout and depression,” Bayerle-Eder said.

Cimberle, 2019

One can hypothesize that this overreaction might occur in many occupations and situations where accountability is high such as medical and paramedical professions, law and accountancy, armed combat, operating heavy or dangerous machinery, and in public persons who experience the pressure of social and political correctness. According to Maggie Kimberl (Riggio, 2020) reporting on United States research for Psychology Today in 2019:

There are also the pressures that clients put on service providers. Cimberle in the 2019 article, ‘Stress, Burnout Widespread and Underacknowledged among Surgeons’ offers the following:

Today, one in three employees blames tech for excess job stress. Because email is cloud-based and can be accessed anywhere, there is an expectation that it should be answered, day or night, within a few hours. Other tech tools that are meant to keep our teams cohesive can also feel like a digital leash, binding us to the stress of our day jobs in our off-hours. Workers report the following about tech: 45% say there is an increase in their workload; 33% say their deadlines are tighter; 29% say tech has made them feel more socially isolated.

Cimberle, 2019

51% of workers have felt burned out at least once

77% of professionals report feeling work-related burnout

84% of Millennials report feeling work-related burnout

64% of workers report feeling stressed or
frustrated at work at least once a week

44% say stress is related to a high-pressure environment

38% say stress is related to problems with management

30% say stress is related to unrealistic expectations

Five Stages of Burnout

The article “What are the five stages of burnout?” (Calmer, 2020) draws on the Winona State University’s burnout study which outlined a five-stage schema for burnout. The stages are 1. Honeymoon; 2. Balancing Act; 3. Chronic symptoms; 4. Crisis and 5. Enmeshment. Though focussing on stages is not critical in spiritual direction, knowing the stages can be helpful in affirming and normalising experiences and symptoms. Below, I briefly describe my experience in italics and pair it with the relevant stage. I also add my religious or spiritual experience of that particular stage.

1. Honeymoon

I left my work in a high-pressure radiology clinic to become a stay-at-home parent for the years our children were preschoolers. I was in my middle to late twenties. Parenting was my job. I had unspoken beliefs regarding good parenting. Many of the standards were how I thought any good Christian should behave. They were based on the ten commandments and the commandment to love others as I loved myself. (Matthew 22.39) There were other standards which I self-imposed such as good communication, teaching and playing with with the children and watching them at play. I wanted to be a good mother.

This ‘honeymoon’ stage is the early optimistic and positive experience of working in a new job. It incorporates the stress of coping with many new things and trying to achieve at one’s best while remaining committed. If coping patterns are healthy, the person can remain indefinitely in this stage as a creative and adaptive person. If they are unhealthy, burnout into the future is a possibility. I did not yet know that I could never meet the unrelenting standards I had set for myself.

At level 1, I needed affirmation as I had not yet learned to self-affirm. I also needed some education about what was realistic for new parents, and what I could expect from myself, my partner and our children.

2. Balancing Act

I joined my neighbour’s prayer group. At this time, I gave my life to Christ in an evangelical kind of way. I had been a Catholic Christian all my life, so making a statement publicly seemed to be just another witness to my faith.

Our children were preschoolers when we left our Catholic church and though I had been baptised Catholic as a baby, I was baptised again into a Baptist Community. I enrolled in a Bachelor of Theology and studied at night to minimise interference with other responsibilities.

I experienced bone deep tiredness from the study, daytime work with the children, home-making, and from interrupted sleep. I noticed my hands trembled when I held a cup of tea. I experienced confusion and lacked peace. I didn’t understand why I increasingly felt that way.

The balancing act stage is characterised by the following five experiences:

1. Dissatisfaction with the job

2. Inefficiency, losing things, avoidance of decision-making

3. Fatigue including deep muscle fatigue

4. Sleep disturbances

5. Escapist activities

At this level, I needed some general and realistic education about what is possible for working parents who study part-time. If I had learnt then about the principles of discernment from the Spiritual Exercises of Saint Ignatius of Loyola (Fleming, 1996) which I did much later, I would have been helped me to know that unless I am doing what is life-giving, I will suffer inordinate stress and be at risk of burnout.

3. Chronic Symptoms

The kindergarten teacher described me as an overprotective mother. She gave me no real evidence for that judgement except that I was reluctant to send our child to the kindergarten five-days per week as most other parents at that kindergarten had. I felt upset. Her judgement drilled its way into my self-doubt. I knew that I was anxious, fearful, depressed and tired and I could not imagine that I would ever feel better. Now I felt angry as well. A kindergarten mum said to me – “you will have to do something about how you feel”. She proceeded to tell me that she was taking medication to help even out her mood swings and she expected to be on it for her lifetime.

The intensified stage two symptoms are:

1. chronic exhaustion,

2. physical illness,

3. heightened anger and

4. depression.

When I was described as an over-protective mother, I became more resistant, unhappy, angry and self-doubting. I needed to hear that kindergarten mum say I needed help. I needed to have some diagnostic tests to ascertain the origin of my symptoms. I also needed some talk, music and/or art therapy. I would have benefitted greatly from spiritual direction, that is, having someone who could listen to my life-story including the important spiritual dimension. I also needed, but didn’t know it, a personal relationship with the divine lover.

4.Crisis

Burnout was a crisis of identity (Erikson, 1980). I battled with the tide of ‘shoulds’ permeating me. My brain was exhausted trying hard to measure up to my ‘ideal’. And my back was chronically painful. I simply wanted to get out of the prison in which I was entrapped. I did not blame ‘God’ – It would have been too risky to do that!

I often contemplated the crucifixion of Jesus and how I had put Jesus on that cross through my sinfulness. This was a form of self-abasement which I thought was a necessary way to pray.

I judged myself to be difficult to live with. I was depressed and full of shame for being who I was.

I went on a two-week retreat. On the last day I confessed to the retreat director that I was full of shame at not wanting to go home. I felt trapped. He suggested that I consider the possibility that I might be free to choose to go home or not to go home. I took this question seriously. Having a choice was a whole new framework for thinking.

The following symptoms become seriously life-depleting:

1. Obsessions

2. Pessimism

3. self-doubt

4. escape mentality.

The retreat director was a wise and insightful priest and spiritual director. I needed his wisdom. He recognised the importance of self-authorisation in decision-making. This was the first time in my life that I considered I could be free to make my own decisions. I decided to go home. After that breakthrough I began to transfer my new learning into many situations.

5. Enmeshment

I did not think I would ever be released from my feelings of depression and anxiety but as I slowly faced the thoughts and beliefs of my childhood, I was able to disentangle from the narrative frameworks which had been imposed on me and which I embodied.

‘Enmeshment’ is characterised by symptoms of anger, depression and/or anxiety. These symptoms often carry other labels. ‘Enmeshment’ implies an experience in which a person is not conscious of what causes the symptoms. I had to face the feelings of entrapment, and I could not do it alone. Little by little the threads were separated and the entangled and trapped sense of myself diminished. It took years but I gained power I did not know was possible. Seeing a spiritual director not only met my needs for companionship and understanding, but also met my need to prioritize my relationship with divine mystery and allow that relationship to contribute meaningfully to my identity as a loved ‘child’.

Early Support: Lostness to Presence

Even now after more than thirty years, there are events which trigger memories of burnout. A sinking interior darkness can occur simply by walking to my letter box. Perhaps this occurrence reminds me of when I wanted to hide indoors and not speak to anyone. There are triggers for powerlessness and betrayal which threaten to trap me. A bird in a cage is one of them.

Trusting Authority

While in the crisis of burnout, a friend suggested I see a particular priest. I came away from the priest’s office more confused. After six months or so, he chose to end the spiritual direction relationship. He seemed angry with me. I came away from the priest’s office more confused.

This priest’s professional boundaries were poor. His priestly role made his boundary violations worse. He held the power in the relationship, and he abused it. I suspect he was actually angry with himself.

In burnout, anxiety caused a loss of sleep, energy, confidence and body weight. It felt like insects gnawing my stomach. The word ‘burnout’ is a trigger of anxiety for me.

I felt drained and miserable. The inner experience was darkness and shame and a sense that no one would want to be with me or help me. I felt as if I was in a lonely and lost place. I didn’t answer phone calls or doorbells. A few people discovered how unwell I was. They occasionally delivered meals.

Fear and self-loathing stopped me from reaching out. What would have been joyful in the past was no longer. I was lacking compassion, especially self-compassion. Burnout heightened feelings of sadness but lowered feelings of pleasure and happiness. I became tired of my own monotonous voice. The aftermath of the burnout lasted many years, and even now, decades later, I find at times I suffer a loss of empathy and lowered affect. This is consistent with symptoms of burnout as in Winona State University’s adaptation of Veninga and Spradley, 1981, five stages of job burnout.

There was shame associated with seeking psychological help. I was supposed to be independent and self-resourcing. Finally, I sought help from a doctor who offered a wholistic approach to healing. He prescribed a drug for depression and anxiety. After taking it, I could not get out of bed for more than a day. I felt panicky. I refused more drugs.

Throughout the year of these visits, I developed a language to share my feelings and beliefs about my family. When I began to feel better, my doctor referred me to his wife. Fortnightly at her country home, she and I meditated for an hour in silence. Then we shared tea, spoke about the experience and I went home. After one period of silent meditation, I opened my eyes to find light more clear and beautiful than I had ever seen it before or again.

I stopped going to see her, except once when we met in the city to share lunch together. A few weeks later she and her husband were killed in an accident. I went to their incredibly sad memorial service and tried to come to terms with the grief of their family as well as my own. It was not long before I encountered a strong sense that I would continue my companion’s work. I trusted that it would happen at the right time.

It is common for spiritual people to fall into a state of malaise and depression while continuing their ministerial work. Mother Teresa of Calcutta was known to describe her feelings in relation to God as empty and silent. (Kolodiejchuk, 2007)

The recovery from my particular burnout required a whole new framework for living. Every shaming narrative had to be faced and reimagined, and the new divine narratives had to be trusted and believed until they became the default. A competent and supportive spiritual director accompanied me in the dismantling and opening process. It became clear that my burnout symptoms were the outcomes of a poor self-image and low self-worth.

"Burning Bush"

— Christen Mattix

Spiritual Direction for Burnout Sufferers: Who Does the Divine in You, Say You Are?

The experience of burnout includes elements of the description that Ignatius of Loyola offers for desolation. He describes it as,

Darkness of soul, disturbance in it, movement to things low and earthly, the unquiet of different agitations and temptations, moving to want of confidence, without hope, without love, when one finds oneself all lazy, tepid, sad, and as if separated from his Creator and Lord.

Fleming, Spiritual Exercises #317

Accompanying a person in burnout requires a working knowledge of discernment and the capacity to discern, in collaboration with the person, whether they are in consolation, that is, being exercised by love, or desolation, that is, being agitated by life-depleting interior movements.

If the burnout develops from a life-long narrative, a new directee7 might not be conscious of the dysfunction involved in that narrative, be it the narrative of a culture and society, family of origin, current family or religion. The unspoken and unknown narratives can be difficult to elicit. On the surface the suffering directee might appear to function reasonably well in work and family life but, at heart, an inner child needs to be heard and loved. So, this kind of spiritual direction is likely to be long-term and not for a spiritual director on the verge of burnout him- or herself.

As in all spiritual direction, a spiritual director would ask a new directee suffering burnout, if they were in psychotherapy and with whom. The director would explain what spiritual direction is (task); the director would outline appointment constraints and the limitations of contact between appointments (time); the director would state where the direction sessions would be held, and make clear that spiritual direction is a ‘no touch’ modality (territory). The director would ask what the directee wants from spiritual direction.

A spiritual director helps a directee to speak about their image of God and experiences of God. To a large extent, the director’s work is to help the directee to hear their own narrative and explore whether it is life-giving or life-depleting. In Christian terms, the director’s work is to hear God’s narrative in the person, and to wonder about who God says the directee is. The director is a companion who envisions the directee as a whole, discerning and free person. The director is able to do that because he or she has examined their own life experience, noticing the strength and love which the divine offers every moment in the life of each person.

When burnout (or a description of burnout) emerges in the conversation, the director would ask when the person began to feel exhausted; would ask about what was going on in their life at that time; what thoughts they were having now and how these thoughts made them feel; the director would listen to the directee’s story and their feelings about it. The director would at all times think and want the best for the directee, would not push, force, make judgements or speak for the directee. The director would listen to all the directee’s emerging emotions and their descriptions; would ask what experiences in life engender life-depleting emotions and which experiences engender more life-giving emotions.

The Winona University website optimistically states that it is always possible to move back up the scale towards Stage One: Honeymoon. The website authors also state that good self-care and awareness can prevent the descending sequence of stages in the first place. In terms of spiritual direction with a person suffering burnout, the five stages of burnout progress in order but the healing of burnout is not simply the reverse process. The symptoms are not neatly contained and healed before moving upwards through to the next stage.

Being fully present in spiritual direction to a person in burnout, requires the director’s belief that it is possible for transformation and healing to happen. Patient love and accurate empathy can support that healing. One must risk exploring the symptoms so as to find their origins. As this exploration takes place, the person in burnout begins the journey of self-trust and eventually embraces the true self which is the divine self. Recovery comes through the awareness that only divine love and companionship can draw a person into a divine healing embrace.

Spiritual direction is a modality which affirms and honours the presence of the divine in every directee. It is through spiritual direction that a person can have their narrative respectfully heard, explored and at times challenged. Knowing that it is the divine which heals, the director leads the directee to the divine through sensitive interventions.

Moving Through Burnout to ‘Life’

The schema below indicates some key movements in the process of healing burnout when paying attention to somatic experiences, and following a person’s process in order to access the content of the unhelpful frameworks for thinking in the person with burnout. The movement could simply be described as:

Symptoms

double_arrows

Narrative

Possibilities

Hope

Love

A brief explanation of each stage is outlined below.

a. Symptoms

A person comes having experienced short or long term symptoms without registering their origin. Examples are:

Vertigo – feeling unstable

Lung disease – unable to breathe

Rashes – feeling irritated

Stomach issues – feeling sick in one’s belly.

Symptoms are key to their source and hence important in their healing.

b. Narrative

A narrative emerges from listening deeply to the symptoms. Memories emerge. A gentle approach to ‘who do others say that I am?’ and the emerging unhelpful narratives reveal some of the source of the symptoms, e.g. the self-hatred story originating in ‘You make me sick!’ or ‘You are a bad child!’ or the story of shame and self-doubt originating in ‘You are a liar! No-one will believe you!’

c. Possibilities

The directee might be prompted to ask, ‘Who am I really?’ Who does the divine say that I am?’ ‘Am I fooling myself?’ Through actions and words, the spiritual director helps in the reinforcement of a divine narrative. In time, the directee begins to relinquish unhelpful frameworks and narratives of belief.

d. Hope and Grief

Relationship with the divine becomes primary. The divine narrative for example in the Judeo-Christian texts might be ‘You are precious in my sight and I love you’ (Isaiah 43.4). ‘God saw that you were good’ (Genesis 1.31). ‘Well done, good and faithful friend’ (Matthew 25.23 adapted). ‘If God is with you, who can be against you?’ (Romans 8.31). The spiritual director honours the directee’s experience by listening to where the life emerges from all of a person’s life narratives.

e. Love

The spiritual director as co-discerner with the directee, listens to where love directs the directee. Initially this can be challenging but as the person more consistently becomes intimate with the divine alive within, the desire for love and to love becomes more evident. The directee becomes aware of the patterns of their vulnerabilities, and desires to move towards life and love and away from fear and hate.

By staying with a person’s symptoms, a somatic experiencing practitioner will have the therapeutic tools to help a person find the cause of such symptoms. A qualified spiritual director who listens to a wholistic experience (body, mind and spirit) of a directee might come to a place of healing in a similar way. The directee might speak literally or figuratively about how they feel; they might use art or poetry or music or dance to express their feelings; and through those artistic media, they find words and meaning to their experience. Depending on the extent of the burnout, the sufferer can be helped by focussing on his or her life narrative; talking about that narrative, questioning and challenging unhelpful aspects of the narrative, sifting and sorting, reframing and embracing the new narrative. A spiritual director does well to encourage the person to speak about the way that God is present or absent in the experience of burnout..

I explained to the priest that I feared I was going to lose Jesus, and he replied simply “You won’t lose Jesus”.

The priest assumed he knew what I meant, and his affirmation preserved the external locus of authority. A spiritual director would have explored how I felt and what it was about Jesus that I could not bear to lose. In this case, I actually needed to lose or at least transform an image of Jesus which no longer sustained me.

A large part of my healing happened through reflection on my relationship with a significant care-giver. It takes a great deal of courage to forgive. I was to let go of my expectations of this care-giver and accept the limitations of that person.

Obstacles to ‘Staying With’ the Directee

It seemed possible that I had lost my faith. The God I thought I knew was nowhere to be seen, heard or felt. One day I said to God: “the only reason I know that you are real is because I am speaking to you”.

How I had the confidence to believe myself is mysterious. I know at some level that the confidence I felt was the presence of the divine affirming and encouraging me to notice that I could believe myself. Having absorbed self-doubt at age five amidst a difficult experience, confidence was no small gift. Gradually I began to believe that God was in all of nature; clouds, air, people and all things. God was not at an unfathomable distance, watching me. A compassionate presence was right there with me.

Some people need to be companioned into the ‘lost place’ when alone they cannot trust that divine life will be found there. If a director’s own unaddressed experiences are triggered, the companioning will become difficult, and hence need good supervision. A spiritual director does not need to have a history of burnout in order to stay present to a directee with burnout, but the director must have addressed their own darkness (fear, depression, anxiety, anger, and various hurts) sufficiently so as to stay as long as it takes for the directee to share their experience several times over as required. The director takes the cue from the directee. If the directee senses that the director is becoming impatient or bored, the directee might not have the ability to discuss that with their director. If there is a standstill, the director might suggest that the directee see another spiritual director. If a directee trusts the director, the directee will continue to narrate their experiences (for example, anger and sadness) for as long as it takes to have the important elements of their story heard.

The Johari Window

The emergence of unknown material into known conscious areas of the mind is exemplified by the well-known Johari Window (Apricot Training Management Limited, Awareness, 2013) created by psychologists Joseph Luft (1916-2014) and Harrington Ingham (1916-1995). The four quadrants are described as:

1. Open Self – known to self and known to others

2. Hidden Self – known to self and not known to others

3. Blindspot Self – not known to self, known to others

4. Unknown Self - unknown to self and others.

In relation to this four quadrant schema of understanding self and others, the director and directee travel ‘blindly’ in the ‘Unknown Self’ window. This window is gradually accessed by staying open, curious and conscious to the inkling of new possibilities in relation to self and others. In this area, spiritual direction more truly trusts in divine communication, both rational and non-rational. It is a hopeful experience when director and directee let go of needing to be wise in favour of waiting on divine communication and its inherent invitation.

If director and directee are both operating in the ‘Hidden’ and ‘Unknown’ quadrants, the director might explore the relevant material with an astute supervisor. The director and directee may be colluding unconsciously to stop the unknown material coming into consciousness. The supervisor will do well to stay with the director’s experience and explore tentatively what might be happening in the directee or in the spiritual direction or supervision relationship. It is important that the directee retains the power over the disclosure of not yet palatable material.

Staying with a directee’s experience in the ‘Known to others, not known to self’ quadrant of the Johari window, can be challenging. It is unwise for a director to name what remains hidden to the directee. Always it is best to address the directee with a question and to notice their growing awareness.

Telling the Story

The important foci in spiritual direction are relationships with self, others and the divine. The important approach or process is to allow the directee to lead, most often through spoken narrative. To underline the importance of a relationship focus (relationship with self, with others and with the divine) within spiritual direction, I offer the following present-day short reflection related to my experience of burnout. I also ask questions which seek to uncover what the symptoms imply about my personal needs and how spiritual direction might address those needs.

I notice that in the process of writing the present essay, I lose concentration and energy quickly. I am having trouble being clear and focussed. Although I do want the story written, the emotions in committing the experience to the essay are challenging.

1) As I write my experience of burnout, I lose concentration and energy quickly. I have trouble being clear and focussed.

  • What do I need? I need many pauses and breaks. I need to breathe deeply and concentrate on my breathing so that memories are not revived, and competing thoughts do not have sway. I might need someone to sit with me to teach me how to do this kind of breath meditation. Although the crisis of burnout occurred decades ago, I can see that I am still vulnerable to its negative power. If I share the present-day experience, I need a skilled companion who will honour my story.

2) The emotions in committing the experience to the essay are challenging.

  • What is happening in me as I both want to write the experience but want also to run away? As I recognise fear and desire are competing, I am more able to allow these two truths to co-exist. However, I understand that fear could rob me of my desire to write a research narrative which could be useful to others.

3) I have a vague sense that I am trying to distance myself from the burnout experience. I notice that I am using the passive voice (I do want the story written) rather than the active voice, (I want to write the story).

I notice that when I use the passive voice, I fail to be fully engaged in the writing, almost as though I am writing about someone else which, at some level, I wish were true. Now I have become aware of wanting to distance myself from the narrative, I will be able to take full responsibility for what I say. I need also to write in the empowering active voice.

Self-Care

As members of a caring profession, spiritual directors and supervisors of spiritual directors are vulnerable to burnout and would benefit from a regime of good self-care, especially when working with traumatised directees, such as those suffering burnout. To avoid the occurrence of secondary trauma, a spiritual director would benefit from:

a. Sustaining

a meaningful prayer/reflective/contemplative practice

B. Practising

self-supervision and regular supervision with a competent supervisor

c. Engaging

regular spiritual direction

d. Following

good diet, exercise and sleep/rest practices

e. Scheduling

regular social, hobby and other life-giving activities.

Forgiveness and Love

As I write this today, I am grateful for emotional and spiritual healing. My carer had a history which made coercive control understandable, but I was not the cause of my carer’s distress. However, it took a long time for me to believe in myself, to forgive myself and to give and receive love.

Unrelenting standards are often traced back to parental expectations of a child. A child-adult will need a considerable amount of support before they can become ‘unrelentingly’ merciful to themselves. The process is dynamic and evocative. Its dynamism asks a question: are you free to choose life, that is, to flow in the stream of life?

Approaches to treating burnout syndrome should be guided by the severity of the symptoms. If these are minor and slight, measures such as changing life habits and optimizing work–life balance are recommended. These measures concentrate on three important pillars: relief from stressors, recuperation via relaxation and sport, and ‘return to reality’ in terms of abandoning the ideas of perfection.

De Hert, 2021, 9

If the symptoms are chronic and severe, the person in burnout is likely to need multiple practitioners and approaches. In spiritual direction, the focus is always on relationship with God, self and others. How has burnout impacted the directee’s sense of God’s activity in her/his life? What changes have occurred from when she/he felt hopeful and motivated on the journey with God? What are her/his narratives and frames of reference in terms of how God ought to be with her/him in life? In other words what is his/her image of God? Has experience strengthened that image or weakened it? Are they helpful images? Are they consistent with a large view of life? Is the narrative open, fixed or flexible? De Hert’s study has this to say about the key issues in restoring a person to health:

A first strategy focuses on relationships. It refers to an understanding of the importance of spending quality time with family, friends and significant others. This strategy also includes actively developing connections with colleagues, to share and reflect with them on emotional and existential aspects of being a physician [or whatever work is shared in common]. A second element that seems to promote well-being in some people is religious belief and/or spiritual practice.

De Hert, 2021, 9

In supervision of a spiritual director, the focus is also on relationships especially in terms of vocation and best spiritual direction practice of the supervisee. What is the relationship between the client and the system in which they work? How do they feel about the system? Is it fair and just in terms of a clear job description? Has the workplace honoured the job description and given the employee the tools and the freedom to make decisions within that job description? Is the system open to change?

Conclusion

This essay has focussed on the symptoms and possible causes of burnout in individuals and systems, and has considered important questions for spiritual directors working with burnout sufferers. Through the death of my spiritual companion, I found an unexpected vocational call which gave meaning and purpose to being formed as a religious educator, pastoral carer, and later, a spiritual director. That call came during my final stages of burnout and in time brought relief from burnout and its accompanying depression. Prayer and spiritual direction have sustained me and deepened my awareness of the divine presence in all things. Feelings are an indicator to my relationship with the divine, but they are not a measure of the divine’s relationship with me. Divine life is in me. God is in all things, all creation, the cosmos, our planet, people, flora and fauna. I believe we are all in the divine life.

Through writing the autoethnography, I have more fully accepted the causes and symptoms of burnout which happened over 30 years ago. Knowing one’s personal limits and boundaries, learning to accept weakness, vulnerability, powerlessness as well as strengths and power in divine presence are key to becoming truly free and fully oneself. I encourage readers to consider further research into burnout, depression, anxiety, and spiritual dryness amongst directors and directees, with a view to enlarging the pool of knowledge for spiritual directors and supervisors. The practice of spiritual direction has much to offer our contemporary world. It nurtures our sense of hope, meaning and purpose in life and our self-esteem born of our relationship with God.

David Steindl-Rast’s comment to David Whyte when Whyte was suffering burnout: “The antidote to exhaustion is not necessarily rest … The antidote to exhaustion is wholeheartedness” is a conclusion to a process. Coming to wholeheartedness is a long journey into re-framing, re-entering a relationship with oneself, finding one’s call or meaning and doing it.

I am grateful for the people who have honoured me as I grappled with difficult feelings so that I might access the events which recurred often enough for me to think and believe that there were no other ways of thinking and believing and no way through depression and burnout. There is a way through. I have found it. It comes to us in unfolding the miracle of patient love along with hope that healing is possible. It is divine love and compassion, precious and accessible within each of us, and supported graciously by a spiritual director.

Footnotes

1 Meaning-making can mean ‘faith’ as for example in Tillich, 1957.

2 Any questionnaire finding its authority in Christina Maslach, (1947 – ) an American social psychologist and professor of psychology and known for her work on occupational burnout, are prefixed with MBI (Maslach Burnout Inventory). There is a non-occupational MBI: MBI-GS (GS=general survey).

3 American Psychological Association Dictionary definition of ‘normal’ is “relating to what is considered standard, average, typical, or healthy. … most often applied to behavior that conforms to a culturally accepted norm, especially as an indication that a person is mentally healthy and does not have a psychological disorder”.

4 Dependent variables (x) are those which depend on other factors which are measured e.g. x= y+2. Independent variables (y) are those which are changed in an experiment and the dependent variable changes in relation to the independent variable.

5 ‘Depersonalisation Disorder is the experience of feeling unreal, detached, and often, unable to feel emotion. It is a phenomenon characterised by a disruption in self-awareness and emotional numbness, where many people feel that they are disconnected or estranged from one’s self. Many people experience depersonalisation during a panic attack and this is often characterised as the peak level of anxiety. It is one way that the mind copes during periods of high levels of stress. For some people the condition can feel as though the world around them is like a movie that they are watching rather than specifically being a part of it’ (Anxiety, UK, 2021)

6 During the pandemic, the Kardia Formation Pty. Ltd. Heart Wisdom Program for the formation of spiritual directors operates solely online from Melbourne, Victoria, Australia. http://www.kardia.com.au

7 In this essay, I use the designation ‘directee’ as there is a different emphasis in spiritual direction than in counselling (‘client’) or another modality (‘patient’, ‘employee’, ‘peer’ or ‘colleague’) although each practitioner does want what is perceived as best for the other. Each practitioner will also have their own emphasis and hence I expect, will be able to make change in care strategies for that modality.

8 ‘Forgive’ in ancient Greek means ‘let go’.

References

American Psychological Association. Dictionary of Psychology. (2020) “Burnout”. https://dictionary.apa.org/burnout. Also “Normal” at https://dictionary.apa.org/normal

Anxiety UK “Anxiety https://www.anxietyuk.org.uk/anxiety-type/depersonalisation/ Accessed 4 January 2021.

Apricot Training Management Ltd. “Understanding the Johari Window Model” (2013) Self-Awareness. At https://www.selfawareness.org.uk/news/understanding-the-johari-window-model

Calmer. (August 2020) https://www.thisiscalmer.com/blog/5-stages-of-burnout

Cimberle, Michaela. ‘Stress, Burnout Widespread and Underacknowledged among Surgeons’ reporting on Bayerle-Eder MD, PhD. Michaela ‘Understanding Stress’. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 13-18, 2019; Paris. https://www.healio.com/news/ophthalmology/20190920/stress-burnout-widespread-and-underacknowledged-among-surgeons

De-Hert, Stephan. (2021) Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies. Local and Regional Anesthesia, (13), 171-183. Retrieved from Local and Regional Anesthesia website: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604257/

Erikson, Erik H. (1980). Identity and the Life Cycle. New York and London: W.W. Norton.

Fuente, Guillermo A Canada-de la, Vargas, Cristina, Luis, Concepcion San-, Garcia, Inmaculada, Canadas, Gustavo-R, &Fuente, Emilia-I de la. (2015) “Risk Factors and Prevalence of Burnout Syndrome in the Nursing Profession. International Journal of Nursing Studies, 52 (1), 240-249.

Grosch, William N, & Olsen, David C. (2000). Clergy Burnout: An Integrative Approach. Journal of Clinical Psychology, 56 (5), 619-632.

Kolodiejchuk, B. Ed., (2007). Mother Teresa: Come Be My Light—The Private Writings of the Saint of Calcutta, Doubleday Religion.

Riggio, Ronald E. (author using the research of Maggie Kimberl) in “Even Under the Best Circumstances, Burnout Is Widespread: When does job stress lead to burnout?” 26 March 2020 in Psychology Today https://www.psychologytoday.com/us/blog/cutting-edge-leadership/202003/even-under-the-best-circumstances-burnout-is-widespread

Thibodeaux, Mark E. (2020). Ignatian Discernment of Spirits for Spiritual Direction and Pastoral Care: Going Deeper. Chicago: Loyola Press.

Winona State University. Burnout. Chapter 9. “Stages of Burnouthttps://www.winona.edu/stress/bntstages.htm

Whyte, David and Br. David Steindl-Rast. A Network for Grateful Living. (2000 – 2021) E-course “Gratefulness: Life as a Wholehearted Journeyhttps://gratefulness.org/dw-session-1-transcript/

World Health Organisation. “COVID-19 disrupting mental health services in most countries, WHO survey” (5 October 2020) https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey#:~:text=Bereavement%2C%20isolation%2C%20loss,outcomes%20and%20even%20death.

This Article Appears In

AN INTERNATIONAL JOURNAL OF SPIRITUAL DIRECTION + COMPANIONSHIP

Vol. 28 | No. 1 | MARCH – 2022

Author

Dr Marlene Marburg PhD

is a codirector at Kardia Formation, a center for spiritual formation in Hawthorn, Melbourne, Australia. Her doctoral work with the University of Divinity, Melbourne, Australia, was entitled “Poetry and Grace: An Autoethnography Which Explores Poetry as Prayer in the Context of Ignatian Spirituality.”

Artist

Christen Mattix

makes paintings and poems in her studio in Mount Vernon, WA.  She received a BFA in studio art from Western Washington University and an MFA in Painting from the San Francisco Art Institute in 2005.  She has exhibited widely including The Whatcom Museum in Bellingham, WA; SAM Gallery in Seattle, WA; and throughout the U.S.

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