I graduated from social work school a few months after Newt Gingrich released his “Contract On America” – slashing social service funding. My graduating class was riddled with anxiety about their ability to get hired at all for the significantly diminishing, shockingly low-paying, and exhausting non-profit agency and state jobs that clinical social workers take out tens of thousands of dollars in student loans to be trained for.
After spending most of my twenties waiting tables in NYC, the $28,000 starting salary for my first agency job (with insurance and sick days!!!) seemed like a fortune. I was hired to work with severely and persistently mentally ill ex-offenders and found the work moving and intellectually challenging. Burnout seemed impossible! An abstraction, a professional hazard – but nothing to worry about personally! I had all my needs met, more security than I’d had ever before. Sick days!! Four weeks paid vacation and did I mention 30 sick days!!!!

It hadn’t occurred to me that those benefits were offered for a reason. And that I wasn’t earning enough to actually afford to go anywhere on those glorious paid vacation days…

The new schedule meant arriving at 8:30 am and clocking out at 4:00 pm – but staying until 8:00 or 9:00 pm to complete the ungodly stacks of paperwork, progress notes, treatment plans, assessment tools, documenting all contact with collateral service providers, phone calls, immigration applications, food stamps, Medicare, Medicaid, SSI forms, urine sample lab forms, parole officer reports, police reports, hospitalization and discharge forms, incident reports, alternative to incarceration assessments etc. I stayed late so that I could at least preserve the hours when my clients were on the unit, to provide some treatment, for god’s sake.

Around the second year, I realized that stress-induced migraine headaches and every imaginable cold and flu virus from a weakened immune system, were going to use up more of those sick days than I could have ever imagined.

And that a week or two of those vacation days were going to be used pinned to my mattress with dread, guilt, and paralyzing despair, unable to face again the multiple tragedies of the average work day. Supporting clients in taking, or not taking, horribly toxic but necessarily effective medication. Clients dying. De-compensating. Disappearing. Clients absorbing institutionalized abuse and perpetrating it on the street. Having men and women that I trusted, and who trusted me, their eyes terrifed, taken forcibly to the hospital in restraints because I had noticed some tell-tale but certain signs that the voices had returned, and were likely commanding them to act, as they had in the past, to harm others, maybe even me.

And the salary just didn’t seem like so much somehow.

This is the formula for burnout. The work itself requires that you take deep, vigilant care of yourself, just to come back to baseline. In order to do that, you need trips away from the city, some contact with the larger world and nature. Perhaps acupuncture or massage, at the very least, a new pair of running shoes or a gym membership: something to work the adrenaline out of your body. You need one or several blessedly peaceful hobbies or activities that have nothing to do with your work, and hours or days to socialize with healthy friends. You need to feed yourself clean, healthy food, have excellent sleep hygiene. You need a home that feels like a haven, and some faith in your ability to pay the rent. You certainly need plenty of your own therapy, private supervision, maybe group supervision too, and probably advanced training. And, especially in New York City, all this costs money, and time.

And you don’t have any, and you have to pay-off those humongous student loans too.

Although in social work school we talked about the possibility of burnout, the realities of poverty, the importance of entitlement programs and social policy, no one had ever talked about the necessity of money FOR the clinician, as an essential tool to buy time, purchase self-care, and to save themselves from sinking into the matrix of trauma that surrounds them everywhere, everyday.

My idealized, youthful, privileged fantasies about money “not being important” were gone with the wind. But the journey toward finding some kind of balanced, Self- and Other-respectful relationship with money would soon reach a new turn on the road.

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copyright © 2011 Martha Crawford