CASE STUDY 1

Ms. Z is a woman, 31 years of age, who just completed her Master's degree in counseling. She is recovering from an alcohol use disorder and has been sober for five years. She is now working her first job as a counselor at a small facility for dual-diagnosis patients. At first, Ms. Z likes her job and feels it is a blessing that she is able to work in an environment that promotes recovery. As a result, her own attendance at 12-step meetings has decreased. About three months into the job, Ms. Z notes that certain aspects of her job are overwhelming. She is finding it difficult to keep up with the rate of discharges and admissions, and she is disheartened that so many patients who she thought would do well are re-admitted to the hospital. Ms. Z has noticed that her heart is beating faster at work, and it is taking her longer to settle down at the end of each day. Nonetheless, she is still optimistic about the prospect of working as a counselor and has been talking actively to her sponsor in Alcoholics Anonymous about how to best cope.

Let us return to Ms. Z, a woman who has been working as a counselor and is also recovering from an alcohol use disorder. To deal with her mounting stress, Ms. Z elected to talk to and be honest with her sponsor about her mounting stressors at work and her erroneously held belief that she was getting recovery vicariously through her patients by working with them on their own recovery. As a result, Ms. Z increased her own 12-step meeting attendance to four meetings a week and made a point to attend meetings her patients were not likely to frequent. She and her sponsor also made a plan to check in by phone once a week about the work-recovery issue.

CASE STUDY 2

Dr. V is a psychiatrist, 50 years of age, who works in an inpatient hospital. Dr. V has been described as unusually kind, compassionate, and empathetic toward patients and colleagues alike. He has a history of dysthymia, for which he received antidepressant therapy. However, Dr. V stopped taking the medication five years ago. Four years ago, Dr. V was offered the position of medical director at a large, reputable psychiatric facility, and he was very excited about procuring this prestigious position. However, Dr. V quickly learned that the job was intense, time-consuming, and stressful. He realized that many of the administrative duties were burdensome, and when dealing with the facility's chief financial officer, he always felt like he was being punished. In the last two years especially, Dr. V has felt that the facility is sacrificing quality of care in order to accommodate more patients. He feels powerless to change much of what he sees wrong in the hospital. Although Dr. V maintains that he enjoys being a psychiatrist, he is wondering if he is right for the position that he once coveted. He recently became concerned when he learned that many of his nurses, who once described him as unusually compassionate, have become afraid to approach him.

Recall also Dr. V, a psychiatrist flirting with burnout. After talking to friends for support, Dr. V decided to visit his own psychiatrist again after five years of being off of medications. Dr. V and his physician mutually decide to initiate a low dose of a selective serotonin reuptake inhibitor antidepressant. He also begins to see a professional counselor again to readdress and redevelop a plan for self-care. For the time being, Dr. V agrees to be monitored by his psychiatrist with appointments every three months.

CASE STUDY 3

Ms. P is a social worker, 35 years of age, who has been working for the child protective services agency in her county for seven years. Ms. P's time at work is spent in a crowded cubicle at the office or going out into very dangerous situations in the field. At first, Ms. P enjoyed helping others, but she very quickly found working for the agency, who she perceives as corrupt, to be burdensome. When she entered the field, she was eager to help people but became frustrated that so many of the families she worked with did not seem to want help. At first, she took their rejection of help personally, but over the last several years, she discovered that she just does not care anymore. It is not uncommon for Ms. P to refer to the agency's clients by derogatory names. There are days when she finds herself running to her car at the end of a work day because she is so eager to leave. One day on the way home, Ms. P drives by a local fashion boutique and sees a "Help Wanted" sign. Her thoughts immediately become fixated on applying for a job at the boutique. Although her husband discourages it due to the inevitable pay cut, Ms. P applies for the job and is hired. Happier than ever, Ms. P vows that she will never use her social work degree again.