Thoughts From the Clinical Director: When is Enough Enough?

[Isn’t this interesting! For this fortnightly installment I went back to my first draft I wrote when I first thought about this project, June 11, 2012 – one year ago! It is interesting to read this now, to look back at where we were and at how much great work we have already done addressing some of these issues. For that opportunity to look back, I won’t edit this, so please bear in mind that you are reading something written one year ago. I’ve made a few small comments, in brackets, in the text, but otherwise it is what I wrote one year ago this month. Special thanks for the poem that Sue Bailey supplied when she realized that it was by the same author of the poem about the spontaneous community that sprang up around the distressed Palestinian woman in the airport lounge.]

This is the first in what I am hoping will be a series of weekly thoughts from me about our work at Buchanan. I know that we are all very busy and that we all work very hard. I know that our daily work is often so crisis-driven and that we all have so many meetings, that we don’t have the time and opportunities to sit down and really talk together about our work. I am working on creating the time and space for such important discussions through the Recovery Forum, the working groups on Substance Use (AOD) and on the Recovery Culture; and I know we really need a planning day as soon as we can get that organized – however, it just seems that this isn’t enough, what more is needed and what more can I do? Until we can have these dialogues in person, maybe sharing my thoughts with you can help you to understand what I wish for – for Buchanan. Maybe this can get us all starting to think about how we do things and what is working well and what could work better.

Please do not feel obligated to read these messages. I offer them with the hope that they will be supportive and promote dialogue; I don’t want them to be just one more thing that you have to read during the week. I am writing these messages as much for myself, in order to get some clarity, as I am for the benefit of anyone else, but I hope that you find something for yourself and our work together in them. Some of these initial messages may be a little long, but I am sure that many weeks will just have a short thought or an inspirational quote.

When is Enough, Enough?

We all go through our days trying to do the best that we can. Yet, often it seems that something more is needed. Things don’t always go smoothly, systems need to be tuned up – just as cars need routine maintenance. What we did before was good, but what needs to change as we change [our clientele changes] and as systems change around us?

Sometimes I find myself asking the question: “Am I doing enough?”  “Is there something more that I could be doing, or should I be doing things differently?”  When I answer that there is more that I could or should be doing, I push harder, I try new things, I rush to get everything done so that I can get to the real work that needs doing. Sometimes in my work, I feel like I am so busy doing things that come up all day that I never have time to get “my” work done. I recently came across this quote below that I thought summed this up and I wonder if you relate to it the same way I do.

“As work turns into an ongoing series of emergencies, our efforts to achieve our major goals give way to damage control. Time is spent in stop-gap measures: putting out fires, plugging leaks, and filling cracks. There is no possibility for creative action or for enjoying the flow of productivity because all our resources go into catching up, repairing mistakes, and adjusting plans. The cycle is self-perpetuating: We do not have the time to make a good plan because our time is taken up dealing with the flaws in the old plan; we cannot clear up our communication because we are processing emotions stirred up by previous communications,” (Tarthang Tulku, Mastering Successful Work, pages 31-32).

Can you relate to those words?

How can we change the feeling that no matter how hard we work, it seems like it is not enough? (I am assuming that you relate to at least some part of this). As individuals, we can decide that enough is enough, that we aren’t putting in any more effort because we don’t feel that we are being recognized for our efforts, or that we feel we are already putting in too much. Sometimes this is necessary as a boundary or of recognizing our human limits, but we have to be careful that it is also not a sign of burnout, hopelessness [for ourselves, our jobs, or even the clients we work with], giving up, withdrawing, going through the motions, or even quitting.

There is another way when we reach this point, and that is to re-evaluate our expectations, our systems, and where we are putting our energy. This can be an evaluation as an individual, or it can be an evaluation of the system in which we, as a group of individuals, are working. As individuals, it takes time and space in order to be able to take a deep breath, to be able to see and understand our situation clearly, and in order to make decisions to change the way we are working on a day to day basis. This may mean looking at what really matters, what is important to us in our work, and what our needs are. Tony Schwartz and colleagues, in the book The Way We Are Working Isn’t Working, write that everyone has physical, emotional, mental, and spiritual needs, and that contrary to the way jobs have been set up in the past, that for an individual to be the happiest and most productive, these needs actually need to be addressed at work. This doesn’t mean that work is the only place in your life that you address these needs, but that in order to not only do your job, but also to feel replenished, valued, stimulated, and rewarded in your job, that we need these elements in our work. (Perhaps in another column, I’ll go into these four needs in more depth).

As individuals working together in a system, we need to look at how the system is structured to see if it makes our work easier or more difficult. We also need to look at other people around us, our friends and colleagues, to see if we can support them in getting their work done. I know that when I feel stressed, burnt out, over-worked, the last thing I want to do is look for more work, but in the business we are in – working with people to support them in their recovery and rehabilitation – the outcome for a client depends on all staff being able to do their jobs effectively. The other really important way that we, as individuals working in a system, can greatly affect our individual work, is by stepping back and looking at the structure of the system. We as individuals may not have created the system, but how we work every day maintains the system. Systems are full of complexity, however, and changing one aspect of a system often has unforeseen consequences, but this isn’t a reason not to evaluate and change systems when necessary, it is just a challenge of working with systems. The benefit of going through the change (which is hard work, just as any kind of therapy, recovery, or rehabilitation is hard work) is that putting in more energy, doing a little more, up front leads to our work becoming easier, more rewarding, more effective, and more productive down the road. In a way, changing a system is an investment of energy in the present that pays dividends in the future.

These are some questions that I have been asking myself, in my work, and in our work together:

How can we work better as multi-disciplinary teams, in such a way that we are better supporting our clients in their journey, and that we are happier in our work with clients and with our colleagues?

 

How can we feel more supported and valued in our daily work?

 

How can we keep our eye on the big picture, on what is really important for both ourselves and the clients we work with?

 

How can we change the system so that it feels more like we are all pulling in the same direction?

 

We have choices as individuals in deciding when we enough is enough. If things feel too hard; if it seems we work and work and work, and yet, it seems to have no effect; if we start to feel like it just isn’t worth it – that enough is enough – then we make have hard choices to make: we can do less, we can go through the motions, we can even quit, and quitting can take many forms, including just doing the bare minimum and going through the motions. However, I would like to offer another choice, and that is to re-evaluate our daily work as individuals and the functioning of the system that we are maintaining every day. If we change, the system changes; if we change the way the system functions, we can change the nature of our work every day.

I invite you to re-evaluate the structure of the system where we work:

How can we bring more of our natural caring and compassion into our work?

 

How can we nurture and support that part a client that wants to change and grow?

 

How can we make our work less stressful?


How can we improve our working relationships with our colleagues?

One way of doing this is a programme called “Releasing Time to Care,” developed in the National Health Service in the UK. We will most likely be using this as a framework for change where we work [this may happen in the future, but it is a complex, lengthy process and there are no immediate plans to implement this]. I will write more about this program in the future, but my understanding of it is that it can be applied in a way that is consistent with the recovery and rehabilitation model that we use with clients. I believe that we can only create an environment supportive of recovery and rehabilitation for clients if we are able to create the same environment for ourselves. Perhaps we can use this programme, as well as any other existing programmes, or even programmes that we create that are particular for our work, to support our daily work, so that we can feel energized by our work, valued for the work we do, intellectually stimulated and engaged in our work, and to feel that our work is purposeful and has profound meaning.

[Doesn’t it seem like I should have written something about when “enough is enough” with working with clients and we decide to move them on from BRC? I thought I wrote something on that, maybe we’ll have a part II of “When is enough enough?”]

Kindness

Before you know what kindness really is

you must lose things,

feel the future dissolve in a moment

like salt in a weakened broth.

What you hold in your hand,

what you counted on and carefully saved,

all this must go so you know

how desolate the landscape can be

between the regions of kindness.

How you ride and ride

thinking the bus will never stop,

the passengers eating maize and chicken

will stare out of the window forever.

Before you learn the tender gravity of kindness,

you must travel where the Indian in a white poncho

lies dead by the side of the road.

You must see how this could be you,

how he too was someone

who journeyed through the night with plans

and the simple breath that kept him alive.

Before you know kindness as the deepest thing inside,

you must know sorrow as the other deepest thing.

You must wake up with sorrow.

You must speak to it till your voice

Catches the thread of all sorrows

And you see the size of the cloth.

Then it is only kindness that makes sense anymore,

only kindness that ties your shoes

and sends you out into the day to mail letters and purchase bread,

only kindness that raises its head from the crowd of the world to say

It is I you have been looking for,

and then goes with you everywhere

like a shadow or a friend.

Naomi Shihab Nye

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