Article #2 Burnout Protection Series

Navigating the choppy waters of Professional Uncertainty and becoming the Competent Practitioner

Doubting your abilities isn’t necessarily a bad thing. Who would you rather be, the cocky novice who thinks he is always right and rarely is, or the steady early learner who is aware of their need for more experience?

When Doctors and Nurses begin their training, they understand that getting it wrong could cost someone their life. For Teachers, the risks of making mistakes are less severe, but the pressure to juggle learning your trade and organise your time efficiently can be just as agonising.

This article is for both the novice and the advanced practitioner. You see, because what I’ve come to realise in my 12 years as a qualified Behavioural Psychotherapist is that professional uncertainty never goes away. With that uncertainty, it is easy to adopt patterns that risk you burning-out.

Well that’s depressing!

Uncertainty remains part of the landscape. Yes, it changes. Being a novice is more frightening. But, when you are ambitious, you want to learn new skills and take on new challenges. These ventures take you outside your comfort zone and place you slap bang in the middle of conscious incompetence once again.

You don’t have to look far and you discover that even the greatest mind’s in the history of this planet were filled with doubt.

The more I learn, the more I realise how much I don’t know.

Albert Einstein

Back in 2003, I started my post-graduate training in Cognitive Behavioural Psychotherapy. At the time, it was a running joke amongst my house-mates to ask me “what new book have you come home with this week, Jim?” It was a joke because they knew that there was no way that I had the time to read everything. Somehow, in my mind, every time I got hold another textbook I was alleviating my fears about not knowing enough.

The feeling of “I don’t know enough” was pretty anxiety-provoking. I am putting it mildly. In truth, I was often afraid of getting it wrong, making mistakes or being criticised.

I was sensitive to criticism. And, I felt an urgency to receive approval, recognition and confirmation that I was doing it right. You could say that I was hyper-alert to the signs and signals of what my teachers really thought about me.

Why is there so much professional uncertainty?

You can’t put a value on high quality training. When you’ve got great teachers, supportive mentors and an organised system or environment in which to learn, you can be resoundingly grateful.

Good quality training lays out the theory, gives you the opportunity to practice and ensures you get the right kind of feedback to help you learn. But even with all of these ingredients in place, you can still feel like you just don’t know what the hell you are doing. So, why is that?

In one of my favourite textbooks, The Resilient Practitioner, Skovholt and Trotter-Mathison, suggest two reasons to explain why there is so much uncertainty:

1. Human Complexity
2. Competing Ways of Knowing

Human Complexity

Human beings are not robots, that much is obvious. But surprisingly, we are not as simple as training courses and text books often describe. Even when the list of symptoms tells you clearly what the diagnosis should be, you discover that it is not that at all. Even when you clearly instruct the student in your classroom, they’re application can make you wonder “were they even here in my lesson?”

Human beings are complex and unpredictable. The body doesn’t always behave as your training has taught you and people don’t learn exactly what you teach them. There is a gap between what is given and what is received. There is a gap between the theory and the practice. They are not the same thing.

Competing Ways of Knowing

The fact that people are complex means that we are not all the same either. People see things differently and so have come up with different ways of seeing that we call models.

These models shape how the healthcare professional learns medicine or nursing, how the teacher learns to educate and how the therapist engages and connects with their client.

The trouble with this is that it makes more complicated for the novice practitioner. You have to apply different models without mucking them-up. You have to make sense of different teacher’s interpretations of the literature and you have to digest the changing science of what we know works. Being a novice practitioner and applying what you learn is choppy waters indeed!

Ways we cope with the landscape of not knowing

So, how do people deal with these uncertainties? Well, you turn up to your lectures. You do your homework and you practice as much as you can. This is the practical and logical approach. The inevitable storm is that we are also emotional people who get side-tracked.

When you get side-tracked, you end up focusing on actions that are short-term ways of coping. They are the natural human survival responses that kick-in when you feel out of your depth.  Here are a handful I’ve come across:

1. Hero Fantasising – In your enthusiasm and drive to save the world one person at a time, you hope and expect that you’ll be successful. And, you will with some, but the truth for many people is that you will also fail far more than you had dared to anticipate.
2. Cynical Disillusionment & Learned Helplessness – this is the dangerous swing away from hero fantasy. Instead of believing everyone can be saved, you find yourself caught up in a cycle of believing that you can help no one or you can only do the basics.
3. Pretend you know more than you do – overlapping with the idea that you fake it until you make it, pretending your skills are more advanced can be a problem. Instead of being open to learning from mistakes, you miss out on the opportunity because you are too focused on appearing competent instead of becoming competent.
4. Put off Practice – It is tempting to say I am not ready. I don’t know enough yet and I need to read, read and then read some more. The trouble is that all the reading in the world will not fully prepare you for the discomfort of trying out a new intervention for the first time. You have to get stuck-in!
5. Copy your Mentor’s Style – This can be really useful. You learn to be a certain way that works, but without learning what she is doing and why she is doing it, you deny yourself the chance to develop your own unique personal style.
6. Criticise your Mentors – sometimes this is completely justified. Mentors are not perfect, they can make mistakes or they can be inappropriate. In these situations, criticism is justified. But, sometimes, criticism can come from a place of frustration, impatience and shame. So, you push back on that discomfort by throwing at the person who has not taken it away from you. You blame them for you not knowing enough.

Big problems arise when you use these coping strategies too often. And that big problem is that you risk burnout. These ways of trying to fix or get rid of your fears and anxieties, are short-term solutions. They only ever delay your discomfort and they don’t permanently get rid of your uncertainty. That is my experience and what it has taught me is that to protect yourself against burnout, it is better to focus on something different.

How to make space for uncertainty

Making space for uncertainty is counter-intuitive. So, it isn’t easy. Your mind has evolved to fix things and so your natural urges are to fix the uncertainty. But, you can’t fix it. You can’t give yourself the experience overnight. You can’t just plug-in to a computer and download it.  Only time will give what you need.

When you make space for uncertainty, it is a lot like pulling up at the traffic lights. When it shows red, you stop. In this metaphor, red is the fear, the anxiety, the frustration and the shame. When it shows up, instead of trying to fix it, try to stop.

And then when you’ve stopped, take some time to acknowledge, what you are feeling. Name it and validate it. You validate what you are feeling when you say, yes it is ok that I don’t know all this stuff. I am still learning. And, it works to say this gently rather than abruptly.

And, then green is like when you are ready to get going again. But instead of just ploughing on through, you choose what direction to take and how fast to travel.

Five lines to gently pull on and stay upright

When you navigate the seas of professional uncertainty, you are in choppy waters. You need to sail your way through. You need to pay attention to the weather, your speed and to the direction. You keep an eye on all of your dials.

Here are five ways you can navigate your way through ‘not knowing’. When your lights turn green, choose what will work best for the situation:

1. Find your Mentor – a good mentor will be available and be supportive. So, do all you can to nurture this relationship. And, when you need their guidance, seek them out.
2. Prepare Adequately – Preparation has always made a difference to my interventions. With experience the degree to which you need to prepare can reduce. And, adequate preparation is a useful goal. Over-preparation can make things worse and not preparing enough can leave you fighting to stay afloat, where both you and the person you are helping can suffer.
3. Keep Learning – make time to learn something new that will develop your competencies and your practice. I can’t ever imagine that there would ever come a time when I would need or want to stop learning.
4. Intervene Mindfully – When you administer your procedure, when you take a class through an exercise or when you move a client through an important psychological process, aim to do it with awareness. Notice what is happening inside you and outside. Track your experience so you can tune-in to its purposefulness.
5. Make time to reflect – this is when you sit down and ask yourself some questions intentionally. Reflection is different to rumination, which is involuntary mulling-over. Reflective practice occurs when you ask yourself pertinent questions to help you learn e.g. what response did it get? what was the feedback from the patient or the student? What theory does this intervention come from? Does this outcome support the theory or challenge it?

When you make time for reflective practicing, you develop as a reflective practitioner. It is the development of your professional self. When you are able to learn through your own reflections, you start to rely on yourself as well as others. You move from the position of not-knowing and beginning to applying the art of your profession.

Many of us aren’t content with just becoming competent. You want to be great. You want to be accomplished and proficient. You want to stretch the boundaries and make it better. You want to excel and help people to the very best of your abilities. If you have this enthusiasm, then my advice is hold on to it, channel it and surround yourself with people who want it for themselves.

Thanks for reading this article, which is the 2nd in a series about protecting yourself against burnout. You can read the first article here. In the next article, we’ll be focusing on how and why you should make the most of your professional successes.

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