A number of publications are directly relevant to the wellbeing of healthcare professionals – you can find these below:

The Burnout Booklet

The Burnout Booklet: A Health Resource for Patients and Practitioners By Katharine Murphy and Olivia Glaze

This beautifully illustrated booklet draws on lived experience of burnout to offer a range of metaphorical ways of describing burnout. I often talk about how the word burnout can mean many different things, and it’s important to understand the individual experience of this to be able to respond in helpful ways. This booklet can help individuals find ways of expressing their experience and also help supporting professionals think in a more nuanced way about the issue.

Creative hobbies and work recovery

Recuperating, Revitalising, and Reaffirming: the experiences associated with creative hobbies, and their impact on recovery, wellbeing, and work by Delores Hill

This research project explored ways in which creative hobbies can support work recovery. This is a concept I often explore with health professionals I work with. It is the idea that what we do outside of work can help to replenish what is depleted by our experiences at work. It requires us to be attuned to our needs and be intentional about how we can support ourselves with what we invest our time in outside of work. Creative hobbies offer ways to meet a range of needs through supporting detachment from work, providing a sense of mastery, lifting our mood, and connection with values. This article describes Hill’s research in a very digestible way, and offers useful practical applications.

Creative Toolkit for palliative care professionals

Co-producing a ‘creative toolkit’ to support the mental health and wellbeing of palliative care professionals: a community case study By Marie A. Clancy, Caitlin R. Kight, Jessica Stein, Naome Glanville, Anthony C. Wilson, and Richard G. Kyle

This publication explores the growing pressures faced by professionals working in palliative care, particularly in the wake of COVID-19, and highlights how a culture of prioritising patient needs often leads staff to neglect their own wellbeing. It presents a co-produced, arts-based “Creative Toolkit” designed to support the physical, psychological, social, and spiritual health of staff through reflection, relaxation, and connection.

Drawing on a small-scale case study, the paper demonstrates how creative approaches can help staff process difficult experiences and build a sense of community, with highly positive participant feedback. While the findings are context-specific and further research is needed, the publication makes a valuable contribution by showing how creative, arts-based interventions can be meaningfully integrated into workforce wellbeing support.

Art therapy to reduce burnout

Art therapy to reduce burnout and mental distress in healthcare professionals in acute hospitals: a randomised controlled trial By Megan Tjasink, Catherine Elizabeth Carr, Paul Bassett, Gehan Soosaipillai, Dennis Ougrin, and Stefan Priebe

This study examines whether a brief, structured group art therapy programme can improve burnout and mental wellbeing among hospital-based healthcare professionals. In a large, multicentre randomised controlled trial involving NHS staff across a range of roles, participants were assigned either to six weekly art therapy sessions or to a wait-list control group receiving usual support.

The findings show that those who took part in the art therapy programme experienced significant reductions in emotional exhaustion, alongside improvements in stress, anxiety, depression, and detachment from work, with benefits sustained at three-month follow-up. While the study had some limitations, including its reliance on a wait-list control and limited subgroup analysis, it provides strong evidence that a relatively short, manualised and theory-informed art therapy intervention can meaningfully support staff wellbeing and could be integrated into hospital workforce support services. The lead author, Megan Tjasink has been a guest on the When Work Hurts podcast – you can listen to her talk about her work here.

The Body Hotel Self-Care Suite

The Body Hotel Self-Care Suite: Evaluation By Teresa Filipponi, Carolyn Wallace, and Thania Acarón

This publication evaluates The Body Hotel Self-Care Suite, a creative, movement- and body-based programme developed to support the wellbeing of palliative care staff within NHS Wales. Focusing on teams at Velindre NHS Trust, the study explores whether embodied, creative practices can enhance wellbeing, psychological safety, and day-to-day working relationships.

Drawing on interviews and pre- and post-programme questionnaire data, the evaluation found that participants reported increased energy, emotional resilience, self-awareness, confidence, and self-compassion, alongside a stronger sense of connection with colleagues. Staff also described applying tools from the programme to manage stress, communicate more openly, and foster more supportive team dynamics. While based on a small, self-selecting sample, the findings suggest that creative, body-based approaches can play a valuable role in supporting workforce mental health and cultivating more compassionate and sustainable workplace cultures.

It’s clear that the arts and creative practice can play an important role in supporting the wellbeing of healthcare staff. Creativity & Wellbeing Week is coming up (18th – 24th May 2026) – this is a great opportunity to consider how you might be able to bring more creativity into your workplace and life.

On 19th May I am running an online workshop for doctors with Dr Alison Smith of Earth & Bloom called Shaping Self Compassion. It’s a hands on workshop using clay to explore and nurture compassion for yourself, something many of us in helping professions struggle to access. It will be a gentle evening combining the soothing and tactile experience of working with clay and other natural materials with a listening circle. Booking closes on 5th May (to give us time to get your goodie bag to you), so secure your place today!

The post Creative health and wellbeing for healthcare staff: a research roundup appeared first on Dr Paula Redmond, Clinical Psychologist.

Working as a staff health and wellbeing psychologist offers a range of opportunities to be creative. As an evolving area of intervention it invites innovation, and permission to try new things.

One of the initiatives I am most proud of is the development and delivery of an art and wellbeing collaboration called Take heART. A project that seeks to improve the experience of staff, patients and hospital visitors through creativity and the arts. But how, as a psychologist did I find myself involved in this work? Let me share a story with you.

© Shaun Armstrong

My story

For a long time I believed “I’m not creative”. This was the story I told myself….and others.  Stories that started when I was a child: attempts to learn a musical instrument, dance lessons, trying art and drama at school all seemed to feed this narrative. The crush of comparison with others reinforced a well-crafted story: “this is not for me, others do it better”. 

I pick this story up many years later when, as an adult patient I experienced the positive impact art and creativity can have on wellbeing. I was undergoing treatment that required frequent visits to hospital. With this came a lot of waiting. Waiting to get assessed, waiting for treatment, waiting for results, waiting rooms and a lot of uncertainty.

As I spent an increasing amount of time in a waiting area, I gravitated away from the main room to a smaller space. To a light filled corridor. A place where there was less waiting and more….. just being. As I made this my new regular spot, my attention was drawn to the art, a picture that sat squarely and proudly on the wall. A familiar, predictable and engaging sight. I recall an abstract depiction of a cell, inside the body. It was beautiful. On a bad day it was slightly painful to look at. It did not shy away from what those coming to the hospital were doing, the treatment they were having.

Art is open to the interpretation of its audience. What I took from it was an intriguing, distracting, honest depiction of a medical, but also emotional, process that myself and others were navigating. Art has power and presence, particularly at times of difficulty and distress. This was the start of my connection with art in hospital.

The final thread of this story can be found a few years ago. After working for much of my career in mental health services I lost my love for the work and my wellbeing started to suffer. I had an instinctive need to pause. Rather than asking myself “what should I do next?” I considered “what gives me a sense of purpose and enjoyment at work?” Supporting other staff and working in services and systems that invited creativity were up there. And so my journey working in a staff support role started. I initially worked during the pandemic with critical care and respiratory medicine staff followed by a trust-wide role. I was outside my comfort zone but inside my creative zone.  

Working in stressed and stretched care systems with limited resources and navigating unchartered territory invited new ways of thinking and working.  As both an ‘embedded’ and trust-wide staff support psychologist I was struck by the challenge of how, with limited resources my role could offer meaningful, effective and sustainable change. In a busy, unpredictable, often anxiety provoking environment, how could the hospital setting feel more welcoming, calming, engaging and soothing?

The Take HeART project

© Shaun Armstrong

Take heART has grown from connection and collaboration. It is a true team effort, a network of staff, departments and community partners coming together to try new things. As a psychologist I have been well placed to bring psychological theory and frameworks to help shape and evolve this development. To operationalise what can feel like abstract ideas such as ‘compassion’ and ‘trauma-informed care’. To support the creation of places and spaces that trigger our emotional soothing systems. Creating conditions for individuals to slow down, connect with their values and importantly with others including the local community. To enable appreciation and gratitude to be cultivated. Also, this has been an opportunity to raise and evolve the profile of my profession, to highlight how psychologists can support not just wellbeing but ‘well doing’.

How you can get started

While supporting wellbeing through the arts and creativity can be powerful, it can feel difficult to initiate and challenging to translate into behavioural change. Especially when working in high demand, low resource systems.  It can be helpful to start small and think BIG. 

‘ARTS’ is one way to guide this process and ask a number of important questions – consider Access, Resources, the Team and how to Shout about it. Try to do so with curiosity, care and a small dose of optimism. We do not need to have all the answers.

© Shaun Armstrong

Access

How can you make what you do as accessible as possible to ALL staff , especially those who do not see themselves as creative? What are the different ways individuals can participate? What invites curiosity and playfulness? What gets in the way of involvement, what are the internal and external barriers? 

For example, how could you not just invite staff to step away from their day-to-day busy environments but also bring art and creativity to them? Why not display art in team areas including staff rooms, offer a touring ‘art cart’ or join an existing staff event such as a team away day or trust staff engagement event?  

Katie Allen and Bedford Road Primary School

Resources

What resources and motivates you and others? Start with YOURSELF….what do you need? What inspires and supports you?  What are the existing budgets you can tap into? Do you have charitable funds you could apply to for initial ‘pump priming’? Are there individuals within your trust who could apply for external grants?

One starting point might be to consider what you already have. Why not create an inventory to log current artwork in your workplace? How might you showcase this?  Maybe set up an art trail? What skills, knowledge and experience would help you grow your projects? What are the strengths and skills you can bring to the work and how would you like to develop these?

Working within your limits is also important to sustain yourself and others. Developing a project plan/timeline, keeping a log of hours spent on a project and setting flexible deadlines can all help with this. As your project evolves and you seek funding, ensuring tasks such as project management and installation are budgeted for. This will create capacity and help you make a case for additional resources. Setting up a regular working group offers an opportunity to review workload, engage and inspire others and in turn create a team.

© Shaun Armstrong

Team

Who can you connect with? Who else is doing (or trying to do) this kind of work in your workplace?  Why not start with just one other person? There can be real power to partnership working. What other parts of your organisation might help?  Organisational Development, the Communications Team, Charitable Funds, Estates & Facilities, Wellbeing Leads and the Senior Leadership Team?  What about those outside your organisation?  Local artists, schools and art colleagues.  Link in with other trusts where they have more well-established arts and wellbeing programmes etc.

Feel free to reach out to take heART via our website or email.

Katie Allen and Bedford Road Primary School

Shout

Once you have started to test out some ideas, how can you shout about and showcase what you are doing and trying to do? You do not need to wait until you feel you have a well-established project. Shout early on.

When starting take heART we found it helpful to identify a name for our group and key aims and vision for the work, which could be easily disseminated.  Having a logo can help create ‘a brand’ and enable others to recognise and link different projects. Gathering feedback has been important.  Sharing what staff say about their experiences can bring the work to life. Working with our Communications Team and photographing what we do has raised the profile of our work. 

Visual artwork displayed in high footfall areas can have a powerful impact and create ‘positive gossip’. Why not walk around your work space with the Estates Team and consider where the high impact and easy to display areas are (e.g. main entrances, stairwells, lifts, corridors and waiting rooms)?  Installing large poster frames is a relatively quick, cheap and easy way to create spaces to display artwork.

Also get good at shouting about your profession and your role, showcase what psychology can bring to the table. It is not just the stories we tell ourselves, but the ones we choose to share with others that can spark change.

To find out more listen to Rachel’s in-depth discussion with Paula on the When Work Hurts Podcast.

The post Take heART: Bringing together psychology and art for NHS staff wellbeing appeared first on Dr Paula Redmond, Clinical Psychologist.

(This is of course just one element of the challenges the pandemic brought for healthcare workers – the nature of the work, the need for PPE, risk to self, and disruption to normal life and social support all had a huge impact too.)

But we also know that demand has been outstripping resources long before the pandemic. The NHS has faced major recruitment and retention issues for a long time. Staff vacancies require longer hours, more shifts and lengthier caseloads from those still working – feeding the vicious cycle of burnout.  And there’s no sign of this easing.

If I had a magic wand I’d conjure up all the health professionals we need so the load could be shared sensibly. But in the absence of magic (and a government committed to funding the NHS properly) what can we do?

Here are some ideas about tackling workload as a risk factor for burnout:

Get the data

Facts & figures can help both you and your managers to take stock of the situation.  Presenting your manager with workload data can help them take your concerns seriously and enable them to take a detailed look at possible solutions. Do a time sampling study over a typical week, writing down what you are doing every 15 minutes. Next, categorise the data according to the type of task e.g. patient facing, clinical notes, meetings, CPD, breaks etc.  This will help you to evaluate:

• How much time you are working compared to your contracted hours, and whether or not you are taking adequate breaks
• How much time you are spending on different tasks
• Whether this reflects your job description, job plan and priorities (and whether there are tasks you need to drop, de-prioritise or delegate)
• Whether you/management have a realistic idea about how long a task takes
• Whether you need more support/resources to complete certain tasks
• Where the inefficiencies in the system lie (e.g. slow/crashing IT, needing to travel long distances for meetings, meetings that don’t deliver on their purpose etc.)

This approach is especially useful when done across teams and can highlight how staff are papering over the cracks of poor resourcing.

Say no

This is, of course, easier said than done, but if you can start learning how to say no to extra requests you can start to put healthier boundaries in place. This is likely to bring a great deal of discomfort, often due to a fear of letting others down. Acknowledge this and be kind to yourself, but know that the costs of continuing to take on too much are high.  Are you willing to make room for that discomfort, knowing it will pass, in the service of looking after yourself?

Reduce the administrative burden of EHR (Electronic Health Records)

This is not something individuals can do on their own, but would make a huge difference to burnout levels. In the most recent Medscape burnout survey, doctors cited administrative burden as the number one cause of burnout.

The introduction of EHR in recent decades has increased this burden due to the use of systems that aren’t purpose built, and that make it easy to continually add more data collection requirements (although it appears very difficult to take any away for some reason).  One study found that ICU clinicians were spending as much as 86% of their time on admin. This was not due to staff being inefficient, but simply that there was too much to do.

Another study in primary care noted the cognitive burden of alerts generate by the EHR. The intrusive nature of the alerts and the fact that GPs did not have protected time to respond increased subjective workload. Interestingly subjective workload was predictive of burnout, but objective workload (i.e. number of alerts) was not. This relates to job control – being able to choose how to tackle work demands mitigates the impact of workload on exhaustion and burnout. Simply building in protected time for administrative tasks can go a long way to preventing burnout.

If you can, seek opportunities to be involved in reviewing your EHR and working to “get rid of the stupid stuff”. This is a complex process but should be given priority by healthcare leaders given the enormous burden it places on staff.

What if you can’t reduce your workload?

Workload is one key risk factor for burnout, but it’s not the only one. Let’s consider how workload interacts with the other factors (job control, reward, community, fairness, and values), and how you might be able to draw on these when your options for reducing workload are limited.

Job control

Studies show that a sense of job control moderates the relationship between workload and exhaustion. People feel less burdened by their work when they have a stronger sense of control over how they tackle it. When we can choose how we want to respond to work challenges and how we organise our time we are more able to manage a heavy workload.

This becomes more difficult in our hyper-connected culture where expectations to be online and available all the time can make it difficult to block out time and plan our own diaries. If you work shifts or are in a frontline role this can be even more difficult.

But managers can make relatively small differences that have a big impact on job control by e.g. allowing protected distraction-free time to complete work tasks; and supporting flexible working patterns.

Reward

No-one goes into healthcare for the financial reward, but feeling that you are being exploited or not being fairly paid will add to workload burden.  You may wish to get more involved in union activity to address this, but it’s also worth considering how you can access a sense of reward in other ways. Make use of discounts offered by your employer/union. Are there other things that would be nurturing for you that you could seek out – training, coaching or other development opportunities? Take your annual leave and TOIL.  Do not feel guilty about taking these rewards – you have more than earnt them!

Community

Draw on the support of colleagues.  Talk to others about your struggles either informally and/or through reflective practice.  Could you join forces with others to address workflow or IT issues? There are often times when others may have more capacity – can you ask for help?  There may also be tasks that you find less burdensome, that others hate and vice versa – are there opportunities for sharing or swapping tasks to reduce the sense of burden?

Fairness

Feeling that work is unfairly distributed will increase workload burden. Talk about this – it may be that others haven’t realised that things are unfair, or it may be that there are (fair) reasons for differences. It may also be that discrimination needs calling out.

Values

When the values of frontline workers and management are aligned there can be greater agreement on task priority which can in turn reduce workload burden. It is vital that leaders are visible in seeking to truly understand the experiences of staff on the ground and that there are clear channels of communication. An example of this would be commitment from senior management to support clinical staff in reviewing EHR systems so that they serve clinicians and patients, and not the other way around.

If you’re recognising symptoms of burnout you might find my Burnout Toolkit helpful – it has loads of taregted evidence-based psychological strategies.

The post Workload and burnout in healthcare: What CAN we do? appeared first on Dr Paula Redmond, Clinical Psychologist.

But how do you know what action to take? The right thing to do will vary depending on what form burnout is taking for you, and what the causes are.

My Burnout Toolkit can help you figure out how burnout is impacting you and offers psychological strategies for coping. This article takes a closer look at underlying causes of burnout, and how to tackle those.

There are 6 key causal factors related to burnout.

1. Workload: This is about how realistic the demands of your job are. A manageable workload not only needs to be realistic given your working hours, and the resources you have, but also needs to include opportunities for variety and professional development.

2. Control: Having autonomy about how we work is important. Are you able to make choices and decisions about how you fulfil your job responsibilities? Are expectations clear? Do you have the resources you need?

3. Reward: Do you feel recognised and rewarded for the work you do – both financially and socially? When an organisation has a meaningful reward system people feel that they and their work are valued. This may be in relation to financial reward, but can also be about how your efforts and achievements are recognised by managers through regular formal or informal feedback, appraisals etc.

4. Community: People thrive when they feel a sense of belonging at work. Organisations that foster psychological safety and inclusion create community support that acts as a buffer against stress.

5. Fairness: We can withstand a lot of stress when we feel things are fair. However, if an organisation is not transparent about its processes, treats people differently or allocates resources inconsistently this communicates a lack of respect and damages our relationship to our work.

6. Values: When our values are aligned with an organisation we are able to share success and meaning in our work. However, tension is created when we feel there is a mis-match between our personal values and those of our employer, or if an organisation does not practice what it preaches.

If there is significant tension in one or more of these areas over a long period of time we can start to feel worn out and drained by our work, ineffective at our jobs and cynical about our employers.  If these issues are not meaningfully addressed we are at risk of burn out.

What can you do if you’re burning out?

Burnout can be very challenging to address as individuals because often the things that cause it are not within our power to change. However, if we can identify the issues that are contributing we can empower ourselves to take action to support our wellbeing.

Here are 6 steps you can take if you recognise signs of burnout:

• Identify the causal factors and things you can change: Work through the 6 causal factors of burnout outlined above. Which of these are relevant to you? Once you have identified the cause(s) of the problem consider how you could begin to address these. Are there things you are able to change yourself? This might be delegating tasks, saying no to taking on any more work, or getting involved in opportunities to change in-efficient or unfair processes. If you’re feeling disillusioned with the values and mission of the organisation can you explore whether there are parts of the workplace that are more aligned to your values, and get involved in these? If you’re feeling isolated are there ways to build better relationships with colleagues, perhaps joining a working group for something that interests you?

• Escalate concerns and solutions: There may be issues you have no power over. Can you speak with your line manager, HR or union rep about these and the changes that need to be made? Often being specific about where the problem lies and what changes could help can enable those with power to more easily take effective action.

• Draw on strengths to buffer against the impact: If the organisation is unable or unwilling to make changes you may be able to buffer the impact of work stress by drawing more heavily on the areas of your working life that are supportive. For example, if workload demands are unlikely to change, but you have a strong sense of belonging, can you reach out to colleagues and let them know how you are feeling? Can you draw on these relationships for support, fun and nurturing? If you’re feeling very unappreciated but still have a good deal of autonomy over your work, can you invest more time and effort into the parts that give you the greatest sense of meaning and satisfaction?

• Take a break: If you’ve tried these steps and they haven’t helped, or they feel too hard because you are already completely drained, it might be wise to take a break. This could mean booking a decent chunk of annual leave, talking with your GP about taking sick leave, or negotiating a career break. Use this time to pause, recuperate and take stock of your options. Is there a realistic chance of things changing at work? Could you apply for a different role? Would reducing your working hours offer better balance, or more pressure? If there’s little chance of things changing perhaps you need a complete break and a fresh start elsewhere.

• Use your learned wisdom to evaluate new opportunities: If you do decide to look for a new job or role, try to learn from the lessons that burnout can teach us. Use your knowledge of the 6 key factors (workload, control, reward, community, fairness, values) to assess the fit between you and your potential new role or workplace. Which of those is most important to your wellbeing? Remember that job interviews work both ways – what questions could you ask to get a sense of how prospective workplaces measure up?

• Respond to your own needs: Whatever you decide to do in relation to your job make sure you allow yourself time and space to notice and respond to the impact of burnout on your health and wellbeing. Take steps to support your physical and emotional recovery through connection, compassion and creativity.  Some examples of this are:
  • Spending time with people who make you feel good about yourself
  • Reaching out for support if you are struggling, such as through counselling or therapy
  • Prioritising sleep
  • Nurturing your body through good food and movement
  • Allowing yourself time for things that bring you joy such as being in nature, creative pursuits or restorative hobbies

If you would like help and support to figure out if and how you are impacted by burnout, which areas of work are most affecting you, and what your best course of action is, the Burnout Recovery Roadmap will help.  This offers an in-depth and personalised assessment along with recommendations and resources to help you take the next steps that are right for you.

The post Help I’m burning out! 6 steps to tackling burnout in healthcare appeared first on Dr Paula Redmond, Clinical Psychologist.

Whilst the causes of burnout are systemic in nature, the impact is very personal. Burnout results in exhaustion, anxiety and disconnection and can have serious implications for physical and mental health, relationships and careers.

Understanding the psychological mechanisms underlying the process of burnout won’t resolve the underlying causes – but it can help to mitigate the impact and empower recovery and restoration.

The three-system model of emotion

Paul Gilbert’s three-system model of emotion describes how we have three basic emotion systems: threat, drive and soothing.  These systems each have different, but important, functions. The threat system alerts us to potential danger and urges us to take action to protect ourselves. The drive system enables us to attend to opportunities in our environment and motivates us to pursue our goals.  Finally, the soothing system helps us to rest and digest and to feel calm, safe and content.

We need all three systems to be in balance for us to function well.  Very often, however, these systems are out of balance, and we find that our threat and drive systems are more often and more easily activated than our soothing system. In fact, for many of us, our soothing system wastes away from disuse, so that in times of stress when we could really do with some soothing, we’re so horribly out of practice that we struggle to access it all.

Threat + drive = burnout

If you’re a healthcare professional you’re very likely to have highly activated threat and drive systems. In fact the training process of many health professions actively selects for this.  In order to survive the gruelling training, and work under the austere conditions of public healthcare, you will need to be highly responsive to threat, both clinical and social – you don’t want to let people down, make mistakes or cause harm.

Unfortunately the system we work in is often also very threat-based – threats of complaint, litigation and disciplinary action.  Many health professionals frequently face verbal and physical assault from patients and members of the public. Bullying and racism is commonplace.

It’s no wonder our threat systems our highly active.

We are taught to respond to this through activation of the drive system – working harder and longer; striving for perfection; enacting defensive bureaucratic processes. When you feel stressed or overwhelmed by work what do you do? If you’re anything like me you’ll probably try desperately to problem-solve, make lists, do some CPD, set up new processes, or put more hours in.  Our systems respond in the same way – more meetings, more tick boxes, more “transformation”.

Often this works well. Usually the more you study the better you’ll do in the exam. As humans we have an incredible capacity for innovation and problem-solving. But – and it’s an important but – this only goes so far, for two key reasons:

1.If we continually rely on our drive system to regulate our threat system we will become exhausted.

2. Not all problems can be fixed. We can’t eliminate risk or pain, we will make mistakes, and we don’t always have the power to change what needs to be changed. Acknowledging this activates our threat system, and if our only option for regulating this is our drive system – see point 1

A vicious cycle of oscillation between threat and drive ensues.  Often we think we can get ourselves out of this vicious cycle by numbing or distraction.  We avoid and procrastinate. We seek refuge in alcohol, sugar or drugs. We spend countless hours on Netflix or social media. Sometimes this gives us respite, but it’s usually short lived and can create its own threats that merely feed the cycle.

Getting locked into this threat-drive cycle is how we burn out. We find ourselves increasingly exhausted, anxious and disconnected. The more we put in, the less we get out. We can end up feeling stuck and hopeless.

The soothing system

But often we have forgotten the third system – the soothing system. This system is inherent in all mammals, and vital for our survival. It’s the system that enables us to care for ourselves and others, and to feel connected to and cared for by others. It enables us to rest and digest, and to feel safe and calm.

We need to have this system online so that we have alternative ways of responding to threat, and so that we can replenish our energies and nurture our drive system.

As healthcare professionals we often are very neglectful of the soothing system. Cultivating this can seem alien, and even scary. People often fear that opening up to the soothing system will dampen their drive and make things worse – they’ll get “lazy” or lose their sense of identity and self-worth. But the soothing system is there to support the drive system – not to replace it. And the alternative, to keep on going in this vicious cycle of drive and threat, is going to derail at some point.

4 ways to cultivate the soothing system

Cultivating and supporting the soothing system can be done through intentional practice.  Have a think about the times when you notice yourself connecting with a sense of safety, calm, kindness and positive bonds with others. What are the ingredients of those experiences? How can you bring more of that into your life?

Here are 4 ideas for cultivating your soothing system:

1.Connecting with others – spending time with people who make you feel good. When we are struggling we often start to isolate ourselves and cut off from others. Reach out to people in and out of work who make you laugh, are supportive or who you feel safe with.

2. Breath work – connecting with our bodies is an important part of cultivating the soothing system. We need to be able to attend to our nervous systems, and we can learn to respond in ways that promote calm and self-care. Soothing Rhythm Breathing is a great way to get started with this.

3. Using imagery and memory – our imaginations can be a powerful resource. The Compassionate Mind Workbook offers a range of really helpful exercises such as soothing colour imagery, creating a safe place, and tapping into memories of being cared for.

4. Creativity – although creative pursuits often activate the drive system by giving us a sense of achievement, they can also be used to intentionally cultivate the soothing system. Knitting, for example, is a craft that can help us slow down, tune into our own needs, foster self-compassion and connect with others. The repetitive movements, portability and tactile nature make it a great resource for activating the soothing system.

If you already have a creative hobby think about ways you can adapt it to more intentionally support your soothing system.  And if you’re a knitter check out our resources at Creative Restoration.

The post Why burnout happens: the threat-drive cycle (and how to stop it) appeared first on Dr Paula Redmond, Clinical Psychologist.

What is creativity?

We often think of creativity as referring to the Arts – the accomplishments of painters, writers or composers. Yet creativity is an innate human characteristic, and one that uniquely sets us apart from other species.  Consider how many different ways humans have developed to build homes, cook eggs or make clothes. These solutions are beyond what we need to survive, yet they are imbued with meaning, pleasure and joy.

The creativity researcher Frank X Barron defined everyday creativity as something (a product, idea or behaviour) that is both original and meaningful. A creative act is one done with intention, creates something that didn’t exist before and has meaning to you.

It doesn’t need to be meaning in the deep philosophical sense, but meaning in that it communicates something, solves a problem or has an impact.  This isn’t about producing art intended for a gallery, but about the process of tapping into your own innate creativity in a way that is meaningful to you – whether the purpose is to create something beautiful or useful; or just to give yourself time to play.

5 ways creativity can protect against burnout

Burnout is characterised by emotional exhaustion, lack of personal accomplishment, and a detachment or cynicism towards work. One can experience some or all of these dimensions to varying degrees. It results from chronic workplace stress due to demands outstripping resources.

Rates of burnout in healthcare have never been higher.  Organisational and political factors are responsible for unprecedented levels of service demand, dwindling resources, and a massive retention and recruitment crisis. We can feel helpless in the face of these systemic issues that we have no control over.

But it is also true that there are resources we can draw on to help sustain and empower us – and creativity is one such important resource.

Creativity can help buffer us against the strains of working in healthcare by helping us:

1.Switch off

Being able to switch off and disconnect from work in your free time is crucial to managing a stressful job, especially one that is emotionally taxing.  Studies show that being able to psychologically detach from work at the end of the day/shift mediates the impact of job demands on burnout risk.

But this can be very hard to do, particularly when your work involves a lot of complex cognitive labour.  Creative tasks can really help with this because they require concentration and often the use of our hands. This taxes the working memory, meaning there is less room for our brain to continue to think about work.

2. Find rest

Creative tasks such as painting, knitting, drawing or writing require us to physically slow down. Absorbing ourselves in the sensory experience of the materials we are working with can help us achieve a flow state and soothe the autonomic nervous system.

Creative endeavours don’t need to be calm and quiet though.  We can also find rest in more energetic pursuits, like dancing, or Jackson Pollock-style painting – especially if what you need is emotional rather than physical rest. Find the creative pace that suits what you need.

3. Connect with others

Creative hobbies can help us to connect with others, and guard against the encroaching withdrawal and disconnection of burnout. We can connect to like-minded communities who share our love for a particular craft; we can create gifts for people and keep them in mind while we create; and we can use our creativity to connect to the values and causes that really matter to us (the Craftivist movement is a great example of this).

4. Re-humanise

Working in big institutions like the NHS can be a very dehumanising experience. We can feel devalued, ignored and unseen. I often hear health professionals talk about how they feel like just a name on a rota, with their unique skills and needs disregarded.  Even worse many experience a sense that even their basic human needs can’t be met at work – the need to go to the toilet, eat healthy food, rest.

Having a creative outlet is a chance to make your unique stamp on the world, even if no-one else ever sees what you produce. You get to choose what and how you do it, and can respond to your own sensory needs without having to ask permission.

5. Cultivate self-compassion

As healthcare professionals we are usually awful at being kind and compassionate towards ourselves. We are very good at heaping criticism and judgement on top of our already battered souls.  Creativity is about play and making mistakes is part and parcel of the process. It’s a great opportunity to practice tolerating (and even accepting) mistakes, uncertainty and imperfection. It also gives us opportunities to learn how to tune in to what we need in any given moment so we can respond with care.

How to bring more creativity into your life

1.Fill your feed

We know that viewing art can give us an emotional boost and reduce physiological stress – whether it’s viewed in person, in a book or electronically. If you’re like most of the people I meet (including myself) you are probably drawn to social media in times of stress – which can only make it worse.  But if you can fill your feed with creative inspiration this will not only help to balance out the doom and gloom, but give your brain an instant dopamine hit.

2. Work and play

Find ways to bring creativity into your workplace. This can be a great way to build connections with colleagues, and make work a better place to be. Listen to this episode of the When Work Hurts episode in which I spoke with Dr Heidi Edmundson about how she has brought everyday creativity into her A&E department.

3. Developing an everyday creative practice

If you can do something creative every day, no matter how small, you will soon start to notice the benefits. Spending just 5 minutes a day is all you need. If you can have some basic tools ready and available you can grab them whenever you have a free moment. Knitting is great for this as it’s really portable and you can make progress towards a bigger project by doing just a few stitches at a time. Amy Maricle of The Mindful Art Studio has some wonderful resources for creating little art in very short spaces of time. And for more ideas check our this blog post by psychotherapist Karolina Christopher on creative self-care.

4. Carve out time

If you find it hard to establish a regular creative practice, or you want to deepen your skills, it could be a great idea to sign up to a regular class, a one-off workshop or a retreat. This will allow you to really focus on the creative process without all the distractions of everyday life. This is a great way to give yourself some restorative time, and develop a deeper connection to your own creativity so that this can be a resource you can continue to draw on to help sustain you in your work and prevent burnout.

If you enjoy knitting join us at our next Creative Restoration retreat! This is a day designed especially for overwhelmed and exhausted health professionals where we will teach you about the therapeutic benefits of knitting and how to weave this together with knowledge and skills from the psychological science of wellbeing. Our next retreat is on 1 October 2022 (with bookings closing on 16 September). You can find out more information here.

The post How creativity can protect against burnout appeared first on Dr Paula Redmond, Clinical Psychologist.

If you recognise these experiences, and they’ve been around for a while without signs of shifting, you might be experiencing burnout.

What is burnout?

The World Health Organisation defines burnout as a syndrome caused by chronic workplace stress that has not been successfully managed.  There are three core dimensions to burnout:

• Exhaustion
• Detachment from work and/or increasing cynicism
• Reduced effectiveness

Burnout is defined as an “occupational phenomenon” rather than a physical or mental health problem. This is important because it highlights that the causes of burnout are problems within the workplace, rather than within the individual.

Burnout is something that can creep up on us – often developing over a long period of time.  Often an acute burnout response can be triggered by a relatively minor event, and it is only when we take a step back to reflect that we notice how it has, in fact, been developing over a long time. Freudenberger outlined 5 stages of burnout – it can be helpful to be familiar with the early signs so that you can take action to prevent it developing into something more serious.

Sometimes people use the word “burnout” to describe distress that has been caused by work, but that in fact maybe better understood as trauma or moral injury. It can be really helpful to have clarity about what you are going through in order to get the right kind of support. My Burnout Toolkit can help you distinguish between these different experiences of burnout and work-related distress.

Burnout in healthcare: the stats

If you work in healthcare and are feeling burned out it may be of little comfort to know that you are not alone. According to recent Medscape surveys 47% of doctors and 65% of nurse practitioners reported being burned out. This figure has been increasing year on year.

Burnout figures vary according to specialty (e.g. 60% of doctors in emergency medicine report being burned out compared to 26% in public health and preventative medicine). Burnout also affects women more frequently than men (56% compared to 41%). This is understood to be related to additional caring responsibilities women often take on outside of work.

How does burnout affect us?

Burnout is not a physical or mental health condition per se, but it can result in significant physical and psychological distress. If people don’t get the right kind of support they might start to suffer from physical ailments, including poor sleep, tension headaches, and lowered immune responses.  Burnout can have a major impact on our relationships as we may have little left to give to our loved ones.

People struggling with burnout may also experience psychological problems such as anxiety or depression.  This can become a vicious cycle because anxious thinking and low mood often lead us to blame ourselves for our struggles, making us feel bad for finding things hard. This can prevent us from identifying the problems in the workplace that are the root cause of the problem, and leave us feeling more exhausted, detached and helpless – thus reinforcing burnout symptoms.

What causes burnout?

There are 6 key causal factors related to burnout.

1. Workload: This is about how realistic the demands of your job are. A manageable workload not only needs to be realistic given your working hours, and the resources you have, but also needs to include opportunities for variety and professional development.

2. Control: Having autonomy about how we work is important. Are you able to make choices and decisions about how you fulfil your job responsibilities? Are expectations clear? Do you have the resources you need?

3. Reward: Do you feel recognised and rewarded for the work you do – both financially and socially? When an organisation has a meaningful reward system people feel that they and their work are valued. This may be in relation to financial reward, but can also be about how your efforts and achievements are recognised by managers through regular formal or informal feedback, appraisals etc.

4. Community: People thrive when they feel a sense of belonging at work. Organisations that foster psychological safety and inclusion create community support that acts as a buffer against stress.

5. Fairness: We can withstand a lot of stress when we feel things are fair. However, if an organisation is not transparent about its processes, treats people differently or allocates resources inconsistently this communicates a lack of respect and damages our relationship to our work.

6. Values: When our values are aligned with an organisation we are able to share success and meaning in our work. However, tension is created when we feel there is a mis-match between our personal values and those of our employer, or if an organisation does not practice what it preaches.

If there is significant tension in one or more of these areas over a long period of time we can start to feel worn out and drained by our work, ineffective at our jobs and cynical about our employers.  If these issues are not meaningfully addressed we are at risk of burnout.

What can you do if you think you might be burning out?

Burnout can be very challenging to address as individuals because often the things that cause it are not within our power to change. However, if we can identify the issues that are contributing we can empower ourselves to take action to support our wellbeing.

This blog series will explore how we can respond to burnout in more detail. If you want a personalised ‘deep-dive’ into your burnout symptoms, the work-related factors that cause them and bespoke recommendations for tackling these check out the Burnout Recovery Roadmap.

The post Burnout in Healthcare: symptoms and causes appeared first on Dr Paula Redmond, Clinical Psychologist.

This was me in 2016. I was working in a Sexual Assault Referral Centre at the time.  A morning at work began with a staff meeting where we ran through the referrals that had come in overnight, we would hear five to six harrowing stories of assault before starting our clinical work.  So those working hours were filled with indirect exposure to sexual trauma.  What I noticed most at this time was the impact on my world-view, which became skewed towards a belief that men were dangerous and that bad things happen to people, hence becoming so wary on my evenings out.  This was vicarious trauma.

What is Vicarious Trauma?

Vicarious trauma is an occupational hazard for any helping professional who empathically engages with traumatised people.

It is the negative psychological impact of working with traumatised individuals caused by a shift in world-view [i] for example, fearing for one’s own safety or distrusting others, leading to symptoms that mirror post-traumatic stress.

Terms that are often used interchangeably with vicarious trauma include: compassion fatigue, burnout, secondary trauma and critical incident stress.

Symptoms of vicarious trauma

There are three areas in which signs of vicarious trauma can present themselves [ii] :

1. Physiological signs

• Insomnia
• Headaches
• Lower immunity (getting colds and other illnesses)
• Exhaustion
• Muscle ache and skin rashes
• Palpitations

2. Behavioural signs

• Increased use of alcohol, drugs or emotional eating
• Irritability
• Avoidance of socialising or sexual intimacy
• Avoidance of work-based activities or the opposite, over-checking emails and staying late at work.
• Decision-making difficulties
• Increased off-loading/gossiping with colleagues at work
• Avoidance of non-work-related activities
• Hypervigilance (being watchful for signs of danger e.g. checking phone or scanning rooms for escape routes)
• Avoiding TV or media stories with trauma

3. Emotional signs

• Anxiety, low mood or anger
• Feeling helpless, hopeless or guilty
• Persistent sense of dread, especially at work (e.g. going into meetings or meeting a new client)
• Feeling emotionally numb or empathically disengaged
• Dissociation i.e. mentally switching off or spacing out for short periods of time.
• Intrusive thoughts or images of the trauma you’ve heard

How does vicarious trauma affect work?

Aside from the negative impact on your emotional and physical health, if left unaddressed vicarious trauma can lead to diminished job satisfaction and efficacy at work.

Below are the three areas to look for signs at work. This is helpful for further spotting signs in yourself but also for noticing signs in co-workers or supervisees.

1. Performance: If your mood is low this may start to impact on your motivation for some tasks (or even for turning up to work on time) . It could also affect your concentration and therefore make you more forgetful. Equally, high anxiety impacts on both avoidance of tasks, or the opposite – perfectionism (e.g. re-reading emails or over-preparing).

2. Morale: It’s easy to see how the above impacts on moral. This can show up as imposter syndrome or apathy. The helplessness can lead to apathy and disinterest, feeling under-appreciated and ultimately this can impact on your connection with compassion.

3. Work relationships: It’s typical to become withdrawn at times like this, avoiding coffee breaks with colleagues for example or miscommunicating with each other (especially if others are all in the same boat). We can become less patient and struggle to delegate.

Risk factors for vicarious trauma

There are factors [iii] that can increase the likelihood of suffering from vicarious trauma.

For example, if you’ve suffered from a trauma in your personal history then you will be more likely to be adversely affected.

A higher number of clinical hours (i.e. more exposure to traumatic material) also puts you at high risk.

There is also evidence that the type of trauma you are exposed to affects the likelihood of more severe symptoms. Working with sexual violence and adult survivors of sexual abuse carries the highest risk.

Finally, if your team and work culture is not trauma-informed then you will be less protected. So, if you are applying for jobs in high-risk fields ask how the organisation safeguards staff from vicarious trauma.

The good news is that despite these risk factors there are things that you can do to look after yourself and ways that organisations can look after their staff.

How to prevent vicarious trauma

What can you do to look after yourself when working in a setting that exposes you to indirect trauma?

Firstly, familiarise yourself with the signs and symptoms of vicarious trauma.  It’s helpful to think about this as a continuum rather than in black or white (“I either have it or I don’t”) terms.  Using this continuum below think about what each part of the scale looks like for you:

Some of the things that can be really helpful for keeping yourself in the “green” zone are:

Ensuring you are tending to your basic human needs such as rest, nutrition, exercise and connection with people you care about. So often these things drop down the priority list when our emotional health is rocky or we are busy. Who or what can help you get back on track with these things if they’ve fallen by the wayside? Hobbies and mindfulness meditations would be the next thing to focus on if your basics are already in place.

It’s also important to find a ritual [iv] that will help you switch off from work at the end of the day, such as walking home and listening to an uplifting playlist; doing yoga stretches or going for a short jog.

Tap into imagery that makes you feel safe and protected when you’re in work mode, and cared-for when in non-work mode.  Spend some time developing an image and practice bringing it to mind when you aren’t stressed. This will help you to bring it to mind when you need it most. Ideas include your favourite place in nature, a nurturing person in your life and a personal achievement.

When you are edging up the amber and into the red zone consider what this looks like for you. For example, are you someone who starts to avoid tasks or the opposite; starts to overwork?  Do you tend to emotionally eat or do you lose your appetite? It can be hard to see it at the time so investing a bit of time after reading this blog to identify your personal symptoms may help you to be alert to it.

Next, take time to ask yourself what your needs are when you are in the amber and red zones.  If possible make some plans for this. If you start to edge up the continuum then you can put in more strategies to manage your symptoms. For example, reading this blog on grounding.

Think about what is within your control at work and start with managing this. For example, have you used the supervision options available to you or can you speak to your manager to set this up if it’s not already in place?  Is there a way you can decline taking on certain referrals for a while to manage your exposure to triggers?  Have you made sure you have regular holidays booked (I tend to find I need a week off every 6-8 weeks, if I leave it longer than that I really notice myself edging into the red more).

What can organisations do to protect their staff from vicarious trauma?

Whilst self-care is important it can only go part of the way to protect you from vicarious trauma.  A large review [v] of organisations showed there can be over-reliance on generic self-care such as mindfulness and relaxation. It highlighted that organisations need to go one step further and make sure that interventions are linked to the specific world-view shifts that are common for the area of trauma of each staff group e.g. in a service working with victims of violence then the intervention needs to be tailored to the worries of distrust and fear for staff’s own safety.

Organisations should consider the risk factors around higher clinical hours. For example, when I worked at the Sexual Assault Referral Centre our manager ensured that therapist positions were carved into part-time roles to avoid over-exposure to individuals.

Managers can also assess and monitor vicarious trauma amongst their staff using tools such as the Pro-Qual (freely available online), ensuring that their systems are set up to support staff accordingly. For example, offering trauma-informed supervision, having peer-support networks, providing therapy and mental health services and training staff and managers to recognise the signs of vicarious trauma.  Importantly allocating time and normalising use of these resources needs to be part of this.

Dr Claire Plumbly is a Clinical Psychologist who works with women who have experienced trauma. She has resources for women who have been sexually assaulted on her website and runs an online hybrid group/1:1 program to help women overcome low self-esteem and anxiety. Find out more at: www.DrClairePlumbly.com

The post Vicarious trauma: what it is and how to prevent it appeared first on Dr Paula Redmond, Clinical Psychologist.

• feeling disturbed by having witnessed things at work that are morally wrong?
• plagued by thoughts of whether or not you did the right thing?
• feel betrayed by colleagues or managers you once trusted?
• struggling with strong feelings of guilt, shame, disgust and/or anger?

If you answered yes to any of these questions you might be experiencing something call “moral injury”. And you’re not alone. A recent study by the BMA found that half of the doctors they surveyed resonated with these experiences.

What is Moral Injury?

Moral distress and injury are closely linked to trauma.  In extreme situations people may witness things, or act in ways, that go against their moral compass. For health professionals this might mean having to make terrible decisions about when to give or withhold treatment; having to enforce policies that keep families from visiting dying loved ones; or not being able to save a patient’s life.

Sometimes we can be prevented from doing what we feel is right due to circumstances outside of our control. Even though we might be able to understand rationally why this happened, it can create a deep moral or spiritual wound. This can shake our beliefs about ourselves as being good people, and invoke feelings of shame and guilt.

Moral distress can also be caused when we feel betrayed by those in positions of authority who we previously trusted. This can happen if, for example, you feel you were put in unnecessary danger by your workplace, or you are required to enact policies that you think are wrong.  These experiences can make us feel angry, helpless and ashamed. We may also feel complicit in causing harm or failing to prevent it.

The experience of moral pain (i.e. guilt or anger when we do or witness something we believe to be wrong) is not problematic in itself. In fact, these feelings can be really important in helping us to act in line with our values. It is when we try to manage or avoid this moral pain in unhelpful ways that moral injury can occur.

If we find it hard to forgive ourselves for what we perceive as moral failings, we can end up behaving in ways that are very punishing or self-sabotaging. We may develop the belief that we don’t deserve happiness or acceptance.  We might start isolating ourselves, relying on substances or sabotaging our close relationships.

How to support ourselves when experiencing moral injury

Coping with moral injury can be really hard, especially when many of the contributing factors are outside of our control.  We need to find ways to approach our pain, make room for it and learn from it without being pulled into self-sabotaging behaviours.  Here are 7 ways of coping with moral injury that can help to strike this balance.

7 ways to respond to moral injury

1. Hear your pain – feeling guilt, shame and anger when you believe something wrong has happened tells you that you care, and that doing the right thing is important to you. It hurts because it goes against your values.  If you didn’t have such a strong moral compass, it wouldn’t be so difficult to bear.

2. Notice your posture – do you find yourself avoiding eye contact, slumping, drooping or hanging your head? This can create a reinforcing feedback loop between your mind and body, increasing a sense of shame. Try to adopt a more open posture, and warm facial expression – this can often have a positive impact on our emotions, and help us get in touch with a sense of compassion for ourselves.

3. Talk – share your thoughts and feelings with others, especially those who have had similar experiences. This will help to validate and normalise your experiences, and is a great antidote to shame.

4. Grounding – this is really helpful when you feel overwhelmed by any strong emotion. Try focusing on your senses – notice 5 things you can see around you, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can taste. You can read more about grounding here.

5. Mindful acceptance – mindfulness is a powerful tool for developing greater acceptance of difficult thoughts and feelings. When we are able to accept our internal experiences as they are we are much less likely to resort to unhelpful coping strategies. This is not the same thing as accepting the situation – in fact being able to accept our thoughts and feelings can often empower us to keep fighting for the change we want to see in the world. Try this Leaves on a Stream exercise as an example of noticing and accepting our thoughts.

6. Self-compassion – learning to be compassionate towards yourself and your experiences can help to heal shame and enable self-forgiveness. Try these exercises.

7. Take valued action – re-connect to your values and take action that is in line with these. This might take the form of activism, or more internal action in terms of how you relate to yourself and others. For example, if equality is important to you how can you act to promote this at work? If compassion is important to you, what can you do to show compassion to yourself and those around you? What do you want to stand for in the face of your experiences?

If you’d like more support with this issue book in a free 20-minute call and we can think together about how I might be able to help.

The post 7 ways of coping with moral injury in healthcare appeared first on Dr Paula Redmond, Clinical Psychologist.

To the NHS worker who called me…

You messaged me asking to talk and I agreed. We met online and you told me how fed up you are, how you feel exhausted at work and how you couldn’t bear being there anymore. You said maybe you just needed better supervision and more support in your workplace.

I said you sounded very unhappy and wondered if you needed to enjoy your life a bit more and how important it is to have community, rest and creativity. You wondered how you could get more of this in your work. Maybe apply for a new job? The place you work at the moment is so underfunded and under-resourced.

Everyone at work always tells you how creative and innovative you are, how much you help effect change and the hope your presence carries for others. Maybe you just need to be in a better supported team?  Maybe you could set up a staff supervision group, you could do it as a pet project, after hours? We then talked some more about the impossibility of this as your colleagues are exhausted.

We came back to leaving your job and you said the people you work with are so vulnerable, you couldn’t bear to walk away.

I wondered if you might look for a therapist. But you felt that this was not really a personal issue and more about finding a way to hold your work space more effectively. This was a systemic problem, not personal and you just needed to find the right systemic change.

I disclosed that I had never managed to create that kind of charge and didn’t know how. Also I had to leave the NHS to then find out that the unrelenting to do list that is everywhere in the NHS, was also inside me.

We discussed how socialism is so important to you and how you felt worried by how many mental health practitioners were leaving the NHS. It felt immoral. I said there are a lot of complicated narratives around leaving. I said I know leaving can feel like you are betraying something vital. I said I’m not too good at being a socialist, but then I also think always having to be good is overrated. You agreed with my poor socialism, we laughed. Sort of. Then you said awkwardly maybe you just need to find the right team? I didn’t reply to that. You looked alarmed.

You needed to go.

We ended the call. I now know I won’t be hearing from you again.

The moment has gone and we can’t go back but this is what I wish you could have known…

Stories and the mother archetype

There are reasons why I love fairytales and myths: they help me think about painful aspects of myself without needing to cut off or run away. One thing they have particularly helped me with is my relationship with the ability to mother myself: my relationship with the mother archetype.

When thinking about the mother archetype in fairy tales and myths, psychoanalysts generally follow the Brothers Grimm frame of ‘mother’ being both the loving birth mother in stories as well as the step-mother who symbolises the dark side of motherhood. The Grimm brothers travelled around Europe collecting stories told only by word of mouth, typically by women to other women in weaving rooms and to their children.

Importantly many of the stories the Grimm brothers collected began with no step-mother, only any mother who might be loving, abandoning, self sacrificing and devouring. In the Grimm brothers’ revisions they slowly separated out the positive from the negative aspects of the mother, elevating one aspect and denigrating another until the wicked step-mother was born.

The potent uptake of these male-written stories, replacing the female oral tradition and then given their revised patriarchal form is one way of noticing the loss of society’s ability to value the feminine.

“Our culture’s wounding and belittling of the feminine and its values has led many mothers to mistrust the world and men to a greater extent than ever before, and this mistrust inevitably becomes part of the emotional heritage of our children.”

Massimilla Harris, Ph.D., and Bud Harris, Ph.D., from Into the Heart of the Feminine

The NHS as “mother”

So many healthcare professionals are the child of a mother suffocated by her lack of self and social worth. Her devaluation is evidenced in her lack of support, constrained sexuality and denied social position beyond the success of her children and husband. Eventually she internalises her worth as being only found in her usefulness to others.

The NHS is sometimes referred to as a kind of mother. She also is a mother suffocated by chronic underfunding, ever increasing expectations of quality of care and relentless shifting political climates.

As the child of the mother in these stories, you inherit the feeling of being unheard, invalidated and an awareness that you (or some part of you) is so unloveable and bad it should not exist at all.

The mothers in these stories want to love their children but to do so they need their children to fit in, to not take up resources, to be good, useful and well behaved. Just as Mother is trying to be. Mother has enough going on without more chaos being added. The child learns to kill off their unwanted messy parts- they see mum’s torment and want to help. The child learns to be useful too.

As one person put it in Understanding and Healing Emotional Trauma by Daniela Sieff:

“When I am hungry, I am not fed. When I’m exhausted, I’m not allowed to rest. When I need to move, I’m forced to stay still.”

If the child can be useful to mum in this way, then maybe mum will be okay and everything else will fall into place. Jungian analyst Marion Woodman calls this narrative the Death Mother.

The Death Mother

Marion Woodman wrote that the “Death Mother is born out of despair. It is incubated by the crushed hope of an unlived life. Death Mother is the shadow side of disappointment. When you look into the eyes of Death Mother you see they are glazed over with hopelessness. You see a blank look; there is nobody at home. You see an unconscious, frozen and profoundly wounded body-psyche devoid of authentic feeling. You see somebody with desperate need to be in control. You see someone who is driven by will power.”

Internalisation of the death mother

At some point in the repetition of this experience the child internalises her. The child learns to be disapproving, denigrating, even repulsed by their impulse to live their own life – it’s just greed, indulgent selfishness and lack of social conscience. You tell yourself you just need to care about others more, you just have to do what is right.

The self, the body becomes something to be mastered and tamed. You can become possessed by the Death Mother and be completely unconscious of it. Your motivations are cleverly disguised from everyone, even from yourself: we see a leader of social conscience, a strong work ethic, admirable self-discipline, a purity of religious faith and NHS heroism.

“These are exceptional times”

The death mother always says she is grateful. She knows what she is asking. She waves and cheers as you go to work. Your work will set us free, she says. She rewards you with more responsibilities, letters before and after your name and gold star certificates.

She knows what she is asking but …. If only she had more money, more time, and was better supported. These are exceptional times. We all need to compromise, to sacrifice. She is right. There can be a terrible cost to others when we set limits. But these are always exceptional times.

She says maybe if you try harder, become more efficient, more effective, have the right attitude, just surround yourself with positive people who care too – doers, who understand the severity of the problem. It will be better next week, next month, next year, next supervisor, next job, next generation.

Then finally Mother will be safe, secure and she will know her value, as will others. Finally then she can care for everyone in the magnificent way that only she knows how to best. My mum, the NHS, the best mum in the world.

Evoking the death mother

In work your internal death mother is easily evoked. The smallest amount of feeling you might let people down or be seen as difficult can render you immobile.

But the brighter you shine, the darker your shadow. The best way to describe her influence on you is your emotional collapse, paralysis, even a longing for the oblivion of death. This is the heart sink and collapse you feel when you said no, but they came back and asked again.

You wish for a different life, but then feel shame at the thought of people knowing your selfishness. Instead you take the extra patients, move the annual leave, silence your objections in the meeting.

You say yes to work and sorry but no to your partner, your friends, your children. You say it’s just this once, again. If only I had more time, more support, more resources, then I wouldn’t need to say yes. It will be better next month, next year, next job, next generation.

Dr Libby Nugent – BSc (Joint Hons), DClinPsy, C Psychol, AFBPs

I am a clinical psychologist and group work practitioner in group analysis. I have particular interest in exploring stories and myths in groups as a way to creatively connect and examine individual and collective psychology.

I am based in North Wales and run online workshops and reflective spaces for anyone wanting to experience in action how through the group ‘s discussion, meeting our reactions, our connection to symbols, imagery and association along the way, we might enable each other to better understand ourselves, each other and some of the personal and collective stories we all live.  Unless explicitly stated for a specific event, no particular background or experience is necessary to participate.

You can find out more about these workshops and groups at my website: www.libbynugent.co.uk

References

Daniela F. Sieff (2019) The Death Mother as Nature’s Shadow: Infanticide, Abandonment, and the Collective Unconscious, Psychological Perspectives, 62:1, 15-34.

Marion Woodman and Daniela F. Sieff. “Facing the Death Mother to claim our lives”

Massimilla Harris, Ph.D., and Bud Harris, Ph.D.. Into the Heart of the Feminine.

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