Rewriting burnout as metaphor

Abstract Today’s healthcare professionals shoulder consequences of budget cuts, staff shortages, longer hours and a growing, aging patient population. To address support for both patients and staff in this challenging context, the kidney dialysis unit of a major Italian hospital was chosen for a three-phase pilot study of Metaphoric Affect Processing (MAP). MAP is a metaphor-based interview technique designed to enhance wellbeing in hospital settings by facilitating the identification, verbalization and regulation of affect as metaphor. The subject of this article is Phase 1 of the study, which focused on mitigation of burnout symptoms among peritoneal and hemodialysis nurses. In Phase 1, nurses were offered weekly group sessions of MAP training. All participants learned to use codified, “poetic” dialogue to explore, share and metaphorically “rewrite” present-moment feelings. By the end of training, a number of nurses also qualified as MAP facilitators themselves. Nurses’ pre-training burnout levels were measured in subcategories of depressive anxiety, loss of empathy, and reduced sense of personal achievement. Assessment after MAP training confirmed nurses’ self-reports of having engaged metaphor to address these aspects of burnout, reducing stress levels, increasing empathy among colleagues and expanding perspective. Phase 1 outcomes suggest that MAP may be an effective intervention to boost wellbeing for healthcare workers at high risk for burnout, and merits further study. This article also offers an overview of MAP’s early development with patient populations in cancer treatment and acute care psychiatric settings.