Monday, November 03, 2008

Burnout

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Lately I mentioned the report by Ine Vanwesenbeeck called:
Burnout among female indoor sex workers [Archives of Sexual Behavior Dec , 2005, Ine Vanwesenbeeck]
The website prostitution procon mentions some quotes of her report:

This study provided evidence that female indoor sex workers in the Netherlands do not exhibit a higher level of work-related emotional exhaustion or a lower level of work-related personal competence than a comparison group of female health care workers (mostly nurses)....

The fact that findings were partly contrary to expectations and contrary to suggestions from others that sex work is intrinsically traumatizing may be explained by sample differences. Here, indoor sex workers were studied, whereas many other studies focus almost exclusively on street workers..."


I took the time to actually read the report (you can download a cheap version here)

I found out that the group of prostitutes Ine Vanwesenbeeck studied in this report is the same as in another report she (co-)wrote with Liesbeth Venicz in 2000: “Er gaat iets veranderen in de prostitutie... - De sociale positie en het psychosociaal welzijn van prostituees in prostitutiebedrijven voorafgaand aan de opheffing van het bordeelverbod” [Something’s going to change in prostitution… - The social position and psychosocial wellbeing of prostitutes the prostitution businesses prior to the lifting of the ban on brothels]. (you can download it here)

In her burnout study she mentions:
Recruitment of sex workers took place by means of fieldwork. Five fieldworkers, who were either prostitution social workers or ex-prostitutes, were trained specifically for this project. Together, they visited a total of 138 sex work sites, selected on the basis of the fieldworkers' network and according to considerations of geographical dispersion. Some of the interviewers were fluent in languages that are spoken by relatively high numbers of sex workers in the Netherlands (e.g., English, Spanish, and Czech) and were provided with translated questionnaires in those languages. In 67 sites (49%), at least one worker agreed to participate in the study. Because the number of sex workers addressed varied per site, it is uncertain what the response rate on the level of individuals was. A total of 105 sex workers were interviewed. Five of these were males and four were male-to-female transsexuals. They were excluded from the analyses here. The remaining 96 female sex workers were, on average, 30.6 years of age (SD = 8.4) and had, on average, worked as a sex worker for 7.3 years (SD = 6.0). Other demographic characteristics are presented in Table I.

Burnout scores of two comparison groups were taken from Schaufeli and van Dierendonck (2000) [she means: Schaufeli, W. B., & van Dierendonck, D. (1995). A cautionary note about the cross-national and clinical validity of cut-off points for the Maslach Burnout Inventory. Psychological Reports, 76, 1083-1090.]. The first comparison group (N = 2,043) consisted of female health care workers, mostly nurses, with an average age of 36 years (SD = 10.1). The second comparison group consisted of people in treatment for work-related psychological problems (N = 142), with an average age of 41.9 years (SD = 8.9). The group was 40% female and 60% male, but no sex differences related to burnout were found. These people were from a variety of professional backgrounds, with half of them having a higher educational level. They were patients for, on average, 4.8 months (SD = 8.3).

(…)

Burnout was measured using a validated Dutch version of the Maslach Burnout Inventory, the Utrecht Burnout Scale for the Contactual professions (UBOS-C; Schaufeli & van Dierendonck, 2000). The UBOS-C consists of 20 items and 3 factors: emotional exhaustion, depersonalization, and personal competence. Participants were asked to rate the frequency with which they experienced various feelings on a 7-point scale, ranging from 0 (never) to 6 (always/daily).
Some numbers from table III (Mean Scores on Burnout Factors for Female Sex Workers, Female Health Care Workers, and People in Treatment for Work-Related Psychological Complaints):

Sex workers (N=96):
Emotional Exhaustion: M=14,9 (SD=11,7)
Depersonalization: M=8,9 (SD=6,1)
Personal competence: M=27,5 (SD=7,9)

Health care workers (N=2043):
Emotional Exhaustion: M=15,3 (SD=8,1)
Depersonalization: M=6,8 (SD=4,2)
Personal competence: M=27,4 (SD=5,6)

Patients (N=142):
Emotional Exhaustion: M=26,0 (SD=9,5)
Depersonalization: M=9,3 (SD=4,9)
Personal competence: M=24,5 (SD=5,1)

She did more or less the same in her Er gaat iets veranderen study, using the same validated Dutch version of the Maslach Burnout Inventory. You might guess that (even if you take into account that the males and transsexuals are not included in the Burnout version of her study) that the numbers should be more or less the same. But they turn out to be COMPLETELY DIFFERENT!!!! In her Er gaat iets veranderen study (see pages 76-77) the number for Emotional exhaustion for the prostitutes is 23,7. The number for Depersonalization was 14,2. The number for Personal Competence is 34,1. The fact that the males and transsexuals were included doesn’t explain this (except when you assume that their average number for Emotional Exhaustion exceeds 117, for Depersonalization it exceeds 70 and for Personal Competence it exceeds 104, which seems all very unlikely to me). She even calls the high score on Emotional Exhaustion worrying. It could be that Ine Vanwesenbeeck has made an error. It must be. But which are the right numbers?

And if the earlier numbers are true, the numbers of the prostitutes are in my opinion more or less comparable to those of the people (Patients) in treatment for work-related psychological problems. And if you take into account (see page 21 in the Er gaat iets veranderen study) that the researchers had the impression that during fieldwork of the research forced prostitutes didn’t want to cooperate (in addition to the quarter of the women who admitted that they have initially been forced into prostitution), you can assume that their situation is even worse.

Anyway, Vanwesenbeeck also made Correlations of Person- and Work-Related Variables with Burnout Factors in her Burnout report and these numbers correspond reasonably with those of the ones mentioned in her Er gaat iets veranderen report. These numbers show that there’s not such much a relationship between prostitution and distress per se, but in combination with having little control over interaction with clients or being forced in prostitution it could have a negative influence. Also having negative feelings about working in prostitution could cause distress. But that seems logical. Having sex per se doesn’t cause distress. Being forced to have sex or doing sexual things you don’t like could cause distress.

However, the newer Dutch reports about the social position of prostitutes in 2001 and 2006 didn’t reveal much difference between prostitutes and the general population. That’s the more surprising when you assume many prostitutes come from poor countries. In the latter report the prostitutes even had lower distress levels on average than the general population. Perhaps the situation in the brothels in the Netherlands actually did improve. This is still difficult, how much of this is related to sample biases?

The solutions to the problems prostitutes face are very simple if you would believe Ine in her burnout report:
Personnel policies, work relations, support structures, the organizational culture, and protection of personnel from violence on the work site have come forward here as relevant criteria by which "good" businesses can be distinguished from "bad" ones. Under a regulatory system, norms in relation to these aspects can be set. These would have to come about in collaboration between authorities and the parties involved so that they are broadly accepted. Departure from these norms could be met with sanctions. To promote broad application as well as other positive developments in relation to work relations, support structures and organizational cultures, both managers and sex workers may be provided with education and training. The sex business has no tradition of formal negotiation of work relations and sex workers are not used to claiming their rights as workers. A process toward better work relations, worker protection, and an improved status of sex workers, once facilitated by a legislative system as now available in the Netherlands, certainly needs further government support.

Finally, clearly it is not only their experience at work that threatens sex workers' health. Acceptance of their professional choice in their private lives appears vitally important as well. Legal rights for sex workers as a professional group are a precondition for adequate government intervention, but does not yet guarantee societal acceptance of sex workers. The struggle against social stigma of sex workers and the reduction or prevention of negative social reactions toward them should be an additional aim of any policy working toward improvement of sex workers' social status and well-being.
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