Burnout, Therapists

  By nature, therapists are caring and compassionate people. We enter the field to help others, and this is a noble and wonderful thing. However, like any quality, caring can be over-done. If therapists leave themselves out of the circle of care, “emotional fatigue and burnout come – and can come fast.

Therapists’ tendency to focus exclusively on other people’s well being and the fact that we spend long hours in this mode account for the high rates of stress, substance abuse, depression and (yes, even) suicide among members of our ranks. In addition to the personal ill effects of burnout, providing poor treatment for clients as a result of burnout is unethical.

BURNOUT 101

• Burnout is the result of job stress stemming from the numerous emotional hazards of the profession.
• It affects most counselors, psychotherapists or mental health workers at some point in their careers. It is not reserved for the seasoned-older therapists; it can strike therapists earlier in their careers as well.
• It manifests primarily as emotional exhaustion, “emotional fatigue” or “emotional overload.”
• This can lead to depersonalization (of patients and self) which manifests through general dislike, and a detached and callous – even dehumanized – attitude towards clients, who are perceived as energy drains or stressors.

Clearly, no therapist can be effective under these conditions.  

Top Stressors: Ingredients for Burnout

1. Emotional Depletion or Emotional Fatigue: Working constantly with people who are in pain, feel suicidal, are grieving over the loss of loved ones, or those severely traumatized, takes a heavy toll on practitioners. The psychotherapist can be “infected” with a patient’s sadness; a condition Jung called “psychic poisoning.”
2. Vicarious Traumatization: This term has been introduced in recent years and has become even more popular after the events of Sep. 11, 2001. It refers to the cumulative effect upon the trauma therapist of working with trauma survivors. In this process, the therapist’s experience is negatively affected through empathic engagement with clients’ trauma material.
3. Grandiosity and Demonization by Clients: While some patients idealize therapists, others put them down. Still others oscillate every other week. The healer may be set on a pedestal only to be knocked off of it soon thereafter. Without objective feedback, therapists can end up confused and in doubt about their own qualities, qualifications, and sense of worth.
4. Constant Worry: Therapists are often in a constant state of worry about whether a patient is going to follow up on a suicidal or homicidal threat. Whether or not the therapist reports such intentions or makes a suicide contract with the patient, sleepless nights and anxiety are significant hazards of the profession.
5. Distraction: Focusing on other people’s problems, which may be more severe than their own, can lead therapists to lose track of their own situation.
6. Helplessness and Sense of Inefficiency: Unlike carpenters, gardeners, or surgeons, psychotherapists rarely see immediate, profound, or tangible results from their efforts. The work is often (though not always) slow. Even when therapy is effective in relieving painful symptoms and termination is successful, patients leave, and with them goes the knowledge of the long-term effect the work has had on their lives.
7. Inability to Shut Off the Therapeutic Stance: While many patients disclose the most intimate aspects of their lives to their therapists, the therapist must share only what is appropriate and beneficial to the patients. Experiencing many such relationships can lead the practitioner to acquire extreme voyeuristic tendencies. It may also lead therapists to transfer the mode of one-way intimacy to friends and family outside of the therapy office.
8. Worry About Board Investigations: Most ethical and risk management instructions fuel unrealistic fears about board investigations and lawsuit. The fact that board disciplines and lawsuits against therapists are relatively rare does not help therapists who carry the burden of constant worry and fear.
9. Grandiosity: Working with people who often idealize you and often are desperate for help and guidance can result in what Ernest Jones labeled “God Syndrome.” Those who develop such an inflated sense of self are likely to be sarcastic, disconnected, and un-empathetic with clients.

Burnout is Preventable! Here are tips:

• Practice Personal Restoration. This can include therapy for you, spiritual practice, exercise, proper sleep, and time with loved ones. Enjoy your life in a way that is sustainable. Everyone needs regular downtime and restoration – especially those in the helping professions. Take time to remember who you are and meet your own needs. Connect with others when you are not in the therapist role. Seek solitude and time in nature. Keep “in touch” with yourself.
• Consult and Get Peer Support. Rather than struggle with difficult cases on your own, seek consultation from experts or colleagues. Ongoing peer support and consultation can be very helpful in preventing burnout.
• Grow as a Person. You’re not just a therapist, there to help others. You are a full person, with your own needs and desires. Whether your passion is painting, writing, playing basketball, cooking, etc. – make sure you have time to do what you love. Provide your clients with good care, but do not make them the (only) center of your life.
• Belong to a Professional Organization. As a member, you can meet with colleagues online and f2f, and you will also receive their monthly publication. This can help foster a sense of community, and keep you involved with professional updates. Finding out early about ethical and legal developments in the field will save you from unnecessary stress.
• Practice Ethical Risk Management: Continue to update yourself on changing laws and ethical guidelines. Stay flexible and open; do not resort to rigid risk management practices. Especially in difficult and stressful cases, seek consultation and extra documentation. See our online course on Risk of Risk Management and our new 18 CE Credit Hours Ethics Course.
• Make Time for Family and Friends. Whether you are married with children, single, or anywhere in between, quality connection with loved ones is important. Make time to engage in activities you enjoy, or simply have downtime with people who are close to you.

ON BALANCE

Staying centered and balanced as an active psychotherapist presents a multitude of challenges. Clients can be demanding, there are times when we are in a state of constant worry, the field is constantly evolving, and our clients often need a great deal of care. Conversely, practicing therapy can be highly rewarding, gratifying work because for many of us, our work is our calling rather than just an occupation. Balance is the key to practicing effectively and preventing burnout. This includes balance between our personal and professional lives, between taking care of others and taking care of ourselves, time alone and time with others, and finding balance between the physical, mental and spiritual aspects of our being.  

Consult on difficult cases or your concern with your own burnout:
Email Dr. Zur.

Related Online Courses

• Risk of Risk Management
• Power in Therapy:
  • 6 CE Credit Hours
  • 2 CE Credit Hours
• Borderline
• Boundaries in Therapy
• Over 125 Online Courses for CE Credit Hours

Essential Clinical Forms: Reduce the worry by implementing basic forms, such as office policies and authorization to disclose information.