Burnout is awful. It’s heavy, hopeless, and tragically common in therapists. Personally and professionally, we have our boundaries tested all the time, and therapists being caring people, it can be difficult to say ‘no’ to helping a person. Particularly in community or non-profit work, counsellors get asked to work insane caseloads, long hours, outside their areas of expertise, and so on. 

Self-care and mindfulness are terms often co-opted by shitty employers and managers to shift the blame to the clinician for how overburdening their demands are on you. 

In simple terms, stress occurs when the demands placed on us outweigh our perceived resources and ability to manage it, and burnout is the result of this occurring chronically. This is harder to recognize when we’re new to the role and new(ish) to the working world in general. Yes, each of us does have to take responsibility for our health, which I’ll detail below. But take a minute to reflect on whether or not your employer (past or current) is taking advantage of you, or is gaslighting you in this context. If you haven’t had this experience at some point, you’re lucky and probably in the minority. It’s messy to combine healthcare and for-profit business, and when they are it’s almost inevitable that client wellbeing stops being the top priority.

So what do we do about burnout?

1. Know exactly what burnout looks and feels like in you, then monitor for it

2. Take care of ourselves so we’re more resilient and remain healthy

Much easier said than done. Let’s dig in to each item.

Know your burnout signs and monitor for them.

• Google several free online burnout screening tests now to (re)calibrate your perception of what constitutes burnout (spoiler: most of us underestimate how burned out we are)

• Create a list of characteristics that you can check for in yourself periodically. Here’s a broad list, and I would personalize it:

6 components at work that contribute to burnout: workload, control, reward, community, fairness, and values. We burnout when one or more of these areas is chronically mismatched between us and the role.

Yellow flags for burnout:

• Irritability

• Catastrophizing

• Higher anxiety 

• Emotional exhaustion

• Some self-doubt, beyond a ‘healthy’ amount

• Empathy fatigue: struggle to empathize w clients (can notice and challenge my negative thought/judgement but the effect isn’t maintained for more than a few minutes)

• Going over time with a client, especially if  it becomes habit

• Not emotionally connecting with clients, not building much rapport or relationship

• Overly casual w clients

• Too many sessions in a row

• Drop good habits/self-care, eg missing an exercise day - esp if habit

• Feeling overwhelmed

• Isolating

• Reduced satisfaction, feel disillusioned

*(these yellow flags can indicate other concerns too, obviously)

Red flags for Burnout:

• Serious self-doubts: effectiveness, choice of career etc

• Progressive boundary crossings - especially when we lose sight of our scope/role (eg emotionally involved in clients’ goal, or feeling responsible for their choices etc)

• Boundary violations

• Unable to regulate appropriately

• Self-medicating

• Unable to show up as a therapist for the one-way supportive relationship

• Feel shut down, numb, emotional exhaustion

• Over-time with clients a habit

• Avoidant coping: food, alcohol, tv etc

• Chronic stress symptoms: headaches, digestive issues, poor immune function

• Chronic lateness 

• Cynical about working conditions, alienation

• Hesitation or unwillingness to go to work, more sick days

• Trouble falling or staying asleep

• De-realization

As for how to monitor for this, select whatever version of self organization works well for you. For me, that means putting a recurring reminder on my calendar to spend a few minutes reflecting on this list of flags every 2 or 3 weeks. As with any issue, prevention is best—and if it’s too late for that, at least catch the concern early so it’s easier to deal with.

Prevent burnout or recover from it:

The following suggestions are useful both for preventing burnout, or recovering from mild to moderate burnout while still working at least part time. Unsurprisingly, many of them are about our boundaries, which are useful to us and serve as a model to our clients:

• Don’t work harder than your clients are on their own wellbeing (risk as an exception to this)

• Remind yourself that you aren’t responsible for your clients’ choices 

• Have firm boundaries with work: don’t ‘donate’ your time or money to your job

• Have strict boundaries about when you are reachable by work and communicate with clients. I don’t look at my work email at home, and I don’t have any work stuff (email etc) on my personal phone

• Have a clear and firm policy about cancellations: a common one is at least 24 hours notice or they’re charged for the session (be humane but cautious in providing exceptions), and be clear what you’ll do if there are multiple missed sessions in a row. I simply do not book additional sessions if a client currently owes for previous or missed sessions. I don’t work in a crisis setting, I provide a sliding scale, and there are free, 24 hour phone and walk in services in my area

• When possible, don’t take on new or additional high risk clients if you’re drained or have many high risk clients on your caseload. Depends on your level of control and how easily/quickly you can refer people

• Be kind, firm, and direct in articulating boundaries with clients: let them know when you’re reachable, what emails are for (basically, only scheduling), when they’ve crossed a boundary of yours, ending phone calls that are going on too long, etc

• Consider if (when possible) an alternative works better for you: 4.5 days a week, 4 longer days, Tues - Sat, something less than 40 hours or whatever. I’ve seen all kinds of bizarre schedules work well for people

• Have a sustainable work schedule, which most employers will push you right to the edge of, if not just passed

• Take a careful look at your expectations for yourself—saving the whole world, taking on responsibility for things that aren’t yours to handle or are out of your control, perfectionism etc

  • These ideas may sound silly, but if we stop and actually look at what our behavior and thoughts imply our expectations and beliefs are, it’s painfully common to operate under absurd, non-conscious ideas that sound childish when articulated

• Acknowledge that ‘heavier’ work can be more likely to bring on burnout, such as trauma, crisis, perhaps grief work

• When reasonable and safe, be open with colleagues about your difficulties. Basically all therapists have struggled with this sort of thing in the past, or currently are facing it (especially as I write this, during the Covid pandemic!)

• Get outside often and unplug: no social media on your phone, take a full day off tech once a week, consider tracking use of social media and the internet. It’s a wonderful tool, but we’ve become the products and it’s creepy. Eg on average, 80% of the time adults in the USA can access their phone without moving their feet

• Engage in regular, consistent self-care. What activities, balance, and variety each of us needs is different, so I won’t go on about this. It’s absolutely critical that we take care of ourselves and are self-compassionate in attending to our own needs

  • Our physical, mental, and emotional health are all active processes, meaning they must be attended to regularly to stay in top form

  • You know how caring, energetic, forgiving, patient, and loving you can be toward your work, friends, family, or pet? You can be like that toward yourself too! Self-care is about enjoyable activities, but sometimes it’s the ‘hard’ stuff too, like going to our own therapy, exercise, being frugal so we have a rainy day fund etc. The more robust your self-care, the more you can withstand one or two areas of your life being destabilized. 

• As a special mention, I highly encourage you to try a month or two of dedicated mindfulness practice, if you’ve never tried it or if it’s been years since you last tried it. Being such a meta-cognitive activity, I (and many others) find it pivotal to good self-care and good decision making

• Do your own therapy when needed!
  

Once a person is more severely burned out the only thing that really helps is lightening the workload (or taking an actual break) and letting time pass while doing calm, restorative activities. 

Conclusion

Burnout is a common challenge for therapists at all levels: 

Graduate students: The impossible situation. Practice good self-care, but do a great job on every assignment, turn them in on time, do research, see clients, make money, have a life...

Early career: Starting a practice or career and starting a family. Expectations and time pressures.

Mid career: Raising a family, finances, running a practice, seeking tenure, (divorce, remarriage, blended families?), etc.

Later career: Raising a family, caring for aging parents, retirement planning, declining health, etc.

This quick look at stages is from a great article by Jeffrey Barnett if you want more reading on burnout.  

Take care out there. I’ll leave you with this classic: “Everyone has a little bit of ‘I want to save the world’ in them. I want you to know that it’s okay if you only save one person, and it’s okay if that person is you”

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