In Therapy

A user's guide to psychotherapy

Seven Mistakes Therapists Make

How to burn out as a therapist

Still no endorsement, but I've got plenty on hand

Every week I talk with aspiring private practitioners (psychology graduate students) who want to know how to have long, productive careers so they can pay back their student loans. Recently I was asked the opposite question - what’s the recipe for misery and futility as a therapist? I was intrigued. It’s not the best approach to always focus on the negative, but sometimes it helps us to better define the positive.

So here we go. Want a brief, disappointing career as a psychotherapist? No problem. Follow these seven simple rules.

Ignore Boundaries: Sure, the big boundary violations (sex, extortion, fraud, etc.) bring careers to a swift end, but don’t underestimate the cumulative effect of the little breaches. Go over your session time regularly, slide your fee below sustainable limits, chase ambivalent clients, promise results you can’t deliver, form friendships instead of maintaining professionalism. If you don’t obliterate your caseload by creeping out or pissing off your clients, you’ll just gradually burn out.

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Isolate: Therapists spend a large portion of their day hidden under a legally mandated shroud of secrecy. The answer to a simple “How was your day?” must omit any detail from the hours you spent in session. The hard work you spend maintaining a functional relationship with clients, including all the challenges and victories, remains unknown. Unless you have supervision, a consultation group, or your own therapy, that is. Also, if all your friends and hobbies outside of work are therapy related, you will become a jargon-filled, myopic mess mumbling quotes from In Treatment to yourself.

Take it Personally: Some clients are going through a world of hurt and either dump or project these feelings onto their therapist. If you take it at face value and assume responsibility for all their issues, your scars and bruises will accumulate. A bit of objectivity and learning to “leave work at work” can go a long way.

Gratify: Clients often have familiar needs: friendship, love, companionship. At times, they may express a wish for us to meet those needs for them. Though our desire to help, and possibly filling a void in our own life (see point #2), it can become tempting to be that friend rather than help them find that friend. Gratifying the client’s needs usually has short-term feel-good benefits but long-term dependency-building consequences.

Eschew Education: Why would I sit through expensive, time-consuming CE courses when I can train a clever monkey to pass a 12-hour online class in 20 minutes? Why? Because this is an evolving field with innovations that have far surpassed my grad school education. The minute I think I know all there is to know about psychotherapy and mental health is the minute I smell the smoke from my own burnout. If the ink has dried on your diploma I’ll see you at the next bad coffee/stale donut/rubber chicken CE course as we learn something together.

Label: Okay, if you’re working with insurance companies we know you need to give a diagnosis. If your client is being transferred to another therapist, some labels are necessary as well. But if you start reducing your daily schedule to one-word descriptions (“my 10am depressive”), and if you're shoehorning everyone into your narrow theoretical framework, you're losing touch with the human side of our work, and your clients probably feel it. 

Know It All: Some clients appreciate know-it-all therapists at the beginning of therapy because they came with questions and gurus have all the answers. But clients ultimately don’t want to have someone else tell them what to do, they’ve come to understand themselves better and make their own decisions. Therapists who argue with clients because they need to be right will learn through frustration or a dwindling caseload that this isn’t helpful. Collaboration is empowering, arguments are draining.

So that's how to successfully fail in seven easy steps. Don’t get sarcasm? I’m happy to translate. If you’d like a long, fruitful, healthy career as a psychotherapist, you’ll improve your chances by holding healthy boundaries, collaborating with other professionals, maintaining objectivity, learning when to say no, committing to lifelong learning, respecting human side of our work, and forming a partnership with your clients. This doesn’t guarantee success, but it will give some protection against burnout and ethical gaffes.

I focused here on the mistakes that contribute to therapist burnout, so this certainly isn’t an exhaustive list of all the mistakes a therapist can make on the job. But I’m sure my gracious readers will be more than happy to regale us with tales of therapist failure in the comments section!

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Ryan Howes, Ph.D., is a clinical psychologist, writer, musician and professor at Fuller Graduate School of Psychology in Pasadena, California.

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