This blog is the user's guide to psychotherapy, but after reading the results of PT's therapist survey I feel a need to address my fellow therapists. Several respondents requested information on preventing and treating therapist burnout. I'll take a crack at this professional conundrum and include some tips for clients of burnt out therapists.
Therapists burn out? Don't we have a bottomless reservoir of empathy and patience? Aren't we masters of healthy relationships, exquisite self-care and self-actualized career fulfillment? We counsel on these ideals and personally strive for them as much as the next guy. But alas, we aren't immune to burnout; defined as "an imbalance between the psychological resources of an individual and the demands being made on those resources." When we give more than we get, we burn out; a common pitfall in our work. We provide a service based on our thoughts, feelings and energy to an often challenging clientele. Yes, we do burn out.
How do you know you're burning out? You may have an inkling when you:
Burnout intensity varies from temporary career ennui to full-blown meltdown. The symptoms range from empathic lapses to grouchiness to resentment to snapping at clients to indulgent self disclosure to a complete disregard for professional boundaries and ethics. Consequences include job dissatisfaction, poor job performance, frantic job searches and/or calls to lawyers.
Why do we burn out? It depends who you ask. A psychodynamic shrink might promote Alice Miller's idea that we select this profession because we're perpetuating a caregiver role adopted in childhood and must confront the hopelessness of never being able to help all the people all the time. A CBT provider might explore irrational beliefs held regarding our worth, self-esteem and career success. Humanistic therapists might look at how we're inhibited from realizing our potential. And there are many other valid opinions. Let the debates begin.
Theorists can reach across the aisle(s) and agree on a few things: psychotherapy can be socially isolating, the progress of the work slow and the emotional toll extreme. The limits of confidentiality make venting frustrations and celebrating success difficult. Many people drawn to therapy are "helpers" who give until depleted; masters at caregiving but novices at self-care. Graduate schools don't do a great job of teaching healthy career longevity. If therapists don't have good boundaries in place, this healing profession can harm them. The list goes on.
When supervising graduate student therapists I regularly witness the good intentions that pave the road to burnout. Spawned from a desire to help, new therapists often feel compelled to go overtime in session, emotionally invest beyond healthy limits and take their work home by ruminating about clients in their free time. They want to serve their clients and validate their career choice so they work extra hard and become hypervigilant to any signs of clinical success or failure. Their self-esteem becomes dependent on their client's progress. That's far too much stress on their emerging therapy skills and too much pressure on the client. Much of my work as supervisor entails teaching (and modeling) patience, lifelong perspective on the client's process and self-care for the clinician. We must meet our own needs first: if we're emotionally spent we're no help to the client.
Onward to the treatment phase. The list below may seem like common sense, but if you're burning out I'll bet you're neglecting one of these areas.
How therapists regain and maintain passion for their work:
The bottom line: in a career where your heart and brain are your most valuable resources, nurturing those commodities should be top priority. Don't just practice what you preach, model healthy boundaries and self-care for your clients. Your actions speak louder than words. Therapy can be an incredibly fulfilling career if you take proper precautions.
For Clients: Do you suspect your therapist is burning out? Are you leaving your sessions feeling like your therapist doesn't care, isn't listening or lacks enthusiasm for her work? I suggest you mention what you're observing to your therapist. Tell her what you've experienced and talk about how it makes you feel. Your feedback is valuable, and may provide a wake up call to the therapist or highlight some other barrier within the therapy. But it's not your job to take care of your therapist, so if you don't feel the issues are being addressed, you might want to consider terminating. Your time, money and effort merit a clinician who is invested in your work.