The Dangerous Silence of Clinician Burnout

What we need to be talking about!

Posted Sep 17, 2018

Most of us entered the field of mental health care because we wanted to be able to help others.  We began this process as eager learners obtaining advanced certificates and degrees.  We engaged in internships that were both intimidating and full of wonder.   Our first jobs were those that may have involved high acuity or complicated cases and we thrived on those challenges.  We felt alive in the midst of chaos and in getting inside the darkness of client minds.  Finally, we settled on the population that we want to work with, and while this may have changed over time, we may not have made the career changes that reflected our evolving preferences and needs.  Some of us changed specializations due to personal or professional interest and others just “fall into” work with various client populations.

And then life happens…dating, marriage, personal issues, having children, moving, stress, health issues, family issues, addiction, etc. But we press on. Maybe we work with a population of clients that have a condition we or a loved one are in recovery from such as addictions or mood disorders.  While this connection initially inspired us, over time the rehashing of a client’s experiences with those particular conditions or circumstances that we know far too well begins to increase our awareness of our own symptoms or history.  Or, we have never dealt with what our clients are experiencing, but suddenly we become aware of how much suffering there is in the world.  Clients don’t start therapy because their life is going well or they are without issues to address.  They generally have a negative symptom or life situation in which they seek relief or resolution from.  The relationship between a therapist and a client involves an energy exchange, and it is often one-sided in that a client is expressing their emotions to the therapist and not hearing the same amount of disclosure in return.  Clinicians are receptacles for negative emotions and energy- and this can be a conscious or unconscious experience.  The same could be said about supporting a friend through a hard time and being on the receiving end of the conversation.  However, clinicians experience this process of being the “receiver” daily and throughout their career.  So where does that energy go?  If we are not taking care of ourselves and charging our batteries, cleansing out mind and body—then this energy can get stuck within us. 

So what is clinician burnout?  According to the New England Journal of Medicine, it is a combination of emotional exhaustion, depersonalization (i.e., cynicism), feeling of reduced personal accomplishment, loss of work accomplishment and reduced effectiveness. 

Why are we not hearing more about this problem?  Clinicians often may not recognize the symptoms, and deny how they are feeling, believe they cannot afford to address the issue, fear other’s opinions, consider the feelings part of the job, fear losing their job. They may have a perfectionist or workaholic personality or face other barriers to addressing this condition.  There can also be thoughts and belief systems that prevent clinicians from acknowledging or telling others how they are feeling such as: “We are trained to help other people and now we are feeling exhausted from what we had worked so hard to accomplish and to do professionally”.  “I know other clinicians who see more clients and work harder than I do but they seem fine, so why am I having a hard time?”, “I must not care about people because I need to take a break from direct care”. 

The truth is that there are clinicians who are able to handle more than others, see a larger caseload, work with more acute clients, work longer hours, etc.  There also may be times in our lives when we are able to tolerate and manage more intensity than others.  We are all individuals and need to be honest with ourselves about what our personal limits may be—or that they are changing.  However, we also need to feel that our workplace culture is mindful of burnout, concerned about overworking staff and encouraging of self-care.  I have been blessed to work most recently in several environments that were aware of all of these factors.  However, I also experienced several workplaces previously that did not care about my professional or personal limits—so I left those jobs.  It is imperative that we take this clinical burnout and burnout prevention seriously, and if a business is not willing to consider and care about your burnout level, then it may be time to look for work elsewhere.  The consequences can result in clinician mental health issues, safety issues, clinician relapse, decreased quality of care for clients, lack of work/life balance, taking and obsessing about client’s problems and overall decreased functioning. 

In particular, I have seen individuals who are in recovery from alcohol or drug addiction revolve their entire personal and professional life revolves around the issue of addiction.  This then led to a lack of work/life balance. They also become numb to the topic of overdoses, deaths, relapses, self-harm, and lack of self-care alternatives beyond recovery-related options. 

If you are identifying with what is being described above, then here are some solutions for how to prevent or address burnout issues:

·       Create a support network of clinicians who you can be honest with or do supervision with

·       Check in with yourself about your current stress levels when working versus when home

·       Make time for self-care to “recharge” your battery

·       Find “energy clearing” and “mind clearing” activities such as yoga, meditation, etc.

·       “Dumb it down” and read or watch mindless TV, movies, magazines, books in order to balance out intense work

·       Take care of yourself! (healthy nutrition, adequate sleep, exercise, etc.)

·       Make changes in work focus or integrate direct care with other work responsibilities

·       Be honest with yourself and loved ones about how you are feeling

·       Add “fun” activities into your schedule

·       Set limits around work that you are doing at home after hours

·       Change jobs

·       Limit the time that you discuss or think about cases after work

·       Limit on-call hours if possible

·       Set aside “technology free” times to calm your nervous system

·       Consider working fewer hours in direct care and add in hours in a “lighter” job

·       Go to therapy

·       Balance caseload with acute and lower acuity cases

·       Move into a management role with less direct care

·       Address countertransference issues in supervision or therapy

·       Be kind and accepting of how you feel

·       Know that you are NOT alone!!!!

For more resources and information about high-functioning alcoholics, please visit highfunctioningalcoholic.com