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Monday, 16 December 2019

Six Major Reasons Why Therapists Burn Out (and Steps You Can Take to Prevent It)

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Being a passionate and effective helper for individuals who have mental health challenges can take a personal toll on the therapist. It’s no surprise that therapist burnout is a pervasive problem for those in behavioral health professions.

Here are a few of the most common indicators of therapist burnout:

  • Difficulty getting up and going to work
  • Getting to work late (making clients wait for you)
  • Difficulty listening or focusing on what clients are saying
  • Decline in empathy
  • Repeating guidance or theory over and over to clients (redundancy and ineffective assistance)
  • Canceling appointments or calling in sick often
  • Excitement or relief when a client cancels
  • Overly self-disclose in unhelpful ways (focusing on you more than them)
  • Fatigue
  • Lack of expression
  • Finding yourself verbally, and aggressively, disagreeing with clients
  • Feeling irritable with clients and outside of work
  • Over-eating or lack of appetite
  • Insomnia or excessive sleeping
  • Dreaming about clients
  • Feeling trapped in your job

The causes of therapist burnout are many, varied, and dependent on the setting you work in as well as the populations you treat. But here are the six most common reasons:

Burnout Reason #1: The Return On Investment Is Not Always Obvious

While it may sound rather calculating to think of counseling in accounting terms, the analogy to ROI holds true in the mental health area.

In most other professions, you can see the fruits of your labor immediately, or at least in the short term. The dentist can take pride in a cavity well treated, a construction worker on having built a sturdy wall, etc.

But for therapists, immediate feedback on outcomes is a rarity. We tend to give clients insights and tools in our offices that may (or may not) survive the test of time at home. Ironically, we’re less likely to hear about successes because those clients aren’t likely to call us back if they’re in a better place. It’s the clients with less positive outcomes who will return for more help.

Burnout Reason #2: Working Intensively with People In Turmoil Can Be Exhausting

Most therapists entered the field out of a sincere desire to help others figure out how to deal with serious challenges in their lives due to both internal limitations and external obstacles.

What most of us didn’t realize when we first entered the field is how draining it can be for the compassionate therapist to help a client cope with upset, frustration, depression, and/or trauma. Most non-therapists probably can’t imagine how working intensely with a trouble individual can be supremely demanding.

But most therapists can attest to how fatigued they can get after even a single session of trying to help someone with mental health challenges. And that’s just one hour in a full day.

Burnout Reason #3: Therapists Can Be Vulnerable to Vicarious Trauma

The American Counseling Association refers to vicarious trauma as “the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured.”

It’s a form of countertransference and it can happen much faster than burnout (which occurs slowly over time).

If a therapist becomes overwhelmed by constantly dealing with a client’s horrific life experiences, burnout may soon follow. Some helpers can be so traumatized by their patient’s trauma that they become numbed or avoidant.

Burnout Reason #4: It’s Not Easy Being Idolized and/or Despised By Clients

To say the least, many clients deal with getting psychiatric help in ways that aren’t always straightforward and productive. Some of our patients act as if we have magical powers to help them instantly. Patients focus on us coming up with perfect solutions that don’t involve much effort on their part to progress in the right direction. That’s a lot of pressure on a therapist (mainly to push the responsibility back onto the client).

And then we have clients who become quickly annoyed with us for not “fixing” them with a wave of our hands. They wonder aloud why we’re not competent enough to help them through their struggles without much effort on their part. Of course, it takes a great deal of clinical experience, confidence, and energy to get out from under their unrealistic expectations and put the ball back in their courts.

Burnout Reason #5: It’s Hard to Stop Worrying About Vulnerable Clients at The End Of The Work Day

Many people find it hard to leave their work at work. But for therapists, it can be much more challenging.

Imagine you just finished a session with a client who expressed some suicidal thoughts and has a long history of self-harm. You’re pretty sure he’ll be ok, but you know there’s always a chance you’ll get a call in the middle of the night or read something tragic in the morning paper. And you’re not sure you handled some of the session optimally. How are you supposed to turn off those worries on the way home?

Burnout Reason #6: Paperwork and Other Administrative Tasks Can Crush Your Spirit

OK, we might have stated that a bit dramatically, but ask therapists what they find most problematic about their job and many will automatically say, “Paperwork and dealing with our EHR.” Not many mental health therapists were attracted to the profession because they got a chance to wrestle with impenetrable software that seemed designed to ruin their lives.

Therapists want to spend their day helping people, not trying to make a dent in a depressingly long list of overdue notes, reports, and other compliance activities. They sure don’t want to spend their time on billing functions or lengthy intake or discharge protocols. Most of our colleagues are even burdened with having to remember the workflows surrounding all those documentation requirements. When exactly is the first admission note due? For which patients do we need to notify a nurse about medical conditions? Have I done everything required to discharge this patient?

What Can You Do to Prevent Burnout?

If you feel any of the symptoms of burnout creeping in, there are a few things you can do to slow it down and prevent it from getting the best of you.

Burnout Tip #1: Ask for Help with Problem Solving

In our experience, clinicians who show signs of burnout are apt to suffer in silence rather than explore ways to ease their burdens. Yes, it’s ironic given how much time therapists spend trying to empower their clients to be proactive and assertive.

Most supervisors and administrators are motivated to improve staff retention and productivity. Indeed, it can be frustrating for managers to be left out of the loop, only to learn after the fact about significant problems they could have easily resolved.

So if you’re struggling, let it be known and work on it as an issue to be managed. There’s no shame in needing to reduce your caseload temporarily, get help with remembering documentation requirements, and the like.

Burnout Tip #2: Leave Work at Work

Easier said than done, right? It can be hard to detach yourself from the stress of the day. But one of the best things you can do is create an “end of day” routine that will shift your mindset away from clients and onto your own life.

Consider ending your workday with administrative work, paperwork, billing, and filing. In doing so, you can detach from the day, and your clients, and slowly step back into your own world.

Try your best to never take paperwork home with you. It can be counterintuitive to think you will complete paperwork after supper, for example, because you will already be transitioned out of the workday.

Remember, you’ve already worked very hard, used a lot of energy, and now it’s time to rest your mind and body...you deserve it.

Burnout Tip #3: Seek Therapy for Yourself

One of the hardest things about being a therapist is feeling like you should have all the answers, even for yourself. When clients unload their troubles on you day in and day out, you may need a sounding board of your own.

There is no shame in seeking out a counselor or therapist that can help you work through your burnout. Your job is tough, and you have the right to ask for help too.

Burnout Tip #4: Plan Your Day Around Your Peak Time

If you find that you have trouble taking on clients during a certain time of day, block that time out for paperwork or administrative work. Not everyone constantly operates at peak performance, so if you know you need a breather in the afternoon, don’t take on any clients at that time.

Furthermore, don’t forget to give yourself non-work-related blocks of time to regenerate. Lunch breaks and short walks do wonders for those in helping professions.

If you want to give your all to your clients, you must be sure to take care of yourself...so you can take care of them.

Burnout Tip #5: Self-Care

Speaking of taking care of yourself...you know you can only help your clients if you are caring for yourself. That means exercise, rest, sleep, and social experiences are all important factors in preventing therapist burnout.

Meditation or practicing mindfulness are both ways to re-center yourself and set your intentions. Meeting your emotional and mental needs is just as important, if not more so, as meeting your clients' needs.

Burnout Tip #6: Keep Your Expectations Reasonable

When clinicians who supervisor other clinicians get together to discuss their experiences, chances are high the discussion will quickly turn to the impact of unrealistic treatment expectations on therapist joie de vivre. Therapists, especially those new to the profession, can set expectations that are simply unrealistic – like expecting that a brief series psychotherapy session can somehow overcome years’ worth of major depression or unproductive parenting or dysfunctional marriage. One surefire way to set yourself up for frustration and failure is to set goals that are unattainable.

Burnout Tip #7: Minimize the Pain of Paperwork

We started out designing our software specifically to help clinicians spend as little time as possible writing notes and engaging in other time-consuming administrative tasks. We also didn’t think it made sense to spend hours training new therapists on paperwork requirements when a computer could serve as a mentor.

The best EHR software should take the burden of the paperwork off your to-do list, and never frustrate you or take away your helping spirit—the one your clients depend on to help through dark times. Implementing systems that take the stress of the “extra” responsibilities off your hands will free up emotional space that can be given back to clients (and yourself).

You are in the helping profession, and it’s a noble career path to choose, but do your best to take it easy on yourself. Your clients will only be able to succeed if you show up feeling your best.

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