Identifying and Managing Therapist Burnout

It’s a new year, we’ve all renewed ourselves with a fabulous holiday break, and we’re raring to go again, having said goodbye to the factors stressing us in 2020, right? Or maybe not. Much of the developed world has, at this writing, only recently come out of lockdown from the COVID-19 pandemic, and many countries are still in the middle of it as they battle a second or even third wave. The constraints made necessary by the virus have changed the world of both personal relationships and work, some say permanently.

This reality is no different for mental health professionals, who may encounter increased demands from clients even as they try to bring their own mental/emotional health into balance after months of stressful isolation, financial strain, and possible separation from friends and loved ones. Rather than beginning 2021 from a position of relative strength and ease of being, many are feeling ragged and buffeted by the extraordinary circumstances that made 2020 a year like no other; in other words, they are already close to starting down the path to burnout. 

But knowing how long and hard the return journey from that condition is, let’s take a different tack. This article is about seeing how we might avoid starting down that road in the first place. We look at a definition of burnout and how many get burned out, list its symptoms and how to know if you are affected, and contrast the difference between stress and burnout. Finally, we include some suggestions for how we can keep ourselves at the wellbeing, rather than the burned-out, end of the health spectrum.

What is burnout?

The World Health Organization defines burnout as:

“ . . . A syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions – Feelings of energy depletion or exhaustion, increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job, and reduced professional efficacy” (McNaught, 2020).

Note that phrase “chronic workplace stress”. This latest WHO definition lands burnout squarely in the camp of an occupational phenomenon, re-labelled after being formerly classed as a life management problem. This has implications for who is responsible for “fixing” the problem, with employers needing to take a greater role in creating sustainable workplaces.

How many of us have burnout?

Worldwide, it is estimated that about 210 million suffer from this, and 11 million Americans do. The U.K. is said to have about 12 million out of its 55 million-strong population of over-16s burned out. In Australia, a 2020 survey found that four out of five white collar working people (many of whom were working from home) suffered burnout last year during the pandemic; this 77% is 6% above the global average, and gives Australia the dubious distinction of being the country in the world with the highest rate of burnout, although we note that, all over Australia, the perception of decreased mental wellbeing as a result of the pandemic (in 45% of people) would mean that pre-pandemic levels of burnout were lower.

While there are no direct statistics, a survey published in 2018 by the Australian Psychological Society found that 26% of Australians had moderate to severe depression, and about that many also experienced high levels of anxiety (McNaught, 2020; Tu, J., 2021; Gerencer, T., 2020; Musker, M., 2019; Barry, 2018). Some experts and commentators believe that the helping professions are hit harder by burnout; emergency service workers, such as paramedics, doctors, nurses, police, and some counsellors continually work in high-stress conditions (Musker, 2019). In any case, there is no reason to believe that mental health professionals have lower than average rates of burnout.

What are the symptoms? How do we know if we’re burning out?

As per the WHO definition above, we can sort burnout’s symptoms into three lists: one for each of its dimensions: (1) depletion or exhaustion; (2) feelings of negativity or cynicism related to one’s job; and (3) reduced professional efficacy.

Symptoms of depletion or exhaustion

• Lack of motivation
• Irritability
• Fatigue
• Insomnia
• Memory issues
• Feeling hopeless
• Nervousness
• Headaches
• Irritability
• Change in appetite
• Trouble concentrating
• Cynicism
• Depression
• Increased illness
• Loss of energy

Symptoms of negativity or cynicism

• Isolation
• Lack of enjoyment
• Apathy
• Impatience
• Being critical
• Feeling persecuted
• Hopelessness
• Negative attitude
• Excessive use of sarcasm
• Disillusionment with work
• Loss of job satisfaction
• Self-medication
• Dread of work

Symptoms of ineffectiveness

• Loss of productivity
• Poor performance
• Missing deadlines
• Habitual complaining
• Missing work goals (Gerencer, 2020)

What to look out for

If you are a mental health professional and wonder if you are burning out, here is a brief set of indicative questions:

1. Has anyone close to you asked you to cut down on your work?
2. In recent months have you become angry or resentful about your work or about colleagues, clients or patients?
3. Do you feel guilty that you are not spending enough time with your friends, family or even yourself?
4. Do you find yourself becoming increasingly emotional, for example crying, getting angry, shouting, or feeling tense for no obvious reason (Musker, 2019)?

A “yes” response to any of these questions means it might be time to change your work habits or attitude. In addition, you may be on the road to burnout if:

1. Every day is a bad day.
2. Caring about your work or home life seems like a total waste of energy.
3. You’re exhausted all the time.
4. The majority of your day is spent on tasks you find either mind-numbingly dull or overwhelming.
5. You feel like nothing you do makes a difference or is appreciated (Smith, Segal, & Robinson, 2021)

Stress versus burnout

Ever since Herb Freudenberger coined the term (Freudenberger, 1974) to describe the kind of emotional shut-down that many health professionals were coming to acknowledge, the term “burnout” has come into ever-greater usage in common parlance; many use it interchangeably with the term “stress”, but they are different. Here’s a handy guide to recall the characteristics that differentiate them.

STRESS	BURNOUT
A person is over-engaged.	A person is disengaged.
There is emotional overreaction.	Emotions are blunted.
The sense of urgency creates hyperactivity.	There is a sense of helplessness and hopelessness.
The individual has a loss of energy.	The person experiences a loss of motivation, ideals, and hope.
Can lead to anxiety disorders.	Leads to detachment and depression.
The damage is mostly physical.	The damage is mainly emotional.
May kill prematurely.	Makes life seem like it is not worth living.

What causes burnout?

We can end up burned out from various factors; here are some job-related ones.

Lack of control. If you are a mental health professional working for an organisation, you may have little control over decisions about your schedule, assignments, or workload, which can lead to burnout. In private practice, you may be able to exert more influence over whom you see, or the maximum number of clients you have, but having too few may be stressful and out of your control. In either case, you may not feel you have the resources you need to do the job.

Unclear job expectations. You may feel uncomfortable if, for example, you are working with a different client population from earlier work and you are not sure what is expected. You may also be travelling toward burnout if the total authority you have or what your supervisor expects you to do are not clearly communicated.

Dysfunctional workplace dynamics. Is there a bully in your organisation, or do you feel undermined by colleagues? Does your supervisor micromanage you? So many mental health professionals work in isolation in their private practices that “bullies” do not typically come from “the office” per se, but the sense of dysfunctional dynamics can still arise from dealing with, for example, endless bureaucratic red tape, uncooperative client families, or unhelpful people or organisations with whom you must liaise or cross-refer.

Extremes of activity. If it feels like clients are either “all the same” – that is, a client population dealing with very similar issues – or alternatively, they are very unwell and require a lot of energy to work with, the work can seem either monotonous or chaotic, and lead to fatigue and burnout.

Lack of social support. Particularly for counsellors and psychologists working alone in private practice, there is the danger of feeling isolated. If this is compounded by a sense of isolation in personal life, it can be very stressful.

Work-life imbalance. When work takes up so much time and effort that there is not much of you left (either time- or energy-wise) after a day of work, you can’t spend sufficient time with family and friends to nurture important relationships. Burnout can come quickly (Mayo Clinic, 2021).

In many situations, these job-related causes of burnout are changed more easily at organisational levels, but saying this does not absolve each individual professional from taking responsibility to make things better for themselves where they can. In addition to these job-related factors, there are lifestyle and personality causes of burnout. 

Lifestyle factors include working too much, without enough time for socialising or relaxing; lack of close, supportive relationships; taking on too many responsibilities, without enough help from others; and not getting enough sleep.

Personality traits contributing to burnout are: perfectionistic tendencies, where nothing is ever good enough; a pessimistic view of yourself and the world; the need to be in control; reluctance to delegate to others; and having a high-achieving, Type A personality (Smith et al, 2021)

Getting off the burnout motorway

Don’t you just hate it when you miss the exit to get off the highway, and you are carried much farther down the road than you planned to go? We asserted at the beginning that it is far preferable never to even start down that ugly burnout motorway, but if you suspect that you have somehow gotten onto the road, here are five exits you can take to get off it as soon as possible.

Seek support

You may have the sense that it was people who put you onto this miserable path. Well, it’s also people who can help you get off it. The problem for some mental health professionals is that, because we help others to feel better and live life more in the joy of their wholeness, we believe we “should” be able to equally sort out our own problems. Reaching out to those closest to you is a compliment; it says that you trust them enough to share the very scary prospect of coming unglued. Being able to ask for help indicates adaptiveness and is a sign of high mental health and resilience. 

At work, you can take advantage of those small moments during breaks or at the water cooler to deepen relationships with compatible others; perhaps some are even possible future friends. For those professionals working more in isolation (e.g., private practice), group supervisions and counselling-related organisations (such as monthly gatherings to hear professional talks or do networking) are invaluable. If that’s not possible (say, in small communities), you can become a member of some community group whose purpose is meaningful and whose activities interest you. Of course, it goes without saying that if you are burning out, you want to avoid people whose mood or outlook is negative, as that can bring you down.

Reframe how you think about your work

We said at the outset that WHO now define burnout as an occupational phenomenon, so we must ask: how are you viewing your work? Perhaps you hate what you do, but trudge along every day because the paycheque feeds your family? Maybe that is enough for you, but for many people, finding so little value in their work is basically an on-ramp to the burnout motorway. Re-evaluate it.  Even if you don’t like parts of your work, can you find parts which give you meaning and purpose: parts which you enjoy and which give value to you and others? If meaning/purpose/value is pretty thin on the ground for your current work, you may need to seriously start scanning the job vacancy ads, but if that’s not practical at the moment, see if you can create a better life-work balance by working less, emphasising much-enjoyed activities outside of work hours, or perhaps taking some leave in order to get away from the situation entirely and re-evaluate what you do wish to do. 

One woman – a psychologist – took personal stress leave and in the contrasting tranquillity away from work realised that no public organisation was going to be right for her; as a sensitive personality, she was always being overwhelmed by others’ problems, and all the people who were clients of the agency she worked for (as for many public counselling organisations) were seriously unwell. Her break helped her realise how much she yearned to get into a field for which she did have passion, so she resigned and gave herself permission to not be a psychologist anymore. 

Check if you need to re-prioritise

Boundaries. Maybe you can’t cut down on, say, the number of clients you have, but perhaps there can be clearer boundaries around their access to you. One prominent psychotherapist in New Zealand used to tell clients that, if they needed to talk to him between sessions, they could have seven minutes for free. After that, he would be charging for his time. “It’s amazing,” he reflected, “how well people can organise their thoughts when they have a specific (limiting) boundary to work to.” If you work for an organisation, you might want to question whether it is really important right now to put your hand up for that extra project the boss wants someone to do. It goes without saying that your “yes” means a lot more if you have a corresponding “no”. 

Turn off tech for some period every day. What? Turn my phone off? Log off my computer? We can feel the shock waves from the suggestion. But it has been noted more than once – especially over this last year of many working from home so much – that employees have suddenly become available at all hours, through technology, and employers have “infiltrated” the home environment. In addition to that being a boundary issue (as above), there are other problems. For clients who may have been attending sessions by teleconference, it is only a baby step to sending the therapist emails in between sessions. You may have an agreement with clients that that is ok and that you will respond in a timely fashion, but are you both clear in this case on how much of that interaction is ok and when you will respond? Beyond that, looking at screens later in the evening may disrupt sleep as we gaze at the blue light emitted (which tends to wake people up). Do the social media posts all really need to be responded to today? It might be possible to engage a creative project with the time saved by not being “beholden” to connectivity: something such as arts and crafts, playing an instrument, or doing another activity that will be a strong antidote to burnout. 

Go slower: Relax and sleep. Yes, this suggestion is old hat. For how many decades now have experts been advising us to relax in some way: perhaps with yoga or tai chi, meditation, or mindfulness activities? Yet often those who need this the most are the most vociferous in stating that they couldn’t possibly take time for structured relaxation activities, that it would stress them more. Ditto on the sleep issue, with science now reminding us that insufficient or poor-quality sleep leads us straight into horrible health issues, such as heart disease, obesity, diabetes, and – most relevant for burnout — depression (Centers for Disease Control and Prevention, 2018). Here’s a challenge for you: if you really believe that you need to go at full speed 24/7 and that you can’t (don’t deserve?) to have downtime, what’s going on with your self-esteem? And if that’s such a major challenge for you, can you work effectively with clients who also have precarious self-esteem?

Make exercise important

It’s true; if you’re burning out, exercise might be the last thing you feel like doing. But perhaps you can convince yourself to maintain a regular schedule of movement if you remind yourself that it’s a wonderful mood-booster, and thus a powerful antidote to stress and burnout. If you really can’t set aside, say, 30 minutes a day for an activity, can you take three 10-minute breaks and walk around the block? It also helps to choose activities that we naturally enjoy. A well-known positive psychologist in Australia said, “I was having trouble with the idea of regular exercise until I realised that I hate lifting weights and I hate seeing a bunch of Lycra-clad people in the gym, but I love being at the beach”. Her exercise became jogging/walking on her favourite beaches. Whether it’s swimming, dancing, rollerblading, martial arts or something else, see if you can be fully present with the sensations of your body moving as you do the exercise, or perhaps the wind on your face, rather than focusing on thoughts.

Go for a healthy diet

This final “exit” off the burnout motorway can be so easily “forgotten”. After all, most of us know that we should have a bit less alcohol, caffeine, or sugary pastries; it’s just getting ourselves to do it. Be reminded, however, that those comfort foods, such as sugar-laden items, breads, pastas, and other grains, quickly give you a lot of energy, but then cause you to crash a few hours later. Other dietary bugaboos, often overlooked, include making sure we have healthy fats in the diet (e.g., a good ratio of greater Omega 3 to Omega 6 fats, which most people have in reverse) and avoiding foods with many additives; both of these imbalances can throw off a person’s mood. A poor diet, like Rome, probably wasn’t built in a day, so re-building back a healthy one may take some time. Perhaps try rectifying one bad dietary habit at a time, until you are truly “eating clean”? (categories adapted from Smith et al, 2021).

Summary

In conclusion, we acknowledge that a lot of this information probably isn’t new to you. You probably make your living spotting stress and burnout in others. But hopefully this post has served as a reminder about how many symptoms of burnout there are, how easy it is to start burning out without realising it, and what some of the ways of avoiding it are. The mental health profession is not a “do as I say, not as I do” endeavour. If we want clients to be joyfully present to themselves, we must model that capacity for being present: to ourselves, first, in order to be “there” for them. That means bye-bye burnout.

Learn more about burnout prevention strategies with Mental Health Academy‘s FREE 5-week Self-care Program for Helpers. In this 5-week program, the intertwined questions of professional and personal self-care are investigated in a holistic manner. The program works from a paradigm of growth mindset aligned with a positive psychology stance, to offer insights and strategies for all levels of self-care. Sign up here.

References:

• Barry, L. (2018). Survey finds more than a quarter of Aussies are stressed and anxious. Better Homes and Gardens. Retrieved on 1 February, 2021, from: Website.
• Centers for Disease Control and Prevention (CDC). (2018). Sleep and sleep disorders. CDC. Retrieved on 1 February, 2021, from: Website.
• Freudenberger, H.J. (1974). “Staff burnout”. Journal of Social Issues. 30: 159–165. doi:10.1111/j.1540-4560.1974.tb00706.x.
• Gerencer, T. (2020). Burnout: Prevention, treatment, and advice for employees and employers. Zety. Retrieved on 31 January, 2021, from: Website.    
• Mayo Clinic. (2021). Job burnout: How to spot it and take action. Mayo Clinic. Retrieved on 31 January, 2021, from: Website.    
• McNaught, S. (2020). Burnout statistics UK – job related. Micro Biz Mag. Retrieved on 30 January, 2021, from: Website.
• Musker, M. (2019). Workplace burnout is all too common. Here’s how to tell if you’re affected. ABC News: The Conversation. Retrieved on 30 January, 2021, from: Website.
• Smith, M., Segal, J., & Robinson, L. (2021). Burnout prevention and treatment. Help Guide. Retrieved on 31 January, 2021, from: Website.   
• Tu, J. (2021). Four in five Australians faced burnout in 2020. Women’s Agenda. Retrieved on 30 January, 2021, from: Website.