Burnout in Mental Health Professionals
As helping professionals, we are trusted with some of our clients’ deepest, darkest secrets. Each day, we are subjected to the heart-wrenching stories and the immensely difficult life situations of the individuals who come to us seeking change and relief.
It is impossible for any helping professional to know what our clients will bring through our door. In this sense, the only constant in our line of work is vicissitude, or variance. Stories compounded by grief, loss, sadness, anger, anxiety, depression, hopelessness, and turmoil are not foreign to us as mental health professionals.
Given how we are exposed to such types of stories and information on a day-to-day basis, it goes without saying that if we do not properly care for ourselves, we can become prone to many types of health issues. These can include burnout, compassion fatigue, heart issues (Schneider, 1984), depression and suicidal ideation (Schneider, 1984), compromised immune systems, headaches, stomach problems, and other stress-related problems. Furthermore, if we do not care for ourselves and are not in top form, we cannot expect ourselves to possess the capacity to care for our clients. Fatigue, left unattended, can lead to an unintentional disservice to those who seek our help.
Recognizing Burnout and Fatigue
Every helping professional should be alert to the potential for burnout. Kottler (2001) describes burnout as “the single most common personal consequence of practicing therapy” (p. 158). Burke (1981) states that “Under stressful working conditions, counselors using poor coping strategies may become disenchanted, discouraged, irritated, frustrated, and confused, resulting in poor job performance,” thus indicating the severity of this problem. Edelwich and Brodsky (1980, as cited in Kesler, n.d.) describe multiple stages of burnout:
- Enthusiasm- “… a tendency to be overly available and to over-identify with clients”
- Stagnation- “… expectations shrink to normal proportions and personal discontent begins to surface”
- Frustration- “Difficulties seem to multiply and the helper becomes bored, less tolerant, less sympathetic, and she or he copes by avoiding and withdrawing from relationships”
- Apathy – “Characterized by depression and listlessness.”
Can you recall or identify a current colleague who, because of overwhelm, stress, or feeling spread too thin, views coming to work each morning as a chore? Perhaps a supervisor who complains about taking on a new client because his or her caseload is already overcrowded? Do you know of a helper who finds him- or herself daydreaming during a session, growing bored, feeling stagnant or complacent, and not knowing what is truly happening in their work with a client? Do you maybe recognize some of these qualities in yourself?
The following might also signal helper burnout:
- Dragging oneself to work and then avoiding clients.
- “Giving up” during a session, and ending it early when the counselor is unsure of where it should go next.
- Missing appointments (or missing work altogether).
- Being late for appointments (or work altogether).
- An increase in judgmental feelings and perspectives toward clients, or a sense of bitterness of resentment did not previously have.
- Forgetting to behave ethically (e.g., abruptly terminating a client, abandoning a client, attempting to treat clients out of your area of expertise, or not taking the time to make an appropriate referral).
- Abandoning advanced training (such as in a particular theoretical orientation from an institute).
- Daydreaming about other people, places, situations, lives, lifestyles, times, etc.
- Having the inability to enjoy free or leisure time and instead spending that time doing, or thinking about, work.
- Increased/excessive drinking, drug use, or eating to relieve or cope with stress.
- Feeling as though your work comes home with you and being unable to get your clients out of your mind.
- Feeling a sense of vicarious trauma from hearing clients’ stories.
Burnout can drastically inhibit one’s ability to appropriately counsel clients, can damage clients, and in extreme cases can cause a helper to leave the field.
Where Does Burnout Come From?
The instances of burnout that I have seen thus far all seem to stem from the same roots. One of these root systems, of course, germinates in young, passionate, and eager helping professionals who have the desire to help as much as they can, as often as they can. However, this is sometimes done without balancing the other side of the scale – the one that involves caring for oneself and finding a balance between the identity of a “helper” and the identity of being “human.” Even Superman had a weakness.
Experienced, veteran helpers can experience burnout simply from avoiding engaging in self-care. What we do requires a great deal of emotional investment. It goes without saying that we need to do things to bring our minds (and bodies) back to a neutral, calm, restful place.
Other problems that germinate from seedlings into symptoms of burnout include thoughts and beliefs such as:
- “I must be able to help every client I work with. Not seeing breakthroughs or rapid progress is unacceptable to me, and means I am a poor helper.”
It is obvious that this kind of thinking can quickly lead to burnout, as it would inspire a counselor to push any and all limits. When clients do not make the strides counselors would like to see, counselors can become resentful. It is critical for helpers to realize that it is unreasonable to expect ourselves to have major breakthroughs with every client we work with.
- “I’m not burned out, I’m just tired.”
Call it what you like, but this feeling of weariness will hinder professional capacities if not addressed. Ask yourself why you are feeling so tired. Disputing the presence of symptoms of burnout ultimately can lead to more impairment.
- “I can handle one more article/book chapter/presentation/conference/client/trainee/intern/etc. even though I’m already feeling stressed.”
Sometimes we need to recognize that our pride is getting in the way. Admitting that we have too much on our plate does not make us any less of a person. In fact, it makes us responsible.
Preventing Burnout: Caring for Yourself
According to Young (2009), “…the effective helper has good self-care skills. Many who are attracted to this profession want to help others, but soon find that in order to do so they must make certain that they have something to give. It is easy to become emotionally ‘bankrupt’ and ‘burned out’ if one does not develop techniques for stress management, time management, relaxation, leisure, and personal renewal” (p. 21).
In other words, if we want to care for others, we must first ensure that we are appropriately caring for ourselves. If we cannot reflect upon our own emotional or psychological states, how can we help others to do that for themselves? After all, the thought that “I am fine and I can keep pushing forward despite how I am feeling” is not our reality. We are people, not machines. We cannot expect ourselves to give to others if our emotional and psychological states leave us with nothing to actually offer.
Here are some tips for preventing (and possibly counteracting) burnout:
- Engage in things that bring you joy and relieve stress.
- Decide on a time of the day when you will not engage in helping-related work and, instead, will focus on leisure.
- Engage in, develop, explore, or take up a new hobby, or revisit one from your past that you enjoyed.
- Take time each day to relax, even if it is only for half an hour.
- Avoid taking on extra clients if your caseload is full.
- Avoid taking on extra work-related responsibilities if you are feeling overwhelmed or spread too thin.
- Learn to say “no” to yourself. Avoid starting a new article, book chapter, or presentation, taking on a new trainee, etc. if you do not feel ready to do so yet.
- Keep your supervision appointments and receive supervision regularly, discussing your concerns. This is where our colleagues and mentors can shed light on our situation. Sometimes an outsider’s perspective helps!
- Receive counseling of your own to manage any difficult feelings you are experiencing.
- Read non-professional literature. Read or learn for fun. (Yes, it is possible.)
- Routinely assess where you stand in regard to your personal state. Reflect on your personal well-being.
It is not the activity that matters, but the personal escape and “vacation” from our responsibilities
Here are two assessments that will help mental health professionals to assess their level of burnout, if any:
Andreula, T.J. (2011). Counselors and stress. Student insights column. Exemplar, 26(2), 11.
Burke. R. J. (1981). Increasing the professional effectiveness of school guidance counselors. School Guidance Worker, 37(7), 51-57.
Kottler, J.A. (2003). On being a therapist (3rd ed.). San Francisco: Jossey-Bass.
Saakvitne, Pearlman, & Staff (1996). Self-care assessment worksheet (in Transforming the pain: A workbook on vicarious traumatization). Norton.
Schneider, J. (1984). Stress, loss, and grief: Understanding their origins and growth potential. Baltimore, MD: University Park.
Stamm, B.H. (2002). ProQOL-RIII. Professional quality of life: Compassion, satisfaction, and fatigue subscales-III. Retrieved from http://www.counseling.org/wellness_taskforce/PDF/ProQOL.pdf.
Young, M.E. (2009). Learning the art of helping. Building blocks and techniques (4th ed.). Upper Saddle River, NJ: Pearson.
Andreula, T. (2013). Burnout in Mental Health Professionals. Psych Central. Retrieved on March 17, 2018, from https://pro.psychcentral.com/burnout-in-mental-health-professionals/