Here Is How Your Exhausted Therapist Is Coping
“Self-care is never a selfish act – it is simply good stewardship of the only gift I have, the gift I was put on earth to offer others. Anytime we can listen to true self and give the care it requires, we do it not only for ourselves, but for the many others whose lives we touch.”
― Parker Palmer
Today we are breaking the fourth wall.
Our posts are usually directed towards those at the receiving end of mental health support, which by the way, includes therapists as well! Earlier this week, we discussed 10 things we wish we knew before starting therapy. For that piece, we drew from our experiences of being both a therapist and a client.
Today, we’re addressing mental health service providers and anyone who is feeling drained, may be starting to recognize signs of burnout, or just needs to read something validating and encouraging.
Also – be sure to read all the way to the end, you are guaranteed a laugh!
Basically, if you were looking for permission to take a break or put yourself first today, you’re in the right place!
Welcome. Get cozy. This one is for you.
We are emotionally drained.
COVID news fatigued.
Mental health fatigued.
Depression ∙ Anxiety ∙ Uncertainty ∙ BLAH
Many of us have adapted to virtual therapy by now. We are accustomed to our schedule of phone and video sessions. This includes the entire process of dressing up to look camera ready, adjusting our environment to appear as presentable as possible, and doing our very best to be attentive and connecting with clients through a screen, which has its own challenges.
We are dealing with whatever this pandemic has thrown our way in the best way we know how, just like everyone else.
With one difference.
We are supporting larger caseloads of people struggling to cope with the isolation of social distancing, enduring toxic family dynamics, or dealing with sudden and distressing changes in their circumstances.
🏀This pandemic is like the play-offs for therapists 🏀
Even a non-sports enthusiast understands that you don’t wind down, take breaks, or recharge during playoffs, when the stakes are much higher. Instead you double down because your efforts matter more than ever.
(I hope you enjoyed that, because it will be my first and last sports metaphor.)
I’m here today to challenge this thinking!
This may be our play-offs, but luckily, therapy is not a game. Therapists cannot afford to sacrifice our minds, bodies, and well-being. We must strive to avoid becoming the collateral damage of our own efforts.
I’ll tell you why. First, let’s do a check-in. And if you cringed because this is how you start every session or group therapy meeting, just know that I did too.
A Quick Check-In
It has been well over three months since lockdown, and the effects of continuously holding space for our clients, sometimes in back-to-back sessions, may be starting to make themselves known.
Do you feel:
Are you finding it difficult to:
Detach from work
Not think about your clients
If you resonated with most, or all of these statements, this next part is a vital read.
Remember what I said above about ensuring our wellbeing does not become the collateral damage of our work?
Therapy is not a profession where you can leave yourself at the door. We bring our entire being into a session, even a virtual one.Tweet
The implication of this is the state of our mind and body may seep into our work with clients.
We honour and hold peoples’ stories, vulnerabilities, and traumas every day. This cannot be done in a detached way, making the wall between work and life impermeable.
This may be the case even more so during the pandemic, where we are expanding our work-from-home hours and try to squeeze in more clients. Sometimes this looks like back-to-back sessions with minimal breaks or buffers in between clients to recharge our capacities.
You guessed it, there are consequences to this pattern over time.
Crucially, maintaining this momentum is detrimental not only to our own health and wellbeing, but our ability to provide high quality work!
To my dear friends and colleagues, prioritizing your mental health is not only good for us personally, it is also our responsibility as therapists.
Here is why.
Burn Out Is Real
I learned that burnout is one of those things you don’t need to know the definition for to understand that it’s happening to you.
Here are some common signs that you may be burned out.
Experiences of depersonalization (i.e. feeling detached, withdrawn, almost as if you are observing yourself from afar)
Finding it difficult to be empathetic and compassionate
Feeling ineffective, unaccomplished, or incompetent
Shortness and irritability with clients
Repeating techniques and interpretations automatically
Blurring boundaries with clients (i.e. oversharing)
Keep in mind that experiencing any of these alone does not necessarily indicate burn out. Some of experiences are quite common occasionally!
It’s when they are consistent, prolonged, and interfere with our therapeutic relationship with clients that we often notice there is a problem.
Researchers have recognized the consequences of burn out for years. One study discusses burn out in helping professions as a psychological syndrome that has serious personal and professional consequences.
It shows that mental health professionals experiencing burn out do not perceive themselves as effective. In hospital settings, this can result in outcomes such as increased turnover and even high patient admissions.
Burn out has physical dimensions too – insomnia, exhaustion, headaches. This combined with the apathy and low self-efficacy can be extremely detrimental to our mental health.
Story Time With Sarah
I’m going back in time to share a gem with you that I learned from a supervisor early in my career.
They told me that I WILL burn out.
And when I do, I should recognize that working through burnout, or ‘powering through’ as we like to call it sometimes is unethical.
As difficult as it may be to admit, we can harm our clients.
Here is the 💎GEM 💎: this dear supervisor of mine told me that when I take a break and I think I’m ready to go back to work- I shouldn’t. Not yet. The process of feeling ready was recovery. The time that comes after that will be rejuvenating.
To approach our work with joy, we want to operate from a space of ABUNDANCE, not merely sit at an acceptable threshold.
This advice has always stayed with me.
Vicarious Trauma Is Not Just For The Textbooks
Similar to burn out, therapists hear about vicarious trauma all the time- to the point where it can feel like an abstract idea.
As therapists, we hold space for our clients’ traumatic experiences. We offer empathy, and safety in those moments.
Sometimes, this process can be overwhelming for us. Our capacity to hold and not be personally affected can wear thin when it we do not give ourselves the time and space to regenerate that capacity.
Without proper care, therapists may experience a version of the feelings and symptoms their clients who are trauma survivors, are going through.
Studies have shown that vicarious trauma and burn out overlap significantly. Just like burn out, it is usually the slow accumulation of events and neglecting vital self-care that eventually becomes harmful.
If you are working regularly with trauma survivors during this pandemic and are finding it difficult to recharge and rejuvenate, look out for these signs:
Feelings of unshakeable grief, sadness, and anxiety
Feeling unsafe in the world
Wanting to spend time in isolation
Increasing substance use
Drastically changing eating habits
Feeling increasingly cynical and hopeless about the world
Experiencing intrusive thoughts and finding it difficult to not think about clients and what they have gone through
Imagine pushing yourself to work through your schedule while holding all of this? It’s hard enough to keep going, let alone being involved in the care of another person.
Vicarious trauma is not always obvious. Sometimes it takes sharing your experience with someone else who can help you recognize it for what it is.
If you are like me, it may become apparent only in hindsight.
Once you do become aware of it, be kind to yourself and step back for a while.
Think of it this way- would you suggest this course of action to your client/fellow therapist/friend. Do it for you too.
Why Self-Care Matters For Our Therapeutic Work: Emotional Co-Regulation
First of all, let’s make it clear that caring for our mental well-being is inherently valuable and important!
However, in the nature of the work do, our state of wellbeing does not exist in an isolated bubble. When we join with clients, they take on a piece of us too.
Okay, this is cool. I am about to unleash my inner nerd- be prepared!
If you ask most therapists and researchers WHY therapy works, they will often tell you:
The jury is still out
The best predictor of effectiveness in therapy is the therapeutic alliance
I know, I know, therapy 101.
One of my favourite mechanisms for this is emotional co-regulation.
This is a bi-directional relationship between therapist and client where a therapist’s emotional state and emotional reactions help the client regulate their own emotional experience (and vice versa).
This occurs at the level of the nervous system (so cool).
When we feel emotionally regulated and present with our clients (safe and social) their autonomic nervous system picks up on this. Our emotional attunement helps calm their nervous system by creating a sense of safety. In other words, your well-being influences the client’s, in an imperceptible yet powerful way.
Of course, this can work in reverse too.
Have you ever been in the room with a client but had a million other things on your mind? It’s no wonder those sessions felt all over the place.
Or perhaps you were feeling anxious, and felt a tension in the room?
Our emotional state has a powerful role in the therapeutic relationship.
Doesn’t it make sense to take care of it?
Enter Me, Your Exhausted Therapist
So what do we do about this Sarah? You are right to wonder. Many of us can’t take extended breaks and go through the process of recovery and rejuvenation
What we can do is find manageable way to incorporate rest and self-care into our day. I’m sharing a few tips below that have been helpful for me, in the hopes that you benefit from them too!
Re-think Your Schedule
Think about whether you are scheduling and sticking to breaks. I have been forcing myself to take a lunch these days and a few short breaks in between sessions to recalibrate.
Also consider easing up on the back-to-back scheduling! Particularly if you are seeing multiple clients on the same day with complex issues.
Book complex clients earlier on the day and earlier on in the week when you are most energized.
Voice Your Concerns
If you work with a team and are struggling to balance an increased caseload, you may find that others on the team are experiencing the same thing!
Be the one to bring up the elephant in the room. Pursuing a work strategy that allows you to prioritize your own mental health might be easier if everyone is on the same page.
Get Out Of Isolation Mode
If you work in a solo practice, consider finding a peer support group! Holding the worries of your clients along with your own can feel heavier when you don’t have someone to share this experience with.
Talking to people in the same line of work facing similar struggles can be incredibly validating and may create a much-needed sense of community and camaraderie.
Maintain Your Therapeutic Frame
For many therapists working from home, the physical aspect of our therapeutic frame has already changed- we are doing sessions from home rather than the office.
We can still maintain our other boundaries though! Timing of sessions and professional and ethical boundaries still remain. For example, if find yourself giving people more time because of the change in context, think about how this might be contributing to your feelings of burn out and the therapeutic relationship.
Feed Your Soul
I cannot stress this enough: live your life outside therapy! Hobbies, friendship, dating, books, films- these will give you the sense of normalcy you need!
If your identity is completely intertwined with work, feelings of burning out are more likely to feel like personal failures. Your work is valuable, but you are more than a therapist!
As therapists, we often spend days holding the darker parts of humanity close to our chest. We NEED silliness, laughter, goofiness and nonsense to balance that out.
Since the quarantine, I have a ritual with one of my clients, each session starts 2-3 minutes of pure laughter. How do I do this? Well, take a look:
What should I be at our next session? Leave a comment below!
Adopt A Self-Care Routine
Take a few non-negotiable moments every day to put yourself first! It can be something as small as sitting with your tea on the balcony, or deep breathing while using essential oils. Whatever it is, make it a fixture of your day.
Even therapists need the motivation, insight, and exploration that therapy provides! This is also a way of showing that we value what our profession has to offer.
Believe me, you haven’t seen it all, done it all, and won’t know it all because you are a therapist yourself.
Therapists, we hope this has motivated you to put yourself first today, and every day, in any way you can manage it. Your own mental health is precious (as are you), and your clients’ therapeutic experience depends on it.
If this seems like a lot of pressure, let me re-frame it for you: we have chosen a career that has a built-in self-care requirement.
There is no need to feel guilty for affording yourself this kindness- you deserve it, and your practice deserves it!
How will you incorporate self-care into your busy schedule this week? I am always looking for ideas, so sound off below!
Until next time,