Speaker A: Welcome to the Therapist Burnout podcast, episode 28. Hello. Hello, therapist. I’m so excited to be joining you again. Okay, so we’ve had a whole month talking about careers, and so today I’m going to give you my three part framework to how you make this decision. This is my thinking from my process and helping other people through their own process and how you can start, really, today, making a plan towards change. I want to add the caveat that if you are thinking you’re burned out, you’re probably past burnout by now. That’s okay. Or if you’re kind of on the edge of burnout, we are past burnout prevention, which is really. And I talked with Kate Donovan, host of the Fried Burnout podcast, and I think she solidifies this idea so well. All of the self care education that we receive, most of that in school was given to as stress management. So that would look like make sure you’re taking your walks, make sure you’re doing yoga, make sure you’re talking to a colleague. All those are important for our health. They are not burnout recovery. So when I’m thinking through burnout recovery, I’m thinking nervous system regulation and really resetting your mind, body, spirit, soul. Love it. I’m having a guest on soon that’s going to talk about moral injury as well. Because our souls are affected by this work, right? How can they not be? We’re talking about the pain of people. We’re talking about these issues that are so close to us, and we see horrible and horrific pain when we hear it. And I think we see it, obviously, through the eyes of our clients, but we literally can see it. Right? When I suffered my own vicarious trauma, several different bouts of it. But one, probably the worst part of it was on an infant loss case. And I won’t go into those details, but I did have pictures in my mind of that. I know that that is something that therapists struggle with. So I think we have to think through this. And likely you are in needing burnout recovery versus burnout prevention at this point. And I think I’m just going to do a whole episode based on a little riff of that. I’m writing that down. Do an episode on burnout prevention. Worst recovery. Yeah. So I want to go over this career kind of spotlight I’ve put on. Sometimes my ideas, they get really squirrely, and as I think through them, they become more solidified. I think that happens for a lot of us. So I’m going to go through the three steps of my framework of how you might start to think about these ideas, because I think one of the top questions I hear from therapists, what else can I do other than therapy? I need to find some kind of non clinical job other than therapy. I can’t do one to one anymore, is often what people say. So that’s the common question. But it’s not really what you need to ask yourself, because before we get to know what the next thing is, we kind of have to figure out, like, what’s wrong with the thing we’re doing. And I think we skip that step often because we’re our nervous system. Fight or flight. Right. We are trying to just make ends meet. We’re trying to make sure our resources are met. We know we need to make a certain income. So that’s going to drive me to our first step. So I want you to do an assessment. And so I have two tools for that. One, I haven’t talked about so much recently on the podcast, but I have my before you quit assessment. And really, that’s kind of looking at and diagnosing those core pieces. And I’m not providing mental health services. That’s not a diagnosis diagnosis. It’s a self assessment of your burnout. Right. And so I looked at the core. I took up one of the burnout scales, and it looked at the core areas that affect us in burnout. And so those are looking at. Just bring it up. That’s looking at who your clients are. So in this section, we’re really thinking about who we’re serving and how our clients are affecting us. I have you look at and answer what is your most triggering or difficult case? And you could talk about a number of them. I typically had a few that were depleting my emotions. And then also thinking about, what are those kind of favorite sessions you’re doing or favorite work? If it’s not one on one sessions, you could think of the type of work that’s renewing for you and then, like, what changes you want to implement. And then I have you look at what the work itself, like, the type of work for me that was certainly doing EMDR sessions could be depleting and then other aspects of your job that you like thinking about your favorite job. I think that was a process that really helped me. Where did I put this? Gosh, I’m so over this. Google. Okay. I was freaking out that I lost this recording, but I didn’t lose the recording. Thank you. I didn’t lose it. And then I have you think this is so helpful because I thought about what were my favorite roles that I’ve done in the past that have been things that have lit me up where I felt more like myself. And those roles included. I’ve talked about this many times in the podcast that I love meetings, that I love collaborating. And so the roles that I did, that too, stand out to me in my mind. So when I was on my predoctoral internship, I worked in a college counseling center and I did group therapy with a senior therapist. And I think I’ve just been trying to find ways to work with other therapists and do co therapy. I think it’ll find me again in my career at some point. I just don’t know when, but I’m excited when that happens again. But it was just such a rich experience. We would do run the group together. We’d have a pretty like a pre process or, no, we had post process, but we would have like a pre planning time before the group. We’d have our group and then we’d have post process where we talked about, you know, how we thought the group went and what was I, what was coming up for me in the group. And it was such a rich experience that I really, really enjoyed. And I think the beauty of college counseling is that you’re not tied to, you know, reimbursement. And I, I work in schools currently, and I think that’s one of the great things potentially about working in a setting where you’re not tied to like the 45 minutes hour or now the 53 minutes hour with the 90837. If you do your own billing or know the codes, you know what I mean, that, you know, we have to meet with a client or at least 53 minutes to build 90837, which is our highest reimbursement code. And most people, I think, are billing that one. So when you’re not tethered to that reimbursement hour or time, I think it can open up. If you’re in the right culture for your work, it can open up some opportunities for being able to do some different types of things, which is cool. So in this, I have you think about for each one, what do you need to stop doing and what do you want to need to implement to change the work that you do? So I also include aware, you know, where, how is the work, the setting affecting you? For me in solo practice, the setting really impacted me dramatically because I was alone. So especially in the pandemic, my office had another, I had a suite and it had another office. And the person that was in that other office during the pandemic, did not come to the office. So really it was just me. So it was me on telehealth in my office. I remember laying down on my yoga mat so many times, trying to regulate and breathe. But I think as therapists, we know the power of co regulation. We know that having our colleagues to co regulate with us is so helpful to us in the work. And so if you’re in solo practice and you don’t have really solid relationships with your colleagues, I think it can be really, really tough to feel like you have that social support, which we know is a protective factor for burnout to help us mediate some of that risk that we. And then lastly, I talk about just you. You know, what in your personal life contributes to exhaustion? I was just looking at a, I’m working on a piece about burnout in midlife and the research for women especially, you know, for female identifying folks as well, who are, those who tend to be caretakers, I think would definitely carry over. And I think though those who are male identifying in the field, certainly your caretakers if you’re in this field. So some of this stuff might apply to you, but not menopause specifically. But I think the concerns for women are dramatic because of all of the changes that occur. So I’m working on a piece for burnout in midlife, for women identifying folks especially. But I think it also is just a difficult time for a lot of us, but it has you identify, like, what else in your personal life is contributing to your burnout. So if we’re just looking at the work, that’s not a holistic picture of us. So we really need to think about what else is happening in my life. When I was working with someone, they were talking about, you know, only have this certain amount of time, and then I have to pick up, you know, my child, and I just can’t do it all. And so I can’t. This client wants to be seen on this day, but I want to pick up my child. I was like, okay, so which one do you want to do? I want to pick up my child. Okay, so what do we. What do we think we need to do? I think I need to move the client. Okay, does that sound like something you could do? Yeah, I think I could do that. And I think, like, it sounds so simple, but if you don’t have someone with you to help see your blind spots again, when I was talking to Kate Donovan, she was telling me I was going to look up some of this research, literally our peripheral vision, peripheral vision. See if I can say it right. I don’t think I did. Anyway, is impacted and burnout. And so I’m going to look at that. Look and see about our vision. I know, coming from a neuro rehab background, that we saw so many changes with people’s vision, from a brain injury, and we know there’s cognitive changes that happen in burnout and with trauma especially. So I think there are some neurocognitive things that can be helpful to know. But back to this kind of thing, focused on yourself. So this assessment you’re doing of you. Okay. Yeah. So how is your. How does the work impact your personal life? For me, I didn’t have space for my kids emotionally. When I came home, I remember just feeling like, and no one can really understand this, but therapist like, my face was sore from emoting and holding, like, a concerned facial expression. It is not natural for us to do that in natural conversation. I can just think, I just had coffee with a friend. I was paying attention to my friend, but I wasn’t listening. How we listen in therapy, it is just very unique what we do. And at the end of the day, I just need to shut down, not do a lot. And my kids need that from me. So they need my energy, they need my emoting. And I didn’t realize how much I was not able to do that for them. And so I had to think of how much you can do at the end of your day and still have energies, how much you can do. And so that gives us information, right? This gives us information about what we can do and what our limits are. And I have you think of a time in your personal life and when work felt more in alignment. For me, I think that was probably back in the early two thousands, before the smartphones. Also doing an episode on anxious generation. Blowing my mind, y’all. Blowing my mind about what is going on. Also apparent and just in the throes of this. So anyway, so I want you to grab that. If you haven’t done that before, go ahead and grab that guide. So it’s the before you quit assessment. I’m gonna change it to before you quit inventory. No, I say it’s before you quit inventory. Oh, my gosh. I’m gonna talk today. Right? And the other one I have is a. I’m gonna. I’m working on revising. This one is my money guide. And so what that money guide does, it really has you think about how much you need to have financially. And we don’t know that unless you’ve done. Maybe you know your numbers and I. You don’t have to do that and whatever, it’s fine. So I want you to also grab that guide, because what that will have you do is really think about your quit number. So you need to know how much money you need to replace. Some of you might be wanting to replace some one to one income with your clients, and some may want to think about a total job change or pivot. So it could look like I am going to totally quit my practice. I’m leaving. I’m done. What is that number I need to make? For me, that was around 45 to 50k, which was mind blowing to know that number for me with a doctoral degree, ten years post licensure, that’s where I was financially, and I wasn’t full time in private practice. I usually had done some adjuncting and things of that nature, but the level of work I was putting into that practice was a 40 hours week. So I digress. I know I’m. I know I’m preaching the choir. Right? In the south, you might hear some euphemisms from me that are from the south. So assessment. So we got that assessment also, you know, when I work with folks, I might have you do if you want. Like, I think the other stuff can be like, extra credit. You want to go do, like, a little ocean evaluation or do the MBTI? You know, a lot of people get into that. I trying to think of one that I did. So the MBTI is really well researched. And so as a psychologist, I like for my instruments to be well researched. So there’s not. I don’t know about the enneagram. When I was in. I think the enneagram was coming up when I was in school, and everybody was like, we don’t know the psychrometric properties on that one. So I don’t know about it. It could have changed. I don’t know. The research on it. Haven’t really looked that much into it, but some people love it. And I’m just like, hey, if it gives you useful information, we’re using it. I also like. And I don’t know if this one is well researched. All right, so four tendencies. Quiz. It was, I think, really helpful to kind of understand. It was based on Gretchen Rubin’s book, and it was. It was. I love this question. How do I respond to expectations? And she discovered people fit into these categories. Again, I don’t. I should look at the book to see what the research is on it. And I just think it gives us some information about it. So they were upholders, questioners, obligers and rebels. And I think it’s kind of face valid what those are. So upholders, like, I need to uphold that expectation. Questioners, that’s me. So I am always thinking about all the angles. How can I really assess and understand? And so that’s my Achilles heel. It’s also a strength of mine. Obligers like, I need someone to really hold my feet to the fire, but I’ll do it. And rubble’s like, nah, you ain’t gonna tell me anything. So anyway, I found that helpful in part of my process. So you might want to grab that. It’s a free quiz. I love little quizzes. I think most of us do. So check that out. Be something you choose to use. Maybe, maybe not. Extra credit is what I think in this process, because most of us have taken those in school. We’ve taken the MBTI, we’ve taken, you know, and there’s a number of those that are on. I might just do a whole episode on. On those kinds of things as well, but I kind of put those as extra credit because I feel like we know a little bit about ourselves. So the big five is the personality test, and it’s really well researched as well. And so those are for openness, conscientiousness, extroversion, agreeableness, neuroticism. There’s that. So assessment. Think about that. That gives you information. As a psychologist, I love assessment. I think I do it too much. You probably have been stuck. Let’s talk about the sticking points for each one. Okay. Getting stuck in assessment is hard because a lot of us are researching everything. We’re researching different jobs. We’re researching how to save ourselves from private practice, how to, you know, charge without, or how to have, like, a full free fee practice how people have come off insurance panels, for example. So we get stuck in this assessment phase where we’re constantly researching, constantly researching but not taking action. And so I really want you to think of this assessment. It’s going to give me information so I can take action, so it can help me. And some of the most motivating things that helped me were knowing my quit number. Honestly, like, the math did not math. I wanted to make more and have less stress. Simple as that. And so when I knew I could do something different for my work, that’s what I chose to do, you know, nearly two years into my process. So it’s not like it was an overnight thing. No, not at all. All right, so from our assessment. Let’s explore options. Let’s start exploring. Before we do that, though, your first step is to stop and take a break. Some of you need a full stop break. If you are in true burnout, like full burnout, your body is having a symptoms. For me, that was panic attacks. I was in a full blown panic attack, driving, and so I did not take a full stop break, but I probably needed to, I think, you know, it was the, um, the pressure cooker of the pandemic likely that caused me to go there and not having any childcare at home. So I’m at work, I see people online, and then at the end of that day, am basically on the hook for childcare. I did have, you know, I do have a very supportive partner, but still, it’s. It wasn’t enough to manage all of that. So full stop break or plan a break. So maybe you need to plan some time to make this pivot, to take a break from your practice, take a break from your job, so you can really devote some time to trying to figure this all out and to regulate your nervous system. So if you’re in full burnout, you need more time to regulate your nervous system. Your nervous system is not a homeostasis right now. So it makes sense that you go back to work, you don’t feel like you got a break because your nervous system has been depleted, likely chronically. And so if you chronically deplete your nervous system, you’re not going to replenish it. So this break point, taking a break as part of this explore phase is figuring out a what do I need to quit first? So oftentimes some of my first advice for people, you do your assessment and we figure out what do you need to stop doing? We don’t figure out, what do you want to do now? What do you need to stop doing? That is step one. Take a break. What do you need to stop doing? Okay, maybe it’s like I need to stop seeing people after 05:00 great. I need to stop over scheduling myself on Wednesdays because then I go straight into picking up my kids and I’m like a frantic mess and I keep doing it. Maybe I need to go quit seeing clients on Fridays. Maybe I need to leave at 05:00 at my agency job and let my boss know, hey, I’ve been given this amount of time to do this task, and I have to leave at 05:00 to get my kids. Which would you like me to do? Would you like me to see the extra client or get my paperwork? Done. So we start to push back and let them know, I’m actually going to start working at a normal human pace again. And I think we don’t even realize that we’re working frantically so often. We’re driving a nervous system into overload so often throughout our days. Let’s not even add the layers of the emotional fatigue, just like the pace at which we’re working. So I think about the pacing of your work, the things that are depleting you, what we need to quit. And that goes for home, too. What do I need to quit doing at home? Can you get extra help at home? Whether it be a family member, whether that be, you know, some people that can help you with things at home. All of that we consider number two is stop throwing spaghetti at the wall and scrolling. Indeed, a lot of therapists are, you know, either that me and my private practice was trying to do new things, like, okay, I’m going to start offering intensives or I’m going to add a group, maybe now that didn’t work, I’m going to do couples. That’s going to be a new thing. I needed to stop first, so I skipped and went straight to throwing spaghetti at the wall and then scrolling and d like, oh, I can’t do this. Maybe I can find some other job that I can do that so down. Okay. And then I want you to think, so if we’ve been able to look at what we want our first pivot to be, we can think about small pivots or big pivots. So if, you know, like, you’re just. I I’m switching jobs. Like I’m already toast. Like it’s happening. Especially if you’re coming out of agency and you were burnt out to the bone. You’re bone tired. I would advise you not to launch a private practice right away, if you can. Maybe part of your work is clinical. Maybe you choose to, like, work on a side stream. Like I talked about, pet sitting. Therapists are pet sitting in 2024. That is the new thing for therapists. It doesn’t be pet sitting. It could be just like a non clinical role. Retail something. Something to make ends meet that’s not clinical. So you can buy yourself that breathing room again to figure out what that full pivot will be. Because a lot of times I just see us move and jump and jump and jump to one thing that’s going to burn us out. We get a new setting. It feels fresh for a little bit, and then here we are again, right back to the burnout train. So I want you to think of, how do I think of the pivot? Whether it’s going to be I’m changing jobs or I’m going to make smaller pivots. Like I’m going to come off some insurance panels. I’m going to really look at those clients that are depleting me. I am going to start charging full fee and figure out ways to market that. That’s a process that takes time. So the first stopgap is really figuring out, like, how much income do I need to replace now, can I buy myself a little bit of time with a side job or something like that? So I can figure out some of these more long term strategies, such as either finding a different type of job on the open market or changing my practice to be something that works for me or launching a private practice that works for me, that works for my life. That doesn’t deplete me, which is entirely possible. I do believe that, that people can thrive in private practice if they put the burnout guardrails in place. So that is my framework. So again, I’m going to go over it. So it’s going to be versus assess to see where are you? What do you really need? Do you need the full stop break or can you buy yourself some time? In the process, though, I want you to be thinking, how am I going to regulate my nervous system? How am I going to make the meaningful change that I need to make to get myself recovered, to heal what is going on in my body and my nervous system, in my mind, in my soul? Because that’s part of it. Second is explore. Okay? Explore what’s not working for us. We’re going to quit what’s not working for us. Quitting is always the first step there. We need to quit what isn’t working for us. Stop throwing spaghetti at the wall. Okay? Stop scrolling. And then think of those pivots. Short term, long term. So short and long term pivots with that. And then from that we make a plan. Did I say number three was make a plan? Make a plan. So that can be, if it’s a short term plan, we’re going to do little experiments, okay? It’s an experiment. We’re trying it out. May not be the thing that works in the end, but we’re trying out that experiment, or we’re pivoting. We’re trying another job that is also an experiment that does not have to be our next thing, the next meaningful career that fulfills us. No, we’re trying it on. So I just want you to have that mindset of having those pivots, because a lot of times we’re stuck in that failure. Or like, for me, I was stuck in the failure of my closed my practice. Like, what does that mean about me? All the things, all the mind drama that was happening when if I had to do it again, and now I see it as I pivoted, like, there was so much going on at the pandemic, like, no wonder I needed a pivot. That’s okay. And now finding other things to do. So I leave you with that, and I hope you got a lot of this episode. Take care. If you want to get the links to all the things I talked about so your before you quit inventory, grab that in the show notes and also the money guide for people, for therapists who want to quit, that’s there, too. All right, talk soon.
Speaker B: Thank you for listening to the joy after burnout podcast. Be the first to hear new episodes by following the podcast and your podcast player. This is an informational podcast only. Any information expressed by the host or guest is not a substitute for legal, medical, or financial advice.
