Speaker A: Welcome to the Therapist Burnout podcast, episode 41. Hello. Hello. Welcome back to the program. It’s me again today, talking to you a little bit about why therapist burnout is different. So I thought about the title of this episode, probably when I was talking back with Cait Donovan, and that is episode number 38, where I talked with Cait Donovan, the host of Fried a burnout podcast. And I was getting the sense of, you know, we do have a different flavor of our burnout. And so I wanted to kind of get us lay out some of my ideas about burnout for therapists. But also I put a post up on LinkedIn. I post over there. So join me, doctor Jennifer Blanchette. Two t’s and an eternity on LinkedIn. And I post about all things therapists barn out there. And it’s some fun discussions. Sometimes people are pretty like they behave themselves, I think, because all your credentials are on there and people don’t behave as badly as they do in, like, therapist groups and Instagram. You can get kind of trolley in there, too. So I think it’s not as weird, honestly. So anyhow, I polled the LinkedIn world about therapist burnout. So I want to talk to you a little bit about why it’s different. Okay, so I’m going to start with this quote from someone who posted on LinkedIn, and they said it feels like being squeezed by the system. There’s no room to breathe and no one is coming to help. That was from Michael Rose. So one of the first points is talking about your caseload and your mix of clients. So a lot of times, in a lot of the settings that we work in, we have heavy caseloads. So certainly that was the case for me when I worked in agency, and my work was a little bit different because I’m a psychologist. So I did primarily assessment in that role. I didn’t have as much therapy. So burnout in testing feels different than burnout as a therapist. And I know both, and I’ve had both. The testing just feels like I have so much work to do. It’s not necessarily emotional work, but it’s just a ton of work to do. And it feels like I am unable to meet the demands of this agency and what I am being requested to do. So that felt a little bit different, and I did feel like I was inching close to burnout, but I left that job where I did primarily assessment based work pretty early on because I was pregnant and I was having a baby. And so I left that at that point in time, however, on internship, I did work in agency when it was primarily therapy, and those were ten hour shifts. And that was a lot. That was a lot going on. I think I’ve talked about this a number of times, but your caseload size and the mix of your cases is important to think about. And another quote from Michael Rose that I loved. It’s not always about how many clients we see. It’s about the intensity of each case that chips away at our mental health. And I found that to be true. And I’ve said this on the podcast before. 20% of your clients cause 80% of your stress, anxiety and tension about the work that we’re doing. And it’s not that we want to totally avoid the 20% of clients that cause us more distress, but we need to have fewer of those types of clients to manage that from a clinical perspective. And just as a human, I mean, if we would just zoom out and think about if I had two friends, and I’ll say I have ten friends, which is high for an adult, so we’ll say I have ten, like, really good friends, right? I have ten people that are acquaintances, but close friends anyway, we won’t get weird about friendships, and two of those are causing me stress, then I’m only going to think about those two friends. I’m not thinking about the eight other friends that are great, that bring me so much joy, that bring me little gifts sometimes. Not that we’re allowed to have gifts as therapists, but, you know, like, if they bake something and you’re like, all right, yeah, that’s nice. They offer you a cheeto in session, I’m like, yeah, I’m hungry. I might eat that cheeto. So we don’t think about those Cheeto clients, right? We’re going to think about the clients who are stressing us out, that we dread every week. And of course, we want to do supervision. We want to do all the things, but at the end of the day, sometimes we’re just going to have difficult clients, and we can’t always avoid it, but we can manage it. And so I really think about having time to fully prepare for that client to decompress after intense cases which contribute to burnout. And sometimes we just need to decompress from the, the material that the client is bringing in. I think when I worked an infant loss case, I developed vicarious traumatization. I had to do my own personal EMDR work because of images that had come to me. So to think about sometimes just the material that we’re dealing with may cause difficulties right. So just that material alone means that we can do fewer amounts of that work. So I think thinking of ways of how to adjust your workload, and I think this comes in by doing like a quarterly deep dive on your caseload every 90 days. I really want you to come to the cadence of looking at your caseload and assessing for progress. Assessing for. Has this client met treatment goals? Because a lot of times in private practice especially, we hold onto clients longer than we should just because we’re humans and we just keep seeing them and we aren’t really doing that clinical piece of looking at the caseload enough. So that would be one thing that I always recommend, is a 90 day clinical audit. Looking at your caseload, seeing who might need to come off that caseload, who needs a different type of work, do they need a different modality of care that might be more helpful, like a DBT referral and then really coming to that next session or next few sessions and telling them why you think they need that referral and having, you know, all that clinical evidence behind you to say, these are the reasons why. And I really think we can’t do that alone. So the problem is, a lot of time we’re looking at our own cases alone. And so I’d really like to think about how we’re looking at cases from a consultation perspective. So part of what I do when I work in a coach with therapist is that I provide clinical consultation and say, okay, well, you know, you’re looking at these different cases. How are they benefited from the care? How is this detrimental to you? Which we don’t often ask ourselves enough. So that’s, number one, thinking about your caseload size and also the acuity and the. Sometimes our clients, well, I’ll just say the sidebar. Sometimes a client isn’t super acute, like their issues aren’t difficult. However, the way they make us feel in session is hard on us. And so even if they’re not a high level of clinical acuity, we might need to still think about referring that client out because it’s affecting us. Maybe it’s counter transference. Maybe just the type of issue is really bumping up against something we’re dealing with. So, number one is looking at caseload and case mix and doing your 90 day deep dive on your clinical load. Number two, the payment dilemma. Dilemma. The payment dilemma. We only get paid when you sit with a client. If we don’t have clients in the chair, we don’t get paid. And that’s, that’s tough because it seems like we don’t have time to do anything else. We don’t have time to do admin because we’re trying to get clients in the door. We’re trying to make sure that we’re getting enough in to meet our own bottom line. So some of the things that can help with that and things that I did when I was in private practice. And this just kind of isn’t about, you know, just private practice. It’s about burnout as a whole. But thinking about if you can have some control over what you’re doing, you can raise your rates, you can build some non clinical services into your practice for additional revenue streams, and that could look like, you know, doing trainings, doing some other things, that takes time to develop, and it’s hard to do when you’re in burnout, but it’s things that I’ve seen people do before. I. So I, you know, this is one of the points of doing, having another stream of income. But I did teaching for a very long time, and so I didn’t need all of my income to come from my practice. And I think that was beneficial for many, many years. And then it must have been right before the pandemic, the institution I worked for closed, and that was no longer a stream of income that I had. So think about that. I think number three, I would say, is fear of losing your life license and being under a cloud of fear. Okay, so therapists talked a lot about the fear of losing their license, doing something that was unethical, like ******* off a client, having a client report us for doing something, quote unquote, unethical. Fearing clinic, fearing clients complaints because we did something wrong. And I think what this becomes problematic because we can feel under constant pressure to please clients versus treat clients. So if we are trying to please the client and not thinking from a treatment lens, like, I don’t want to upset you, I don’t want to **** you off, because then you might come against me, report me, or I fear that I’ve done something wrong or wrong by you that may not be in the best interest of our client. But I think it gets so muddy because we are worried about them being happy, not them getting better. And I think most burnout therapists will know what I’m talking about in that when you first start out in your journey as a therapist, you really think of the clinical issue and how I can help this client through this clinical issue and not as much of, like, pleasing them. And that comes into play, certainly, like, we want to be well liked we want to feel like we do a good job. We want to feel like the client is making progress, but that doesn’t happen all the time. Sometimes therapy feels really ******, unfortunately for us and the client. And it’s hard when we’re motivating from a place of fear of losing our license or doing something wrong that we may not do right by that client or right by ourselves. All right, so four is that we’re expected to be superhumans. And this kind of, I think, again, talking about people pleasing, right? So I think from society sees therapists as, like, these. We are super evolved, emotionally well balanced people. We have it all together. We have great boundaries personally. That is just not the case. Not the case. This quote from a therapist, Colin Albrow. I think I’m saying that right. We’re expected to be these all knowing, always perfect healers. And when we don’t meet that standard, the guilt is crushing. Another therapist, Tamara Hubbard, said, mentioned how therapists are seen as superhuman and how this pressure makes it hard to admit burnout or ask for help. And I really have you think about your boundaries. Uh, they can. And I think sometimes we think that we always have to accommodate someone to be flexible. Um, I fell into this trap when I first started my practice, like, needing to limit my hours or charge more or charge for cancellations. I was never great at charging for cancellations. I know I’m not the only one. Some therapists may be great at it. I was not great at it. I just felt like, again, would I **** off the client? Would they be upset with me? I did have some clients that were understanding, and they knew it was my policy, and they would just be like, yeah, just charge me. It’s fine. And I’m like, okay, great. Thank you. Not always great with more of the clients who are more bristled right about it. I’m recording the second part of this episode. This is the back half. I’ve recorded it a couple days after the first half, which is always interesting to me when I do that, because I have, like, kind of different ideas that bubble up. Right. I wanted to tell you before we jump back into the content of this episode that I do offer coaching for therapists. So I often don’t explicitly talk about it here on the podcast, but I am gonna talk about it a little bit, because I think the more that I do it, the more that I see how much my clients are getting from it and that I don’t want people to suffer. So I work with therapists who pretty much are done with therapy, they are on their way out. They are trying to close their practice. They’re trying to leave agency or do something completely different. Those are majority of the therapists that I see. Some want to stay in the role as a therapist, and a lot do not. Some are taking a break because I think what happens is when burnout hits, we really have to stop the bus. And I was talking a little bit to one of my coaching clients about, I really wish that I had the gift of stopping completely for a few months, taking a sabbatical, taking time completely off. And I think I could have. I think I could have. It just didn’t seem available to me in my mind that I could try to work out a way to not work for a while. And part of that, I think, was fear because I didn’t work for a while after my first son was born and felt in some ways like my own mental health was suffering at that point in time. This was like eleven years ago, so it’s really processed. My son, I had a traumatic kind of birthing experience with him, and I could not go back full time with this heart baby. And so I really felt very vulnerable. And if I could tell myself then from my older, wiser self now, is that you will figure this out. You don’t have to rush to get a job. We will be okay. And things financially were tighter than they ever had been for our family. So it’s just so interesting that the things that we tell ourselves, right? The things that we tell ourselves that we have to do, that maybe we can take a break, maybe we can find room and I don’t know everybody’s situation. I’m not trying to. Maybe you can’t, and that’s fine. But could you do some work that doesn’t create this level of emotional fatigue for yourself? And so that’s what I help my clients do. I help them figure out, like, number one, how to pause. And I provide a container for that. How to figure out, you need to pause. We need to make a 90 day game plan about what are your next steps. And so I meet with clients twice monthly. We do a 75 minutes deep dive that first month, and then I’m. We make the blueprint for the next three months to figure out how things can change for you, because likely you have been in burnout and overwhelmed for a very long time. So I charge 475 a month for that service. And you have access to me every week. So if you want to send me a little message, you get a nice response back. So I digress so anyway, the link for that is in the show notes. So please book a call today. I’d love to talk with you, even if we decide not to work together about your first steps at a burnout. And I really see this console call as a service to you, whether or not it’s me or you’re going to do some work in therapy or with another coach, I just want you to find a space. Find a space to do the work, to figure this piece out. And don’t do it alone. Okay? So back to our content. Today we are jumping back into number five. I hope my numbers are correct. I think it’s number five. Emotional labor and compassion fatigue. Okay. So many of us talk about, I am so burnt out because I think that’s the words that many therapists use. Those are the words that I used. Those are the words that therapists often use. And I have some quotes from LinkedIn. One therapist said, therapists do so much invisible work, holding space for trauma and pain, but no one really sees how exhausting that is. And so I just wanted to kind of talk a little bit about those terms. So, burnout. The hallmarks of burnout from the World Health Organization are energy depletion, feeling exhausted, which sidebar. So one of my most popular posts on LinkedIn was, therapists are tired. They are dreaming of working at target and drinking lattes. So many of you resonated with me posting that, that I think I’m always going to talk about target. I’m going to go in Target and do a photo op one day for a new website of, like, it’s time to get your red vested girl. Anyway. Okay, I’m sorry. That was. That was a little much. So, one, energy depletion, you want to work a target. Number two, mental distance, increased distance from your job, increased feelings of cynicism or negativism towards it. So I experienced this a great deal. I would pull up to my office and I’d be hot as a hornet, not wanting to go in there, like, why do I have to do this? Everyone’s gonna be an ******* today. I just wanna be done. And that was from burnout. That wasn’t from my clients. I had some tough clients, sure, but that was from me. I think living through the pandemic as a therapist, feeling really untethered to supports. I tried to get as much of support as I could, but, yeah, that’s where I was. That’s where a lot of you are. So I’m just gonna say it and name it. And three, reduce professional efficacy. So feeling ineffective. So, at the end of that, I just felt like I didn’t trust myself. I. Like, I started this practice, like, I got that wrong because obviously it didn’t work out. And now I have panic attacks, I’m depressed, and, like, I don’t even know what to do with my life. So I think, of course, we’re gonna feel like we’re not very effective as a professional if we’re also feeling all those things that a lot of people don’t speak out loud because they don’t want to be seen as ineffective. They don’t want to be seen as the imposter, which many therapists think they are. So I think a lot of us identify with that definition. I just think it’s incomplete for therapists. So to complete it, I think we also need to look at the compassion fatigue literature and their thoughts and their different terms, which are a lot of terms. So compassion fatigue is one of those. And that really is that cost of caring. It refers to the emotional and physical exhaustion that can affect helping professionals and caregivers over time. And I think this pertains to a lot of folks in various roles. Right. I think teachers can struggle with compassion fatigue. I think that other caregivers can struggle with compassion fatigue. It’s not essentially unique to therapists, but it’s unique to helping professionals who use empathy and ability to connect with loved ones and friends. Second term would be secondary traumatic stress, where you experience those actual symptoms of trauma that may warrant a diagnosis of PTSD. And third, vicarious traumatization. And this term really is more about the negative transformation in the self of the trauma worker that results from the empathetic engagement with traumatized clients and the reports of trauma traumatic experiences. And that was Laurie and Perlman who coined that term. And while these are a lot of terms, I think it’s talking about, like, three distinct things. Sometimes compassion fatigue and secondary traumatic stress are put synonymously. Right. And I’m kind of curious, like, can we have compassion fatigue that doesn’t develop into traumatic. Into secondary traumatic stress? I think you could. I’m just gonna go with that. Even though in the literature, you often see them together. So in that vicarious trauma piece, is that we often. I think. I mean, I think we often have a disruption in our sense of self because of the work. I think that term speaks more to that. Another term. I’m also good. I’m just throwing terms today because, yeah, I guess language can help us. Right? And so I think one. Another concept that we should also explore which I’m going to talk a little bit more on the next podcast with a guest, is moral injury. And so I’m looking at the National center for PTSD, and typically, we think of moral injury in the context of veterans or soldiers who have witnessed stressful circumstances, and they may have been part of, failed to prevent or witness events that contradict deeply held moral beliefs and expectations. And that could be in the context of war, maybe that was something that went against their beliefs. And it’s the distressing psychological, behavioral, social, and sometimes spiritual aftermath of the exposure to such events. And so, while it’s been talked about in the context of the military, I think it’s also been discussed in the context of health care workers as well, who’ve had to make difficult decisions related to, like, life and death or triage or resource allocation when they may not have been able to save a patient’s life. Also, in crisis situations, healthcare workers may witness what they perceive to be unjustifiable or unfair acts or policies that may lead to a sense of betrayal. And I think I could definitely identify with some of that as a foster care caseworker, of the disparities in care and feeling like I’m creating the trauma for that child and why I haven’t worked with children since working in foster care. And so I know that there’s many therapists that likely work in systems where they feel like they are perpetuating trauma, they are perpetuating injustice. And so I think it’s important that we talk about this term, because I know what’s happening for a lot of therapists, the cumulative effect of emotional labor on therapists well being, it can lead to compassion fatigue and these other syndromes. And I think a little bit about the time in the pandemic. If you were a therapist in the pandemic, there were so many blurred boundaries between us and our clients experiencing that collective trauma. You know, I kind of liken it to breaking the fourth wall, like, in storytelling. It’s like the technique wherever a character acknowledges the audience or the fictional world they’re in. And so we had to acknowledge the situation that we were in, in the pandemic, as humans to our clients. Or it felt inauthentic, at least it did for me. So I couldn’t be like, what do you think about that? No, it was nothing anyone experienced, right? And so we were all responding in some ways to it and trying our best to do that in a way that was therapeutic and ethical, but it was uncharted territory. There is no documentation of how to manage a pandemic as a therapist, there will be now maybe a part of this work, of how we deal with these, these huge events, right? So I think the, the pressures, at least of that for me were huge and that it all coalesced together because there was no, like, there was no point where I was like, okay, like, therapy ends now. Then I go home and my kids don’t have care. And so I’m caring at home, I’m caring at work. I have no idea what’s going to happen with their school. I have no idea what’s going to happen with protocols. And if clients can come back, if clients want to come back to the office, if clients are mad at me because I’m not bringing them back to the office, I mean, oh, you know what I’m talking about. You live this. And then let’s talk about number six, burnout in students before they even come to the profession. So a lot of people talked about this on that LinkedIn post that the one person said, burnout doesn’t start when we’re licensed. It starts in grad school, when we’re already working for free and emotionally exhausted. And I’ve gotten a number of messages from students in counseling programs, folks that are just starting licensure process, people who are considering going into a career for therapy. And part of my answer is like, I don’t know if I’m the best person to ask. I closed down a practice, but maybe they want to hear from me, right? Maybe they want to hear for someone who has gone through the burnout piece, closed a practice, open to practice, went to agency, did 20 million things in my 20 years experience in mental health. What my thoughts are on it, and I probably would tell them to do something else at this point. But I am also hopeful and I know that we need people to do the work. So that piece is also hard. It’s both. And, and I don’t know what to do with that. Right. I think for therapists to really research and look at the environments they’re in as much as possible, really look at your grad school. How do they make sure the health and wellness of their students is paramount? On outplacements, on internships, on how they support their students, on how they train them with things regarding burnouth, with how they can make money after their degree? I shared on the last episode, I did not make meaningful income post degree. So I started in 2006 for my doctoral program. And really it took me to about 20, 1617. Yeah. 2016 took me almost ten years to make some meaningful income. And could I have just worked a job with the master’s degree that I had at that time? Like, in business? Like, I think of, like, office space. Could I have gotten, like, an office space job and, like, live my life? Maybe. Maybe that would have been better. I don’t know. I can’t go back in time, but I just would have people think about that. And this goes back to kind of that passion hypothesis, right? That we believe that our work has to be our passion and that our passion will help us be fulfilled in their work. However, your passion cannot always be your job because it’s not going to be enough to sustain you. Right. I think it’s better to think about what skill do I need to do a job that works to meet the needs of my life? Passions are tennis. Like, that’s my passion. Now, I don’t identify my work as my passion, and I didn’t think of that before, but we train our students to follow their passion. I was interested in psychology. Like, who isn’t? But will that get us to where we need in our life? I’m ranting on that point. Okay, let’s wrap it all up. So, I really want you to think about how we kind of think about burnout in therapy. A lot of times people tell me they feel like they failed, but it’s often a reflection of the systemic issues in our field. It’s not a reflection on you. And until we see that, you’re going to think that it’s you. Another quote from a therapist on LinkedIn, Brittney Lindsay. She posts a lot. Burnout isn’t always about needing more self care. It’s about a broken system, one that asks too much of us with too little support. All right, so that is your episode for today. I encourage you. I encourage you guys to share this with a therapist friend. Follow the podcast and your podcast player. And if you are so inclined, create this podcast an Apple podcast, because it does let the podcast player know that, hey, this is a great podcast, and we need more of that to have this message grow. All right, it’s been great. You guys have a good one.
