Speaker A: Do you really need to have the news on at night? Do you really? You know, you are making these choices on how you’re using your time. You do have some control over that. So I try to challenge people to. Time is a proxy, I think, for so many negative feelings and things happening right now. But people say, oh, I’m so busy, I’m so busy. I’m so busy. I wrote about this in my first book. We have a culture that worships busyness, and I called it the cult of busyness. And you don’t have to be part of that cult. You can step outside of it. You do have the ability to do. And, you know, I always caveat this by saying there are people out there working three jobs to put food on the table for their kids. Those people are busy. Legit. Like, those people can say they’re busy, but if somebody asks me, oh, you’re so busy, I very intentionally never say I’m busy anymore. I say, my life is full. I’ve made these choices and it’s very full, but it’s nothing. You don’t have to participate in all that, I guess, is what I’m saying. And I think people have forgotten that they have control and they can make those kind of choices.
Speaker B: You’re listening to the Therapist Burnout podcast, episode 43. Hi, therapist. Welcome back to the Therapist Burnout podcast. We have a guest today. I’m talking to Doctor Jenny Byrne. How’s it going? It’s so great to have you.
Speaker A: It’s good. It’s summer, it’s hot, it’s sticky. I’m inside in the air conditioning, so all is good.
Speaker B: Yes. I was just saying on the pre interview that I’m in a tank top because I don’t have central air in Maine. And so when it’s close to 90 degrees, you need to adjust your clothing. So I will kick it to you and have you share your burnout story.
Speaker A: Thank you. Yeah, thank you for having me here. I’m really passionate about this topic and you’re going to probably hear that in my voice. So I shared this story recently, and this was kind of a secret story that I hadn’t shared with anybody outside of a couple trusted people, including my husband. And I decided it was time to put it out there and it was really scary. So it’s still a little scary to talk about, but it’s out in the world now. I had something happen to me almost ten years ago now when I had a private practice that was an outpatient practice, I ran a psychiatrist mostly psychiatrists who did medicine, but also therapy. And I was really proud of some things in my practice I was really proud of, especially my documentation. So that’s kind of a pain point for a lot of people. I was very proud of the templates I had created and the attention to detail, and what I felt was very, very thorough. I was also very proud that I met the needs of the patients I saw. So a lot of the needs at that time, if you remember, ten years ago, were in full force opioid epidemic, and there was a new treatment called buprenorphine, or suboxone not many people knew about. It wasn’t in the press like it is today. And I decided I would serve my community and learn how to prescribe this medication and how to mentor to do so. So these are some things I was proud of. What happened to me was I had a patient who had trouble with a lot of things, anxiety, depression, but also was addicted to about five different substances when they came to me, the worst of which was methamphetamine, the least of which was Ambien, that he had been prescribed for his sleep. He was hooked on Ambien and couldn’t get off. Also had some cocaine in the mix, some opioids in the mix. It was really dangerous in substance use treatment. Try to tackle the problem and start stripping away the things one by one, starting with the highest risk one. This patient was on buprenorphine, and a pharmacist noticed that this patient went to the pharmacy and had been prescribed Ambien too early. And the patient was requesting that I give it to him early, and I said no. You’re abusing it. No. I said no, actually. But the pharmacist, even though I said no, decided to report me to the medical board because of this patient history without ever talking to me. And because medical boards have to do a thorough investigation of every single complaint, they showed up at my office one day, unexpected. And that triggered a chain of events, which I’ve written about. I won’t go into all the details, but basically I had a medical board investigation. They pulled charts at random, and they happened to pull, of course, the most complicated, most sick patients in the practice. They sent them out to a peer reviewer who. I didn’t know who it was. I didn’t even know if they were in my specialty. I didn’t even know if they knew anything about buprenorphine, which was kind of newer at that time. And I had a lawyer, had to get my lawyer from malpractice to represent me and my lawyer advised me, don’t question it. You have to just go with the process. If you question it, they will penalize you. And at that point, it could have been a public complaint against me in the press. It could have had, at its worst, taking away my license to practice. So I did what my lawyer said. He was a good lawyer. I trusted him. My husband’s a lawyer. He said, listen to your lawyer. So I did. So I never talked to anybody. I never talked to mcElboy. I never talked to the person that reviewed my charts. And they gave me what was kind of a slap on the wrist. It was not a public letter, but they did make me go to an in person, one week long class on prescribing opioids, which was highly ironic because I didn’t prescribe opioids. I prescribed the treatment for people who were hooked on opioids from other places, but they didn’t even understand the difference. So the first day I went to this class, I had to fly there. It was in Ohio. I had a small child, two small children, actually, at this time. It was a big cost for me to fly there. Childcare had to be arranged. I closed down my practice. I lost a lot of money. I went to this class, quote unquote. And the first thing they did when I was in this room with other doctors is they showed pictures of jails all across the United States and said, this is where we send you when you do these things. And it was basically a week of shaming and scaring us. I don’t know what the other doctors. I don’t know their situation. Anyway, this all resolved. It didn’t have any practical implications other than that week of lost income. But the psychological wound of that, it took 18 months from beginning to end, and I was really wounded. And so I think when you ask about burnout, I would have said up until last year that I was very burned out. When that happened. I was really wounded. Things that I was the most proud of were attacked. I felt like I was doing work that nobody else wanted to do, treating these people with opioid disorders. And I was getting punished and shamed and stigmatized. So it left a pretty deep wound. And I revisited it when I was working on this topic, and I realized that that wound was still really painful, and I shared it with a couple people. I was like, I don’t know, maybe I should write about this, but I’m really scared. And as soon as I started talking about it, I’ve had people come forward to me and say, that happened to you. That happened to me. I didn’t think it happened to anybody else. I’ve never told anybody, you know, and I’ve had a lot of people come out and say this to me, and they’re just like, oh, my gosh, I’m so glad that you wrote that because I thought I was all alone. So it’s kind of a long story, maybe, but that wound is still there. I think that it’s healed quite a bit, and then sharing it with you, even, it’s still a little scary. I think it’s healing, and I think I’ve learned through the experience that sharing it and hearing from other people has been very healing. And I hope people listening, if any of your listeners have had something similar, that even just hearing that story maybe is somewhat healing for them as well.
Speaker B: Yeah, I mean, I think when you said about, like, just the start of hearing, and I read this in your book about the board complaint, but just hearing you say board complaint gave me chills, which I think any licensed professional, that is one of our biggest nightmares of that actuality coming to fruition.
Speaker A: And what was so hard, I realized about it was not only the investigation and the lawyer, like, just the logistics, but I thought the medical board was there to protect me. I thought they were there to get the quote unquote bad doctors and that they would be there to protect me. And instead, I felt like they had turned against me and were actually not listening and not paying attention and just kind of out to penalize me for no reason. So my peers, who I trusted and thought were there to help me, I felt like they were actually attacking me. And so that peer shaming, I think, was part of what made it so painful.
Speaker B: Yeah. Say more about, like, the peer shaming. Was that people you knew or.
Speaker A: No, I didn’t know anybody at that time on the medical board personally, but I had some kind of professional connections with a couple of them at the time. But it was really just more like I thought that was a group that protect me and take care of me and help me. And I very quickly realized how fragile it was. I mean, it was so fragile. Like, this could have gone the wrong way if I didn’t listen to my lawyer, if I got really mad or started yelling at them or. Right. If I hadn’t done all that, what if they just took my license away? What would that have done to my career? And it felt so fragile. It was like my husband always says, he’s an attorney. He’s like, don’t pull the thread. You pull that legal thread and things can really unravel quickly. I felt like the thread had been pulled and it was just very fragile, and it was just frightening, honestly. And it went on for a long time, so it really didn’t get resolved for almost two years. And every day now that I have to fill out a form, I have to attest to my credentials, I have to apply for a license. Every time they ask, have you ever had a complaint? I have to say yes. And then they asked me to send them all this documentation, and it’s like wounding over and over and over. I still have to report it, and I’ll always have to report it, because that’s the honest answer to that question.
Speaker B: Yeah, I know that for malpractice insurance. And that’s. I mean, even that just sitting with the. Have you ever, like, even other things that happen, have you had a crime in the past five years or the past ten years or something of that nature? But when we’re thinking of licensed professionals, it’s like your entire career, which feels pretty punitive.
Speaker A: Yeah. So I think it wasn’t exactly burnout in the classic sense. I mean, I would have said it was burnout because I felt mentally and physically depleted by the entire experience. Even, you know, after a year had passed, it was still unresolved. I still. That was still depleting me. But now I really feel like it really fits more with this idea of moral injury, which was a wound kind of on my. My soul, if you will, and challenging me at the very core of what I valued and what I thought I was doing in life. So it was like a really deep wound. I think it’s different than burnout. Yes. I was depleted by the process, but it was something different.
Speaker B: Yeah, maybe. Can you speak a little bit the differences between moral injury from a practitioner’s perspective, as opposed to, like, you know, when I think of moral injury, I think veterans, I think, like, they saw something in war or did something in war that changed their soul, changed their person, and then that really affected their self concept and view of the world. So maybe just give us a little background into how we can apply that to us.
Speaker A: Yeah. So I think the easiest way to think about it, I’m a very visual thinker, is to. To think about a Venn diagram. And there’s like, three circles. One of them is burnout, one of them is moral injury, and one of them is trauma or PTSD. And they all come from the military. Interestingly enough, some of these come from the military. So I think it’s interesting, the parallels there. So, burnout, the way I think about it, is kind of this physiological state of exhaustion, whether that’s mental, physical, or both. And then the moral injury, the definition I’ve used is the one from the military experience, which is where it came from, which has three components. You either do something, witness something, or a part of something that goes against your internal values, whether those are like personal, professional, spiritual, family. Second, that it’s either ordered or condoned by somebody superior to you. Third, that the stakes are high. And then you have PTSD, which is, again, a response to a traumatic event. And as you know, not everybody exposed to trauma develops PTSD. So that’s where that Venn diagram, I think, comes into play a lot. If you’re already burned out, you’ve already had some moral injury, I think you’re going to be more likely to get PTSD, but that’s also based on your genetics and your. Your background and your childhood and kind of other factors, too. So the wounds on the soul, I think, to me, is what really defines the moral injury. Like, it’s something that went against your values. So in healthcare today, many clinicians, especially mental health, do a lot of things which don’t feel right. So if you work for a company where you’re expected to see eight clients patients a day and your empathy fatigue is done by 03:00 p.m. seeing those other two patients doesn’t feel good to you, right? Like, you’re not showing up for them the way you want to, but your job is telling you you have to. So that’s kind of a common one. Another one has to do with the increasing need to document for legal and compliance and all these other functions and not having tools to do that. And so the clinician is spending a lot of time in front of a screen instead of looking at their patient, and that makes them feel bad as well. That’s not how they were trained. And then you kind of just get into this loss of autonomy, which I think is a big one, that clinicians want to feel autonomous, they want to feel like they can do what is right for their patient the way they’ve been trained to do it. And there’s just a million little things at you every day which are getting in the way of that, and you feel like you’ve lost autonomy. And when I interviewed people for the book, I interviewed, like, 30 plus clinicians, and they all said kind of the same thing, which is, at the end of the day, I feel like I can’t do, I can’t take care of my patients, and I don’t like showing up and feeling like I’m doing a bad job. Like they really just, it’s not like another job where you just show up and kind of check the boxes. Like they really feel. Checking the boxes doesn’t feel right. That’s not what they signed up for. That’s not why they went into this profession. So there’s, I think, a lot of different contributions. But to me, the intersection of those three in the last five years. So we had, burnout had been going on in healthcare for, since probably the early two thousands, maybe even late nineties burnout had been getting worse and worse because the industrialization of medicine and healthcare. Then you had, I think, a lot of moral injuries happening as the independent practice, especially physicians, started going into healthcare systems instead of being independent therapists, a little different. I think therapists stayed independent a little bit higher frequency.
Speaker B: But it seems like for, and you’re, you know, just in case anybody didn’t catch, you know, you are a psychiatrist, so you. I would gather that likely the psychiatry tends to stay more in systems than perhaps a therapist or a psychologist would stay. Maybe I’m wrong.
Speaker A: I think the answer is yes. But the reason for that is not because that’s what they want. I think a lot of times, the complexity of running a medical practice. Cause I’ve run a practice with therapists and psychiatrists in the group, and the layers around prescribing and compliance and all of that just adds so much extra that a lot of the psychiatrists are like, you know, it’s not worth it. I’ll just go somewhere and let somebody else do all this, especially the pharmacy stuff, which I can tell you, like, that can drive a person to insanity. Talk about moral injury. But, yeah, so I think you already had burnout for like, 20 years, and then you also had this moral injury, and then the pandemic hit. And, like, that was the trauma that, I think, pushed people over the edge because they already were superimposing a traumatic experience with this other stuff. And it’s not like you and I didn’t sign up to help people through hard stuff like a pandemic. But it was the layering of all the stuff. The demand went up, the acuity went up. We were exhausted and depleted. We were doing virtual, which for a lot of people was new. Wasn’t for me, but a lot of people. That was a new way of practicing.
Speaker B: Yeah, it was for me. Like, I wasn’t. I did maybe I did one virtual session, like, a month before the pandemic, and then I was all virtual.
Speaker A: And how do you, like, think about how different that is, right, physiologically for your body and learning how to. I think for some people it’s great. Actually, some people, it’s the best way to practice. Other people, it’s the worst way to practice. And then I think the majority of people like a little bit of both. I don’t know if that’s your experience.
Speaker B: Yeah, I mean, I closed my practice last year, so I left doing private practice. But, yeah, I think it depends on the person and their mix and, like, you know, what was happening. But I think just talking through the pandemic, pieces of things. I just recorded a solo episode on anxious generation, the book that I read about the influence of the advent of the smartphone. And so I think, like, there’s. And I also come from a neuro rehab background, so I’ve been dealing with overwhelmed brains my whole career. And so just thinking through, okay, like, we already had a new smartphone starting in, like, 2010 ish. And so we have so much more screen use. Then we layer a global pandemic where we’re, like, consuming news constantly, like one of the three letter news sources constantly. We also have the phone where we can get it 24 hours a day from our bed, anywhere. So it’s not like the 18 hundreds. When something horrible happens, you get a paper delivered, and that’s your news of the day, and you’re done until the paper comes again. It is constant by our sides. So add the layer again, then that we have the neurological fatigue of the actual screen, as opposed to the information that is traumatizing us. And then we’re trying to co regulate on a screen for clients. So layer upon layer upon layer upon layer. I think the pandemic was just the perfect recipe for a lot of practitioners to, like, full surrender. Like, what do we even do now?
Speaker A: What was a matter of survival for people? You know, if they kept going, they weren’t going to make it, honestly, whether your body was going to shut down and make you sick or mentally, you were becoming depressed or whatever, like, it was kind of a survival. And there was no. I think the other thing about the pandemic was there was no real pause afterwards. We never got a chance to pause and gather ourselves and have people say, thank you, take a break. Let’s talk about it. Let’s help each other. We’ll come back. Yes, we’ll come back. But we need a moment that never happened. It just kept rolling the demand kept growing, like you said, maybe I do agree there’s a contribution of the way people manage their time that is pretty globally unhealthy. I mean, all the evidence points to that. There are many advantages, sure, of having the on demand information, but it contributed to people feeling helpless and hopeless. And I still talk to people now who, clinicians, who they say, I don’t have any time, Jenny. I don’t have any time. I can’t do this. I don’t have any time. I was like, are you sure? Like, let’s take a step back here. Like, let’s. How are you using your phone? How are you using tv? How are you consuming news? Do you really need to have your phone on all day? Do you really need to have the news on at night? Do you really, you know, you are making these choices on how you’re using your time. You do have some control over that. So I try to challenge people to. Time is a proxy, I think, for so many negative feelings and things happening right now. But people say, oh, I’m so busy, I’m so busy. I’m so busy. I wrote about this in my first book. We have a culture that worships busyness, and I called it the cult of busyness. And you don’t have to be part of that cult. You can step outside of it. You do have the ability to do. And, you know, I always caveat this by saying there are people out there working three jobs to put food on the table for their kids. Those people are busy. Legit. Like, those people can say they’re busy, but if somebody asks me, oh, you’re so busy, I very intentionally never say, I’m busy anymore. I say, my life is full. I’ve made these choices, and it’s very full, but it’s nothing. You don’t have to participate in all that, I guess, is what I’m saying. And I think people have forgotten that they have control and they can make those kind of choices.
Speaker B: Yeah. Yeah, I think, you know, I love Cal Newport. Newport. Am I getting that right? What’s slow productivity? Yeah. I mean, I love, you know, and other authors, I think, that are kind of, like, resetting this, like, how we work. What are we even doing? Because I think the tendency, if we don’t examine how we’re working, is that work will tend to be at this frenetic pace that we can never meet the demand of the work.
Speaker A: Your boss. Ways of working. Yeah, I call it the ways of working. And I advise a lot of companies now as my main role. And what I always tell the CEO’s, which I think is hard for them to adapt to, is that right now, the ways of working are the work. You probably are going to spend a third of your time as a leader talking about how do we work together? How do we communicate? What are the expectations around response times? What are you going to do if you have a low empathy day right now, as we’re going through this transformation and work that is the work. And people really struggle with that. They just want to go faster and faster. And that’s american culture too. Part of it is our american culture. But even worldwide, the acceleration of communication, it’s just never really been re examined or the nine to five. I mean, I learned a lot about that. Again, researching for the first book that’s from the Ford factory floor. All of the things around time come from the Ford factory floor. About 125 years ago now.
Speaker B: Yeah. When they re examine like, okay, well, we don’t want to work like 13 hours a day. So like 8 hours sounded great. Probably to them. They were like 8 hours, yay, this is great. But it was very.
Speaker A: Yeah, it was considered like advanced social policy to have an. And Ford did it. Cause he wanted to get good workers. And so he’s like, I’m gonna say 8 hours a day, five days a week. And that was, blew everybody’s mind that somebody was going to do that because it was so much kinder and gentler than what the other factories were doing. So it, it was very popular. He got all the best people.
Speaker B: Yeah. And it made sense for that time. And they weren’t doing knowledge work, so they weren’t doing the work that we’re doing, which is soul work, sitting with the pain of people hour after hour after hour. And so we can’t, it’s not like we’re turning out cars.
Speaker A: Well, empathy fatigue is very real, and I trained in that, and you probably trained in that, that, you know, you have to manage your own empathy stores. And for different people in different days of the week, it’s going to be different. So you have to be very mindful of your own empathy. If you’re having a rough day, you may not have as much empathy as you normally would. If you’re sick, if you got a sick kid at home, if you know, whatever, you have to be mindful of that. And for therapists, a lot of these companies, they started to work at companies and they had this idea of the nine to five. And a lot of my work has really focused on getting people to understand that that doesn’t apply. It doesn’t make sense in the therapy setting.
Speaker B: Yeah.
Speaker A: I know some therapists that worked a nine to five, and I know a couple that love it and just would do it all day long and totally happy doing that, but I think that’s rare. I think most of us need more time to recharge ourselves.
Speaker B: Yeah. So I’m wondering if we can go back. I’ve kind of gotten to the time, which I think it’s all related to the pressures that therapists. But maybe talking a little bit about how your book is moral injury, and I know that maybe talking a little bit of what you learned from these interviews and more, the themes that you found in your book.
Speaker A: I learned so much. One of the most fun things about writing for me is doing the interviews, because some of the people are good friends. Some of them are just total strangers. Some of them are experts in their field, and they’re not. You know, I interviewed a lot of physicians, but also therapists, also, even some operations folks, some healthcare executives, and they all said the same thing, which is really that something doesn’t feel right and having the words to articulate what feels bad. Most people don’t have the words to articulate what they feel inside. So a lot of people use the word burnout because that’s the popular press right now, but it could mean a lot of different things. So when people said they were burned out, I asked them to go deeper, like, tell me exactly what you mean. It wasn’t always burnout. Sometimes people are using that word to mean a lot of different things. So that was one thing. It’s like people assume they’re saying the same thing, but burnout to one person might actually be something very different to another thing. The other thing I heard over and over and over and over again, even by the leaders of the companies, is that I don’t want to feel like a cog in a machine, and I feel like a cog in a machine. So the industrial mindset and the words and the operations and the way everything is being discussed is very industrialized. I think that the word burnout is an industrial term, which is one of the reasons I don’t love it, because it makes it sound like we’re a light bulb that can get replaced. I’m a burned out light bulb, so just go recharge me and pop me back in, or go get another light bulb and stick it in there. I think even the word burnout is an industrial word. So I think this theme of feeling like a machine and not liking it. Like, this is not why I got into this in the first place. That was another really common theme I heard.
Speaker B: Yeah. I think that burnout for therapists and clinicians in general, it doesn’t really, like I said, it doesn’t really encapsulate our work, and it doesn’t capture compassion fatigue or vicarious trauma. And I was on LinkedIn and some thread somewhere. We were talking a little bit about just that word and how someone had told them they had been torched. And it’s very common, like when you’re walking through fire, that you might get a little burnt, you might get a little, you know, torched by the work that you’re doing. I think that’s an expectation. Like when we going back to thinking about military, like, we don’t necessarily blame a soldier for having PTSD or having depression or having anxiety from seeing the things that they seed. However, I feel like being burnt out, quote unquote, is viewed as perhaps a lacking of the therapist. I don’t view it that way, but I think somehow in our culture as therapists and doctors, it was like, oh, they couldn’t cut it, or. And no one’s saying that, but I feel like there’s a. There’s an implicit message somewhere that if we didn’t do enough self care or whatever, then that’s what happens.
Speaker A: It’s definitely a blaming the victim kind of idea. I also heard from a lot of people this intense feeling of shame about either burning out or having injury and not cutting it, quote unquote, having this feeling like, oh, my gosh, I’m not resilient as I should be. Nobody else feels this way. It’s me. Shame that they couldn’t fix the problem, shame that they didn’t speak up. I heard a lot of that. Shame that they didn’t speak up. Shame that they did something they weren’t proud of. And just this intense self loathing, which most of the people I talked to had internalized. I treated in my practice, my psychiatry practice. I saw a lot of clinicians, I treated a lot of them, and some of them externalized it and became agitated or angry or lashing out. I had one patient I wrote about who became acutely paranoid, but most of them were internalizing this deep sense of shame, like something is wrong with me and not wanting to talk about it. And so one of the fixes or the healing for moral injury is, first of all, just to talk about it right now. There’s this feeling of, it’s hard to talk about things that are really painful in medical culture, especially, you’re not supposed to, you’re trained not to talk about it. And I heard a lot of people say to me, folks who are more like, I’m a Gen X. People, like, more Gen Xe age would say, you know, there just used to be a lot more collegiality. Like, I just felt like I had doctor friends or therapist friends and nurses, and we would just kind of sit around and talk to each other. And there was just a collegial feeling. But now we’re all in our little cubicle boxes on these machines, and we just feel like we’re a conveyor belt. And that sense of collegiality just seems to be missing. And part of that is staffing. Right. When the staffing is turning over quickly, you don’t build those relationships the way you used to. And the rise of locums tenens and nurses especially, you don’t have the time to build that trust and safety where you can talk to your peers and your friends. So I heard that one a lot. Like, I just don’t feel there’s a collegiality. I just feel like I’m on an assembly line cranking out my little widget. And it didn’t used to feel that way. And then the earlier career clinicians maybe who grew up in a different time were like, I didn’t expect it to be like this. They never maybe experienced the same collegiality that the Xers did, but they knew that something was, like, missing. And I don’t know that the Zs are really interesting to me now. I have teenagers that are zs, and their experience is also very different. So there also is kind of this generational layering on top of everything where I do think we. I’m over generalizing, but we tend to see the world in different ways in the different generations.
Speaker B: Yeah, definitely. I think I was, I reflected back on, like, some of my favorite times in work, and some of those times were before smartphones. Again, I just keep going back to, like, when did work feel more collegial? It was probably when, you know, I was in a work environment where we didn’t have phones, we had lunch together regularly, we knew each other’s lives. We were friends outside of work. And I feel like more and more, that kind of peeled away in my career. And also, I think for therapists unique to maybe us is that we can’t, we make more outside of a group practice or outside of these companies that might be happening in psychiatry, too. Like the telehealth kind of mills of therapy that are really grossly underpaying therapists, and they’re largely telehealth, so they’re super isolated. And so I think our work itself has become more isolated because we are not with people. That’s one part. So then what do we do when we have a difficult case or we’re struggling personally in our lives? We had a bad day, and we’re only seeing our clients. We’re not seeing other people.
Speaker A: And I think, again, sometimes there’s a little bit of a proxy that if we were all back together in one building again, everything would be okay. But when you roll back, this trend had been going on. It was pre pandemic. So even when people were in the same building together, there were these divisions progressive. It was just so slow that people didn’t really notice. First. It was like, okay, you have the computer stations, but the computer stations used to be a center part of the place that you worked. And so you’d still be gathering together and talking about things informally, but you had to go to the computer. Maybe I’m just really old. You actually had to go to the computer and sit there and put the labs, and you couldn’t do it from anywhere else in the building. Like, you had to go to that computer. And if you wanted to really talk to someone, you called them on the phone or you went to see them. I think these divisions. Yes, doing telehealth makes it more obvious, but I really think that’s not the only reason for why we’re feeling. I think the phone, like you said, is a big part of it. We’re just mentally in our phone a lot, but you also just have to carve time and space out to talk to people. And if you’re just booked up every day, all day, and that’s all you can do, you don’t have peer supervision. You don’t go to a journal club. You don’t go to a conference. Like, all these things we used to do more frequently because of this time scarcity mindset. I think people and money scarcity, people don’t do it anymore. There were a lot of different ways that you could have that support, but they’ve, like you said, peeled off over the years, even pre pandemic. And, you know, I have a couple friends from residency, and I realized, like, a couple years ago, I haven’t really talked to my friend, like, why? These are, like, people that, like, I trust with my life, and I haven’t even talked to them. Like, what’s wrong with me. And I literally had to go on my calendar and put a weekly reminder, like, call your friend. Like, here are the ten friends you really matter to you in life. Like, just call them or text them or whatever. But that was the level of intentionalness that was needed for me to remember to do that regularly, and that made such a difference. And now I feel much more reconnected. But I haven’t seen them in person. Most of them, it’s just been phone or text, but even a simple text, like, hey, happy Friday, it matters, you know, these little things. So the tech can be your friend or your foe, I guess, is what I’m saying. And there’s some people have this narrative, like, well, if we were all just in the room together, everything would be better. And I don’t think that’s true. You know?
Speaker B: No, you’re right. I think that makes sense. It’s kind of going back to the theme you were talking about of the way we’re working. So I think kind of changing the way we’re working. And that does come from leadership. If you’re in a company, if you’re by yourself, then it’s you, right? I always say, like, sometimes you’re the ******* boss if you’re in private practice, because I was my own ******* boss at times who was, like, scheduling myself seven clients straight. And I. I didn’t do that all the time. But then when I had those days that were really hard, I’m like, why did I do this to myself?
Speaker A: And this is where tech can be your best friend. I mean, tech can do all sorts of wonderful things for your calendar. If you let the tech schedule your patients, tech is going to be better at having boundaries than you are, I guarantee. I try to set really good boundaries and be intentional, but if a patient calls me like, oh, hey, can I see you at 07:00? I got this thing. I’m probably going to say yes at my own detriment because that’s who I am. But the tech doesn’t do that. So you can use it, and it’s really helpful. You can send. I actually do text with patients. I still practice. I text with patients, but there’s a bounce back message when they text me. It says, I will get back to you within this amount of time. And then I have to not be, I think you cussed. It’s okay to say ******* boss to myself, and I have to give myself, like, okay, you know, Jenny, you’re going to look at your email in the morning, and then you’re going to close it and then you’re going to look at it again at 04:00 and if somebody texts you, you’re not going to answer it, but you have to, you have to tell yourself and you have to be accountable to yourself. And when I think when you have this time scarcity and this money scarcity, it leads you into that fear mindset, and that’s when your boundaries just start to dissolve. But tech can actually be really helpful, I find, for setting really good boundaries.
Speaker B: Yeah, definitely. I think. And just also at the start of therapy, I mean, I got better about this as I became more time in private practice of setting those boundaries with clients and say, like, hey, if you contact me over the weekend, I’ll send you a message back on Monday or whatever day that I responded. And so we’re also communicating those boundaries more often to clients. So they don’t have the expectation that we’re going to respond to things over the weekend or we’re going to be taking calls at certain times, or that we see clients at certain times, because.
Speaker A: We know deep down from our training that patients crave boundaries and that that can be therapeutic for a lot of people. I think the devil is in the details with the boundaries, sometimes the words you use and how you explain why you have a boundary, I’ve seen, unfortunately, there’s like a trend to flip to the opposite extreme, where I’ve had therapists where I pick up the voicemail and says, I will not answer your call. I only talk to you at my convenience. Go to the ER if you have a problem with this wording and this tone, which some compliance person probably told them to put on their voicemail, but it’s awful. It doesn’t communicate a thoughtful boundary at all. It just says, stay away, I don’t want to talk to you. And so think the devil’s in the detail with the how and the words. And what do you do when the boundary is breached? Because they will get breached, the details of how you explain and how you talk and get through it together. I think with my experience, and maybe this is what you had, too, that when you have a difficult boundary with a patient and you get on the other side of it, the relationship deepens very quickly. And trust is much deeper once you get on the other side of some of those hard conversations. And so I see some clinicians, in their desire to protect themselves, just shut down all the boundaries and just say, I’m not going to talk to you. You’re out of here. Unfortunately, they’ve flipped to this opposite extreme, which I have to say, yeah, maybe you get home for dinner, but I bet that doesn’t make you feel good inside. So I think there’s a way to have those boundaries that’s intentional and kind and is good for you as a clinician and also good for the patient. But it does take, it takes a little work and a little intention, and then honestly, just some practice getting comfortable with the right words. And I just hate to see people go on the opposite extreme where, like, I have to protect myself. And so I’m just going to shut this patient down, you know, because I don’t think that feels good either.
Speaker B: No, no, I don’t think it does. But I think it comes from fear. It comes from, you know, like, hearing, I don’t want to be. I don’t have the board complaining, I don’t want to be in a situation where, you know, I’m taking advantage of. And so I had to be so clear and so upfront because, you know, I’ve had clients take advantage of my kindness or my flexibility, quote unquote flexibility, because maybe early on in their career, they felt like that’s what they had to do. They had to be super available and, like, fix out the whole world. And, um, what a lot of us tend to do as helping professionals, we see pain, we want to fix it.
Speaker A: So true. And for physicians right now in psychiatry, you’re seeing this show up a lot with ADHD treatment because of all of the complexity of stimulants and controlled substances and the press and people are very sensitive about it. So what you see now is a lot of psychiatrists not treating ADHD, which to me, again, is like the pendulum. The solution is not to just say, I’m not treating ADHD. The solution is there’s a lot of other ways to manage risk around stimulants and to talk about non stimulants and to have patients really clear about how to take medication and what to do if they’re struggling. But most of what I see now is the opposite direction where they’re like, I’m just not going to do that. It’s just too risky, and so I’m not going to treat it. But then you have ADHD, which is 5% of the adult population, and now you’re finding, I’m sure the therapists listening, it’s very hard to find physicians to treat ADHD because they’re so scared. Like you said, it’s a fear mindset. And they’re so scared that their solution is like, I’m just not going to do it. But then again, I don’t think they feel good about that either. At the end of the day, like, I think not taking care of someone in pain or suffering, I don’t, you don’t go through all this training, you know, you don’t go through all this work in this training and this profession. If you didn’t care, it would be foolish, you know, therapists and physicians. I mean, you’re smart people. You could do other things. If you didn’t care, you wouldn’t, you wouldn’t do this. So I don’t think it feels good if the only way to protect yourself is to not take care of other people. Yeah.
Speaker B: And I think that can come from, like, overextending our empathy to over, like, the compassion fatigue component of. I have to put this boundary because I need a wall because my stores have been depleted, and then if I leave the door open, I could get burned, I could get hurt, I could hurt a client. I can’t have these things happen. And so I understand the reasoning, but I think part of the solution is making sure that we are getting deep rest, that we are finding ways to have careers that financially sustain us. All the things I did want to get back, I’m pivoting. I did want to kind of hear from you what you think. What can we do? If we’re in this juxtaposition of, like, we want to hold our value, we want to also be there for our clients. Do you have any like, guideposts or some tips for folks?
Speaker A: Yeah, definitely. And the good thing about moral injuries, sometimes the ways to heal it are free. So first of all, talking about it, knowing what it is, talking about it, that’s huge. So I mentioned my solution. I put on the calendar to talk to my friends, which I think sounds silly, but that’s what I have to do.
Speaker B: Finding you’re not alone.
Speaker A: Okay, thank you. Finding a peer support, whatever that is, in your community or your friends, and being able to talk about this, not just a case, but actually being talk about how you’re feeling and get your peers to support you, that’s a huge thing you can do to find a little bit of balance. The other thing is really what’s not just unique to healthcare, but in all work, I think, is who are you? What is your brain? What is your body, your human? Jenny’s brain isn’t great. After 04:00 p.m. i’m really great. At seven in the morning. I get up and do all my email in my workout clothes or my pajamas or whatever, because my brain is really good, and then I need to go work out, and then I need to come back, because I know my body at this point. I know what I need to do to take care of it. And that might mean I work these kind of strange times of the day, but that’s what works for me. Or I don’t mind texting my patients. I actually find it not intrusive at all to get a text from my patients. So for me, that’s not intrusive. I can control my little robot. It can send bounce back messages. It can divert the call if I’m on vacation. It can do all sorts of things. So for me, to use texting as a way to communicate is very comfortable, and I can use the tech part to help me. But then for somebody else, that may feel highly intrusive. My kids tell me if somebody calls them out of the blue and expects a phone call on the fly, that they feel like that’s very intrusive, which for me, doesn’t feel interesting.
Speaker B: They don’t call each other. They don’t call each other, right?
Speaker A: So I think, again, it’s like, who are you? What’s your brain? What’s your body? What’s going on with you? What is the optimal way for you as a human being to work? And then how much can you configure your job around that? And then keep yourself accountable, like the phone. And again, it’s a great example. It could be your best friend or your worst enemy. You have to go through and, like, make sure you’re not getting notifications. You have to make sure. I’ve been getting political text. I don’t know about you. It took me half an hour. I had to sit there and, like, figure out how to get them to stop coming to me, but I did. I had to take that time to go do that, but now they’re not coming to me anymore. If I had just allowed them to come, you know, I’d be getting ten a day just in the middle of the work day. And that was very distressing to me. So I think it’s really like, know thyself. And as therapists, we should be really good at that in theory, because that’s kind of what we do. But we’re, you know, it’s always harder to look at yourself. So if you need a coach to help you look at yourself, to have that mirror for you, if you need another therapist to do therapy with you, to give you that mirror, if you need to go online and take a personality test again, if you need to wear a ring to monitor your stress level during the day, I can’t tell you the answer. Like, everybody’s different, but it’s really, you have to know your brain, your body, what works best for you, and then how much can you configure around that? And it’s going to look different for everybody. So there’s no one good solution, honestly. But as you said, the basics, you need to sleep, you need to eat well, you need to do things that bring you joy. You need to balance the empathy. You need to know how much of screen time is good for your mental health. Another one is social media. I decided I would go off all social media. I’m only on LinkedIn professionally, and I do spend some time there, but I’m not on anything else. It just wasn’t good for me.
Speaker B: Same. I’m actually same. I just have it on my desktop and I deleted all my social media apps, so. And that works for me. And I think, you know, trying to get into that mindset of like, no.
Speaker A: But somebody else may say the Facebook group is where I get all my support. I’m in this Facebook group and that’s where I get all my support. And I’d be like, great. But you may need to figure out how to set your facebook so that you’re not spending time on rabbit holes for things that aren’t supporting you. You might need to take half an hour and figure out, how do I just focus on this peer support group on Facebook that helps me? And how do I filter out all this other junk that I don’t want to be looking at? Right. So again, it’s not a one size fits all solution, but I know for me personally, I feel really bad if I’m on social media a lot. And so I just had to go off all of it.
Speaker B: Yeah, makes sense. Well, I could talk to you all day, but we had to wrap up and I just wanted to ask you before we leave, how are you finding joy?
Speaker A: For me, that was one of the best things about the pandemic, was I realized I like to spend time by myself, and I got back into things I did in high school, so I went back into music. That’s what’s bringing me the most joy. I was a musician all the way through college, and I picked up a new instrument and now I’m learning how to sing, which is kind of hilarious because that was not a skill set, shall we say. I was told not to be in the chorus when I was a kid. But I’m playing bass, I’m singing. I’m in a group that performs and that brings me such joy. And I love showing up and like being part of that group. And I don’t even have to use words, you know, I don’t even have to talk. I just play.
Speaker B: That’s great.
Speaker A: So that’s what works for me, just playing.
Speaker B: I love it. Love it. Wonderful. Well, where can the good people find you if they want to learn more about your book or more about the wonderful work you’re putting in the world?
Speaker A: So I did mention I am on LinkedIn. That’s my own social media. You can direct message me there. I will always get back to you, I promise. That’s probably the easiest, honestly. The book is on Amazon, so just put my name, Jenny J e n n I e Byrne Byrne. And the title of the book, moral injury. I just released the audiobook and you can listen to that if you have an audible credit. I used a virtual AI to record it, so I’d love your feedback on what you think.
Speaker B: Interesting. Cool. Great. Well, thank you so much for being on the program. I’m sure people are going to get a lot out of this.
Speaker A: Thank you for having me. Thank you for all you do.
Speaker B: Thanks. Hey therapist, thanks for listening to the episode today. If you love this podcast, send it to a therapist friend who may need it. Also consider leaving a rating and review on Apple Podcast. It lets the podcast player know that this is a great podcast. You should send it to more people. Also, I’d love to hear from you. So I have included my pen pal list for other therapists. Yes, I do write back and I’d love to hear from you for podcast topics to know how you’re doing in this in these therapy streets. So I’m here for all of it. So I would love to hear from you and we’ll talk soon.
