Speaker A: Welcome to the therapist burnout podc episode 70.
Hey, therapist, welcome back to the program. Today I’m talking to you about, is it depression or is it burnout?
So I had this episode at the beginning of the year where I talked a little bit about the differences between depression and burnout. And it’s Mental Health Awareness Month. And so in the month of May, I’m focusing on therapist mental health because there’s just not enough resources.
What I noticed during that episode and subsequently talking to other therapists on LinkedIn is just there’s not a lot of resources for therapists who are struggling with their own mental health.
So part of this episode and this episode series is to help reduce stigma, because I think for therapists, as much as we know our mental health is. Can be affected by the work, and we have a lot of risk factors going into the work. Right. So there’s been a lot of research that talks about the risk factors that therapists have, because maybe they’ve gone through something themselves.
Maybe they’ve thought, hey, I’ve struggled with anxiety or I’ve struggled with depression. And so I’d love to help someone else with this issue, which is great, which is a wonderful reason to get into therapy.
And it also makes you susceptible to. To issues further down the road.
So I wanted to dig into this a little bit more, and I just want to reflect on the beginning of the year. I thought it was burnout again.
I even joined a burnout group because I thought that’s what I was experiencing.
I hit this wall. And I think one of the mantras that I say about this podcast is, I can’t burn out of my burnout podcast.
Oh, such annoying laughter.
Because I think I know that you’re my people who listen to this podcast, because if you’ve got an advanced degree, if you’ve gotten a doctoral degree, if you’re like me, I have, you know, 4 degrees and, you know, a few certifications.
I think we tend to throw ourselves into doing more, into trying to do all the things to get ourselves out of burnout. And I think what was the hallmark of the big episode of burnout that I had over the course of 21 to really 23.
It was. It was two full years, honestly, of struggling and figuring out, am I going to close my practice? I had to recover from panic disorder and do a year and a half of EMDR therapy.
And in all of that, I think that episode, I. I became depressed, and that was scary to me because I couldn’t do anything to get out of it. I think I could work on getting myself out of the panic attacks, and I did the EMDR therapy for it.
But when depressive episodes hit, there’s not a lot I can do except surrender and really, like, okay, I know what to do. I know this feels awful right now. I know it will change and it won’t always be forever that I’ll feel this low.
But it’s. It’s a very vulnerable place to feel like you’re out of control and you’re helpless and really, we’re not. But I think when you’re in that place and I’m speaking to you therapist, if you are in this place, because I get people writing into me telling me they’re hopeless and helpless, that you won’t always feel this way and you don’t have to do. Keep doing life the way you’re doing it. If there’s anything that I could tell you, that’s my truth.
So I wanted to revisit this topic, number one, because it was one of the most top downloaded episodes that I ever put out. And so I know it’s resonating with people.
Also, even with all my knowledge. Even with all the knowledge you have, you’re likely missing the signs if it’s depression or if it’s compassion fatigue, vicarious trauma, or the whole shebang.
I just think getting granular can be really helpful in your burnout recovery.
You know, I. I’ve even zoomed out to think about why therapists call what we’re experiencing as burnout, because really, it’s a whole host of things that therapists experience. It is burnout Sometimes. Yes. The classic. So for burnout, I point people to the World Health Organization definition, which is the commonly used definition of burnout, which is that burnout is conceptualized from resulting from chronic workplace stress that has not been successfully managed. And it has three dimensions. Feelings of energy depletion or exhaustion, increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job, and reduced personal, professional.
Reduced professional efficacy.
And burnout refers specifically to the phenomena in occupational context and should not be applied to describe experiences in other areas of life.
So that’s your definition of burnout. And I think what the problem is, most of therapists I talk to, they say, oh, my burnout affects every aspect of my life. Like, I am carrying this clinical burden with me in the soccer field, with my kids, game to my vacation.
I’m carrying it with me all the time.
And I know that I wasn’t alone. I know because I hear it from other therapists. This is not a just me experience. This is a universal therapist experience. That what we call therapist burnout is not that definition.
It’s not the World Health Organization’s definition. I think there’s aspects of it, sure, that we’re experiencing it, but it is not the whole story.
And so I think, you know, looking at the definitions, I feel like you understand the definition of depression. But if you’re like me, I was just like, whoa, okay, that was what I’m experiencing actually, even at the top of this year.
And why it’s so hard to tell the difference, what the research says about the overlap and why it matters and how we can benefit from a new, broader definition of burnout.
Redefining burnout, y’all, just a reference mislabeling can delay healing. This is really about clarity, compassion, and taking the next right step. And so that’s been mentioned a lot in research and books about really getting granular about the definition.
So we’ve really talked about what is burnout. It’s those classical signs of exhaustion, depersonalization, and reduced accomplishment that really feeling, like, untethered to yourself.
And Maslach and Freudenberger coined that term in the 1970s.
So resuming out to burnout in healthcare, we know that the burnout rate has been increasing. It’s been really studied a lot in physicians, actually, because I think there’s like, hey, we need to make sure physicians stay because they make a lot of money for the healthcare system.
I digress.
So I just want to zoom out and talk about the trouble with burnout as a construct. So I’m looking at this meta analysis from Rotenstein. Hopefully I’m saying that right, et al. 2018.
And they looked at there are 142 different definitions in 182 studies using the MBI, which is the Maslach Burnout Inventory, which is commonly used in burnout research.
It’s commonly used to assess burnout, but it was never intended to provide a diagnosis, and it’s not a diagnosis. So instead it measures three separate dimensions of experience, which means researchers have a used inconsistent threshold across studies to define who was burned out. And this lack of uniformity led to wide variance in reported prevalence from 80 from 0 to 80%.
And furthermore, Rotenstein et al highlighted that these inconsistencies make it nearly impossible to compare studies or understand the full scope of burnout across populations. And I don’t have all of the research in front of me about therapist burnout, but from what I’ve seen, the studies say burnout is around 30 to 60%, depending on the study of who is measuring and what they’re measuring. And maybe that’s getting at some of that, that we are not talking about the same thing.
Furthermore, according to Gile and Sen 2024, this lack of a unified definition undermines the utility of the burnout construct in both clinical and research settings and hinders efforts to estimate prevalence, evaluate interventions and draw conclusions about impact.
And because it’s not a medical diagnosis, there’s no formal treatment or protocols used for insurance to cover it.
Oh, insurance.
And I think what I talk about often and what we also hear in therapist spaces, groups, Facebook groups, Reddit threads, if there’s growing recognition that what we’re calling burnout is a cluster of overlapping phenomena.
Compassion fatigue, vicarious trauma, moral injury, clinical grief, system induced despair.
And I think just looking at this more comprehensively and really figuring out what granularly am I experiencing can really help us understand what we need.
So I think what I want to drive home is that burnout is just one thing. It’s not often the whole picture.
And that really matters with how you respond to what support you need and the field like what’s, what are we telling clinicians? And that’s, I think one of the passions of this, this podcast and my platform is that I don’t want new clinicians to burn out.
I want I we need therapists.
I don’t know what these tech companies are saying, but I think this AI chatbot thing is going to run its course. It’s going to be there, right? There will be chatbots, it’s fine.
But people are going to want people to help them heal because we’re humans.
So contrasting that with depression. So I’m not going to read you criteria defined by the DSM 5, but they are hallmark system symptoms such as persistent low mood, loss of interest in previously enjoyed activities, sleep and appetite changes and suicidal ideation, thoughts of death, things like that.
And I think it can be triggered by external stressors like work, but still it’s depression. So, and, and that was true for me. I had an episode of depression after I became a new mother and I really hadn’t had one like that before.
I think, you know, due to the changes hormonally that was on with me in the postpartum period and I have experienced that since. And I think part of my burnout was that it can trigger my depressive episodes at times or if I’m taking on too much all of the things start to stack for me, just noting we do have tools to assess for depression. We have a common definition. So I think that’s what helps differentiate depression and burnout is that with depression, there’s a clear diagnosis, there’s a clear way that we describe it.
And it’s something that the definition of burnout and burnout recovery slash, treatment slash, whatever we’re doing with burnout, that’s different.
And what we know that there’s a high overlap between burnout and depression. So there’s a high correlation between depression and burnout symptom scores. And burnout’s emotional exhaustion aligns with fatigue.
But depersonalization mirrors withdrawal or numbness.
Burnout may improve with work changes and depression needs internal and external supports.
So I think that’s an important distinction. So I think for me, when I had this depressive episode, I was like, oh, like, am I burned out? Am I just not feeling, you know, connected to my work? And do I hate this is the work burning me out? And some. That’s my contract work, Some of that’s this podcast work. It is work. It is a passion.
It is something I enjoy doing. And also, it’s still work. Also, it’s still something that I have to do during the week. So I have that reality in place now that I’ve been podcasting for four years.
When I went into it first on my old podcast, which was TBA Therapist, where I talked about TBI and all the sequelae associated with that, you know, it was something I felt was really important and met a need, and I wanted to continue to do that. And I totally was unable to do that anymore. And so part of this podcast is finding ways to do that sustainably so I can get paid by doing this work, by having this platform that is important that I do that so I can continue to do this work.
So I think our just to think about words. Okay, so burnout is somewhat socially acceptable for therapists. I think most therapists will. And I’m. I’m in this container right now, a coaching container with therapists.
And I feel like almost all of them are like, yeah, I’m burned out.
No one will like, say, oh, you know, here is. My name is Sally therapist, and I focus on whatever their clinical expertise is. I’m experiencing depression, and that’s why I’m in this coaching group.
No one says that no one’s going to do that.
And I think we see that actually in research. Saying I’m burned out avoids leaving yourself as mentally ill as not Being able to, quote, hack it, or having some kind of perceived defect and attached stigma that we can attach to mental illness.
But by avoiding the word depression, we can prevent ourselves and other people by getting the proper treatment for that.
And I think that the other compounding difficulties in the definition of therapist burnout is that we experience moral injury from the work,
being forced to do things against our own values or ethical standards. I’ve had to do that across my career, or I’ve been asked to do that.
And I think we can internalize that. If I’ve done something I didn’t agree with, or I keep doing something that I don’t agree with, do I internalize that? Does that become part of an internalized belief that I don’t have a voice, that I am stuck?
And then that can in turn kind of either double down some existing depression or trigger an episode, perhaps, and also with compassion fatigue. So if we are emotionally outputting so much that fatigue and emotional exhaustion can often lead to psychomotor retardation or your body slowdown. Right.
So why is it hard to tell the difference?
So the burnout definition says, does your distress only happen at work? I don’t know any therapist who says they’re just their clinical distress or difficulty in their role as being a therapist or psychologist.
It’s just at work, it colors everything.
Is it better on the weekends or is it still heavy at home?
I think my experience when I was working as a therapist is, are those days where I had a tough clinical day, the next day or two were difficult. And if I had to go right back in the next day, then that stacks, and I didn’t get that ability to restore my nervous system.
And then we’re constantly running from chronic nervous system depletion, which I talk about a lot on the podcast. And if we’re not really re energizing our stores, if we’re not renewing ourselves, then that’s the way we run. We run in sympathetic dominance.
And so something to ask yourself, do I feel joy outside of work?
I got to the point in my burnout and depression symptoms during 2021-2023 where I had trouble accessing that. I really did. All right. Is your thinking darker than usual? It doesn’t have to be necessarily suicidal, suicidal ideation, intent, or plan, anything like that, but it’s something I had experienced where I had frequent thoughts of death at the darkest places of depressive episodes.
And I think being granular about that with your mental health provider. So I’m hopeful if you’re Feeling any of that, that you are connected to your own therapist, to your own mental health provider, perhaps a medication provider, if that is needed for you as well. Something that, that I accessed during probably 2022, 2023, something like that.
When I’ve talked about clinical grief, I lost two clients in the pandemic.
And that affected me more than I could have ever imagined.
And I bring that up because I know I’m not the only one struggling with that either. If it was a death by suicide or a client died, in my case, it was two clients that had not from COVID in 2020, interestingly enough, but had passed away.
So I. What I want to drive home to you is that getting granular and naming what you’re actually experiencing is, number one, it’s validating. And number two, could actually get you the support you need.
So while you might be avoiding it because you’re scared of that emotion or of that feeling or of the situation, if we’re looking what you actually need, then it can be helpful whether that be, okay, I’m depressed, so I, I need therapy or I need medication support with this, or maybe I need to join a group therapy container.
Just this year I joined a burnout group because I thought it was burnout and not depressed. So I don’t think we always do a great, great job of knowing what we’re experiencing, especially if you’re in it.
So please know that that I think is a human experience, that it’s hard to see the label of the jar when you yourself are in the jar. So please don’t think, how could I not see this?
And that’s when I talked about like, what are the causes for your depression, for your burnout versus the reasons. A lot of times you’re like, why? This is what I did earlier in the party.
Why am I depressed? There’s no reason for me depressed. I need to find the reason.
There could just be causes, not reasons.
So I will offer you that to really take that in for yourself.
So what can help?
So system level interventions would be to reduce, reduce your workload and improve mental health access to reduce stigma for depression.
And I think most of us know for depression, most of us, the evidence based therapies for depression are typically CBT and interpersonal therapy.
But there’s other interventions that are helpful. So if that’s not the thing, that’s for you. There’s mindfulness based cbt. There’s, you know, increasing your physical activity, which is, it’s research based to increase physical activity.
But I think you need support and monitoring and help with that.
So I think just to reframe a little bit, what if what I’m calling burnout is actually vicarious trauma, moral injury, clinical grief or depression?
Getting granular can be really helpful because you may be experiencing one of these, some of these, or all of these at once, which I feel like I was during the, the, the, the height of what I was going through in 2021, 2023.
Language really matters because it’s going to help us figure out what we need for help.
So really I would like you to ask yourself what is underneath? I’m burned out. I’m just so burned out. What’s underneath of all of that?
What I wish I’d known even at the top beginning of this year is that depression isn’t always obvious.
Even though you’ve. Even if you’ve been through it before, it can wear the mask of burnout.
Rest alone didn’t lift my fog, especially during the hallmark of my burnout slash compassion, fatigue slash all the things I needed, clarity and boundaries and support, nervous system regulation. I needed a lot a team.
I used coaching, I used personal therapy, a lot of things.
And I think I’m just remembering myself in 2020 when I lost my second client and I took a week off. I wish I would have taken more time, I wish I would have given myself permission to stop and take longer amount of time to really integrate that loss.
But I felt like then my nervous system was just in this super sympathetic dominant state that I couldn’t do it. I felt like I had to keep going. I felt like I was in a crisis, which we all were in 2020.
And that week break was really me not being able to go to work anymore for that week.
So I just don’t want you to delay getting support if you need it. So reaching out to support if you need it is important.
So I’ll have all these resources on my website. It might take a little bit for me to get those on my website, but I will link that in the show notes so you can.
If you wanted any of the research studies that I referenced today, what I want you to know is you’re not alone. I hear similar things from therapists nearly every day either via LinkedIn, DMS emails to me of people telling me how they’re feeling and experiencing this.
I think getting granular about what burnout is for you is really important because it really does show up differently for a lot of different clinicians and perhaps it’s getting support around depression.
So over the next month I’m going to talk about anxiety, I’m going to talk about trauma, which will probably be a two part episode because there’s just a lot in the trauma bucket to explore related to our own mental health and really how our nervous systems change through the work is what I’ve, I’ve. The more I have unpacked my own.
Gosh, I need to give it. I’m. I need to really chew on what I’m calling therapist burnout.
I don’t want to call it therapist burnout soup. So therapist burnout, I don’t know, I, I can’t come up with the thing right now is. But I think getting granular about what you’re experiencing, it might be a lot of things, but really digging into it could be very, very helpful.
Also, I just wanted to share a window into things I’m building. So I alluded that I am in a coaching container with other therapists. Building something. I’m building something for you.
So part of this podcast is that a lot of therapists write into me and wanted help to close their private practice. So that’s pretty much what I have been doing.
I also help therapists with general burnout. They’re like, let’s, well, I don’t know what it is, what am I experiencing? I just can’t do life this way. So I definitely help therapists with that as well.
But the big thing that I think therapists have wanted support for me with my expertise and helping them close their practice. So part of what I’m doing is creating material for that of building a course for therapists where they can access some of that knowledge without as much one to one support from me.
And so I’m, I’m building that out and with it I’m also building out kind of my guideposts on burnout recovery and what therapists might want to think about and what practices they might want to consider if they are struggling in their own burnout.
So I’m excited by that. I think I’m also excited. I mean part of, I, I’m just going to say a dream on the podcast. Part of what is getting me exciting excited about building things is that I really find joy and joyful exercise, joyful movement.
I am a yoga ish teacher. I teach a format that does a little bit of yoga, a little bit of Pilates, a little bit of everything to music and we know that the nervous system is regulated by and so I love this format that I teach and I’d love to bring something like that where we can retreat, where I teach you this yoga class that’s done to beautiful music, that’s regulating to the nervous system, where we have time to just really connect with each other and be seen and known and heard and untangle this web.
So that is the other thing that is sparking in me, and I want it to come. It’s not coming yet. I’m not sure what that looks like. Does it look like a retreat?
Does it look like a container of some kind? Where it’s group coaching, where we kind of untangle the web? I don’t know.
But somehow movement has to be in it. I almost like, I want a dance party, y’all. I want.
My people are people that love music, that want to dance, that want to feel alive.
And so I’m just trying to add more experiences to that to play.
We have one life, and we weren’t constantly meant to feel depleted. And so I want that for therapists. I want you to feel alive. I want you to feel supported, connected, known.
I don’t want you to feel isolated and lonely. So if you need a friend, I can be your friend.
I am in your ear and with you, maybe on a walk or washing your dishes. So I hope that this has been helpful. And I’ll also link supports for mental health.
So the NAMI Warmline is a support line. They also have support lines just for clinicians. There is not a ton of support for therapists, but there is some out there, so I’m going to link some of those resources.
But if you need support for depression, I would encourage you to reach out.
It can be hard to find a provider, especially if you are a clinician.
You might have to go through two therapists. I went through five to find the right person that I felt like I could share more with. It’s worth it. You’re worth it.
Okay, take care. Bye.
