Speaker A: Welcome to the Therapist burnout podcast, episode 71. Hey, therapist. Today I’m talking to you a little bit about why did therapists wait until things are really bad to get help? So it’s a continuation of my series.
In the month of May, it is Mental Health Awareness Month, and I wanted to focus on therapist mental health because we really focus on everybody else’s.
That’s the honest truth.
And so my focus is to highlight if things are going on for you, then how do you get support and maybe why? So for this episode, I was going to say, let’s do anxiety versus burnout and trauma versus burnout, but I just kept thinking when I dropped that episode last week, that I wanted to zoom out.
Why do we wait until it gets so bad, until we reach out for support?
So certainly a lot of this podcast and a lot of what you tell me is because my story resonates, and the things that I talk about resonate with your story, and that’s what people are writing into me about.
And so I wanted to go in the Wayback machine. I talk about this often.
I think I keep hearing more and more other therapists who either started their practice in the pandemic or they experienced an extreme bout of burnout in the pandemic and then subsequently had their own mental health symptoms.
So I knew in the pandemic that I was experiencing a high level of stress. I think all of us were. But. But I don’t think the first time I noticed it actually was in the fall of 2020.
So my kids were not in school. I had a kindergartener in March of 2020 and a preschooler.
So they were, gosh, way back machine.
They were five and maybe six and four. Six and four. Let’s say six and four. And there was no school.
I was trying to figure out how to run a practice online, which I had never done before.
And we had no childcare.
I remember just waiting to hear what the school was going to do for the fall so that hopefully I would have childcare.
And it really wasn’t to work. It was just to kind of get back to normalcy, honestly. And, you know, I know. I think a lot of people had it rough in the pandemic.
We all struggled. People who were alone had it hard.
People who had young children had difficult, people who had teenagers. I work in high school, so I’m. I’m seeing those pandemic children who are graduating now. So there’s been a few of them that I’m sitting on IEP teams with IEP that’s an individualized educational plan.
If you are not in the U.S. that’s what we do for special education students. And you know, a lot, a lot of students came into special ed during the middle school years when they were during the pandemic.
So we, a lot of us had it rough, but therapists, we had it rough.
We had it pretty rough.
And I, I just don’t think there’s any other parallels of going through the same thing with your clients that they’re going through, that you’re going through and processing that in the moment together and trying to hold it together in some way and not show what you were really feeling about things.
Which kind of goes in my point about what I want to talk to you about today. So I want to talk to you about the concept of interoception. So let’s get into it.
So I, I think this is the missing L why therapists struggle to get help. So on LinkedIn post, which I’m going to talk about later, but I posted something about why don’t, why do we wait until we are fried to a crisp?
People are right in to me saying, like, I am crispy. Like burnt to a crisp. Crispy. Burnt *** chicken tender, crispy.
I get it.
I think this concept of interoception, which I don’t think I’d heard it phrased this way until I heard, heard Kate Donovan talk about it, of being aware of your own body cues.
I’ve heard it talked about in different ways. I heard of neuroception. Stephen Porges talks about the concept of neuroception with people who experience trauma, that they are scanning for danger or they’re in sympathetic dominance.
But interoception is talking about our own awareness of our internal body cues, like our own heart rate, fatigue, tension, thirst, needing to use the restroom, things like that.
And I’m laughing because I’m remembering my son had a fifth grade band concert this past week. It wasn’t during the part of his band concert. There’s also a chorus concert.
And so I’m watching the kids sing and all of a sudden the student comes down and they have to use the bathroom and they just come down and the teacher’s like conducting and they’re like, I need to go off the stage.
And she’s just like pointing, go, you can go to the bathroom.
And I think as an adult we can’t fathom if we were like in a performance or we’re doing something like that, like going to the bathroom because our he’s telling us go to the freaking bathroom, we’re gonna pee our pants.
And I get. Children may not have as much bladder control as adults and all of that, but kids still have this ability, most of them, unless there’s some kind of issue, right, where they may not sense that. I worked with people with brain injuries for a very long time, and I still work with people who, you know, have some neurodevelopmental conditions that may mean they aren’t aware of their body signals.
So thinking about interoception, our own awareness of body cues, I, I wanted to dive into the research.
What do therapists struggle with this?
And I looked at this research.
It’s Hollinin et al.
24. Therapists show higher anteroceptive awareness than clients, but not higher accuracy. So we’re aware of our own body cues, but it doesn’t allow us to respond. So we’re like, oh yeah, I gotta pee, or oh yeah, I gotta, you know, get up, my body’s freaking out.
I, I talk frequently about when I was doing a lot of online therapy. I was suppressing a lot of my own body cues and I would pick up my cuticles, they would bleed.
And I was just like, oh, I am. I didn’t realize it until after the session or after what was going on that that was happening. Therapists may notice the signals, but override them constantly due to what we’re being asked to do in the work.
And I, I just think of the work that I’ve done over the years. You know, when you sitting with the pain of people.
With some clients, I felt like, oh my gosh, I need to use the bathroom. Can I get up? Some clients, they would just keep talking and not be aware of me in the room as much or it felt like I didn’t have permission to do that or all the things.
And with other clients I would like if I had to use the bathroom. I tried to do it between sessions, of course, but some of them, you know, I’d be like, oh my gosh, I, I gotta use the restroom.
I’m gonna get up and go do that. Or model. I’m going to drink some water. I never really ate in session with clients just because that feels weird. I’ve heard people do that, but yeah, just not.
Not something that I choose chose to do as a therapist. Nothing wrong with that. I think it would be good modeling. Like, I’m hungry, I’m going to eat something. So why do we miss the signs?
So OBOL 2023 states that interoception is not linked to Years of experience.
Therapists with higher interoceptive awareness had better emotional regulation and less burnout, likely because they did what their body needed them to do. And again, so more research. So to CAT 2017, therapists can attune to others, but struggle to track their own distress.
So we can notice the distress in other people but not notice our distress as readily. So, going over to a LinkedIn roundup, I asked the question and I posted this post on LinkedIn.
If you’re not over there, I am Dr. Jen Blanchett with two T’s and an E Sadi LP.
That’s me.
I’m rhyming. I’m not trying to rap on the podcast at the present moment, but it was feeling some type of way right there. All right, so my post.
Sometimes we don’t catch burnout early. And I say it like that because some of the posts I see out there are like, before you burn out, make sure you know you’re watching your schedule and having good boundaries and, and we can do all those things and still burn out. Burnout is not an individual problem. It’s systemic. I will preach that until I don’t have this platform. So I say we ignore the signs until it’s too late.
We’re not burning out. We’re burnt, torched, fried to a crisp. That was definitely me.
The irony.
I wrote a whole dissertation on compassion fatigue. I did do that. I haven’t talked about that much on the podcast, but.
And let’s just go a little segue while I’m reading you this post.
But I remember being very interested in trauma work from the early stages of my career. So I worked and had my first episode of burnout as a foster care caseworker.
And I had been really interested in trauma from that time and from that work. And so when I went to trauma conferences, I was really interested in care for the helper.
So I would go to all the compassion fatigue workshops. And let me tell you, if you go to a trauma concert, go to the compassion fatigue talk. No one’s there.
It’s like tumbleweeds running, running through the burnout or compassion fatigue talk. No one wants to do that. And I guess it’s because, like, we. We still want to ignore what is going on inside of us that it’s normal to not want to focus on our own distress.
Completely normal. Okay. Anyway, so I knew the signs.
I was even in therapy.
My body was sending signals that I didn’t listen to until panic attacks started.
I mean, I knew my body was telling me things before that started, I mean, there was, there were definite signs and it was just like the pressure release that my body did.
It was saying, actually we’re taking you out now. We’re trained to check in with ourselves, to say, I remember that my training, you know, my supervisor’s checking with me, how are things going on for you personally? And you know, sometimes I think I would, I would share some things, but it was always kind of couched in a way that I felt like I needed to protect myself.
I couldn’t really open up all the way to my clinical supervisor. And while I did personal therapy as well, I don’t think I knew how much I really needed when I got into the depth of my career.
And also I didn’t have as much support as I had then. I didn’t have the ongoing supervision, ongoing training, ongoing peer support that we forget about, that we haven’t, our training, that we don’t have as independently licensed clinicians. But the implicit message, keep going, hold more, be the steady one, don’t crack, you can handle it, be there for the client. So I wanted to read you some of these LinkedIn responses that people answered the question, why do we push so hard until there’s nothing left?
And one person said, definitely the implicit message. You wrote, we tell ourselves we need to be able to handle it. And honestly, we just have to keep going. Our jobs either pay poorly or we’re self employed.
Very few therapy jobs have enough of a safety net in terms of benefits or salary to allow us to slow down and take care of ourselves. And they said, unless perhaps we have partners or others to pick us up, pick up the slack.
And that was true for me. You know, I do have a partner, I do have privilege where when I was in school, you know, my parents supported me. Honestly, I think a lot of us would stop a lot sooner, but we know we can’t. So we gaslight ourselves until it’s severe. Another person said, there are these moments where you have a sense that you’re not quite okay, where you feel the overwhelm, where you are not quite sure you can fit another patient’s story in your head, but you need to work, you need to keep accruing hours towards licensure, you need to pay bills. You can’t stop because it would mean giving up years of education and training, student loans requiring payment and going backward is certainly not an option.
And I responded back to that comment and I said, I told myself so many times in the process of getting licensed and getting through my doctoral degree and Training and internship and blah, blah, blah, blah.
All the things I can do anything for a year, and I did that. And I got the degree and jumped through all the hoops. And I’m proud of that. I’m proud that. That I was able to do that. I am proud of my training.
And I think a lot of us would say, would we do that again?
Would we? We had to do it over again.
I am not sure. Other person said, yes. It’s embedded into the fabric of work environments, and they’ve got to pay bills. I really loved this response.
So the desire to help, fueled by internal beliefs that to help others, we can’t appear weak or be in touch with our own needs, and the external reality that workplaces are trying to do more with less.
And if we don’t step up to help those who need the help, they won’t get it. And that one really hits. Another person said, brunette found me on deployment in the Navy.
I pushed through like so many do, until my body forced me to stop. And they’re saying they’re now in as they’re in school as a psychology student preparing to apply to turn their pain into a purpose.
Oh, I react to things like that.
When I say, turn your pain into a purpose, I’m like, you don’t have to. You don’t have to turn anything into a purpose. You could just be, like, making money, doing,
like, working in the library.
But I get it. I get it.
Another therapist said, my first experience with burnout came after doing a year and a half of six clients per day of EMDR at a treatment facility.
I ended up getting shingles.
My nervous system became dysregulated and shut down from trying to regulate my client’s nervous system.
Another person said, actually, I think it’s a necessary part of one’s development as a professional. I’m not a therapist, but I’ve been in the helping field long enough to have a couple, three burnouts like that.
Couple three. I say that sometimes, same as you. I saw the signs, made some effort, took steps, and still crashed. But it has been these experiences that have taught me to manage boundaries in a more balanced way.
And I would say I agree with that in part. You know, the part I agree with is that, you know, sometimes we.
We’re not going to see our burnout coming. It’s. There are, and I’m going to get into that later as well. Why we may not see that we’re not coming, and still it comes, and so we have to deal with it.
But why Is it a necessary part of one’s development as a professional? I don’t think that’s true for everyone.
My partner, actually, when I started this podcast, because I had another podcast and, you know, I just. I just have ideas to share with the world. I suppose that’s just the way I am.
He was like, is. Is there enough to talk about on burnout on a podcast? And yes, almost two years later, I’m still talking about burnout, therapist burnout specifically. And there’s plenty to talk about.
I have not run out of ideas at all by any stretch of the imagination.
But I say that because he, I don’t think has ever burned out of anything because I think he probably is more resilient in some ways than I am. I wouldn’t say that. So I wouldn’t say he’s not resilient, but I would say socialization of men is different than women.
He also just naturally works at a human pace.
So I always say you have one speed.
Like when we’re getting ready to go somewhere, there’s just no rushing him.
It’s like I’m like, okay, okay, okay, I’m ready to go. Let’s go, let’s go.
When I’m the one who’s running late. But when he’s the one that’s running late, it’s like we are walking at a normal pace.
And while I can be annoyed by that sometimes, it’s also something that I think impacts his ability to be able to work at a normal human pace, which is one of my mantras. Jen, work at a normal human pace, because that is not a great skill that I have.
Yeah, I would say I’m learning, but I struggle still. I struggle still with that. Okay, so that’s your LinkedIn roundup. If you’re not there, I’d love to have here hear your input as well about just what you’re thinking about on different topics that I post on.
While we may have increased awareness, increased interoception, as therapists, we. It doesn’t create a situation where we act on it. It’s the whole concept in therapy. I wish, I always say I wish that insight could produce change.
And that’s the same thing. We as therapists have more insight into what is going on with our body, but we don’t act on it. So therapists may not just be ignoring their needs.
They may have been taught that ignoring the body is profess.
Think of all of the situations in your training where you were rewarded for over functioning.
You’re calm under pressure, oh, she was in that crisis situation and you looked so calm. You seemed like you were really in control or wow. They are always available.
They don’t need time off. They seem to always, you know, be able to come in if they need to come in.
And that doesn’t just apply for therapists. That applies to many fields. I think if we think through all of those implicit messages that come in about us over functioning and then the asks of productivity that we, that come upon us when we worked in agency roles or in.
I’ve never worked for a tech company, but if you’ve worked for a tech company that has productivity requirements, I worked in an agency where I had productivity requirements. I didn’t stay very long, but that was my, my journey into entrepreneurship, which I have been an entrepreneur now for 12, 13 years, something like that. So some of these subtle internalized belief are that the client always comes first.
And while we are a fiduciary, I believe in so many ways we have to be that as entrepreneur. Our ethical imperative that we make sure that we are, are really thinking about the client, client’s needs and doing no harm. That does not mean that we put ourself last. Good therapists don’t need much. You don’t go into this for money so you’re not going to make a lot in this career.
Yep, I guess we just have to do more with less. There’s so many people that have need.
We have to keep going. You’re always there for me at the end, when I was, when I was, at the end of my time in my practice and that, that, that I think that chronic fatigue and the depersonalization and getting detached from the client and from the work, when clients would tell me things like that, like you’ve always been here for me.
What am I going to do without you? I, I was at that point so detached that I was just like, I don’t want you to be attached to me. I don’t want to be there.
I don’t want to be that person in your life. And I could not separate myself and say, oh, I get that. Yes, you know, I get that therapy has been that for you.
But therapy never should be that for a client. It should never, you should never be their person. But somehow that’s where we have gotten in our role as therapists. Not everybody, but I think there’s implicit messaging that we’re there for them no matter what.
And we are there to provide a service and to help them work through a depressive episode, to work through, gain some Skills to be able to have a successful marriage, to be able to learn X, Y and Z.
You know, all the things. So just to recap this kind of moment on talking about interoception or kind of listening to our body’s cues, that’s a simple way to say it.
We know it helps reduce burnout, but it isn’t reliably developed in our training. And Duncan 2017 went as far as to say that emotional suppression is framed as clinical competence.
We know that interoceptive skills can be taught and they can help therapists regulate and avoid some emotional exhaustion. I would argue that we cannot that intervention is not going to change the system.
Right. It’s not going to change that. You have the expectation that you have to see 30 clients a week if that’s your expectation for every work. So we know burnout is systemic.
And so that’s what I in my mind when I see burnout research and studies on therapists, we’re still going with individual interventions with yes, those are important, those are helpful but if we’re not thinking of systemic ways to change this.
So let’s think about how are we teaching our therapists in schools? How are we talking with agencies with the largest providers of mental health services? I heard something this week that BetterHelp employs about 15% of therapists and more globally.
So if you’re listening to this, they might be trying to to break into UK markets and markets in Australia. I’d be interested if, if those of my therapist friends across the pond or down under or other places let me know if you’re hearing things from tech companies.
I’m sure you are. I’m sure that’s part of what’s happening. But if these systems are, you know, dictating that we have to see a certain number of clients or there are certain productivity requirements they’re not focusing on how’s that therapist doing?
What do do they need? Are they going to burn out? I think systems reinforce that pushing through is a clinical virtue that we’re rewarded for numbing rather than noticing we are confusing presence with performance and how many clients you see, how many sessions you were able to do.
I also think that you know one of the issues. One research study said Corgan et al that self stigma and fear of incompetence can be part of the barrier to getting help for mental health.
Also confidentiality concerns. Also lack of access to time or truly understanding providers. I often tell people I saw five different therapists before I decided to stay with my long term therapist.
So again some of the research recommends that doing a reflective body based practice in supervision and training is really good to think about for supervisors. So if you’re a supervisor, really think about incorporating this into your training for your trainees.
We, due to the work we are likely not going to be great at this. So we have to develop this skill. So using some yoga based therapies, somatic experiencing therapies can be helpful to start to notice what our internal experience of of us in session is and just practical ideas.
So you know, in EMDR what I was an EMDR clinician when I was doing a body scan, just seeing like where am I holding this? What am I noticing? Journaling some of the somatic signals that you are struggling with and also like the simplest things.
So thinking of what are, what are the simplest ways that I can attend to my body’s needs today, can I start to think about bringing like nutritious food to work? Can I like focus on bringing myself lunch, eating my lunch, drinking water, peeing when I need to pee. So I think of like sometimes our body’s giving us these whispers like you’re hungry, you’re thirsty, you need to pee. You have these needs.
And the more that we nurture that relationship to our body, the more our body responds in safety. So the more it feels safe. Otherwise if we’re staying in fight or flight constantly, our body is going to continue to hold.
You likely know this, I knew all of this and still I pushed myself to the point where I didn’t have a choice anymore. So I just want to reframe. When a therapist is struggling with their own mental health or with end stage burnout, I think a lot of us can get to the point where we, I mean I was in panic, I was like what is this is I was googling therapist burnout. What are the symptoms of it?
You know, was googling when I was in deep depression. What is this? What am I experiencing? Because it was unlike anything that I’d ever experienced. And I think we tend to personalize and say what are the reasons?
Like and how am I not taking care of myself? And sure, yes, you need to take care of yourself. You need to get more sleep, you need friendships, you need to do probably some yoga or some other stuff of self care, of a self care nature.
But that’s not the reason you’re burned out. And you know that the causes are the system that rewards the over functioning training that teaches self erasure, that we’re just focused on the client, we’re just focused on one more Session.
Where, where, where was I? I wasn’t left. There was nothing really.
I got to this point where I felt like there was not much left of me. I said, for probably a year, I don’t trust myself. How could I have gotten to this place?
But we’re in a culture that praises us, pushing through. And if you need to hear this, I just want you to, to hear you’re not weak for needing support, if it’s therapy, if it’s, you know, reaching out to friends, seeking out supervision or consultation, and that you don’t have to feel this way.
You don’t have to stay in places where you continue to feel this way every day. So in closing, I just want to give you some time to reflect. What signs has your body been giving you lately?
What would it be like, in a small way to respond to it today? Could that be taking a walk? Could it be making sure you drink your water, bringing lunch, having a nutritious breakfast? Small ways that you can start to listen to your body and start to experience more safety internally? If no one else will tell you this, you’re worthy of support, you’re worthy of your own attention, your own care, your own mental health care, therapy, whatever it is, whatever you need. I’ve told this to many, many people over my career and especially as I’ve been coaching and burnout. You can be selfish, and you need to be selfish if you’re experiencing burnout or mental health difficulties.
So, yeah, that is the episode today. Little heavy, little like breathy breathing.
Yeah. So I am still in the throes of building things for you guys.
I’m in kind of a step back season.
I took too much on, which I tend to do, and I’m trying to step back.
So I’m not going to be taking personal clients on for a while for burnout coaching. But I’m building something in hopes of being able to offer some things to a greater, greater amount of therapists and still sustainable for me.
Again, I want to help all the people, but I try to help everybody or do all the things. I help no one. And I do know that from experience, you can still join the pen palace. I do write back, I do answer my own messages, and I look forward to hearing from you guys. So on the pen pal list, I send you the show notes from all of the podcast episodes and, and you hear about all the things first.
So the things that I’m building for therapists, you’ll hear about them first as well. Take care. Bye.
