“Please place the oxygen mask over your own mouth and nose before assisting others.”
You can’t help someone else unless you have first helped yourself. So why is it so difficult to apply that same rule to our own practice as mental health professionals? 2018 research by Simionato & Simpson found that just over half of the psychotherapists they sampled reported moderate to high burnout.
Burnout occurs when you have pushed your body and mind to the limit and feel so emotionally, physically and mentally exhausted that body and mind effectively shut down to protect themselves. As therapists we are constantly working in emotionally demanding situations, so it's no wonder we can sometimes feel overwhelmed.
It’s not just in session that we make ourselves emotionally available, but also in between, as we hold clients firmly in mind, meaning that they (and their anxieties) remain with us. It’s incredibly difficult for us to ‘switch off’ when we leave the therapy room and not bring our clients home with us.
Simionato & Simpson found that being younger, having less experience and becoming over involved in client problems were the most common risk factors for moderate to high levels of stress and burnout.
But burnout might also occur:
If we overstretch ourselves, taking on more clients than we can handle
If we work with traumatic cases a lot of the time - being exposed to your clients's trauma vicariously can really throw you off balance
If we feel unsupported or undervalued - isolation, lack of reward, and inadequate supervision can make an already challenging environment completely untenable
If you feel you are not making a difference
Some of the many symptoms of burnout include loss of energy, loss of optimism, and a feeling that you have nothing more left to give. It can also manifest itself physically in the body, through aches, pains or illness.
It is not uncommon to mistake compassion fatigue for burnout. Compassion fatigue is actually just one of the many defining symptoms of burnout and is the name we give to the feeling of losing your sense of caring about your clients and/or starting to feel irritated by their problems.
Of all the different manifestations of burnout, this is the one that therapists find particularly hard to admit to feeling. Why? Well, we place huge expectations on our ability to offer unconditional regard for our clients, and so having feelings to the contrary somehow feels like a betrayal to our vocation.
But this is where being honest about how we are really feeling matters. The truth is that we can all be affected by our clients issues, however much experience and training we have. Sometimes it hits us much harder than we think and we can’t prepare ourselves for when this might be. Sometimes it takes a friend or family member to point out to us that we are struggling.
The Importance of Good Supervision
Being in regular supervision with a highly experienced professional who challenges and nurtures you cannot be overestimated. My Supervisor is worth his weight in gold. He doesn’t tell me what I want to hear, but always shows me what is happening,
Peer supervision can also be incredibly helpful, showing you are not alone and giving you the opportunity to share coping strategies with others. Aside from networking groups in your local area, it is worth noting that there are a vast number of fantastic online support networks available too on various social media platforms such as Facebook. These have been set up with the intention of providing a safe space for practitioners to discuss challenges and important issues relating to private practice. They can be great sources of comfort, giving you reassurances that you are not alone in feeling the way you do.
You need to learn to feel comfortable with having regular conversations with yourself about what you need, whether you are getting it, and if not, what you can do to make things better.
Supervision can be the best release valve if you learn how to use it properly.
Taking Regular Breaks
It might be impossible to book multiple ‘holidays’ throughout the year, but that doesn’t mean you can’t find other ways to build in proper breaks to promote good self-care. This might be as simple as making changes to your working hours and factoring in longer breaks to give you some time to rest and recover between clients or reviewing what clients you see and when.
Having shorter, more frequent breaks can be more effective in keeping you balanced than any two week all-inclusive holiday can ever be.
Know Your Limits
Make sure you feel properly equipped to work with whatever issues your clients bring to you. If you do not feel comfortable, why? Is it because you feel it is outside of your competency? Or is it rather a temporary loss of confidence that can be worked through in Supervision? If the former, refer on to someone with more experience who is better placed to meet your client’s needs and perhaps look into getting some specialist training to give you the confidence and skills you need.
Only take on what you can handle, not what you feel you need to earn - even if that means reducing your client load to something more manageable. Over-stretching will no more help your clients than yourself. You need to be able to give your best to each client, not a compromised version of yourself.
Professionally, we are masters at keeping boundaries in place. Yet outside of the therapy room, this can very easily slip as we find ourselves getting caught up in our thoughts about Client x or worrying about Client y.
We need to teach ourselves how to turn the metaphorical key on the therapy room door and leave the ‘noise’ behind. It’s imperative for our clients and ourselves that we set boundaries and stick to them.
Listen to Yourself!
As counsellors we become so good at listening to others but sometimes neglect our own needs, meaning self-care is the last thing we think about and our wellbeing suffers.
What this looks like is unique to each of us although getting enough quality sleep and eating a well-balanced, nutritious diet helps.
For some, switching off might mean going for a long walk in the countryside. For others it might be meeting up with friends for a bite to eat. Perhaps the therapeutic fatigue you are experiencing is the result of a client activating old wounds in you and you would benefit from re-engaging in personal therapy?
In summary, become better at listening to yourself and your needs.
Speak out if you need help - this could be to friends or family or you might feel you need something more than that. Perhaps speaking to your Supervisor or a peer will give you the proper guidance you need to get back on track
Do more of the things that make you feel good - always look to prioritise self-care
Do less of the things that make you feel rubbish - ask yourself do I really need to do this, and what will happen if I don’t? Is there someone else who could help me with this and lighten the load?
Don’t ever feel guilty for putting yourself first once in a while!