Burnout: The high cost of caring?

Palkee Baruah

(The writer can be reached at palkeeb@gmail.com)

Practicing psychotherapy is undoubtedly fulfilling and gratifying but there are times when we as therapists might feel distressed or experience feelings of emotional discomfort despite its many rewards. Let me just take a crack at this professional conundrum and write about how burnout actually is prevalent and it affects many of us and include tips and strategies that could be helpful in preventing burnout in therapists. I know we are conditioned as therapists that we have an unending reservoir of endurance and compassion, as therapists we are masters of relationships, self-care and whatnot. But alas, we are not immune to burnout which is defined as "state of physical, emotional and mental exhaustion caused by long-term involvement in emotionally demanding situations" (Figley, 1995, p.11). After all it's not always easy to "walk the talk". Especially times like this when mental health is in shambles because of the ongoing pandemic all around the world. Therapists might feel emotionally exhausted and loneliness because of the chronic work related stress along with the tendency to help as many individuals as possible. As therapists we are more vulnerable to the psychosocial stressors, which if persistent will lead to burnout.

Burnout, a term first coined by Freudenberger (1975), has three components:

 Emotional exhaustion,

 Depersonalization (loss of one's empathy, caring, and compassion), and

 A decreased sense of accomplishment.

Each of these components falls into a continuum and we may experience unpredictable expanses of each component at different times during one's career. It is vital for us as therapists to keep a track of these components for our emotional and mental well-being to avoid feeling burned out. While definitely prevention is better but when we experience burnout, we should stop and reassess our current scenario and make the changes needed to get us back to the track.

One early sign of burnout is increased work effort coupled with no increase in productivity. In some cases work output may actually fall. Concomitant with the fatigue seen in early burnout are "distancing behaviours." (Freudenberger, 1979).

Burnout can also be manifested in verbal withdrawal with patients, rigid behaviour or going by the book attitude, displacement of self-anger on patients, along with some other affective, cognitive, physical, behavioural and motivational manifestations like low mood, emotional exhaustion, guilt, low self-esteem, dizziness, hyperactivity, etc.

One might tend to confuse burnout with stress, but stress is actually a contributing factor in burnout. We can say in simple words, not a lot of stress but too much of stress leads to a burnout. Stress is essential in burnout but it is not necessary that every time stress would lead to a burnout. Basically stress is not a disorder like burnout. Each of us has experienced stress in our lives. One thing that I would like to add as a psychologist is that stress leads to anxiety and physical consequences whereas burnout leads to depression and emotional consequences, generally.

We as therapists definitely struggle to admit that we are emotionally exhausted and tend to feel guilty to take a break from helping our patients. It seems awful to leave our patients unattended and our needs seem pale in comparison to theirs. Even with an awareness of compassion fatigue and the impact of vicarious trauma, we as therapists tend to shrug off the idea of burnout and think it won't happen to us. After all, we are sacrificing our self-care for the greater cause. "There can be shame in admitting that we are experiencing compassion fatigue, but we are humans, and we are not protected from stress just because we have therapeutic skills," says Dr Linda Dubrow-Marshall, BACP-accredited counsellor and lecturer in psychology at the University of Salford. "Admitting this means we can address these issues."

As anyway our profession is an emotionally demanding one, burnout is an increasing concern in the mental health field and should be addressed as much. Ironically, the mental health field has paid relatively little attention to the health and well-being of its own workers. But when we realise we are in the throes of burnout, it is good to acknowledge and talk to someone we can confide in or a colleague who is going through a similar phase or have experienced burnout and have overcome it. Self-care and support groups are very important for therapists because of the nature of our work. Proactively engaging oneself in self-care activities like meditation, journaling, spirituality, taking a break will help prevent the challenges usually faced in our profession, although self-care is an ongoing endeavour. The practice of self-care by therapists should be an ethical imperative. Self-reflection and self-assessment should also be incorporated in our self-care strategy. Also supporting a strong network of family and friends is also very important.

In my honest opinion, we should seek therapy for ourselves before we delve into the profession as therapists ourselves and avoid transference in therapy. Plus the way we choose to respond to distressing situations is pivotal in avoiding emotional fatigue along with good preventive steps and coping strategies to minimize its deleterious effects. Being self-aware is vital and catering to any warning signs that shows in our self-care regime is a pivotal factor, for example feeling bored in a therapy session, waiting for the session to end, etc.

The bottom line is 'therapists should know how to stay balanced and centered with both their personal and professional lives'. There will be times when patients can be demanding, we might have constant worry with our progress as our field is constantly evolving. It is imperative for us to take self-care as a priority and nurture both our brain and heart as it is our valuable resources in our line of work. Being resilient is also vital as therapists and to have an emotional reserve, otherwise therapist as a profession is extremely rewarding and gratifying. It is also pivotal to how we respond to the experience of extreme stress and what coping strategies and preventive steps we take to minimize its deleterious effects. Obviously whatever I have mentioned is not exhaustive, it is just to give you an idea of ways to cope better.