Six Tips To Avoid Burnout As A Therapist

The United States is in the midst of a mental health crisis. The COVID-19 pandemic significantly increased the number of people reporting mental health concerns globally, and the United States has seen a significant uptick in the number of people reporting symptoms of depression and anxiety. Before the pandemic, the nation’s behavioral health service providers were already strained, but the additional challenges of a global pandemic have pushed the system to its limit. 

The combination of a significantly increased workload and ongoing therapist shortage has led to heightened job stress and burnout among many mental health professionals. There are unique challenges to preventing burnout in a field that prioritizes genuine emotions and unconditional positive regard, and many practitioners are expending extra energy to avoid the worst burnout symptoms. This article will examine interesting facts on therapist burnout and explore common tips to address it. 

How is burnout defined?

Burnout commonly refers to either a short-term or long-term sense of exhaustion and dissatisfaction with work. Short-term burnout can occur after a particularly stressful day but generally resolves itself after a short rest period. Long-term burnout is typically much more substantial and generally appears after a long period of self-sacrifice and neglect of one’s own well-being. Increasing episodes of short-term burnout can often indicate that long-term burnout is approaching. 

It is important to note that burnout is not a clinical diagnosis and does not have a consistent definition in the literature. There are several conceptualizations of burnout, but one of the most popular breaks it down into three domains: 

• Emotional exhaustion manifests as a sense of being exhausted by the psychological effort necessary to complete work tasks. An emotionally exhausted person might be fatigued and overly tired, making adapting to new work tasks more challenging. 
• Cynicism and depersonalization are defined as detachment, indifference, or lack of concern regarding work. It may appear through a loss of idealism or interpersonal avoidance of coworkers and patience. 
• Reduced personal achievement is characterized by a negative professional self-evaluation. A person might feel they need help to perform their job adequately and may interpret negative results as much more significant than positive ones. 

What makes burnout different for therapists?

Burnout is not unique to therapists; anyone in any industry is potentially susceptible to it. While burnout can happen to almost anyone, some fields have additional expectations or challenges that make burnout more likely. For example, in many circumstances, physicians have an ethical imperative to treat their patients and must provide medical services to the best of their ability. That might create a “patient-first” mindset that, although noble on the surface, could significantly reduce the physician’s well-being and ability to practice effectively. 

Similarly, mental health professionals also face imperatives that guide their practice. Therapists are expected to engage genuinely with their patients to establish an adequate therapeutic rapport. Many therapists are trained to provide their patients with unconditional positive regard, which is an attitude of caring, acceptance, and nonjudgment. Positive regard can be a challenge for anyone, even more so for an overworked therapist approaching burnout. Many therapists also carry a strong sense of duty regarding their patients and may sacrifice their own mental health in favor of serving them.  

Mental health providers, as with many helping professions, face two important challenges that significantly increase the risk of burnout:

Depleted compassion reserve

Many therapists conceptualize compassion and empathy as finite resources. They are gradually depleted by working with patients and are restored by engaging in activities that promote mental wellness. When that store of compassion is entirely depleted, the practitioner will likely experience a phenomenon known as compassion fatigue (CF). The term originated in the nursing profession and was originally defined as “a loss of ability to nurture.”

A therapist experiencing CF will likely find it extremely challenging to empathize with their patients, which could harm therapeutic rapport. It is important to note that compassion and empathy are not infinite, and emotional fatigue is a significant driver of burnout among therapists. 

Vicarious trauma

Vicarious trauma refers to experiencing a traumatic event through the eyes of another, such as when a patient describes their traumatic experience in therapy. A therapist must meter their reactions and remain empathetic to maintain therapeutic rapport, but it is likely difficult to genuinely relate to the patient while maintaining a safe emotional distance from their trauma. Because of this, many therapists carry the weight of their patient’s trauma along with them and may need additional help to process that trauma effectively. 

Evidence suggests that constant exposure to others’ trauma can contribute to therapist burnout substantially. The human brain is not well-adapted for constant traumatic exposure, even if that exposure is simply information relayed from another person. Adverse effects related to vicarious trauma are seen more frequently among mental health practitioners who work with high-trauma populations, but any therapist could potentially be affected. 

Tips for therapists to prevent and manage burnout

Evidence suggests that burnout is prominent in many industries, but there are ways to reduce its impact. Therapists and others in the helping professions have unique needs to consider when addressing burnout, but many of the techniques that are effective across industries will likely have some benefit for therapists. Some common tips and strategies to prevent therapist burnout are summarized below: 

Focus on the basics

When a person is deeply dedicated to their job, as many therapists are, it can be easy to forgo basic health and wellness behaviors to increase work performance. It may be helpful to revisit the basics of mental self-care to begin combatting burnout. At the most fundamental, that includes getting adequate sleep, eating a healthy diet, and establishing a workout routine. Getting regular exercise may be especially important due to exercise’s strong connection with resilience and stress reduction.

Reduce the workload

In many cases, preventing burnout is as straightforward as reducing external stressors. If possible, consider taking a reduced load or forgoing optional tasks for a period of time. It might be helpful to critically analyze what work activities are taking most of your effort and investigate whether there are small but meaningful ways to reduce the burden of those activities. 

Set appropriate boundaries

Proactively reducing workload and the associated stress may require setting healthy boundaries. Therapists often help their patients with boundary-setting skills, but they may not always apply them adequately. Many therapists are natural helpers, and some may view the word “no” as an extreme response to a request. Despite this, a lack of boundaries can significantly increase stress levels, and it may give others the impression that a therapist is not as close to their limit as they appear.  

Foster relationships with peers and supervisors

Evidence suggests that peer support can substantially reduce the adverse effects of burnout. It might be helpful to join or start a therapist support group. Many therapist support groups focus on emotional support, helping fellow practitioners restore their empathy reserves and maintain adequate mental well-being. Some support groups also focus on case consultation and solving practical problems, which may help reduce the mental load of juggling many patients. Similarly, fostering strong relationships with supervisors can give a therapist access to professional support and may provide another avenue to access emotional support. 

Create a personal inventory of strengths and virtues

Burnout often manifests as detachment from work and a poor self-evaluation of one’s ability to complete work tasks. It may be beneficial to consciously and deliberately consider the strengths and core values that make someone a good therapist. Many people choose to journal or write a list of their therapy strengths. It will likely be helpful to revisit and expand that list as time goes on. Consistent exposure to what makes someone good at their job may offset some of the negativity and low self-efficacy that come with burnout. 

Seek professional help

Burnout - either long-term or short-term - is an excellent reason to consult with a provider of mental health services. Therapists especially may benefit from working with another practitioner. The practice is also common; one study found that 87% of therapy providers attended therapy at least once, many likely to address emotion fatigue or burnout. Therapists may also be experiencing burdens in their personal lives that could contribute to worsening burnout symptoms. Seeking mental health care from a clinical psychologist, therapist, or other professional could be a beneficial and productive step toward addressing burnout. 

Many people with hectic schedules and professional obligations are turning to online therapy to meet their needs for mental well-being. Online therapists practice using the same evidence-based techniques as in-person therapists, like cognitive behavioral therapy, which has demonstrated effectiveness in treating stress-related disorders. Furthermore, the recent boom in teletherapy has led to a substantial increase in research surrounding online psychotherapy. That research suggests that online therapy can be just as effective as traditional in-person therapy. 

Takeaway

Therapists and other behavioral practitioners are at a higher risk of burnout due to the significant emotional load that comes with genuinely connecting to a patient and establishing a therapeutic rapport. In addition, therapists are also exposed to trauma, which may impact them vicariously. When managing burnout, it is important to remember the basic behaviors of well-being, such as getting enough sleep, eating a healthy diet, and getting regular exercise. Therapists may also benefit from joining a support group or forming closer connections with supervisors.