Therapist Burnout: What It Is and How to Fix It

Health care workers on the front lines of the coronavirus pandemic are physically and emotionally exhausted. For more than a year, they’ve faced crushing client loads, a lack of vital medical gear, tremendous loss, and anxiety about bringing the infection home. Their personal trauma is almost certain to outlast the virus. 

Many mental health professionals are experiencing the same fatigue. Six months into the pandemic, most psychologists were seeing more clients, especially those seeking help for anxiety, depression, stress, and sleep disorders — problems therapists were often facing themselves. Many said hearing their own life story told back to them could be overwhelming. None signed up for a pandemic or an unprecedented surge of clients. Many, working nights and weekends, couldn’t keep up. Around 41% reported feeling burned out, according to an American Psychological Association (APA) poll. 

Further underscoring the demand is a recent analysis of more than 190 million emergency department visits before and during the coronavirus pandemic. It showed a big upswing in 2020 for visits related to mental health, suicide attempts, overdoses, and violence compared to non-pandemic years. 

Burnout Explained

Burnout is emotional, mental, and often physical exhaustion, usually from long-term stress. Social psychologist Christina Masloch narrowed this big-tent definition to focus on mental health professionals. Her Masloch Burnout Inventory has three components:

• Emotional fatigue or overload
• Detachment or lack of empathy, which can affect quality of care and harm clients
• Loss of purpose or feeling ineffective 

There’s some debate about Masloch’s inventory, and many believe the mental health field would benefit from a broader definition. For now, Masloch remains the gold standard.

However it’s measured, burnout shouldn’t be ignored. Chronically stressed therapists may develop their own health problems and their clients can receive poor care. The APA’s ethics code requires therapists with burnout to get help or stop working for a time. The National Association of Social Workers has a nearly identical ethics code. It advises those who have problems that interfere with their job to get counseling, cut back on their workload, or stop working entirely to “protect clients and others.” 

Causes of Burnout

Even before the coronavirus, most mental health workers experienced burnout at some point, often at the start of a career. Early-career psychologists report more work-related demands and fewer professional resources than established therapists. Studies have found that therapist well-being increases with age and experience, suggesting better stress management and self-care over time.  

Other drivers of burnout:

• Emotional fatigue. Therapists often work with people who are unhappy, in severe emotional pain, or traumatized. Daily contact with deep levels of suffering inevitably takes a toll. The more empathetic the therapist and the more challenging the client, the more emotionally draining the work can become.‍
• Vicarious trauma. This occurs when a therapist isn’t able to balance empathy with the need to detach from the experiences of trauma survivors. It’s more common in therapists who have known trauma themselves, or lack a supportive way to discuss the intense challenges of their work.  ‍
• Chronic concern. Therapists rightly worry about their clients, especially those who threaten suicide. They also, less realistically, worry about board investigations and lawsuits. That these are relatively rare doesn’t always relieve the anxiety.‍
• Switched roles. Therapy is a one-way street. Clients reveal themselves; therapists don’t. It can be stressful and increasingly difficult for therapists to maintain normal, mutually rewarding relationships in their personal lives.  ‍
• Self- doubt. Progress can be modest and slow in coming for some clients. Therapists may question themselves and their expertise. Although most people seek help for treatable issues, it’s important to recognize that not everyone can be helped and that therapists have little control over client choices. 

Preventing Burnout

Burnout prevention increasingly focuses on self-care — exercise, mindful eating, proper sleep, healthy relationships. More and more research suggests this is an ethical imperative for people in professions with high emotional costs. 

The problem is that therapists aren’t always good at self-assessment or acknowledging they need help. A handy tool, the Self-Care Assessment for Psychologists, measures resilience in five areas, including life balance and professional support. One study found that psychologists with high scores in all five areas were less likely to experience emotional overload and burnout.

The Center for Mind-Body Medicine has also been valuable for many health care workers. CMBM normally works with trauma on a population level but now offers online mind-body skills workshops for health professionals dealing with the added stress and demands of the pandemic. Its evidence-based interventions include several types of meditation, guided imagery, autogenic training, relaxation, breath work, movement, and self-expression, such as writing and drawing. 

Support groups are another option. Many have sprung up during the pandemic, ranging from the Physician Support Line, with a staff of more than 700 volunteer psychiatrists, to small local groups specifically for mental health professionals. Working with a few trusted colleagues who support and monitor each other for signs of burnout may be best for therapists who have concerns about stigma and discrimination, or are just strapped for time.   

Burnout prevention shouldn’t take too long, cost much, or feel like a burden. Even “micro” self-care can make a difference. It’s as simple as shrinking larger self-care measures like a massage or yoga class into things that take just a few minutes — a quick stretch on a foam roller or a few minutes of deep breathing between clients. 

Practical solutions, like rebalancing caseload, cutting back on clients, engaging with healthier populations, scheduling dedicated personal time — even telehealth — can help, too. Ultimately, though, as the American Psychiatric Association points out,  systemic change is also key. They stress that the greatest source of burnout may be the framework therapists practice in — one, they say, “designed, in some ways, to produce it.” 

The Legislative Front

The Dr. Lorna Breen Health Care Provider Protection Act aims to prevent suicide, burnout, and mental health disorders among health care professionals. The bipartisan legislation was introduced into both chambers of Congress on March 4, 2021. Among other things, it would require the Department of Health and Human Services to recommend ways to prevent provider burnout and direct the CDC to encourage health care workers to get help when needed. It’s too early to know the fate of the bill, but it might stand a chance, even in a deeply divided Congress.

SOURCES:

American Psychological Association: “Patients with Depression and Anxiety Surge as Psychologists Respond to the Coronavirus Pandemic.”

Pathman, D.: “Survey of the Pandemic Experiences and Effects on Clinicians in Safety Net Practices in 20 States: Interim report with early response data.”

Jessi Gold, MD, assistant professor and director of wellness, engagement, and outreach, 

Department of Psychiatry, Washington University, St. Louis.

JAMA Psychiatry: “Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic.”

Pediatrics: “Physician Health and Wellness.”

American Psychological Association: “Ethical Principles of Psychologists and Code of Conduct.”

Zur Institute: “Therapists’ Burnout: Facts, Causes and Prevention.”

Professional Psychology: Research and Practice: “Work life, well-being, and self-care across the professional lifespan of psychologists.”

Advent Health University: “Vicarious Trauma: Information, Prevention, and Resources.”

United States Department of Justice Office for Victims of Crime: “What is Vicarious Trauma?”

Journal of Counseling Psychology: “Development of a Self Care Assessment for Psychologists.”