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A therapist struggles with burnout and stress

Therapists Are More Burnt Out Than Ever

Burnout is an ongoing issue for therapists and clinicians. But new research finds that COVID-19 made these challenges significantly worse.

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The title of the American Psychological Association’s nationwide 2021 Covid-19 Practitioner Survey says it clearly: “Worsening Mental Health Crisis Pressures Psychologist Workforce.” 

And yes, that pressure has been intense as of late/recently. 

Let’s look at the highlights of this survey, discuss related research on practitioner burnout, and cover some practical advice that can help you feel better about your work and your life. Starting today. 

2021 was a difficult year for mental health practitioners

Among the 1,141 doctoral-level psychologists who responded to the APA practitioner survey in September of last year: 

  • 62% saw an increase in referrals vs. 37% the year before.
  • 68% with a patient waitlist before the pandemic saw it grow longer.
  • 41% said they weren’t able to meet patient demand.
  • 46% said they felt burned out.
  • 56% reported turning to peers for consultation and support for burnout.

Those numbers clearly show a psychologist workforce under increased pressure due to COVID’s effect on the populace. But despite that, more than three-fourths of responding psychologists said they were able to maintain a positive work-life balance versus just over half who had said so the year before (i.e. the first year of the pandemic). 

Those work-life balance findings point to two things:

First, psychologists are resilient people. They actually got better at maintaining work-life balance as the pandemic ground on. 

Second, a person can feel both burned out and be okay with their work-life balance. How else to explain that nearly half of respondents reported feeling burned out during 2021, yet more than three-fourths said they were able to maintain a positive work-life balance?

Feeling burned out predated the pandemic

In a lengthy treatise published in the August 2022 issue of Current Psychology, researchers Ami Rokach and Samir Boulazreg looked at burnout among mental health practitioners over time. 

Why the focus on this subset of practitioners? Because, as the authors state in their introduction, “Psychologists, in general, are trained in, and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others.” Further, “The demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, and the professional hazards faced by those caring for others.” Finally, because: “The exhausting, demanding, and draining nature of psychotherapy makes clinicians an especially vulnerable crowd when it comes to the susceptibility of stress.”

In other words, the risk of stress and burnout comes with the job. Therefore, the first step is to be aware if it’s happening to you. If so, hopefully you can take action to remedy it. 

How to know if you’re burned out

In 1981, the American psychologist Christina Maslach and her colleagues came up with the Maslach Burnout Inventory (MBI) to measure burnout in individuals. Underpinning her MBI, Maslach identified burnout as happening across three dimensions:

  • Emotional and physical exhaustion
  • Increased distance from your job, characterized by feelings of negativity, cynicism, sarcasm, and so on.
  • Reduced professional efficacy, meaning not doing a good job, or doubting your ability to do a good job. 

In a recent update on the MBI, Maslach, now a professor emerita at UC-Berkeley, cautioned that those three dimensions shouldn’t be understood as symptoms per se, but rather as areas of work to be measured separately. Thus, the MBI yields three scores for each respondent for (1) exhaustion, (2) cynicism, and (3) professional efficacy.

Point being, the MBI is a useful tool for measuring burnout. But it can be misused and misinterpreted by individuals as well as by organizations attempting to measure or monitor the mental health of their employees. 

Maslach worries that organizations sometimes use MBI scores to “diagnose” workers, and then tell them they or their team needs to “shape up,” or that maybe they should consider quitting or being reassigned. She believes the use of the MBI in this way is unethical.

For more on Maslach’s MBI, and how you can use it as a self-assessment tool, start here and here 

Maybe it’s time to give yourself a break

A noted expert on stressed-out therapists and laypeople alike, the late psychotherapist Albert Ellis researched and wrote extensively on how to cut yourself some slack in life. 

For example, a particular interest of Ellis’s was in identifying and challenging the sometimes unreasonable beliefs that therapists hold about themselves. Over decades of experience, Ellis identified five illogical yet common self-beliefs. They are:

  • "I have to be successful with all my clients practically all of the time.” 
  • “I must be an outstanding therapist; clearly better than other therapists I know or hear about.” 
  • “I have to be greatly respected and loved by all my clients.” 
  • “Since I am doing my best and working so hard as a therapist, my clients should be equally hard-working and responsible, should listen to me carefully, and should always push themselves to change.” 
  • “Because I am a person in my own right, I must be able to enjoy myself during therapy sessions and to use these sessions to solve my personal problems as much as to help clients with their difficulties.”

Looked at objectively, these are self-defeating patterns of infallible, perfectionist thinking. Because of these self-perceptions among many therapists, Ellis believed they sometimes ended up thinking and behaving in the very ways they were asking their patients to set aside and overcome. 

4 ways to take care of yourself

  • Embrace sleep. This is a perennial item on our need-to-do-better-about-this list, and I’m listing it first. Despite the common beliefs of too many busy mental health practitioners, sleep is not wasted time. When you sleep, brain waste gets taken away, and muscle and neurological renewal occur. This leads to increased mental energy and endurance which may, in turn, improve your ability to get more done during the day. 
  • Schedule a regular massage. If that sounds like pampering, it isn’t. Especially for those of us who see patients all day, either remotely or in person, and who have to sit upright and attentively as we give those clients our full attention. This can take a serious toll on the neck, shoulders, and upper back. A regular massage will help you steer clear of muscle soreness and spasms, in addition to easing overall tension. 
  • Be (more) active. A no-brainer here; the key is making time for it. If you treat exercise as the priority it is, you’ll naturally make more time for it–and start seeing the benefits almost immediately. These include improved mood, more mental and physical energy, better sleep quality, less stress, and an easier time maintaining a healthy weight. 
  • Stay hydrated. Research done specifically on therapists has shown that during work hours, they tend to drink much less than the recommended amount of fluids. This can have a variety of ill effects beyond just physical symptoms. Dehydration can lower your energy levels and ability to stay alert and focused.Make a point of keeping a water bottle handy, and sip generously from it between patient sessions. 

Finally, a salute to you, a quite possibly overworked, overbooked mental health practitioner who is nevertheless doing life-changing and saving work every day. Thank you for that—especially during these last two-plus challenging years since COVID hit. 

If you’re feeling overwhelmed or burned out, let someone know. Share with a colleague. Make use of their empathy and experience.

Most of all, be honest with yourself about what you can handle, and take action if needed–today. Remember, you won’t be much good to others if you’re not good to yourself first. 

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