Throughout history, for most people it was just expected that work was a difficult, tedious, underpaying, and often soul-killing grind. But in today’s world, something we call “burnout”—that mélange of weariness, depression, and apathy, seasoned with a tincture of cynicism—has become as pervasive as the common cold.
The actual term burnout can be traced to the mid-70s, when psychoanalyst Herbert Freudenberger used it to describe the kind of physical and psychological breakdown suffered by idealistic volunteers who’d given their all to aid organizations, including free clinics, women’s shelters, crisis intervention centers, and the like. These worthy souls not only cared too deeply for their own good, but also tended to be perfectionists with entirely unrealistic goals, aiming to solve, once and for all, their clients’ problems and, while they were at it, completely renovate society. The further their goals receded from accomplishment, the worse the volunteers felt and the likelier they were to begin blaming others—their supervisors, coworkers, the “system,” even their clients.
While today the term burnout is applied to just about anybody who feels too much unpleasant pressure at work, the concept in its original form was tailor-made for therapists. For one thing, they’ve been virtually indoctrinated in the belief that empathy, caring, commitment, even love, comprise their most important clinical tools. Then add to that the fact that so many clinical settings make it hard for us to succeed in our work, requiring us to do ever more paperwork, work more hours, and see more clients for shorter amounts of time, and it’s no wonder so many therapists regularly feel like smoldering little crisps of their former selves.
But as noble as our devotion to our clients may be, suffering right along with them out of loyalty or a sense of duty long past the time when the therapy has stopped moving isn’t the same thing as good, or even particularly ethical, treatment. In this issue’s cover story, “Burnout Reconsidered,” Scott Miller, Mark Hubble, and Françoise Mathieu argue that the focus on enhanced self-care as the most helpful approach to burnout is, at best, misguided. The real remedy, they believe, is differentiating between caring too much—no matter how much more of it you do, the client doesn’t get better—and actually doing what’s necessary to help your clients.
After studying the work of the field’s top clinical performers, the authors conclude that the primary cause of burnout is actually clinical ineffectiveness. Rather than doubling down on the empathy and commitment, the antidote lies in taking the trouble to realistically assess the client’s progress, then taking concrete steps to get therapy back on track—or have the inner fortitude and honesty to help struggling clients find other sources of help.
The point they make—which goes against the dominant ethos of our field—is that there’s no shame in admitting failure. The real failure lies in clinging with a death-like grip to the exalted, if never quite admitted, self-image of oneself as a saintly healer, who never, never, never gives up on a client. Ultimately, Miller, Hubble, and Mathieu believe, the victim of that self-delusion isn’t just the therapist, but even more importantly, the clients as well.
Richard Simon, PhD, founded Psychotherapy Networker and served as the editor for more than 40 years. He received every major magazine industry honor, including the National Magazine Award. Rich passed away November 2020, and we honor his memory and contributions to the field every day.