I treated many clients who were dealing with burnout on the way to my own experience of burnout. I’d built a full-time clinical practice at the same time that I was in a full-time faculty position. When my regular hours filled up, I started seeing clients late in the evening by video, as well as on Saturdays. I didn’t think I could work fewer hours as I was trying to support my growing family and accommodate my clients.
Looking back, I now see several beliefs that contributed to my burnout. Together, they led to unrelenting stress that sapped my enthusiasm—and even made me wonder if life was worth living.
1) It’s my fault if a client doesn’t improve.
When Mark left my office after his session one day, I closed the door, put my head down on my desk, and sobbed until my stomach hurt. Mark was obviously in tremendous emotional pain, and no treatment had been able to lift his crushing depression. He had tried everything, even electroconvulsive therapy, in addition to the evidence-based CBT we’d worked on together. Nothing seemed to make much of a difference.
I kept thinking that I should be able to figure out how to help him—to identify some overlooked physiological cause or find a technique that would prove effective. Without realizing it, I was taking on an unrealistic degree of responsibility for Mark’s suffering while entertaining fantasies of being his savior. As it turned out, I didn’t have that kind of power.
As a therapist, your slice of the pie that represents “Reasons My Client Is Not Improving” is relatively small. All the same, it’s hard not to blame ourselves when treatment isn’t effective, as if the whole pie is our fault. But most of the time the lack of progress has nothing to do with the quality of care you’re providing.
Ask yourself: Do I assume an undue degree of responsibility for my clients’ improvement? What are some other explanations for why a particular client doesn’t get better?
2) I’m not doing enough.
Our society fetishizes productivity. It’s considered virtuous to be busy, and a vice to be idle. In this social context, it’s no wonder we tend to feel like we’re underperforming. There’s always more to do, more to achieve, more clients to see, and money to make.
Nevertheless, we’re not built for constant activity. Any demand on our time, energy, or attention creates stress, and our nervous system requires downtime to discharge the accumulated tension and strain.
Ask yourself: Is it possible that I am doing enough, or even more than I need to? Where did the belief come from that I have to push myself all the time? What space might open up in my life if I weren’t perpetually busy?
3) I don’t have time to take care of myself.
It was easy to talk with my clients about the importance of self-care, and much harder to make time for it—especially because of the unhelpful belief that I wasn’t doing enough (above). I always had the intention to pause and rest, but with the tacit rule that first I had to finish everything on my to-do list. Ha! Of course that never happened.
Ask yourself: What is getting in the way of taking care of myself? What do I need to do for myself that will help to sustain my energy and enthusiasm for the long haul?
4) I have to make everyone happy.
Years ago, a mother contacted me about her teenaged son Alex, who was struggling with severe OCD. She was desperate to find effective treatment for him as soon as possible, and I scheduled to see him at my first opening. However, I came down with a migraine on the day of our first meeting, which forced me to cancel all my clients for the day.
Later that day, I received an alarmed voicemail from Alex’s mom, who expressed concern about the cancellation. Afterwards I felt like I’d failed because she was so upset. But as I thought about it later, I realized that my other five clients had expressed concern only for my health, and had reassured me that they understood my needing to cancel. Maybe Alex’s mom was upset not because I had failed, but because of her own anxiety and expectations.
Most people want to please others, and as therapists, we may be especially prone to this tendency. After all, making people happier is literally our job. But the imperative behind the belief that “I have to make everyone happy” burdens us with excessive expectations. It’s impossible to please everyone, whether our clients, their family members, or our own loved ones. When we inevitably fail to make everyone happy and someone is upset with us, we’ll drain our own happiness if we assume we must have done something wrong.
Ask yourself: Do I really have to please everyone? What will happen if I don’t?
5) I’m not allowed to say no.
This final belief is closely related to the previous one. We can’t say yes to every request for our time, but it’s hard to say no, including to potential clients. People generally come to therapy because they’re hurting, and we want to ease their pain. I struggled for a long time to turn people away, until a helpful conversation I had with my mom (thanks, Mom). She told me that I could work 24 hours a day and still not see everyone who needed help. That insight helped me to see that I had to draw the line somewhere with my hours, and that it made sense to do it in a way that kept me from running myself into the ground.
You’re allowed to say no to seeing that one additional client that puts you over the top, to requests from colleagues and students, to that referral even though it came from someone you know and respect. You don’t have to say yes when what you really mean is no.
Ask yourself: Do I really need anyone’s permission to say no? What can I say no to in the coming days that will protect my health and peace of mind?
When I finally realized I was burned out from constant stress, I soon cut back on what I was doing. Nevertheless, it took several months to unwind the cumulative effects on my body and mind. I suspect the chronic illness that developed after that intense period was due in part to the extended time of mental, physical, and emotional stress.
In recent years I’ve been much more careful to manage my stress every day. Just as I work with my clients in CBT to help them question their unhelpful thoughts, I’ve worked at questioning the false stories of my own mind. When you feel the stress building up in yourself, pause, take a gentle breath in and out with awareness, and then notice any unhelpful beliefs that are contributing to the strain you feel. Seeing through these falsehoods can help to prevent burnout, or to recover from it as quickly as possible.
Portions of this article are adapted from Mindful Cognitive Behavioral Therapy: A Simple Path to Healing, Hope, and Peace (HarperOne, 2022).
Photo by Pexels/Andrea Piacquadio
Seth Gillihan, PhD, is a clinical psychologist, podcast host, and author of multiple books on cognitive behavioral therapy and mindfulness. His most recent book is Mindful Cognitive Behavioral Therapy: A Simple Path to Healing, Hope, and Peace.