Thank you to everyone who responded to our July Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
July Quandary: When I first started out as a therapist, I loved the work. In the midst of all the challenges, it felt a privilege to be doing it. Recently, however, I’ve found myself losing steam. I catch myself mentally checking out when clients are talking. I constantly feel exhausted and worry this could be affecting treatment. I learned about burnout in graduate school, but never thought it would happen to me, let alone this early in my career. Money is tight, and I worry about who’d manage my caseload if I took a few weeks off. Has anyone else ever felt this way? What are some good, realistic forms of self-care beyond just taking a vacation or going to the spa?
1) Love Your Clients, But Love Yourself First
Having an individual practice can be wonderful. I wish I’d started mine years before I actually did. However, there are some aspects that do cause quite a bit of anxiety. I stress over how many clients I have and if it’s enough to pay rent and bills. At times, I even stress over losing clients and whether it means I’m not a good therapist.
How do I take care of myself? I call my self-care living. I see a therapist. I pay for house cleaning twice a month when things are good and once when they’re slower. I buy myself something I want if it’s on sale. I try not to deny myself sleep. I do aromatherapy and use skin-care products to take care of my body. I cuddle with my pets, play Elder Scrolls online on my Xbox, and spend as much time with my husband and family as I can.
Since I work Saturdays with clients who can’t make it during the week, I take Tuesdays off, no matter what. More recently, I’ve taken up aquatherapy, and swim whenever I can. Sometimes, I’ll travel to New York City to meet a friend. Since I moved outside the city, there are self-care habits I’ve refused to give up, like getting my hair done. I also make sure not to take on other people’s emotional journeys, in or outside of my office. I watch a lot of TV and laugh. After all, laughter is the best self-care! I love my clients, but I come first.
Eve Applebaum, LCSW
2) Take Your Full Lunch Break (and Other Tips)
I’ve been a therapist for 14 years, which has taught me the absolute necessity of engaging in real, ongoing self-care. Several practices have proven to be especially valuable over the years.
To start, I make sure to talk about my feelings with my clinical supervisor, my own therapist, and my friends. I know this may sound simplistic, but it’s crucial. We need support. After all, this is really hard work. When I can, I engage in some form of meditation or mindfulness practice. We tell our clients to do this all the time and need to follow our own advice. I also try to make exercise part of my routine. It doesn't have to be anything elaborate: just getting my body moving several times a week.
I also make sure to take my full lunch break. I use my lunch hour to eat with coworkers, meditate, or go for a walk. I also make sure to leave work at work. When I finish my day, I visualize all the clients and stress from my day leaving me. I don’t take it home. I try to be cautious of how I might be squandering my emotional energy. My mantra: don't work harder than your clients.
Perhaps the therapist in this quandary could explore various projects she could volunteer for or areas of counseling she’s interested in getting more training in. She could consider working with a different client population, using her skill set and training in other ways, or even changing jobs altogether.
Working to stay happy and engaged as a therapist takes effort. Sometimes we do need a vacation, but we need ongoing self-care and personal growth to keep ourselves truly fulfilled at work.
Janice Vitale, LCSW
3) Cut Yourself Some Slack
As an older therapist, I know what burnout is! Thankfully, I’ve had a meditation practice for years. Without consistently practicing meditation, I doubt I’d be able to continue with this work.
First, though, I think we need to cut ourselves some slack and consider just how much our modern culture contributes to our tendencies to be impatient with clients who might be slower to progress in therapy than we’d like. There’s nothing wrong with feeling cranky: we just have to know how to control our crankiness.
If this therapist has the opportunity, I’d recommend she spend more time with friends who have nothing to do with her practice. I’d recommend she try to take a traditional hatha yoga class, with slow-moving asanas. Personally, I’d avoid the new hot yoga classes. I’d also recommend she try some traditional breathing exercises. In the end, I’d tell her to give herself some love and forgiveness, and look at all the good she does! I’ll bet her clients are much more grateful for her help that she realizes. I'm sure she’ll get through this the best way she can. She already is, just by asking for help.
Myles Paulson, LCSW, MSW
Staten Island, NY
4) Make Self-Care a Daily Practice
I’m new to counseling and currently work in a college setting. What I love about my profession is that self-care is imbedded in our code of ethics. Being an ethical counselor means not practicing self-care isn’t an option. But that’s easier said than done, right? One of my supervisors used to check in on me every so often to tell me to get lunch, since I was prone to skipping it so I could catch up on reading for classes. Another allowed me time off to travel to see my partner, who lived nearly five hours away.
The bottom line is that self-care needs to be a daily practice. This can take many forms. Last summer, for instance, I started a morning meditation practice to help me be more present with my clients. And guess what? It helped me become a better partner, friend, and family member. It helped me experience more peace in my daily life. At lunchtime, I’d go home, make a meal for myself, and watch an episode of my favorite show. If I couldn't make it home, I'd eat lunch with colleagues, then do some yoga stretches or take a short nap afterward. These days, I'm working on reducing the time I spend using my phone, and I see a massage therapist every week. And yes, I use my vacation time—and make the most of it!
Elena Yee, MS, NCC
5) Just Stop
Just stop. What I mean by this is that sometimes, we just need to stop when we’re feeling burned out. When burnout happens to me, it doesn't seem to come all at once, but creeps in over time. I keep it at bay by looking for subtle signs that I may not be living in the present moment. At my agency, I often work with dysregulated children, unstable adults, and clients who’ve experienced trauma, so my days can be busy and unpredictable. When my thoughts are racing, and I’ve been moving too fast to fix, solve, or get things done, that’s when I know I’m burning out and need silence.
At that point I practice taking deep, intentional breaths. I know that I need to be creative, to be in nature, and to meditate. I might practice yoga or do some body movement, drink more water, or have a healthy, feel-good meal. I know that I need to nurture the spiritual, emotional, physical, and mental parts of myself. Instead of doing laundry, I’ll go for a hike. I’ll spend quiet time with my dog in the woods without feeling guilty that I’m not with my children, and I’ll go barefoot in the river while noticing the wonders of nature: observing birds and getting my hands dirty in the mud.
That’s my self-care. I don't do it perfectly, but I know the signs that I need to clear my head and let go of stress. I’ve come to realize that when I’m irritable, restless, sensitive to criticism, or start to fantasize about calling in sick, this means the insidious burnout monster is creeping up on me again.
East Hampton, CT
We'll post a new response to each Clinician's Quandary on the first Tuesday of every month! See how to submit to next month's Quandary here.
August Quandary: I have some great exercises, like journaling prompts and guided mediations, that I know would benefit my clients between sessions. Although they seem interested when I introduce the idea, they always “forget” or can’t find the time to follow through. Do others who give “homework” between sessions have this problem? What should I do?
Photo © iStock/Elenathewise
Topic: Professional Development