“I hope she just wants to play UNO or something,” said Rachel, my colleague at the community mental health center. Her school-aged client was due to arrive in 10 minutes. A few of us therapists were inhaling our dinner in the center’s kitchen, while others were chatting or looking at their phones, savoring our only break in a day of back-to-back clients. The clock above the sink was about to summon us to our evening sessions, and while we knew Rachel was half-joking about UNO, we smiled wryly and nodded with a shared understanding of what she meant: I have nothing left to give.
That night was eight years ago, and it certainly hasn’t become easier to be a mental health professional since then. Burgeoning caseloads, financially strained agencies, high-acuity clients, evasive insurance companies, increasing paperwork and productivity standards, and, oh yeah, a global pandemic have clinicians facing what feels like an insurmountable amount of stress. So much stress, in fact, that I can’t be the only one questioning my career choice and fantasizing about taking a job at a doggie daycare. (In my version I just play with cute puppies all day and don’t have any of the other gross responsibilities. But I digress.)
Holding others’ pain while we sort through our own emotions and life experiences isn’t new. It’s part of the job. But COVID-19, which brought on stress that no one could have prepared for, has made the current conditions for therapists unsustainable and likely to lead to burnout. Chronic apathy, detachment, and cynicism are all hallmarks of burnout, and, when left unattended, they can permeate our entire lives. Burnout can also be difficult to recognize, particularly in a profession where the only objective is to help others. So where is the line between being a “good” therapist and giving too much of yourself away?
There’s certainly a larger conversation to be had, eventually, about how the mental health care system creates burnout conditions in the first place. But as the new year begins, we’re all still in the thick of helping clients navigate unprecedented grief, stress, and hardship while simultaneously dealing with our own. Right now, traditional self-care, a viable antidote to burnout, feels like too much to ask of clinicians who often struggle with it even in the best of times.
So how do we hit the reset button as we begin a new year? Research on burnout across professions says the answer to burnout isn’t less work but rather more meaning and an increased sense of efficacy. As therapists, we’ve already chosen meaningful work, but how can we increase our sense of efficacy? Organizational psychologist Adam Grant says the answer is achieving small wins in our daily life.
I’ve come up with a list of daily go-to practices that are simple and restorative for me.
Keep it teeny-tiny. Identify three small tasks you can do each day that will boost your sense of agency and accomplishment. These tasks should be simple enough that you can remember them, though writing them down certainly helps if you like the satisfaction of crossing something off your list. Examples from my list: make the bed; delete five emails; floss teeth; clear the dining room table; compliment one person; open mail from yesterday; wipe down my keyboard. If you’re not able to complete your list, the tasks are too big.
Decrease the number of decisions you make in a day. Like Zoom fatigue, decision fatigue is real! I’m not suggesting you wear the same black turtleneck every day like a Silicon Valley billionaire, but you can make things easier on yourself by making decisions ahead of time, when you do have energy left in your reserves. In my household, as an example, mornings are much smoother when outfits were chosen, lunches were packed, and breakfast was decided upon the night before. I’m just not a morning person, so the fewer decisions I need to make then, the better and more accomplished I feel, which allows me to show up to work more centered and present.
Start and end your sessions on time. Oh, the art of gracefully cutting someone off at the end of fifty minutes. It never feels great, and yet it’s almost always the right thing to do. It certainly feels better than being eight minutes behind for the rest of the day. Keep a clock where you both can see it and refer to time early and often. I often say something like, “I can hear you shifting to what feels like a new topic and I want to be mindful of our time together. We have only five minutes left. Perhaps we could push pause on this until our next session so that we can unpack it together meaningfully instead of rushing through it.” Clients feel heard, you’re setting therapeutic boundaries, and you’re teaching containment skills: win-win-win.
Develop a between-session practice or ritual. This doesn’t need to be complex. Choose something small and restorative that works for you: use the restroom, have a snack, stretch, write your progress note, take a lap, and settle in for a full minute of concentrated breathing or meditation. The idea here is to avoid starting a new task or mindlessly doom-scrolling social media— anything that winds you up. Emergencies aside, there isn’t much you absolutely must attend to between sessions and even fewer things you can actually accomplish. Find your “zone” and stay with it. Note: If you find an in-between session ritual to look forward to, it’ll become much easier to end sessions on time.
Take breaks (however short) and protect that time fiercely. The least-stressed people I know are those who unapologetically take breaks from their work. Sometimes it’s a walk with my dog, sometimes it’s cleaning a room in my house—it doesn’t really matter what my break activity is as long as I’m fully absorbed. For me this winter, it’s shamelessly engrossing myself in a teenage soap opera from the early 2000’s over my lunch break. I block my calendar, don’t take calls, answer texts, scroll social media, check my work email, nothing. For that dedicated amount of time, it’s just me and those impossibly good-looking teenagers with underdeveloped prefrontal cortexes who keep making poor decisions.
Ask loved ones to give you space during and after work. I don’t know about you, but my partner does not understand what it’s like to see eight back-to-back clients in a day. If he did, he wouldn’t dare ask me what I think about a complicated family issue within minutes of me emerging from my office. Finally, after months of overextending myself to be available, which inevitably led to bickering, I said to him, “I know you don’t get it, and that’s okay. Please, unless there’s an emergency, wait to talk with me about anything ‘heavy’ until after I’ve finished working for at least thirty minutes.” Setting this clear boundary was a game changer.
Create space between a request and your response. Although we often feel a sense of urgency, there are very few things that require an immediate response. Consider inserting a few breaths, minutes, hours, or days between your urge to respond and your response. This small practice has made a big difference when my attention and energy have been so splintered.
Stop telling strangers you’re a therapist. Just stop. You know why.
Kate Sample, MA, LPC, has spent most her clinical career as a therapist working with at-risk tweens and teens in residential, school, community, and private settings. A passionate advocate for ongoing professional development, she transitioned her skills to the continuing education world, where she’s developed treatment-focused trainings, conferences, and publications for PESI.
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