Jessica, a counselor in her mid-30’s, works at a large, public mental health clinic in a major metropolitan area. Her workday begins early, the alarm sounding off at 5:30 a.m. Up she gets and down to the kitchen she goes. By 6:30 a.m., with breakfast finished, mother and daughter are out the door. After scraping the snow and ice off her 2001 Toyota Corolla, Jessica jumps into the driver’s seat and turns the key. Following its familiar protest, the engine growls to life. Then the four-mile commute begins. It usually takes 45 minutes, but if there’s an accident or road construction, all bets are off.
As she winds her way through traffic, her grip on the wheel tightens. She was hoping to arrive early enough to complete clinical notes left over from the day before. She’s already on notice with her supervisor. Checking the dashboard clock, Jessica realizes the chance of arriving early is slipping away. That’s when the feeling starts—first, a heaviness in the shoulders, quickly followed by a tightening around the heart. Jessica lets out an audible sigh and closes her eyes. She’s no stranger to these sensations: they’ve become a near-constant companion on her way to and from work.
After a day-long workshop in which the presenter had reeled off the signs of burnout, Jessica immediately recognized herself. In almost every way, the job she once loved had become unrewarding—a dreadful daily ordeal. Increasingly, when working with clients—and even when meeting with coworkers—she found herself feeling either bored or detached, her heart no longer in it.
Indeed, the world seems to be in the midst of a pandemic of burnout, spread across all age groups, genders, professions, and cultures. The toll is severe. Growing rates of absenteeism, job turnover, and reports of depression, anxiety, exhaustion, and physical illness (e.g., insomnia, hypertension, high blood sugar, excess body fat, abnormal cholesterol levels, cardiovascular events, musculoskeletal disorders) are well documented.
In fact, an entire industry of authors, coaches, and trainers has sprung up to address the problem, providing books, videos, presentations, retreats, and organizational consultation. Across such offerings, the advice given is remarkably similar: practice mindfulness meditation, eat healthy snacks, go for short walks, exercise regularly, get enough sleep, join a service organization, take up a hobby, attend a continuing education event, learn to say no, see a therapist, and take time out to value oneself.
But at the same time, the shared feeling in Jessica's group was that none of these strategies had any real chance of solving the core problems they all faced: too much paperwork, too many clients, deteriorating and inadequately maintained clinic facilities, ongoing financial uncertainty, and administrative indifference.
So what are Jessica and the many others who find themselves in similar straits to do?
Don’t Stop Believin’, Hold on to that Feelin’
Being completely immersed in and sharply attuned to the client’s experience has long been the sine qua non of “good” clinical practice. Research confirms as much. For example, a large multinational investigation by University of Chicago’s David Orlinsky and the University of Oslo’s Michael Rønnestad involving more than 10,000 therapists found the majority not only yearn for but consider a deep connection with their clients the pinnacle of professional development.
Curiously, our own research showed that Healing Involvement (HI—the construct used by researchers to capture clinicians’ felt sense of being deeply connected to their clients—varied by success rate, with top performers rating it significantly less important to their work and identity than their more average counterparts. At the same time, this group of therapists evinced little interest in traditional self-care practices. Most importantly, they reported far less burnout.
Determined to make sense of the discontinuity between the best and the rest, we reached out to top performers. How, we wondered, could caring less—at least as our field might view such findings—yield better results for clients and, simultaneously, protect clinicians from burnout?
One of the first practitioners we spoke with was Paulina Bloch, a highly effective therapist identified in our research, who works for the National Health Service in Staffordshire, England. When asked about the role caring played in her work, she thought for a moment and replied, “I guess I have a funny relationship with that word. It’s not me liking or worrying so much about my clients, or even being deeply invested in their lives or stories really. It’s a question of whether or not I’m helping.” Paulina paused, wondering out loud whether she should say what was on her mind, then continued, “The first thing I think when I meet a new client is When can I stop seeing this person? And I know I can do that if I get results.”
Such findings indicate that the real challenge for practitioners is knowing when to let go, “when to stop believin’ and to let go of that feelin.’” In the same way that we don’t marry everyone we date, therapists can’t help everyone who comes through their doors. Research shows that therapists, on average, fail to help as many as 50 percent of their clients achieve a measurable improvement. So sometimes we have to let go, relinquishing both the belief that we have something to offer and the duty we feel to help.
Fulfillment of Purpose
In the end, we don’t fulfill our purpose by providing caring, empathy, and compassion, no matter how lovingly extended. We do fulfill our purpose, however, when we consistently engage in the kinds of therapeutic practices that objectively promote the client’s improvement. Further, genuinely and demonstrably helping people improve is the entire point of therapy and, in the end, the best of all ways to show that we really, deeply care.
Scott Miller, PhD, is the founder of the International Center for Clinical Excellence, an international, web-based consortium of clinicians, researchers, and educators dedicated to promoting excellence in behavioral health services. He’s the coauthor or coeditor of eight books and numerous chapters, research studies, and popular articles.
Mark Hubble, PhD, is a national consultant and graduate of the postdoctoral fellowship in clinical psychology at the Menninger Clinic. He’s coauthored and coedited six books and is a senior advisor and founding member of the International Center of Clinical Excellence.
Françoise Mathieu, MEd, CCC, is a certified mental health counsellor and compassion fatigue specialist with more than 20 years of experience in trauma and crisis intervention. She’s the director of Compassion Fatigue Solutions, Inc., and author of The Compassion Fatigue Workbook.
Illustration © Getty Images/Roy Scott
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