She landed her dream job when she graduated, working at a state-run substance-use treatment centre at a local detention facility in Denver, Colorado. She worked in jail-based behavioural services and her job put her in direct contact with inmates struggling with drug and alcohol addiction. “I started working immediately with people who were facing some pretty hefty charges,” says Smith, now 31.
Not long after she started, she began feeling the emotional toll that comes with handling acute cases. “I remember asking a supervisor about it. What can I do, and how can I prevent taking some of these experiences home with me?” she recalls.
Smith realised the primary source of her psychosomatic symptoms was her work
Smith pressed on for another year or so, but started experiencing psychosomatic symptoms. At first she wasn’t sure where it was coming from, but eventually she realised that the primary source was her work. “I got to a place where I was sitting with a client and I found myself walling up in order to protect myself. I knew I needed to be able to let down the wall to make them feel safe.” Smith ended up resigning and took a break to travel. Today, she runs a private practice and no longer works in the US criminal justice system.
Nowadays, it can seem like stress and burnout are just a regular part of modern working life. In 2019, the World Health Organization listed burnout as an occupational phenomenon, describing it as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”.
Burnout in the workplace is often examined from an always-on and ‘hustle’ work culture perspective. Mental health professionals like Smith are certainly not immune from such pressures, but they have the additional exposure of working on a daily basis with emotional issues and trauma.
In 2018, when the American Psychological Association analysed several studies that looked at burnout among mental health services providers, its researchers found that “anywhere between 21% and 61% of mental health practitioners experience signs of burnout”. A 2018 research review paper published in the Journal of Clinical Psychology analysed 30 years of research on this topic, involving 9,000 psychotherapists. Over half of the therapists they sampled reported “moderate-high levels of stress and burnout”.
Guilt and a broken system
Like Smith, Ivy Kwong, a 39-year old licensed psychotherapist based in Seattle, Washington, also experienced burnout early in her career. As an intern, Kwong worked with immigrant children from Central and South America. Not only was she exposed to traumas that put most of her clients in constant “survival mode”, but she was also working with limited resources. For example, many of her sessions required a Spanish-speaking interpreter, but the interpreter was stretched thin and could not always be present. A lot of what led to burnout, says Kwong, was “realising the systemic issues that were impacting my ability to be effective”.
Even for therapists who don’t work with the same constraints, burnout can creep up in insidious ways, according to Smith. Despite being taught the importance of self-care in their training, many don’t realise that they’re heading towards burnout until it’s too late. Dr Gregory Moffatt, licensed professional counsellor expert at the American Counselling Association, says that because mental health professionals are focused on making others better, they often feel “invincible”.
Burnout in mental health professionals can manifest in ‘compassion fatigue’, where therapists take on the pain and suffering of others
There’s also a sense of guilt associated with self-care. “We feel like we’re doing something selfish,” adds Moffatt. For him, his wake-up call came when his marriage started to fracture. Fortunately, he was able to use his experience to rebuild and strengthen his relationship with his wife, develop a self-care practice and identify the warning signs to prevent him from slipping into the same situation in the future.
Signs to look out for
In extreme situations, burnout in mental health professionals can manifest in “compassion fatigue”. This is where the therapist takes on “the pain and suffering of others”, says Smith. Compassion fatigue can move into vicarious trauma when counsellors and therapists start to experience similar symptoms to their clients.
In less extreme situations, signs of burnout may include lack of focus, constant fatigue and an inability to shut off. “Sometimes there’s this numbness… where you don’t feel reactive to things. If you were to see a tragedy on the news, your reaction is sort of dulled,” says Dr Harrald Magny, a psychologist who runs a private practice in New York City.
For others, it’s about paying attention to shifting moods. Adriana Alejandre, a Los Angeles based trauma therapist and host of the podcast Latinx Therapy, says, “I notice that my energy levels get lower when I get home, and when that’s happening more consistently, I tend to isolate and not be emotionally available for my family.”
The importance of self-care
Almost all the mental health practitioners interviewed for this article agreed that therapists and counsellors need to be better at practicing what they preach when it comes to self-care. What that looks like will be different for every individual, but the key is being able to set appropriate boundaries.
Lori Gottlieb, psychotherapist and author of Maybe You Should Talk to Someone,says that therapists need to get away from the mindset of “doing everything they possibly can”. Gottlieb, for example, sets specific hours for her clients to contact her. “If something comes up that can’t wait, then they need to call 911 or go to an emergency room,” she says. She also stresses the importance of basic self-care practices, like taking adequate breaks between appointments, eating properly and exercising regularly. When practitioners get too invested in their work, those things can go out of the window, says Gottlieb.
For Alejandre, it’s about balancing her case load between “high-level need” and “low-level need”. “I take breaks after very heavy sessions, and I make space to pause.” For Smith and Kwong, being able to choose who they work with has been a critical part of preventing burnout. Moffatt and Magny stress the importance of having peer support and the willingness to access counselling services themselves. Many acknowledge that more open and honest conversations about burnout will likely help reduce its prevalence within the mental health profession.
“I would like to see more people talk about their strategies for self-care,” says Alejandre. She stresses that she’s not interested in hearing about the expensive practices that self-care has become associated with, but “the very subtle thing that people do on a day-to-day basis that makes them happy, that contribute to their ongoing wealth of energy”.