By Lucinda Hotchkiss, Ph.D., C.G.P.  

Feeling Burned Out? AGPA Can Help

Thinking of retiring to a remote tropical island and becoming a recluse?  Feeling burned out in your role as a therapist or mental health professional?  Or maybe you are feeling excited about your work and looking forward to challenges ahead.  Whether you want to stoke the fire of your professional enthusiasm or rekindle it, AGPA can help.

Are You Burned Out?

With all the external pressures of managed care, decreased financial resources, government cutbacks, and the internal pressures that we clinicians sometimes feel – the pressure to be perfect, a wish to rescue others, the drive for accomplishment – burnout is a danger.  Burnout can make you feel you have chosen the wrong profession, but you may just need ways to nurture your professional self. 

 “Burnout” is a ubiquitous and unfortunately, very familiar, term.  But it may still be helpful to try to define it clearly – so we can figure out what to do about it.

Many of us know the feelings of burnout.  The feelings of ineffectuality, helplessness, hopelessness, anger, boredom, lack of control, and resignation.   In our work, what used to be interesting and challenging begins to feel like a burden.  We have difficulty focusing on the client or the task at hand.  A therapist taking on a new client worries, “Will I have enough time to complete all the paperwork and calls, let alone be of help to her?” I experienced this at my mental health center when I was told I had been assigned a new client, and all I could think about was the paperwork and how I would fit her into my schedule.  With burnout, we may get less done but take more time to do it.  The talking we do about our feelings may become obsessive and pointless rather than helpful in working through to a solution.

When burned out, clinicians feel they cannot do their job in a way that is consistent with their professional values or their clients’ needs.  It is experienced as a painful gap between one’s professional standards, values, ideals, or usual performance and the quality of one’s current work.  Overwhelmed with emotional, financial, and time demands, we may feel we have nothing to give or cannot possibly meet the demands of the workplace or our clients.  Then comes the guilt about these feelings.

Skovholt (2001) distinguishes caring burnout from meaning burnout (p. 111).  Meaning burnout occurs when one perceives one’s work as either not meaningful to oneself and/or one’s patients.  Often meaningfulness, a sense of purpose, and doing valuable work can be a big compensation for the hard work and sometimes lower salaries that mental health professionals get.  When a therapist loses the sense of meaning in the work, much of the reward for the profession ceases.  Sometimes the desire for personal or professional growth grinds to a halt.

Perhaps most devastating is a burnout in caring about one’s clients or one’s work.  Caring burnout (Skovholt, 2001) involves difficulty in the caring cycle, which consists of attachment-involvement-separation, which the therapist goes through with each patient (p. 112).  Due to ambiguous losses or other pressures that deplete the therapist, one may have difficulty attaching to, or engaging, the client.  This could include not attaching appropriately, or becoming overly attached.  The next part of the cycle, involvement, can also be disrupted.  A therapist can become too detached or over-involved.  Third, a therapist with burnout may have difficulty with the separation process at the end of therapy, feeling overwhelmed with feelings of loss or denying them, such that they cannot be recognized and validated in the client.

Losing perspective on other aspects of one’s work also occurs.  I knew I was on the edge of burnout when my efforts shifted from growing professionally to just surviving my work.  The idea of taking up a new task or idea feels like a burden instead of a challenge.  Worst of all, inertia sets in and one feels incapable of, or hopeless about, getting out of burnout.

Causes of Burnout

According Grosch and Olsen (1994), burnout is a systems issue, including interactions among the internal state, dynamics, and history of the therapist; the systems in which one works or has professional affiliations; client-related pressures; and the systems of one’s personal life (p. 66).

Due to increased financial pressures from funding and payment sources, some work settings hold us responsible for stress the things we cannot really fully control and hold us responsible for them.  These include whether clients show up or not, and total number of clients seen per week.  Other uncontrollable situations add to the stress, such as not always knowing the outcome of one’s work with a client and ambiguous losses (never finding out why a client ended treatment).  In addition, taking on a new patient brings many unknowns, including possible difficult countertransference, unforeseen crises, or exposure to traumatic material. Skovholt (2001) says that burnout grows through too much focus and investment on what we as clinicians cannot control -- and too little focus on what we can control (pp. 126-127).  Aware of this imbalance, we can shift our focus to what we can control – professional expertise, and improving the quality of our relationships with patients (p. 127).  This is achievable in several ways – by focusing more on learning opportunities and professional support systems, by making systemic changes at work, or by finding more nurturing work settings.  This way we will feel more energized about our work and better about ourselves as clinicians.

Intrapsychic Contributors to Burnout

According to one AGPA member, burnout is a state in which “narcissistic supplies, such as reinforcement, acceptance, and rewards (like influence) are not met.”  This deficit is magnified if a therapist grew up with little mirroring or lacks mirroring in current relationships.  If a clinician develops a parental transference to a supervisor or institution, he or she may get caught in a cycle of trying to please others and never completely succeeding.  Growing up in a chaotic or critical environment can prime a therapist to seek out such work environments and feel the same sense of being overwhelmed and anxious as in childhood.

Grosch and Olsen (1994) offer helpful insights into other intrapsychic therapist factors that put clinicians at risk for burnout.  Sometimes therapists can be unrealistic or perfectionistic in their expectations of themselves or clients.  To develop a sense of mastery of prior trauma, family of origin issues may influence the therapist to seek out a role as either a rescuer or victim, both of which may affect their interaction with their clients and the systems they work in.  A therapist who did not receive enough healthy narcissistic mirroring growing up may be driven to seek this out professionally – even when it is detrimental to the quality of the work.

This being said, not all burned out therapists become this way because of intrapsychic risk factors.  The current world of mental health offers enough pressures to create burnout for almost everyone.

External Contributors to Burnout

Burnout can come from various external sources, including the workplace -- whether a hospital, mental health agency, private practice or a combination.  One may feel conflicted between one’s clinical responsibilities and administrative requirements (e.g., clinically helping the client focus on strengths, but feeling a pressure to make them seem as impaired as possible on the insurance form).  With the demands of managed care and other financial considerations, one’s values may conflict with the values of the work environment.  These may include emphasis on seeing the most clients possible in the least time; receiving lower pay; and spending less time in training, supervision, and peer consultation.  Due to time pressures in some settings, there also seems to be a breakdown of the multi-disciplinary team-oriented approach, which used to provide support for handling difficult situations.  A therapist who is not able to negotiate (whether for external or intrapsychic reasons, or both) to maintain a sense of professional mission and values may burn out in these environments.

Another source of burnout comes from pressures or crises in one’s personal life.  Marital problems or world conditions, such as terrorism, may drain energy usually available for doing therapy.  Time pressures can be a chronic strain.

Burnout:  How AGPA Can Help

How often have we helped others look at themselves from a systems, as well as an intrapsychic, perspective – but neglected to examine ourselves this way?  As discussed above, burnout results from over-emphasis on uncontrollable external factors (ambiguous losses, certain aspects of client behavior) exacerbated by the therapist’s own internal pressures and dynamics (e.g., the need to be perfect, the sense of never doing enough) and other factors such as political climate and home life. 

Given that burnout occurs in a system -- involving an interaction among one’s history, the system one works in, and the systems one lives in -- an organization with expertise in group therapy provides multiple useful perspectives.  It provides nurturing, validation, empowerment, and insight – all within a systems perspective.  AGPA offers a wide range of educational, consultative, professional development, and supportive resources to prevent or reverse burnout. 

AGPA helps the clinician deal with all parts of the systems that influence burnout.  Nurturing oneself professionally and personally, and becoming a part of a new system in which to grow, helps defeat burnout.  AGPA also provides a forum to explore how to change the larger systems that

influence our work (e.g., insurance reimbursement guidelines, mental health legislation).

Further, AGPA can help us combat causes of burnout that we can control:  our knowledge and the quality of interaction with our clients (Skovholt, 2001).  It can also add to our quality of your life by providing professional and personal support. 

“The Annual Meeting is energizing – otherwise I get very little opportunity for personal consultation.”  This is how one AGPA members describes what she values about our Annual Meeting, a multi-disciplinary five-day conference in February that gears its offerings to clinicians of all levels of experience.  One develops a new, expanded network consisting of “relationships with other practitioners from all over the country.”

At this year’s Annual Meeting -- titled, “The Healing Power of Groups:  Generating Hope and Respect” – one member who attended said,

 “Institutes [small group intensive two-day experiential/didactic seminars] are a source for personal exploration and renewal -- contact with clinicians who feel the same way I do about their work.”

Support and learning opportunities exist year-round, with Special Interest Groups (e.g., women’s issues, private practice) organized across the country.  In addition, there are programs throughout the year involving consultation, teaching, and learning from masters in the Affiliate Societies around the country.  These societies have offered peer support groups for therapists affected by September 11 as well as other issues.  On-line seminars and the AGPA’s well-respected journals are other sources of learning. 

Perhaps the most valued aspect of AGPA is as a personal and professional support system.  Members see it as a source of friendship and camaraderie.  They look forward not only to the formal learning opportunities but to the joy of staying in touch with one another or the fun of going out for dinner and discussing a change in perspective after a seminar.  As one member put it, there is nothing better than seeing a colleague at the Annual Meeting and feeling “happy to see one another; knowing you remembered me.”  AGPA “is a primary way that I take care of myself.”  Another says, “Meeting with other people who are committed to group psychotherapy re-awakens excitement about doing my work.”

In sum, AGPA also helps combat burnout by allowing one to join a new system – a wide, rich community beyond the home and work environments – that is dedicated to personal and professional growth.  As a member of a wider community, one can expand one’s professional and personal sense of self in different settings (e.g., be a committee member, teacher, or a trainee).  Taking on a new role in a new system can energize a burned-out professional.  One also gains new resources for personal and professional nurturing – and the satisfaction of being a team member in an interdisciplinary organization.  Most important, AGPA provides a temporary retreat from daily pressures and allows one to reflect and gain perspective on one’s work and life.

References

Grosch, W.N., & Olsen, D.C. (1994). When helping starts to hurt: A new look at 

burnout among psychotherapists. New York: W.W. Norton.

Skovholt, T.M. (2001). The resilient practitioner: Burnout prevention and self-care strategies for counselors, therapists, teachers, and health professionals. Needham Heights, Mass.: Allyn & Bacon.