Avoiding Burnout Traps: Managing the Conflict between Empathy and Exhaustion

• The Empathic Personality
• The Interpersonal Dynamics of Burnout
• The Intrapersonal Dynamics of Burnout
• The Attachment Dynamics of Burnout

“The best people possess a feeling for beauty, the courage to take risks, the discipline to tell the truth, the capacity for sacrifice. Ironically, their virtues make them vulnerable; they are often wounded, sometimes destroyed.” – Ernest Hemmingway

As a beginning therapist, my first five years were spent in uncomfortable places. Maximum security facilities, county crisis centers, and emergency rooms. In these environments, I could feel stress in the air like it was coastal humidity, and chaos was the rule rather than the exception. I seemed to meet two types of therapists in these places. There were those at the beginning of their careers and those who were nearing their end. The clinicians in their middle chapters of their work had often left for administrative roles and private practices.

I found the new and veteran therapists to be different in some noticeable ways. The new therapists were often energetic and inspired. They were personally invested, and despite their lack of experience, they seemed to help clients make significant improvements. They didn’t make much money, but they didn’t mind having roommates or driving economical cars. They had a cause and that was more than enough.

The veteran therapists were less excitable. They were wise and calm, and they had witnessed how idealism can lead to painful lessons in therapy. Sometimes they were rough around the edges, but because they had the benefit of making a therapist’s salary for many decades, they drove slightly newer economical cars. Their vehicles had fewer miles, powertrain, and bumper to bumper warranties. The big leagues.  

I had only been a therapist for a few years, but I quickly found myself losing my passion. I wasn’t sure I would grow into a seasoned therapist because I wasn’t sure I would remain a therapist for much longer. To manage my exhaustion and stress, my days became bookended between caffeine in the morning and alcohol at night. My sense of humor darkened, my wife worried, and my friends pulled me aside to express their concerns. I was changing, and those around me were whispering about it.

What I believed about therapy was changing, too. I started to believe that my clients who improved would have done so without my help. With my clients who didn’t make improvements, I started believing they simply couldn’t change. I was once a true believer, but I was becoming a skeptic. I was losing my faith in therapy. 

I didn’t notice I was changing while it was happening. The process was gradual, and it didn’t have an obvious turning point. It felt like a current had pulled me down the shoreline and I lost track of my towel which was further up the beach. I had become someone different, and it wasn’t someone I wanted to be. I spent months asking myself how this transformation occurred, and eventually, I came back with my answers.

The Empathic Personality

In graduate school, I was taught that empathy was a vital part of therapy. I was told to pack my bags, leave myself behind, and join my clients behind their eyes. To be a therapist was to commute to the deepest feelings and perceptions of another. Empathy was interpersonal travel, and to be a therapist meant holding a passport that permitted me into deeply private conversations. It got me through customs.

At that time, I thought about empathy in the way I thought about kindness. I wanted to exhibit more empathy and kindness for the people in my life. Clients or not! These virtues seemed pure and uncomplicated, and it was hard to imagine an overabundance of either. But eventually, I started thinking about empathy as something more complicated than kindness. This tendency to be aware of others and to travel into their worlds wasn’t simply a virtue, but it was a temperamental characteristic. Unlike kindness, this personal characteristic came with risks.

It was this new understanding of empathy’s risks that unlocked the answers about what happened to me. It helped me understand why I transformed from an energetic therapist into a calloused one. It helped me understand why I hated my economical car.  

I think that empathy can be separated into two different categories: there’s unmanaged empathy and managed empathy. Here’s how I think about the difference. When my empathy is unmanaged, I can join into the pain of others, but I can’t disconnect from it. This type of empathy has one step and so becoming glued to the suffering of others becomes inevitable. Alternatively, when my empathy is managed, I can join in the pain of others and then uncouple from it. Managing my empathy has been a two-step process.

My therapeutic training only focused on joining into suffering, but I was never taught how to uncouple from it. I never made the distinction between unmanaged and managed empathy. To be fair to my counseling educators, it’s not realistic to expect a seminar entitled, “Uncoupling from the Suffering of your Clients.” But because I didn’t learn to separate from suffering effectively, I relied on my unmanaged empathy. Joining into the pain of others had always come intuitively, and so I simply did with clients what I had always done in my personal life. This unmanaged empathy flowed by the gallon, but it eventually became a stream, and then it dripped and dried bare.  

The Interpersonal Dynamics of Burnout

When my classmates and I studied to become counselors, we shared universal experiences. Nighttime classes, unrelated daytime jobs, and increased coffee consumption. At some point, my classmates and I purchased our first therapist uniforms. Horn-rimmed glasses for some and shawls for others. Some bought cardigans. It was Carl Rogers couture.

During this time, those in my personal life expressed an interest in what I was learning. I was asked for my perspective more often and I eventually became more comfortable giving it. People changed towards me, and I changed towards them. I gradually became a therapist in my own mind and in the minds of others. These changes in my social world weren’t always positive. I answered late-night phone calls when help was needed. I was cornered into awkward conversations at parties. During an argument with a friend, I was told, “You should know better — you’re a therapist.” I wasn’t yet, but fine. Checkmate.  

After I finished my graduate program, I found my first clinical job. My empathic temperament had previously led me to help those in my personal life, but I was suddenly assisting clients, too. While it was once possible to have a private life filled with people I hoped to help, the new empathic demands of therapy led to working with suffering on all sides. There was no place to separate from suffering and I became a 360-degree giver. This was the first trap that led to unmanaged empathy and subsequent exhaustion. Mother Theresa could do it, but I couldn’t turn my life into Calcutta.

To practice managed empathy, I could no longer remain in the helper-role in my personal relationships. While my relationships with clients were characterized by one-way assistance, my personal relationships couldn’t remain this way. Most of the time, a simple conversation changed my one-sided relationships into two-sided ones, but occasionally more was required. Sometimes I had to use dials and levers. This was how I disconnected from the suffering of others, practiced managed empathy, and escaped this unmanaged empathy trap.

Restructuring the Interpersonal Dynamics of Burnout

I’ve never liked the word boundaries. The word has always seemed forceful and rigid, and to “set boundaries,” always sounded formal and severe. For me, this made the prospect of establishing limits less approachable. But the space between myself and others did need to be refereed, because it had become flooded with unrealistic and demanding people. It seemed that like nature, dysfunction abhorred a vacuum.

Rather than “setting boundaries,” I started thinking about using dials and levers. Here’s how this worked. When a relationship was one-sided, but the relationship was too important for me to end, I set the relationship on a dial. I reduced my involvement in the relationship by lengthening my distance in degrees. I took steps backward until I reached a comfortable interval. Putting a one-sided relationship at a greater distance made these relationships more sustainable. I could help when I was around, but I wasn’t around too much. But other relationships exhausted me regardless of the distance that I created. When I attempted to leave the helper role behind, some people didn’t go without a fight. Pro bono therapy was a hell of a drug. In these situations, I used levers to end the relationships entirely. I moved the lever from the “on” position to the “off” position. While the dials worked in degrees, the levers worked in absolutes.  

I found distance by degrees to be preferable to absolutes, and eventually I was able to regain some measure of control in my relationships. When I changed my one-sided relationships into reciprocal ones, I could step back from being a 360-degree giver. Once I implemented dials and levers, this created newfound open space in my personal relationships, and in this space, I could practice the second step of managed empathy. I could uncouple from suffering there.

The Intrapersonal Dynamics of Burnout

My public roles and my private values have always been an important part of understanding myself. Part of my sense of self comes from being a spouse, father, brother, and the professional role that I play. The other part of my selfhood comes from the values that I’ve privately held dear. But problems emerged for me when there was a poor balance between the public roles I played and the private values I held, and this was a setup for the second unmanaged empathy trap.

In my earlier stages of counselor development, I viewed becoming a therapist as too central to who I was. I over-identified with my therapeutic role, and I lost part of myself. To understand how this occurred, I started noticing professionals who went through similar transformations. I also noticed the professionals who didn’t.

What I learned is when a public role elicits some amount of societal reinforcement, there’s a tendency to over-identify with it. Take the surgeon, for example. Most surgeons don’t think being a surgeon is something they simply do for work, but instead, being a surgeon is a central component of their identity. This is also true for professional athletes, executives, politicians, and lawyers. But it’s not true for those who stock vending machines or drive garbage trucks. These jobs don’t come with societal applause. When talking about their work, these folks often say things like, “It pays the bills.” The job serves a purpose, but it’s not the most important thing about them. They leave it off the dating profile.

While being a therapist doesn’t elicit the same societal reinforcement as being a surgeon, I think it comes with similar risks. It was often difficult to leave my therapeutic identity in the chair. I was a therapist when I drove into work, and I was a therapist when I left.

I think I underwent a charismatic therapeutic conversion. My identity had become consumed by my new public role, and my transformation into the therapeutic persona was too thorough. I became a therapist in every area. I read books about therapy and talked about therapy with my therapist friends. I attended therapy conferences and built my community around therapy. I even started talking in a therapeutic dialect: “reframe” this and “normalize” that. I became a born-again clinician. It wasn’t a good look for me.  

When I allowed myself to be overtaken by my therapeutic role, I stepped into this second unmanaged empathy trap. I was always a therapist behind my eyes, and so I was never without clients. This meant there were fewer places in my life to separate from suffering. Luckily, there was a way out. I didn’t need to accept that my personal identity would be consumed by my public role, but instead I could learn to do something requiring just a bit less personal investment.

Restructuring the Intrapersonal Dynamics of Burnout

It was those who worked less emapthically-demanding jobs who taught me how to escape this trap. Like them, I learned to create space between my professional and personal identity by prioritizing my private life. The person who drove into work became different from the person who drove away.

This meant treating therapy more like functional work and less like a totalizing identity. To develop a sustainable therapeutic career, I needed to nurture and protect my non-therapeutic self. I needed to cultivate an identity that rested more upon my private values and not entirely upon my vocational role.  

In order to do this, I adopted new endeavors that weren’t remotely connected to therapy. I also reconnected with old friends. These old relationships helped me remember who I was before I was a therapist. I didn’t use words like “schema” or “metacognition” back then. But in order to avoid the second unmanaged empathy trap, I had to avoid the charismatic therapeutic conversion. I had to cultivate a private life where my non-therapeutic self was expressed. It was when I allowed the part of myself that was disconnected from my therapy to engage the world around me that I could separate from suffering more easily. I could practice managed empathy there.

The Attachment Dynamics of Burnout

It seems that within human relationships there’s a spectrum of give and take. On one side of the spectrum, I’ve met the habitual givers. These folks are highly empathic and accommodating. As moons orbit planets, they orbit the lives of others. Orbiters rotate around the people in their lives and keenly discern and meet their needs. They’re natural satellites.

On the other side of the spectrum, I’ve met the habitual takers. It seems that these folks expect to be accommodated. They’re unaware or disinterested in the feelings of others. They often find it upsetting when others don’t adjust to them. They expect to be orbited. And of course, most of the people I’ve known fall somewhere in between these two extremes.

This spectrum became relevant to my eventual exhaustion because, like most therapists, I found myself closer to the cooperative patterns within the orbiters. The ability to assess and meet the needs of others had always come naturally, and so becoming a therapist was a perfect fit. Perhaps without knowing it, it was my cooperative predisposition that guided my professional direction. 

Eventually, problems emerged because of this strong cooperative urge. When decisions were made, I often found myself deferring to the preferences of others. Instead of imagining what I might enjoy, I would comply to connect. When people asked about where to go for dinner, I might say, “Wherever, I’m easy.” When asked if I needed anything from the store, I would respond reassuringly, “No, I’m okay with whatever you pick up.” I was engaged in need-mirroring. I think of need-mirroring as the reflexive matching of the preferences of others, and while it increases cooperation in relationships, it also leads to a life that’s directed by others. 

With my interactions often characterized by deference, I lost track of my own desires. My difficulties with a self-directed life became even more concerning when I tried to listen inward for my own preferences, but no inner voice responded. I could no longer locate what I sincerely wanted. It seemed that desire itself worked like a muscle, and because I hadn’t listened to myself for an extended period, this muscle eroded. I had undergone appetite atrophy.

Becoming locked into this orbiting orientation was the third unmanaged empathy trap that led to my exhaustion. It became difficult to separate from suffering when I was overly attuned to the perceptions and desires of others. While rotating around my clients was essential to my therapeutic work, when I orbited those in my personal life, it became difficult to know what I needed. But like the first two traps, there was a solution that helped me practice managed empathy. This strategy helped me restrengthen the muscle of desire, it separated me from the needs of others, and I became able to listen to myself once again.  

Restructuring the Attachment Dynamics of Burnout

The path to overcome my orbiting style was to express my needs more regularly within my relationships. Prioritizing myself more allowed me to move closer towards the middle of the spectrum of give and take, and this restored the balance within my interactions.

There were problems at first. I had practiced need-mirroring for too long, and when I tried to track down my desires, I couldn’t find them. So, I tried something simple. Instead of searching for my needs, I invented them. I practiced having a preference. When I got it right, it sounded something like this:

Them: “Where do you want to go to dinner?”
Me: “Eh. I don’t care, – you know what, I feel like Mexican food.”   

When I was halfway through need-mirroring, I tried to express an invented preference, instead:

Them: “I’m headed to the store. Do you need something?”
Me: “I’m good, thanks. On second thought, can you pick up some gum?”  

My objective wasn’t to detect and convey my deepest desires, but to practice expressing any preference at all. This was effective because the strength of my cooperative impulse had anesthetized my desires, and to lift the anesthesia, I needed to increase my comfort with being less cooperative. When I practiced expressing an invented need, I was creating a moment where I stood apart from the desires of others. I was practicing a small act of non-cooperation. Slowly, as my comfort within this non-cooperative space grew, my desires eventually reawakened, and I was able to express these desires within my relationships.

It’s a strength to orbit clients in therapy because this can help me perceive unspoken needs and adjust on their behalf. Yet when this tendency ran free in my personal life, I lost the ability to direct myself, and my exhaustion knocked at the door. But when I practiced having a preference and become more comfortable standing apart from the needs of others, my desires could be once again detected. This created separation from the suffering of others and a return to managed empathy.

***

While I once thought that empathy was an uncomplicated force for good, my exhaustion led me to conclude otherwise. Empathy is something that’s effective when guided, but it’s harmful when it’s not. Empathy is like water. It’s beautiful in the river, but not in the flood. However, if the traps that lead to unmanaged empathy can be understood and managed, the wisdom of the seasoned therapist can be cultivated without losing the spirit of the new one. That has and will forever be my goal.