In August 2021, history was made at the rarely visited intersection of the worlds of Olympic sport and mental health. Renowned gymnast Simone Biles intentionally chose to self-select out in an effort to protect her emotional well-being. Wow. Just wow. She respected that she was not strong enough emotionally to be able to perform at her best and decided to support her team from the sidelines.
I often ask myself, “When was the last time that I, as a clinician, ‘sat out’ because it was creating too much of an emotional struggle for me? And what does it mean to ‘sit out’ as a therapist? To not take on a new client? To limit the time I spend in my practice? To block out thoughts of clients when I am not with them? To do less? To be less?” While it may not always seem so, especially when clients are not in crisis, therapeutic stakes are typically high for them most, if not all, of the time. And I don’t want to do less at the cost of the therapeutic relationship, let down my guard or put either my client(s) or myself at risk or in a potentially libelous situation. Yet how this constant pressure to perform at the highest clinical and professional level does impact my physical and mental health.
Being a caretaker to my patients, my practice, and my own personal and familial obligations requires an ongoing Olympian effort. No breaks, no holidays, no weekends, no sick days. Always on. Always watching. Always watched. I don’t often have the luxury of turning off my mind, letting the next steps or decisions play out on their own. I don’t easily turn off my mind as I am always thinking about the next step or, even worse, what could happen.
I can’t just turn off and not take care of my patients, my child(ren), my family, my job, my house. And I don’t typically ask myself to make big shifts, as they can be too scary and abrupt. Instead, I try to think about changing the way I can more seamlessly (when possible) build in mental and physical breaks. I’m not suggesting that I regularly schedule weekend yoga retreats or hours at the spa. That kind of thing doesn’t work for me, although it sounds lovely. And these activities aren’t realistic for me at this point in my life.
My concern is with burnout, which I have come to recognize in myself in the following ways. It’s not an all-or-none thing, as I may experience variations on these themes at different times:
Shifting My Mindset
As a psychologist who has a strong sense of responsibility, I set unrealistically high standards for what I “should'' be doing on a daily basis. I am often anxious in my attempts to stay on top of it all. I attempt to anticipate and accommodate the needs of my children, family, friends, my employees, and my patients. You could call me an over-functioner. My natural tendency is to give, give, give, and I have a hard time receiving. This mind contributes at times to a feeling of being burned out, depleted, and resentful. These are some of the mental tactics I have tried:
Case Example
I have been working with a particular woman, a mother of two children with special needs whose anxiety mimics mine. Sometimes her anxiety triggers mine. She is often in tears during a session and feels like the demands of her world are many and overwhelming. She is burned out from her daily internal high demands that she believes she simply can’t meet. She feels that she has a “role” and “job” to complete each day, which is to tend to her children, husband, mother, siblings, friends, and her children’s school as a PTA member. Her self-care is forced and difficult for her to implement. During our sessions, I am very aware of how her experiences are very similar to mine, and how difficult it is to help her find good outlets for her anxiety and to help her set boundaries in her life. I often think, “I can dish it, but it’s so hard to take my very own advice.”
Find Boundaries and Set Them
Setting boundaries has always come hard for me when it comes to choosing myself over others. However, I have had some success with practice in saying (and sticking with) practicing some of the following:
Setting boundaries has also come for me with a ton of guilt. I have come to expect these feelings and so have learned to respect them, honor them, and let them pass. I have resisted the urge to return to the person I said “no” to and change my response. And the more boundaries I set, the more comfortable I have become. It has gotten easier. These have been important lessons that I have been able to impart to some of my clients who are willing to try to be different—for their own sakes. Sidestepping my own burnout has been the payoff. Helping my clients do the same is a bonus.
File under: The Art of Psychotherapy, A Day in the Life of a Therapist, Musings and Reflections
I often ask myself, “When was the last time that I, as a clinician, ‘sat out’ because it was creating too much of an emotional struggle for me? And what does it mean to ‘sit out’ as a therapist? To not take on a new client? To limit the time I spend in my practice? To block out thoughts of clients when I am not with them? To do less? To be less?” While it may not always seem so, especially when clients are not in crisis, therapeutic stakes are typically high for them most, if not all, of the time. And I don’t want to do less at the cost of the therapeutic relationship, let down my guard or put either my client(s) or myself at risk or in a potentially libelous situation. Yet how this constant pressure to perform at the highest clinical and professional level does impact my physical and mental health.
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Being a caretaker to my patients, my practice, and my own personal and familial obligations requires an ongoing Olympian effort. No breaks, no holidays, no weekends, no sick days. Always on. Always watching. Always watched. I don’t often have the luxury of turning off my mind, letting the next steps or decisions play out on their own. I don’t easily turn off my mind as I am always thinking about the next step or, even worse, what could happen.
I can’t just turn off and not take care of my patients, my child(ren), my family, my job, my house. And I don’t typically ask myself to make big shifts, as they can be too scary and abrupt. Instead, I try to think about changing the way I can more seamlessly (when possible) build in mental and physical breaks. I’m not suggesting that I regularly schedule weekend yoga retreats or hours at the spa. That kind of thing doesn’t work for me, although it sounds lovely. And these activities aren’t realistic for me at this point in my life.
My concern is with burnout, which I have come to recognize in myself in the following ways. It’s not an all-or-none thing, as I may experience variations on these themes at different times:
- Fatigue
- Agitation
- Feeling sad
- Difficulty formulating thoughts or sentences
- Struggling to make simple decisions
- Feeling waves of anxiety without a known trigger
- Overeating
- Undereating
- Waking up in the middle of the night and not being able to return to sleep
- Not being able to turn thoughts off at night
- Staying busy and distracted all day
- Feeling overstimulated—it’s too loud, it’s too bright, feeling over-touched
- Not being able to start and finish a task
- Noticing daily routines, like showering, seem complicated and laborious
Shifting My Mindset
As a psychologist who has a strong sense of responsibility, I set unrealistically high standards for what I “should'' be doing on a daily basis. I am often anxious in my attempts to stay on top of it all. I attempt to anticipate and accommodate the needs of my children, family, friends, my employees, and my patients. You could call me an over-functioner. My natural tendency is to give, give, give, and I have a hard time receiving. This mind contributes at times to a feeling of being burned out, depleted, and resentful. These are some of the mental tactics I have tried:
Instead of thinking...“I have to get this done today.”
I try to think…“If I don’t get this done today, I will get it done tomorrow or the next day.”
Instead of thinking...“I didn’t get enough accomplished today.”
I try to think...“I got as many things as I could get done today, and that is good enough.”
Instead of thinking...“I didn’t anticipate that well.”
I try to think...“I’m not a fortune teller, and I will manage whatever situation arises as it arises.”
Instead of thinking...“I can do more.”
I try to think...“I need to stop when my body and mind tell me I’m done.”
Instead of thinking...“Everyone needs me.”
I try to think...“I need to satisfy my own needs first so that I can be there for others. I need to fill my cup first.”
Case Example
I have been working with a particular woman, a mother of two children with special needs whose anxiety mimics mine. Sometimes her anxiety triggers mine. She is often in tears during a session and feels like the demands of her world are many and overwhelming. She is burned out from her daily internal high demands that she believes she simply can’t meet. She feels that she has a “role” and “job” to complete each day, which is to tend to her children, husband, mother, siblings, friends, and her children’s school as a PTA member. Her self-care is forced and difficult for her to implement. During our sessions, I am very aware of how her experiences are very similar to mine, and how difficult it is to help her find good outlets for her anxiety and to help her set boundaries in her life. I often think, “I can dish it, but it’s so hard to take my very own advice.”
Find Boundaries and Set Them
Setting boundaries has always come hard for me when it comes to choosing myself over others. However, I have had some success with practice in saying (and sticking with) practicing some of the following:
- “Thank you, but I’m going to pass.”
- “I appreciate you thinking of me, but not this time.”
- “Thank you, but that’s not going to work for me.”
- “That sounds good, but I’m going to take a raincheck.”
Setting boundaries has also come for me with a ton of guilt. I have come to expect these feelings and so have learned to respect them, honor them, and let them pass. I have resisted the urge to return to the person I said “no” to and change my response. And the more boundaries I set, the more comfortable I have become. It has gotten easier. These have been important lessons that I have been able to impart to some of my clients who are willing to try to be different—for their own sakes. Sidestepping my own burnout has been the payoff. Helping my clients do the same is a bonus.
File under: The Art of Psychotherapy, A Day in the Life of a Therapist, Musings and Reflections