Burnout Among Therapists in Trying Times

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There seems to be something of an epidemic among psychotherapists, with almost half reporting they are burned out (Lin et al., 2023). Burnout is worse among therapists who report their own systemic marginalization on a societal level (Shell et al., 2022). It’s hard to read news about or directly experience racism, Islamophobia, antisemitism, and so on and then absorb the painful stories of patients. It’s hard to relate to patients who take the other side on disputed hot-button issues. Indeed, relational depth between therapists and patients seems to protect against burnout (Zarzycka et al., 2023). Presumably, relational depth means mutual acceptance of differences, not insistence on uniformity of opinion or appearance.

It may be that, as architect Louis Sullivan once said, the “problem contains and suggests its own solution.” Thus, the APA Monitor article cited above says, “These findings highlight the continued need to support psychologists as they care for their patients” (emphasis added). Perhaps the problem is that so many therapists “care for” their patients rather than treat them; perhaps it is ineffective and misguided “to support psychologists” rather than to challenge and excite them.

Sure, the support of both clients and therapists may sound good on the surface, but it is bound to produce burnout because it is bound to be ineffective in the long run. Indeed, the whole reason psychotherapy had to be invented is that comfort and advice and validation don’t change the personality patterns that interfere with a person’s life. If there are no personality patterns interfering with the patient’s life, they shouldn’t be in therapy. Therapy should help patients get better, not feel better.

Burnout, behaviorally, is a state of extinction, a lack of reinforcement.

For therapists, this mainly comes from patients not getting better. Also, the initial pleasure in getting praise from patients wears thin after a while and stops being rewarding. The cure for burnout in therapists is to get better at doing therapy, not to get support, just as the cure for a batting slump is coaching, not validation. Indeed, many therapists end up seeking validation, support, and advice from their patients (although I’ve yet to meet the therapist who pays the patient when this happens).

As just one example of managing patients’ reactions to the news, the therapist doesn’t need to agree or disagree, condole, or instruct. Instead, the therapist can note that the vast majority of the patient’s reaction is to the news itself, but a small part of the reaction has to do with the patient’s personality and the reason for the therapy. The therapist can then explore that piece of the reaction. By thus practicing therapy and not politics, it’s a chance to do something efficacious.

If reading or watching the news activates us and makes us want to proselytize our patients to our point of view, let’s stop watching the news. Let’s read history instead. (Unless you’re Armenian, Jewish, or Native American, as examples, then maybe you’d better stick to fiction since their histories are pretty depressing.) If we’re zoning out in front of sitcoms, let’s remember that there’s nothing funnier than psychopathology, people sticking with their outdated map regardless of where it takes them, like poorly programmed robots. To regain our comedic sensibility, let’s observe our patients’ attachment to their ineffective patterns; for that matter, let’s observe our own commitments to being nice, to being supportive, to being right, even though they leave us feeling self-righteous but ineffective.

If we escape from unpleasantness by doing puzzles, let’s remember that there’s no puzzle more interesting than decoding our patients’ metaphorical communications about how they are really experiencing us. People without power, like patients, speak in parables. Interpreting their parables is intellectually engrossing, and it’s also exciting because they are almost always about us.

If clinical theories are good enough for our patients, they’re good enough for us. If we’re a burned-out ACT therapist, let’s try using the hexaflex on ourselves. Defuse ourselves from our politics, say, or stay in the present when we are in the therapy chair, or get some perspective on ourselves. If we do CBT, let’s examine our belief that the world shouldn’t be the way it is, that it sucks. If we practice psychodynamically, let’s explore the righteousness and moral superiority with which we process news reports and rediscover how hopeless, how without hope, it is to perform the part of an angel.

Therapist burnout is largely a consequence of the contemporary movement to tell patients how terrific they are and how unjust the world is. This doesn’t work. It makes patients more dependent on the therapy, and it also makes them more depressed, one of depression’s key features being the belief that the world is a bad place. It defines the therapist’s role in a way that is exhausting rather than intriguing. Then, when these therapists start to feel burnout, instead of using clinical theory to activate themselves, instead of seeing the burnout as the result of their own ineffective repertoire, which needs improvement, they tell themselves how terrific they are and how unjust the world is.

Burnout and depression are signs you need new skills, not signs that you need someone to commiserate with you.

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