What Burns You Out?

In the previous post, I talked about therapists being pushed to the point of exhaustion. A few weeks ago I came across a recent study on burn out and job satisfaction affecting client outcomes.

Therapist burnout was linked with poorer anxiety and depression scores. Plus, lower job satisfaction was associated with poorer depression outcomes. This seems to be the first study to demonstrate a link between our wellbeing with clients anxiety and depressive symptoms.

As you read this, you might be thinking this hardly anything new. Yet, this isn’t a trivial matter. Because it’s about a person’s wellbeing. That’s you.

I will address two primary components that contribute to burnout. At the end of this blog post, I offer suggestions on how we can recalibrate ourselves.

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#1. The Trappings of Busyness:

There is almost little chance of escaping busyness.

Here’s the predicament. The more we chase time, the faster time speeds up.

Time is a currency of life, that we have no exchange for.

Henry David Thoreau famously said, “It is not enough to be busy. The question is: what are we busy about?” I suspect, in many ways, we wear busyness like a badge of honor. If I’m sauntering through life, it might seem we are not productive, not in demand, not wanted for the good that we can do.
I analysed the way I spend my time. The amount invested in truly productive work is a fraction of the noise.

Emails are the biggest culprit. Next comes my mobile device, nudging me with silent vibrations from time to time. Oliver Burkeman writes an article in Philosophy, titled Attentional Commons, “Information overload isn’t really the problem at all. Our true plight—in this world of overfilled inboxes, push notifications and digital billboards—is an overload of attempted communication: a cacophony of efforts to stake a claim on our attention.”[1]

“Attempted communication” from our mini-bots in our pockets has a cost. Every time a bing goes off, it fractures our attention. In an “attention economy,”, we are at high-risk of becoming a divided self.[2] Here’s Burkeman again: “The obvious comparison here is with money. If any stranger could remove a few dollars from your bank account whenever they felt like it, you’d rightly be incensed—and they’d be guilty of a crime. Yet that’s exactly what happens with attention.”

Every time a new message comes into your inbox within the therapy hour, even when you do not attend to the notification, your cognitive load is split. Every time you wander off to another matter, we veer off into another territory, away from our original intent.

“Thus we are busy people just like all other busy people, rewarded for the rewards which are rewarded to busy people.”

~ Henri Nouwen, from The Way Of The Heart, p.22.

If Nouwen (one of my favorite authors) is correct, we must admit that busyness is, a trap to a good life.

#2. Emotional Demands

We don’t address this often enough in the practice of psychotherapy. Working with strong and difficult emotions on an almost daily basis enriches the depths of how we see and experience life, but it is also nonetheless taxing.

Take, for example, notice the effects on you after working with a suicidal client. It’s near impossible to switch off the rumination. Typically, it isn’t just because of a given case that wears you down, but a composite of that, with a heavy caseload, demands outside of the clinical practice, and things going on at home.

Two other emotional drains: When we do not know if we are effective, and when we know we are not effective. The first is easily solved by systematically measuring your client outcomes at every session. The second is more confronting. It requires you to dig a little deeper and come to terms with the fact that the actual practice of psychotherapy, can longer continue as an individual sport. You need guidance from someone you trust.[4]

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Embodiment:

There isn’t an easy answer to all of these.[3] Most of the time, unfortunately, we begin to take heed of the effects of burn out when I’d body speaks—actually when it screams. That’s when we fall sick. Recently, I have a bound of gastric that was atypical. It lasted longer than a week. I could either do one of two things: Treat this a noise, or listen to this as a signal. Looking back, I admit that was pushing myself too hard. Trying to stay on top of deadlines, making enough money, managing various projects, attending to clients’ crisis, and trying my best to be a good father all at the same time. I’m embarrassed to say, my wife and kids pay the price.

So maybe the following advice is autobiography[5]. Go through each of them, and take on board whatever you like, spit out those that don’t sit well with you.

Tips:
#1. Build {White Spaces} into your schedule.

{White Spaces} means do nothing. Build in slack between your busy schedule. Treat it like any other event. Like driving, give ample buffer space in-between you and the driver in front of you. This allows you to be responsive to anything that might creep up. Refrain from scheduling meetings or activities one after another. By incorporating {White Spaces}, this gives you time to think. Moreover, this prevents us from falling prey into a planning fallacy. We tend to believe we can squeeze in more than we can manage.

#2. “X” multiply by 1.5

We think we can get more done that we really can. Because of this planning fallacy, we schedule things more than we can handle. Meetings often end later than scheduled, and that leads you to be later than you hoped for at the next meeting. It’s a snowball until the end of the day. Even getting home from dinner gets delayed.

A good method to inoculate from this bias is to multiple all planned activities by 1.5.[6] In other words, if I have a 1-hour meeting scheduled at 9am, instead of locking it in till 10am, I will block out 9 to 1030am. If the meeting ends on time – a rare treat – take that time to consolidate key points from that meeting, get going with any follow-ups, or give yourself a breather.

(Note: I’d encourage you to this in your clinical practice, giving you just enough time to catch your breath between sessions.)

#3. Stress And Recovery

Contrary to popular belief, stress is not the enemy. On average, it takes approximately 20-23mins to get into a state of full absorption into a given task, and based on our ultradian rhythms that regulate our physiology when we are awake, we can typically expend our full focus on an activity for no more than 90-120mins at a stretch. If we attend to exert and prolong our exposure to stress without breaks, our performance decline.

On the other hand, as noted by authors Lohrer and Schwartz of the book, The Power of Full Engagement [7], in order “to build capacity, we must systematically expose ourselves to more stress – followed by adequate recovery.” (p. 43; see second graph above). Introducing mini-breaks such as getting off your seat, going for a short stroll, or a short 15min nap, introduces an important function of recovery that promotes better subsequent performance and mental agility.

#4. Mind That Body (Not “Mind Over Body)

Convention wisdom prescribes the notion that we can use our minds to overcome our body to perform in accordance with our will.

Listen to your body. Can you tell the difference if you are depleted of energy due to lack of proper nutrition, or if you are sleepy due to fatigue? Do you notice the difference in how your body feels when you are angry, anxiety, or happy?

Our body holds important information as to how we are feeling. Tuning in to our physiological states, and taking care of it, is a vital component of not only physical health, but also psychological health. In fact, being mindful of our physiological state is a core component of emotional intelligence!

The mind-body relation is not as distinct as we think it to be. This is why physical exercise has such a profound positive impact on alleviating low moods.

Our mind is there to take care of itself, as well as our body. When we take care of our bodies, our mind is then able to perform at its peak. (Note to self).

#5 Visionary Time

Finally, set aside time attend to your development. Professional development often starts with an experience of personal growth. Nourish your learning needs. Take the time to figure out what you need to work on to get better in your craft before figuring out how to improve. A sense of development is inoculative of burnout.[8]

Feeling overwhelmed is not necessarily a function of having too much to do but rather not knowing what to do next. Invest in the time to do this. It’s a gift to your future self. (If you are interested, join Scott Miller and I this summer for a two-day deliberate practice intensive in Chicago.)

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YOUR TURN: I love to hear your stories. What burns your out? How do you deal with this?

Til next time,

Daryl

 

Notes:
[1] Attentional Commons, by Oliver Burkeman. The New Philosopher magazine, issue #17. 2018.
[2] The Undivided Self, by Parker Palmer. I love the Souds True Production of this Interview conducted by Tami Simon. Available on Audible.
[3] See John Norcross’s book on the topic of Self-Care, Leaving It In The Office.
[4] See posts on Supervision/Coaching, e.g., Everyone Needs a Coach.
[5] I first heard author James Altucher use this phrase.
[6] I learned this method from Cal Newport’s blog.
[7] I highly recommend this book. The Power of Full Engagement, by Lohrer & Schwartz, 2003. In the book, they offer any useful idea: Focus more on energy management than time management.
[8] See this article in Psychotherapy Networker by Scott Miller, 2015, Burnout Reconsidered