The Root Cause of Therapist Burnout
There have been many articles written about and research done on the causes of therapist burnout. We can all name the main ones, like high workload, lack of support, and insufficient self-care.
But how is this different to any other industry? Other employees experience burnout for similar reasons. How is it different for therapists?
I think the root cause of therapist burnout is therapeutic ineffectiveness, i.e. having a strong desire to help our clients, but not being able to do so effectively.
Therapists got into this line of work because we want to help people heal and improve their lives. When we can, it feels like we’ve fulfilled our purpose. But when we can’t, we get discouraged. We feel like a failure.
The key factors that can make us less effective as therapists are the organisation we work in, the clients we work with, the modality (or modalities) we use, our personal circumstances, and our internal capacity.
If we can figure out what makes us feel ineffective as a therapist, we can prevent or reverse burnout.
1. Organisation
As a therapist in an agency or group practice, you may face constraints in terms of your caseload, the type of clients you see, the hours you work, the modalities you use, and the administrative or marketing work you’re assigned.
You may not have as much support as you might need from your management, supervisor or colleagues, as everyone is subject to the same pressures. And you may not resonate with the organisation’s culture and values.
It’s hard to be effective as a therapist when you feel overloaded and undersupported. It’s a fast-track to moral injury and burnout.
So should you stay or should you go?
If you haven’t already done so, you can start by identifying the specific issues that are causing you to be less effective as a therapist, and to have an open discussion with your supervisor about this.
Agencies and group practices have a mission to attract and support clients. By framing organisational problems in terms of their impact on clients (not just on you), you are giving your organisation an incentive to make changes.
If you’ve already done all you can and nothing has changed, then please consider looking for a role elsewhere. You and your clients deserve better.
Reflection:
What workplaces practices make me less effective with my clients?
What adjustments can I reasonably make or request, e.g. reduced caseload, less admin work, more supervision?
If nothing is going to change at my current workplace, what’s holding me back from leaving?
2. Client
On one end of the spectrum, you won’t be effective as a therapist if you have too many clients, or too many complex or high-risk cases. This will be too mentally, emotionally and physically taxing, and you won’t be fully present for every client.
On the other end, you won’t be effective either if you have too few clients, or too many straightforward and similar cases. You won’t feel challenged; you won’t grow. You’ll feel jaded listening to “the same old stories” again and again.
Neither will you be effective as a therapist if most of your clients are not a good fit for you. For example, if you see mostly youth but prefer working with adults, or if most of your clients present with anxiety but you prefer working with grief and loss, sessions will just feel harder and more tiring for you. You won’t be able to get into a flow state.
It’s impossible to strike the perfect balance all the time. But I’d suggest you aim for around 80% of your clients to be the right fit for you, and to spend a maximum of 60% of your time seeing clients.
Reflection:
What volume or type of clients would enable me to be most effective?
What adjustments can I reasonably make or request, e.g. to see fewer, more or different types of clients?
Is there any additional training I could do in my area of interest?
3. Modality
You won’t be effective as a therapist if you use a modality that’s a wrong fit for you or your clients. You’ll feel frustrated, like you’re pushing against a brick wall. You’ll start to think that the client is “resistant”.
If you like the type of clients you’re currently seeing and the modality you’re using, but aren’t seeing results quickly enough for some clients, then consider whether you’re using the right modality for those clients.
But if you find that you’re struggling with most of your clients, or if you can’t get fully on board with the modality you’re using, then it may be that the modality is not a good fit for you.
For example, a modality that focuses on clients’ emotions may come very naturally to one therapist, but may quickly drain another. Or a modality that targets clients’ thoughts may be intellectually invigorating to one therapist, but feel too cognitive to another.
These days there are almost as many modalities as there are therapists. I think it’s because each client and therapist is unique, and so is the way they heal. If your modality isn’t working for you, be open to exploring others. You may find other modalities you resonate with more, or perhaps you’ll integrate and create your own blend.
Reflection:
Which modality makes me most effective with my clients?
Do I resonate more working with the head, heart, body, or brain?
Are there any free online resources, e.g. YouTube videos, PESI courses, that could give me a taster of other modalities?
4. Personal Circumstances
Therapists are also human. We have our fair share of health issues, caregiving load, financial stresses, and relationship problems.
But it’s obviously hard to be fully effective with our clients when we’re feeling overwhelmed or distracted.
Being a therapist can feel like a mission, a calling. We can end up putting our clients first – above our relationships, our health, and certainly our happiness. But in the long run, this leads to exhaustion, resentment and burnout.
I don’t know what your life circumstances are, but I know you’re doing your best and still showing up for your clients every day.
If it feels “selfish” to put yourself first, maybe this could be a bridging question: What changes could you make in your life to be more effective for your clients?
Maybe you need to let go of some things, or maybe you need to ask for support for other things. There’s no shame in applying the advice we sometimes give to our clients. It’ll make you a better therapist and, more importantly, a healthier and happier person.
Reflection:
What’s making me feel exhausted, overwhelmed or distracted?
What impact does this have on my effectiveness as a therapist?
What are 3 changes I could make that would have the most impact?
5. Internal Capacity
Why were we drawn to this profession? I think for most, if not all, of us, it’s because we too were wounded, suffered, and healed. And we want to use our experience to help others.
None of us will ever be “fully healed”; we learn and grow every day. But to be effective as therapists, it helps to be “mostly healed” and able to self-regulate. We’ll still face hurt, disappointments and setbacks, and we’ll still feel upset. But we should have the skills and resilience to process such events quickly and get back on track.
If you know you have unresolved trauma, or if you often get dysregulated and find it hard to shake it off, or if you find yourself ruminating frequently - then do consider going back to therapy.
When our internal world is turbulent, we’ll be more sensitive to stress, fatigue and countertransference. We won’t be the best therapist (or human) we can be.
I know that going to therapy takes up precious time, money and energy, and can even feel like a mark of failure as a therapist. But you can use your knowledge, experience and network to shop around for a modality and therapist that suits you and the issues you want to work on.
For example, many of my therapist clients come to me specifically for MEMI or Brain-Switch 2.0 because they work fast and don’t require sharing of details. I also share with them techniques for self-regulating after intense client sessions (see my blog post, “When Therapists Need Therapy”).
Reflection:
How happy am I?
How often do I get upset and how quickly can I calm myself down?
What’s holding me back from getting the help that will make me happier and a better therapist?
An Invitation
Therapists are one of my favourite type of clients to work with - definitely no burnout there!
I’m always moved by your dedication to your clients, to being the best therapist you can be for them. I know that when I help you, I’m also helping hundreds of your current and future clients.
If you want to explore working with me, reach out to book a session or an introductory call. I will treat you with the respect, dignity and professional courtesy you deserve.
Eunice Tan is a trauma-focused psychotherapist and the founder of Free From Trauma. Specialising in neuroscience-based approaches like MEMI and Brain-Switch 2.0, she helps clients and fellow therapists resolve painful memories and move forward with hope.
