Therapist Heal Thyself: Strategies for preventing burnout in 2020 by Elizabeth Scarlett

Therapist Heal Thyself: Strategies for preventing burnout in 2020

by Elizabeth Scarlett, RP

Many mental health professionals are finding themselves increasingly exhausted, cynical, or ineffective in their work during this COVID-19 pandemic. Burnout can hide in plain sight. The good news is that there are practical internal strategies to help address it. These may require some deep reflection and adjustment, but offer a significant return on that investment.

In 2019, the World Health Organization classified burnout as an “occupational phenomenon...resulting from chronic workplace stress that has not been successfully managed.” Adding to the usual stressors we experience, providers of mental health services have felt the significant demand of responding timely and appropriately to COVID-19 while also supporting anti-racism initiatives following the deaths of both George Floyd and Regis Korchinski-Paquet, among so many others, at the hands of the police. Our world is changing, public safety is on the forefront of everyone’s minds, particularly for vulnerable, marginalized, or racialized clients. These issues combine to make mental health support more essential than ever. And all the while, in the background, helping professionals face the threat of job burnout. How can we address this?

Let’s take a step back and explore the origins and components of burnout. Burnout is not a new term for most mental health professionals. It was first coined in the 1970s by American psychologist Herbert Freudenberger. Since then many professionals, most notably Christina Maslach, have extensivelyV researched the syndrome. The Maslach Burnout Inventory (MBI) is a commonly used tool for measuring burnout by looking at three components: emotional exhaustion, depersonalization, and personal accomplishment. Yet, there are very few practical interventions to prevent and cope with burnout. I myself took a 14-week mental health leave from work in 2018, during which I invested some time researching burnout and self-care. Online checklists fell short. While suggestions to get a massage, join a yoga class, and walk in nature are helpful to a degree, they didn’t improve my symptoms.

In retrospect, I disregarded the signs of burnout for years. I felt exhaustion, cynicism, and sense of inefficacy building within me, but attributed them to one or another external cause. Efforts I attempted to combat these symptoms often backfired. For instance, I jumped into new projects, and. by doing so, increased my sense of overwhelm. I never lost my love for what I do, yet I found myself dreading going to work. At the end of the day, I would stare blankly at my computer screen as my case notes piled up.

The internal pressure was mounting. I ignored these symptoms until they became too painful to ignore and I finally acknowledged that I was experiencing burnout, with support and encouragement from my doctor, therapist, and loved ones. During my leave of absence, it became obvious to me that self-care was the primary method to prevent and heal burnout, but that self-care needed to go beyond the tasks that are just healthy or enjoyable. True self care needs to extend into one’s mindset and be driven by core values. I was trying to “fix” my burnout by external means. While the activities I chose were, and still are, a vital aspect of warding off burnout, internally deciding how I’m spending my energy, and shifting priority to putting my own needs first, made the real difference. I need to remind myself now, more than ever, of this lesson, especially since many of the external self-care options are greatly reduced during COVID-19.

Burnout prevention has since become the focus of my practice, the Behavior Elevation Academy, which I now operate in collaboration with Dr. Julia Moore, Senior Director of the Centre for Implementation, developing courses and articles grounded in the latest research Here are five practical activities that have a broad appeal to therapists and their clients. They can be summed up by the word VITAL.

V—Values Triangle: Personal core values are the foundation to burnout prevention. At the peak of a burnout, values can be easily overlooked. Summarizing your core values into a top three (a values triangle) creates a simple gauge for where to focus your energy when you are feeling distressed, overwhelmed, or detached. For example, my values triangle is simplicity, curiosity, and connection. I refer to this triangle as my “true north” to guide me back to what matters most to me whenever I find that I’m feeling out of sorts. Consider what values are here to help guide you. I—Ideal day: This is a simple activity that helps to apply your core values into a vision of a future where you are thriving. Imagine that it is a few years in the future and your life is how you wish it to be. Now, in as much detail as possible, describe a typical day in this idealized life.

This activity not only helps to set goals and harness the power of imagery, but also helps to tune in with what already is working well in your life.

T—Time for self: Carving out time for yourself on a regular basis is the key to re-charging energy and overcoming exhaustion. As mental health professionals, we often become “other” focused. Being proactive about allowing time for reflection, planning, and acknowledging our accomplishments enhances our energy, focus, and sense of purpose.

A—Acknowledge negative self-talk: This is one area that we as therapists may be academically knowledgeable about, but we don’t always personally apply it. Our cynicism is often encouraged by our negative self talk about ourselves and others. If we start by noticing our automatic thinking patterns, it is a key step to shifting them.

L—Limit obligations: One element of burnout is the sense of inefficacy. Many of us get lost in a never-ending to-do list and the many demands that sometimes cause us to feel unproductive. Addressing this means learning to say no, setting (and maintaining!) boundaries, and remembering that you are just one person. There is always more work to do and there are always more people to support. Yet think of the example we want to set for others. Moving away from a sense of self-sacrifice and toward self-compassion is a gift that starts with us and has a positive ripple effect to those around us.

As you can see, these concepts are simple, and they need to be. When you’re in a state of overwhelm or burnout you don’t have the time or mental energy to take on much. However, these are all activities that, when regularly revisited, can help one thrive and avoid burnout.

I will admit, over the past several months of self-isolation, while dealing with uncertainty about the future as well as undertaking a deep personal exploration about my own racism and white privilege, some old familiar burnout symptoms have started to show themselves again. Perhaps, though, this is a time of opportunity for many of us. Self-care is not limited to the actions we take, but also requires that we recognize our personal values and needs, and engage in self-compassionate inner-dialogue.

Self-care is not something to fit in when we have time. As helping professionals, we have a responsibility and ethical obligation to take care of ourselves and refresh our energy so we can best support others. It is still a work in progress for me to recognize my own needs and “paying myself first” with self care, but I truly believe that more open discussion about this topic is an important step to ensure that the helpers are helping themselves.

About the Author

Elizabeth (Carey) Scarlett is a Registered Psychotherapist with the CRPO based in Toronto, Ontario, with over 15 years experience in the mental health field. She specializes in serving clients with concurrent substance use and mental health concerns in a wide range of environments. She is especially passionate about her work providing trauma informed care, teaching suicide intervention strategies, and supervising new clinicians. With Implementation Scientist Dr. Julia Moore, Elizabeth is the co-founder of the Behavior Elevation Academy, offering blog posts, online courses, and resources geared toward moving toward thriving and away from burnout.