My Experience(s) with Burnout
I decided it would be fitting (if not ironic) to reward myself for my one-year blogging anniversary with a post on burnout. I wrote this for The Practice of the Practice, a consulting agency for individuals in private practice. I felt like my transition to private practice mimicked a lot of the struggles my clients face in really figuring out the question, “what do I want?”
Note: This is a personal account, and should not be seen as reflective of each individual in the field.
The first things conjured when the term “burnout” gets mentioned — especially as a social worker (or teacher, I’ve heard) — is “overworked,” and “underpaid”. In my eight years in the field of public mental health, as opposed to private practice, the bulk of the supervision was task-oriented. This, because of the outsized volume of tasks (or, as in a treatment plan, a single task that gets repeated an outsized number times), an almost exclusive focus on productivity for the agency’s financial viability, and the “issue” that arose should productivity be deemed too challenging to meet. At some point late in the game, I began to realize the sad fact that it had almost nothing to do with patient outcomes.
Working For an Agency
The punitive culture at the outpatient clinic could be easily felt. If a client, perhaps one with a truly severe and persistent mental illness, were to complain about their therapist and want a transfer, it was seen as something negative on the therapist. I once, for no really good reason other than not a good fit, had two clients within two weeks request a transfer to a new therapist. When you have a caseload of over 50 clients, you can’t be expected to be proficient with every single one, it is impossible.
However, the way supervision occurs, as a task-based model and not a clinical one, any lapses in productivity were seen as lapses in proficiency and as deficiencies. In much the same way, the most successful practitioners are able to find their ideal client; I doubt that they have 50 of them on their caseload. And, as a client of a therapist, if he told me he had a caseload of 50, I’d likely find a different therapist!
Receiving an agency award earlier in that final, fateful year (ironically enough, for advocating for the well-being of the social worker) did little to mollify the pervasive effects that the volume of work was doing to my personal psychology. I remember it quite vividly, probably because my state of mind was one that was grappling with trauma. The Wednesday of the week after seeing 40 therapy clients for the first time in my professional career, I decided my burnout was too much to bear. And, I gave notice to begin a full-time private practice. Little did I know yet, but as Maslow predicts in his Hierarchy of Needs, there are varying degrees of burnout. It was the next degree that I found to be critical in getting the help and support I needed. And, can now enjoy my work and be compensated more fairly.
Working In Private Practice
But, in private practice, this is quite the balancing act. Because you are also in charge of growing your business and managing the inevitable ebb and flow. We do have a say in our actual caseload numbers — and building business in some ways means growing the numbers. So, especially in the beginning, the temptation can be to take on any prospective client and, too many of them. And, in my case, perhaps too broad of a range. The equivalent of getting “spread too thin” can really make you question the job you do. In perhaps one of my more meaningful mistakes, I agreed to work with a client who I questioned taking from the moment I spoke to this person on the phone for the first time. And, my feelings were confirmed shortly into meeting with him.
It was nearly impossible to have him referred out despite my best efforts. And, I would leave sessions feeling miserable about the work I was doing. In analyzing the case, I could see how masochistic his tendencies were. So, ineffective therapy was right in his comfort zone, and he deserved nothing more than that. Needless to say, this was not a good fit. But, it took almost two years (!) for us to terminate our work. I could say that I may have been just as burnt out, again. And that “again” was perhaps more disappointing to me.
This time, though, I was able to find a silver lining that was significantly more elusive in agency work. I was my own boss. And, there was not anyone who could tell me how to adjust my work, except for me. This was the first moment I realized how good we really have it. A sense of both power and control (defined by the individual) are universally innate needs. I began to take more training, wanting more knowledge, but also enjoying the educational process.
I found models that resonated with my experience as both a therapist and as a person. Emotionally-Focused Therapy and Focusing, both of which are experiential, attachment-centered in the case of EFT, and delving into the human struggle. When it felt like a natural fit for me, the orientation with which I was choosing to practice, each client became positive energy because I could feel capable of practicing my style.
Learning From My Burnouts
Burnout can be a “concrete” numbers issue. We see too many people, and even though conceptually we are feeling good about the work we are doing, it eventually will be too much to bear. We may even take on more and more because of the false perception that we can solve everything at the rate we are going. But, when it comes to being our own boss, burnout is something to which we can be even more susceptible. This is because there is an emotional component of defining what the work is that will be most fulfilling. AND, how much of it I need to do. We have so much control, sometimes that’s all it takes to get in our own way.