Therapy and burnout

I get a number of emails from folks outside of New York asking questions about therapy. High school students looking for advice on therapy as a career or a young therapist asking for tips on starting his or her own practice. A few months ago I got on that has me thinking about what it means to be a therapist, how I think about the practice of therapy, and  how those views of mine line up against some broader assumptions about how psychotherapy works. I asked the sender if she'd mind if I responded here, and she happily consented.

She writes:

I am about to graduate with a degree in Sociology. While I'm not exactly sure what I want to do after May, I've been looking into the possibility of getting a MSW and then becoming a licensed therapist. This work appeals to me because I really want to help people and have a sense of purpose in my future job. I am however concerned that I will feel overwhelmed. How did you find a balance with your work as a therapist so that you don't get burnt out?

Burnout is a topic in a number of professions, but it has it's own connotations in therapy. Like doctors and social workers, therapy is an profession that's about helping others.

As the story goes, because of the intimacy of the work and the ways that therapists make use of themselves as emotional vessels in the relationship as a means for helping their patients grow, many assume therapy to be taxing, particularly intense, and therefore particularly draining.

Therapy is hard work and, when done well, it is particularly intimate. Sometimes I leave work at the end of the day feeling tired, as anyone can, but to be honest, I don't feel spent. I'm not burning out. Tired or not, most of the time I feel inspired. Rejuvenated, even. Quite the opposite of burnt.

Which has me thinking about why, in a field with so much talk of burn out I'm, well, not burnt.

Challenging the assumption that helping in therapy yields a net loss of energy

It's a simple formulation of Newtonian physics: If you expend energy you're left with less to give out until that energy gets replenished elsewhere. The assumption that gets carried over when it comes to therapy is that the therapeutic encounter is a fundamentally depleting one. The therapist expends energy that is received by the patient. The patient leaves the session with more energy (caring, good will, strength, support) and the therapist with less.

This transactional way of understanding the therapy session--the therapist gives, the patient receives--is a fine image. Only it's not the only way--and in my view the best way--to understand or to practice therapy.

Let's re-imagine the scenario. Rather than one person receiving from another we conceive of the encounter as two people coming together to create a growthful, meaningful experience. In this frame both parties exit the encounter with a net gain of energy. The encounter itself produces more--discovery, joy, meaning, love, excitement.

Self care

So called self care is generally cited as the antidote to burnout. Therapists are fond of commenting that they're taking a "self-care" day and heading out of NYC, taking in a yoga class or spending a day in the park. Of course, this implies, these things are done to prevent burnout. In this framing, taking time to enjoy recreation, exercise or plan time away is given a special meaning. Therapy is specially depleting and therefore a therapist must specially replenish: We don't take days off, we take "self-care" days.

Which begs the question: If the practice of therapy--building with folks to help them create their lives--is so unhealthy for therapists, is it so safe for their patients?

Taking care of

Another question comes to mind as well: If taking care of others in this particular way is so depleting as to require a special sort of care of the helper (the therapist) then maybe therapists aren't such a great model for helping. Perhaps the very way we conceive of helping needs a revisit.

I care about my patients a great deal. But I don't think about my work as taking care of. My work as a therapist with people who are depressed or anxious or whatever my patients are struggling with isn't to take care of them in their suffering--it's to change it.

I'm not a caretaker. I'm a firefight. A kick-in-the-rear giver (when needed). A complacency preventer. A discoverer of possibilities. An explorer. A co-constructor of new ways of being in the world. And does that leave me burnt out? Not hardly. It's INVIGORATING!