“There’s no shame in taking a step back to focus on self-care.” As I was saying this to one of my clients recently, it hit me: if I truly believe that, then I need to practice what I preach! It was obvious to me that my client was suffering from burnout, due to the demands of her job as a mental health professional as well as her family caregiver responsibilities, and equally obvious that she absolutely deserved to set some boundaries, ask for help, and take a break to recharge her batteries. And yet, even though I was beginning to see signs of burnout in myself, it was a real struggle to acknowledge this, and give myself the same permission to step back.
This is the dilemma that many of us in the helping professions face: if you’re a nurse, doctor, psychotherapist, social worker, or teacher, you may have received training to recognize the signs of burnout, and you may know what to tell your patients, clients, or colleagues to do to relieve it. In fact, you might spend your days counseling others to take a step back, set some boundaries, reach out for help, and get some rest. But when it comes to you, you’re far more likely to tell yourself to just push through the exhaustion, and ignore the growing cynicism and feeling of detachment from the work that you used to love.
So what exactly is burnout? The World Health Organization (WHO) defines burnout as “a syndrome resulting from chronic work-related stress, with symptoms characterized by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.” It is not a medical condition or mental disorder.
Christina Maslach, professor emerita of psychology at UC Berkeley and co-author of the Maslach Burnout Inventory (MBI), describes burnout as “feelings of exhaustion, inefficiency and cynicism, defined by a detachment from work and a lost sense of meaning.” Developed in 1981, the MBI was the first instrument to measure burnout, and remains widely used today.
Are people in the helping professions more likely to experience burnout? According to recent surveys [3,4], burnout seems to be growing among workers across occupations, fueled by COVID-19 pandemic-related trends in working from home, remote schooling for children, and staffing shortages. But healthcare workers and educators have been hit the hardest, and even prior to the pandemic, these occupations have historically been most impacted by burnout. To understand why, we can examine the traits of people who are most vulnerable to burnout, but even more importantly, we need to look at the characteristics of jobs that burn people out.
Burnout doesn’t happen to slackers, but rather to those who are the most conscientious and hardest working, and who regard their work as a calling. The traits of people who are most vulnerable to burnout include:
- Being a helper, by nature or occupation;
- Scoring high on conscientiousness and agreeableness (Big Five Personality test);
- Taking pride in one’s work ethic and dedication;
- When the going gets tough, they don’t quit, they just work harder; and
- They believe that asking for help is a sign of weakness.
Do any of those ring true for you?
Burnout is caused by chronic and excessive job-related stress, not by any deficiency in the individual. The characteristics of occupations that have highest rates of burnout include:
- Involving the provision of direct services to people in the areas of health, mental health, and primary education;
- Responsibilities are loosely or vaguely defined, additional responsibilities are constantly being added;
- Success is difficult to measure, there’s never an endpoint or goal post;
- Rewards are intangible, few, or fleeting;
- Job demands exceed what is humanly possible, given time and resource constraints.
Therefore, it is increasingly difficult to do the job well, or meet the needs of those you are supposed to serve. Does this sound like your job?
How do you know if you’re suffering from burnout? In my experience, these are the key signs:
- You’re more impatient or irritable than usual;
- You don’t feel well-rested after a night’s sleep;
- You’ve stopped doing activities that normally bring you pleasure or involve self-care;
- You find yourself saying or thinking more often, “I just don’t care” about your job; and
- You don’t feel ready to go back to work after your regular days off.
You may also find yourself getting more and more behind on routine work and household tasks, and thinking more often about quitting, changing jobs, or retirement.
A key point: burnout is not the same as depression. Because there is a significant overlap of symptoms, those who are suffering from burnout may believe, or may be told, that they’re clinically depressed, however, the causes of burnout are different, and so is the treatment. (Of course, it’s possible to have both burnout and clinical depression, in which case you will need to address both conditions.)
What is the treatment for burnout? Ideally, a signficant amount of time off work. For some people, a couple of weeks might be enough, for others, a month to a year may be needed. Of course, this is not possible or realistic for many people, so then you will need to implement these self-care tasks while continuing to work:
- Start with setting some boundaries. Learn to say “no,” or “not now,” and let go of any non-essential tasks;
- Ask for help from colleagues, or delegate if you can;
- Prioritize getting more sleep and exercise, eating healthier, and reaching out to family and friends for social connection;
- Change your attitude or approach to work. Become willing to be “good enough” rather than “great;” commit to leaving work on time, or if you work from home, create boundaries to separate work from home and family life;
- Take some time to review your life goals, and what gives you a sense of meaning and purpose. If it’s not your job anymore, then begin to explore other options.
- Finally, I highly recommend seeking out a psychotherapist to assist you in this process.
When I saw my client again, she seemed a bit happier, and reported that she had set some limits with the family members who had been most demanding of her time. She’d also resumed her exercise routine, was making plans for a trip with friends, and was actively looking for a job that was less direct-service oriented. And how did I address my own incipient burnout? I have decided to take a break from teaching mindfulness classes, even though I love doing so, to give myself more time for rest, relaxation, exercise, and visits with friends and family.
1. Burnout an “occupational phenomenon”: International Classification of Diseases WHO. 28 May 2019. Referenced in Wikipedia page on occupational burnout.
2. Christina Maslach, quoted in Zuckerman, C (2021, April 30) How to Beat Burnout without Quitting Your Job. NYT online, retrieved March 28 2022.
3. Survey by Robert Half Int’l, referenced in Maurer, J. (2020, December 16) Remote Employees Are Working Longer Than Before. Retrieved from SHRM HR Today, online ed.
4. Threlkeld, K. (2021, March 11) Employee Burnout Report: Covid-19’s Impact and 3 Strategies to Curb It. Retrieved from Indeed.com.
5. From “The Exhaustion Funnel,” handout from my MBCT course.
In a recent poll, 70% of Americans agreed with the statement: “It’s time we accept that Covid is here to stay and we just need to get on with our lives.” New York Times writer Charles Blow cites this in last Sunday’s column, and goes on to say, “The number of lives taken by Covid in this country alone – north of 900,000 – is almost unfathomable. But, somehow the public has absorbed and reckoned with it in some way. We have taken on a Darwinian sensibility about it all, accepting it as sudden thinning of a herd, a form of natural selection. It is both sad and stunning.”
I’m not sure I agree with Blow’s take on the poll results. To me, they speak of denial rather than acceptance, in the same way that anyone grieving a loss has experienced those well-meaning folks who say, “it’s been three months (or six, or twelve), isn’t it time to move on?” Americans as a society don’t deal with death very well, it makes us uncomfortable, and as a result we don’t allow ourselves to grieve. Instead, we tell ourselves and each other, “move on.”
But just as most people are profoundly affected by the death of a loved one, and find it difficult to move on, it seems to me that we as a society have been profoundly affected by the events of the last two years – either caused by the pandemic or resulting from its politicization – and as a result, we are really struggling to reconcile what our eyes and ears tell us is true with what our minds want to believe, and with what our hearts are able to absorb.
Our minds want to believe that life is fair, that we live in a just society, and that if we “do the right thing,” we will be rewarded with a happy and successful life. Isn’t that what we were told, by parents, teachers, or other well-meaning adults (who also wanted to believe)? How do we reconcile these beliefs with what we have experienced?
The unfairness of who the virus’s victims have been: young people, parents of young children, healthcare providers, adults in their prime, beloved grandparents; the injustice of access to costly treatment options being a function of wealth, status, and race; the surges of contagion and hospitalization being driven by those who don’t do the right thing, who refuse to mask up or get vaccinated; and finally, the shock of realizing that even though you did everything right – masking, sanitizing, quarantining, getting vaccinated, social distancing, depriving yourself of life’s pleasures – still, you came down with the virus anyway. How do we make sense of it all?
The answer for many people seems to be, “move on.” In other words, just ignore what we’ve seen, stuff our emotions, numb out with more TV, social media, shopping, drinking or drug use, and pretend that we’re fine, totally fine. Is that what “normalcy” looks like? To me, that looks like delusional thinking and denial.
Denial, as I often tell my patients, is a normal defense mechanism, and as such, has a protective function, which is to cushion us from the full impact of a grief or trauma too big to bear. Most children and many adults will instinctively move into “magical thinking” following a loss or a traumatic event, where one part of the mind does know what has happened, but another part acts as if everything is perfectly okay. I think this may be what is occurring for many people.
Last spring people were talking about “languishing,” from an article by the organizational psychologist Adam Grant, that described what I and many others were feeling then – “a sense of stagnation and emptiness. It feels as if you’re muddling through your days, looking at your life through a foggy windshield.” Indeed, Grant seemed to capture the zeitgeist of the moment, however, that was a very different moment than the one we’re in today.
There was a guest essay in Sunday’s NYT, by executive coach Brad Stulberg, who references Grant’s article, and has this to say: “But now, nearly a year later, as with just about everything related to Covid, we’re sick of languishing too. We want to feel motivated, and to get unstuck. The question, of course, is: How?”
Yes. I have been wanting to feel motivated and to get unstuck, for months now. At first I thought maybe I was still “languishing,” but actually I don’t think that’s what’s happening, for me, or for most of us. I believe we are grieving, whether we know it or not. Whether or not in denial, we are numb, but not from “numbing out,” rather from the shock of recognizing that the losses we’ve experienced aren’t just a bad dream that we can awaken from.
We are also angry, perhaps very angry, yet without a clearly identifiable person or cause to direct our anger toward, just like what happens when a loved one dies. We may engage in bargaining, promising to be a better person or devote ourselves to a noble cause if we can just be done with this stupid virus, and feel happy again. And many of us have fallen into depression over the past year, as so often happens after a loss.
These stages of grief, familiar to most of us, were first described by Elizabeth Kubler-Ross, in her classic book, On Death and Dying. As I’ve discussed with many of my patients, the stages do not occur in a linear way, like chapters in a book, but rather as amorphous feeling states that we go in and out of over time, usually a long time, longer than we expect or want. We can experience all of them – denial, anger, bargaining, depression – at the same time, even as we have moments, days, or weeks of feeling relatively calm and “normal.” That’s what grief looks like. Doesn’t that seem a lot like what we’re experiencing today?
There’s another stage of grief that Kubler-Ross identified, which because she listed it last, we tend to assume is the final stage: acceptance. Actually, acceptance comes and goes just like the other stages, though it does tend to grow over time as the reality of our loss(es) sinks in. Some people have the mistaken belief that acceptance means “I’m A-okay with what happened, and I’m good to go now,” in other words, moving on. However, that’s not what Kubler-Ross meant, as she was really writing about the experience of the person who is dying, coming to a place of peace and acceptance of their fate. Circle of life, and all.
Acceptance, for the loved ones who remain living, is actually a starting point, rather than an end to grief. As David Kessler, a student of Kubler-Ross and author of Finding Meaning: The Sixth Stage of Grief, writes, “meaning is not in the death itself, or in how they died, but rather it’s what is in us afterward.” The process of grieving can be transformational. It has the potential to transform us into a wiser and more compassionate human being, or it can leave us bitter and uncaring. Which path will you choose? Kessler reminds us, “we can’t heal what we don’t feel.”
I believe that it is going to take years for most of us, both individually and collectively, to truly make sense of what we’ve lost during this pandemic, and come to an understanding of how that loss has transformed our lives and our world. We will be making progress when we can acknowledge the enormity of our losses, and start talking about how we’ve been affected.
A letter to the editor of the San Francisco Chronicle caught my eye yesterday morning, as I was reading the paper over breakfast. Unlike most letters to the editor, it reads like a poem, and I quote it in its entirety here, having received permission from the author, because she sums up my thoughts and feelings more eloquently than I can:
An Open Letter to my fellow Americans
“Let’s move on,” everyone says
But, there is no where else to go
This illusion of movement to a future promised land,
just beyond the horizon of inconveniences
“Let’s get on with our lives,” you say
Have you been asleep all this time?
Haven’t we all been living our lives through the mess, the sorrows, the death and disease? What is this life you’re so anxious to get on with?
Will it look so much different than the now-moment you’re in,
that you proclaim so loudly in my ear and make such a fuss,
so I can understand what you’ve given up?
Truth is, your life will go on looking much the same
Many of you haven’t given up all that much
The illusion of normalcy, whatever that is
The luxury of not hearing about one million dead Americans
The permission to stop caring
It’s not easy, with one’s hearts and eyes open to a painful truth
But it’s not all bad
Because we are here
And that means we’re alive
Breathing, beating, dancing alive
Every morning a song
Every evening a prayer
This is our lives
The unbearable weight of being here.
(Alicia Parker, MFT)Learn More
The calendar tells us it’s a new year, so my mind tells me I should set goals and make plans, decide what I want to accomplish this year, and yet – how to do so, when the world seems more unstable, uncertain, and unpredictable than ever? Welcome to 2022, or “twenty twenty, the sequel!”
Actually, I gave up making New Year’s resolutions several years ago, and switched to setting intentions. I find that intentions are much easier to set, and commit to, as well as much more useful in daily life, than goals or resolutions. This is especially true in these uncertain times. (Of course, I still do set goals and make plans, I just don’t hold onto them quite as tightly.)
What’s the difference between intentions and goals or resolutions? And how do intentions differ from expectations? According to the dictionary, an intention is “a thing intended; an aim or plan. Conceptions formed by directing the mind towards an object.” (Oxford Dictionary, online)
A goal implies a finish line or goal posts, which you have to reach to win. Depending on the goal you set, that finish line may be far away, not even visible to you, so it can feel abstract or unreachable. When you set an intention, it’s all about what you’re doing, saying, and thinking right now, today. Examples: a goal is “to lose 20 lbs,” while an intention is “to make healthy choices and decisions around what I eat.” A goal might be “to make more money, or pay off debt”; an intention would be: “to be as responsible as I can with my finances.” Do you see the difference?
Goals point you in a direction, but it’s your intentions that let you know whether you’re staying on the right course, because they help you monitor your progress and receive feedback from yourself, others, and the environment. As they say, “it’s about the journey, not the destination.”
Intentions represent an alignment with an inner moral compass, as in “His intentions were honorable.” When we focus on our intentions, we are checking in with ourselves about what’s important to us. By contrast, when we focus on expectations, we often set ourselves up for disappointment. Setting an expectation is a way of trying to control the outcome, or another person or people, whereas setting an intention focuses on the only things we can rightfully hope to control: our own attitude, words, and behaviors. We let go of the outcome.
Intentions also reflect our core values, whether or not we are aware of them. These may include being kind, friendly, honest, open, responsible, reliable, agreeable or cooperative. They can also include the opposite qualities!
Intention is one of the three components of mindfulness, in Shauna Shapiro’s model (the others are Attention and Attitude) and as described in this definition from Jon Kabat-Zinn: “Mindfulness is the awareness that arises from paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.” Can you identify the intention here? It’s to be purposeful in how you pay attention. And in how you bring the wandering mind back to the present, over and over.
Most conflict in our relationships with others stems from miscommunication about intentions. One person says something, and the other reacts as if they heard something totally different. The intention of the sender was different than the impact the communication had on the receiver. When you’re the receiver, taking a step back to consider what the sender’s intention was, perhaps giving them the benefit of the doubt, can help reduce reactivity and lead to a more harmonious relationship.
When you’re the sender of the message, and you observe that the impact was different than what you intended, what to do? Simple – reflect back on your intention, and make your response consistent. For example, if your intention was to be kind, and you see that the other person seems hurt, ask yourself, what can I do or say now, that would be kind? Perhaps offer a hug, or an apology? Or if your intention was to be assertive, and the other person reacted as if you were aggressive, then ask yourself, how can I clarify that I’m not angry, while still standing my ground?
I’ve queried some of my clients and mindfulness students about their intentions for the coming year. Not surprisingly, I heard “make exercise a priority.” That’s a perennial favorite. Patience and kindness were mentioned by several people, along with more unique and specific intentions, like “spend time with my new grandbaby, in a way I wasn’t able to with my kids” and “reduce paper towel use.”
So what intentions have I set for this year? I prefer to let them develop organically, in response to what’s happening in my life, so they may change, day to day, but they also tend to stay the same. For example, the intention to be more patient is one I’ve had for years. Making it an intention rather than a goal reminds me that it’s a daily practice, and that I may never actually achieve being a patient person!
The world we live in today seems to call for, even demand, the ability to be open to change and to rapidly changing information, as well as to be flexible and adaptable to rapidly changing circumstances. Flexibility in turn requires a willingness to let go of the outcome, and accept that what’s happening may not be what I want or expected, or even what I need, but whatever it is, I can deal with it.
Keeping mindful of all of these intentions calls for a mnemonic, an acronym to help me remember. After playing around with the basic words and their order for a bit, I came up with: Openness, Flexibility, Letting go of the outcome, Acceptance and Patience – or, O FLAP! When I shared this mnemonic with my husband, his reaction helped me come up with another, to use on alternate days: Openness and Flexibility paired with Understanding, Compassion, and Kindness. That one’s easier to remember!Learn More
Well, we’ve made it to the end of 2021 – what a weird and wearying year it’s been. A year of “wait and see,” of plans made, changed, cancelled, then made and changed or cancelled all over again. It’s been challenging to live with so much uncertainty, hasn’t it?
As a trauma counselor, I’m familiar with the emotional numbing that can happen when the nervous system is bombarded with threats to one’s well-being; lately I’m seeing this not only in many clients, especially the educators and healthcare professionals, who have dealt with the worst of it, but a bit in everyone, myself included, as we are all bombarded with threats to our whole society’s well-being, which I shall not enumerate here – no doubt you are well aware.
This is also the time of year that people who are prone to seasonal depression, like me and some of my clients, may struggle even without a pandemic. It’s been hard to sort out what part may be SAD (seasonal affective disorder), triggered by the loss of sunlight, versus normal sadness about all of the pandemic-related losses we’ve witnessed or experienced.
And yet there was much to be grateful for this past year, in my life and I hope in yours. First, I was among the first to be vaccinated, and now I’m boosted too, and so far have avoided getting the virus. The same is true for most of the people I know. With the vaccines and boosters have also come new treatments for those who do get COVID, so that even as we are dealing with a new, more contagious variant right now, the chances of getting seriously ill or dying from it have been dramatically reduced.
Second, the world has opened up again. It’s hard to even put into words how nourishing it was to be able to return to live music performances this summer and fall, in venues where I felt safe because proof of vaccination and masking were required. I’ve heard similar feelings from many others. Support for the performing arts has never been stronger. And while some events got cancelled recently, and some holiday plans changed due to the virus or the crazy weather, still the stores and restaurants remain open, and judging from the full parking lots at the shopping mall across from my office, business is good!
After last year’s lockdowns, shutdowns, and other deprivations, our gratitude for what we have grew.
We learned to appreciate what’s most important, and for most of us, being able to get together in-person with at least small groups of family or friends is top of the list. If we can just do that, we’re okay. We didn’t miss the commute to work, or long days in the office, and we learned that an awful lot of jobs can be done just as well remotely. Even, apparently, psychotherapy. While I still prefer seeing clients in person, I learned that for some clients, a Zoom or phone session is actually preferable.
And I never thought I’d say this, but when our neighborhood pool re-opened in May, for the first time in over a year, I couldn’t wait to get up at dawn to plunge into a cold body of water! I’ve learned how important my morning lap swimming is to my overall well-being. To paraphrase an old saying, perhaps a pandemic is the crucible in which all life’s lessons can be learned. What new insights or life lessons have you gained in the past year? And how would you like to apply them, going forward?
“Come, look up with kindness yet,
For even solace can be sourced from sorrow.
We remember, not just for the sake of yesterday,
But to take on tomorrow.”
(from New Day’s Lyric, by Amanda Gorman, published in the SF Chronicle, 12/31/21)Learn More
Before there were vaccines for COVID-19, all we had were face masks, sanitizer, and social distancing to keep ourselves safe. Even though it was a scary time, there was a feeling of unity or solidarity that some likened to how it was during WWII, because we were all making sacrifices for the sake of everyone’s survival. (And even though many people died from COVID, did you notice that hardly anyone got the flu last year, or even the common cold?)
Then the vaccines arrived, and as the first group got their shots while the rest waited their turn (and as some shameless folks cut the line) we began to see an interesting phenomenon: people who discarded their masks like they were the crutches of the newly saved at a revival meeting – “I’ve been vaccinated, now I’m saved from this virus, hallelujah!” – and suddenly it all got a lot more complicated. We’re still trying to figure it out.
Not only are there ever-changing rules about when and where face coverings are still required, but we also have to sort out a whole new social etiquette of mask wearing. What do we do when I’m fully vaccinated but you’re only partially? What if half the family has been vaccinated but the other half is still not eligible? Is it okay to ask if someone is vaccinated? And if we’re all sitting outdoors to eat does vaccination status even matter?
With these new rules of etiquette came a new version of mask shaming. Last year it was the people not wearing masks who were publicly shamed. Today, it’s flipped: people who have shed their masks after vaccination are challenging their friends or relatives who continue to wear them, saying “really, why?” when they don’t mean it as a question but rather a put-down.
It’s unfortunate that mask-wearing, like everything about COVID-19, has become politicized. Choosing to wear a face mask, or not, has become a new form of virtue signaling, telling the world what political party you belong to, what news feeds you subscribe to, what cultural or ethnic group you identify with, whether you’re a rule-follower or an independent thinker.
What people seem to forget is that this pandemic is a public health emergency, and that mask wearing, like vaccinations, has one purpose only: to protect us, and especially the vulnerable among us, from serious illness, hospitalization, or death. The COVID-19 virus doesn’t care whether you’re a Democrat or a Republican, what your skin color is or how much money you have. The virus doesn’t care what you believe, whether you’re a kind person or a sociopath. It just wants to keep itself alive by infecting as many of us as possible, while replicating and mutating as fast as it can. (And as we’ve seen, vaccination does not confer immunity, so you can still become infected, as well as transmit the virus to others.)
There are many among us who are vulnerable, or live with someone who is. Children and the elderly, of course, also pregnant women, but what about the many young or middle-aged adults who have a chronic illness or a compromised immune system? They are advised to continue wearing masks after vaccination, and yet, because they have an invisible illness, you can’t tell by looking that they’re in a high-risk group.
It is to help protect these people that I continue to mask up in public, but also to protect myself, even though I’m fully vaccinated. To me, wearing a face mask is a simple, inexpensive way to fight this coronavirus and support the overall health of the community.Learn More