Back from Burnout
It’s been a while since I’ve written here – let me explain my absence. Early this year I began to recognize the signs of something resembling burnout in myself, and decided to take the advice I often give to my patients, to take a step back from some of my activities and responsibiilities in order to focus more on my well-being. The activities I chose to give up were writing blog posts and newsletters, teaching online mindfulness classes, and taking new patients.
At the time I thought this “break” might last for a month or two, but as it turned out, I needed much longer to heal and restore what was depleted in me. It wasn’t as simple as “get more rest,” nor was it about setting boundaries or saying no to excessive demands on my time. That’s the prescription for typical burnout, but this was a different kind of emotional exhaustion. I practice what I preach about self-care, so I was getting plenty of sleep, regular exercise, and healthy nutrition, and I’ve got good boundaries. Then why was I so exhausted?
I am a “silver lining” person, usually able to find the good or beneficial even in the worst of circumstances, and I had been doing that for the first year of the pandemic, but then it stretched into two (now three) with no clear end in sight. Those first months of the lockdown were hard, but there was a sense of “we’re all in this together” that made it feel more like an adventure. Then when vaccines became available, there was a sense of relief, and hope that this would be over soon. Instead, it got worse, fueled in large part by all of the people who refused to get vaccinated, mostly for reasons that made no sense to me. I no longer felt like we were all in this together.
I am also a person who has always felt a deep connection to Mother Nature, and when my batteries need recharging, I head to the woods, or the ocean, or just my garden. During the lockdown, I was grateful to have a yard and garden, and to live in a neighborhood that’s safe to walk in, where I could access trails into the hills. I was able to spend more time outdoors, which helped, but it’s also depressing to try to grow things during a prolonged drought, and with all of the extreme weather events (remember that day in August 2020 where the sun never came out, and it felt like we were on Mars?) Forest fires, hurricanes, floods and mudslides – we are experiencing the harsh reality of what our reliance on fossil fuels has done to the planet, and yet, people aren’t changing their habits, and fossil fuel companies have doubled down.
On a related note, I’d been working hard to maintain my optimism for the benefit of my patients and students, as well as colleagues and friends, all throughout the dark years of the previous administration. But here we are, still living under that dark cloud six years later, with nearly a third of adult Americans still believing the lies about a stolen election and voter fraud. Those lies and the people who promote them threaten the very foundations of our democracy.
As I write that last paragraph I realize I risk losing a few of you as readers, which points to one of the gravest concerns that I have about the world we are living in today: we seem to have lost the ability to even listen to, let alone respect differing views, opinions and perspectives. That factor alone has affected my motivation to write, because I believe what makes something worth reading is its potential to stimulate thought, challenge existing views, and offer a new perspective. And I simply can’t pretend things are okay when they are definitely not okay.
My training as a psychotherapist was traditional, in that I was taught to keep my personal views and opinions separate from my work with patients, and to not share anything about my personal life. When I was a young therapist, still in therapy myself to heal my own childhood wounds, that proscription suited me nicely. But over time, as I healed and matured, and as the field of psychotherapy itself changed, I began to share more of myself with patients. I brought my experience with therapy, 12-Step programs, and mindfulness meditation into sessions. I “showed up” for my patients in a new way, which not only felt more authentic for me, but also allowed the work we were doing together to go to a deeper level. This was more satisfying for me as a therapist, and led to deeper levels of insight and healing for my patients.
I experienced a similar sense of satisfaction teaching mindfulness classes, as I was able to observe my students struggle with the practices week after week, and then suddenly have an “aha” moment that was transformational, perhaps life-changing. Even when I was teaching in the evening, after a long day of seeing patients, I would come home feeling grateful to be doing this work.
But the satisfaction, gratification, even joy that I experienced from my therapy sessions and mindfulness classes began to dissipate once everything moved online. I didn’t notice this right away, as I was so busy just mastering the technology, and relieved when it all worked and we could see and hear each other. And I was glad to be able to still provide support to my patients and students, as we all struggled through that initial phase of the pandemic.
Soon it became clear, however, that something was getting “lost in translation.” A day of Zoom sessions would leave me depleted, rather than nourished. Many of my colleagues noticed this, too (though I wasn’t seeing my colleagues in person anymore, either). Eye strain was part of it, as was the distraction of seeing myself as well as my patient on the screen. Phone sessions were easier in a way, and yet the challenge remained one of establishing a genuine connection. Telehealth can easily become simply a check-in. I noticed that mindfulness classes became more superficial, too. It’s difficult to dig deep into someone’s experience when you can’t see what’s happening in their body.
What I’m getting to here is what I’ve come to understand as a primary cause of my burnout: the loss of personal connection. Zoom and FaceTime are great tools that clearly have value as a way to connect, and I appreciate their convenience, but I think we’ve all come to realize that something gets lost, and that something is an intangible, hard to measure or define, energy. Without getting all “woo woo” I’ll just say, science has shown us humans are energetic beings, and we are biologically hardwired to read each other via “body language.” We also need each other’s physical presence for emotional regulation. We are “wired for touch.”
There’s another piece here for me, which is so personal that I’m hesitant to share it. During the past two years both of my adult sons moved to the East Coast, one of them taking my new grandson with. Talk about a loss of personal connection through touch! I wholeheartedly supported their moves as being right for them, and was able to appreciate what the Buddhists call “sympathetic joy,” when you’re happy for someone else’s happiness, even if it may cause you unhappiness. But still, it’s been a loss, one that I know many of you can relate to.
It’s not just my own lost connections that depleted me. As an empathic and highly sensitive person, I have felt a collective grief for the loss of millions of lives to COVID (a trauma that we have not fully acknowledged as a society). And I feel the effects of the many ways in which all of us have become isolated and disconnected from each other, both as a result of the pandemic as well as the polarized political climate. The positive energy I had once felt from the #MeToo movement and Black Lives Matter dissolved into despair, as women’s rights and BIPOC rights are increasingly threatened everywhere, ultimately at the level of the US Supreme Court.
There are objective data that confirm this societal trauma: we’ve seen significantly higher rates of anxiety, depression, substance abuse and suicide, not to mention increases in domestic violence and gun violence, over the past couple of years. Besides political and economic factors, there’s a biological explanation for this too: when human beings lose their sense of connection with other humans, despair, hopelessness and alienation take over.
I didn’t arrive at this self-diagnosis until after I’d already embarked upon its cure. Sometimes we can only see clearly in hindsight; action is necessary before insight appears. As I began to see more patients in the office, led a few mindfulness meditation groups in-person in the park, and finally felt safe enough to travel to visit my sons and their families, my personal dark cloud began to lift. I also focused on “changing the things I can,” as the Serenity Prayer reminds us. This turned out to involve a move to a new home, with a dedicated and Zoom-friendly home office (after two and a half years of improvising) as well as a last-minute decision to find a way to keep my Pleasanton office, which I’d barely been using. Both decisions required navigating through uncertainty and letting go of control, but ultimately feel right.
Now I’m gearing back up to see patients two days a week in the office, following COVID protocols, while continuing to offer telehealth sessions the other weekdays, which feels like a more sustainable balance. I am also planning some in-person mindfulness classes for 2023, starting at Las Positas College in January-February. Today I’m meeting some new colleagues for lunch. And I am really looking forward to taking a week off next month for my first in-person meditation retreat in several years!
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Burnout in the Helping Professions
“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.”[1] 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.”[2] 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.[5] 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.
Notes:
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.