“Like many other roles that involve helping people, providing psychological therapy can be a challenging and emotionally taxing line of work” (Delgadillo et al., 2018, p. 1).
As a result, burnout in the therapeutic community is unfortunately all too common.
A 2020 study offered some deeply concerning findings regarding the psychological wellness of mental health practitioners. In an online survey of 298 qualified therapists, 78.9% suffered from “high burnout,” and 58.1% experienced “high disengagement” (Johnson et al., 2020).
The data is concerning for the profession but also for our clients. Psychological wellbeing directly impacts successful treatment outcomes for clients (Delgadillo et al., 2018).
A burned-out therapist is at risk of creating unconditional positive disregard. Such therapists can no longer “hear” their clients or experience their pain. Such professionals may be unaware of this and continue to offer treatment (Cochran & Cochran, 2021).
In line with the research, mental health professionals clearly need burnout prevention, reduction, and recovery interventions (Johnson et al., 2020).
What do we mean when we talk about burnout?
Academic literature describes burnout in therapists as a psychological syndrome experienced when feeling emotionally exhausted by work and disengaged from patients (Johnson et al., 2020).
Several factors influence burnout.
Vicarious trauma involves cognitive changes — thinking differently — in response to disturbing and upsetting accounts of traumatic client experiences (Delgadillo et al., 2018).
“Compassion fatigue denotes a state of emotional exhaustion that can occur as a result of intensive empathic involvement with people who are in distress” (Delgadillo et al., 2018, p. 1).
Together, vicarious trauma, compassion fatigue, increased workload, safety issues, role ambiguity, time pressures, reduced resources, and limited supervision contribute to occupational burnout (Delgadillo et al., 2018).
6 Common Symptoms of Therapist Burnout
In her valuable book, Simple Self-Care for Therapists: Restorative Practices to Weave Through Your Workday, therapist Ashley Davis Bush (2015) distinguishes between small-B burnout and big-B Burnout.
The former is feeling exhausted at the end of a long day. Our brains are fried, and “burnout” can often be addressed with a little self-care, such as getting a good night’s sleep or meeting up with a close friend for a meal.
Big-B “Burnout” is much more severe. It “doesn’t happen after only a few busy days. It’s a chronic condition that arises after the accumulation of months and years of neglect and self-sacrifice” (Bush, 2015, p. 22). Burnout results from the persistent wearing down of body, mind, and spirit.
Several of the most common symptoms include (Bush, 2015; Cochran & Cochran, 2021; Saunders, 2021):
Excessive and prolonged physical and emotional fatigue
Experiencing feelings of:
Prolonged and sometimes debilitating stress
Dread for the week ahead
Boredom with clients, work, and friends
Feeling overwhelmed by simple everyday tasks and commitments
Feeling physically unwell, both generally and specific ailments such as back and stomach pain and headaches
Lack of passion and excitement for or engagement in work
Existential doubt regarding whether the career is appropriate
Academics and therapists Jeff Cochran and Nancy Cochran (2021, p. 116) “believe burnout usually comes from caring greatly but finding one’s self or one’s work ineffective.”
Research also suggests a causal link between self-efficacy — our belief in our abilities — and burnout. Our self-perception of ineffectiveness could arise from a combination of factors, including poor or limited training and serving difficult client populations (Cochran & Cochran, 2021).
High workload, poor quality management, and limited resources are also vital factors in the onset of burnout, impacting work–life balance, job stress, and role conflict. Personal characteristics play a role in susceptibility, with young psychologists in the public sector most at risk, and is likely exacerbated by fewer years of work experience (Johnson et al., 2020).
“When you work with suffering every day, you are always at risk of emotional overload” (Bush, 2015, p. 23). And it’s no surprise. Our capacity to mimic the feelings of others is ingrained in our nervous system in the form of mirror neurons. They allow us to experience another’s feelings and internally reflect their emotional content (Thomson, 2010).
While it’s a wonderful evolutionary adaptation, facilitating improved communication and more effective functioning in social groups, in therapy, continually experiencing client upset and negative self-beliefs can take its toll on the therapist’s wellness (Bush, 2015; Workman & Reader, 2015).
The role of vicarious trauma
“All therapists have traumatic stories that stand out for them” including potentially “emergency department visits, terminal diagnoses, prison riots, cigarette burn scars, sexual abuse episodes, exploding bombs, and overdose” (Bush, 2015, p. 25).
Being able to manage the traumatic narratives of clients professionally while maintaining some distance is not easy. As humans, we are changed by the stories we hear. Vicarious trauma refers to being exposed to human trauma and suffering and, despite being potentially damaging, is intimately linked with the role of a mental health professional (Bush, 2015).
How to Prevent Therapist Burnout: 7 Tips
Burnout is not inevitable, though it can seem like it.
There are strategies and approaches therapists can use to avoid feeling emotionally exhausted from work and disengaged from clients (Johnson et al., 2020).
The following tips can be combined or focused on independently (Cochran & Cochran, 2021; Postings, 2022; Saunders, 2021).
1. Manage and reduce your workload
Reducing clients and the number of sessions can form an essential part of preventing feelings of being overwhelmed.
It allows us to focus more on the needs of our clients while maintaining our wellbeing and helps ensure we offer an appropriate level of empathy, therapeutic listening, and unconditional positive regard.
2. Research the effectiveness of your work
Do we know whether our treatment is working? We can review old case notes or reach out to previous clients to understand how effective treatment has been for them.
Seeing clients’ progress is encouraging, though we must recognize that not all treatments are successful. It can also help us realize that each client’s rate and amount of progress are unique, and we should not be disheartened when change is slow.
3. Focus on self-care and self-acceptance
As a therapist focusing strongly on the wellbeing of our clients, we may forget to care for ourselves. “Strive to base your self-care on being, rather than doing” (Cochran & Cochran, 2021, p. 117).
While it’s essential to recognize our accomplishments, there will always be something else to achieve, which may impede self-acceptance. Rest, do the things that give you pleasure, and seek and accept social support.
4. Build supervisor relationships and safe spaces
The quality of supervisory relationships and the availability of safe spaces to talk are linked to reduced burnout. Seeking an experienced supervisor and having regular meetings and a safe space to discuss demanding aspects of the role can reduce our disengagement and the likelihood of burnout (Johnson et al., 2020).
5. Create a personal inventory
“By learning how to value ourselves, we learn how to value others” (Postings, 2022, p. 155).
We must recognize our strengths: what we are good at, how it makes us feel, and how we perform when using them. Creating a personal inventory of successes can be motivating and energizing and protect us from the consequences and spread of negative emotions.
6. Continue to learn and develop new skills
We are all works in progress. Identifying gaps in our knowledge and following up with new learning and training, especially as an opportunity to meet up with other, like-minded individuals, increases our intrinsic motivation.
Meeting the basic psychological needs of relatedness, autonomy, and mastery (competence) boosts self-confidence and wellbeing (Ryan & Deci, 2018).
7. Strengthen resilience through mindfulness
Resilience can offer protection from burnout, increasing our capacity to cope, rebound, recover, and find new paths for moving forward following obstacles.
Regular mindfulness practices can help us accept who and where we are and view ourselves with greater self-compassion, which has been shown to reduce burnout (Pereira et al., 2017; Shapiro, 2020).
Although we cannot remove all the factors contributing to burnout, we can manage them more effectively.
Recovering From Burnout: 6 Strategies
The burnout prevention tips offered earlier in this article can and should be considered and actioned, where appropriate, during recovery from burnout.
But there are other strategies also highly valued by therapists and other professionals, as they help us recover from burnout and typically sit under the title of self-care.
The overwhelmed and most likely disengaged therapist must now devote time and energy toward themselves, focus on their own needs, and practice a great deal of self-compassion (Delgadillo et al., 2018; Bush, 2015; Cochran, & Cochran, 2021).
Stop and rest
A burned-out therapist cannot offer the support a client needs. Clients need to be carefully handed over to other professionals for continued treatment.
Become more grounded
Like mindfulness, grounding can reduce anxiety and stress and help you feel more present. While mindfulness is nonjudgmental awareness of current circumstances, “groundedness, on the other hand, is the state of feeling unshaken to the core, having your wits about you, and being rooted in your purpose” (Bush, 2015, p. 68).
It reduces reactivity while keeping us aware of what’s going on around us without being hijacked by emotions. As a result, grounding techniques protect us against vicarious trauma and can be practiced before returning to a manageable workload.
A withdrawal often characterizes burnout — a lack of energy for what we want or must do.
As part of recovery, we must find the energy and motivation for what is essential in our lives (Bush, 2015):
Reconnect with your values
As a therapist, your journey most likely started as a way to help people through their emotional pain. Revisiting these values and increasing your self-knowledge before returning to work will identify whether you are on the right path or need a change. Doing so will create the energy and motivation needed to reconnect with your life domains and move forward (Wilson & Dunn, 2004).
Awareness and use of strengths
Identifying personal strengths and becoming better able to use them will help energize and intrinsically motivate you to push through feelings of apathy and disengagement and restore your drive to help people (Niemiec & McGrath, 2019).
Goal setting and targeting
Goals are intrinsically motivating and often used with clients during therapy. Equally, setting and working toward your personal and professional goals can benefit your mental health while giving you something clear and value driven to work toward (Poulsen et al., 2015).
Create an ownership mindset
It is tempting to think everyone else is to blame for our burnout, but this is not helpful. Such a mindset can block a therapist from doing anything about the situation. Taking the stance that “others may have contributed to my situation, but I can make choices that can improve my present and future” may be more helpful (Saunders, 2021, p. 86).
As a therapist, you are free to choose how your work life should be and what you will do to get there.
Ultimately, recovery from burnout is about self-care and a compassionate outlook toward yourself and others. It is vital to reassess what a meaningful, value-driven work–life balance looks like that is individual to you (Johnson et al., 2020; Cochran & Cochran, 2021).
Measuring Therapist Burnout: A Questionnaire
The Oldenburg Burnout Inventory (OLBI) is a valuable test for occupational burnout and has been used successfully for scoring burnout in therapists and mental health practitioners (Delgadillo et al., 2018).
The 16-item questionnaire assesses two aspects of burnout: emotional exhaustion and disengagement. Each item is scored between 1 (strongly agree) and 4 (strongly disagree). For example:
“I always find new and interesting aspects in my work.” “I can tolerate the pressure of my work very well.” “During my work, I often feel emotionally drained.” “When I work, I usually feel energized.”
A 2018 study using the OLBI found that mental health practitioners had some of the highest levels of burnout compared with other occupational groups (Delgadillo et al., 2018).
Helpful Tools From PositivePsychology.com
We have many resources available for therapists wishing to increase their level of self-care and feel more in control and engaged in their lives.
Our free resources include the following:
This helpful worksheet encourages reflection on the frequency and quality of self-care in five essential life domains.
Therapists can learn to recognize their personal risk factors and warning signs and practice self-care.
This tool offers a list of 20 self-care strategies for psychologists and other helping professionals, including:
Ensure your physical needs are met. Cultivate sacred moments. Practice gratitude. Create a professional greenhouse at work. Laugh and play. Schedule me-time. Take a hot bath. Meditate. Seek supervision and peer support.
The Spheres of Personal Control
When feeling overwhelmed, it’s helpful to identify what is within our control and what is not.
This exercise supports us as we identify the limits to our sphere of control.
Step 1: Identify desired outcomes and goals. Step 2: Identify actions that will help get closer to those goals. Step 3: Determine which of the actions are within our control. Step 4: Identify factors that are outside personal control. Step 5: Repeat the steps for each goal.
Once complete, you should have a clear view of actions that should have less energy spent on them (out of our control) versus more energy (within our control).
If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, check out this collection of 17 validated stress management tools for practitioners. Use them to help others identify signs of burnout and create more balance in their lives.
A Take-Home Message
Burnout is common among therapists, impacting their wellbeing and the successful outcome of client treatments. And it’s no surprise. Experiencing the traumatic narratives of clients is difficult and can leave the listener changed by what they hear.
Those struggling with burnout typically experience emotional exhaustion and disengagement from their practice and patients, along with feelings of anger, frustration, dread, and overwhelm. They all contribute to their emotional state and their negative experience of work commitments.
The therapist may be left caring greatly but feeling ineffective. However, burnout is not inevitable. There is hope.
By adopting the practices outlined in this article, therapists can reduce the likelihood of burnout. If you as a therapist are already experiencing such feelings, you can learn to restore balance and control in your life.
Ultimately, our clients deserve the very best treatment available — and so do therapists. Mental health care professionals provide a vital service to others and need to practice a similar level of self-care as their clients.
Bush, A. D. (2015). Simple self-care for therapists: Restorative practices to weave through your workday. W.W. Norton & Company.
Cochran, J. L., & Cochran, N. H. (2021). The heart of counseling: Practical counseling skills through therapeutic relationships. Routledge.
Delgadillo, J., Saxon, D., & Barkham, M. (2018). Associations between therapists’ occupational burnout and their patients’ depression and anxiety treatment outcomes. Depression and Anxiety, 35(9), 844–850.
Johnson, J., Corker, C., & O’Connor, D. B. (2020). Burnout in psychological therapists: A cross‐sectional study investigating the role of Supervisory Relationship Quality. Clinical Psychologist, 24(3), 223–235.
Niemiec, R. M., & McGrath, R. E. (2019). The power of character strengths: Appreciate and ignite your positive personality. VIA Institute on Character.
Pereira, J. A., Barkham, M., Kellett, S., & Saxon, D. (2017). The role of practitioner resilience and mindfulness in effective practice: A practice-based feasibility study. Administration and Policy in Mental Health and Mental Health Services Research, 44, 691–704.
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Poulsen, A. A., Ziviani, J., & Cuskelly, M. (2015). Goal setting and motivation in therapy: Engaging children and parents. Jessica Kingsley.
Ryan, R. M., & Deci, E. L. (2018). Self-determination theory: basic psychological needs in motivation, development, and wellness. Guilford Press.
Saunders, E. G. (2021). To recover from burnout, regain your sense of control. In HBR guide to beating burnout. Harvard Business Review.
Shapiro, S. L. (2020). Rewire your mind: Discover the science and practice of mindfulness. Aster.
Thomson, H. (2010, April 14). Empathetic mirror neurons found in humans at last. New Scientist. Retrieved March 16, 2023, from https://www.newscientist.com/article/mg20627565-600-empathetic-mirror-neurons-found-in-humans-at-last/.
Wilson, T. D. & Dunn, E. W. (2004). Self-knowledge: Its limits, value, and potential for improvement. Annual Review of Psychology, 55(1), 493–518.
Workman, L., & Reader, W. (2015). Evolutionary psychology: An introduction. Cambridge University Press.
About the author
Jeremy Sutton, Ph.D., is a writer and researcher studying the human capacity to push physical and mental limits. His work always remains true to the science beneath, his real-world background in technology, his role as a husband and parent, and his passion as an ultra-marathoner.