The 26-year-old counselor cares for the clients she leads in two groups composed of individuals with substance abuse and mental health problems. She cares for the few individuals she has time to see when her groups aren’t meeting three times per week, three hours per session. She even cares about doing a good job on the mounds of paperwork that clutter her desk.
It turns out, though, that Sharon may not be spending as much time caring about the person who matters most — herself — while she tends to the needs of others at the community mental health center where she works.
“Last week, I felt that I definitely was burning out,” says Sharon, who asked Counseling Today not to reveal her last name. “I felt that I had symptoms of generalized anxiety disorder, of post-traumatic stress disorder. I dreamed of getting shot.”
So Sharon decided to shift gears. “The newest belief I’ve adopted is that I’m doing a job and not doing therapy,” she says. “If I look at it that way, I can cope with my stress better.”
Counselor burnout. With increasing caseloads, managed care headaches, mounting paperwork and the ever-present stress of listening to other people’s tales of despair all day before going home to play with the kids at night, it is an issue that many in the counseling profession take very seriously.
“It can’t be overstated,” says Gerard Lawson, an assistant professor of counselor education at Virginia Tech and coleader, along with Jane Myers, of the American Counseling Association’s Wellness Interest Network. “Everyone in the helping professions, especially counseling, wants to help people. But it’s all meaningless when the instrument — you — isn’t OK.”
When Lawson chaired the ACA Task Force on Impaired Counselors from 2003 to 2007, he and Beth Venart wrote a paper titled “Preventing Counselor Impairment: Vulnerability, Wellness and Resilience.” They defined counselor impairment as something that occurs “when there is a significant negative impact on a counselor’s professional functioning which compromises client care or poses the potential for harm to the client.”
Impairment, Lawson and Venart wrote, includes substance abuse or chemical dependency, mental illness, physical illness and personal crisis. The term “burnout” was included under the personal crisis category.
But what is burnout? What leads to it? How can it be treated? And, perhaps most important, how can counselors avoid it?
Counselor burnout is defined by its symptoms: feelings of exhaustion, detachment and dehumanization when dealing with clients, in addition to feelings of depression and inadequacy. And then there is burnout’s close cousin, compassion fatigue, when the helper is traumatized by her efforts to be compassionate with the individual suffering from the initial trauma.
“We find that 5 percent of people in the helping professions suffer from burnout and 10 percent suffer from compassion fatigue,” Lawson says. “That should give us pause. It’s not a huge number when we look at the 95 percent who aren’t suffering from burnout, but what do we do with the 5 percent, and how do we make sure that the 95 percent doesn’t slide into the 5 percent?”
Few protections in place
Graduate school would be an obvious place to stem the tide before people enter the counseling profession. Or so it would seem.
“It’s not attended to enough,” says Myers, a professor in the University of North Carolina at Greensboro Department of Counseling and Educational Development and a past president of ACA. “We focus on professional development as part of the curriculum, but we don’t have any training on burnout.”
Likewise, according to the task force Lawson chaired in 2003, state licensing boards don’t deal with the issue adequately. The task force found that few intervention programs existed to assist counselors and only a few states — Minnesota, Michigan and Virginia — had good impairment programs that defined impairment to include stress, substance abuse, mental illness and physical illness.
So graduate programs turn out counselors who gladly dive into the deep water. Helping people is their goal, and burnout is generally the furthest thing from their minds. They often start out at community mental health agencies because they can work there before getting licensed. This is where they are given freedom to see clients — individually and in groups — pretty quickly. And this is where clients with the most serious mental illnesses await.
“If you want to burn people out,” Lawson says, speaking of community mental health agencies, “we have the perfect recipe.” Namely, new counselors seeing clients with not-so-new problems.
“A lot of our graduates talk about the severity of their caseloads,” Myers says. “It’s very difficult when you’re treating the severely impaired. If I feel I’m not a success as a counselor, there’s a good chance I am going to burn out.”
Battling against burnout
Burnout certainly isn’t restricted to recent counseling graduates or workers at community mental health centers, however. Still, Lawson acknowledges that private practice offers greater control, and control mitigates against burnout.
Balance also is a key to the prevention of burnout, whatever the age of the counselor. “Meditation, exercise, vacation, dedicating time to your family … Folks that tend to these aspects of their life fare better with burnout,” Lawson says. “There’s a significant improvement with work when you do wellness activities.”
“There’s a crossover between our professional and private lives,” Myers adds. “We’re more prone to high stress if there are problems at home. It’s easy for our clients to become secondary when we have problems in our private lives.”
Myers also emphasizes the importance of engaging in non-counseling activities. “On a scale of one to 10, I’d say that’s about a 15,” she says. “You have to have balance. You have to do things that renew you in other areas of your life.”
Counselors can also benefit from practicing what they preach, including seeking counseling themselves. “I think counselors can be reticent to see other counselors,” Myers says. “When you’re a counselor yourself, you might not think another counselor will be effective dealing with you. … (But) the best theorists and clinicians in our field, starting with Alfred Adler, have stressed the importance of having someone else hear our stories and help us gain new perspectives.”
Adds Lawson, “Going to counseling contributes to the counselor’s development in that it improves interpersonal skills and flexibility to meet the needs of clients, insulates clients from the influence of the counselor’s own unresolved issues and bolsters the counselor’s ability to manage stresses related to counseling work and to renew themselves. From our research, we know that 83 percent of counselors have been in counseling at some point in their life, including 18 percent who indicated that they were currently attending personal counseling.”
Good supervision is another key to preventing burnout. “It’s the No. 1 way to mitigate burnout and compassion fatigue,” according to Lawson. “And good supervision should, in my estimation, include more than discussion of cases. It should include a supervisor asking, ‘How are you doing?’”
“One of the challenges of the burned out counselor is that she/he is likely to be unaware of the impact of the burnout,” Myers says. “Burnout creates, to a greater or lesser extent, an impairment of our ability to be fully present to our clients. Although we can often overcome the effects of burnout with time, a rapid return to wellness is best and most quickly achieved if we truly believe in and are willing to practice the power of our art. So I strongly encourage counselors experiencing burnout to seek both professional peer supervision of their work and personal counseling to help them move beyond impairment to wellness and to follow a self-reinforcing path to a high level of wellness.”
Still, even with these safeguards in place, counselors can experience burnout. Bills pile up. Paperwork piles up. Clients with serious mental health problems don’t get better overnight. Left unchecked, burnout can make a counselor who was once so eager to help others equally as eager to leave the profession altogether.
“One of the components of people who get into this profession is that they are passionate about what they do,” Lawson says. “They want to help. There’s a great potential for burnout, especially when they don’t see the payoff until way down the line.”
Things weren’t paying off five years ago for Cathy Woodyard, an ACA member based in McKinney, Texas. She was teaching at Texas Woman’s University, seeing clients individually and experiencing signs of burnout.
“I gave up my job as a counselor educator because I found it was depleting me,” Woodyard says. “I gave myself a week in a cabin. I took movies. I took scrapbooks.” And she came away with a feeling of renewal.
Woodyard and Connie Fox, a friend and counselor Woodyard had met at an ACA Conference, decided to put together retreats for counselors. The counselors, mostly from Texas and Oklahoma, go on weekend retreats twice a year. One of the retreats in Oklahoma City included a talk by a therapist who specialized in dream work. Another retreat incorporated psychodrama. A retreat in Santa Fe, N.M., last fall included a visit from a shaman. A massage therapist was featured at another retreat.
Woodyard plans to expand her retreats to include individuals from other professions. Meanwhile, the counselors who attend Woodyard’s retreat talk about themselves. They talk about cases. But mostly, they engage in renewing activities.
“I couldn’t counsel if I didn’t do something like this,” Woodyard says. “My therapy would turn into problem-serving. It wouldn’t be about growth. I don’t trust a counselor who doesn’t work on themselves.”
A counselor herself for nearly 20 years, Woodyard sees individuals, runs four groups and conducts a monthly experiential workshop that primarily focuses on self-exploration and dealing with fear. From her perspective, what are the top three factors contributing to counselor burnout? “Lack of self-care, a schedule that is too full and seeing a population that is too demanding,” she says.
On second thought, make that four factors. “I think you need a variety of clients,” she says. “If I worked with all children, I think I’d burn out. If I worked only with an older group, I think I’d burn out. When you’re working with a tougher population especially, there’s something refreshing about seeing different types of people.”
Woodyard’s husband, Jim Bray, is in a different profession altogether, working as an electrical engineer. “I’m so glad he’s not a counselor,” Woodyard says. “It forces me to remember that there’s a different world out there. He’s into antique cars. When he’s talking about that, it brings me out.”
Meanwhile, Sharon is trying to bring herself out of her funk. Sometimes, to protect herself, she calls what she is doing “a job,” not therapy. She also has another name for what she does. “I look at myself as a drive-through therapist,” she says. “You pull up, and you get a kernel of something that can help you.”
But what can help Sharon?
“I care immensely about these people,” Sharon says. “But there are moments of frustration that I can’t fight through.”
ACA member Chris Morkides is a psychotherapist in private practice in Swarthmore, Pa. Contact him at firstname.lastname@example.org.
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