Counseling Today, Cover Stories

The battle against burnout

By Bethany Bray March 28, 2018

Fill in the blank: The way to avoid burnout is __________ .
Self-care? Professional fulfillment? Spirituality? All of the above? The answer to this question will be different for each person — and most likely involve more than one idea. The question, however, needs to be continually on the minds of counselors, both for their own good and for the good of their clients.

Counselors, as helping professionals who listen to and support clients through some heavy and distressing issues, often on a daily basis, are at high risk for professional burnout. Researchers focusing on practitioner burnout for a 2012 Administration and Policy in Mental Health and Mental Health Services Research journal article found that as many as 2 out of every 3 mental health workers “may be experiencing high levels of burnout.”

But helping professionals aren’t the only ones who can be pushed to the limit. Clients can burn out as well, whether they’re parents struggling to balance work and family life or individuals who feel stretched to the max by the demands of their job and other aspects of life.

In other words, “anybody and everybody” is at risk of burnout at different points in their lives and careers, says Kayla Pedigo, a licensed clinical professional counselor and certified sex offender treatment provider in Idaho. Even so, counselors often internalize the harmful negative associations that society at large holds about seeking help.

“It’s very difficult to say, ‘I need some time for myself.’ That can feel selfish for a helper. It takes a lot of strength to know what you need and how to ask for it,” says Pedigo, a member of the American Counseling Association.

Counselors can fall into the trap of feeling that they “should have it all figured out,” says Allison Crowe, an ACA member and a licensed professional counselor (LPC) in North Carolina. “It’s a myth that we don’t need our own support at different times. Going through a master’s program in mental health does not negate the need for personal mental health help down the road.”

“Stress is not a diagnosable mental health condition, but it will turn into one if we don’t work on it,” Crowe adds. “Coping is an important thing to think about, and coping in ways that work for you. … Working long hours, vicarious trauma, empathy fatigue: These are all things that are part of a counselor’s job. All of that will build and build and build to levels of burnout. We need to build in a wellness plan and coping strategies.”

Fanning the flames

The Merriam-Webster Dictionary defines burnout as “exhaustion of physical or emotional strength or motivation, usually as a result of prolonged stress or frustration.” Many things can cause burnout, but being isolated or feeling unsupported at home or at work can be major contributors, as can the repetition of facing the same challenges or doing similar tasks over and over.

Every job situation will come with varying degrees of stress and frustration that ebb and flow. Burnout, however, is more than that. It is an all-encompassing feeling that you are being pulled in every direction at once and that no matter what you do, you are unable to make progress or move forward. If chronic burnout is left unmanaged, it can lead to issues with physical and mental health.

The onset of burnout feels different for each individual. In both clients and practitioners, it can take a healthy dose of self-awareness to recognize the red flags that indicate they are experiencing something more than day-to-day stress.

Pedigo, the clinical director at Aspire Human Services, a program for clients with intellectual disabilities in southeastern Idaho, says that one of her first signs of burnout is finding that she doesn’t want to stay for the full length of staff meetings. It indicates that she is becoming disengaged and having trouble being present, she says.

Another signal is when she finds herself turning down invitations from colleagues to go out to lunch. She knows it would be good for her to step out and take time away from the office, “but it feels like I can’t even take a minute to do that. … I feel like I have a million other things to do,” Pedigo observes. “I’m always thinking of what’s next, what’s next, what’s next. That’s when I know I need to take time to slow down, take a break and return refreshed.”

Another indicator of burnout in clients and counselors can include feeling a perpetual sense of self-disappointment — that no matter what you do, you are always falling short, says Erin M. West, an LPC and licensed school counselor. “It’s that sense of being overwhelmed — that you have too much on your plate and not enough time to feel like you’re doing a good job in all of your roles or [to take] a sense of pride in the work you’re doing. It can be demoralizing and defeating,” says West, a lecturer in the school counseling and clinical mental health counseling programs at the University of Texas at Tyler.

In general, burnout is a constant feeling of being at the end of your rope, she says. It can manifest in physical symptoms such as feeling fatigued or exhausted, crying easily, having trouble sleeping and becoming emotional over things that wouldn’t normally affect you.

Similarly, people experiencing burnout who are normally easygoing might find themselves feeling more angry or sad than usual and struggling to make decisions out of a fear of making the wrong choice, Pedigo says. People wrestling with burnout may also become more susceptible to getting sick and take longer to recover when they come down with something.

Another potential indicator of burnout is inflexibility of thought, Pedigo adds. In clients, this may manifest as resistance to ideas that a counselor suggests in session. For practitioners, it might show up as a reluctance to refer or to seek help with a challenging client and resistance to feedback, Pedigo says. This can shut down the creative process, “and new, fresh thought just doesn’t happen as easily,” she adds.

Pedigo regularly checks her reactions to the feedback she receives from colleagues. If she finds herself taking the feedback personally or disagreeing reflexively, it can be a sign that she is feeling overwhelmed and “focused on me more than the greater issue,” she says.

Another red flag for practitioners is disengaging in session with clients, West says. “It’s that feeling of sitting with a client and having them talk to you, and in your mind, you’re thinking, ‘I don’t know what this person just said.’ You realize after a period of time that you’ve been thinking about something else and you’ve missed what the client has said. Or it may be noticing that things your client is doing or saying are irritating you more than usual. You might notice that you’re putting a lot of blame on clients for not making progress instead of asking ‘What is my role? How can I help?’” explains West, who co-authored a 2016 Journal of Counseling & Development article on stress and burnout in counselor educators.

When counselors realize that they’re not being fully present in a client session, it is “just a horrible feeling. … The whole reason for getting into counseling is to help others with the weight they’re carrying. It can feel really defeating if you’re not able to do that,” West says.

 

Playing with fire

Counselors who are detaching from their work and not taking steps to address burnout (or missing its indicators) are entering a danger zone rife with ethical pitfalls, says Monica Band, a certified rehabilitation counselor with a private practice in Alexandria, Virginia, who is doing clinical supervision toward an LPC. Exhaustion can lead to practitioner indifference or a cynical attitude, says Band, an ACA member and an assistant professor in the clinical mental health counseling program at Marymount University in Virginia. As a result, practitioner-client boundary issues can become blurred, and the counselor’s ability to make competent decisions or to connect and build rapport with the client can all become impaired.

Band wrote her doctoral dissertation on predictors of burnout in first responders and law enforcement chaplains. She will co-present an education session on that topic at the ACA 2018 Conference & Expo in Atlanta later this month with Lisa Jackson-Cherry, a professor and counseling department chair at Marymount and coordinator of the university’s pastoral clinical mental health counseling program.

“[Burnout] can be a fog over our lens because we’re not taking care of ourselves. It hits at a cognitive level, where we’re not able to make culturally competent, ethical decisions [as counselors]. We might not even be in the right headspace to choose which intervention will help our client,” says Band, president-elect of the Virginia Counselors Association. “Unfortunately, burnout gets so bad that we internalize it. Our boundaries get blurred, and we can turn to advice giving instead of giving competent care. It can turn into countertransference issues, which can create an unsafe environment for our clients.”

The prevention of burnout — and the commitment to seek help if it occurs — is both a best practice and an ethical mandate for professional counselors. The introduction to Section C (Professional Responsibility) of the 2014 ACA Code of Ethics includes a statement that “counselors engage in self-care activities to maintain and promote their own emotional, physical, mental and spiritual well-being to best meet their professional responsibilities.” Standard C.2.g. instructs counselors to continually monitor themselves for professional impairment and to seek assistance if they recognize that they are impaired.

Rising from the ashes

A good first step for counselors who realize that they’re in the throes of burnout is to acknowledge it and to talk about it with a trusted colleague, such as a supervisor, Pedigo says. She acknowledges that being vulnerable and sharing such a difficult issue is extremely hard, but she believes that putting the problem into words can be helpful. In part, that’s because counselors struggling with burnout will discover that many of their colleagues have been through the same issue at some point.

When a counselor is burned out, “it feels pretty crummy to be there, but there is power [in admitting] it,” Pedigo says. “For me, it minimizes the isolation [of burnout] to bring in more people who will give good advice and love me anyway.”

Likewise, counselors can begin to address burnout in clients by normalizing their experience. Counselors can offer a listening ear, assure clients that burnout is a common issue that many people go through and let them know that they can take steps to manage it, Pedigo says.

“Sometimes, what [clients] need the most is one person in their life with whom they can share that they’re feeling this way,” she says. “For example, as a parent, it’s difficult to admit that you’re struggling and that it’s hard. You love your kids, but you are at the end of your rope. Be the person [clients] can share that with.”

In addition to engaging in therapeutic work with clients, Pedigo suggests that counselors connect them to resources outside of the counseling office that they can trust. This might include support groups and social or nonprofit organizations that focus on areas with which a client is struggling, such as career development or family and parenting issues.

Counselors can also assist clients struggling with burnout to connect the dots between their symptoms and the root of the problem, Band notes. This often involves helping them recognize that stress and burnout at work can spill over into their home life and relationships — and vice versa.

“Show them that these things are not in separate categories. We know that as counselors, but our clients might not know that,” Band says. “Connect the physical exhaustion they are feeling with the relational pieces to create congruence. While they might feel helpless and feel like they can’t get anything done, it’s not them or something they’re doing. It’s broader and feeding into other things. It’s not their fault. It’s all the dimensions that are weighing and feeding off of each other to make them feel that way.”

One possible antidote to burnout, both in counselors and clients, is change, says Crowe, an associate professor in the counselor education program at East Carolina University and president of the North Carolina Counseling Association. That often means getting creative to keep things fresh and changing up routines.

As a counselor educator, Crowe tries to rotate the classes she teaches so that she isn’t repeatedly covering the same material and subject matter. Other ideas she suggests to counselor educators to add variety include picking up a different project that doesn’t involve teaching and looking for short-term studies or teaching opportunities abroad. For practitioners, change might involve developing a new specialty, starting a new therapy group or trying something new such as consulting work, Crowe suggests.

Pedigo found herself confronting burnout when her caseload consisted entirely of individual clients. She worked with colleagues to switch and share tasks, and now she leads team meetings, co-facilitates a group and provides supervision, in addition to still seeing individual clients.

With clients, Pedigo suggests that counselors switch up the tools they use in session (she is a fan of using humor, when appropriate) or simply offer a change of scenery. For instance, meet in a different office or room, or take the session outside.

“Be a little more active in session, try a different intervention or even just change where you sit in the room,” Pedigo says. “Try and be more flexible — that’s the goal.”

Fire prevention

When it comes to avoiding burnout, self-care is the first thought that pops into many counselors’ minds. Indeed, unplugging from social media, engaging in creative hobbies, exercising, meditating, participating in spiritual activities, getting together with others socially and carving out some alone time are all helpful action steps to take. However, the avoidance of burnout often requires a comprehensive approach that touches on both individual and organizational levels. This can involve everything from counselors initiating staff retreats or mentorship programs at their practices to downloading mindfulness apps for their smartphones and stocking their offices with their favorite CDs, tea selections and an aromatherapy diffuser. Most important, however, is for counselors to engage in anti-burnout measures before they start feeling overwhelmed or chronically stressed.

Burnout can affect both individuals and entire counseling programs, Pedigo says. She recently collaborated with colleagues to address this issue at her program by organizing staff training to identify and prevent professional burnout. The initiative assisted in improving the culture at the practice for both counselors and administrative staff, she says. Pedigo will touch on this experience in an education session titled “Burnout: Working With Challenging Clients” at this month’s ACA Conference & Expo in Atlanta. She will be co-presenting with Jason Byrd and James Osborne, her colleagues from Aspire Human Services.

Part of the practice’s focus on burnout is to reinforce the idea that prevention is an ongoing and continuous process, not just something that happens during vacations and on weekends, Pedigo says. “We try to focus on self-care every day so that it’s a part of our routine in our personal lives and here at our office,” she explains. “It’s much healthier to just enjoy your day with built-in things that are going to keep you well than to hold everything in for a ‘miracle trip’ or an event in the distance to help keep you well. When we’ve seen others do that — and have experienced that ourselves — we’ve noticed that it isn’t as effective and doesn’t promote a healthy lifestyle. It’s just a fix until your next fix.”

Comprehensive burnout prevention needs to come from the top down at counseling practices and school and college programs, agrees Crowe. Counselors who are supervisors, managers or heads of programs can promote healthy behaviors to break the cycle of burnout.

“Have your employees leave or hit the gym during their lunch hour and take their vacation days. Make sure they leave by 5 p.m. and don’t eat lunch at their desks,” Crowe says. “Have workshops that talk about stress, balance and other issues. You can do as much as you can individually [to avoid burnout], but if a system is not wellness-oriented, then it will be a bad cycle. We have to think systemically about how to do that.”

“We have to be advocates to move toward that system-level change. We have to talk about it when things aren’t doable,” she continues. “Think critically about whether the setting you’re in is promoting healthy behaviors. If not, advocate for yourself about making changes. [For school counselors,] speak to your principal to have a training or a wellness-related professional development, or to change a policy or expectation in your workplace.”

Crowe previously worked at a practice with numerous practitioners, including LPCs, psychologists and marriage and family therapists. The program’s weekly staff meetings offered invaluable opportunities to debrief with colleagues and destress, she says. Staff members would break into small groups to go over case studies and talk through the challenges they were facing.

“There were times when the clinician might break into tears when presenting a particularly sad or difficult case. Talking it through and sharing it with other practitioners was helpful,” Crowe says. “It was so wonderful [to] get feedback and support from colleagues. That three-hour meeting was our time to come together.”

West adds that supervisors working with new counselors in practicum should make sure to discuss the risks of burnout early and often. As a counselor educator, West suggests to her students that they begin a self-care routine as they start their master’s program, before things get too stressful. This is especially needed for those who have things going on outside of school, such as managing a family, navigating life transitions or being involved in other commitments, she says.

“There is a fear, particularly among young practitioners, that if they speak out, it means they’re not a good counselor or will get fired. That’s a real shame because problems develop when we stop creating the space to be able to talk about them,” West says. “I try to always ask supervisees, ‘How is your work with this client impacting you personally?’ Create an environment where they aren’t afraid to say how things are affecting them. [Experiencing stress and burnout] doesn’t mean you’re a bad person or a bad counselor. It happens to all of us, so let’s talk about it and how to handle it.”

Learning to rely on a support system of trusted people, both professionally and personally, can also help clients who are at risk of burnout, West notes. Counselors might suggest that clients take breaks during the workday to visit with colleagues who are supportive and with whom they can chat, briefly, about nonwork topics. Outside of work, clients could be encouraged to identify friends and family members who have been through similar experiences. Counselors can also suggest that clients create their support systems not based solely on who they think should be included (for example, family members), but based on “those who are genuinely a support and beneficial to your life,” West says.

Crowe says she sometimes gets the support she needs by meeting with friends who do not work in a similar profession to hers. That way, there is less temptation to “talk shop,” she says.

Counselors also shouldn’t hesitate to engage in personal counseling themselves, Crowe urges, both preventively and when they are feeling overwhelmed. “Your willingness to get support will contribute to your longevity on the job and to being able to cope with the demands of being a counselor in today’s world,” she says.

“We are supposed to be the strong ones, psychologically,” she adds. “We are supposed to be in touch with ourselves and are taught in our [master’s] programs that you’ve got to be OK with yourself before you help someone else. But the reality is, life happens. If you’re going to be a counselor for 30 years, you need to feel very comfortable in getting support when life happens.”

Fireproofing

As important as creativity, getting outdoors, spending time with loved ones and other go-to self-care methods may be, it is the intentionality behind them that is key, West says.

“It sounds small, but it’s the idea that you’re taking time away from your desk to do something that you find enjoyable,” West says. “Be intentional: I am actively making a choice, in this moment, to do something that is enjoyable to me, even if it’s something as simple as lighting a candle.”

In a similar vein, Pedigo finds it helpful to remind herself to focus on the aspects of her work that are particularly meaningful to her, such as the adventure-based counseling that her agency provides. She makes it a priority to go on at least one adventure-based outing with clients each month, even though her position does not require it.

Make time for “whatever grounds you,” Band urges.

When discussing burnout with clients, counselors shouldn’t neglect the topic of spirituality, Band says. Research shows that spirituality can buffer against stress, and focusing on the greater sense of purpose that spirituality can offer may be comforting for many clients.

“The conversation is worth having when you’re talking about burnout,” Band says. “Spirituality can really impact the well-being of your clients, giving them a greater sense of purpose and life satisfaction. Having a spiritual attitude, and the idea that there’s a connectedness to life, and a search for the sacred and belonging — that can help build resilience and boost posttraumatic growth. The idea of being able to make meaning out of something bigger can help people persevere through difficult moments in life.”

However, Band cautions, counselors shouldn’t bring up spirituality with clients out of the blue. Those discussions should be reserved for clients who have mentioned their own spirituality in previous sessions or on an intake form.

With clients who value spirituality, Band suggests asking them to talk about how it has helped them through challenging situations in the past. Counselors should discuss spirituality in whatever terms the client uses, Band says. For example, if they call it a relationship with God, ask them how that relationship has changed as they became stressed and overwhelmed: How is it now, and how would they like it to be?

“[Spirituality’s] continuous search for meaning and purpose in a client’s life, and an appreciation of the depth of it, that will get to the very crux of where your clients are in seeking meaning and purpose, which directly relates to burnout,” Band says. “If we’re able to understand their spirituality and check in on it, we’re able to directly connect to their burnout experience.”

Burning bright

Avoiding burnout can be a career-long challenge and a constantly moving target for many counselors. The coping mechanisms and self-care practices that counselors find helpful are likely to vary at different phases of their career.

“It will take time to figure out what works for you, and it will change over time,” West says. “Be reflective, reevaluate and be willing to change.”

The first things that seem to slip when people feel overwhelmed are the very things that could be most helpful, such as taking time to exercise or to cook a healthy meal for dinner, Crowe notes. “What matters is getting back on the horse and realizing when you’ve let stuff go,” she says. “Tell yourself that it’s OK to leave at 5 p.m. or to take a lunch break.”

However, maintaining a perfect work-life balance is a misconception and an unrealistic expectation, West says. She often tells her counseling students that finding balance is a lifelong pursuit and, indeed, “something that I am continually working on as well.”

“Life is stressful,” West says. “No matter how much we try to remove ourselves from stressful environments, the truth of the matter is that stressful things will always happen in life.” At the same time, cultivating a healthy support system and maintaining good patterns of self-care can protect us from becoming overwhelmed to the point of burnout when those stresses do occur.

The key is making burnout prevention a priority, West says. As the adage goes: You can’t pour from an empty cup.

“So much of it comes down to choice. Setting an intention and telling yourself that you want to take active steps [to avoid burnout] doesn’t mean you’re a selfish person. It means you’re not compromising yourself and you care about your own quality of life,” West says. “Just because I decide to take time for myself and that I matter, that doesn’t mean I’m a bad counselor. In fact, it means that you’re taking steps to be the best you can be. You have to be the focus sometimes, and that doesn’t mean you’re a selfish person.”

 

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Related resources

Counseling Today and CT Online (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Counselor Self-Care by Gerald Corey, Michelle Muratori, Jude T. Austin II & Julius A. Austin (newly released by ACA)

ACA Conference & Expo

  • Numerous sessions will be presented on burnout, self-care and other professional issues at the ACA 2018 Conference & Expo, being held this month (April 26-29) in Atlanta. Find out more and search for sessions via topic at counseling.org/conference/atlanta-2018.

 

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Kids can burn out too

When counselors think of the populations most susceptible to burnout, law enforcement personnel and first responders, helping professionals, single parents, and adults living with mental illness or in poverty might come to mind. But children can burn out just as easily as adults, says Erin M. West, a licensed professional counselor and licensed school counselor who teaches in the school counseling and clinical mental health counseling programs at the University of Texas at Tyler.

In today’s modern age, children are often overscheduled, being involved in everything from extracurricular sports and after-school activities to pre-college prep work. This pace can lead to burnout — the symptoms of which adults may misinterpret as behavioral problems.

“Kids just need time to play and engage in unstructured activities and even sit in boredom,” West says. “A lot of times, when kids start to get overscheduled, you can start to see behavioral issues because they don’t have time to play and relax. Instead of viewing it as burnout, it’s often viewed as disruptive behavior.”

Often, children are given little control over their schedules. Counselors can help remedy the situation by educating parents that play is, in fact, a way for children to learn, West says. Parents are typically just trying to do what they feel is best for their children and may not realize that packing their schedules full of activities can have unanticipated consequences.

When families’ schedules are lightened, it can often lessen parents’ feelings of burnout as well, West notes. Counselors “can help change the perception that involving your kids in a gazillion activities doesn’t necessarily mean that you’re doing more for their mental, physical and intellectual growth than [if they did] one activity per week,” she says.

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her
at bbray@counseling.org.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

2 Comments

  1. Linda White

    Setting Boundaries as a therapist is essential in maintaining a balance lifestyle to better assist our clients and enhance our professional growth.

    Reply

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