Bad sleep, nightmares, fatigue, poor appetite. After a difficult few years, therapists are burnt out
Afew weeks ago, I took two weeks of unplanned sick leave. It was nothing dramatic, just a creep of symptoms so slow I didn’t notice them, until suddenly, I did. Bad sleep, nightmares about violent clients, fatigue, poor appetite and concentration. For the past three years, I’ve felt like a bunch of overcooked spaghetti, repeatedly tossed at a wall. Most often, I stick – valiantly – but this time I slid right off.
When I went back to work and spoke to colleagues about it, there were many nods. We started talking about how we felt, beyond the superficial and safe banalities of “tired” or “busy”. Since then, I’ve had many conversations with therapist friends and colleagues across the globe. The echoes are the same – tired, busy, exhausted, dropping caseloads, leaving the profession, reducing clinical work, indulging escape fantasies, re-training.
There is an iceberg heading our way, and it’s the iceberg of therapist burnout.
This doesn’t surprise me. We’ve supported people through the intensities of a pandemic for more than three years now, while living the reality ourselves. We’ve also helped people navigate bushfires, floods, the ravages of climate change, changes in geopolitical orders, wars, and destruction. It’s sometimes felt like the world is broken, and we’ve often been the last line of defence between people and utter hopelessness.
We’ve carried the moral injury of trying to help people while watching other systems fail them — inadequate Medicare rebates, uncertainty about the extension of mental health funding, the harms our “tough on crime” approach has caused to the most vulnerable, poor disability support, racism, spiralling costs, the failing health system and lack of trained mental health staff because of decades of poor university funding.
We cannot fix any of these issues; we just watch, advocate and try to hold hope for ourselves and our clients. There’s a helplessness in knowing the harms being done to the people we care for and being unable to intervene.
We have moments of self-sacrifice (“I don’t matter as much as my clients and colleagues”), invulnerability (“I won’t get PTSD, I know the symptoms”) and unrelenting standards (“If I can’t help this client, I have failed”). These are the tendencies we were chosen for, and the tendencies reinforced and fuelled by a system that constantly praises us for going above and beyond, and deifies us as heroes, forgetting we are justpeople.
Before the pandemic, there was a sense of life as normal, and the difficult things came intermittently, instead of the constant flood we now have. There are days I walk away from work having seen six clients, each of whom are in the bleakest place of their lives. Forensic and trauma work is especially dark. Clients talk to me of rape, murder, floods, fire, death, bereavement, stalking, family courtand trauma. I am a mirror for them, reflecting, exploring and soothing. With each client I am razor sharp and attuned – I love this work, and I value my clients. After my workday finishes, I am heavy. “Where do you feel this in your body?” is a question I often ask clients. When I ask myself this, the answer is simple:
“Everywhere.”
I sometimes lie in a dimly lit room after work, listening to the same soothing Spotify playlist. I cannot tolerate noise, loud music, new people, stimulation, small talk. I flick restlessly between TV channels or try (and fail) to focus on a book. I am a tuning fork, finely attuned to any vibrations, any disturbances – and I have not stopped humming since 2020. My therapist friends and I laughingly send each other pictures of ourselves lying in bed at 7pm. We extend each other understanding and care when we cancel social plans. Our forgiveness of each other is implicit and unspoken.
Most other people don’t get it. “You’ll be in bed by six like a nana, won’t you?” my friends in hospitality tease. I make connections with new people, then disappear, unable to sustain conversations.
I never thought burnout would be so beige.
The answers to this burnout are complex, and require political and social acknowledgement that the systems we have set up have failed, and that a focus on economic growth at the cost of social progress doesn’t work.
The answers for me also involve sustained political and social action, understanding from colleagues, selfreflection, boundaries, permission to be imperfect and to operate at reduced capacity for the next few years, grief, examination of the quantum and type of work which suit me best, support of new therapists entering the profession at this hard time, collegiality and consideration, a focus on the values which drew me to this work, balance between rest and activity – and careful selection of work, roles, and organisations which match my values and truly understand and honour the weight of the work I do.
The answers for each therapist may be different.
While the show will go on with or without us, we deserve the best support we can to stay in the show, juggling, caring, and holding.
• Dr Ahona Guha is a clinical and forensic psychologist from Melbourne. Her first book, Reclaim: Understanding complex trauma and those who abuse, is forthcoming from Scribe Publications in February 2023
• In Australia, the crisis support service Lifeline is 13 11 14. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In the UK, Samaritans can be contacted on 116 123.Other international suicide helplines can be found at befrienders.org
prising that the government has not dared to oppose Russia openly.
Against this political background few Georgians expected our politicians to take any actual steps in protest against Moscow, despite the public mood. But people are increasingly uneasy at the influx of Russian citizens who have arrived in Georgia since the start of the bombing. Russians don’t need a visa and can stay for up to a year without one, but it is worth mentioning that Georgian border control appears to be stopping nobody from crossing other than Russian opposition activists.
The situation has become more acute since 21 September, with huge numbers leaving Russia via almost every single border checkpoint with neighbouring countries. Those arriving in Georgia are fleeing not just the discomfort of western sanctions, which was the case in the weeks and months after the war began, but now include many who have no wish to lose their own lives on the battlefields in Ukraine.
At first glance, there is no problem at all in a noble act of hospitality – Georgia giving shelter to people who do not want to fight in war is truly a kind act. Beneath the surface, however, problems are brewing. Even without official numbers, a brief walk around central parts of Tbilisi is enough to confirm that the language predominantly spoken in the streets now is Russian.
Few, if any, of these displaced Russians, even if they are fleeing a totalitarian regime and positioning themselves against the war, seem keen to show off their pacifist ideas once safely in Georgia. Apart from a couple of small-scale demos, I cannot recall any significant acts of protest by relocated Russians against the war, let alone in support of Ukraine. At the end of September a popular joke circulating on Georgian social media went: “Oh, man, it is exhausting to read thousands of posts by Russian migrants freely criticising Putin’s politics and the war in Ukraine.” Of course, the truth is very few Russians have taken advantage of the (still existing) freedom of speech in Georgia.
Some are more vocal in expressing their disapproval of the graffiti in the streets supporting Ukraine or comparing Putin to male genitalia. When a bar in Tblisi began asking its Russian visitors for “visas”, issued if they ticked a “Glory to Ukraine” box, many Russians, including the reality TV star Ksenia Sobchak, protested vociferously on social media. I witnessed a Russian customer in my local cafe storm out swearing obscenities when a staff member, who did not speak Russian, politely told her the wifi password was “StandwithUkraine”.
In these instances, the complaint is always about alleged “Russophobia”. Yet a fear now widely discussed among Georgians is that these 2022 arrivals could eventually form a new Russian diaspora and in some hypothetical future scenario serve as justification for the Kremlin to order another attack on Georgia in the name of “protecting” Russian-speaking citizens. However absurd this sounds, one should not forget how Putin has weaponised language and identity issues as a pretext for invading Ukraine.
The legacy of Russian imperialism has cemented colonial attitudes in some – Georgia struggled to end its status as a Russian colony, but is still regarded by many Russians as their holiday home, their back yard, a sunny place where the likeable neighbours often speak Russian, albeit with a funny accent.
Georgian-Russian relations have a long, complex history. But the view I have long held of Russia, as a serious threat to the world order as well as neighbouring nations (a view regarded by many of my western European friends as paranoia about our former colonial masters), has been confirmed by events in Ukraine. The question is what price will have to be paid before Russia is stopped. War in Georgia in 2008 was not taken seriously, nor were the events of 2014 in Ukraine. It took horrific images of atrocities in Bucha, Mariupol and many other places for some western governments finally to take action.
Given the public outcry among Georgians about the bloodshed next door, it is pathetic that the government, which has a responsibility to act, still tries to pretend we are a third party in this war and should remain neutral.
Georgia faces a critical choice: the country has to comply with demanding criteria to acquire EU candidate status. Either the acting government gives up its Russian ties and interests, and its openly pro-Russian rhetoric, and takes adequate action in the right direction, or we remain where we have been for more than 200 years – in the cloaca of the great Russian empire. I take responsibility for the vulgar word choice. In fact, I have tried to curb the full extent of my indignation, fury and outrage in what would otherwise have been an unbroken wail – an expression of hopelessness and misery.
Davit Gabunia is a Georgian playwright, translator and novelist. He is the author of Falling Apart (2017), a bestselling novel in Georgia.
This essay is part of a series, published in collaboration with Voxeurop, featuring perspectives on the invasion of Ukraine from the former Soviet bloc and bordering countries.