Bad sleep, nightmares, fatigue, poor appetite. After a difficult few years, therapists are burnt out
A few 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