How Therapists Avoid Becoming Depressed, Embittered Burn-Outs
I have been practicing psychotherapy for about 15 years now. I’ve worked with abandoned children, abandoning mothers, schizophrenics, a few sociopaths, folks who want to kill themselves more often than not, and deep, chronic depression and anxiety (which is the center of my private practice). In these years, I’m asked by patients, with some regularity, and bafflement, “How can you stand to listen to all this all the time?” Good question: how is it that we psychotherapists can engage day in and day out our patients’ suffering—which is to say, the stream of human suffering—and not become burnt out husks?
Here’s how I answer them: “When I’m sitting with you as your therapist, I’m not hearing bitching or complaining or interminable pain. What I’m witness to, and participant in, is the universal process of transformation, in the form of you as a unique human being. Your specific complaints, the particular struggles, the unique frustrated desires, are all slices of a life that, as with all human lives, came from somewhere, have an exquisite logic and structure, and inevitably is bending inevitably towards healing and transformation.”
That’s not hyperbolic, or Pollyanna, or wishful; rather, that’s what I actually experience. Not that I, like my patients, can’t at times get caught in the minutia—I can. But it doesn’t last. The Buddhist adage of “This too shall pass” becomes observational the more time we spend in the therapist seat. Not in a way that diminishes the particulars, or disrespects the uniqueness of our patient’s suffering. It’s actually the opposite, where the struggle with the boss, or the trenchant issue of the wife not doing dishes, becomes lit up, illuminated, at times made numinous, by the experience of each of these particulars being the “out-picturing” of the in-wired human process of transformation.
It seems that what makes a psychotherapist long-lived, and deepens their love (rather than mere tolerance) of the work, is this experience (not mere belief) that each patient is utterly unique, and exquisitely universal at the same time; is utterly vulnerable and fragile, and staggeringly strong and expansive; is painfully confused and ignorant, and burning magnesium-bright with unacknowledged greatness and unavoidable transformation; and, regardless of their own story, cannot actually be “stuck,” with such stuckness merely being an illusion created by a limiting sense of time and perspective.
Not to say grueling encounters don’t exist as a therapist. We therapists are particularly aware of the paradoxes of humanness, especially our own vulnerabilities and shortcomings, and those can play out with the unique vulnerabilities and shortcomings of our patients. We learn to recognize these weaknesses, own them, be curious, avoiding disaster as we grow more and more skillful. But pain is pain, and we have to practice exactly what we teach and support in our patients, the honest allowing of that pain, while both managing it (to prevent overwhelm, and acting out), and having a grounded faith as we work towards healing and transformation.
Less and less as I play out my role as therapist do I find myself holding onto certain scripts or injunctions about what therapy is supposed to produce for a particular person, while also being more and more clear on this inbuilt, ubiquitously human drive for transformation. “Hope” is too weak a word for what develops as a therapist, and what undermines the danger of burn out. Instead of hope, what develops is perception; you stop hoping that therapy will be useful, and start seeing how it inevitably is effective. Not wish, but trust, a trust build on repeated observation of what actually happens with human beings when they are given an environment and relationship (like therapy) where they are loved, appreciated, known, respected, and guided towards a transformed reality that they can feel in their bones actually exists, but can’t get at only by themselves.
So that’s what keeps me from being an embittered, burdened, charcoal-grey burn-out of a therapist. It’s only when pain is getting stuck in our minds and hearts and bodies that we can exhaust our stores of energy and hope and faith; when we experience pain as the local expression of growth, the proximate expression of transformation, then to hear and work with a patient’s pain is to be witness to and companion with the deepest dimension of a human life. When you don’t see pain and suffering as concrete and indigestible, to be managed at best, but rather see it as the contours and forms of the yearning for transformation, then it’s hard for anything to get stuck.
Admittedly, this may all sound a bit “on a good day-ish.” Or it might sound like thinly veiled religion or spirituality. Or the politically correct line that therapists are contractually obligated to hold. Fair enough, but that’s not it. As a person who has had more than his share of the bleakness and despair that underlies depression, I am quick to go into eye-rolling mode when some assertion is not backed up by thoroughly vetted facts.
So, what I’m saying here has been checked by my inner skeptic over a decade and a half, and keeps being confirmed in my experience, and in the reports of colleagues who survive and thrive in their work as psychotherapists. Which I’ll summarize as this: it makes it virtually impossible to burn out when your work—including all its struggle, worry, conflict, and confusion—is constantly fueling you, constantly feeding your recognition and perception of life and humans as awesomely complex, impossibly complete, inexplicably courageous in the face of the savage in the world and themselves, and ultimately, despite the claims of shame, staggeringly unabandoned by Love.