Therapist Burnout

This section is for discussion relating to the Layard report, and subsequent schemes like Improving Access to Psychological Therapies where lower intensity inteventions are offered in primary care
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enchanted
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Therapist Burnout

Post by enchanted » Thu Oct 11, 2018 6:45 pm

Hi there,

I am a qualified PWP and I've been working as one for the past two years. I am experiencing severe burn out as a result, all the classic symptoms such as sleep problems, poor concentration, dizziness, irritability, empathy/compassion fatigue. The sheer relentless / conveyor belt nature of IAPT just does not provide any adequate time or space to really recover, and unfortunately with a mortgage to pay, I am really struggling to see what I can do to support myself through this.

I guess I am turning to this forum for some peer support - can anyone recommend anything that I can do to manage this? There seems to be a lack of resources online for therapist burn out. There's lots available for self-care, but what if you have passed that point?

Thanks in advance.

Dedicated PWP x

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hawke
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Joined: Tue Feb 07, 2017 11:10 am

Re: Therapist Burnout

Post by hawke » Thu Oct 11, 2018 9:05 pm

Oh I feel for you - I'm a recently ex-PWP, it's a tough job.

Firstly, know that you are not alone in feeling burnt out - this study found that two thirds of PWPs experienced burnout. It's nearer to half in other NHS psychology practitioners, if the stats are to be believed.
https://www.ncbi.nlm.nih.gov/pubmed/28084121

Firstly, I would really consider getting yourself to a GP. I was experiencing many of the same symptoms about 2 years into my IAPT career, and believed it was pure burnout - turns out I had an undiagnosed LTHC that was hugely contributing. I think psychology practitioners have a tendency to assume everything is psychological, so do get checked over physically too.

It can feel incredibly tough, but I would seriously consider talking it through with a trusted colleague at work - ideally your supervisor or line manager, as they will be the ones who have some power to change things for you. Any reasonable line manager/supervisor would rather make some temporary adjustments for you, than have you go off sick or leave completely. Are there parts of the job you like or find easier than others? For example, treatment is often more emotionally engaging and rewarding to restart the compassion & empathy. But I found phone assessments/cCBT much easier to do when I just wanted an easy life for a while. We were allowed to do phone assessments from home with a laptop, which made the world of difference sometimes. Equally, doing more work from our central base and running more courses meant seeing colleagues more frequently, which could be helpful. There could be times of day that could be adjusted - starting later, or dropping an evening temporarily. Or if there's a particular GP surgery that's complex or involves a lot of travel, maybe there's scope to move around. It's highly likely that your senior colleagues have felt like this at some point, or at the very least have seen colleagues come and go because of it, and want to stop that happening to you. Go to them for support and with some solutions.

Longer term, what really helped for me was figuring out where I wanted to go in my career. I think part of the PWP burnout comes from a feeling of being stuck and the repetitiveness. Is there a particular area you want to develop in? A particular area of clinical work, or perhaps some service development? Or are you wanting to move on to a senior PWP/HI post at some point? Sometimes just feeling like you're making progress towards something can help on the days when the clinical work gets to you. Is there a way you could bring value to the service, while having a temporary reduction in your caseload? My old manager used to be brilliant at juggling our levels of burnout/boredom and always had something (like training or a project) up her sleeve to dangle as a carrot in front of us to keep us going.

Do whatever you need to to ride out the burnout peak right now. Have a good look at your annual leave, and consider taking some time off. And if not, don't be afraid to use some sick leave and do whatever you need to do to refresh. I've often found a long weekend of doing nothing but self-care has been enough to set me straight. You may have an employee assistance programme you could phone, just to get an outsider's perspective on things.

One final point was a comment someone made on the forum recently about burnout being a protective mechanism that potentially allows us to stay working in the NHS for long periods of time. Since reading that, I suppose I have a different perspective on burnout, that maybe it's part of a normal cycle of being a health care professional in the economic times we find ourselves in. It reminded me of the various distress tolerance and compassion focused therapies - accepting where you're at currently, and riding out the burnout wave rather than fighting it. Having said that, the sheer numbers struggling in IAPT says it all - so first do whatever it takes to get yourself back to a good place, and then use your experience to try to change your environment for the better. There are lots of good ideas here - https://iaptus.co.uk/wp-content/uploads ... t-2017.pdf

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Victoriomantic
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Re: Therapist Burnout

Post by Victoriomantic » Thu Oct 11, 2018 9:13 pm

((Apologies in advance if this list sounds directive. It's just me listing as many ideas as I can think of, and it's a serious topic. Your wellbeing is super important!))

In all honesty, if you are experiencing burnout (and those symptoms you described!), the best thing you can do is go to your line manager and ask for an Occupational Health referral. Might be worth exploring having a reduced caseload for a short time just to give yourself some catch-up time / breathing space. Also go to your GP and request something like a general physical check in case the dizziness etc. is indicative of anything underlying. Also good to keep GP in the loop. They might even sign you off, even just for 1w, to give yourself a break.

I would also strongly recommend using annual leave wisely e.g. take a long weekend just to chill out at home / get away for a change of scene, and a chance to rest. Engage with some hobbies or something distracting + usual self-care stuff. Within that time, maybe put aside an hour or so to brainstorm what you like and enjoy about your role, to combat some of the empathy/compassion fatigue.

Other important ideas:
- Self-practice!!! Thought records/challenging, behavioural activation outside work, worry diary, Urgent/Important time management quadrants, mindfulness, rumination-busting techniques, sleep hygiene etc...
- As part of that, make your own red/amber/green relapse prevention plan and have regular review days!
- Keep a journal / list / notebook etc. for times clients have made your smile, or celebrated small success etc. And get into the habit of updating that regularly, be it daily or weekly, or just as and when something happens
- Make your workspace as clean/tidy and homely as possible... is there a plant or something you can put on your desk? I had a picture of my dog & cat, and a desk calendar of sunny Corsica. All work notices were to be kept pinned behind the computer so I didn't feel surrounded by work. If you hotdesk, maybe just a cute sticker to put on your computer, or some kind of colourful mascot that you can just set next to you each day (e.g. keychain, an eraser shaped like your favourite animal etc). Or failing that, a cozy jumper to have with you in the office. Hot water bottles are always a good shout
- If there are more experienced team members you are close to or look up to, ask to have an informal chat, they will likely be willing to offer advice, or a sympathetic ear, or even mentor
- Listen to music while you do admin, if you are someone like me that finds music helps to set a pace and/or keep you focused on task by putting you into your own little world
- It's difficult, especially when you feel overwhelmed, but try and make sure you take your lunch break and leave on time... if you absolutely must stay late or sacrifice lunch breaks, make sure it's no more than 1x per week. If that's difficult then at least get up and go outside to get fresh air and stretch your legs even if it's only for 10 minutes. So important!
- Try and get your team involved too (with the above) to hold each other accountable. Team morale and working environment will make a BIG difference. Team reflection can be useful for normalising -- and try to problem-solve rather than just verbally ruminate and spread anxiety about high targets / service demands (I find that type of anxiety is contagious!)
- Regarding the team, what can be very helpful in my service is reminding each other to go for lunch / go for lunch together, and leave on time etc. And when you do go for lunch, talking about work/clients is OFF LIMITS. Only psychology talk allowed is stuff that you find interesting and non-IAPT related e.g. ("I saw a great TED Talk about X"). Better yet, nothing psychology related! Talk about TV, films, books, hobbies, what to do on the weekends, daydreams about holidays you want to go on, things you're looking forward to, gossip about friends or partners etc. Lunch is a break, not informal supervision. Try and keep it at the same time each day.
- If you commute, don't ruminate about work! Work is work's problem. Read, listen to music, or nap.
- If you are at home and suddenly remember something you have to do at work, just email your work address or text your work phone (if you have one) so you can forget it... that's Tomorrow You's problem
- If you have control over your diary, try and make it so that days are as consistent as possible (e.g. Mondays are for triages and groups only, Tuesdays are just for GSH etc.) so you don't have to switch tasks too much. Even if you're someone that thrives on variety, see if you can find a way to let things slow down for some kind of consistent baseline to help get your head together and concentrate better.

...For context, I was a Graduate Mental Health Worker for 8m and PWP for 2y, now just started HI training. I've been where you are several times over as a PWP, it's a very tough and demanding job, and it's easy to lose yourself. All of the above are things I have done and found helpful. At the worst I was on a 65% caseload via Occupational Health for about 5 months because of the stress (although in that circumstance I had a lot of rubbish go down in my personal life). That helped the most for giving me space and a breather. But all of the other tips are useful too.

Happy to be PM'd if you want to talk to someone that's been there and has a tendency to slip into that stream very easily!

Remember... put your own oxygen mask on before anyone else's!
Last edited by Victoriomantic on Thu Oct 11, 2018 9:19 pm, edited 2 times in total.

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Victoriomantic
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Re: Therapist Burnout

Post by Victoriomantic » Thu Oct 11, 2018 9:15 pm

Looks like hawke got there first and along similar lines :lol:

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miriam
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Re: Therapist Burnout

Post by miriam » Thu Oct 11, 2018 10:49 pm

Seconded (or thirded) for occupational health, and being signed off for a while if need be. I had some CBT sessions via OH before I left the NHS and they were helpful. But ultimately I left my job, and felt a lot happier for doing so.
Miriam

See my blog at http://clinpsyeye.wordpress.com

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