Psychologist burnout on the increase


Anne Pratt, Ph.D., a private practitioner in Connecticut, says that physical symptoms should send up a “red flag,” for psychologists who are under a great deal of stress. (photo by Kathryn Hardy)

By Phyllis Hanlon

Construction workers sport hardhats, mechanics wear steel-toed boots and welders shield their eyes with protective glasses, all in an effort to prevent serious injury. Although the dangers psychologists face are not usually physical, they, too, need defensive gear to stave off the emotional ravages that can occur as a result of overwork and other job-related stressors. The volatile combination of increased caseloads and paperwork, elevated patient acuity and reduced reimbursements requires psychologists to don "hardhats" in order to effectively treat clients without becoming a casualty of their own work.

According to trauma specialist Karen Saakvitne, Ph.D., psychologists afflicted with vicarious traumatization (VT) - a phrase coined by Laurie Anne Pearlman, Ph.D., and I. Lisa McCann, Ph.D., in 1990 - are "soul-weary, have increased fatigue, cynicism and dread, and carry their work around with them all the time in the form of worry, stress and tension." When the fundamental joy of performing the work that psychologists love is constricted or negatively transformed, she emphasizes that it's time to investigate the reasons.

Together with Pearlman, Saakvitne created the "ABCs of VT." First, she suggests psychologists become aware of their emotional well being and also admit to the reality of job-related stress. "The kind of work we do as mental health providers has unique occupational hazards," she says. "Be aware of your needs so they won't overwhelm or surprise you." Saakvitne next focuses on balancing work, rest and play. "We're drawn into the profession to take care of others. We give away of ourselves beyond the point where we maintain balance," she says.

The last part of the equation speaks to the psychologist's need for connection. Saakvitne promotes the idea of community. "It's too hard to keep track of yourself," she says and recommends peer support groups, attendance at workshops and seminars and other networking opportunities to nurture emotional, physical and spiritual health. A staff member at the Trauma Stress Institute (TSI) in Connecticut for 13 years, Saakvitne is now in private practice in Northampton, Mass. and understands the importance of regularly reconnecting with others. "In private practice, you have to make a conscious effort to stay connected," she says.

Anne Pratt, Ph.D., also previously at TSI and now a private practitioner in Suffield, Conn., says that in addition to obvious signs, other, subtler clues might escape notice. "It's natural to find emotional nurturance in a psychologist," she says. However, when family members routinely seek that kind of attention and the "I-gave-at-the-office feeling" emerges, it's a clear indication of a problem. She adds that physical symptoms, such as poor sleep habits, increased alcohol or drug use and "straying from appropriate boundaries in therapy," should send up a red flag. Pratt says that psychologists have to be healthy themselves in order to effectively treat clients.

In addition to VT, other terms describe various types of psychological burnout. Pratt notes that compassion fatigue, named by Charles Figley, Ph.D., "captures the depletion or exhaustion therapists feel when they've given and given to a client who needs so much attention." Another oft-used term, says Pratt, is secondary posttraumatic stress disorder (PTSD), associated with the transference of symptoms in psychologists who treat trauma victims.

Jilisa Snyder, Ph.D., director of the Anna Marsh Behavioral Care Clinic at the Brattleboro Retreat in Vermont, suggests that good supervision, knowing your limits and self-monitoring can be effective management tools. Snyder urges regular self-restoration in the form of annual vacations and, better yet, daily actions, such as reading, hobbies, yoga and other personally fulfilling activities. If these strategies still prove inadequate, professional help could be warranted. "If some of your own personal intrapsychic distress is activated by your work, you might need to get some psychotherapy," she says.

In some cases, psychologists administer self-tests, the efficacy and wisdom of which draws mixed responses. Pratt admits that it might be helpful, but notes the importance of consulting with another professional. "You can get some good hints from the test but you learn more in-depth when you talk to another person," she says. Although self-tests can be useful, Mark Ciocca, Ph.D., in group practice in Concord, NH, says that psychologists are "savvy about tests." Even so, by admitting to a majority of the symptoms listed, a psychologist may acknowledge reason to seek help. He states that external sources such as a spouse, partner or colleague greatly influence a psychologist's decision to seek help.

Ciocca says that psychologists tend to choose therapists wisely. "They are looking for a specific therapy and a good match from the start," he says. "The ordinary consumer just looks for any therapist, but psychologists are looking for a particular niche and therapy." However, local colleagues might not be the answer. "Because people work with you in other ways, you may hesitate to go to them for personal treatment. There is that dual relationship aspect," he says. Oftentimes, insurance becomes a concern as well. Therapists don't necessarily feel comfortable using an insurance carrier for which they also provide services. "Many choose to pay out of pocket," says Ciocca, "which may shorten treatment."

Saakvitne also refers to a potentially awkward situation when colleagues are in a client/therapist relationship and emphasizes the importance of clarifying roles. "It's more comfortable sitting back and letting the other person talk - which is what we do as therapists," she says. "In this setting however, the person as client can take in from the other psychologist." Deploring the attitude of shame that is attached to the need for psychological intervention, Saakvitne encourages a more nurturing attitude. "We need to challenge the misinformation and stigma that's been unwittingly promoted within the profession. We need to be extremely respectful, give helpful information and have a genuine connection," she says.

Although psychologist burnout appears to be increasing, formal training programs are difficult to find. Saakvitne says, "Supervision is the major way of transitioning the wisdom of the profession. We are an 'apprentice profession.'" Saakvitne believes that every psychologist should undergo psychotherapy before and sometimes during, clinical practice. "It doesn't work to give so much attention to others and not know what they are undergoing," she says. "You need to know how hard it is to be in their position."

Psychologist burnout on the increase (July 2004 Issue)

Psychologist burnout on the increase
(July 2004 Issue)