1. There is a general unwillingness to discuss work in social and family circles. When queried by friends about what is new at the office, the therapist’s eyebrows rise, shoulders shrug, but nothing comes out. In fact, the therapist, if she makes any response at all, may snort and then use all her therapeutic skills to deftly change the focus to someone or something else.
  2. There is a reluctance to check voicemail and email or call the office for messages and a resistance to returning calls. It is as if there could not possibly be any message that is worth getting excited about. In their most pessimistic states, burned-out therapists may think that a message can bring only three possibilities: (1) someone is cancelling an appointment at the last minute, leaving a gap hole in the therapist’s schedule during the middle of the day; (2) a new referral has called and wants to be squeezed into an already overloaded week; or (3) a life insurance agent has called to talk to the therapist about his inevitable death.
  3. When a client does call or text to cancel, the therapist celebrates with a bit too much enthusiasm. Dancing and singing in the hallway is a dangerous sign of advanced deterioration. Whispers under one’s breath such as ‘Thank God!’ and other expressions of relief are certainly more socially appropriate, but they are equally indicative of professional dread.
  4. One of the clearest signs of burnout in a therapist is when several clients complain of similar symptoms. When there is a rash of complaints about hopelessness, frustration, pessimism, and doubt in the therapeutic process, the clinician may silently be in agreement. Because clients resonate our faith and beliefs, they also sense and imitate our despair. Frustrated and unmotivated therapists do little to promote growth in their clients. If clients improve, it will be largely in spite of their therapist rather than because of her help. In fact, some clients will get better just to escape the punitive drudgery of their sessions.
  5. The alarm clock is less a signal to begin the day than an order to resume one’s sentence. There is reluctance to get out of bed; excuses to avoid getting started abound. During the day, the therapist functions at half speed and is lethargic, apathetic, disconnected. Much time is devoted to coffee breaks and ploys to stall action.
  6. As in all instances of prolonged stress, therapists are prone to anesthetizing themselves with self-prescribed medication. In some cases, legal prescription drugs are used with regularity. Just as frequently, stressed therapists resort to abusing the recreational substance of their choice. Just as with the general population, therapists may also be prone to medicating themselves with other coping strategies: overeating, compulsive shopping, gambling, overexercising, sexual acting out, addictions, destructive risk taking.
  7. Cynicism is manifested in a number of ways. To colleagues and friends, the therapist may make a number of deprecating remarks about clients, ridiculing them for their weaknesses, joking about their helplessness. And the therapist may find a commentary running through his head during sessions: ‘If you only knew what a fool you look like,’ ‘You are so boring, no wonder your wife left you,’ ‘I don’t care what you do. What are you asking me for?’
  8. Sessions lose their spark, their excitement, their zest and spontaneity. There is very little laughter, little movement. The room feels stagnant. Voices become monotones. There are lots of yawns and uncomfortable silences. Sessions end early.
  9. The therapist falls behind in completing paperwork and billings. Progress notes, fee sheets, treatment plans, and quarterly summaries pile up. During the best of times, such chores are handled with less than joy; the burned-out therapist may spend more time complaining about the forms to be completed than actually finising them. Management intervenes to slap the therapist’s hand, often with other punitive measures to enforce compliance with organizational rules.
  10. During leisure time, there is a distinct preference for passive entertainment. Losing yourself in videos, television, or the internet is easier than getting out in the world to do something. One therapist commented about this: ‘I’m so tired of having to be responsible for other people’s lives that I want someone else to take charge of mine. I just don’t have the energy for anything else.’
  11. The therapist is so emotionally tied to work that an active social life is completely precluded. He has difficulty relinquishing control, feeling he must do everything himself. He experiences excessive internal pressure to succeed and an overidentification with his clients to the point of losing his own identity.
  12. The therapist is reluctant to explore the causes and cures of her burned-out condition. Rather than making needed changes or confronting the emotional difficulties that are blocking satisfaction, she prefers to make excuses and criticize others for the problem. Much of what a therapist does involves interrupting this destructive cycle in others; thus one symptom of burnout is an inability or unwillingness to apply one’s therapeutic wisdom to oneself. There is probably some ironic justice in creating so devastating a punishment for those who practice therapy in a spirit of hypocrisy and self-neglect.

    From the book On being a therapist, by Jeffrey Kottler, pages 146, 147, 148.

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