Part 6 – A Letter to Therapists: Burnout and the Hands-on Approach to your Salvation
Part 6 – A Letter to Therapists: Burnout and the Hands-on Approach to your Salvation
“Your imposter syndrome will follow you until you learn how to not dance with it.”
Several years back I was doing a “Rapid Resolution Therapy” training with the founder, John Connolly. He would do demonstration sessions with a therapist from the training as we all circled around. In his fashion, he typically would say something that blew our minds. We would clamor around him afterwards in the debrief and request how he knew what to say at a particular moment. His response would always frustrate and disappoint the crowd as he said, “It’s what came to mind.” It wasn’t until a few years after those trainings that I truly understood what he meant. He wasn’t trying to be an ass (even though we believed he was at the time). He was simply trying to say, “I’ve learned a lot in my career and I have a huge library of content to pull from. When you have that many things at your fingertips, sometimes the response just comes to mind and it’s not a planned intervention.” His response of “It’s what came to mind” was just a note that said “I hope you learned from what I did because I cannot download all of my knowledge to you so you can skip the dreaded process of moving from unknowing to knowing.”
At the early stages of a therapist’s journey, very few things come to mind. I recall back when I was a young therapist (at the juvenile age of only 23) that the things that came to mind were structured and specific. The things that “came to my mind” back then were teach an “I statement,” practice deep breathing, and… well, that may have been it. I rightfully scrambled and worked on finding therapy homework sheets, videos to show in session (It’s not about the nail is still my favorite), and stealing interventions from my peers so that I could add to my empty library. During that time, I had one thing that was going in the right direction for me, I practiced being present and working from what I had. I was honest with my clients if I was stumped (that sometimes is the most validating response a client can get), I discussed following up on an issue with my supervisor if I didn’t know where to go with it, and all along I practiced just witnessing my clients’ experience. This worked really well for both myself and my clients and allowed me to feel at home in my sessions. All these years later, I still feel most at home during a session, unless it’s with someone who is triggering the heck out of me… and that still happens every so often. The best part is that I made it to a place where “things come to mind” in most of my sessions.
This final chapter of my burnout blogs is dedicated to the therapists who struggle with having “very few things come to mind.”
Therapists use interventions like mechanics use tools. If we only have some duct tape and a screwdriver in a session, there is only one thing you can do. Accept that you only have some duct tape and a screwdriver and use them when you can. Some mechanics specialize in foreign cars, some in high end cars, some in electric cars, and most in everyday cars. When someone brings in their Toyota Corolla to a mechanic that only works on Formula One racecars, that mechanic may have no idea what to do. It’s not that they’re incompetent and it’s not that they are uneducated, it’s that they have focused on building their library in other areas. As a therapist sets out on their journey to fill their libraries, it’s good to remind ourselves that we don’t know what we have not yet learned and there is no magic wand. It’s wonderful to be a learner and expand your knowledge base and sometimes it sets you up to only know a little about a lot. You are then left with less tools than you think versus becoming an expert at using a specific set of tools. Start with one or two modalities and read the book to its conclusion, not just a few chapters. As you fight the urge to move on to several other books on your shelf, remind yourself that you have permission not to know it all.
Young therapists need to work on being in session when they are in session. They need to work on returning their mind to their client when it floats away to some other thought. The emotional energy that is created in the brain will lead to burnout when a therapist is being emotionally pulled to make a change while being handcuffed in the session. It can be energy draining in the moment to emotionally push past the “not knowing” parts of the session. At the same time, we can be aware the “not knowing” often triggers fear and shame.
Let’s try an example to illustrate how this would look for a young therapist:
Karla is talking to her therapist about her love of Mexican food and her inability to portion control when out at her favorite Mexican food restaurants. The therapist is nodding along to the story when Karla turns to the therapist and says, “how can I just put the fork down and let the waiter know that I’m finished with my meal?” The therapist may be thinking, “I have never learned anything about compulsive overeating and I don’t know what to do. I’m not even sure if I know what to do for myself because I, too, overeat at Mexican food restaurants.”
Instead of providing an answer, the therapist reflects by saying, “It sounds like there is something inside you that will not put the fork down and tell the waiter to take your plate. Can you tell me about that at all?” As the therapist is waiting on the client’s response, they might jot down “compulsive overeating” on their notepad and return their focus to the client. This way they can be present and be okay with not knowing where to go. If the client then pressures the therapist for an intervention, the therapist can say, “You know what, Karla? I don’t know how you can get through this issue as I don’t have a lot of experience with compulsive overeating. I can put it on my to-do list to review some interventions, but at this point all I can offer is a listening ear and an open heart.” Karla, having more acceptance for other’s shortcomings than she may for herself gives an understanding head nod and shifts the topic to the date she was on while engaging in the compulsive overeating. During that shift, you hear something about boundaries and you pull from your mental library “that thing” you know about boundaries and address it with Karla. Karla leaves your session feeling heard, safe, and with a little boundary homework. You leave the session asking yourself, “Do I ever want to research compulsive overeating?” As you think about this question, you answer yourself, “I think I’m going to refer out to my friend Kenzie who is really good with eating related disorders.”
I hope this illustrates the lack of pressure you can feel in a session. The lack of pressure in a session can feel so enjoyable and if you learn to make this your “normal,” you will learn to fall back in love with therapy. I think this can relate to any job, as even the checker at Target can feel pressured to perform differently, and if the training was inadequate, they may be trying to keep up with the Jones’ at Wal-Mart.
The other side of being present with the client in session is the path of the session. An insecure therapist will tell themselves that it’s not okay to just go with a client wherever they go and respond as needed. They might tell themselves that if they don’t respond quickly and helpfully, they’ll be “found out.” This can push them to also over-plan, over-prepare, and over-control a session. This leads me to imagine a session Monica from Friends would provide. Instead of white-knuckle gripping the steering wheel, why not practice a mantra about your permission to yourself to be a human being. Your permission to take time to respond. Your permission to not know everything.
The problem with being a therapist is that we are the experts in the human experience. That is vast! We are NEVER going to know it all. Even worse, it’s always changing. Giving yourself permission to have bad sessions will likely free your mind up to allow things to “come to mind.” It’s one of those paradoxes that we learned about in grad-school. If I tell myself I can fail, I can relax enough to find success. If I tell myself I have to achieve success, I won’t relax enough to not fail.
Lastly, it’s a journey. I hear all the time of therapists who stopped because of burnout. Had they just embraced this phase of their development, they might have added a handful interventions to their mental libraries and started to feel more confident and competent. I sure do hope that the new front desk receptionist we hired doesn’t suffer from this affliction or else we’ll be right back to group interviews. I say that to say, your imposter syndrome will follow you until you learn how to not dance with it.
By Jason Temple, LMFT