The daily reality of providing healthcare services while managing a private practice can be stressful. Not to mention the added stress of a global pandemic, increased economic uncertainty and a plethora of virtual technologies that we’ve had to adjust to over the last year.
Given this kind of resilience that’s been asked of all of us in some form or another, it’s no wonder that professional burnout is becoming an increasingly prevalent phenomenon.
The good news is that you’re not alone.
To help shed some light on the matter, we spoke with Dawn Delgado, a licensed therapist of 14 years, about her advice on how to deal with and prevent professional burnout in healthcare. Dawn runs her own therapy practice in California and as one of her many specialities, she works with clients and clinicians alike to help them improve their self-care, set better boundaries and keep burnout at bay.
In our conversation, we covered:
- her thoughts on the current state of burnout among private practitioners
- the most common signs and symptoms of burnout that you should be looking for
- how to deal with burnout once you’ve identified some symptoms
- what strategies to put in place to prevent and avoid burnout in the long run
Hey Dawn, so nice to talk to you today. Let’s get everyone familiar with your background. Could you give us a quick intro into who you are, what you do and why you talk about things like burnout and self-care?
Absolutely! My name is Dawn Delgado and I am a licensed therapist based in Los Angeles. I’ve worked in the mental health field for 20 years and I specialize in EMDR, trauma, eating disorders, depression and anxiety management. With those specializations, it is vital that my own self-care is solid. The risk of professional burnout is high, especially now during the pandemic.
I’m also a clinical supervisor to other therapists across the nation and have therapists and other private practitioners who are clients of mine. So a big part of what I do is to help people maintain their own self-care when they are caring for others in any type of way, whether it’s psychotherapy, physical therapy or any other speciality.
As healthcare professionals, we often hesitate to speak publicly about professional burnout because we worry that clients may feel guilty about their practitioners being overworked. So I want to stress that personal self-care is part of our job and is our responsibility as health professionals. We all need a community and our own support, which is why I am also a huge advocate for practitioners continuing to do their own work in therapy.
You mentioned the pandemic. From your own experience as a private practitioner, how do you perceive the current situation among your colleagues? How do you think COVID has affected everyone?
So while professional burnout is always an important topic in any field, it’s become more relevant in my mind during the pandemic. Not only are people under tremendous amounts of their own stress, but work environments have completely changed. A lot of people have had to adjust and work from home, change their practices to a virtual platform or expose themselves continually in the office to the risk of COVID. Extended screen time has also had different effects on different people.
Caseloads have either drastically decreased or increased for many professionals during the pandemic. I know for psychotherapy in particular, as many countries and states are moving back towards re-opening and “a state of the new normal”, many therapists are full with a waiting list. Those of us who have had a comfortable work flow are having our boundaries pushed and our caseloads expanded.
So what once worked for self-care is now being tested. People are going through a LOT with various aspects of the covid pandemic, financial, stress-related, anxiety and depression, challenges with substances and food used to cope with the uncertainty, trauma and PTSD related to the pandemic, relationship and parenting tensions, and transitions for everyone.
How do you feel like the idea of things “going back to normal” is affecting people in particular?
What I think is especially interesting about that is that we would kind of assume that with things going back to normal, our mental states would return to normal as well. But what I’m finding in my practice and in practitioners that I supervise is that there’s still a heightened anxiety. It seems hard for people to explain how they feel exactly, but I’m hearing the same thing over and over with a lot of clients that they’re exhausted and they’re overwhelmed.
I feel like on the one hand people are experiencing this desire to ramp up, travel, go back to work and go back to normal. But at the same time, it’s almost like we calibrated with whatever our normal was during the pandemic. And now that’s been turned on its head and people are becoming more overwhelmed by smaller activities, smaller social gatherings, things that we used to be pretty calibrated with. So those two things are meeting and people are having a hard time understanding why they’re so overwhelmed.
Alright. So let’s say someone is feeling overwhelmed and exhausted. What are the common signs of professional burnout that people should look out for?
In general some of the warning signs, I would say are changes in energy level, feeling drained, and a grouchy mood. Cravings for substances. Lots of people who have been leaning on different things to cope during the pandemic, like alcohol, substances or food. Tension in relationships, I would say. Feeling snappy with loved ones, struggling to remain present in sessions, compassion fatigue, need for more sleep or sleep difficulties, lethargy, anxiety, apathy, to depression. Some of us may have the Sunday Blues and dread going to work or be reluctant to return emails and phone calls.
However, professional burn-out shows up differently in everyone and it is important to know your individual signs of burn-out. So I think it’s really important that no matter what your practice is, you just tune in and see what your body’s feeling. I always encourage people to do a 4-step check-in. How is your physical body doing, your mental space, your emotional state as well as your spiritual self? Just check in on yourself on those four levels regularly and notice things that are potentially outside of your usual norm. You can use a checklist or an article with signs and symptoms to self-reflect, absolutely. Those questions can sometimes help us self-reflect, but we can’t compare ourselves to other people so we should always use our own body and experience as a baseline.
So if someone has identified some warning signs that they might be getting burnt out, what do they do next?
Recognizing signs and symptoms of burn-out is a great first step. The next step I usually recommend is to assess the severity of the burnout. One idea is to use a 1-10 scale to rate one’s level of burnout, which can be tracked over time. And I think it’s really important that people understand how to customize their own 10 point scale. What does your personal 10 look like? What does 10 look like for me might not be what a 10 looks like for you. I might be crying and curled up under the blankets in my bed when I’m at a 10 and somebody else might be speeding down the freeway.
Like I said before with the common symptoms, burnout shows up in so many different forms and manifestations so it’s really important that we know what that scale looks like for us personally. Even if it’s mild, medium and severe at its simplest. Once you’ve identified where you are on your own scale, you can determine what kind of measures to take.
A 1, 2, 3, or 4 on the scale could mean that a little extra rest or sleep, connecting with a friend or talking to someone could be all that is needed. Maybe you need to get outside or go for more walks in nature. Another huge part is making sure that the foods you’re eating are really nourishing, that you’re staying hydrated and that you’re getting enough movement. You know the things that are applicable to all of us, just living in a human body.
A rating of 5, 6, or 7 would mean that short periods of time off or reducing the clinical caseload is strongly recommended, in addition to personal therapy and a physical, emotional, spiritual self-care plan. I talk a lot about the “Sacred No” in self-care. Sometimes that’s hard for people – saying no or not meeting an expectation. But when I’m supervising clinicians, I’m often helping them assess their schedules and learn how better boundaries can help them to reduce burnout and be more effective throughout their day. So you always want to take into account boundaries, where your time is going, how the schedule is managed, and sometimes even spending 15 minutes managing your schedule or any other admin can save five hours on the other end.
And then anything above a 7 rating on the burnout scale means that more drastic steps such as medical leave or prolonged periods of time-off should be taken to immediately target the burnout. If professional burn-out is ignored or goes untreated for long, it can have a detrimental impact on the individual’s health and wellness, as well as on the clients that individual is treating.
I’m sure that for many it can be hard to talk about boundaries and stepping away to prioritize themselves when they feel like they are a crucial element of helping or healing in their clients’ journey. How do you recommend practitioners deal with the kind of pressure they might be putting on themselves?
That’s another huge part of proper boundaries and self-care. As helpers, supporters, healers or anything in that genre, if our self-care isn’t center stage, then we’re not as effective, we’re not as helpful. And that’s a lesson that kind of takes time in the maturing of understanding that and prioritizing that. Remembering that your clients don’t get effective care if you’re not taking care of yourself and if that isn’t front and center. That’s the lesson that I think people often have to learn the hard way, even though we talk about it.
I remember early in my career, it took me years to learn that. I would worry about clients, I would find myself dreaming about a clinical case or thinking about something that was discussed in session while I’m exercising or taking a shower. And those are also signs to do better self-care and to have better boundaries for yourself. So when you’re on for someone, you’re showing up completely present. And when you’re off, it needs to go back to centering yourself. That’s the only way that we can show up as effective practitioners.
Great! We’ve just talked a lot about how to deal with professional burnout after it’s happened but of course ideally, we’d want everyone to avoid getting burnt out in the first place. So what can practitioners do to prevent potential burnout in the long-run?
We are in the helping profession because we want to help those who are struggling so it is very common for practitioners to feel challenged by saying no to people seeking services. But at the same time, we have to remember that we each have our limitations and maximum at which the quality of our work diminishes.
What those maximums are, may depend on the industry you’re in and if you’re physically working with people and their bodies or if you’re mentally, emotionally working with people, holding space for trauma and struggle that people are going through. Just kind of be aware of the output of your work and that’s gonna be an important evaluation tool for you. So for example, a massage therapist may have a physical max of what they can do in a day without fatiguing themselves. Mental health therapists and coaches are going to have more of an emotional max.
In my case for example, I know what works for me in terms of how many complex trauma clients I can have on my caseload at once. How I space them out across the week is important because if I load up too many intense acute trauma clients in one day, that’s going to be a day that I’m feeling a lot more burnt out than another day. So, for me, I have to be aware of spacing it out.
But for someone who’s in the physical body care, they might need to be aware of their physical energy and the output there. So I think it’s kind of relevant to identify which genre of work you’re in and to then look at both your time schedule maximums but also your physical, emotional, and energetic output.
Once we’re aware of our max, the kinds of self-care practices you want to use to prevent burnout are very similar to the ones you’d use to deal with it in the moment. Any kind of mindfulness practice, maybe yoga or any type of enjoyable movement. As well as what I mentioned earlier, staying hydrated, limiting caffeine and other substances, things that help maintain our physical body. Setting boundaries and assessing different types of relationships in your life. When those things are put into action on a regular basis, we’re less likely to get burnout and need any sort of medical leave or prolonged vacation time.
Another element that is quite important when it comes to preventing burnout is whether or not you manage your own caseload and schedule. Both self-employment and an employee/supervisor relationship can come with important things to consider. Could you touch on that a bit?
Yeah, I do think it depends on the work environment. If you’re in private practice and you’re managing your own schedule and building a business, a couple of things I think are really important are having a peer-to-peer community where you can talk with people, network, share, debrief, and have some of that support. And then managing your schedule in the way that works with your nervous system. What time of the day do you get tired, is there a time of day where you need a nap? Do you have enough time gaps in between appointments? Are you on in the mornings and then you want to lighten your load in the evenings? Or the other way around?
If you’re working in an agency or group setting and you’re not managing your own time, it becomes more important to have a voice and speak up, let your supervisors and teammates know how you’re doing, when you’re taking your breaks, when you need a break. If your supervisor isn’t checking in with you about how you’re doing, you need to be more accountable to checking into yourself, especially if you’re a people pleaser or a high achiever, and you’re likely to ignore your own body signals to produce work for your bosses. It is definitely harder to say no and set boundaries sometimes in an agency type setting, but doing it preventatively again, will help to prevent you needing medical leave or a mental health vacation, later on. So it is really, really important that we have that kind of open dialogue where people can feel safe to open up.
Of course, I recognize that I work in mental health and that not every work environment may have that type of open dialogue where it’s safe to do that with a supervisor. So I’m careful to speak on how to do that in a different setting. But I do think that as we de-stigmatize mental health and as we have more conversations about self-care, it’s in the best interest of companies to prioritize the employees and their self-care and happiness over productivity because positive self-care, workplace enjoyment and positive peer relationships in the workplace do promote productivity and bottom line revenue. So as someone in the mental health industry, I would encourage all bosses and supervisors to make employee self-care a part of the conversation.
That was our conversation with Dawn Delgado, a licensed marriage and family therapist of 14 years. Dawn runs her own therapy practice in Los Angeles, California and as one of her many specialities works with clients and clinicians alike to help them improve their self-care, set better boundaries and keep burnout at bay. If you want to follow her and her work, you can check out her website as well as Instagram.