As a psychotherapist, I have always held myself to a high standard. I pride myself on being a bastion of strength, which in my mind and the minds of most of my clients, meant that I always kept my distance, stoically reflecting people’s minds and emotions as they grappled with their times of despair, terror, regret, trauma and pain. For decades, I sat opposite countless people, offering an ear, a shoulder, a sounding board. Through years of listening and helping people heal the scars of their childhoods, truly, I could not have been happier with my calling.
But what happens when the helper is the one needing help? What happens when the weight of other’s traumas is just too much to bear alone? This is my story of burnout, secondary trauma and how I travelled the rocky path back to equilibrium and effectiveness in my work.
The Slow Burn of Burnout
But there were warning signs that I didn’t accept until it was too late: my fatigue, the way it pooled in my muscles and remained even after my last session of the day; my dread on Sunday evenings, the certain knowledge and very real anxiety of starting another week back at the wall; the patient I was already losing long before I entered a client’s room – both in and out of the office.
At first, I attributed it to ordinary stress – after all, being a psychotherapist is not exactly a low-pressure position. But as time went on and I continued to get sick, I sensed a change within myself. No longer did I conduct sessions with the spontaneous flow of free association that I had previously. I started to feel distant from my clients, their problems no longer seen through the lens of compassion, but through that of a detached diagnosis.
Only when I looked up from my computer screen, unable to force myself to write up my session notes, did I realise: I was burnt out.
The Insidious Nature of Secondary Trauma
Burnout was bad enough, but I was now suffering from something more insidious, deeper and harder to pinpoint: secondary trauma.
Used in the helping professions it’s known as vicarious trauma or compassion fatigue. Secondary trauma arises from the simple fact that, for many in the helping professions, we’re regularly exposed to the pain and suffering of others. Over time, we come to absorb that trauma as our own, effectively failing to have our own needs met and ourselves feeling traumatised.
For me, it emerged in nightmares replicating the horrors of the tales my clients had told. My mind became overly alert; I began jumping at perceived threats wherever I went. The world, which I had persistently believed to be fundamentally safe, felt dangerous and foreboding.
The Breaking Point
One day, when a long-standing client, Sarah, was making her way through difficult material around the abuse she’d received as a child, something snapped. It was like someone had relieved the pressure on the wheel rim – the tyre, implausibly, had finally exploded.
I couldn’t breathe. My heart raced. The room felt like it was closing in on me. As the falling sensations started and I knew for sure that this was going to be a panic attack, I also realised – with a start – where I was: in the middle of my own therapy.
I somehow maintained my composure to the end of session, but as soon as Sarah left I collapsed into my chair, shaking. I couldn’t keep functioning like this. I wasn’t doing myself any favours. Even worse, I wasn’t doing my clients any favours either if I was showing up as unavailable and dissociated.
Taking the First Step: Seeking My Own Therapy
As the proverb goes: ‘Therapists make the worst patients.’ We’re so accustomed to sitting on the other side of the couch that the thought of talking about our own issues can feel downright alienating, even scary. But I knew that if I wanted to continue working in the profession I loved, I needed to accept help.
I crawled over to my desk, quivering fingers dialling the phone number of a trusted friend – a colleague whom I had respected and admired as a therapist, and perhaps even envied a bit, for she happened to specialise in treating therapists with mental-health difficulties. This simple act of contact, of making that phone call, was for me one of the most difficult things I have ever done, and a first crucial step towards what it takes to return to our best selves.
The Process of Healing
My therapy sessions with Dr Chen were no cakewalk. She gently but firmly pushed me to reckon with the damage that a professional life spent absorbing others’ traumas had done to my psyche. We investigated the origins of my urge to help, unearthing some uncomfortable truths about the role my own insecurity played in fulfilling that urge, and my challenges in setting clear boundaries.
One such development came when Dr Chen asked me to consider, basically, what it would be like to have my own work. ‘Imagine you’re a patient,’ she said, ‘come up to my office with all these symptoms, these struggles. What would you tell them?’
The question came to me like a thunderbolt. I’d made life exhausting by holding myself to an impossible standard – boundlessly benign, eternally steely, and immune to the very human responses of compassion and emotional burnout.
Rediscovering Self-Care
Along the way, she coached me towards creating a deeper self-care plan. It wasn’t a lofty speech about the power of Epsom salts and candles (although there is definitely a time and a place for both). It was the kind of fundamental lifestyle reorganisation we all ought to take.
We started with the basics:
Creating a calming night time routine and sticking to a regular schedule are examples of good sleep hygiene.
Nutrition: Fueling my body with nourishing foods and staying hydrated throughout the day.
Homework: Finding daily ways to shake off the blue funk – something as simple as taking a brisk, 15-minute walk, an activity that shouldn’t be underestimated for its remarkably astringent mood-lifting power.
But self-care, I learned, goes far beyond these physical aspects. It also involves:
Mindfulness practices: I started a daily meditation routine. Eventually I mastered sitting with my feelings and thoughts in an unbiased way.
Creative outlets: I took back up painting art and really used my art to heal and process my emotions the mentally draining work.
Social ties: I consciously worked on all my relationships away from the workplace, by getting back into touch with old school friends and making sure I spent more time with my extended family.
Setting Boundaries: A Crucial Skill
The hardest – possibly the most critical – thing for me to learn in my recovery has been to set and hold healthy boundaries. As therapists, we are taught to be there for our clients – to hold space for their pain and struggles. At some point, though, I had forgotten where their needs left off and mine began.
With Dr. Chen’s guidance, I began to implement new boundaries in my practice:
Restricting my caseload: I cut the number of clients I saw daily and increased downtime between sessions.
Forcing breaks in the action: I built in scheduled breaks throughout my day, both to do short bursts of formal mindfulness exercises, and also to step outside and have a blast of fresh air.
Designing a leaving ritual: I devised a little ritual to be performed at the end of each workday, as a way of ‘exiting’ my clients’ problems from the workday.
Polishing the ‘no’: This proved to be the most difficult of the changes when I left the workforce, only so I wouldn’t say yes to pointless activities or commitments, or to busywork from clients. It was important that I could be at my best for the clients I did have.
The Challenge of Implementation
After all, having the knowledge of what to do and carrying it out are two different things. And making these shifts wasn’t always easy. I felt guilty taking time out for myself, scared that I was failing my clients. My inner critic was charged and noisy, berating me for being selfish and weak, for not being up to the task.
Yet gradually, with practice and persistence, things slowly began to shift. The nightmares became less frequent. I began to be able to feel more present in the Holderian moment within my sessions as well as the present moment of my day to day. The world began to feel a little more hopeful, a little bit brighter.
Rediscovering the Joy in My Work
After the initial period of prioritising my own mental health passed, something delightful happened: I fell in love with my work again. Unencumbered by the haze of burnout and the futile clutches of secondary trauma, I could dive more fully into being there for my clients. After sessions, I no longer felt exhausted, but energised and excited about the work we were doing together.
And what the more client-focused sessions taught me was that by looking after myself, I was better able to look after them. My enhanced availability and renewed optimism enabled me to be the kind of therapist I’d hoped to be.
Sharing the Journey
I also felt compelled to share my experience with colleagues in my field. I started speaking about burnout and secondary trauma in the mental health profession, and writing articles on the subject. The response was astounding: other people kept thanking me for speaking out and saying that they had been suffering in silence and hadn’t known how they could ask for help.
The lesson I took from that experience was the need to end the silence around the mental wellness of mental-health providers. We’re human too and, like almost everything, we can get tainted by what we get involved in. It’s okay and, in fact, it’s essential for us to get some help to cope, as and when we need it.
Looking Forward: A New Approach to Practice
I cannot promise that my practice today bears much resemblance to my practice then, but it does. I now hold regular, scheduled supervision sessions with trusted colleagues to process difficult cases; I have now and periodically shift to a less challenging caseload; I make self-care and boundary-setting non-negotiable.
I still have bad days. Clients’ stories can still hit a little too close to home sometimes, or the emotional burden of work can begin to feel a bit heavy. But now I have the tools, and I’m more observant of myself, more likely to notice these things before they slip into a state of desperation.
To my colleagues in the mental health professions reading this: it’s okay. It’s okay to find this tough. It’s okay to ask for help, to be not so good at the time. Looking after yourself is not selfish or inconsiderate: it’s necessary to continue looking after others.
And to anyone seeking therapy: we’re on our own journey too. We can help you only because we do our work, because we’re doing our best to grow and change.
The Ongoing Journey
Maintaining mental health – for therapists as well as clients – is not a static place of arrival; it’s a dynamically shifting path that demands constant attention, resource allocation and, at times, redirection. But it’s a path worth travelling.
It was difficult, even painful, to go through my own burnout and secondary trauma; but I am also a better therapist, a more compassionate human being, and a more robust advocate for mental health – both for my clients and for my fellow professionals in this vital field.
In short, to anyone currently struggling with feeling powerless, disillusioned or just exhausted: there is hope, and with the right support, tools and strategies you can make it back to the place in yourself within this work where you felt you had something meaningful to say and to give. You’re not alone here. And it isn’t merely okay to ask for help sometimes, it can be the Courageous choice.