Occupational Hazards of Being a Therapist
Exposure to Suffering
Exposure to traumatic details and experiences which can lead to secondary trauma, vicarious trauma, compassion fatigue, and ultimately burn out
We may become jaded, dissociate from our own emotions and experiences, feel more irritable, fantasize about another career, wish clients would cancel and not show up for sessions, and more
Hearing accounts of people pain and suffering over and over can be challenging unless we finds ways to manage it
Compassion Fatigue
Over identifying with clients and feeling exhausted/tired due to taking on client’s information/suffering/pain/distress from listening to them
Feeling sad, nightmares, physical exhaustion, over working, lack of ability to empathize, anxiety, cynicism, anger, depression, using substances to numb feelings, overwhelmed, tired, depleted are common symptoms
Caring for others is part of our job, but it requires boundaries, outside consultation, practice, and regular care for ourselves
Vicarious Trauma
Occurs due to years of experience (over time, not a single event)
Shift in beliefs about the world, self, and others
“Life is unfair”
“No one understands me and what I’m experiencing”
“Others are dangerous”
“This work shouldn’t be this difficult. Why can’t I handle being a therapist?”
“Who am I if I wasn’t a therapist?”
“The world is unsafe”
“Why are people so evil?”
“Am I competent enough to be a therapist and do this work?”
Behavioral responses
Avoiding friends and family
Isolation
Laughing at things that are not funny
Using substances to numb overwhelming feelings and thoughts
Isolation & Feeling Lonely
Being a therapist can feel lonely because the work is unique in so many ways and also due to issues of confidentiality
Getting consultation and support is crucial from peers, supervisors, and colleagues
Having a life outside of work is also key toward maintaining connection to something larger than just our work
Limited Capacity to Meet Needs (Systemic Issues)
This is true in the United States where there is a lack of providers for clients, insurance coverage (and lack of coverage), high costs for mental health care, wait time for care, and more
We are only one person unable to meet and see all clients we want to see
High Caseloads
This is especially true in agencies, hospitals, and companies where a clinician is expected to maintain certain client caseloads related to performance expectations
High caseloads can lead to vicarious trauma, compassion fatigue, feeling overwhelmed, clients unable to get the treatment they deserve (i.e. weekly frequency vs. one session every 5-6 weeks), etc.
In private practice, therapists are more able to have more choice around their caseloads
Time Constraints
If you accept insurance or work for an agency that accepts insurance, insurance dictates time spent with clients
A 38-45 minute session is billed as CPT code 90834
A 52-55 minute session is billed as CPT code 90837
Self & Community Care Is Mandatory
Taking care of self is necessary
Reaching out to our community/family/friends/support is also necessary
We cannot do this work alone and should not do this work alone
Replenishing ourself through:
Regular and consistent time off
Eating nutritious foods
Getting regular and consistent quality sleep
Drinking water
Getting exercise and moving our bodies
Limiting caffeine intake
Limiting substances like alcohol and drugs
Having flexible boundaries
Not checking email on off days
Engaging in regular daily practices to get out of our head and into our body
And more
Being a Therapist is a Lifestyle
This is not the sort of job where you can clock in and out for most people
For most people, this requires shifting our life and how we live on a day to day basis
This can include:
Life long learning such as continuing education and supervision
Self and community care
Work life balance
Attending one own’s personal therapy
Saying no and boundaries
Letting go and accepting the reality
And more