When I was a newly graduated counselor, over thirty years ago, I took my first job in an outpatient alcohol and drug treatment center. I didn’t know about clinician burnout, but I remember my feelings of anxiety upon seeing my first clients. At the time, I wondered, “What treatment modality should I apply?” I also worried, “Are my listening skills adequate and professional?” I sought supervision from an older and seasoned therapist who told me, “Just remember, it’s all about the relationship.”
The Relationship between Client and Clinician
I survived my first two years at the treatment center by applying both treatment theories and listening skills. But I never forgot that the relationship between counselor and client is crucial to healing and recovery. In fact, research has shown what so many counselors know intuitively, that the therapeutic relationship itself is essential to the success a client experiences. And in their 2001 study; Lambert. M.J. & Barley, D.E. called the “therapeutic relationship” the most important common factor to successful outcomes. But we’ve all been through a lot since 2020, and clinicians are humans too. What happens when the counselor is experiencing burnout and not practicing self-care?
I received another piece of advice I remember from the early years. It was to be sure and practice self-care. As I was told, “We don’t wade about in the trauma of clients’ lives without getting some mud on our shoes.” As therapists, we know our job is to establish secure, confidential, and trusting relationships with our clients and yet practice boundaries.
At times it is a balancing act to practice emotional detachment and compassion. When I get too involved with a client, it’s hard to stay objective. If I get too absorbed in my feelings, I’m not sure if I am helping or hurting. And when I begin to avoid confronting a client or feeling protective it’s a clue I am getting too involved. Another feeling I may have for the client is pity rather than compassion.
When I am blinded by my feelings, I can’t do a client justice. Addiction is a deadly disease and if I am feeling sorry for a client, that client is not getting the help he or she deserves.
Counselors who are overly involved need to pull back and gain objectivity. Much is written about clinical vicarious traumatization. This is the therapists’ compassion fatigue and burnout. And workplace related and personal factors are challenges counselors face during different times and phases in our careers. For graduate students, these challenges loom large, as they work to do a good job on assignments, turn them in on time, do research, undertake internships, and hold down jobs.
Those counselors in early careers are often starting a practice. Or starting a family, paying student loans, managing expectations and time pressures. Mid-career counselors can find themselves raising a family, juggling finances, running a practice or becoming more involved in management and clinical roles. And sometimes even dealing with issues of divorce, remarriage and blended families. Late career counselors can be struggling with retirement issues, health concerns related to getting older, and aging parents.
Counselor Self-Care – 15 Questions
How counselors respond to the experience of distress is key. Along with preventative steps to take and strategies used to minimize its deleterious effects. A Self-Care Assessment developed by Kramen-Kahn (2002), lists 15 questions to determine a counselor’s level of self-care.
- Appear competent and professional?
- Appear warm, caring and accepting?
- Regularly seek case consultation with another professional while protecting confidentiality?
- At the end of a stressful day, utilize self-talk to put aside thoughts of clients?
- Maintain a balance between work, family and play?
- And nurture a strong support network of family and friends?
- Use healthy leisure activities as a way of helping yourself relax from work?
- Often feel renewed and energized by working with clients?
- Develop new interests in your professional work?
- Perceive client’s problems as interesting and look forward to working with them?
- Maintain objectivity regarding clients’ problems?
- Maintain good boundaries with clients, allowing them to take responsibility for their actions while providing support for change?
- Use personal psychotherapy as a means of maintaining and/or improving your functioning as a therapist?
- Maintain a sense of humor so you can laugh with your clients?
- Act in accordance with your profession’s legal and ethical standards?
Emphasizing the Importance of Clinician Burnout & Self-Care
In our daily lives of working with clients with addiction and mental health issues, we counselors emphasize the importance of self-care. And of attending to one’s physical, mental, emotional and spiritual needs. We also talk about the importance of pursuing pleasurable and relaxing experiences. Wellness is one of the most important things to maintain as a counselor, because if we are not well, it will get in the way of being able to work with the needs of a client. If we see ourselves as instruments of healing, it is important to keep our instrument well-tuned.