How does being a counsellor affect your mental health?
Compassion Fatigue (CF), Secondary Traumatic Stress (STS) and Vicarious Trauma (VT) have all been highlighted in the research literature as risks for counsellors, psychologists, and other mental health professionals (Sutton, et al, 2022). In the current post-pandemic era, burnout amongst mental health workers is a subject more prevalent than ever and subsequently has been studied widely in practitioners from numerous countries, including India, Australia and the United Kingdom (Joshi, 2020, Dobson et al, 2021, Pappa et al, 2021). This article discusses the notion of burnout in therapists, looking at the arguments for what causes the various types of psychological stress, the perspective of a counsellor who has experienced symptoms of burnout and finally what the protective, evidence-based, factors are available for helping counsellors manage their own psychological health and safety.
Mental health practitioners deliver caring which is arguably ‘one way’ (Guy, 2000) and there is a logic to the notion that engaging in helping another person who is suffering distress or living with the effects of trauma could mean an automatic increase in the stress or a negative effect on the mental health/wellbeing of the helper (Devilly, Wright & Varker, 2009). However, is this always necessarily so? Experienced psychotherapist Irvin Yalom disagrees when he talks about the experience of ‘therapy helping the therapist’ in his bestselling work The Gift of Therapy (2002). People, including therapists, have fundamental needs for relatedness, competency and autonomy according to Self Determination Theory (Deci & Ryan, 2012). In accordance with this, for a key example, competency as a therapist, relatedness with others including helping and the undoubted autonomy available to a counsellor who makes decision over how their practice offers a potentially rich and fulfilling experience and in short will, for many, be their meaning.
Although, very often burnout is used as an umbrella term, it is important to distinguish between different types of these commonly described ‘negative affects’ (Gaboury & Kimber, 2022) as they each have distinct features: compassion fatigue is essentially the notion that we have a reduced ability to express/feel empathy. Secondary traumatic stress by contrast includes both emotional and physiological mimicking of a clients’ symptoms and feelings; and vicarious trauma relates specifically to the disruption of cognition in the counsellor, for example an impaired ability to trust others or feel safe (Sutton, 2022).
So, it is not just a cut and dried case of deciding whether we do or do not suffer negative effects from helping but rather asking in what way? And what is it that increases risk and what offers protection from burn out. So, what increases the risk of burnout? Several factors may of course be predictive of burnout risk, including caseload, coping strategies, individual perspective and personality traits but also age, gender, relationship status and our relative feelings of security (Sutton et al, 2022)
‘The literature suggests that mental health professionals who are female, younger in age, unmarried, less educated, and less experienced in their field of work report greater incidences of STS’
Sutton et al, 2022
Chief amongst the suggestions for negating or helping with lowering the risk for STS, CF and VT is, of course, supervision and this may be useful whether it is with a peer counsellor, an experienced counselling supervisor or else a counselling support group; for example, a sample from a 2020 study involving 208 school counsellors showed a distinct negative correlation between supervision satisfaction and burnout (Fye et al, 2020). The quality of supervision therefore may well be a vital component in reducing risk for counsellor burnout, with some work (encompassing a cross-sectional survey of 298 therapists/counsellors) suggesting it was the counsellors’ perceived quality of supervisory interactions that predicted burnout (Johnson, Corker, O’Connor, 2020) lower perceptions of quality supervision increased burnout risk and perceived high quality lowered that risk.
Although naturally the focus of this article is on the therapist, there is also a strong argument for protecting clients via looking after the mental health of therapists. For example, research tracing the negative effects of burnout in therapists on their clients (Delgadillo, Saxon and Barker, 2017) suggests a significant association between high burnout scores in therapists and a knock-on negative effect on the treatment outcomes for their clients, this study encompassed 2,223 patients and 49 therapists. It makes sense that we benefit our clients from looking after our own mental health, i.e., put your own mask on first before you help others.
Five tips for helping you to avoid burnout:
- Take care of the Physical Self
So often the link is made between eating well, regular physical activity (daily physical activity!) and our mental health – This is not merely about generally staying healthy, some researchers in large scale studies suggest that being physically active in leisure time specifically lowers risk of burnout (Gerber et al, 2020). Easier said than done? What did you do today to maintain/help your fitness or promote your dietary health?
- Take care of the emotional self
Counsellors benefit from meditation, grounding exercises, walking in nature and talking to upbeat friends just like anyone else. What are you favourites? Feeling grass or sand beneath your feet? Square breathing or mindfulness meditation? We clearly benefit from coming into the present moment and not spending all day ‘in our head’.
- Ensure supervision is always part of you practice
Whether this is with a licensed practitioner, or a group of other counsellors give yourself (and offer) the opportunity for the mighty offload, talk, (whilst observing confidentiality), about how it’s going how you cope and how your colleagues or supervisors cope share ideas and experiences – it will probably help.
- Operate great self-talk
For example -‘I am doing a good thing in my sessions, it is helpful to my clients, I am well trained and I do not have to carry their trauma with me for the rest of the day’ and so on.
- Go to great professional development opportunities
It can be so uplifting to get the chance to sit and hear from other practitioners about modalities you have not yet trained in which serve as a refresher for the ones you have already trained in. Take a break, learn something powerful and get a recharge- hopefully the lunch/location and coffee will be good too!
Deci, E. L., & Ryan, R. M. (2012). Self-determination theory.
Devilly, G. J., Wright, R., & Varker, T. (2009). Vicarious trauma, secondary traumatic stress or simply burnout? Effect of trauma therapy on mental health professionals. Australian & New Zealand Journal of Psychiatry, 43(4), 373-385.
Delgadillo, J., Saxon, D., & Barkham, M. (2018). Associations between therapists’ occupational burnout and their patients’ depression and anxiety treatment outcomes. Depression and anxiety, 35(9), 844-850.
Dobson, H., Malpas, C. B., Burrell, A. J., Gurvich, C., Chen, L., Kulkarni, J., & Winton-Brown, T. (2021). Burnout and psychological distress amongst Australian healthcare workers during the COVID-19 pandemic. Australasian Psychiatry, 29(1), 26-30.
Fye, H. J., Bergen, S., & Baltrinic, E. R. (2020). Exploring the relationship between school counselors’ perceived ASCA National Model implementation, supervision satisfaction, and burnout. Journal of Counseling & Development, 98(1), 53-62.
Gaboury, K., & Kimber, M. (2022). Consequences of vicarious traumatization among mental health service providers with a history of child maltreatment: A narrative review. Psychological trauma: theory, research, practice, and policy.
Gerber, M., Schilling, R., Colledge, F., Ludyga, S., Pühse, U., & Brand, S. (2020). More than a simple pastime? The potential of physical activity to moderate the relationship between occupational stress and burnout symptoms. International Journal of Stress Management, 27(1), 53.
Guy, J. D. (2000). Self-care corner: Holding the holding environment together: Self-psychology and psychotherapist care. Professional Psychology: Research and Practice, 31(3), 351.
Joshi, G., & Sharma, G. (2020). Burnout: A risk factor amongst mental health professionals during COVID-19. Asian journal of psychiatry, 54, 102300.
Johnson, J., Corker, C., & O’Connor, D. B. (2020). Burnout in psychological therapists: A cross‐sectional study investigating the role of supervisory relationship quality. Clinical Psychologist, 24(3), 223-235.
Pappa, S., Barnett, J., Berges, I., & Sakkas, N. (2021). Tired, worried and burned out, but still resilient: A cross-sectional study of mental health workers in the UK during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18(9), 4457.
Posluns, K., & Gall, T. L. (2020). Dear mental health practitioners, take care of yourselves: A literature review on self-care. International Journal for the Advancement of Counselling, 42(1), 1-20.
Sutton, L., Rowe, S., Hammerton, G., & Billings, J. (2022). The contribution of organisational factors to vicarious trauma in mental health professionals: a systematic review and narrative synthesis. European Journal of Psychotraumatology, 13(1), 2022278.
Yalom, I. D. (2002). The gift of therapy: An open letter to a new generation of therapists and their patients.