Balancing empathy and self-care: Essential skills for future marriage and family therapists
Counseling couples and families to help strengthen their relationships and withstand hardship can be incredibly rewarding, but it can also take immense physical and emotional tolls on the marriage and family therapists (MFTs) who are trying to help. It’s not only marriage and family therapists who are at risk of experiencing the adverse effects of working in the mental health field—in a 2022 resource guide from the Substance Abuse and Mental Health Services Administration (SAMHSA), they state that over half of behavioral health providers report experiencing symptoms of burnout.
The American psychologist Herbert Freudenberger first coined the term “burnout” in the 1970s to describe the consequences of severe stress, particularly within caregiving professions. It has three main components, each of which exist on their own continuum of intensity: emotional and physical exhaustion, depersonalization and detachment from one’s job and a decreased sense of accomplishment.
If mental health professionals like marriage and family therapists want their career to remain sustainable and fulfilling, it’s extremely important that they vigilantly watch for signs of burnout and prioritize their own mental health. And while you are bound to experience moments or periods of increased stress, there are steps you can take to prevent the symptoms of burnout before they have a chance to jeopardize your personal wellness and leave you questioning your career choice.
What is self-care?
“Self-care” often gets thrown around as a catch-all term for treating oneself to certain luxuries like going on a vacation, getting a massage or taking up yoga. Though these indulgences are important—and most mental health professionals could probably use a vacation—what they lack is sustainability. These kinds of acts of self-care are a temporary salve for a larger problem. Unfortunately, they don’t address the root cause of burnout.
Self-care for mental health professionals must also include things that prevent burnout from occurring in the first place so that their practice leaves them feeling energized and fulfilled instead of drained and defeated. It’s all about cultivating a work-life balance that works for you.
Setting and sticking to your boundaries
“In the context of being an MFT—and I would say this applies to anybody who’s in a caregiving profession—but one of the more important pieces around self-care for me is asking, ‘Am I clear about what my boundaries are?’ Are you making sure that you’re adhering to the things that actually keep you well?” said Vanessa Bradden, a Licensed Marriage and Family Therapist (LMFT) and Content Development Specialist with the American Association for Marriage and Family Therapy (AAMFT). Establishing clear boundaries and expectations with your clients, therefore, is a must for any therapist wanting to prevent burnout.
“I think there are a lot of myths too about who we are and what we’re capable of, and I’m pretty transparent at this point where I’ll say, ‘I am here to work with you, but I’m not magic. I’m not going to perform a miracle here.’ And I also teach my younger colleagues to set the tone in a first session. Make it clear, review things upfront, because it’s easier to do that than to try to backpedal and say, you know, I’ve been letting you go all the way to the hour, but we’re actually supposed to stop right at 10 [minutes] to the hour.”
Though it may seem like a little thing, Bradden argued that those ten minutes you get in between sessions are—or should be—part of your self-care. You need that time to get up, move your body, use the restroom, get a snack, whatever it may be. If you consistently sacrifice those precious minutes to clients that don’t know their time is up, your day will be even more fatiguing. So be clear about your expectations around when sessions should start and end and your cancellation policy, as well as the consequences if those expectations are not met.
Another major client boundary you should set is the expected level of communication between and outside of sessions, as well as your preferred mode of communication (e.g. email, texting or phone calls). Communication with clients regarding scheduling and logistical matters should be expected, but some clients may want to contact you between sessions about matters in their life as they come up.
Some therapists may be okay with this, but if you aren’t willing to give that level of attention outside your sessions, you must establish that expectation. After all, therapists and other mental health providers may be more prone to burnout if they feel like they’re constantly “on-call.”
Establishing your own support network
As a marriage and family therapist, the importance of maintaining healthy relationships with our loved ones is surely not lost on you. Cultivating a network of people that lift you up, support your career and simply allow you to be yourself is vital to maintaining mental wellness. Don’t forget to heed your own advice and make time for the friends and family in your life.
However, sometimes our friends and family can’t fully understand what it’s like to be a therapist and the unique hardships they face. That’s why peer-to-peer support groups and other professional communities can be incredibly helpful in finding people that can relate to you and the challenges of working in mental health. Local professional associations are a great place to start looking, and you may be able to find more casual support groups through social media sites like Facebook and Reddit.
“Make sure you have a group of collaborators. I have my group of women who are all MFTs, where when I need to, I can go to them and say, ‘I have a case, and I’m stuck and I need your help.’ And so we ourselves have to know where to look for those supports, we have to make sure we have supports around us,” Bradden said.
Trusted colleagues can also be immensely helpful to lean on when our personal and professional lives start to bleed together.
“After the client leaves, maybe I’m in tears because I also just lost someone, so there are ways in which something can hit so close.”
Bradden described how she had a client some years ago who was going through a situation that was similar to something she herself had experienced. She went to her professional support network to ask for their guidance about whether she should take this client on and if her parallel experience would help or hinder her professional judgement.
Going to therapy as a therapist
Finally, consider going to therapy yourself. Even the professionals need some professional help, too.
“This isn’t a requirement, but I think it’s really important for therapists themselves to be in therapy, even if life isn’t in flames. You want to prevent that from happening, and part of that is having a space where you can go and express whatever frustrations you might be having,” Bradden said. “Therapists are human first. We also have had traumas. We also have had losses and difficulties. And we also went through the pandemic, you know. So there are a lot of things that are happening in the world around us that we didn’t get a course or a credit for in school.”
Even if you aren’t necessarily dealing a crisis of your own, Bradden said seeing a therapist can be great because they can help you formulate a plan when life or work does inevitably throw curveballs your way. “We too are anxious, but we still have to be there for our clients. Our anxiety does not come before what they’re going through. So therefore, where are we going with that?”
Charge what you’re worth
Just because you’ve chosen to go into a caregiving profession doesn’t mean you shouldn’t be adequately compensated. Don’t be afraid to charge what you are worth so you can have the financial security you deserve.
“And I think if therapists, and especially young therapists, think, ‘Well, I’m here to do good. I’m not here to get money.’ That will lead to burnout! You are lowering yourself as a professional. You are not stepping into your worth. This is your skill, and you should be paid for your skill.”
Bradden also said that clients might refuse to pay you if they don’t think you fixed their problem. If this happens, you should consider letting them go as a client.
“It comes down to this sort of distorted expectation that somehow I was supposed to perform something that you expected, but it didn’t meet your expectation. But you still have to pay for that service. Caregivers have sort of an innate pull to this kind of work, but that doesn’t mean we don’t want to get paid for it.”
Take care of your physical health
Current research continues to demonstrate time and again that our physical and mental wellness are inextricably linked. It’s imperative, therefore, that you don’t neglect your physical health in the process of combatting burnout. Three big needs you want to pay attention to are your diet, activity levels and sleep.
Of course, we know that in practice it can be all too easy to let these facets of your life take a backseat. Still, take some time to evaluate whether these facets of your physical health could be affecting your mental health:
- Diet: When you can eat, opt for healthy food options that are minimally processed and incorporate a variety of nutrients into your diet. If needed, schedule breaks throughout your day to give yourself enough time to eat.
- Exercise and movement: Most mental health professionals spend most of their day sitting down and talking with clients. Unfortunately, we know that a sedentary lifestyle can increase one’s risk of a multitude of health problems. To combat this, do your best to incorporate movement into your days as much as possible. Though longer workouts are great, even just getting up and walking around for five to ten minutes several times a day can help offset the health risks linked to inactivity.
- Sleep: Besides simply feeling rested enough to take on each day, sleep is vital to our health and wellness in many other ways. It affects our memory and ability to learn, our metabolism, circulatory system, immune system and so much more. Experts recommend that adults get at least seven to nine hours of sleep per night.
Other work-related stressors
There many are other job factors as a therapist that can have a massive impact on your mental health:
Overloaded schedule:
A busy schedule that leaves you little time to take care of your own physical, emotional and social needs can quickly become overwhelming. If you are feeling like your work schedule is bursting at the seams and leaving you exhausted, you may need to stop taking new clients or rearrange your schedule in a way that works better for you. “Decide how many patients a week is enough for you. I think that there’s a point where if you’re seeing too many patients a week, you are not able to be your best self. I say if your idea of full time is 20 people a week, then let’s keep it there. But if you’re not saying no because you’re a people-pleaser, and now you’re seeing 35 [a week] but then you go home Friday and sleep until Sunday, that’s not good. It’s really knowing where your line in the sand is,” Bradden said.
Vicarious trauma:
Mental health providers can experience trauma and trauma symptoms as a result of working closely with victims of traumatic experiences. This is known as vicarious trauma or secondary trauma, and it’s a phenomenon that other healthcare providers like nurses and physicians can face as well. If you think you are at risk for experiencing vicarious trauma or you already are, you may want to consider finding a new population niche and/or seeking mental health treatment.
Safety:
You might take on a client that ends up crossing a boundary that makes you feel unsafe. If this happens, you should take immediate steps to address it. “The whole thing too about being empathic, it doesn’t mean we can’t fire people. It doesn’t mean we can’t say, ‘Hey, you know what? This is not safe anymore. This does not feel good to me.’ And you can handle it in a diplomatic way, but you cannot do your job if you feel like something is unsafe,” Bradden said.
Identify your “Why”
Knowing why you want to be a therapist in the first place should be a motivating force throughout your career, but especially when the job gets tough. Therapists should be willing to engage in some deep self-reflection to get to the heart of this question—and themselves.
“Do you know your ‘why?’ Do you know why you want to do this? Take some time, write it down, journal it out, set it aside, go back to it. Really, you have to do a lot of self-reflection. Show the reasons. There’s not a right or wrong reason, but you need to know what it is, what is your goal here? What do you want to do with this? And then you have to really be willing, I think, to engage in your own therapy and really know yourself,” Bradden said.
Unfortunately, younger therapists are at a bit of a disadvantage here. In her experience, Bradden said that young students straight out of undergrad that go right into working as a therapist often struggle and don’t continue. “But people who are doing it as a second career often really get into it. They’ve had time to be in that robot job that feels soulless, and then they go, ‘Well, I want meaningful work.’ So whatever your motivation is, really explore it, and then have a game plan.”
Final say
Marriage and family therapists and other caregiving professionals experience some unique stressors and that can lead to burnout, but it doesn’t have to be a career that leaves you utterly depleted. If you haven’t done so already, take some time to identify what is causing excess stress in your job and what you can do to address it. Maybe you need some more support from professional colleagues, or maybe you need to scale back your client load, or maybe you just need to take some time off.
And if you are still deciding whether you want to be a therapist, Bradden suggested getting out there and simply talking to people that are doing it so you can get an honest feel for what you’re in for.
“I would say to people in their early 20s, maybe just coming out of grad school, or anywhere along the line: set up some mock interviews with people that are already doing it and ask what they do for self-care and ask them how they got down this path. Just talking to others and hearing their real time experiences is more informative than just imagining [how things will be].”