Your Therapist Is Just as Burnt Out as You

One Saturday night a couple of weeks ago, Caitlin*, a 29-year-old psychotherapist, sat on her kitchen floor and cried for hours. “I felt a tight panic in my chest thinking of all the weeks ahead with no end in sight,” she recounts, in an email sent between back-to-back sessions. “I just thought: I can’t do this. How am I actually going to do this?”

Since the onset of the pandemic, a parallel mental health crisis in the UK has snowballed. According to the latest data from the Office of National Statistics (ONS), by mid-2020, almost one in five people were suffering from depression, twice the number of the previous pre-pandemic year. At the same time, mental health charity Mind found that 60 percent of adults reported that their mental health got worse during the first national lockdown, with reports of pandemic-related burnout on the rise.

This has all translated into increased demand for mental health services as prescriptions for antidepressants reach an all-time high. According to estimates from the Centre for Mental Health, up to 10 million more people will need new or additional mental health support as a direct result of the pandemic. But while reports of a third of UK doctors experiencing signs of burnout and compassion fatigue have been widely covered in the press, less has been mentioned about those working to support the nation’s mental health.

“While the training we have undergone is invaluable, I’m not sure me or my colleagues could have felt adequately prepared for something of this scale,” explains Caitlin, who lives in the north of England and works for a national employee assistance programme. “Our referral rates are sky-high,” she continues. “On a typical day it would be a case of three to four referrals maximum, but at the moment we are making 10 to 12 a day.” 

For Deniz*, a 33-year old London-based psychotherapist working in the NHS, the increased demand has also been massively overwhelming. “In the before times, we’d usually expect around 400 to 500 referrals per month, per borough,” she explains. “Now it’s more like 1,200. But there are still only the same amount of us.”

Lou Campbell, a psychotherapist who runs Mindfulness in the Workplace and manages a team of mental health practitioners, says this workload has had a knock-on effect: “We are all exhausted, there’s no doubt about that.”

“Resource rarely increases, which means waiting times do and therapy is more diluted,” explains Nadine*, a 45-year-old therapist working in the NHS. “One of the primary risks of burnout in mental health workers is not only being overworked but a sense of incompetency that can kick in if you feel unable to do a good enough job and don't get the desired outcomes.”

This, Nadine believes, is also exacerbated by the fact that mental health workers are all stuck at home, many juggling childcare responsibilities, and are less able to access support from their peers. “Peer support is paramount to building psychological resilience in the face of working within mental health and keeping steady,” she says. “Many of the people who I work alongside talk most about the loss of support from colleagues, which makes the challenges of working online harder.”

Alongside the above, therapists have also had to adjust to performing their role through a screen. Everyone I interviewed referenced Zoom fatigue. “For someone used to going out every morning and interacting with people, having to sit staring at a laptop screen for six or seven hours a day has been difficult to get used to, especially at the beginning,” explains Deniz, who lives in a small flat. “The room I deliver care in is also the room I sleep in and do just about everything else in.” 

While many of us can relate to staring at our screens in one room all day, therapists’ jobs are, by nature, particularly emotional, and require a lot of concentration. This means it can get pretty draining. “I’ve had to work really hard to be able to be able to sleep in the same room where I’ve been taking in all that sometimes traumatic information all day,” says Deniz. And when so much of therapy traditionally relies on reading body language, forged by important gestures such as eye contact, trying to deliver the same level of care through a screen has been nigh-on impossible for some.

Caitlin notes that many of her clients are struggling with a lack of “end point” when it comes to the pandemic, and is keen to point out that therapists are also experiencing this themselves. “We are going through this pandemic too, and are experiencing our own feelings of isolation, loneliness and missing loved ones,” she says.

Nadine agrees: “Mental health workers are coping with what everyone nationally is coping with: lockdowns, anxiety, bereavement, loss and the pressures of homeschooling… I think people often assume that if you work in mental health, you are superhuman.” 

“At the end of the day,” Deniz says, “we’re all just people, trying as best we can to get through what life is throwing at us.” Deniz notes that therapists are not immune from neglecting their own mental health needs for fear of stigma within the profession or among colleagues. “I’ve had so many people over the last year contact me asking me about my own experiences accessing employee counselling, many of whom express a concern that they will be judged for needing help themselves.”

As attention shifts towards imagining a post-pandemic world, this isn’t necessarily the light at the end of the tunnel you might expect for mental health workers. “One thing therapists know to be true is that trauma response is often delayed,” explains Deniz. “A lot of conditions that people may have developed during the pandemic won’t just go away — those people will need support for weeks and sometimes years to come, as well as people who might find it hard to adjust when the world opens up again.”

Roughly put, whereas for NHS frontline workers, reduced admissions are a signal that work is likely to become less busy, many therapists fear that things are only going to get more intense for them in terms of workload over the coming months. 

This all means that mental health professionals – particularly those working in the NHS, where strict monitoring makes it harder to take breaks – will need more funding and support to cope, or risk burning out too. “People have been signed off for a week here and there,” Deniz tells me. “But there’s this feeling that it’s only going to get worse.” 

Ultimately, Lou believes, this may result in more people moving from working in the NHS to the private sector, where they might have more control over time. Dr Adrian Neal, who helped put together a resource from The British Psychological Society looking at the impact of the pandemic on psychologists, agrees that now is the time to ramp up support. “As we move forward, we want to see not only individual wellbeing of psychologists protected and supported, but wider, systemic changes to ensure we have workplaces and environments which are equipped to support the psychological workforce as a whole.”

The first step to supporting mental health workers in real, practical ways is government funding. While £27 million government funding was recently injected into the charity Think Ahead – in order to train 480 more support workers and reach 10,000 more patients – a much wider and more continuous systemic change is needed beyond the pandemic to acknowledge the delayed burden this may have on therapists, and the assistance they need to keep going. 

“Even the private sector is struggling to mop up the demand spilling over from the NHS,” Lou points out. “The pressure is huge at a time when I know if I can’t help someone, they may have nowhere else to go.” Without urgent attention, it can feel as though the whole system is at risk of collapse. 

Before you start worrying about your own therapist, it’s important to note that none of this is the responsibility of service users to solve. All experts explicitly stated that those in care or receiving support must continue to do so, especially at the moment, and that despite the challenges and difficulties thrown up by the pandemic, they still love their jobs. 

“This is our moment to step up,” says Lou. Deniz agrees: “Very rarely do you get a therapist saying they hate their job, so to see friends struggling to cope is upsetting. I just want the resources to be there to be able to do the best job I can do for as many people that need it.”

*Names have been changed

@rosestokes