Thoughts On Emotional Burnout, Compassion Fatigue from a Therapist’s Experience

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Today the cool ocean air flicks my skin like fingertips. I am walking, lost in melancholy, lost in grief, but somehow still happy. I don’t know if happiness can exist without melancholy. They exist together, cohabiting like gophers burrowing for warmth. For every feeling an equal and opposite feeling accompanies it. 

Today there is peace in observation. I observe the strange house painted blue like a summer sky, and the rusted basketball hoop that has fallen over from the heavy gusts of wind from last night. I can feel my anxieties present, wanting to worry about a patient I feel like I failed or about the emotional exhaustion I’ve been feeling of late. I wonder about my abilities, I wonder if I am good enough or if I will ever be good enough. But today these voices are quieted down because for now. I am present.  

I have felt burnt out of late. It’s not hard to understand why. COVID has lasted a year. I stare at my computer screen for 30 hours a week, talking to computer projections of people. I miss people who aren’t my bubble. I miss my office and sitting across from someone and experiencing their body language and presence.

Additionally, my patients have been suffering a lot this year. They are isolated, bored, and sometimes do not want to live.  I am here to guide, to cajole, to soothe, to help of course. I feel their suffering more than my own some days. And this last week it has been too much. I want to bury my head underneath the covers and reenter the world for another week. 

Some days I have nothing to give. I want to connect and stay present in my uncomfortableness but don’t have the energy. I am certain I am experiencing compassion fatigue. Some days I feel rejection acutely. The truth is I like praise. I like being liked. I like being told I’m good. And when I receive that reassurance from my patients I feel content. I am on the right path, I say to myself. I am a healer. I am connected. 

The other side of praise, however, is criticism. When I am emotionally exhausted, when I have little to give, I can feel criticism everywhere, mostly within myself. Sometimes I am paranoid. Sometimes I think that my patients are unsatisfied, that I don’t really help, that they will leave soon, that I will be alone. I can see how that fear lingers in the background. Nothing feels safe. Everything is uncertain.

But uncertainty and loss are a large part of the therapist’s experience. Sometimes people leave therapy because they aren’t getting what they need. It is easy to personalize that, blame one’s self for not knowing enough or being enough. And sometimes people leave therapy after years together. There is no rhyme or reason to it. It was just time to move on. I have not quite figured out how to deal with these experiences. They still feel like rejections. But perhaps that is the problem. I see these interactions through binaries. Praise or blame. Acceptance or rejection. Success or failure. Truth is always more complicated. 

When I am alert, when I can see myself clearly, I see how much my ego plays apart in this all. My ego, my “I,” is so scared. It does not want to die or feel alone. It wants constant reassurance and security. If it doesn’t have that it feels anxious and alone. Despite this being impossible, my ego asks for it anyway. Is that any way to live? 

The work, I think, is to stay open-hearted despite the fatigue and pain. To feel heartbroken in melancholy. To live in uncertainty and embrace it. And to practice compassion and loving-kindness despite it all. Suffering comes from resistance and staying closed. Vulnerability lets us open to the experience of being here, which is so much. I know this to be true but I still, find it hard to practice. But I must still try otherwise I cannot do this work. 

But more than anything, I could use a vacation! This COVID year has lasted forever. Two weeks on a Caribbean beach would do wonders for my burnout. Maybe nothing is better for the therapist’s soul than a Pina Colada near a blue ocean and a sunny sky. 

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