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Friday 1 June 2012

Private Practice: Your Burnout Warning Signs

This is it! The Friday series based on my book Private Practice Made Simple (available from and has been going on for several months now, and we have come to the end of the adjunct documents supplied at  
Summer: Time to get outside.
For example: hiking Stawamus Chief in British Columbia.

It's also summer, so I'm going to call a halt to the Friday post and continue with a weekly posting schedule  at least until September.

This week, however: A topic that almost anyone can relate to, and a form that anyone can use, whether you are a therapist or not.

The burnout continuum

All or nothing thinking pervades our world. We use it without thinking, without noticing. One of the places it comes up is when we talk about burnout.
  • "I'm burned out."
  • "I'm not burnout out."

Burnout, then, is something that either happens or it doesn't. There are two slots, and you always fit into one or the other. Supposedly.

In fact, of course, burnout is a continuum that runs from "no burnout symptoms at all" to "completely incapacitated." It's like height, or shyness, or physical coordination. Everyone has some, so we are always on the continuum. It's only a question of where. 

If burnout was an all-or-nothing dichotomy, there would be few warning signs. One moment we'd be in one category, the next we'd flash over to the other. 

The fact that it is a continuum means that we flow along it, day by day and hour by hour, rising and falling with the circumstances of our work, the quality of our sleep, and dozens of other variables. One day we feel a little more exhausted, a little less enthusiastic, the next we feel better. 

We hope that we will never migrate fully over to the "burned out" end of the continuum. We can use the small shifts as useful and indeed welcome cues to make adjustments and take care of ourselves.

As therapists, we do precisely the same thing with our clients. We suggest replacing the "depressed or happy" dichotomy with a mood continuum, and invite a calm appraisal of shifts along it, welcoming signs of increased symptoms as useful and nonlethal cues to take better care of oneself.

In the case of burnout, of course, this begs a question. What are the subtle changes that happen as you shift toward the burnout end of the spectrum? What are your cues? What will signal you to take action?

Some sample signs of burnout

At the Private Practice Made Simple workshops I ask therapists to share the changes that they notice when they are becoming just a bit more burned out. Everyone seems to experience the phenomenon in a slightly different way, but here are some of the warning signs they report:
  • Not wanting to go into the office.
  • Getting behind on administrative work such as billing.
  • Snappish at home.
  • Thinking more about clients when not at work.
  • Not preparing enough before sessions.
  • Feeling too tired to exercise.
  • Poor sleep.
  • Tempted to have an extra glass of wine with dinner.
  • Not calling or emailing friends as often.
  • Putting off report and note writing until the next day.
  • Reluctance to return phone messages.
  • Feeling rushed all the time.
  • Feeling impatient with clients.
  • Talking too much in session.
  • Attempting to take control of clients' lives / tell them what to do.

Needless to say, there are many more.

An exercise sheet

There are many forms accompanying Private Practice Made Simple that are posted for free download at The page with the complete list of them is here.

Here's a brainstorming sheet to help you identify your own signals of impending burnout:

The form invites you to think of two occasions when you have felt somewhat closer to burnout than usual. Then it asks you to identify the risk factors that seem to have led you there. It starts with external factors: time pressures, too many clients, trouble at home, and so on. Then it invites you to think of internal factors, like physical ailments, difficulty sleeping, little exercise, or seeing clients that mirror your own problems a bit too closely. Once you have your list, the form invites you to rank the importance of these factors from 1 to 10.

Then you are asked to consider how you managed to get your energy back. Chances are, it wasn't just the passage of time. You did something, or something happened. What helped? What brought you back closer to the "not burned out" end of the continuum? It also invites you to consider strategies that you have never tried. Many of these are discussed in Private Practice Made Simple.

The idea, obviously, is that you want to reduce the threshold for becoming aware of impending burnout, so that you notice there is a problem before it gets out of hand. Then, rather than simply hoping the issue goes away, you can consult your list of strategies and actually put some of them into practice.

That's it for now!

Over time, I anticipate that there will be additional posts about private practice issues. But that's the end of the series for the moment. Whether you buy the book or not, I hope that this series of posts and the accompanying exercise sheets prove useful in making your work as a clinician more rewarding and effective. 

Posts on PsychologySalon will continue to appear on a weekly basis through the summer and into the fall.

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Want more information on operating a private psychotherapy practice? 

Check out my book Private Practice Made Simple, available at bookstores and through Amazon here.

Vancouver Workshop November 29 2013

Click here for information and registration for the one-day workshop Private Practice Made Simple being held in Vancouver Canada Friday November 29. 

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