Are You Too Burned Out to Work? An ethical assessment of therapist burnout and impairment

Curt and Katie chat about the ethics of working while burned out. We look at what burnout is, how it develops and what the impacts are on clients and treatment outcomes. We also explore individual and systemic strategies to mitigate the risks of burnout.  This is a law and ethics continuing education podcourse.

Transcript

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In this podcast episode we talk about therapist burnout

So many therapists complain that they are burned out, but then continue to work. Is this ethical? In this continuing education podcourse, we explore what therapist burnout is, how therapists get burned out, potential impacts on the therapeutic work with clients, and when (and whether) it moves into the threshold of unethical behavior. We talk specifically about what makes a therapist impaired and how therapists can assess their own capacity to ethically care for their clients. We also look at how to respond to signs of burnout appropriately. Finally, we dig into systemic concerns that lead to burnout and who really is responsible for a therapist’s burnout and potential impairment.

What is burnout?

• Maslach’s definition of burnout: exhaustion, cynicism, and inefficacy
• Burnout is enduring
• Physical and emotional exhaustion, fatigue
• Detachment and depersonalization
• Self-doubt and reduced sense of personal accomplishment
• Difficulty focusing and numbing
• Feeling demotivated

What do the therapist ethics codes say about working while burned out?

“It’s shocking that an organization that represents people who focus on systemic impacts on people, makes it an individual mandate to show up to work in the best way possible. Rather than addressing the systemic issues that cause people to burnout in the first place.” – Curt Widhalm, LMFT

• Don’t practice while impaired
• You must engage in self-care (according to the National Association of Social Workers)
• There does not seem to be a lot of direction or information about how systems should shift to decrease the risk of burnout for individual clinicians
• In creating ethics codes there are competing philosophies related to destigmatizing mental health (even in clinicians), but also requiring therapists to be “perfect”

What Causes Burnout for Therapists?

• Bureaucracy
• Inadequate resources, lack of training
• High caseloads and time pressures
• Unrealistic expectations and the “reality crash”

How can therapists assess how impaired they are while experiencing burnout?

“When we are trying to determine: is this an indicator of impairment or burnout leading to impairment, or if it’s just trying to manage a job that’s unmanageable – I think that is an important question that we should look at.” – Katie Vernoy, LMFT

• The most important assessment is the level of impairment, looking at the impacts on clients
• Exploring the distinction between being human versus being impaired
• Context and communication with clients about expectations
• What is the intent behind the behavior gives you a sense of whether it is burnout or circumstances beyond the therapist’s control
• How was the mistake handled?
• Looking at how often we cancel or are late for appointments, missing work once a month, etc.
• There needs to be an open dialogue with clients about efficacy

What are the potentially harmful impacts of therapist burnout on clients?

• Therapists have negative feelings toward clients
• Therapists are worse “role models” for clients
• Cynicism
• Not remembering what was said session to session
• Lack of therapeutic continuity and progress
• Lack of therapeutic alliance
• Becoming untrustworthy
• Boundaries slipping
• Avoiding topics that are too taxing on the therapist

What can therapists do to mitigate the impacts of burnout on their clients?

“So many people I’ve talked to have acted as though their job is happening to them when they actually can make the choices of when they work [and] how much they work.” – Katie Vernoy, LMFT

• Assessing capacity and create schedule to be able to consistently show up
• When you take time away, look at what you’re coming back to
• Boundary setting and self-advocacy
• Having your own therapy and adequate supervision
• Manage caseload
• There are systemic changes needed
• Individual leadership over how you set up your work
• Increase social support

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

Once you’ve listened to this episode, to get CE credit you just need to go to moderntherapistcommunity.com/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed – you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://moderntherapistcommunity.com/courses/are-you-too-burned-out-to-work-an-ethical-assessment-of-therapist-burnout-and-impairment

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information including grievance and refund policies.

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources for Modern Therapists mentioned in this Podcast Episode:

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Our Facebook Group – The Modern Therapists Group

 

References mentioned in this continuing education podcast:

• Apgar, D. (2021). Developing the next generation of social work activists: Support for eliminating the micro–macro divide. Journal of Community Practice, 29(1), 62-78.
• Apgar, D., & Parada, M. (2022). Missing the Mark? Reframing NASW’s Ethical Mandate for Self-Care as a Social Justice Issue. Advances in Social Work, 22(3), 876-899.
• Bell, C., Roberts, G. L. R., Millear, P. M., Allen, A., Wood, A. P., Kannis, D. L., Jona, C. M., & Mason, J. (2024). The emotionally exhausted treating the mentally unwell? A systematic review of burnout and stress interventions for psychologists. Clinical Psychology & Psychotherapy, 31(1), 1–14. https://doi.org/10.1002/cpp.2909.
• Finan, S., McMahon, A., & Russell, S. (2022). “At What Cost am I Doing This?” An interpretative phenomenological analysis of the experience of burnout among private practitioner psychotherapists. Counselling & Psychotherapy Research, 22(1), 43–54. https://doi.org/10.1002/capr.12483.
• Holmqvist, R. & Jeanneau,M. (2006). Burnout and psychiatric staff’s feelings towards patients,
• Psychiatry Research, 145(2–3),  207-213. https://doi.org/10.1016/j.psychres.2004.08.012.
• Miller, J., & Grise-Owens, E. (n.d.). Self-Care ‘IS’ an Ethical Imperative for Social Workers. Self-Care “IS” an Ethical Imperative for Social Workers. https://www.socialworktoday.com/archive/exc_020420.shtml.
• Simonato, G., Simpson, S., & Reid, C. (2019). Burnout as an Ethical Issue in Psychotherapy. American Psychological Association Psychotherapy, 56(4),  470-482.
• Van Hoy A, Rzeszutek M. Burnout and psychological wellbeing among psychotherapists: A systematic review. Front. Psychol. 2022;13:928191. https://doi.org/10.3389/fpsyg.2022.928191.
• Vivolo, M., Owen, J., & Fisher, P. (2024). Psychological therapists’ experiences of burnout: A qualitative systematic review and meta-synthesis. Mental Health & Prevention, 33, https://doi.org/10.1016/j.mhp.2022.200253.
• Williams, B. E., Pomerantz, A. M., Segrist, D. J., & Pettibone, J. C. (2010). How impaired is too impaired? Ratings of psychologist impairment by psychologists in independent practice. Ethics & Behavior, 20(2), 149–160. https://doi.org/10.1080/10508421003595968

*The full reference list can be found in the course on our learning platform.

 

Relevant Episodes of MTSG Podcast:

The Burnout System

Addressing the Burnout Machine

All Kinds of Burned Out

Burnout or Depression?

Niche Burnout, An Interview with Laura Long, LMFT/S

Thriving Over Surviving: Growing a Practice without Burn Out, An Interview with Megan Gunnell, LMSW

Choosing Yourself as a Therapist: Strategies to address burnout, compassion fatigue and vicarious trauma – An Interview with Laura Reagan, LCSW-C

Are You Burned Out or Are You Bored?

Should Therapists Admit to Making Mistakes in Therapy?

That’s Unethical!

Structuring Self-Care and REPLAY – Structuring Self-Care

An Expert Witness Weighs in on Therapist Malpractice: An interview with Dr. Frederic Reamer

Impaired Therapists

Smarter than SMART: How therapists can improve goal-setting with clients

 

Who we are:

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Hey, modern therapists, we’re so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchase this course, pass the post test and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, or you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com.

Katie Vernoy 0:47
Once again, hop over to moderntherapistcommunity.com For one CE once you’ve listened well.

Curt Widhalm 0:55
Welcome back modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about the things that go on in our field, how we are as therapists, this is for therapists by therapists, and those of you who aren’t therapists who just want to enjoy the ride and peek into our lives. And…

Katie Vernoy 1:14
Welcome!

Curt Widhalm 1:15
This is another one of our CE eligible episodes, and kind of sparked from a little discussion in our Facebook group, the Modern Therapist Group by one of our friends, Krissy Martinez, who makes the claim that practicing while burned out is unethical.

Katie Vernoy 1:37
She didn’t make the claim. She asked the question “Is practicing while burned out unethical?” So let’s not let’s not put words in Christie’s mouth.

Curt Widhalm 1:48
Okay, I stand corrected. And…

Katie Vernoy 1:51
You’re sitting, you’re sitting corrected.

Curt Widhalm 1:53
And I created about half a dozen different responses back to that, especially after you tagged me on the post. And then I just got to a point where I was like, Katie, this deserves to be its own episode. And then the more we looked into this, the more we’re like, there’s some research behind this. And there’s some stuff that we should be talking about, because this isn’t something that has necessarily a really clear yes or no answer. So, when it comes to claiming ethics, we’re going to dive into this, we’re going to look at it a little bit more deeply. But when you first saw this question, Katie, what was your response?

Katie Vernoy 2:37
I went two ways. First was, yeah, I think it can be and there’s all of the reasons we get burned out as therapists and we need to stop it. And we need to change the systems that put it in place all those things. So, I went to, I think the typical conversation that you and I have had about burnout and all those things. But I also and this is the response I put into the group as I feel like there’s a ‘yes and’ there. We are allowed to be human, we’re allowed to have a bad day, make mistakes and have repairs. We have a whole episode on can therapists admit mistakes, or whatever it is, we’ll put that in the show notes with a lot of other episodes that we’ve talked about burnout on. But to me, I feel like there the question was so stark, it was a yes or no question. And it seemed to have as you interpreted it, a leading tone of Yes, it is unethical to practice while we’re burned out. And to me that felt so robotic, like we can’t be humans, we can’t have bad days. I wanted to dig into it some more. And so I’m glad we’re actually digging into this into a full on CE episode. So we get a whole hour to talk about it. Because, you know, this has been an area of interest for me for a long time.

Curt Widhalm 3:58
You know, I’ve heard from some listeners before that when we don’t make stark commitments at the beginning of an episode, it makes it maybe not quite as interesting. I was hoping that you would be like, I stand on the yes side or I stand on the no side and then we can debate. I’ve also heard from some listeners that that just pulls out the worst of our arguing from us. So, whichever side that you are on listeners know that we are hearing you and taking that into account. But Katie has been around me long enough and around other people where being able to come and sit and reason with this is maybe the basis for like: burnout’s not like a yes or no box. Like you can be burnt out in some areas and not in others. You can be burnt out by a particular kind of client presentation and not by others. And so there might be just even kind of a session by session sort of thing. But I think that there’s a whole lot of contributing factors to this that, as Katie previewed, we’re gonna dive into.

Katie Vernoy 5:08
Before we get started, I think it probably makes sense, as I like to do, is making sure that we have a common definition of what burnout is. We just actually fairly recently had an episode where it was burnout versus bore out. And so we’re actually talking about traditional burnout right now, which is a prolonged response to chronic emotional and interpersonal stressors on the job. And as defined by three dimensions of exhaustion, cynicism, and efficacy, which is from Maslow et all 2001. And so I just wanted to make sure that we’re clear because because in this previous episode, we were we were digging in and kind of shaking the definition around a little bit.

Curt Widhalm 5:47
And ways that this can show up is that it can be enduring, it can be something that we experience as both physical or emotional exhaustion, fatigue, detachment, just kind of showing up to work and like doing the bare minimum, especially when we look at how we operate in the fields, it can be kind of just depersonalized, we show up, we do our job. And I’ve heard from people all over the world that just sometimes the nature of their agency, community mental health, whatever it might be, ends up being something where you have to go and put on work face, and it’s not congruent with who you are as a person. And you just have to, those can be contributing factors that lead to like not getting that like, great, emotional, like fulfillment out of the work that you’re there. In turn that leads to not feeling as accomplished, as we talked about in the burnout versus bore out episode, difficulty focusing, and really just not being motivated to do a whole lot better.

Katie Vernoy 6:58
And I think even for some folks, there can be numbness, there can be self doubt. I mean, I don’t know how many different people we’ve talked about that are like, Oh, there’s the imposter syndrome. And that’s, in some ways, I wonder if it’s related to burnout, because there’s that self doubt and that kind of not feeling congruent with who you are. So, burnout, I think people know what burnout is. But I wanted to make sure we had a common definition, because we’re going to really dig into is it unethical when you practice when you’re when you’re behaving or feeling that way? And so I wanted to make sure we all had the same kind of understanding of that.

Curt Widhalm 7:34
So, that’s where we’re starting. The question comes in: Is it unethical? Now, we’ve also done episodes in the past of people just being like, I don’t like that. But that comes out as ethical. So we’ll take that episode as well in our show notes. So, as we do on this show, what we do is we go to the ethics codes, and we actually look like what do the ethics codes actually say, not just use our own opinion. Now, every single one of the major ethics codes does have something about practicing while impaired. And therapists or counselors or social workers or psychologists all have something that refers to: We don’t practice when we are impaired, and it will harm clients. And to Krissy’s credit, she found the part of the CAMFT ethics code that says this, and she cited that in her post. Now, we’re going to dive into in this episode, just kind of like how impaired is too impaired? Like if you didn’t sleep well enough last night: is that too impaired? Preview on that one: the answer is probably not. But the overall aspect of this is, I think, further heightened by a decision in the 2021 NASW code of ethics that makes it to where social workers have an ethical mandate; an order to engage in self care. So not only is it don’t practice while impaired, but you must also engage in self care activities.

Katie Vernoy 8:06
So NASW is not just going to an impairment, and it’s not okay to be impaired, but saying that all social workers must practice self care. Like why would they add that individual mandate?

Curt Widhalm 9:25
It’s shocking that an organization that represents people who focus on systemic impacts on people, makes it an individual mandate to show up to work in the best way possible. Rather than addressing the systemic issues that causes people to burnout in the first place.

Katie Vernoy 9:45
Wow. I can I guess I can see the point of saying that social workers should be able or are should be allowed to do self care. I don’t know that that actually mandates systems to allow for self care though. And so then it’s just this extra curricular activity that social workers are supposed to be doing. They’re supposed to be taking care of themselves, and then also having a job that doesn’t necessarily support their mental, emotional and physical health.

Curt Widhalm 10:17
Yeah, and I’m going to point to a couple of different things on this. First, this is an article from Social Work Today that is by Jay Miller, PhD, MSW, CSW, and Erlene Grise-Owens, EdD, MSW, LCSW, MRE. And this is called “Self-Care ‘IS’ an Ethical Imperative for Social Workers.” So, this is in defense of NASW’s work here, and I’m not going to read all of this, but they start this out with a very validating ‘Without question, being a social worker can be challenging. Collectively, the literature documents a host of suboptimal employment conditions, including poor perceptions of their work, inordinately high caseloads, and shortages of community resources. Consequently, social workers may experience disproportionately high rates of stress, vicarious trauma, and moral injury, among other consequences. Within that context, an emerging self-care movement is afoot.’ And they go on to say that self care is something that is individualized. And that it encapsulates the notion that self care should be for the individual, what works for others might not be for you. It should be integrated. They go on to say that, yeah, there’s a thing called work life balance, but as a social worker, you should really be reframing it just as life balance. This should be intentional. But it’s not something that just happens you have to be intentional about it. And I think you and I agree on this, that this is we’ve talked about systems of self care ourselves. And our vantage point on that was really more of like, alright, this is how you survive in the system, not like…

Katie Vernoy 12:10
It’s your responsibility and you must live for your work.

Curt Widhalm 12:13
Exactly.

Katie Vernoy 12:14
But keep it in balance, keep it in balance.

Curt Widhalm 12:16
This should be structured, it should include SMART goals, and it should be sustained.

Katie Vernoy 12:23
Okay.

Curt Widhalm 12:23
Now, there are times where I know that I come across as a little bit condescending, maybe even a little bit more condescending. But this is one where I am not even trying to hide this in some of the arguments that are being placed as far as we’re going to acknowledge all of these systemic things that make it to where this is a pretty terrible underpaid job with high case loads, and people end up feeling like crap. Therefore, you should be in it for the outcomes, not the incomes.

Katie Vernoy 12:57
Well, I just kept thinking, wow, this is really rugged individualism at its best, or maybe at its worst, like, self care is individual. I’m like, But what about community care? What about systems that support the individuals within them? Like it is so short sighted around what can be done to help people in their jobs like, Oh, my goodness.

Curt Widhalm 13:25
So, I will counterbalance that with this incredibly lovely article, we’ll put all of our references in the show notes over at mtsgpodcast.com. This one is called “Missing the Mark? Reframing NASW’s Ethical Mandate for Self-Care as a Social Justice Issue.” It was written by Dawn Apgar and Mackaully Parada. And they say that a review of workforce data suggests that the need for self care in social work is largely due to poor working conditions, inadequate pay, unavailability of quality supervision, and a lack of professional recognition. Thus, making self care largely a personal responsibility is adopting a blaming the victim mentality that the profession has historically rejected in their approach to client problems. Social work is rooted in examining the social conditions of people within their environments, focusing on making macro level changes to remedy systemic problems. And I could go on and on and on about how much I love this article. And rather than just reading research articles, we’ll put a link in our show notes. But this, this ends up becoming the problem of looking at this from an ethics code kind of thing. It’s a valiant attempt to try and fix it. And much earlier in my career I remember having similar thoughts; that we should put self care into the ethics code. And looking at like, hey, not only is this avoid the bad kind of Don’t be too impaired, self monitor that kind of stuff, but also do the good. And the more that I’ve adopted a view around, what are systemic problems, and what are things that can be done. I don’t necessarily agree that the individual mandate in ethics codes is the right way of going about this. The problem is, ethics codes are written for individuals. And so there’s a really, really hard way to put this as far as we want people to do this. And we think that it’s so important. I can imagine several meetings of social workers and ethics, social workers, sitting around being like, we really want people to engage in self care, this is really, really important. But somewhere in that discussion, it got lost to being like, but now we’re just blaming the victim. And now we’re just making this to where, all right, these people have to go and fix things themselves, while being victims of the various systems that making them feel that way.

Katie Vernoy 16:05
While you were talking, I was thinking about myself as a clinician, and especially a pre licensed clinician, and armed with an ethical mandate that I must take care of myself, I may have asked for better wages, I may have said, No, I’m not taking an extra case, because it’s against my ethical code to do so. Now, I was a big mouth, and constantly advocating for myself, advocating for things and I don’t think everyone had that for themselves. So, I don’t think this is necessarily realistic to expect. But I think we’re actually seeing some of that and how people, especially the newer folks in the field, coming in worried about burnout and saying, I’m not going to take that job, I’m not going to take that caseload number. And I think it’s a little off, I think there’s potentially some unrealistic expectations. But I do think that that could, in the, in the right hands be a little bit of a, I was gonna say, an armor, I don’t know what that I don’t know the right word here. But it’s something where you can say, Hey, I can’t do that, because that will burn me out. And I’m supposed to take care of myself, according to my ethics code. So, you’re gonna have to figure something else out. But I guess I don’t know if that I see many people beyond me as a big loudmouth. Especially in pre licensed or employed situations, being able to use that as the, what is the word I’m looking for? The ammunition, to use that as ammunition in order to protect themselves from the system.

Curt Widhalm 17:41
In my roughly 10 years of teaching in graduate programs at this point, I’ve seen a lot more discussion around self care being integrated into a lot of discussions in the classrooms, and including my own and just about every class that I have talks about it. And my talk about it’s largely mirrors our episode on structural self care. Like these are problems with the field. Radical acceptance, like you’re gonna have to deal with some of that stuff.

Katie Vernoy 18:12
Yeah.

Curt Widhalm 18:13
I don’t know that it’s framed in the same way in everybody else’s conversations around self care. And for a lot of my students, they do talk with me about like, I present it much differently than the way that they hear it from other people. I think we’ve largely moved past a place, take a bath, go have a spa day, go, you know, go do all this super privileged stuff that might be out of the budget for people who are in grad school. But it is something where I think we’re doing a better job of talking about it. I’m hearing this not only from you, but other practice owners in my area have even seen this in some of the interviews that I’ve done hiring in my practic. Where people are interviewing in for roughly entry level positions. I use that term oddly for people who have master’s degrees, but…

Katie Vernoy 19:05
Sure.

Curt Widhalm 19:05
…entry level positions into the therapy world, saying, I expect full time wages at halftime caseload. And there is somewhere in the middle that is a respectable workplace to work. And being able to have like a trauma informed workplace, being able to have appropriate paid time off policies, being able to have realistic expectations out of case loads, while also still functioning as a business. And I think that we’re in this odd place in our profession that is somewhere between: We all recognize that the traditional way is not working with the current funding systems. However, we’re still looking at it as a very dichotomous like it’s not just the individual’s responsibilities, moving into these positions. And if we are going to consider putting stuff into the ethics codes about this, the ethical codes should say something like, when you are employing or managing other clinicians, you should take steps to monitor for burnout, self care, that makes it more about creating a systemic workplace environment that addresses these things, rather than solely focusing on the individual aspects. But even that, as wonderful as that idea is, as I’m patting myself on the back for it, is a terrible thing to put into the ethics codes, because then it still puts the responsibility on one person.

Katie Vernoy 20:41
Yeah.

Curt Widhalm 20:41
Rather than actually addressing the systemic issues.

… 20:45
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Katie Vernoy 20:46
As you were talking about that, I was thinking, Okay, so we’ve got the individual clinician, and then we have the individual supervisor, or business owner of some sort that, as you were saying, isn’t still this individual onus. I have, I have a thought around the larger system that I want to get to. So, I’m bookmarking that for just a second. But how many ethics codes are there and off the top of your head, I don’t want you to look, around supervision and supervisors? Is it a third? Is that a couple?

Curt Widhalm 21:19
Are you talking about individual like, like, it’s?

Katie Vernoy 21:22
For separate the types of codes for supervisors, it seems like there’s not a ton.

Curt Widhalm 21:30
The one that I’m most intimately familiar with has is the California Association of Marriage and Family Therapist ethics code. There’s an entire section on being a supervisor, being an instructor that off the top of my head is roughly an eighth of the entire ethics code.

Katie Vernoy 21:50
Okay. Okay. So that was kind of where I was heading. It was not like a full on, like, huge amount, but it is it’s adequately covered. But we’re really talking more about in a lot of the ethics codes, it’s more about the actual practice with clients of clinicians. There’s a section on how to supervise them, and teach them. But it’s mostly about dual relationships. If I remember correctly, I don’t want to go off the off the rails…

Curt Widhalm 22:14
Right, right.

Katie Vernoy 22:14
I don’t want to go into it. But it would be interesting to have that be part of it, right? Like your job as a supervisor, or employer or an instructor is to make sure that your clinicians, the clinicians in your charge, are able to take care of it. But to expand on your idea around how that puts another individual mandate. Instructors have the guidelines based on whatever the curriculum is right, and making sure that there’s all that stuff covered. But whether it’s a community mental health or public service agency, or whatever, or a private practice that is either private pay or hybrid, there’s so much in the system that does not account for sufficient income coming to therapists.

Curt Widhalm 22:58
Exactly, yes.

Katie Vernoy 22:59
There’s all of the bureaucracy. And there’s an article I found, it’s a meta analysis from 2022 Van Hoy and Rzeszutek that went through how therapists actually get burned out. And there’s another one Vivolo, Owen and Fisher, which is 2024. So this is hot off the presses. But one of the things that really provide a really leads to burnout is bureaucracy and not getting paid enough. And when we think about even individuals in private practice, insurance companies have wide wide ranges of pay, but most of them are very very low. And especially for California therapists, they don’t really cover the cost of living at a reasonable caseload. And so there are so many systems that can impact a therapist and their their level of burnout. You have to have a certain amount of income, you can’t necessarily control the number of private pay clients that you have. And so when you have insurance, you have to take a ton of cases, way more than you probably kind of can, you know, kind of physically do. Or if you’re in a Community Mental Health Organization, you’re either underpaid or your caseload is gigantic, or both. And that those are government systems, insurance systems. There’s, you know, the layer below, which is how people are taught to manage and what to look for. I mean, going back to this, this article, there’s, there’s so much about what what causes burnout that I’m like, oh, yeah, that is exactly what the especially new new caseload, new new clinicians would face:higher workload, less experience, working in the public sector. There’s, there’s this other thing that I thought was interesting that there’s like these unrealistic expectations about the job is and then there’s a reality crash when you actually start your job. So it’s like newer clinicians are more at risk. And then the other thing is lack of adequate resources, time pressures, working overtime, the impact of non clinical work, such as administration and managerial tasks, high case loads. This is the other article. Poor quality supervision and the clinical complexity of the work. All of these things are like, Oh my gosh, and then the other parts of the medical model, a lack of agreement on what should be done and the devaluing of talk therapy. So when we look at what causes burnout, like so much of this is really systemic stuff. It’s not individual things.

Curt Widhalm 25:34
So, I think the charge then becomes like, in the midst of changing the system, like where we are, as far as being able to address this, the advocacy that you and I do, the macro level stuff that I would assume that the social workers are doing.

Katie Vernoy 25:51
We hope.

Curt Widhalm 25:53
That I know that there are calls to kind of separate out some of the macro versus the micro sort of stuff within social work. I’m not a social worker, I do know another article from Dawn Apgar. Just every so often, when we do these episodes, I fall in love with researchers. So, anybody who knows Dawn Apgar could just like, introduce us through email. That would be great. But another article by Dawn Apgar “Developing the next generation of social work activists: Support for eliminating the micro–macro divide” gets into some of the you don’t need to be in one camp or the other, you can do both. And taking more of a comprehensive look out of right there is macro work to do: talking with legislators, speaking up on issues that you want, while also doing the micro level work. That there is space for both. In the meantime, we have to kind of look at the systems that we are dealing with. And I think coming back to the core issue of Krissy’s question is, alright, if there is burnout, and if there are clients to be seen in your practice: How much burnout can you have while you’re actually seeing clients? Like if you show up to work and you’re like, I’m 8% burnt out today; Is that unethical?

Katie Vernoy 27:19
What would 8% impaired even look like or 8% burned out even look like? To me it seems like there’s there’s so much subjectivity here as well as, what about just, I’m a human, and I’m tired?

Curt Widhalm 27:34
Well, I mean, well, I remember when my children were little, and the disrupted sleep that went along with having young children. And even though my practice at the time was almost entirely just like working with teenagers. So, even though I had a later in the day work schedule, I can tell you that my sleep was not consistent. And ultimately, just in the way that people who are sleep deprived tend to function probably didn’t show up for every session with 100% just laser focused on things. So outside of, you know, just eliminating anyone who’s of childbearing age from being able to see clients, we have to assume that everybody’s not operating at 100% all of the time, and that there is a percentage that we’re like, that is clearly terrible. So, I’m gonna throw a number out there that I don’t know if that numbers like 25%. But there’s a number somewhere in the middle, that’s like, Yeah, I think it probably depends on the day where that one is like, Okay, you’re actually doing something that is impaired, you’re missing stuff. These mistakes are causing problems.

Katie Vernoy 28:58
Yes, and…

Curt Widhalm 28:59
Yes, and there’s research to back this up.

Katie Vernoy 29:04
Well, yes, there’s research to back it up. But I think before we get to the research, I was just thinking about the assessment of that. We can’t assess ourselves and not not well anyway. And when we’re really looking at impacts, there’s so much clinical fodder when we show up as a human. And so even in that regard, when you’re talking about 25% impaired and making a mistake, I mean, some of the mistakes I’ve made have been horrible for my clients, and the repair was hard fought or didn’t happen. And some of my mistakes were the best clinical inventions, quote, unquote, mistakes were the best clinical inventions I did. Because I was more real, I had less of a filter. And so I think, to me, there was an article I found to speak of research, Holmqvist and Jeanneau, I don’t have the year but I’ll put that in the show notes, that a negative impact on clients might be a few have negative feelings towards your clients. Because of the level of burnout. I thought that was interesting. Because before we started recording, you asked if like, sometimes you kind of get bored or fallout of interest or something with your client. And I feel like those things are also humanity. Like I don’t necessarily have negative feelings towards my clients. You know, typically. Sometimes I get frustrated as I would with anyone. I get frustrated with the people I love the most, and I have negative feelings towards them. So, why not my clients? But I think there’s that, that element of if I have negative feelings towards my client, what if I use that clinically?

Curt Widhalm 30:49
So you’re talking about managing it?

Katie Vernoy 30:53
Okay. So, maybe maybe I’m taking one step too far? Is that what you’re saying?

Curt Widhalm 30:56
Well, yeah, I mean, I at least look at things in the the ways that we’re supposed to manage things is: okay, it starts with assessing ourselves for it. And then once we find problems, then we do something with it.

Curt Widhalm 31:14
So, so what you’re saying is, if we don’t do something about it, that is when there’s the stronger negative impairment.

Katie Vernoy 31:21
Yes.

Curt Widhalm 31:22
Okay. So I’ve got a list. So, I we can add to them. But I have a list of the impacts that if you don’t address them and have repair, they would be pretty bad. Being really cynical. I mean, I don’t know. Can we can either of us claim that we can get by without becoming cynical at some point?

Curt Widhalm 31:43
No, yes.

Katie Vernoy 31:47
Being a worse role model for your client. I mean, we’ve talked about that meme. I think we when we were talking to Laura Reagan, about the picture of the guy that looks so horrible, and it says your your therapist tells you to do self care. Meanwhile, this is what my therapist looks like. Not remembering what was said session to session. I mean, we’ve joked, you know, in burnout talks that we’ve done like; my favorite way to get by that is: So what resonated with you last week, what stood out most? What did you what what, what did you take most from last week? When I don’t remember. Fortunately, I don’t have that problem now. But when I was really working a lot when I was working at an agency, and in my private practice, I would I would start forgetting things. Lack of therapeutic continuity and progress, negative impacts on the therapeutic alliance, becoming untrustworthy. And the first one is always like showing up late or forgetting to attend, forgetting appointments. But also potentially, you know, it’s very bad when it goes to not holding confidentiality or not doing it in the way that you promise to. And I think mostly that would be like, with family sessions, and like sharing something a kid client didn’t want you to share or something like that. Boundaries slipping. I mean, that’s a big one. We had our conversation with Dr. Reamer, and he was talking about that that’s oftentimes what people get brought up to licensing boards about. And then also, and this is, I think, a more refined clinical one is avoiding topics that are too taxing on the therapist. So, you’re avoiding moving the client forward clinically, because you don’t have the spoons to deal with it.

Curt Widhalm 33:25
So, all of these are going to show up to different levels.

Katie Vernoy 33:30
Yeah.

Curt Widhalm 33:31
Like, what is it that makes something like 8% versus 25%? And one of the questions that I posed to you before we started recording is like, how often are you late for sessions? And ultimately, that conversation got down to: Well, what is late? Like, one of the one of the balancing things that we’ve tried to do over the last seven years of our podcast is, all right, be human and be ethical. And somewhere in between those two is, if you’re two minutes late, is that late? Or is that is that human? Is that like in order for me to show up and be 100% laser focused, that’s what I need to do? If our caseload, if we’re working in an agency, if our caseload is like, Okay, I’m trying to be able to caseload manage in between sessions and in order for me to finish a phone call with somebody else and get you into the office on time, if I’m three minutes late. So, there is kind of like balancing out some of that.

Katie Vernoy 34:42
Yeah, it’s context…

Curt Widhalm 34:43
It’s context oriented.

Katie Vernoy 34:45
It’s context specific. And I think, to me when we’re talking about that it’s context specific, both on the job that you have, the expectations of the client, and also the relationship you have with your clients. I know for myself at this point, I feel kind of bad if I’m one or two minutes late because especially for virtual sessions, like you see the timer start going, Oh crap, better login quick. So, I’m invariably on time. There might be a couple minutes as I’m opening, getting myself set up and opening the door for in person clients. But when I was working in community mental health, I was frequently 5 or 10 or 15 minutes late. And that was the expectation. And I had had communication with clients about it, because of what you’re talking about; whether it’s caseload management, crisis management, or just traffic in Los Angeles, because I was driving from house to house. And so I think, when we are trying to determine is this an indicator of impairment, or burnout leading to impairment, or if it’s just trying to manage a job that’s unmanageable, I think that is an important question that we should look at.

Curt Widhalm 35:49
And getting into the context is also the respect that’s given around it. That the part of this that I struggle with is like, do we contribute to being overly perfectionistic by needing to be rigidly on time? I’m sure that there’s some listeners or potential listeners, who would be like, that’s just really poor boundaries. You’re supposed to be on time, all of the time, no matter what. It’s like, drive down the shoulder of the freeway in Los Angeles, if there’s traffic, that’s late. You have a perfectionistic duty as a therapist to be there. But there is kind of the all of the different aspects. I am sometimes a couple of minutes late, and generally make it up on the back end of the session, and…

Katie Vernoy 36:40
Which then makes you late for the next session.

Curt Widhalm 36:41
You know, I’m very rarely outside of those extremely like traffic oriented…

Katie Vernoy 36:50
I’m just giving you trouble.

Curt Widhalm 36:51
I know that you’re giving me trouble. But this is also something that invariably happens with some of the clients. Because I’m pretty transparent about this; like, Hey, I’m two minutes late getting you in, I’m going to tack it on to the end of the session. And some some clients, some wonderful caretaking clients will sometimes be like, well, Won’t this make you two minutes late for your next clients? And I’m like, ultimately, let my boundaries be my boundaries.

Katie Vernoy 37:18
Yeah.

Curt Widhalm 37:18
I have that buffer. The reason our sessions are 50 minutes is this.

Katie Vernoy 37:23
Yeah.

Curt Widhalm 37:24
And for the really concerned clients, they’ll follow it up with what if you’re, like, 10 minutes late? I’ll be like, the very, very rare times where that has happened it’s usually something where five minutes beforehand, I’ve already reached out to you in been like I’m at least 10 minutes late.

Katie Vernoy 37:43
Yeah. So, so I want to get back on track on the topic for today, which is, how do we know that you’re late because of LA traffic and the practicalities of a job that’s hard to manage? Or that you’re burned out and this is now impairment? And then I think the other question is, does it matter if the impairment is because of an unmanageable job, or burnout?

Curt Widhalm 38:08
Well, I will speak for myself in this but if this kind of question was put before me, on an ethics committee, part of my evaluative process would be: what is the intent behind it? Like, so traffic: How do you generally manage getting to your office in the morning? About, you know, I know that for my office, depending on traffic in the morning, it’s somewhere between 15 and 50 minutes, thank you, Los Angeles, I love you. But knowing that part of my day to day is an hour and a half before I am out to work, I’m checking what traffic is. Like there is kind of and I think most people who live in see me in person who live around me, are also potentially affected by the exact same traffic and there’s kind of a shared experience around it.

Katie Vernoy 39:06
Sure.

Curt Widhalm 39:08
If somebody is making an accusation or a complaint against a therapist, that they are burnt out, and it’s affecting things because they’re late. How was it handled is another part of it. Are you reaching out and saying, Hey, I’m running late for sessions, here are our options for dealing with this. If it’s just kind of the alright, what happened is, it’s the middle of the day and the therapist is just like, I’m going to take a break in between sessions and they lose track of time because they’re scrolling on TikTok on their phone. That points a little bit more towards not managing job responsibilities, rather than being able to problem solve for some of the structural parameters around. Now, also, if I see a complaint that is: my therapist was two minutes late one time on an ethics committee, I would very much be like, people get to be humans in this profession. Where it’s more likely to come out is pointing into some of the things like my therapist is falling asleep in sessions. My therapist is there’s no consistency to what they’re saying from week to week, they are… And even in the discussions that we see around that some of our evaluative process is, is this unethical bad therapy? Or is this just a bad match between client and therapist in the first place? So, there’s a ton of context that goes around this.

Katie Vernoy 40:41
So I mean, you’re speaking to the complexity of this question, is it ethical to work while burned out? It’s like, maybe if you can manage what’s happening. If it, whether it’s traffic, or whether you slept in, because you’re exhausted, and you got moving slowly, because you’re feeling burned out. If you’re communicating with your clients, and you’re getting yourself there, and you have the context around it, and you’re doing the repair. Maybe you’re not too impaired. But if you don’t care, and you’re just showing up whenever and your clients don’t know if you’re going to be at their session or not, if you’re going to fall asleep during the session, if you’re going to say stuff that doesn’t make any sense. That’s when we’re getting more to that point. But to me, that stuff seems fairly egregious and you’re talking about 8% versus 25%. Like those things to me seem like 50 or 90 participants. They don’t, they don’t feel small. And so how do we assess our own level of impairment related to burnout?

… 41:38
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Curt Widhalm 41:40
So, and that is speaking to the issue that is in the ethics code; is that we have an ethical responsibility to assess ourselves and take actions to not practice when burnout is affecting our clients. Now, we’ve done some episodes on licensing boards will not step in and be like, Yo, I know you got baby twins, but like don’t practice for a year until it starts to impact clients. One research study that I want to talk about here, though, is what would seemingly be the most appropriately named “How impaired is too impaired? Ratings of psychologist impairment by psychologists in independent practice.” This is a 2010 article by Williams, Pomerantz, Segrist and Pettibone. And they sent out to research participants a couple of different scenarios and had the research participants who are all psychologists rate, whether or not the therapist in question should continue to practice or whether they should take a step back and stop seeing clients until some issues were addressed. The couple of scenarios that they looked at were issues that were framed as substance abuse issues and issues that were framed as being around being depressed. And out of each of these issues. There was kind of five levels of severity of what the behaviors were. So some of them were around things like being late for sessions, losing interest in clients during the month. Some of the differences between the severity levels were the frequency and the impact of clients. So, as an example, at level three out of five kind of the mid level a psychologist was described as experienced each of the following once per week: feeling sad all day, crying, having trouble sleeping, and experiencing very low energy. Also, at level three psychologists depressive symptoms were described as interfering with client care in numerous ways, such as problem concentrating with most clients one day per week, losing interest in three clients in the past month, being late for work once each month, missing work once each month and canceling one additional appointment each month. Level two includes all of these exact same symptoms but at a lower frequency or intensity. So, out of the research respondents in this survey, psychologists in both the substance abuse and the depression areas rated that when the clinician in the vignettes was experiencing level three symptoms that was the level at which impairment was affecting clients and the therapist in question should be taking a step back from their practice.

Katie Vernoy 44:42
So, level three; remind me how often were you missing appointments or late.

Curt Widhalm 44:48
Late: once a month, missing work: once a month, canceling an additional appointment: once a month.

Katie Vernoy 44:54
So, this was considered impairment they should step back from their practice.

Curt Widhalm 44:58
Yes.

Katie Vernoy 45:01
Wow, that seems pretty rigid.

Curt Widhalm 45:04
One of the limitations pointed to in this study, there’s a couple of pretty important ones. One is that these are psychologists rating each other, and we’re a lot harder on each other than we tend to be on ourselves.

Katie Vernoy 45:20
Yeah.

Curt Widhalm 45:20
That sounds weird, because I know a lot of us in this field create our own kind of imposter syndrome and like, try to live up to this perfectionism sort of thing. But have you ever heard therapists talking about each other and the judginess that we do it with?

Katie Vernoy 45:34
Yeah, I might have heard a little bit of that.

Curt Widhalm 45:38
So, especially when it comes to judging negative behaviors, we’re a lot harder on other people than we are in ourselves. And that in this particular question, a question around the ethics of self monitoring makes it to where it’s a lot easier to see flaws in what other people are doing than it is to see flaws and what our self is doing, and the impact out of that. The other part of this is that, as I pointed out a couple of minutes ago, until clients say that it is harmful, that’s really where the ethics are, the licensure boards end up seeing it as being problematic. So it takes clients having to complain about this, not just other therapists judging about it.

Katie Vernoy 46:22
The thing that we were talking about before the context, you know, missing a day, being late for sessions, those kinds of things, like we talked about context that would make it not burned out and impaired, right. The, the way we handle it, the reasons why, you know, the intention around it, all those things. But, you know, if we’re looking at unethical meaning an ethics complaint, or a board complaint, or whatever it is, yeah, it would be if the client complained. But to me, if we’re trying to do quote, unquote, our own, you know, our own assessment, I think we would want to look at what the impact of our behavior is on our clients, whether it rises to an ethics complaint or not. I feel like when we’re good clinicians, we’re eliciting feedback from our clients on how we’re doing. Whether that’s a formal process like SRS, ORS, those types of things, or if it’s just really being very open and requesting feedback from our clients on an ongoing basis. To me, if the actual gold standard of am I impaired is whether it’s negatively impacting my client, it feels like this has to be a conversation with our clients.

Curt Widhalm 47:37
I think since this article was published, it’s been 14 years now. I’ve heard some places in the field be able to address this a little bit more by being able to elicit feedback. There are better things in place as far as being able to monitor the impact on clients, before it becomes problematic. You point out the SRS, and the ORS as a couple of examples of this, that I think are more common practice, and especially in places that track outcomes a lot more specifically. So, I do think that the field has kind of shifted in the response, maybe not to this particular article, but it has addressed this in some ways. As you pointed out, there’s a lot of rigidity around even just some of the ideas that are still very much prevalent in here. If people need a day off, yes, go ahead and take a day off. Plan it. Like don’t have it be like, Alright, I’m not showing up for work today. There’s also just kind of the responsibility that happens. If you’re an independent practitioner in private practice, and you wake up and you are like, I am not going to be effective for my clients today, I need to take a mental health day and I call all of my clients and I reschedule them appropriately. I’m not going to have any problems with that, if that’s happening, kind of, you know, once a month or so, and you’re doing it in a way that takes care of your clients. If you’re doing this once a week, then there might be some other factors that you have to really look at as far as Is what you’re doing a sustainable workload? So again, there’s there’s context upon context here.

Katie Vernoy 49:24
And it makes me think about folks who are not 100%, neurotypical 100% able whatever the words are, I think about physical needs when you have disabilities or other types of medical concerns that you’re navigating. I think about neuro divergent folks and showing up and working with other neuro divergent folks and being able to be a little bit more flexible in timing and how you interact. But I was also thinking about, you talked about, you know, being sad more days than not those kinds of things. Can people with mental health concerns be therapists? Because when we’re looking at that rigidity, it’s talking about being 100% okay. And we know, or at least I’m gonna say, I know that folks with lived experiences have something to bring to the mental health world as clinicians. And so if we’re talking about burnout, can someone who is depressed and treating their depression doing what they need to do, Can they be a therapist? According to the ethics codes? I think, yes, obviously. But like, are we saying that somebody that has a mental health concern, or a physical disability or something along those lines that they because they may show some of these different signs that they can’t be therapists, according to the ethics codes.

Curt Widhalm 50:49
So the ethics codes are created by the therapists who are part of the professional associations. So I point that out in that I do hear from virtually all of the professional associations that we don’t want to stigmatize mental illness. That if people are able to perform and function well in their jobs, alongside mental illness, then that is something that we welcome and encourage with open arms. That’s been really a lot of the context around any discussion that I’ve seen with professionals, especially over the last 10 years. However, I think that there is a competing, long standing idea that unless you’re perfect, you are a failure. That is going back to this article, How impaired is too impaired, there’s a quote that they reference from 1987. This is from Guy who says there’s a corporate investment in promoting the image of therapist invulnerability and superiority in order to instill public confidence in the efficacy of psychotherapy and the competence of its practitioners. Since, since it is the arena of the emotions in which the psychotherapist labors, there’s likely to be a desire to portray them as a perpetual victor rather than an occasional victim.

Katie Vernoy 52:18
Wow. But you said that was from 1987. Right?

Curt Widhalm 52:22
Yes. And I don’t think that it has really shifted that much. Because when we are talking about the litany of people that you just gave, we talk about when they’re successful. And while they can show up as as vulnerable, when it comes to impacting clients, we may give more context into understanding the individual practitioners, you know, struggles in the day to day, but we only like those stories when it works,

Katie Vernoy 52:53
When they are victorious, right? When they…

Curt Widhalm 52:55
Exactly.

Katie Vernoy 52:55
When they’ve been able to talk through and say, Hey, I am you, I’m like you, and I’m gonna give you all of my tools. It’s like the life coach thing, right? I’m gonna give you all of my tools so that you can interact with the world more effectively, because I have succeeded. But I do believe that there are folks that are a little bit more on to that, like I’m sharing true vulnerability and still practicing. But I guess we don’t know how those are being received by their clients. And we can’t know how some clinicians, not all clinicians, how some clinicians might perceive them as potentially impaired and a risk to clients. I think you’re right. I was thinking No, no, but what about all the TikTok therapists, they all have some some diagnosis? And it’s like, wait a second, no, but they are victorious.

Curt Widhalm 53:42
I don’t know of any research, and it would be a tremendously difficult thing to research because I imagine that the people who aren’t victorious, don’t stay in the field. They…

Katie Vernoy 53:56
Or, or if they do, they are just doing their work and they’re not advertising it.

Curt Widhalm 54:02
Right. In addition, I think, you know, really, probably the therapists of the last, say, 10 or so years. If you’ve been longer than this, I’m not slighting you. But I think there’s really just kind of the first generation of therapists and modern therapists, the ones that we’re bringing together through our podcasts in our community. It’s the first generation of therapists that’s like, you know what, we can show up imperfectly and do this job.

Katie Vernoy 54:32
Yeah.

Curt Widhalm 54:33
And so I don’t think that that generation of therapists has had the time to be in the leadership positions to really shape the way that the the field looks at things. This is still a quote that I find resonant even though it’s, you know, 35, 37 years old now, that ends up being something that is still very much there.

Katie Vernoy 54:57
Yes, and I think it also has to do with the client base, and I think that the the newer generations are embracing authenticity or vulnerability, whichever the right word is, and therapists who are imperfect, who are like them. And so I think we have a lot to learn over the next several years as our client base gets younger, and is more able to embrace imperfect therapists and therapists are more more willing to show up imperfectly. Because I think that creates a more nuanced question that goes back to when a therapist is a little bit depressed or managing their depression or a little bit anxious or managing their anxiety or burned out. It’s not like, hey, black and white, if you’re burned out, you’re not able to perform. It’s if you’re negatively impacting your clients, you’re unable to perform and you’re impaired, you’re too impaired to perform. And so the next question I have, because all of this is dynamic, is let’s say you’ve determined I am too impaired, I’m going to take some time off; how do you know that you’re now no longer impaired and can get back to work? Because some people talk about burnout recovery, like it’s this gigantic thing. And I think that it is for some folks. And for some folks, it’s like I just need to get a respite for a couple of weeks. And I can get back on track. And I’ll be okay. Or I need to make some shifts. And we can talk about some shifts and preview an upcoming episode. But but the question I’ll go back to is, how do we know if we’ve determined Hey, I’m too burned out to go in today? How do I know that I’m ready to go back the next day?

Curt Widhalm 56:48
I don’t know that there is a one size fits all answer to this. And…

Katie Vernoy 56:55
I was trying to give you a hard question, Curt.

Curt Widhalm 57:00
Where my mind goes on this is initially to what are you walking back into? You know, there are times where I’ve come back from vacations, where it’s like, hey, I need to get away from it for a couple of weeks, to really get out of the day to day structure that I have. And I think I’ve been open about it on past episodes. And there’s been times where I come back from vacation, it’s like, I am so ready to see all of the clients and I’m renewed and refreshed. And there have been times where I’ve come back. And it’s just like, oh, it’s actually my schedule and my caseload that is making me have to evaluate why I’m feeling this way. Like it’s it, so part of it is those in privileged enough jobs to be able to slowly ramp back up into things is kind of the find the level at which you’re able to continue to maintain success and find the balance of being able to be in the right job and know kind of where your limits are, don’t exceed them or have the regular things put in place in your schedule to consistently show up to work.

Katie Vernoy 58:16
Yes, and I think a lot of folks aren’t actually able to do that. And so I think when we are looking at someone who’s very burned out, they have to take a day off, a week off, two weeks, off a month off, whatever it is. And so they come back because they just physically or emotionally couldn’t do it and they come back, oftentimes, it’s not about slowly ramping back up, it’s figuring out how to ramp down. And you and I have had a conversation about trying to get you to ramp down. And so I’ll link to that episode in the show notes as well, because you didn’t, you struggle with that. But I think there’s this this piece of being able to do some of the stuff we talked about in structures of self care in order to be able to address and mitigate the risk for burnout. Because those are system things if you can do it. I apologize to all of those, all of you who are in community mental health, it’s a lot harder to make your own schedule in that way. But you can get your elbows out around end of work day and those types of things. And so maybe we can talk about, maybe have we done an episode on this? Maybe we can do an episode on how to try to avoid burnout or or try to push back against burnout in community mental health. But there’s some pieces to this, where what you can do is different than what the system needs to be doing. Some of the stuff in one of the articles I read that was a buffer from burnout is: having your own therapy and adequate or positive supervision, lower workloads if you can manage it, and that that comes to a place of financially what do you need to do? And for me, what I’ve had to do is I stopped taking insurance and I raised my fee because I could not do the work that I was doing; continue to gain experience, so the more experience you have, the less likely you are to burn out, which doesn’t totally feel true. But I can understand that, and making sure that you try to to increase your autonomy and feel more efficacious in your work. And so the autonomy piece, I think, for practice owners, or people who are in like group practices or those things, I think it really is actually taking individual leadership over how you operate, because that’s usually how it’s set up. Whether it’s what days you work, what your schedule looks like, like a lot of those things can be fairly impacted by by you. Not always, I mean, if you’re working with kids, oftentimes you have to work nights and weekends, okay. But you can try to set what you can set and actually make those choices. So many people I’ve talked to have acted as though their job is happening to them when they actually can make the choices of when they work, how much they work, those types of things. And so when we can find a way to get more autonomous and set up things like in our systems of self care episode, I think we can, we can be better about this. But if you wait until you crash, and then try to come back, oftentimes, this is a ramp down because you can’t afford to either lose the income. Or you have so many clients that are relying on you that you can’t just pawn them off on other people or close them out without really being very thoughtful about whether it’s a handoff or finishing up the clinical care for them. And so this isn’t, this isn’t an easy one. And I hate to be like, Oh, well, you know, it’s, it’s almost impossible, I feel like I’ve done for myself a fairly decent job of creating a schedule that works better, and I’m still tweaking it. And it keeps changing, because my needs change. But I am in the very privileged position of being able to manage my own schedule, because I’m a private practitioner. And so I think this is a systems issue. And I think that leads to the episode, the next CE episode that we’re preparing for the trauma informed workplace, I think that there’s some other things that we can do there. What are your thoughts on kind of how we can try to mitigate the risk or manage the burnout, more on a systemic leve?

Curt Widhalm 1:02:15
To repeat some of the things that we’ve already talked about, and especially being important to highlight the importance of them? is adequate pay, adequate expectations of job positions, the adequate ability to not just have therapy be your whole life.

Katie Vernoy 1:02:42
Yeah.

Curt Widhalm 1:02:43
And I say that to somebody who does a whole lot of therapy and does a whole lot of stuff in my free time: podcasting, you know, working, you know, on lobbying legislators, you know, doing a lot of that kind of stuff. But it’s also being able to divest yourself away from it at times. And there’s a lot of the education around burnout and self care, and even in our episodes, that really talks about like, Okay, here’s how it is on the job, but what we don’t talk about is like, go have a friend, like go have a true, like, we should be talking about like…

Katie Vernoy 1:03:24
Friends that aren’t therapist?

Curt Widhalm 1:03:25
Friends that aren’t therapists, or, or have friends who maybe are therapists, where you both agree of like, Okay, we’re gonna go out and we’re going to do…

Katie Vernoy 1:03:34
Not therapist.

Curt Widhalm 1:03:35
We’re gonna go have our dance parties, or whatever else, it is. Like you out there have the potential for that, but to talk about, like, in the midst of all of the loneliness epidemics that are going on right now. Just like, go and do things that are meaningful, that aren’t related to therapy, or mental health sort of stuff, like, go pick up…

Katie Vernoy 1:03:58
But what do you even mean by that, Curt?

Curt Widhalm 1:04:02
Be a part of something that’s like, go clean up litter off of like walking trails or something like that.

Katie Vernoy 1:04:08
So, like because we do so much around therapists and therapy.

Curt Widhalm 1:04:12
But I mean, it’s, it’s really like, be a part of something bigger than yourself that’s not just a system that has repeatedly shown itself to be broken and abusive.

Katie Vernoy 1:04:23
Yeah. I just think about respite and rest. And we talk about this in the systems of self care that you can’t constantly be stressed. And so you have to take those days of rest. And I think for myself, the days of rest oftentimes are what you’re talking about. It’s it’s going and doing something completely unrelated: gardening, making bread, you know, something that has a very different feel to it. And so I think, to me, to sum up since we’re coming to the end of our time: no, it’s not inherently unethical to practice while you’re burned out. It is unethical to put practice when you’re impaired, or sufficiently impaired to harm your clients. And that’s how you define that. Burnout is an issue for our field. It has been addressed more as an individual concern, when in fact, it’s a systemic one. But while we’re addressing the systemic concerns in the different ways that we address them, we have to take care of ourselves individually, because we still do have that individual responsibility to our clients. And so doing some of these things that we talked about can help to try to mitigate the risks of burnout. But it’s tough and sometimes it’s going to be to the point where we really just need to take care of ourselves against the system sometimes. Yes, I know you want to see me tomorrow at noon, I cannot see you tomorrow at noon. And that’s a hard hard boundary to set. So, I think it’s worth that all of us need to do.

Curt Widhalm 1:05:59
You can find our show notes over at mtsgpodcast.com. Listen at the beginning of a or the end of the episode or go to our show notes for information on how you can get continuing education credit for this. Visit our Facebook group that we mentioned earlier, the Modern Therapists Group. This episode is proof that we participate and we sometimes make episodes out of the things that you post there. And until next time, I’m Curt Widhalm with Katie Vernoy.

… 1:06:27
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Katie Vernoy 1:06:27
Just a quick reminder, if you’d like one unit of continuing education for listening to this episode, go to moderntherapistcommunity.com, purchase this course and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.

Curt Widhalm 1:06:42
Once again, that’s moderntherapistcommunity.com.

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