Hi! I'm Alicia Johnson, LMFT a licensed therapist specializing in burnout and stress. Ask me anything!

You mention finding time for yourself, how does one do that if there isn't time and energy left over after all the demands of work, kids, a house, a spouse, and leaving time to get enough sleep?

Great question!! I actually wrote a blog post on this very thing because you are right, there are real barriers to "finding time for self"

Finding time for ourself doesn't always mean we have to have alone time. There are some people who genuinely cannot get more than a few seconds alone for very real reasons. Taking care of ourself and finding that time means we get a little creative. Can we incorporate others into the self care? can I put on some music and dance and be silly with the kids? Can I grab a friend for errands? can I listen to an audiobook while working on chores?

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Also being mindful and intentional in some moments even if only 5 seconds. I may not have the energy some days to do deep self care or coping tools so maybe I spend 5 seconds while brushing my teeth to list 1 thing I am grateful for or focus on my breathing for those 5 seconds and get back to the chaos.

Also, the book how to keep house while drowning by KC Davis can be a huge game changer. she is a mom and therapist and ADHDer so the chapters are SHORT and manageable because she understand the chaos

Is it possible for people to return from burnout to do the same job? All the people that I know that went into burnout never returned to do the same job.

is it possible, I am sure but it is very hard.

Burnout tends to happen because there are deep systemic issues within the workplace. So even as we heal and grow, if the workplace doesn't also change or adapt, then it can only be a matter of time before we are faced with those same issues. So people often find new places that are better without the systemic/deep issues from the last place

Can burn out ever be resolved without treatment/therapy? What does burn out look like after, say, 3 years of ongoing stress? Thank you for doing this AMA. I think your line of work is really amazing.

I do think it can be resolved without therapy but it takes work (heck it even takes work with therapy).

In therapy we talk a lot about boundaries, values, needs, negative beliefs, and coping tools. Those are all things people can do outside of therapy and do the work on their own.

I will add a caveat that burnout can be very hard (not impossible) to recover from while we are currently in the place that is causing it. So if it work burnout and nothing changes yet we are doing the work, it is like an uphill battle. Or if we are burned out at home and our partner isn;t listening to offering support, that is an uphill battle. Again not impossible but hard.

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As for what burnout can look like after 3 years, it really does depend on the person and the other factors but probably lots of feelings of helplessness, hopelessness, exhaustion, lack of interest or energy to do things, getting irritable with people, maybe even feeling anxious or depressed. chronic stress on our body can even lead to health changes, sleep changes, and more.

Thanks for asking these questions!

After a long and very difficult year, my wife and I are finally taking a vacation for a few weeks.

We plan to do zero work, spend time with family, put the phone down, and generally try to do as little as possible.

What's the best way to relax on vacation when you're burnt out? I'm planning to be as intentional as possible with what I do, and to try and stay in the moment, but I'm also a little worried about not getting the relaxation I need...

Thanks for doing this AMA!

Yay I am so excited you guys are taking a vacation! And you said a magic word that is what I tell a lot of my clients, intentional so this is already a great start!

When we are burned out rest may be difficult. I often suggest starting small so if your body and brain are used to always going and going it may feel weird doing nothing for a day or even a few weeks. We can trick our brain and find relaxing or mindful activities that still feel productive. A nice walk can make us feel like we did something even if we didn't answer emails that day.

Also focusing on rest vs recharging. Some activities we need to do to calm our body down. Like naps, sleep, laying on the couch and watching tv. Those are needed at times! Those activities may recharge but they also may not. So make think about what it feels like to not be burned out and what activities can you do to get that spark back? Is it doing a hobby, being silly with your wife, trying new places with them? Igniting your passion and values? We need rest and recharging.

And lastly, grace and forgiveness. Burnout can be a punk and skew and filter nice things into negative things so if you don't perfectly relax or if it doesn't go as planned be kind to yourself that you did the best you could at the time and learn from it for future breaks!

I hope your vacation goes well.

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Great awareness of these patterns. That is a super helpful first step.

have you guys talked about taking time outs during these times? that can be a way for her body to not be hijacked by anxiety and also time for you to deal with your own valid feelings.

Another tip I give my clients is to use "I statements" and practice the speaker listener technique. both of those you can find on google! I statements help you share your feelings and perspective and help minimize the person feeling 'attacked" which then minimizes their urge to get defensive. the speaker listener is annoying at first but sooo helpful because it makes the person repeat what they think they heard so the response is actually to the statement instead of what we may interpret when we are stressed/angry/anxious/etc

What are some of the common themes associated with burnout and stress you see across patients who are graduate students or in higher education? This might not necessarily be directly related to academia.

Oh gosh I have lots of thoughts on the treatment of grad students and people in higher ed. With burnout, we have to think systemically meaning there are larger forces at play that tend to make stressful times unhealthy. Grad school is expected to be stressful and work but when we have students who can't afford housing or insurance or food how do we expect them to really care for themselves? There are larger systems in play that force people in higher ed to work past their allotted time, review things for free, work on committees, etc which takes up time and energy for people to care for themselves.

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so I guess the themes would be that there is a lot of pressure from these systems that use guilt and power to take advantaged of these populations and make it near impossible to set boundaries, have time for fun/hobbies, taking care of our health, or affording healthcare.

I’m returning to therapy next week for the first time in ten+ years. We have two kids under two and mostly aren’t sleeping, which has revealed many cracks in my emotional armor.

Any advice for parents of young children surrounding sleep/stress?

Good luck for going back to therapy!! A huge step in getting this handled!

Oh gosh that sounds very difficult! Anytime there are littles with behavior changes like that I tend to recommend seeing a doctor to see if there is anything underlying there. Or thinking about if there have been any major changes that are leading them not to sleep. I tend to talk with clients about sleep routines, for both the littles and the parents. Can there be shifts so at least both parents are getting some sleep until the sleep issue is resolved.

Any tip on how to get better at compartmentalization? My partner is struggling from work related burn-out and often thinking about work related matters (manager at a restaurant) on her off hours and weekends. She will often comment on how she "just needs a break." I try and talk to her about compartmentalization and leaving work at work, but then the excuses come flying: "but I have to figure this out or else....," "if I don't do this tonight...," "I didn't have time to do this earlier because xyz," "I have to go take inventory on the weekend because I'm better at it." These kinds of things...

I do some "well, if you weren't to figure that out tonight, what's the cost/worst thing that could happen" to try and help do some reality testing on prioritization and assessment of urgency. But more justifications come flying.

So, yeah, I guess this is a 2 parter...the question above on tips for helping a partner suffering from burn out compartmentalize better. and 2, any tips for me, as the parter trying to support her?

Thanks!

uuuufda I feel this one. This sounds like real chats with me and my partner haha.

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To start- even though it sounds like you are coming from a very helpful and logical place, when we are that stressed or burned out logic does not make sense. those tools you mention are great for when we are at lower levels or medium levels of stress because our frontal lobe is still working and we can think more clearly. when our body becomes flooded our frontal lobe checks out/goes offline and it doesnt work the way it is supposed to so logic and reason go out the window. so for your partner, I would suggest more body based coping tools, grounding, stretching, punching pillows, whatever it takes to release some of the built up stress and then when they are at the medium level that is when those logic tools may be more helpful!

for you- just validating emotions can be super powerful and helpful. we tend to not want our loved ones in discomfort or pain and we rush to wanting to fix it but sometimes we just have to ride the wave with them. saying "dang that sucks" can be powerful. and asking them what they need from you. also- dont forget to take care of yourself too. when we pour into others and are around people deep in burnout, it can impact us also so dont get lost in the help!

What percentage of the working population do you think are experiencing burnout or a feeling of stress from helplessness against what feels like an attack on quality of life?

I wish I could confidently say a number but unfortunately I have no idea. I would say more than people expect though because burnout and work stress can go unnoticed for a while due to our brains trying to be in survival mode. But I am thinking of the economic changes, holiday seasons, inflation, corporate dynamics, low wages, student loans, family costs, housing costs, etc and that is all reason to be stresssssed out.

How do you deal with the mentality that you feel you are unable to take time to rest because you know you'll have made everything harder for yourself upon your return?

I use the mantra rest is productive in those moments. When I am nearing empty, sure I could push through and do tasks but 1. it is likely going to take longer and 2. i will likely make mistakes.

If I give myself breaks, recharge, and rest. When I come back to the task I am often more eager to do it, have more creative thinking power, more motivation, and will do a better job.

It is a win win.

How do you know you are burnt out? What are the clinical signs?

each person can differ slightly but here are the common signs I see.

irritability, exhaustion, lack of joy, feeling hopeless, short fuse.

other common things may be changes in sleep, more frequent urges to quit, noticing or thinking about work while at home.

How similar is burnout to depression?

very similar! burnout technically isn't a diagnoses (yet) so we see a lot of overlap with the lack of energy, hopeless, changes in sleep/appetite, etc. we also know people who are burned out have a higher risk of getting depression

Its interesting that a lot of these signs can be from other things too, but eventually cause burnout as well. My signs came from lack of proper sleep (not enough oxygen which caused not enough quality sleep) which eventually caused a burn-out. Its really all interconnected and if one thing fails, the whole chain breaks. It also impressed me how long it took for my body to restore after I got better sleep. It was a very long process (about 1,5 years of struggling). Only recently I realized that my mood was normal again, my emotions under control, more energy to do stuff and not as much troubling thoughts that prevented me from getting into sleep mode. What also didn't help is that the sleep medication I got was actually holding me back, but also made me addictive enough that stopping it was a big big hurdle. My therapist was able to convince me to really go for it and I thank him a lot for it now. I have a lot more respect for your profession now.

you are spot on! so many of our symptoms overlap and that is why it is super important to look at all the factors and contexts to get the full picture. so glad you found a good therapist who was able to help!

Are there are breathing techniques that focus on de-stressing or reducing burnout? I spend 20 mins in the sauna a few times a week and I like to try different breathing techniques like box breathing or 6 seconds in and 6 seconds out.

Yes! breathing techniques can be great for our nervous system! It is best to try them out when calm and maybe not in the sauna to see which ones you like then can practice other places.

My fave is called 4-7-8 breathing. You breathe in for 4, hold for 7, exhale for 8. I personally adjust mine to 2-3-4 breathing so do what feels comfy as long as the exhale is twice the inhale.

box breathing or square breathing is nice. you can imagine or draw a box with your finger and alterative inhales and exhales. you can pick a number like 4 and take turns breathing in and out.

another one is diaphragm breathing. so putting a hand on chest and belly and breathing in through nose so that the belly rises then exhale through mouth.

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I hope you find one that you enjoy and works!

One line of thinking that persists in my head (even after seeing a counselor for awhile) is the concept of not feeling "eligible" so to speak. I mean that to delineate the need for real therapeutic, clinical work as opposed to someone like myself who (fortunately) has had no major trauma or medical conditions but just experiences general low level anxiety and depression like probably all adults.

Like I just needed a life coach or something as opposed to proper therapy and that I was taking up a slot in these counselor's patient panels when I wasn't utilizing the full extent of their clinical capabilities.

Is this a concept you think about on your side? Do you find yourself with patients that really just need a few close friends in their life?

I could probably do a whole ted talk on this so I will try to be brief haha.

Therapy has typically followed the medical model meaning you needed "something wrong with you" to get help. This is still true if you want to use insurance because they require a diagnosis to use benefits.

A newer line of therapy has started where we know there are benefits to meeting all types of "issues" not just clinical and diagnoses. I personally don't diagnose and often see people dealing with normal life stress who just want a space to process and better cope with things.

I wish there was less stigma around seeing a therapist because people often wait until rock bottom or until things get worse instead of taking a more preventative or maintenance approach.

Appreciate that response. It's true that if I frame it from the perspective of preventive/maintenance care it definitely puts a different shine on things.

I suppose it's on me to ensure I am upfront about this with any therapist to make sure they're on the same page. Admittedly I felt nervous about this dynamic but never vocalized it!

you bring up a great point about being on the same page with the therapist! Some therapists do focus on the "problem"/diagnosis/behaviors/etc whereas others are more strengths focused, verbal processors, and future thinkers.

It is best to find a therapist that fits with what you need. Some people want the super clinical evidence based treatment focusing on depressive symptoms. Others dont though.

I offer free consults where clients can ask these very questions and I encourage anyone looking to start therapy to set up a free consult with the potential therapist so they can determine if the therapist is a good fit for them.

What kind of qualifications does a licensed therapist require? Like bachelor degree etc? And on which side of the world are you?

In my country, therapist isn’t a protected term and literally anyone can use that title.

Thank you!

I am in the U.S. so a therapist needs a masters degree, and then typically 2 years of supervised work experience meeting a certain hour requirement, and then to pass 1-2 tests.

Is stress and burnout really an 'us' problem or is it a problem caused by our workplaces and societal expectations? Aren't self-care and a lot of coping techniques only trying to fix symptoms rather than the illness?

I agree that burnout is due to workplace and societal issues. It sadly becomes an us problem because many of us have lived experiences where we don't know how to set boundaries, we blame ourselves, we feel guilty, we feel inadequate, we don't know what to do. so the burden of recovery gets put on the individual.

Self-care and coping can be bandaids but they can also solve deep issues. and sometimes we need bandaids.

Take self-care for example. sure taking 10 minutes to do a face mask might seem like a silly self care thing on the surface. but if I am being intentional to take 10 minutes out of my day to do something for the sole fact that I want to do it. I am prioritizing myself, even if just for a little bit. I am going to work on not feeling guilty or bad or pressure to take care of other things. that then turns to shifting my mindset that my needs matter. i matter.

and that deep work is where we can then feel empowered to set boundaries at work, create clear expectations to our loved ones, listen to our needs, and not let guilt and pressure take over.

Is it possible to suffer burnout from a job even when the workload isn't too high? I work in tech support where about 80% of my job is just waiting on calls to come in, but said calls shoot my stress levels though the roof, and if I'm on call and get a call after hours it disrupts my ability to relax and participate in leisure activities.

I've had more difficult jobs but this one seems by far the most stressful.

yup! burnout isn't always related to workload. it can occur when we don't find joy and purpose at work, when our values aren't being met, when we aren't being used to our full potential, when we don't love certain tasks.

Nurse checking in. I've been burnt out for years, panic attacks, loss of sleep, loss of appetite, serious depression, etc. I've worked thru burn out multiple times in my career, typically just working more and more.

I've finally found my way into my retirement job, I'm less than 5 years out from being able to retire from this profession and my current job is considerably easier, although I still wish I did just about anything else in the world. I'm holding on to the light at the end of the tunnel with a tight grip and I'm trying to grin and bear thru 56 more months.

I'm certain I have developed some very poor coping mechanisms with stress and burn out. I'm likely going to push thru another few years and retire relatively young, but I feel like it'll be similar to rebirth.

My question is, when someone has finally left the job they've been experiencing long term burn out from.... is that it? I'm sure there is more to fixing burn out than just quitting, but more specifically, is there a... post burn out aftercare regimen? Or some specific type of therapist to see? I feel like I've kind of lost my sense of self after being absorbed by work stress and depression for nearly 20 years, and once I'm done I already feel like I'll be pretty lost.

my heart goes out to the nurses. a lot of my case load is nurses.

to answer your question- sometimes quitting is enough but to target the deep symptoms like the loss of self or even to prevent any resentment some sort of after care could be helpful. therapy can be helpful with this if they specialize in EMDR or burnout or even retirement transition but it is not always needed. sometimes self relfection and getting back into hobbies, finding value in other places, connecting with yourself again, finding new purpose, etc those are all healing things.

Based on your experience, what are some common things you see across your clients who struggle with burnout, anxiety, stress, and work-life balance? What are the tools you provide them for help?

Common things I see are that they have often derived their worth from their work. That they feel guilty if they don't do x, y, or z at work or make mistakes. That they are often over doers and take on more of the house work and relationship tasks without asking for help.

The tools we often work on are setting boundaries, finding worth and value in other places, challenging negative beliefs, finding support, and recognizing strengths.

How bad can the physical symptoms of stress/anxiety/depression become? My wife recently "had too much" and shes surprised how crippled she became - to the point of generating anxiety for her health (she is seeing a doctor). She hust has a hard time comprehending how she can feel so physically bad (no energy, body pains, all sorts of hormonal issues like hair loss, marks on nails etc).

Sadly chronic stress can really impact our health and it sounds like common things that your wife is experiencing if she has been exposed to a lot of stress.

We know from research stress can impact our blood pressure, heart rate, chemicals in body, etc. so yeah the lack of energy, physical pain/tension, hormone changes are all very real things that stress can do. I am glad to hear she is seeing a doctor because even though this sounds scary our bodies are resilient and can change with proper stress releases and even medications may help.

Were lucky we live in Denmark - shes been granted 2.5 months paid sick leave, doctor and psychologist. She will start really slow like 10 hour week max.

But she is now beginning to stress that shes not feeling any substantial improvement in symptoms. Shes not the patient type heh...

ha I hear that! that is the tricky thing with burnout and anxiety too is that is can play tricks on our brain and skew our perceptions!

What methods have worked for those dealing with imposter syndrome or stress associated with not getting enough done?

this is one of my fave things to work on with clients!

We often examine where the beliefs stem from and work to replace that with a more helpful one. We work on realizing that we can be successful, hardworking, good, etc AND make mistakes, take time off, not be perfect.

It includes a lot of self-compassion work. I use the website https://self-compassion.org/category/exercises/#exercises

it is a great starting spot to challenging that inner critic!

I just started extended leave 3mo to start due to operational burnout and stress. I find it interesting how the times of a acute burnout that I thought I was recovered from actually were slowly building on each other. That being said, I'm happy I'm doing something about it, and I'm trying to be very intentional with this leave and how I recover. Any advice for how I should approach this time off?

So glad you are taking this time for yourself! and you make a great point how our past burnout can kinda creep back up.

as for this time I typically recommend people find the cause of their burnout so it doesn't come back. thinking about values, needs, boundaries, priorities, etc and see if there are ways to achieve those. i also recommend a combo of rest activities AND recharging activities.

I filed a big complaint against my past therapist who works at my school and I haven't seen them for a while now. They probably still work there, but the complaints director told me that they had a big 80 page response and they grappled heavily with a lot of issues. How much stress and burnout can something like this cause to someone in the mental health profession?

As for the complaint, I am settling for just an apology and I feel bad for making my therapist feel bad. How do you think they can even recover from what happened?

I can't speak for how that person felt but in general burnout is huge in the mental health profession. I am in some therapist groups and getting feedback (or complaints) are tough because we are humans first. That isn't our clients responsibility to worry about that though. It is the responsibility of the therapist to seek supervision, consultation, and even their own therapy. Those resources are how I hope that person can recover from what happened. Maybe getting therapy or supervision and examining their feelings and learn from it can make them into a stronger therapist. definitely not your fault for raising those concerns, those are clients rights to do so!

I work with the postpartum population. I'm curious how you would tailor your approach to a client where a work/life balance does not exactly provide much solace. In situations where there are no other alternative forms of childcare, how might you work with somebody to address their feeings of burnout?

part of balance to me is knowing that we are not always in balance. sometimes balance means leaning into one area of life and giving more of ourselves to that area. the thing with balance is we eventually need to correct or lean back otherwise we fall. kinda like riding a bike.

So with my clients who are postpartum we set realistic expectations, practice grace, practice self-compassion, and find little wins and get creative with taking care of self.

Looking for career advice. Therapy has helped me a lot and I've thought about becoming an LMFT myself, but the world of it is very large as far as education and certification goes.

How did you find your school of choice and do you have any advice for someone who is looking to get into the field?

For reference, I'm a man in my early thirties with a bachelor's degree in business admin and IT management who works in the tech industry.

Thanks!

As for looking for a college, I found one that had small class sizes, opportunities for scholarships, and was accredited because I knew I would be moving around alot and that makes licensing easier. I went right after undergrad and didn't have a family so it was easier to prioritize those things. If someone is looking for schools it is important to think about if they want full time or part time, if they can do an unaccredited one and stay in the same state or if they need an accredited one, and how much prep work do they do to pass the national exam.

I had people in their 40s and 50s in my program so it defintely isn't too late for a career change and that experience can bring a unique perspective to the therapy relm! I hope you get some clarity on what you'd like and enjoy whatever career you choose to do long term!

I have a legal/professional/ethical question, feel free to ignore!

Let's say you're running a twitch stream. It's not mental health related at all, but your community knows you're a licensed therapist as your "day job". Someone in chat starts saying sad or worrying things, or is just having a terrible day.

Where is the line / third rail as far as what you can say or offer as a friendly empathic human on the internet without exposing yourself to professional risk or liability?

I know this sounds like a stupid "I'm a black belt so I have to register my hands as lethal weapons" thing, but with state-by-state licensure being so restrictive for online therapy in the US, I'm curious. Thanks!

not a stupid question at all because I think many therapists are finding themselves in more of these situations with social media.

With any legal question I do have to say that it really depends on the state laws. As for exposing self as therapist I don't know of any laws or ethics that would require you to do that but what comes to my mind is what is your liabaility to offer help if someone was in crisis. I know that might be an extreme case but that is where I think the laws and ethics could be messy. I know one thing that is often recommended is to have a disclaimer in places online such as even though you are a therapist this isn't therapy or you are not their therapist and have a link to other resources.

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I am going to give the technical answer and then my answer ha because they differ.

technically according to our dsm PTSD can only be diagnoses for witnessing or experiencing a life threatening event or an assault. and burnout is not an official therapy diagnosis or would qualify for PTSD.

HOWEVER- I think that is bs and we know from research the very real effects of stress ont he body and how harmful some workplaces are to our body and mental health. so I would say burnout turns more into ptsd like when we start avoiding work, dreading work, thinking about work at home and replaying events, thinking negatively, and stuff like that. it can be worsened if our supervisors are not supportive or have added to the unhealthy environment.

unfortunately employers don't have any legal responsibilities for this. they can sadly justify things, fire people, and focus on the bottom dollar. GOOD SUPERVISORS would take this seriously, work with people to find ways to improve the environment, get support, and find helpful solutions that work for both the employee and employer. I am sorry you didn't get the support you deserve!

What's the best way to detect burnout in oneself?

Awareness is the first key! So doing self reflection on how you have been feeling, thinking if you've noticed any changes, checking for tension inthe body can all be helpful. if you have safe supportive people in your life you can also ask them if they noticed anything change or if you seem off

Many thanks, Doc!

not a doc, I have my masters, but you're welcome!

Welcome and thx for taking your valuable time to do this!

Do you have recommended (academic) information/links or experience(s) with differences and therapies for neurotypical versus autistic burnout cases?

May your holidays by grand and uplifting!

I personally dont but I have a colleague who created an INCREDIBLE resource page for different topics on autism and I believe burnout was on there! https://therapyforpetpeople.com/resources-for-neurodivergence

I don't know if your specialization stretches to this topic, but I wonder : do you have some insight between the overlap between ADHD and burnout?

As a person with ADHD it feels like I burn out easier than the average person, to the degree that I'm constantly emotionally drained/exhausted.

I'm curious how much of this is directly the ADHD or indirectly caused by other things (as in disordered attention being more taxing on the mind).

I personally don't have training or education on ADHD (a failure on my training program) but from other colleagues I have talked to and even some of my clients who have been diagnosed with ADHD it does seem to have some correlation! I wouldn't be surprised to see more resources and research on this in the next few years! Academia runs a little slower than real life.

I recently spoke to my bosses about my time management. I told them that I could work harder and faster and be more efficient, but that I would need to be compensated with taking the rest of the day off, for example. Their response was that if I’m more efficient I should ask for more work, and I tried to explain that it would just burn me out. They didn’t understand where I was coming from even though it’s such an obvious and simple idea- my question is what you think about the conditions and mentalities people have to deal with such as the outdated thinking of my bosses, which ultimately result in burnout and stress?

Thank you.

This is what we are seeing A LOT right now in workplaces. Older generations and more traditional type mentality where we need to hustle hustle and work harder and be grateful for a job versus people who are learning about boundaries, worth, work-life balance, life outside of work, prioritizing families, etc.

My thoughts are we have to think of our priorities and values. Some people can accept working with these differences and find other ways to survive the job. For some people, that value difference is too much and like you said can deepen the burnout. For those people I work with helping them set boundaries or even looking for other jobs that are in line with their values and where they can feel worthy.

Is it healthy to think that you need to be stressed at all times and that burnout is a natural part of life?

I wouldn't say it is healthy because we know chronic stress can impact our health but I will say it serves a function and some people may find that it motivates them, they are "used" to it, or that it is the lesser of two evils.

So, should I take steps to get help for this?

Classic therapist response- it depends. If it doesn't impact your functioning and you aren't noticing any negative symptoms or side effects then in theory you can keep on going. I am bias however and think therapy is great but I understand that may not be a step you want/need so there are other "steps" such as noticing your emotions and reactions, refelcting on your priorities and values, seeing if any boundaries need to be made, practicing coping tools, or chatting with friends all of those can be helpful in managing burnout and stress as well so doing whatever feels best for you whatever that may be

It’s not as bad as it used to be, i’ve been getting help for it, but i’m worried about falling back into bad habits and ignoring the signs until it’: too late.

for my clients who terminate we go over a what next plan and warning signs to look out for. so maybe for yourself you can think of some signs to look out for and if those start occurring then you do whatever next steps you need

Can you speak on people suffering from physical pain like musculoskeletal pain due to constant stress? What if the source of constant stress is something mental?

This is not my area of expertise but I do know we have therapy and treatments that address chronic pain and illness so there are ways to decrease symptoms, stress, and find ways to manage/cope.

What is burnout? I understand there is the colloquial use of the term but people use it as though it is some sort of diagnosis. How do you "cure" burnout from work if you've invested years and years of education, money, and time towards a career? Doesn't this seem like a structural issue as opposed to an individual one?

you are correct that there is no formal diagnosis of burnout. in the mental health field we describe it as the complete emotional, mental, and physical exhaustion people face and the related symptoms that occur due to it.

People can recover from burnout by setting boundaries, living in line with their values, finding coping strategies, asking for help, changing careers/jobs, negotiating benefits/pay, finding worth in other places, and creating healthy routines.

It 1000000 percent is a structural issue. I use the term systemic but yes you are correct. All work is stressful and has cons but when there are these systemic issues at play that is where the burnout happens. It is when we are not valued at work, not given freedom or opportunity, no opportuntiies for growth, not having boundaries respected, etc.

Like a lot of things, even though we are not the cause, the recovery ends up on the individual.

So here's the scenario: You work a job where people treat you like garbage, and you've been overworked since COVID, working every workday for 2+ years and not knowing what PTO is for because you can't use it because you're doing 3 people's work. Now you've told your therapist about this, and all he says is that you need to find a new job. How do you avoid punching him in the throat so hard you crush his larynx?

I am sorry that was his response. While I can totally see the red flags he sees in the current work environment there are a lot of other responses that would be more helpful.

Some people don't get it sadly. They think it is as easy as quitting or taking major actions. I hope you were able to share with him that it was not a helpful comment and actually get the support you need.

As for general anger coping tools my faves are jumping jacks, throwing pieces of tissue that are wet against a door, walking, angry songs blasted in the car, and a good vent session with anyone who will listen to me complain about the idiots.

Can burnout happen even when you're at a job for a short period of time? I've been at a new job for about 7 months and I'm feeling all the symptoms of burnout you described. This job requires way more evening and weekend work than I was led to believe and we're a week into an unforeseen major crisis. I feel crazy to think about job searching but I've never been as stressed and anxious.

yup! there is no time requirement for burnout.

if you aren't wanting to job search, do you have the energy to do some self-reflection on the cause of the burnout? the aspects of the job that are draining? do you have the support in this place to ask for those changes or set those boundaries and see if things get better? if not then that is typically when I start the convo if finding a new job is worth it. such an annoying process though!!

My husband and I have become roommates who co-parent & co-manage the household. We have a lot of struggles - I'm on disability because of chronic migraines & severe depression, his mom has severe Alzheimer's, and we have little-to-zero family support.

I ask him for hugs, kisses, occasional cuddles and while he'll give them to me, he doesn't unless I ask. Kisses are pecks and never sexy. We haven't had sex in years because I got tired of initiating and stopped. I'm in therapy and doing everything I can to get better, but I need affection & intimacy to help me get better. Plus I just miss him & the sexual connection!

I do not doubt our love but we both have long struggled with acknowledging & talking about our own needs. Looking back, we rarely talked about sex even when dating. When we stopped having sex, it wasn't sudden. It had been fading for years, in a large part because it was only when I asked.

He insists there are no medical issues. We both masturbate separately so I think everything is "there."He quit counseling when we started talking about needs though he very enthusiastic when asked about having an active sex life together. It doesn't help that despite our both working from home, he's an early bird and I'm a night owl thus anything after 8 is out for him, and the idea of sex in the morning is a no-go for me. I recognize that I can only change myself and am trying...

A few months ago, I offered to "rip of the band-aid" and just have sex rather than work up to it. Later I suggested that we get a little tipsy to help with nerves. He thought both ideas were great and agreed to them. With the unspoken expectation that of course, I'll initiate. I thought I'd try to seduce him but when we've had a smidge of time (usually early afternoon), I just couldn't force myself to feel sexy or work up the courage.

I'm frustrated and feel lost. What can I do to restart our sex life? Despite being exhausted from my own challenges, I miss him terribly!

No need to apologize for the length, it sounds like this has been bothering you for a while and it needed to come out!

As for the question, unfortunately couples therapy isn't my specialty. What I often tell my clients is that we can work on our stuff but we are only a piece of the equation. have you guys considered couples counseling? sex is one of the most common reasons couples go to therapy. and my guess it there is something deeper that is impacting the closeness and desire on both your ends. sending good vibes that you guys find the closeness and the support you need.

What are the symptoms of burnout?

it can vary person to person and depends on the situation but some common ones we see are exhaustion (mental and physical), getting irritated easily, changes in sleep/appetite, feeling helpless and hopeless, and not being able to do things you enjoy.

Whats something you can say or do to somebody of which you suspect might have a burnout or is starting to show symptoms of a burnout? Something that helps them either figure out they might have it or motivate them enough to seek help to figure out if they need to act?

ohhh great question. it depends how close you guys are and how open they are to receiving that info.

it could be as simple as saying, hey i wanted to let you know if you need to talk about stuff, you can always chat with me.

it can be asking if they have been stressed about anything. if you're close you could comment that they seem different and you wanted to check in.

if they are more open, you could say something along the lines of hey i am worried about you and wonder if there is something deeper going on. if they have the language of burnout you could ask them if they have been experiencing anything.

sometimes I take the approach of sharing about my own burnout and what helped so they know they aren't alone and that there is hope.

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what is tricky is that burnout does a good job of hiding because our brain sometimes doesnt want to acknowledge it because then it becomes real and something we have to deal with.

I’m struggling quite severely with fixated behaviours at the moment.

Some background: My partner of 5 years and I broke up over a year ago. My work contract ended a few months after. I’ve been unemployed since. I struggle with language tasks and tend to procrastinate, as a long time writing essays in uni then 7 years as a teacher marking and giving feedback has resulted in written and verbal communication being stressful. I suffered a long-term B12 deficiency. I lived in one city and drove back to my hometown during the weekends to see my son. I drove 17 hours a week to commute for work. Before and during this, my hormones felt out of kilter and I’d be up til the early hours feeling sexually frustrated (probably not the correct term).

The problem: I fixate on things that are unimportant, like making a video, playing a game, fixing a broken item, making myself available for people even when it’s not what I want to do. I will deprive myself of sleep / food / hydration / hygiene if one of these tasks is complex. Every day I dream or ruminate of the break up.

My perspective: I burned myself out with work (and partly due to a deficiency), and having geographically split responsibilities, and suffered consequences in my relationship and my life. I now continue to burn myself out even more, and fixate on things rather than take a healthier approach. I know I am hurting myself, but I don’t know what the problem is or where to seek help or where to begin.

My dr has treated the B12 deficiency and I have regular jabs. I don’t feel like I stopped during many years of work, and the drive to push through times where I’ve had to be ‘always on’ has resulted in this year of unemployment where I’ve given myself no rest and instead developed fixating behaviours.

My questions: Where do I begin? How can I refocus? What is happening? Why do I hurt myself like this?

I am so glad to hear you are working with a doctor for the physical health stuff. There is such a tie between our mental health and physical health.

I know I am going to sound like a cliche therapist but I tend to recommend therapy. Getting to the root of issues, replacing patterns, challenging cycles, replacing negative thoughts/behaviors, etc that all can be addressed in therapy.

I tell clients that change is hard. Our bodies like things to stay the same (even if it is harmful or not the healthiest) because it is what it knows. It knows how to prepare for those things and how to survive those things. When we start changing, even for the better, our body can feel discomfort and auto correct itself back to the old patterns. That is why we see people continue the "unhelpful" or "harmful" behaviors even if they logically know better.

If therapy isn't your thing. I tend to start with awareness and figuring out the functions of the behaviors. Our brain thinks they are protecting or working in some aspect so if we can figure that out, we may be able to replace that with another way to get that need met.

What are some tips to fight the stigma of talking about it? Some professions have had the position that you'll ruin your career if you come forward for help.

Very true! It sucks that it is still taboo in many workplaces and even in our society there is a lot of shame and judgement talking about it.

I tend to suggest starting small. Can you share with a few people? Are there safe people in your life you can be honest with? They may also share their own struggles. There are power in numbers. Then, finding other supports. Maybe it is listening to podcasts about this topic and then sharing that on social media. Or following certain accounts and sharing their content. It may not be safe at the workplace but are there other areas that you can do small things that lead to big change?

I "should" myself into prolonged stress and burnout. These shoulds come mostly from high personal standards and expectations. There is so much I want, so little I can humanly do. I don't know how to prioritize - I never feel confident in my choices or decisions and keep worrying I'm wasting my time on something that could be less-than-my-best-choice. I'm highly effeciency / result-oriented. Everything needs to work in the best possible way to ensure the maximization of my wellbeing and success. Needless to say, I'm a perfectionist/completionist.

People say to prioritize your wellbeing, and well even though I know rationally I need rest to continue performing in the long term, I always feel I'm slacking and/or could be doing more, and doing more better. It never feels good enough, and I'm afraid of looking back at my life with regret. Immediate perfection and mastery in all aspects isn't possible, yet it's what leads me to sabotage myself over and over.

How do I get out of this?

this is so relatable!

I used to have similar thought patterns and it took a lot of time and work to reshape this.

Here are some things that helped me and some clients I have worked with,

- I use the mantra rest is productive. if I am tired and pushing to get work done, I likely will make mistakes and it takes me a lot longer. if I give myself even a 15 minute break to walk around the block and get a snack, I come back to the task more energized, excited, creative, and will likely do the task better.

- Start small. Can you give yourself 30 seconds to yourself. then 1 minute. then 5 minutes. etc. we often jump head first into self care and try to take a full day off and then are in a guilt and shame spiral.

- learn and practice self compassion. kristen neff has 2 great books and a website that teaches gradual steps to overcome these "should" https://self-compassion.org/category/exercises/#exercises

Fellow therapist here. I work with folks with imposter syndrome, which tends to be work related.

Can you recommend any trainings or resources that have helped you conceptualize and treat burnout? Bonus points for the same about corporate culture and office politics.

unfortunately I havent found any great trainings since it isn't a diagnosis (yet). Most of my experience comes from my models such as narrative therapy and thinking about the systemic pressures we face and how we internalize them. I also read the latest research (sometimes) and learn more about moral injury, compassion fatigue, etc.

In terms of trainings, I do rec any self-compassion trainings from kristen neff, that works well with the imposter syndrome my clients have experienced.

How do i ask for an FMLA for this cause?

I've told my doctors that things are slipping away, and i need some time to work on my routine because I'm wasting my days.

It's not fair to myself or to my boss or to my friends/family.

I have actually filled out FMLA paperwork for clients before. FMLA tends to prefer if it comes from a medical doctor but I have gotten some approved for mental health reasons. I believe you just print out the forms or call them and ask them to complete them. it can be an annoying process but so worth it once it gets approved.

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Therapy can be a great tool to help with all those things! retirement is often a huge transition and time of stress so having a plan to make it meaningful is a helpful step. people find time with friends, hobbies, travel, try new things, etc. hope it works out and that you get to enjoy things!

Hi. What do you know about burnout in autistic people?
The reason I'm asking is that I've been suffering from autistic burnout for the past 2.5 years (at least) and recovery still seems a long way away.
If you'd like I'm open to any questions you may have in regards to my situation.

I personally have no training in working with autistic people. My program and license never allowed for me to assess and diagnose that BUT i have a wonderful colleague who has a great resource guide and may lead you to some stuff on burnout (I am 99 percent sure she has something on their about autism and burnout)
https://therapyforpetpeople.com/resources-for-neurodivergence

What do you think about sex between a client and therapist. Now I know what your taught, but I want your raw honest perception? Please 🙏

It is against our laws and ethics. There is a huge power dynamic between a therapist and client. A therapist knows so many intimate and personal details about clients whereas the client knows hardly anything about the therapist. To get into a relationship is taking advantage of that power.

Now, I know sometimes, in small towns or after time has passed, people justify it, but in my own ethics it is something I am against.

Does money alleviate burnout?

I have found with my clients that money doesnt typically cure burnout but it helps. It really depends on the cause of burnout. If your place is setting high expectations and not paying you your worth that can impact our mental health. If they are paying us for our time and showing value in the work that I do, that can be a protective factor for burnout.

I’m suffering from autism burnout. The grind of being mistreated and putting myself back together has left with little or no energy to do what I’m passionate about. I take rest periods but the burnt out state returns. Should I take a sabbatical from my long-term projects to heal?

breaks and vacations can be helpful but for some people if they are constantly mistreated when they return the burnout can come back. it may be helpful to take that time and figure out if there are changes or boundaries that need to be set to help you live the life you deserve and to be treated better

Hi, I am a therapist myself in progress. As therapist we are bound to get stressed and burnout due to our work. So how can we as therapists help ourselves during times like this? Also how can we deal with compassion fatigue associated with burnout?

This is my jam! I work a lot with other therapists on how to recover and prevent burnout so I will try to be consise!

Burnout is not inevitable in our field. Stress yes, but it doesnt have to be burnout. Our grad schools and community mental health agencies, and other workplaces may lead us to believe it is all part of the job but it is possible, and okay, for therapists to enjoy their work, take time for themselves, and get the support they deserve. this often comes with working in a supportive work environment (not typically CMH), having good pay, getting regular consultation or supervision, working with good fit clients, getting our own therapy, having hobbies and a life outside of our work, and more.

Are you tired of answering these yet?

no! I love talking about burnout and having these discussions. I need to take some breaks here and there mainly because my shoulders start hurting if I am in front of a screen too long but that happens regardless!

If you live in America, your purpose is to pay taxes and die. How do you distract people from this? Also are you medicated or just raw dogging the end of the world?

I think that is a limited way of looking at things and it doesn't align with how I view life or how my clients choose to view life. I believe in finding hobbies, experiencing joy, creating connection, and feeling good about oneself which makes life pretty great.

Okay now the second part. It is an AMA after all

not taking medications currently but very open to that for myself if I need that resource in the future and very supportive of people who take medications. I think I already answered the second part by saying that doesn't align with my worldview. I don't think about or worry about the end of the world and instead focus on the day to day by finding joy and connection. if that's how you want to word it for the sake of the internet, then go for it.

I have difficulty in sleeping on time despite feeling sleepy.I sleep at 3-4am in night. I am a student btw whenever i try to sleep in night. i start overthinking about future or my past mistakes starts kinda worrying about things like intrusive thoughts and also. I used to have anxiety attacks in first have of 2023 and it is fine now. Is it anxiety from which iam suffering now ? and what can i practice to overcome my demons ?

it is hard to diagnosis without all the info because so many diagnoses (and just life stuff) can look similar. Worry, intrusive thoughts, sleep changes, and overthinking are all signs of anxiety however. Some people also meet some symptoms of anxiety and doesnt mean they qualify for the diagnosis so just something to think about that what you're experiencing is very real but without a formal assessment you may or may not have a diagnosis.

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some things I recommend for folks with sleep stuff and overthinking are cognitive tools which direct our thoughts into thinking about specific things. for example, pick a category (such as food) then go through the alphabet and name a food for each letter.

another great tip is to practice 4-7-8 breathing which is inhale for 4 sec, hold fot 7, and then exhale 8.

if you want to get to the root of the overthinking and anxiety I do think therapy can be a helpful resource to change these patterns and think more helpful thoughts.

What do you think would be more stressful, fighting 1 horse sized duck, or 100 duck sized horses?

Seeing as I would be scared of fighting even 1 duck sized duck , 100 duck sized horses could easily outnumber me and take the win.

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I am not trained in ketamine treatment so I am not sure how the clinics are run. Sorry! I do more talk therapy with my clients.

If you were a hotdog and you were starving, would you eat yourself?

probs not but I think my cat would.

Thanks for the AMA!

I've reached out to at least 15 therapists over the last year (sometimes by email, sometimes by phone) and I haven't gotten a single reply. Are they all so full and busy that they can't even email me back at all? It's been extremely frustrating, as I am in desperate need of help with some anxiety issues.

I am so sorry this is happening! I sadly have seen this a lot. Here are some general things I notice

- if you are emailing, many times it goes to spam. I had a client email me and it went to spam and they thankfully have a good join with me and they were like wth did you see my email.

- If you are finding them from psychology today, people sadly don't update their info. When I myself looked for a therapist and used psych today I reached out to about 10 people and heard back from 1. they say they are accepting new clients but then they arent. super irritating.

- if they are a small business/solo provider, they may be too busy and not have great systems in place to attend to emails and calls.

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If you are comfortable, I have found the best luck searching in my local community facebook groups. people there are often more honest about if they have openings and are on the lookout for clients. or, look for folks who have self-scheduling consults because then they get an email from their system and it is on their calender. consults should be free and last about 15 minutes to go over any questions

Do you like country fried steak?

yup