You bring everything you have to your client sessions. But the fact of the matter is that some clients simply will not make the progress you so desire or even get worse.
This post is all about how the practice of gratitude counteracts therapist burnout and fatigue. The morale-dampening effects of experiencing clients’ deep suffering and lack of progress are realities we must all face. We can explore how gratitude may be a salve to this humanistic injury.
Our training doesn’t emotionally prepare us for lack of therapeutic progress
Most of us aren’t really trained to think in this way because it reveals a very hard truth. Despite our every effort, some people will not change their lives for the better under our watch. All our years of training, consultation, and skills-building may still not do the job we expect and hope.
In fact, some clients may even get much worse.
What do we do about this harsh reality? How do we prevent burnout or hopelessness when the very aspiration of our profession is called into question over and over again?
Take the example of a car mechanic who has trained for years and has really honed his craft. Let’s assume that the mechanic diagnoses and works on 80 cars per month.
How would it feel to the mechanic if every month he couldn’t adequately or accurately diagnose 40 of those cars. The cars are just too complicated or have a long-standing and complex history of difficulties. Or perhaps the mechanic hasn’t seen enough of certain types of cars to be considered a “true expert”.
And how would he feel if after running a series of diagnostics, he then labored away for days on several cars only to have the owners show up again and again. They would complain about the same problem but sometimes bring up entirely new issues.
Of course, human beings are not cars, and as therapists we are not interacting with static, inanimate objects. But if you put yourself in the mechanic’s shoes, you might feel pretty disillusioned pretty quickly unless you had a meaningful way to cope with the success rate alluded to above.
Gratitude counteracts therapist burnout and fatigue: A simple solution to a complex problem
Fortunately, we don’t have to look for very complicated solutions to a complicated problem. Part of the solution is already within our grasp – it’s all about the attitude and the act of gratitude.
I’m not suggesting, however, that gratitude “cures” all experience of emotional fatigue or hopelessness from a severely challenging case.
I am suggesting though that gratitude, in its various forms, can serve as a way to help transform hopelessness and disillusionment into appreciation for what is, what has been, and what could be.
Finding even the smallest of nuanced aspects of our work for which to be grateful is one key to preventing burnout and cultivating wellness. (One of the handful of successful programs on burnout prevention incorporates this very principle and practice.)
But how do we do this when our work can be so demanding and thankless?
Start where gratitude already flows
It’s far too easy for us to find our minds focusing on what isn’t going well or where we feel our competence is lacking.
So start with what is going well. For which clients can you easily feel warmth? Start with the therapeutic progress that is easily observed. What do you already feel competent doing?
Practice gratitude for the grind and the tough stuff
How do we muster the energy of gratitude when therapeutic progress is non-existent or when we are simply frustrated with a client or the way that client relates to us?
In these cases, you don’t have to force it. However, you likely are able to find, when you step back and really reflect, some elements of the therapeutic work on which you can shine a light of appreciation.
Maybe you can be grateful for how you handled client anger directed toward you or rode the waves of very intense emotion along with your client.
Integrate Gratitude into Everyday Practice
“Doing gratitude” would involve consciously and intentionally directing your mind to these positive elements and expressing your genuine appreciation.
- You could do this in between sessions or on your commute home. You could do this right before you see a client. Or by internally expressing gratitude in the middle of a session, you may mindfully notice your client’s new insights or positive behavior change.
- Keeping the gratitude active, alive, and fairly consistent are guiding principles that can help us reap the maximum benefits from a gratitude practice. In fact, calling it a gratitude practice can indeed increase our ability to manifest something that can too often remain latent and under-utilized.
(Lest we feel that this is yet another thing to accomplish or another form of self-care or burnout prevention that we must do, rest assured that it’s not necessary to practice gratitude 24/7 or with every single client at all times. Gratitude can be practiced a few times a week or every other day. We are much less likely then to “burn out” on gratitude practice. How ironic would that be?)
- If you gravitate toward writing things down, then jot down 3 things for which you are grateful about a particular client or two. Doing this “often enough” will likely help you see the value in this brief practice.
- If you would rather hear your own voice actually utter the sentiments of gratitude, pull out a small digital recorder or use your smart phone voice memo app. (Just be sure to de-identify the clinical information for ethical purposes – you could say something like “I’m so thrilled and honored that she finally made that phone call to her father. She found it so hard for so long. What a huge step.”)
Monitoring the Effects of Your Practice
Although we often are (or at least feel) too busy to even do a gratitude practice during our hectic workdays, tracking the effects of your practice can be a very valuable and worthwhile endeavor. But don’t overload yourself – just experiment.
So see if you might record how often you practice gratitude along with how you feel about work and your clients. You could even make/take a make-shift Maslach Burnout Inventory and rate yourself at regular intervals on a 5-point scale for each of three domains of burnout. They are emotional exhaustion, depersonalization (i.e., unfeeling, impersonal response to those you serve), and personal accomplishment (i.e., feelings of incompetence and lack of achievement).
Good luck with your gratitude practice!
I’d love to hear to how it’s going, so please drop a comment below. Your fellow therapists will benefit from knowing what positive effect gratitude practice might be having on you and your practice.
Be well,
Matt
Thanks Matt, gratitude is definitely a great tool and one that I practice.
For me another great tool is acceptance, accepting I can’t fix everybody, that I am just human, and just as we usually say “stay with what the client brings/feels”, we must follow our own advice and stay with and accept what we feel when we are unable to “fix” a client.
I appreciate this comment about going with what we bring just as we do with the pts. I also like the reminder to practice gratitude. I wrote my dissertation on positive psychology so I know better but I have not been diligent about cultivating gratitude. Thank you for the link with burnout too. I’m going to start a gratitude journal by August 1st and include the good things happening in my psychology practice. What an idea to include successes and evidence of my own competence because that will help with reducing detachment and nurturing empathy for the pts I work with too. I like that. Thanks Matt.
Hi Jason,
Your comments are much appreciated. Yes, putting into practice these principles is so tough sometimes. Making that commitment and deadline is super useful. Good luck to you with this. I also found that having a “practice buddy” can also work wonders. I did this a few years ago with 2 collegaues practicing Loving-Kindness and gratitude. We emailed each other once a week and shared our gratitude and loving-kindness expressions. I definitely noticed a change in my happiness level after several weeks. Did I continue with that practice? Nope. Why? Not sure.
But I think we very often need “recommitment ceremonies” to establish once again the deeper reasons we are doing something for ourselves.
All my best to you!
Yes indeed, Paloma. Acceptance, I think, is the steady companion of gratitude. I appreciate your sentiments about knowing when we can’t or shouldn’t “fix” and either just be or realize that that part of our client’s thinking, feeling, or behavior is not within our reach, etc. lots of metaphors to conjure up, I’m sure 🙂
You’ve inspired me to write more about the pairing of acceptance and gratitude. I actually think that sometimes deep acceptance must precede meaningful gratitude – the “coming to terms with what is” can perhaps better allow us to open to what we can then appreciate about what is.
Thank you!
I believe that a little gratitude every day becomes a productive and reassuring habit with enough practice. Even tho’ I have
been a therapist for more than 30 yrs. I am still pleasantly surprised when a client says something like: you know, I just
realized that I am not feeling frozen and scared like I used to and I even accepted a hug from someone yesterday without discounting it in my mind, or even worse, outloud! It certainly isn’t a habit yet for a client in that stage of recovery from their life thus far to have a developed practice of gratitude and yet I know it’s a budding practice! So, thank you Matt, for inspiring us to share our ideas about a very relevant aspect of healing and becoming whole.
Hi Martha,
Thanks for your comment! It’s so wonderful to see such progress in a client’s life, and both therapist and client alike can practice gratitude (together or of course independently) for this movement forward – even if it doesn’t look like progress to someone from the outside. We know it is.
Best to you!
After working w severely abused and neglected children and teens for the better part of 15 years… I was so grateful for having the relationships that could promote some insight, maybe healing in some kids. However, what I found was the entire lack of empathy, gratitude, or even sometimes a lack of friendliness that permeates the ‘work environment’… My experience was that the ‘adult’ side of things was far more ‘7th grade’ than my 7th graders. I wish someone would teach a class on ‘office politics’. This is the part of the job that almost killed me. There was no recognition for managers of the severity of the fragmentation of the children and the therapists’ sense of hopelessness.
Hi J B,
Thank you for your comment! Sounds like from very challenging work that, when viewed individually, could be perceived and felt with a good deal of gratitude at times. Yes, the work environment and the lack of recognition, acknowledge, empathy, gratitude, etc. can make things exponentially worse and be a true source of burnout. It isolates, it activates our sympathetic nervous system and/or can trigger us to shut down or turn away. I think this is, in part, exactly what Maslach highlights in her Burnout model – it’s the exhaustion, the detachment, the perceived incompetence we can start to feel when our environment does not meet our needs. In your case, it sounds quite egregious. I wish there was mandatory training on office politics and rules of engagement in these settings. It’s absolutely crucial. I’m sorry for that part of your experience. I wish you all the best moving forward.
Thanks for the reminder Matt. This is a lovely way for me to start my observations. A text from an exhausted and overwhelmed client the day after her first session. To think that she found the time and energy to send this message is amazing.
“Hi Dorothy. I just wanted to say thankyou so much again for yesterday! I felt so relaxed and peaceful afterwards and felt like that for most of the day too! xx “
Thanks for your comment, Dorothy. That is indeed a lovely sentiment expressed by your client and something to take in and savor for you, the therapist. It’s awesome to have those moments of gratitude from clients and then to reflect on our work with gratitude, even for a few moments at a time. Thanks again!