When helping others for a living becomes traumatic, experts prescribe self-care

Social workers and therapists are there for others who are struggling. But what happens when those who give support start to feel burned out?

A therapist named Caryn, who asked that her last name not be used, recently noticed big changes in herself. She’s worked with tough cases, everything from abused children to patients with drug addictions.

“Before I always kind of prided myself as being pretty on top of things — I was pretty structured in my everyday life,” she said. “If I wanted to do something, I would do it.”

But then, after seeing the same patients come back through her program again and again, and not getting support from her job, Caryn began questioning what good was she doing. She said she felt stuck in a toxic cycle where she worked.

“It’s just kind of this whole systemic thing where I just started to feel like a cog in the wheel,” she said. “Just like the patients feel like they’re not getting adequate care. And the staff feel like they’re not getting adequate care from the people, the higher ups.

“And the higher ups are like, well we don’t have enough, and we need to remember that we’re trying to make a profit here.”

Soon, Caryn wasn’t sleeping well, even after taking an Ambien or some melatonin. Sometimes both. During her waking hours, she began feeling like she was on autopilot.

“I just started coming home every day, and just sitting on the couch, sometimes not even watching TV or reading,” she said. “I would just sit there, or I would start crying out of nowhere.”

A social worker named Joanna, who also didn’t want to use her last name, has a similar story.

“On days when I would come home, being burned out already, I would have to go to bed at 8 o’clock, because I just had nothing left,” she said.

She also struggled with feeling like she had to be “on” all the time.

“I wasn’t good at turning my phone off at 5 o’clock. I wasn’t good at seeing the phone ring and being able to just say if someone else is on call, they can handle it,” she said. “I would jump to, and I would let that encroach on my personal time, time that I could have spent doing self-care and taking care of myself.”

Both women expressed feeling so down that it was hard to think it could get better.

“I think for me, that not doing any kind of self-care, I couldn’t figure out what I needed, I didn’t try to ask for help,” said Joanna. “It was a really scary place to be in.”

“I think the hardest thing about burnout is that what you believe about the world has shifted — you become this very bitter person who thinks that the world is inherently evil and bad,” said Caryn.

Ravages of vicarious trauma

That’s one of the hallmarks of vicarious trauma, said Eda Kauffman, a field director at the master of social work program at Penn’s school of social policy and practice.

“If you’re listening to stories of trauma all day, every day, or you are exposed to communities where trauma is really front and center — after a while — the way the brain and the body works is you internalize some of … those experiences,” she said. “And you being to react as if you’ve been traumatized yourself.”

Kauffman, who prefers to talk about “compassion fatigue” more than burnout, said compassion fatigue isn’t something that can be cured with a relaxing trip to wine country. It carries a host of physical problems such as stomach issues, and insomnia.

“So, it really can, after a while, just be untenable, and either people kind of check out,” she said. “Sometimes they’re really smart, and they do leave their jobs. Other times, they just kind of power through it. And it looks like someone we think of as pretty jaded.”

Her advice to social workers is to think deeply about self-care — and she’s not talking about getting a manicure on a Sunday afternoon.

“I always say, ‘Listen, I am not going to be the person who’s going to stand up here and talk about bubble baths.'”

She talks about it in three ways: One, self-care related to a social worker’s personal life. Two, self-care related to the job. And three, self-care on the agency level, meaning, what is someone’s agency doing to promote an environment that avoids burnout?

“And what works best is when all three of those are working in conjunction with each other, so that maybe you’re kind of not taking great care of yourself for a while, that happens, but your agency provides an environment where it encourages you to take care of yourself,” Kauffman said.

Lara Krawchuk, who runs retreats for professionals in this field, is also a social worker. And she said that third area can be tricky.

“The big X-factor that we can’t control for is that organizations sometimes aren’t healthy, sometimes the budget means that the workload is overwhelming.”

She says health care in general has become increasingly stressful. Sometimes, her retreat offers vital solace for people to go back and do their work; sometimes, a retreat isn’t enough.

“Other people realize, I am in the wrong place, I need a change.”

Making changes

A year ago, Caryn decided she needed to get out.

“I was in such a bad mood that I was just scowling all day,” she remembered.

She started saving money gradually, and she recently handed in her resignation.

With time and distance, Caryn said she realized that she wants to take some time off and eventually transition to a more flexible role. She credits a supportive supervisor with helping her to figure that out.

As for Joanna, taking better care of herself has made a difference. Instead of bubble baths, she’s nourishing her creativity.

“Now I am in a writing group, I sing in my car, and, even if it doesn’t sound great, it feels amazing,” she said.

And she’s adopted stronger boundaries. She used to pick up her phone no matter what.

“In past years, I’ve managed that a little better. So the phone goes off. And, if someone calls, if they leave a voicemail, maybe I’ll listen, maybe I’ll let the triage staff know.”

Now, she said, it doesn’t have to fall just to her.