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I'm a therapist supporting more clients than ever before – and I'm burning out

Lately, after an emotionally-fraught session with a client, I’ve been finding myself switching off the computer and sitting in sudden silence, exhausted.

It’s a strange feeling when the same spot where you eat and go to bed is also where moments earlier you have been privy to a person’s bereavement and trauma.

As a private counsellor who also works in a GP surgery, I’m currently seeing 20-28 people every week. My client load has always been high, but that’s double what I’d see pre-pandemic, and I know people grappling with 35+.

I’m fast burning out, but the demand for therapy is only growing – and like a duck seemingly gliding in the water, beneath the surface I am frantically paddling to stay afloat.

Before lockdown, 1.4million people in the NHS had already been referred for therapy.

Then, when lockdown happened, we were thrust into working online and from home. Bit by bit, expenses went up and the income came down, thanks to extra training requirements, expensive encrypted software, insurance and supervision for online working.

Committed to staying available for patients in what was already a time of need, now multiplied by the sudden shift in circumstances, we rallied – but this wasn’t a simple transition.

There are privacy factors to consider that can impact confidentiality. These had to be ironed out to make it safe. You also can’t hand someone a tissue when they’re crying online, there are audio glitches and it’s difficult not being ‘present’ with the client in the room.

However, at the same time, online therapy has created a new kind of creativity, safety and emotional intimacy, which I found surprisingly powerful.

Some clients and patients took to it well, while others, understandably, were not able to do so: for those in difficult circumstances such as domestic abuse, the idea of having a session from home was impossible.

This was heartbreaking, as people I’d been supporting for several years suddenly disappeared, without an opportunity to say goodbye – such a crucial part of ending therapy – after all that hard work.

In one particularly difficult call, I watched as my client cried, trapped in lockdown unable to visit an elderly family member who’d been taken ill with Covid-19 in hospital – and I desperately wanted to offer some comfort beyond a screen, but I couldn’t.

While on other calls, I’d hear screaming children in rooms next door of frantic mothers and fathers who were desperately just trying to keep it together.

There is no choice but to keep it together – and despite the struggles, through it all, I’ve never failed to show up on time, nor forgotten any detail of my clients’ stories, even if just five minutes earlier I desperately wanted to cry, pull back the duvet covers and sleep.

Burnout, for me, feels like silently screaming into a void.

I’ll be alert and focused for each session, only to drop into a heap in a zombie-like slump at the end of an emotional day.

Sessions finish as late as 9pm, and then I’ll wake up at 3am, unable to fall back asleep, go for a three-hour walk at the crack of dawn and fall back in a heap before buoying myself up to continue.

I desperately need a rest and struggle to relax. 

Throughout lockdown, I’ve maintained my own network of necessary support: weekly personal therapy, three incredible clinical supervisors, and the amazing support from my peers. 

But, living alone, I have had few loved ones to talk to directly and for months, my clients were the only people I saw. I too have family members shielding. I too am not sure if life will ever be the same again.

The thing about therapy is you don’t get to slip up or take a day off without notice, because your actions have an impact, and one error in judgement can cause harm.

There is no choice but to keep it together – and despite the struggles, through it all, I’ve never failed to show up on time, nor forgotten any detail of my clients’ stories, even if just five minutes earlier I desperately wanted to cry, pull back the duvet covers and sleep.

As we transition out of lockdown, the surge in referrals is only set to increase.

According to the Office of National Statistics (ONS), the number of cases of depression during the pandemic has doubled from one in 10 to one in five, and 89% report feeling stressed or anxious.

Additionally, 42% of adults with depression said their relationships were impacted, while the domestic abuse charity, Refuge reported a 25% increase in calls since lockdown.

I am starting to get the impression that my profession is containing the chaos, but without any recognition or support.

During the time of Clap for Carers, how many were clapping for us?

We too were on a frontline where colleagues were dying and clients were falling apart, while services were stripped beneath. 

There is, piled on top of this, high expectation for therapists to offer lower cost (or free) therapy to key workers and NHS staff – without government funds to make up the difference.

The threat of looming redundancy has also meant I have adjusted fees for existing clients so they wouldn’t be left without help.

The mental health crisis in itself has been rightly recognised, but workers are not being thought about in the calls for more provision of service. If we’re not paid to provide our work, we will become defunct, too. 

And I know I’m not alone in burning out – fellow colleagues, I see you.

What’s got me through the last few months has been remembering why I chose this profession. I love my job and knowing I’m keeping people from falling apart is what keeps me going.

One client, who had spiralled, said they really appreciated our sessions and thanked me for helping them move on from a difficult chapter, which felt wonderful to hear.

Hopefully, as talk around mental health continues, it can start to include the helpers, too. Please, remember us.

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