Work Burnout Series #2: Where does work burnout come from? Answers from a Massachusetts Depression Therapist

Work burnout can show up as not being able to handle work problems calmly, finding yourself not caring about your colleagues, or feeling emotionally numb. But what causes it?

I’m Bronwyn, counselor for depression and burnout. There can be any number of causes of burnout. In my experience, the root of workplace burnout often centers around not listening to your own limits and some form of moral distress. Burnout at work can be caused by both crossing your own boundaries and structural issues within your place of employment or field. 

Work Burnout from Crossing your own Boundaries

I used to work as a medical social worker with hospice. I carried a phone and laptop with me all the time. It was not uncommon for the social workers and nurses to keep their phone on after hours. Being in that kind of role lends itself to checking your email and phone a lot. The more you care, the harder it is to turn your phone off. There can be any number of reasons and rationales to justify your continued involvement. This kind of scenario can extend beyond the medical field too. The more you care, the harder it is to let it go. 

Don’t get me wrong. It doesn’t necessarily mean that you’re burned out if you keep your phone on you after hours. (It is important though to consider how your limit-crossing is affecting your patients. If you become ill or they have a need when you’re asleep, will they know how to function in the system of on call staff?) But although not turning off your phone at your shift end may not mean you’re burning out, it does present an example of the need to assess your own limits. Is checking your email getting in the way of the rest of your life? Are you resentful of the fact that you are tied to your work phone? Resentment is an excellent way to check your limits. If you’re resentful about it, you’ve crossed your own line. And crossing too many of your own lines at work for too long can definitely lead to work burnout. 

Everyone’s limits for work life balance are unique. You’re the only one who can figure out what works (and doesn’t work) for you. It’s time well spent though! If you’re not paying attention to your resentment and your boundaries, that can be a recipe for burnout. 

Workplace Burnout from Moral Distress

So back to the part about the part that your employer - or the system in general - can play in burnout. Wendy Molaska, MD, primary care physician, says in an interview with Linda Falkenstein, “Most people call it ‘burnout.’ I prefer the term ‘moral injury,’ because it implies that it’s the system that is broken — and I really believe our healthcare system is broken.” Dr. Molaska is one of many primary care physicians who have set up an alternative to this broken system. She is the founder and owner of Dedicated Family Care, a Direct Primary Care clinic in Madison, WI. The Direct Primary Care model allows her to practice medicine in a way that takes care of herself and her patients.

It’s not simply burnout if you’re working within a system that requires more of you than is healthy or possible to give. In healthcare, that leads to questionable patient care. If your own limits don’t fit within the system you’re working in, it could be that the job isn’t a good match. It could also be that the system needs to change.

For example, I worked with a hospice agency that put my caseload at around 30 patients. That was manageable. There was time to make visits without being rushed, most of the time. I had colleagues who worked for other agencies that put social work caseloads at 60-90 patients. You can’t give adequate care to 60-90 patients at a time within a hospice setting. That is an example of moral distress. As an employee, you are stuck between taking care of your patients and taking care of yourself. You not only risk causing your patients harm, but losing your job.

Work Burnout and Moral Distress: My Story

My own experience of burnout has elements of straight work burnout and moral distress. I worked in community mental health, at an agency that was comparatively better than most. I had a wonderful supervisor and great colleagues. I was paid even if my clients didn’t show up. However, I was required to see at least 25 clients each week. Some people will tell you that’s a fine number. For me it was too much and caused me to burn out.

Part of the reason I got burned out was that I’m Highly Sensitive and have the capacity to give good attention to about half the number of clients I was required to see. Part of the cause of my work burnout though, has to do with a healthcare system that is insurance based and not care based. What I have seen, with a few exceptions, is that it is not sustainable for a therapist to see 25 clients who have experienced complex trauma every week. Clinicians need space to process vicarious trauma. They need lots of time for consultation and for their own self care. Clients need clinicians that are getting the support they need. It’s not fair for anyone. That’s the element of moral distress. 

I quit my job with that agency because I moved, but at the time I thought I just wasn’t cut out to be a therapist. It took me a few years to realize it was possible to avoid burnout and still be a therapist. In my own private practice, I am in charge of how many clients I see and the ways that I support myself clinically. As a result, I love my job! It wasn’t being a therapist that burned me out. It was the agency setting that didn’t work for me. Now that I can set my own limits and stick to them, I’m no longer burned out.

Work Burnout: Your own experience

Where do you find yourself crossing your own limits at work? What would help you to keep those boundaries?

Are you experiencing moral distress at work? If so, what are some alternative models? Could you implement them in your place of work? Could you implement them on your own?

Would you like support in finding your way out of burnout?

About the Author

I’m a recovered burned out therapist who loves supporting people find their way out of burnout at work. Owner of Bronwyn Shiffer Psychotherapy, I’ve been interviewed on workplace burnout and conducted workshops for hospice staff to address burnout on the job.

In addition to depression counseling, I also provide anxiety therapy and HSP therapy. Based in Madison, WI, I provide online therapy in Boston and throughout Massachusetts, virtual therapy in Washington, DC and telehealth therapy anywhere in Wisconsin.