The website STAT, which focuses on news in health care, published an editorial last month under the headline, “Physicians aren’t burning out. They’re suffering from moral injury.” Almost all of its conclusions appear fully applicable to psychotherapists as well. Could it be that we’ve been talking about therapist burnout from the wrong framework?
Early on, authors Simon Talbot and Wendy Dean point out that the concept of burnout does not resonate well with physicians. “It suggests a failure of resourcefulness and resilience, traits that most physicians have finely honed during decades of intense training and demanding work,” they write. The training and work of being a therapist may not rise to the levels that physicians face, but they certainly are intense and demanding. Particularly for those therapists working in community mental health.
The authors then go on to describe what they mean by moral injury, a term first used to describe one impact of war on the soldiers within it. The concept of moral injury holds that when someone commits, witnesses, or fails to prevent actions that violate their own morals, their very identity is shaken. This can impact how they relate to the larger community and society around them.
This is something many therapists experience regularly. Sometimes it is inherent to the shortcomings of our own roles; we can’t be everything to our clients. Perhaps more often, we experience moral injury when, through our clinical work, we bear witness to the systemic failures and injustices that just break people. (If you can ignore its more ham-fisted elements, this poem offers some examples.)
Talbot and Dean go on to talk about the various economic pressures that impact physicians’ work. This may be where the parallel for most therapists grows weaker. But their discussion of how new professionals enter the field is likely to be especially resonant for therapists:
“Most [therapists] enter [therapy] following a calling rather than a career path. They go into the field with a desire to help people. Many approach it with almost religious zeal, enduring lost sleep, lost years of young adulthood, huge opportunity costs, family strain, financial instability, disregard for personal health, and a multitude of other challenges.”
Well, we can safely say that a lot of therapists experience the field as more of a calling than a career. We know many therapists come to this field to help people. We know the process of achieving licensure is time-consuming, results in crushing levels of debt, leads therapists to put off getting married, and does indeed present a multitude of other challenges. But the most important takeaway here is that the entire concept of burnout — like the concept of self-care — inherently places the blame for the impacts of a broken mental health care system on the people doing their best to work within it.
To borrow Talbot and Dean’s words, therapists “are smart, tough, durable, resourceful people. If there was a way to MacGyver themselves out of this situation by working harder, smarter, or differently, they would have done it already.”
We pay a high price to work in this field, not just in strict financial terms. It’s time to reject the notion that mental health professionals are to blame for their own suffering.