Counselor Burnout with PD's

 I began this week’s post by thinking about something that all good counselors should be well aware of: counselor burnout. It’s a topic we discuss in supervision and in classes to ensure that we do not reach the point of burnout by making sure we are engaging in self-care activities and are not over extending ourselves so that we remain effective in our counseling relationships. And so we don’t go crazy. So, in thinking about counselor burnout, in my opinion, the number one type of client to ignite counselor burnout would easily be personality disordered clients. These clients have limited insight and often very limited behavioral controls, which makes it hard to incite change and even harder to set appropriate boundaries with clients who are often angry, intrusive, needy or emotional abusive to their counselor. So, with that in mind, I started researching (and by researching I mean googling) counselor burnout when working with people suffering from PD’s. What I found was actually very surprising and a bit disheartening. I started reading comments people had placed on an article talking about counselors “firing” their clients. These comments were almost exclusively posted by people that were self-proclaimed borderlines who did not understand why their therapists had dropped them. 

Many of the cases described involved the therapist cutting off communication abruptly and telling the client not to contact them again. Others described therapists who had tolerated their labile emotionality and angry outbursts for months, only to eventually tell the client they were referring them to a different therapist because they could not handle the behavior anymore. These types of clients went on to say they did not realize the emotionally abusive and angry outbursts they expressed when they were upset was not acceptable behavior until it was too late and they were being fired by the therapist because they couldn’t handle it anymore.

I found reading these comments to be eye opening to what a person with borderline personality disorder may feel during a termination of therapy. It seemed that before they were fired by the therapist they didn’t realize the way that they were behaving was inappropriate, and from what was described it seemed like many of the therapists did not set and maintain appropriate boundaries to begin with. 

This lack of clear rules and boundaries of what was and was not appropriate behavior in therapy led to the counselor feeling burnout and overwhelmed, which in term led to exasperating abandonment and rejection issues in the client through the termination of therapy. It is my feeling that counselors must take care to establish clear rules and boundaries from the start of therapy so that the client understands the expectations they are required to meet in order to continue the counseling relationship. Further, the counselor needs these rules and boundaries to be set in place to prevent burnout when dealing with emotionally volatile patients who are challenging to work with. Finally, it seemed that a lot of counselors terminating therapy were not clear as to the reasons why they felt this was necessary. However, this report is coming from the patient themselves so it may be that the therapists in these situations were being clear but not being heard. Even in that case, I think that makes it all the more vital to be explicitly clear when explaining why therapy is being terminated with a client with Borderline Personality disorder, if in fact termination is the only possible solution.

All in all, my point goes back to the importance of preventing counselor burnout not only for the counselor’s benefit, but also to ensure we are not harming our clients. I’ve included some articles below that details what burnout is, strategies to prevent it and ways to reverse it once you’ve realized too late that you are burned out.

Preventing Burnout 

Burnout in Mental Health Professionals 

Therapist Burnout 

And, as always, PJ was ever so helpful with this week's post. He contributed his thoughts from afar while lounging in his excessively manly zebra pet carrier.

Have a wonderful week!

Kim