Burnout Threshold

[foreverbull]

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Just curious for informal feedback, for those seeing clients for psychotherapy, what is your weekly limit for direct contact hours or hour-long sessions in your career, after which point you feel burnout or too drained?

Has this number changed since grad school? Any surprises? Does it vary by presenting concern or site?

Curious to see if this has changed for folks between grad school and career, and if so, how much factors like site, etc. make a difference.

 

[Spydra]

I'm very curious if this burnout limit changes based on the medium, meaning in person vs telepsych. I'm still a grad student but I noticed a huge difference in medium immediately. In person I was burnt after 2 clients a week and my caseload was 6 so that was a problem. With telepsych burnout hasn't happened and my caseload remained the same when we transitioned. They're the same clients too.

 

[mypointlesspov]

This is a really good question! I think it depends on the nature of the work. During my fourth year of my program, I had two 16 hour practica. One was at a hospital doing child welfare evals/trauma work and one was at a college counseling center. At the hospital, I averaged one evaluation per month with a caseload of five clients (who were inconsistent with attendance), but I felt far more burnt out than I did at the college counseling center where I had 11 individual clients and a group all of whom had high show rates.

During my internship year at a child welfare/trauma site, I carried one to two evaluations, a caseload of 17 individual clients, and a group (though that eventually fizzled) and I rarely felt burnt out. The primary difference between the two practica and the internship was the amount of support I felt from my supervisors. I've found that I rarely feel burnt out if I have good relationships with my supervisors and feel comfortable going to them with any issues. Transitioning to telehealth completely eradicated whatever little burnout I had toward the end of internship.

 

[WisNeuro]

I've only carried 1-2 therapy patients at a time for the better part of a decade at this point, I'm also curious as to what the burnout point would be now.

I did mostly PTSD work, with other anxiety disorders and DBT secondarily. I never really had a problem letting therapy work stay in the therapy room once the workday wad done. If anything, problems with bureaucracy/administration probably affects my levels of burnout far more than the clinical work does.

 

[summerbabe]

4-60 min sessions per day, 5 days per week is fine, especially if there's variety and/or interesting patients. I'm wired to be a generalist so I can't imagine being a VA PCT therapist doing 20+ CPT cases a week.

But push that to 5 sessions a day (or more) every workday and I'll start to slowly lose my ability to be as present as I can be during each appointment, feel more burdened by session prep, procrastinate on notes, and start to hope for no-shows.

 

[medium rare]

I see an average of 55 patients a week (~11/day) but I have a mix of 30-and 60-minute sessions each day. I don’t know how long I’ll continue this pace, but right now I do not feel ‘burn out’ at all and I love what I do. Personal threshold for burn out varies considerably (especially among therapists, I would say) and I do think it’s essential to continually and honestly monitor for burn out.

I do frequently feel drained at the end of the day but I view this differently than moving towards burn out. I engage in regular self-care and would like to think I would make necessary adjustments if burn out began to set in. I’ve also found regular consultation with colleagues to be invaluable. On a typical day for me, I’ve usually left work behind by the time I finish the drive home.

 

[AcronymAllergy]

I'll be interested to see how this ultimately comes out as well, although I don't know if it'll change much from where the results are now. I believe the workload expectation at our clinic for outpatient MH psychotherapy staff is the equivalent about 6 60-minute appointments/day.

Edit: And just for the fun of it to give an assessment perspective, I could see 4 to 5 outpatient neuropsych evals/week (without a psychometrist), along with the same number of feedback sessions and a few intake interviews, without feeling burnt out. Anything more than that and I'd want testing support (I'd also want to be paid more).

 

[Ollie123]

Tough for me to answer since I am only in clinic 1 day a week. I can do 8 sessions in a day without breaking a sweat at this point and routinely do. World's better than trying to do a few sessions every day since then I just feel scattered. Might be different if I was seeing 8 patients 5 days/week, but might not. I do need a little time to recharge after, but a car ride home would be enough in normal times.

I also very admittedly do not see the most intense populations. I would struggle tremendously seeing that much BPD, for example. Actually, I would just stop seeing patients altogether if anyone tried to make me. Really any extremely high-acuity population can (at least for me) make one patient feel like 5 because of all the additional energy that goes into case management, managing risk, etc.. The usual depression, anxiety, adjustment dx, mild-moderate SUD, etc.? No problem.

 

[cara susanna]

I've learned that 6 per day (5 day work week) is my limit, and that feels like I'm pushing it. 4-5 is ideal. I should add though that I try to keep sessions around 45 min max so I have 15 min for notes and admin afterwards, unless they're prolonged exposure obviously.

 

[Sanman]

5 intakes or 9 full psychotherapy sessions per day is about my limit. More if I am doing 90832 sessions.

 

[deleted343839]

For me, burnout has little to do with patients themselves and more to do with operational/administrative stuff outside my control. I don't work in a "mental health" setting so my schedule and workflow is different than most of the providers around me, and that contributes to some of the issues. Volume-wise, I'm good with up to 7 patients on a clinic day, but I don't see patients every day. Telehealth has made things harder because some basic clerical tasks have been shifted onto my plate.

 

[PsychPhDone]

For me, burnout has little to do with patients themselves and more to do with operational/administrative stuff outside my control. I don't work in a "mental health" setting so my schedule and workflow is different than most of the providers around me, and that contributes to some of the issues. Volume-wise, I'm good with up to 7 patients on a clinic day, but I don't see patients every day. Telehealth has made things harder because some basic clerical tasks have been shifted onto my plate.

SAME
also in general, like others have said, burnout varies dramatically depending on setting. I really enjoyed inpatient rehab psych and felt much less burnt out doing that than other settings (including college counseling). So...wide variability here.

 

[Sanman]

For me, burnout has little to do with patients themselves and more to do with operational/administrative stuff outside my control. I don't work in a "mental health" setting so my schedule and workflow is different than most of the providers around me, and that contributes to some of the issues. Volume-wise, I'm good with up to 7 patients on a clinic day, but I don't see patients every day. Telehealth has made things harder because some basic clerical tasks have been shifted onto my plate.

Agreed to a point, the match between specialty and patient matters too. Bread and butter gero issues no problem. Throw me an OCD patient or something I haven't seen in a while and the mental stress is higher. Operational stuff can really drive you nuts as well.

 

[cara susanna]

Good point. I notice I'm a lot happier when I'm working within my specialty. Also I've noticed my burnout increases with "legacy" patients that aren't really doing treatment, or patients that require a lot of management.

 

[PsyDr]

I think it's important to note that there is a significant difference between feeling drained and being burnt out.

 

[beginner2011]

I think it's important to note that there is a significant difference between feeling drained and being burnt out.

I agree. In my experience there's a qualitative difference between burn out and work load. They're related, but there are other factors that contribute a larger portion of the variance, so to speak. E.g., administrative burden, perceived competence, patient severity, etc.

 

[borne_before]

My burnout is related to admin bull crap and the number of times we don't have an in person interpreter because cyracom sucks.