A recent study has found that repetitive Transcranial Magnetic Stimulation (rTMS) is effective in treating depression. The results showed that the majority of patients experienced a significant reduction in symptoms, with some even achieving complete remission. Read More.


Nurses, doctors, teachers–all of us in the helping professions are facing a crisis. What do we do? How do we maintain the fire to help people without being taken advantage of or needing to be helped ourselves? Lisa returns to the show with a full list of resources from Carve your Own Path so we can live and thrive between the extremes of martyrdom and self-indulgence. Transcript below.


Welcome to the Ascend Health show I’m your host Nick Angelis I’m one of the owners of AscendHealth Center and I’m here with Lisa Schaefer LSW LICDC RYT they get all of them yeah well welcome back to the show thank you it’s great to be here so last time we talked about yoga we talked about addiction and this time I want to take another approach of talking about burnout because often in mental health it seems that there’s almost two populations one is the people who are really suffering they have difficulty holding down a job there’s some addiction issues sometimes and on the other end uh sometimes the snide term is the worried well or it’s uh sometimes first world problems but at the same time it’s still legitimate issues so I want to talk about how we can prevent burnout and how it can still be successful in life without burning out

yeah I think that’s a million dollar question actually that all of us are trying to figure out it’s like the things that you didn’t know what adulting was really like when you were 16 17 wanting to be independent and on your own and now um you know holding down a job maintaining you know either marriage or um parenting responsibilities in in addition to you know cooking dinner taking the kids to the soccer game and then at the end of the day it’s you know kind of rinse and repeat and a lot of people aren’t taking time to breathe or even get in solidarity time you know where they can read a book listen to a podcast take a bubble bath or you know just have some time for themselves right well that makes a lot of sense

I think there’s I just listened to this the other day there’s a song by Weird Al called first world problems and it highlights all of these and I think that’s sometimes the issue is is it fair to say oh well other people have it much worse or is it like no this is my problem right now because we know both of us being in mental health now for quite some time that there are some patients where we do have to tell them like nope this isn’t that big of a deal not in an invalidating way but just okay we’ve talked about this we’ve processed processed it now it’s time to move on to the next issue but I guess finding that boundary of like when do we say okay we really need to deal with this and make sure it’s complete and when do we just say no I think this is fine we’ll just have to talk about other things

yeah I kind of what comes to mind is just this morning I was looking at you know the dirty dishes in the sink and you know kind of feeling like oh I you know this is another task that I need to do and you know needing to come back to that but remembering why are there dirty dishes is because I was social it was because I was out connecting with nature in these last beautiful days that we have here in you know the fall and so you know what is that trade-off and so you know sometimes you know that trade-off is to pour into our cup and some of those responsibilities get kind of left behind but we shouldn’t feel bad about that right so sort of deciding like in this case people need to come first and in some cases tasks need to come first

yeah that makes sense so to stay healthy you’re saying the first thing is to prioritize okay in this case I need to hold myself accountable but maybe the example I I wrote you an example for email is I feel a lot of times because I did this too so I had a corporate wellness company still do called behave wellness and there’s a lot of you really need to take mental health days you need to take care of yourself and now I’m an employer so every so often I tell people no you need to come to work actually so the the example I thought of is let’s say you’re invited to a wedding and that morning you’re like you know what I’m not really feeling it I’m not mentally feeling up to going to this wedding today well they already paid for your meal so just not showing up and also this is interesting because I think this poster behind us is going to collapse on us at any moment which is also very exciting so how do how would you do something like that is it more of you just leave a message and leave a gift or is that like no I really need to put myself first and because that is our culture you know put myself first what are my needs yeah I think that those kinds of showing up um examples are how do you how well do you know the person are they you know somebody who would be open to hopefully they would be open to hearing like you know today I am emotionally not able to you know commit to something um and if they’re not open to that then you know kind of looking at the boundaries within that relationship that you know you’re going to ask for something that you need for your mental health for your well-being and someone’s going to tell you no right so it might be something where you’d make it right for example like hey here’s a nice wedding gift as opposed to sorry I couldn’t adult today okay that makes sense so so then there’s almost like a middle ground between being self-indulgent and irresponsible or also working ourselves to death to you know be everything to everyone and and even you know kind of going with the wedding example um maybe you don’t go to the ceremony and you only go for an hour or two to the reception and so you work those boundaries in where you’re not staying for maybe the six to eight hours of the full activities but you are giving yourself like a sliver of That Pie as opposed to feeling as though you have to be present for all of those things okay so what you’re saying is sometimes the key is to just not be a perfectionist where um and honestly I don’t struggle with this at all I’m often like oh I did this thing it’s great let’s do it uh like the show for example but for many people it’s like no unless I can’t do it exactly right I’m not going to do it at all so you’re saying there is a middle ground where we give ourselves a Grace yeah and you know again those boundaries um are time time is mental health time is money and so you know if you’re saying you know I’m not able to expend this amount then what are you able to afford so if I can’t afford a hundred dollar pair of shoes you know what can I afford that’s still going to get me my needs met so maybe that’s a 20 pair or a thirty dollar pair you know if I can’t spend eight hours doing something socially can I do something that’s two hours right so on the one hand we’re not perfectionist with our time or what we’re able to do but on the other it’s um and I know this whole episode is a little bit about finding that middle ground so there’ll be a lot of examples back and forth so maybe uh okay so these are my new tennis shoes because we talked about shoes and in order to keep them nice I should take care of them maybe not run through the mud maybe wash them maybe not use them for ridiculous things if I have other pairs of shoes that are better for cutting the grass so on the one hand we’re not being perfectionist we’re not putting all of our effort into something and doing it completely we’re okay if it’s not perfect but on the other hand we’re also taking care of what we have because and I’m kind of preaching to myself right now because time is money and a lot of things it’s not as easy as oh I’ll just replace this once I wear it out I’m cooking a lot today already yeah and you know one of my favorite people brene Brown um and so if you know me you know that um I like to quote her um you know she talks about you know having a 10-day or having an eight day instead of a 10 day you know we lose the ability to be vulnerable when we’re seeking and working out of perfectionism because we don’t allow ourselves to have mistakes we don’t allow other people to have mistakes and where’s the grace and humanity and that because we are imperfect people right so it’s almost circling back to the burnout idea it’s almost like many of us have this noble cause like for the two of us it’s mental health like we need to help the city of Akron and the surrounding areas to be better to have better mental health but that burden to have that noble cause itself can sometimes cause burnout because we’ll say well no this is really important people are relying on me I must do this I must save the day yeah and I think you know as being professionals um you know I don’t know about you but I I know there have been times where I’ve canceled the doctor appointment because you know I needed to meet this deadline or meet with this client um do a report where then it goes months before I make that appointment again and so again it’s it’s finding that balance you know how can we work around maybe it’s you take that time out during the day but then you work an hour later or maybe you talk to you know whoever is on the receiving end of that responsibility and say Hey you know this is something I need to do so that I’m well so that I can show up and be here and I think for me what helps too is when I captivated by this noble cause I have to think well how does this make me feel does it make me feel fulfilled does it make me feel important and if so maybe it’s not all about that person or that need anyways uh for example hopefully none of them will watch this so I’ve worked a lot of anesthesia places and I like the feeling of Nick your only hope can you come in and provide anesthesia for these poor patients why yes I’ll change my schedule and I’ll come to the rescue with my red cape flowing behind me and everything will be great then I realize no this is causing chaos in my clinic everywhere else in my life and it just means that they need to be more responsible and figure out their Staffing yeah yeah and so it came to the point where I was like nope you’ll have to shut down this place for the day I already have a plan and I can’t help you at all which was hard for me which it shouldn’t be at all because you know Ascend Health Center that’s what I do that should be my main priority but somehow I noticed no I’m trying to save everybody and we all have limits of what we can do and it’s prideful to thinkable no one can do this without the great power of the Nick Angeles one’s like nope they just need a warm body with a master’s in nursing that can do anesthesia and if they can’t find that that’s not on me I think what you said there was really powerful because no is a complete sentence and I know I teach uh you know people that I work with that know is a complete sentence and we don’t need to justify and we don’t need to rationalize with people why we can’t you know meet their requests or demands at times and we need to practice that as well that you know we can’t be everywhere all the time so can that actually be part of the therapy where a client or a patient really wants you to do something and part of the lesson that you’re working on is actually the boundaries and being okay with not getting your way and sometimes you really need something and you still can’t get it yeah that makes sense that is something that we try in our office to talk about that we don’t want to undo the work of the therapist by uh making exceptions in cases where nope these are the rules in your degree to them so but how do you do that without patronizing either like we still want to again this whole burnout thing today is about if we’re trying to do these great things or we’re trying to have professional careers um how can you do that without being patronizing or almost treating someone like a child I think for our field one of the wonderful things that we have is supervision so that we can bounce ideas off of other people and so we have this Collective community of therapists or people within your agency that you can um get different ways different interventions different approaches that might help and so again the the answer isn’t solely going to come only from you where we’re able to tap into resources so then maybe we’re not patronizing someone and we’re able to say hey I don’t always have the answer but you know Nick does and so I’m going to go talk to Nick and see what Nick might say about this and then you may or may not have an idea but I I guaranteed if you’re sitting in a room with four or five people somebody’s going to have a different approach just because we all come from different walks of life and that probably works really well for that humbleness that I was talking about that because you will burn out if we make healing the world our personal specific responsibility by talking to others we can get a sense of like no because that’s how I figured out that I was trying to save the world unless people are telling me like do you really need to go drive an hour just to rescue them because they couldn’t figure out their Staffing and I realized oh like this is me wanting to show up and be the hero this is not me wanting to help all these people that need my help so in talking to someone else you can kind of replace the ego and look at it more objectively yeah yeah that was super good timing as the ego fell

um yeah and you know I think in terms of burnout where there isn’t the ability the availability to talk about like your feelings you know if you don’t have a supervisor that you can go to or a community that you can go to where they can validate and even um empathize with the experiences you know especially when we when we as therapists you know run into clients who might not be in an active stage of change where there may be more in those first steps where they’re kind of thinking about wanting to make some changes and they’re at least showing up and they’re expressing about motivation but they’re not really doing the steps yet and sometimes when you work with people who are kind of in that Perpetual stage that can be overwhelming and lead to burnout as well because it’s like well I’ve thrown everything you know known to man at this person as far as resources and ideas and nothing is sticking or nothing is working and so then imposter syndrome can kind of come into when we’re feeling burnt out because we’re not meeting our needs so that makes sense so you’re saying if we’re ministering to somebody and pouring in all the knowledge and wisdom we have and they’re not better sometimes it can and you know a lot of the back of my mind is Nurses since you know I’m a nurse anesthetist but still nurse burnout is a huge topic even in regular news right now and if you’re doing all this work and so it’s still not getting better if you’re not careful instead of what can I do to make them better it might become something like well this is reflecting poorly on me they must get better um in anesthesia the example is doing a spinal anesthetic where you’re sticking a needle in the back and trying to get the exact spot so that you can do anesthesia that way and I’m usually not stubborn at all I’ll try it once or twice like this doesn’t seem easy you know there’s four other ways we can do this anesthesia let’s do it that way but I’ve been in other cases where someone just was like no I can get this it’s like no there’s plenty of other options and um I think part of it is if we’re like well maybe I’m not great at for this patient maybe I don’t have the skills necessary that’s okay let’s move on and figure out what we can do for them as opposed to like no we we must be on the same page and we must make this happen yeah yeah we are not I think you had said earlier you know coming in with the cape you know we’re not the heroes especially for clients with mental health um they are the experts of their own life right and um just to be a resource is my goal and my you know position so you know that can kind of help lead um to less burnout or compassion fatigue because it’s not my responsibility to make them change it’s to show them what opportunities there are for a change and then looking at you know the pros and cons of all behavior and obviously this isn’t just for those of us in healthcare what I’m trying to get at is those those who have any responsibility so maybe your kids aren’t acting right or why are my employees not doing this way so maybe part of it then would be well talk to them about it see what their goals are make sure those goals are aligned because uh some people they’re like no I just want to feel a little better and I want to put in whatever effort will lead me to feeling a little better and then I’m fine and then other people might say no actually I need to be 100 better and I want to put all the effort that it’ll take to get there and then that way by speaking with the patient or the parent or the family member or whoever it is you can kind of align and say okay here’s what’s the realistic goal is here’s what we can accomplish together and here’s what we can’t and that I think that kind of takes care of the huge amount of time that it sometimes takes to realize Oh wait we’re not even going in the same path that we don’t have the same idea of what we want to do yeah because I have my needs and you have your needs and we come to those needs based on all of the things that make us who we are as individuals and we could be saying the same thing but not using the same words and having miscommunication and feeling unseen and unheard but if we stopped and had a moment you know we would be able to see that we’re trying to have achieved the same goal right yes I know for me personally like I don’t mind discomfort I kind of enjoy chaos and hardship so you know I was saving up a lot of money for retirement and I realized well I actually need to save a lot less money than most people because if I ended up somewhere where I’d really save my money the last 10 years of my life I kind of enjoy it to be honest so I don’t need to think of this like well let me make sure my lifestyle never changes well other people they know that even though they’ve of course taken to Heart what we’ve said about perfectionism they’ll still they’re still prone to wanting everything in order so they have to kind of take care to make sure that they take care of themselves almost like the idea of you know the nick of today really needs to be good to the nick of two weeks from now when he signed him up for overtime or told him he was going to do all these things which is a really strange joke I use all the time for myself yeah and you know that’s kind of like one day at a time kind of mentality of you know just doing what I need to do today and as long as I’m able to meet my needs today then tomorrow we’ll figure itself out so what do you do yourself because obviously you’re a full-time mental health therapist you do the yoga being a licensed independent chemical dependency counselor you’re doing a lot of stuff yeah so your secrets my secret we won’t tell anyone this is just me and you um for me that’s really important is my sleep schedule first and foremost I’m pretty um concrete on you know what time I go to bed and you know I have an alarm set my Fitbit to tell me you know hey it’s time to start to get ready for bed and then I do you know my nighttime routine and 9.999 times out of 10 I’m in bed at 10 o’clock you know and you know Friday Saturday it doesn’t matter um and I keep that you know scheduled because for me um without sleep the train can come off the rails very easily um and so you know kind of doing some of those small things that are within our control so really kind of being mindful of how much social media I’m on in recognizing that oh I wanted to go to bed at this time but maybe I was scrolling on my phone and then missed that time frame um so really kind of giving myself Grace when that does happen but trying to implement different habits so that doesn’t happen um and you know just being really consistent with that another thing is you know just moving my body and it doesn’t necessarily have to be like a full-on you know high intensity workout but maybe it’s a 30 minute walk around the block with my dogs maybe it’s you know an hour yoga class but as long as I’m able to kind of move energy in my body every day that makes sense so what you’re saying is you don’t have to okay where’s my Lululemon outfit and wait is it time for the live stream of this like you just do something simple so sometimes it may help you to okay here is the yoga class I’m doing or here’s a specific movement that’ll help and other times like nope I just have time to walk around the block and that’s all I’ll be doing yep so again you’re not putting these huge expectations on yourself where oh I better do all this self-care so I don’t burn out let me make my list of exceptional self-care activities yeah since that itself can be its own weird cycle and something that I’ve been more attuned to lately is tapping into my creative side you know we really kind of lose that momentum out of childhood and as an adult if I’m on a zoom call um lately I’ve been cracking out my coloring book and coloring you know mandalas while I’m on a zoom call that maybe you don’t need my eye contact for um and uh painting or crafting after hours I’ve been kind of organizing my craft room and so you know kind of looking at how creativity can also be a way to pour out emotions that we’re feeling but also a way to kind of fill our cup that makes a lot of sense in our clinic since we do the ketamine infusions and the sprovado which is similar we start having adult coloring books and journals it sounds strange like well this is a treatment that dissociates your mind helps create new connections to beat depression like why do you also need to color but we notice well no if we’re stimulating the creative parts of the brain if we’re having to dissociate in novel ways that are helpful instead of just so maybe I’m almost off my treatment but they want to make it home yet so I’ll just flip through my phone then it starts habits and new patterns for the brain of like no when I need a moment it’s good to recognize first that we need a moment but then I can do something that isn’t seeing you know what my best friend from high school is doing on the internet these days or something that isn’t really going to help me or do anything other than give my brain some static so that I don’t have to think about my life right now so that’s great and then so at Karma path you still do the yoga and the mental health what else do you all do for that sort of professionals avoiding burnout um so we have art and mindfulness workshops with our art therapist Jenna um savago and I do Reiki workshops and I offer one-on-one Reiki as well which is a really great way to tap into energy healing and moving around that stuck you’re feeling yeah an Ascend Health Center we have therapists Psychiatry we do TMS or transcranial magnetic stimulation it’s a drugless way to work through depression and anxiety and then we do ketamine treatments and supervato as well and these are all sort of Alternatives too well I’ll just take some Zoloft and then I’ll get through my day but I think to summarize what we’ve been talking about the first step isn’t well let me quickly go to the doctor let me get a medicine for this or let me add one more thing to my plate it is to slow down find out which of which of these things is because of my own Pride because of the way I was raised where I need to show people that I’m competent and capable because that’s such a huge thing even like during covert there was a break where we were allowed to just sit at home and not be productive but now I feel that our lives have just accelerated back into this no I must do all the things and maybe one thing that can help us is to remember no you don’t always have to be awesome nope you’re still awesome even if you do it in your own way and you can say no and still be awesome right and perhaps a better way to wear that is other people don’t think you’re awesome you don’t have to show everyone like no look I’ve got everything together my family’s behaving my business is going well I’m saving the day every day at work that’s a lot of pressure to put on ourselves yeah and again it that sort of pressure to be so many things also doesn’t help those who we’re responsible for parents kids patients whoever it might be like we end up not really understanding what their needs are because there’s this need of our own to like make sure that I look like I have everything together and I’m really helping people the the phrase that I use often at our Clinic to our patients is uh you don’t go to the dermatologist wearing makeup I mean like no like you need to show your true self otherwise we’ll be guessing it how to treat you and I think that’s a good lesson for us too that if we want to avoid burnout we have honest sometimes painful conversations with ourselves and oh there goes another painting hello and so that’s the last thing uh I want to go back to what you said real quick as we’re finishing the show sometimes we can’t have that honest look with ourselves like it sounds really good to say on TV just look and that’s where what you were saying where you have friends whether it’s colleagues or therapists with you or just people who know you well because your friends and family they’re not surprised by anything they don’t believe any facade that we put up so I think that is one last thing about burnout of how we can prevent it is just ask people it’s an awkward question sometimes you may hear things you don’t want to hear but if you really are serious about not burning out then ask those difficult questions to friends and family how am I doing am I being prideful am I working too hard am I trying to impress you instead of just being my true self and another thing that brene says is that she carries a one by one square of all of the names of the people whose opinions matter most and if that opinion that she’s receiving isn’t on that square then she can kind of decide on whether or not how impactful that information is going to be for her because you know especially in the day and age of internet and comments and things why would I let a stranger comments on the internet really impact how I view myself or view the world where these people who are a part of my life every single day and add value to my life those are the people who I needed to check in with well thanks for joining us today and I’ll close with this phrase which is never accept criticism from people you want to accept advice from

[Music] [Applause]

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