Burnout

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.

Nick:
Hello and welcome to the Ascent Health Show. I’m your host, Nik Angeles. I’m one of the owners of Ascend Health Center and I’m here with Lisa: Shafer LSW like DK Wright to get all of them. Yeah. Well, welcome back to the show.
Lisa:
Thank you. It’s great to be here.
Nick:
So last time we talked about yoga, we talked about addiction. And this time I wanted 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, sometimes the snide term is the worried well or it’s 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 we can still be successful in life without burning out.
Lisa:
Yeah, I think that’s $1 million 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, you know, holding down a job, maintaining, you know, either marriage or 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 kind of rinse and repeat. And a lot of people aren’t taking time to breathe or even get in solidarity time where they can read a book, listen to a podcast, take a bubble bath or, you know, just have some time for themselves.
Nick:
Right? Well, that makes a lot of sense. I think there’s just listen 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?
Lisa:
Yeah, I kind of what comes to mind is just this morning I was looking at the dirty dishes in the sink and 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 the fall. And so 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?
Nick:
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 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 Behav Wellness, and it was a lot of you really need to take mental health days, you need to take care of yourself and now AM employer. So every so often I tell people, no, you need to come to work actually. So 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 how would you do something like that? Is it more of you just leave a message and leave a gift or is it like, no, I really need to put myself first And that is our culture. You know, put myself first. What are my needs?
Lisa:
Yeah, I think that those kinds of showing up examples are how do you how well do you know the person? Are they somebody who would be open to hopefully they would be open to hearing like, you know, today I am emotionally not able to commit to something. 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?
Nick:
So 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 be everything to everyone.
Lisa:
And even kind of going with the wedding example. 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 6 to 8 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.
Nick:
Okay. So what you’re saying is sometimes the key is to just not be a perfectionist where 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 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.
Lisa:
And you know, again, those boundaries are time. Time is mental health, time is money. And so 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 $100 pair of shoes, what can I afford that’s still going to get me my needs met? So maybe that’s a $20 pair or a $30 pair. If I can’t spend eight hours doing something socially, can I do something that’s two hours? Right?
Nick:
So on the one hand, we’re not perfectionists with our time or what we’re able to do, but on the other 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 okay, so these are my new tennis shoes as 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 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 learning a lot today already. Yeah.
Lisa:
And you know, one of my favorite people, Brene Brown. And so if you know me, you know that I like to quote her. You know, she talks about, you know, having a ten day or having an eight day instead of a ten 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 in that? Because we are imperfect people, right?
Nick:
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 a really important people are relying on me. I must do this. I must save the day.
Lisa:
Yeah. And I think, you know, as being professionals, you know, I don’t know about you, but 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, 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 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.
Nick:
And I think for me, what helps too is when I’m 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, for an example. And hopefully none of them will watch this. So I’ve worked on a lot of anesthesia places and I like the feeling of Nick. You’re our 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. And then I realized, 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. 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, I send 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 think, well, no one can do this without the great powers of Nick Angeles. It’s like, Nope, they just need a warm body with a masters in nursing that can do anesthesia. And if they can’t find that, that’s not on me.
Lisa:
I think what you said there was really powerful because no is a complete sentence. And I know I teach people that I work with that no 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 we can’t be everywhere all the time.
Nick:
So can that actually be part of the therapy where a client or 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.
Nick:
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 making exceptions in cases where these are the rules and you would agree 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, how can you do that without being patronizing or almost treating someone like a child?
Lisa:
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 get different ways, different interventions, different approaches that might help. And so again, 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 guaranteed, if you’re sitting in a room with 4 or 5 people, somebody is going to have a different approach just because we all come from different walks of life.
Nick:
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 was people were 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, 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.
Nick:
Yeah. Yeah. Oh, that was super good timing for that. That was great timing. As the ego fell, so did our side.
Lisa:
Yeah. And I think in terms of burnout, where there isn’t the ability, the availability to talk about like your feelings, 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 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 in their 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.
Nick:
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 and, you know, I’m a nurse anesthetist, but still, nurse burnout is a huge topic even in the regular news right now. And if you’re doing all this work and someone’s still not getting better if you’re not careful. All 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 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 using not stubborn at all. I’ll try 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 I think part of it is if we’re like, Well, maybe I’m not great 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.
Lisa:
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. They are the experts of their own life. And just to be a resource is my goal and my position. So that can kind of help lead 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 the pros and cons of all behavior.
Nick:
And obviously this isn’t just for those of us in health care. What I’m trying to get at is those of us 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 and make sure those goals are aligned. Because 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 will 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 or we don’t have the same idea of what we want to do.
Lisa:
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, we would be able to see that we’re trying to have achieved the same goal, right?
Nick:
Yeah, I know. For me personally, like I don’t mind discomfort, I kind of enjoy chaos and hardship. So 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 could really save my money the last ten 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 said about perfectionism, 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 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.
Lisa:
Yeah. And you know, that’s kind of like one day at a time kind of mentality of just doing what I need to do today. And as long as I’m able to meet my needs today, then tomorrow will figure itself out.
Nick:
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.
Nick:
So what are your secrets?
Lisa:
My secrets? We won’t tell anyone.
Nick:
This is just me and you.
Lisa:
For me, that’s really important is my sleep schedule. First and foremost, I’m pretty concrete on what time I go to bed and I have an alarm set on my Fitbit to tell me, you know, Hey, it’s time to start to get ready for bed. And then I do my nighttime routine and 9.9, nine nine times out of ten, I’m in bed at 10:00 and Friday, Saturday, it doesn’t matter. And I keep that schedule because for me, without sleep the train can come off the rails very easily. And so 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 and 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. So really kind of giving myself grace when that does happen, but trying to implement different habits so that doesn’t happen and just being really consistent with that. Another thing is 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.
Nick:
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’s the yoga class I’m doing or here’s a specific movement that’ll help and other times it’s like, Nope, I just have time to walk around the block and that’s all I’ll be doing. 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.
Lisa:
And something that I’ve been more attuned to lately is tapping into my creative side. We really kind of lose that momentum out of childhood. And as an adult, if I’m on a Zoom call lately I’ve been cracking out my coloring book and coloring mandalas while I’m on a zoom call that maybe you don’t need my eye contact for, right. And painting or crafting after hours. I’ve been kind of organizing my craft room and so kind of looking at how creativity can also be a way to pour out emotions that we’re feeling right, but also a way to kind of fill our cup.
Nick:
That makes a lot of sense in our clinic since we do the Ketamine infusions and the Spravato, which is similar, we started having adult coloring books and journals and it sounds strange like, well, this is a treatment that dissociates your mind and 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 a dissociate in novel ways that are helpful instead of just maybe I’m almost off my treatment, but they won’t let me go home yet, so I’ll just flip through my phone. Then it starts habits and new patterns for the brain of like know 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 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 Carbon Path, you still do the yoga and the mental health. What else do you all do for that sort of professionals avoiding burnout.
Lisa:
So we have art and mindfulness workshops with our art therapist, Jenna Savageau 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 feeling.
Nick:
And 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 Spravato as well. And these are all sort of alternatives to 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 COVID, 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.
Lisa:
No, you’re still awesome. Even if you do it in your own way and you can say no and still be awesome. Right?
Nick:
And perhaps a better way to word 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. And again, that sort of pressure to be so many things also doesn’t help those who are responsible for parents, kids, patients, whoever might be like we end up not really understanding what their needs are because there is this need of our own to make sure that I look like I have everything together and I’m really helping people. The phrase I use often in our clinic to our patients is you don’t go to the dermatologist wearing makeup. You mean like. No, like you need to show your true self. Otherwise we’ll be guessing at how to treat you. And I think that’s a good lesson for us too, that if we want to avoid burnout, we have to have honest, sometimes painful conversations with ourselves. And there goes another painting. And so as the last thing 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. 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?
Lisa:
And another thing that Brené 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 need to check in with.
Nick:
Well, thanks for joining us today and I’ll close with this phrase which is never accept criticism from people you wouldn’t accept advice from.
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