Dealing with Emotional Pain: No Laughing Matter.

By Aiala

I don’t think I've ever met any normal human being that hasn't met, at least once in his life (or many times) with the “emotional pain” monster. That tremendous feeling of devastation stuck in our throats, chest or any other place in our body where he makes himself at home. We feel like crying and sometimes the helplessness is so great we can’t even shed a tear. This leads to even harder feelings of frustration and distress, to hopelessness and depression.

Emotional pain can be caused due to many different factors, each one independently or a mix of them: the ending of a relationship, loneliness, unemployment, the loss of a loved one, illness, feelings of emptiness or being unfulfilled, low self-esteem, and so on. And the truth is that you don’t need to justify your emotional pain: if it’s there, it’s real and it needs your attention and care.

What is Emotional Pain?

Psychological pain is an unpleasant feeling (a suffering) of a psychological, non-physical, origin. A pioneer in the field of suicidology, Edwin S. Shneidman, described it as "how much you hurt as a human being. It is mental suffering; mental torment."^[1] There is no shortage in the many ways psychological pain is referred to, and using a different word usually reflects an emphasis on a particular aspect of mind life. It may be called mental pain,^[2][3] emotional pain,^[4] psychic pain,^[5][6] social pain,^[7] spiritual or soul pain,^[8] or suffering.^[9][10] It is sometimes also called psychalgia.^[11] 

While these clearly are not equivalent terms, one systematic comparison of theories and models of psychological pain, psychic pain, emotional pain, and suffering concluded that each describe the same profoundly unpleasant feeling.^[12] Psychological pain is believed to be an inescapable aspect of human existence.^[13]

Emotional pain is a very serious matter and should be treated as it. The emotional or psychological pain we feel inside is real, and the physical pain we feel due to the emotional one is real as well. It’s not just a bad joke of our psyche; even so that many sources mention the fact that we use metaphors of physical pain to refer to psychological pain experiences, better known as a psychosomatic symptom.^[12][13]

 Somatization is defined as the tendency to experience psychological distress in the form of physical symptoms. Astoundingly, in one study of 1000 patients presenting over a 3-year period with 567 new complaints of 14 common symptoms (including chest pain, fatigue, dizziness, headache, edema, back pain, shortness of breath, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation) a physical cause was found only 16% of the time ( Alex Lickerman, M.D. in Happiness in this World).

The purpose of these symptoms is to occupy and distract the consciousness, to prevent it from discovering or dwelling upon repressed sensitive emotional issues. The subconscious mind perceives these issues to be a threat to the consciousness and self image of the individual and will do whatever it takes to conceal them (see defense mechanisms).

Physical pain and related symptoms are extremely effective ways to make sure the conscious mind stays focused on the physical body, which gives it no time or resources to probe into the depths of the hidden subconscious [14]. 

What makes it worse and harder to deal with this pain is the way we feel about it (shame, resentment, confusion) or not even understanding what is happening to us. This usually leads to different reactions:

Anger: When we are in emotional pain, it is very often – and maybe the most common primary reaction– to feel anger and resentment towards the one who caused that pain: it could be G-d, an ex or actual partner, a friend or even ourselves. Inside we believe that the aggravation was done TO us, in a personal way, and we feel resented, betrayed, sad and disappointed. According to Steven Stosny, Ph.D. in Anger in “the Age of Entitlement”, over time, the blame-anger response congeals into chronic resentment, which is a generalized, automatic defensive system geared to protect an ego made fragile by the perceived need of protection.

Denial:  denial is probably one of the best known defense mechanisms, used often to describe situations in which people seem unable to face reality or admit an obvious truth (i.e. "He's in denial."). Denial is an outright refusal to admit or recognize that something has occurred or is currently occurring. Basically, the pain is so deep we feel we can’t even affront it. So we busy up our lives, filling it with entertainment, work, sports or anything else that will help to cover the pain and make as if everything is just fine.  So it’s of no surprise that the same day of a major break-up with your long term partner, your friend might find you laughing out loud drunk in a bar, telling everyone that you've never felt so great before. For further reading on Denial Defense Mechanism, click here.

Social Isolation: due to the shame we feel inside as for feeling the way we do, we live in constant fear of rejection. We judge ourselves harshly, condemning our feelings as childish, immature, stupid, unreasonable and so on. We tend to believe that if someone would find out the way we feel inside, s/he would reject us, scoff us, or probably think we are exaggerating or that something is seriously wrong with us. We walk through life feeling misunderstood, lonely and different, leading us to draw away from close friends and/or family instead of seeking help and comfort from them. Finally, the emotional pain we were originally feeling worsens by the pain of loneliness and feelings of alienation making it mostly unbearable, darkening our inner view of the world and life.

Negative Compensation Behaviors:  The term compensation refers to a type of defense mechanism in which people overachieve in one area to compensate for failures in another. For example, individuals with poor family lives may direct their energy into excelling above and beyond what is required at work. In a positive way, compensation helps us achieve great success in areas where we feel stronger at (ex. Art making) as a compensation for our lack of aptitude on math. In a negative way, when referring to compensation behaviors due to emotional pain, it is most common to find people adopting compensation behaviors to “fill” the hole caused by their pain, instead of finding a way of healing it. these compensation behaviors differ strongly from each person. Still, the most common ones are: smoking (as for anxiety), eating (as for loneliness), compulsive shopping and any kind of addiction.

Self-destructive behaviors: Self-destructive behavior is often a form of self-punishment in response to a personal failure, which may be real or perceived. Self-destructive behaviors may be used as a coping mechanism, when things get to be 'too much' to handle, and especially when we are passing through an emotional pain period in our lives, and we blame ourselves for it.

It manifest itself in different ways: as an active attempt to drive away other people. For example, they may fear that they will "mess up" a relationship. Rather than deal with this fear, socially self destructive individuals engage in annoying or alienating behavior, so that others will reject them first.

More obvious forms of self-destruction are eating disorders, alcohol abuse, drug addictions, sex addiction, self-injury, and suicide attempts.

An important aspect of self-destructive behavior is the inability to handle the stress stemming from an individual's lack of self-confidence- for example in a relationship, whether the other person is truly faithful ("how can they love someone like me?"); at work or school, whether the realization of assignments and deadlines is possible ("there is no way I can complete all my work on time"). Self destructive people usually lack healthier coping mechanisms, like asserting personal boundaries. As a result, they tend to feel that showing they are incompetent is the only way to untangle themselves from demands.

Successful individuals may self-destructively sabotage their own achievements; this may stem from a feeling of anxiety, unworthiness, or from an impulsive desire to repeat the "climb to the top."

Self-destructive behavior is often considered to be synonymous with self-harm, but this is not accurate. Self-harm is an extreme form of self-destructive behavior, but it may appear in many other guises. Self-harm (SH) or deliberate self-harm (DSH) includes self-injury (SI) and self-poisoning and is defined as the intentional, direct injuring of body tissue most often done without suicidal intentions. The most common form of self-harm is skin-cutting but self-harm also covers a wide range of behaviors including, but not limited to, burning, scratching, banging or hitting body parts, interfering with wound healing (dermatillomania), hair-pulling (trichotillomania) and the ingestion of toxic substances or objects [15, 16, 17].

IMPORTANT: if you are dealing right now with emotional pain, and you are hurting yourself in any way described above or in any different way, or the pain has prolonged for more than 6 weeks affecting your daily tasks (waking up, sleeping and eating patterns, not going to work), personal relationships, mood,etc., please seek professional help asap. Call a friend, a relative or anyone you trust and know you are safe with. Do not feel ashamed of what you are going through. Know that you are not alone, and usually people close to you will be happy to lend a hand, support you and be there for you. Getting help will help you feel much better, and hopefully the pain will pass. 

If you are a therapist, and your patient is hurting himself or suffers from any symptoms described above, make sure you get the right supervision on the case, and maybe a psychiatric consultation is recommended as well. 

Click here to learn how Art Therapy can help you heal your pain!

References:

1.     Shneidman ES. The Suicidal Mind. Oxford University Press; 1996. Appendix A Psychological Pain Survey. p. 173.

2.      Weiss E. Bodily pain and mental pain. The International Journal of Psychoanalysis,. 1934;15:1-13.

3.      Orbach I, Mikulincer M, Gilboa-Schechtman E, Sirota P. Mental pain and its relationship to suicidality and life meaning. Suicide and Life-Threatening Behavior,. 2003;33(3):231-41.doi:10.1521/suli.33.3.231.23213.

4.      Bolger EA. Grounded theory analysis of emotional pain. Psychotherapy Research,. 1999;9(3):342-62. doi:10.1080/10503309912331332801.

5.     Joffe WG, Sandler J. On the concept of pain, with special reference to depression and psychogenic pain. Journal of Psychosomatic Research. 1967;11(1):69-75.

6.     Shattell MM. Why does "pain management" exclude psychic pain?. Issues in Mental Health Nursing. 2009;30(5):344. doi:10.1080/01612840902844890.

7.      Macdonald G, Leary MR.. Why does social exclusion hurt? The relationship between social and physical pain. Psychological Bulletin. 2005;131(2):202-23. doi:10.1037/0033-2909.131.2.202. PMID 15740417.

8.     Spiritual pain: 60,000 Google results. Soul pain: 237,000 Google results.

9.      Rehnsfeldt A, Eriksson K. The progression of suffering implies alleviated suffering. Scandinavian Journal of Caring Sciences. 2004;18(3):264-72. doi:10.1111/j.1471-6712.2004.00281.x.

10.     Psychalgia: mental distress. Merriam-Webster's Medical Dictionary. But see also psychalgia in the sense of psychogenic pain.

11.     Meerwijk EL, Weiss SJ. Toward a unifying definition of psychological pain. Journal of Loss & Trauma. 2011;16(5):402-12. doi:10.1080/15325024.2011.572044.

12.    Wille RSG.. On the capacity to endure psychic pain. The Scandinavian Psychoanalytic Review. 2011;34:23-30.

13.   Flaskerud JH.. Heartbreak and physical pain linked in brain. Issues in Mental Health Nursing. 2011;32:789-91. doi:10.3109/01612840.2011.583714

14.   http://www.cure-back-pain.org/psychosomatic-allergies.html

15.   Klonsky, E. D. (2007), "The functions of deliberate self-injury: A review of the evidence",Clinical Psychology Review 27 (2): 226–239, doi:10.1016/j.cpr.2006.08.002,PMID 17014942

16.   Skegg, K. (2005), "Self-harm", Lancet 336: 1471

17.    Truth Hurts Report, Mental Health Foundation, 2006, ISBN 978-1-903645-81-9, retrieved 2008-06-11

Stop There, Therapist!! Are you taking good care of yourself?

By Aiala

When speaking about giving to others for countless of hours, sometimes even prioritizing their needs before mine, I can say I used to be a winner. Sounds familiar? I didn't realize how bad this was, until one day I started feeling resented towards my closest friends. Deep inside I felt that I couldn't deny any favor, or even say that this wasn't the right time to talk. I would push tons of my personal needs just to attend everyone else’s, including my family's. 

And when I became a therapist, this issue obviously burst into my clinic. Patients would come late, or wanted to stay longer; or didn't want to leave at all! They would call at any time or asked me for personal favors; the case is that I found myself struggling for the sake of therapeutic boundaries and keeping a setting. The issue kept popping up, and took tons of my energy and concentration that should be focused on the patients and their therapies. This, plus my self-criticizing habit was an exiting receipt for self-discouragement (thoughts of: this is not for me, I’m a terrible professional, I’ll never succeed before going mad etc.) and obviously working tons of extra hours just to put everything together. I felt exhausted; physically and emotionally.

Then, one amazing day, a Jewish statement got into my life and definitely changed it for good:

"He [Hillel] used to say, if I am not for me who is for me, if I am not for myself what am I, and if not now, when." (Ethics of the Fathers, 1:14).

Well, as a person that believes in Divine Providence, I thought that this might have something to do with my issue and hoped that one day I would have the time to investigate about the topic. But in the meantime, while I was still so busy, I would just leave it in my “yet to do box” at the basement of my unconscious mind.

After some time, I happened to mention the statement above en passant in a supervision session, and we started to talk about how overwhelmed I was feeling. I even started to resent some of my patients, and this was obviously affecting the quality of my job. I thought the conversation was going to turn over to the “counter-transference” style and meeting the shadow story, when out of the blues my supervisor asked me: are you taking good care of yourself?

Excuse me? – I asked. (I thought I didn’t understand the question). She repeated it, stared at me and then repeated the question one more time, adding some “you know…taking care of yourself. Exercising, therapy, having fun sometimes…” well, I obviously wasn’t. And then it all sunk in: if I am not there for me who is? Meaning, that I can give to others, real giving, only after my own vessel is full.  

Reading different articles on the subject, I came to realize that many therapists find themselves in the same boat, ending up totally burned out specially the fresh ones.

Click here to read more about the hazards of the profession to the therapist (including emotional depletion, depression and helplessness), and here to read about the hazards to the therapist’s family (including emotional drain, jealous and treating family as patients). You will realize that YOU ARE NOT ALONE!!

Below are some things I have tried and found helpful to improve my self-care as a therapist and as a human being. Hope they are of some help to you too.

Praying

I pray or practice a short meditation before starting my day, and when I get to the clinic. It helps me feeling reassured, guided and secure.

Exercising

I have found exercising an amazing source of renewal and re-energizing! Whatever works for you is good. I walk (it helps me clear my mind) and dance zumba! Its tons of fun J

 Therapy and Supervision

I believe both are a must. About therapy, there might be times you are in need of a rest and I believe that’s ok too. Still, it’s something that should be around. About supervision, I believe that for the first five years it’s mandatory and responsible to get it. After that, you will become a supervisor yourself J

Keeping a Journal

I love keeping a journal made of white, plain papers where I can write and draw, all at the same time if necessary. I take it with me mostly everywhere; so whenever I feel overwhelmed or just like expressing or ventilating, I can do it! Lucia Cappachione talks a lot about it (see video below).

 Join a group of colleagues and/or forums on psychotherapy

Researchers [i] have found that most feelings of incompetence, stress, depression and drop – out of the therapy career in novice therapists emerge from their lack of “community” support, over - exigency and unrealistic expectations about their selves and their work. Joining a group has helped me to feel supported and confident about my work, while sharing my doubts and distress with colleagues that also share similar experiences and distresses and are willing to talk about it in a non-judgmental environment.

Hope these helped a bit. If you have your own trade-mark tips, please share them with us! We’ll all gain tons of it!

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[i] Feelings of Incompetence in Novice Therapists: Consequences, Coping and Correctives.

Anne Therialult, Nicole Gazzola and Brian Richardson (University of Ottawa).

Canadian Journal of Counseling, 2009.

On Burnout

Burnout is a result of job stress stemming from the numerous hazards of the profession described in the preceding sections. At different periods of their careers, it affects all psychotherapists to some degree. Unlike the commonly held belief that burnout is experienced primarily by seasoned therapists, research has shown its frequent occurrence with neophyte therapists as well. Maslach, who wrote the important book Burnout - The Cost of Caring, states "It is a response to the chronic emotional strain of dealing extensively with other human beings, particularly when they are troubled or having problems."

Burnout manifests primarily as the therapists' emotional exhaustion and depersonalization of both their patients and themselves. It has also been called "emotional fatigue" or "emotional overload," when the therapist feels drained, depleted, all used up, with nothing else to give out. The depersonalization aspect of burnout manifests through general dislike of, and a detached and callous even dehumanized attitude towards the people served. The burned-out therapist experiences low energy, reduced interest and satisfaction, and often dreads work. Burnout in beginning therapists is linked closely to emotional overload and a sense of inefficacy.

Burnout is the leading cause of psychotherapists' high rate of depression, drug and alcohol abuse, and suicide. Due to the myth of care-giver invulnerability, psychotherapists are susceptible to burnout. Research has shown that psychotherapists are more prone to becoming depressed, substance abusing, or suicidal than any other comparable profession, such as physicians, attorneys, accountants, and dentists. 

Reference: http://www.zurinstitute.com/burnout.html

HAZARDS TO THE THERAPIST'S FAMILY

1. Emotional Drain: Listening all day to people in pain depletes the therapist. At the end of the day

the skillful listener may be exhausted. Home problems seem minor, dull, and insignificant compared to the horrendous stories patients have shared. Many therapists prefer to be left alone at home, while others see homecoming as their first opportunity of the day to unburden themselves and stop the flow of other people's complaints.

2. Interpretation: The psychotherapist's most pervasive intrusion on the psychic lives of their family members is interpretation. Interpretation of dreams, slips of the tongue, or unconscious behavior, whether correct or incorrect, is harmful. Interpretations foster distrust, foment a sense of exposure, and may create excessive self-consciousness in those being interpreted.

3. Questioning and Inquiry: Psychotherapists are trained to ask questions or to reflect back in a way that facilitates better understanding. Many children and spouses respond poorly to continuing questioning, such as "Why do you feel that?" or "Did you consider the consequences?" Lengthy interrogations (which may last 50 minutes and during which the therapist-parent is totally rational and composed) confuse kids, who appropriately expect their parents to sometimes lose their professional composure, become more engaged, and display a normal range of human behavior rather than use the interpretive "Freudian whip."

4. Distancing and Use of Jargon: Another common complaint among the psychotherapist's family members is their parent's or spouse's ability to distance themselves from the emotional realities of the domestic scene. This dispassionate aura, while an important therapeutic mode for some clinicians, is also characteristic of many therapists' intimate interactions. The use of jargon as a means of distancing is usually used as a counter attack when the therapist feels defensive or uninvolved. Often the therapist lashes out with, "you are projecting," meaning, "your anger has nothing to do with me."

5. Total and Uncritical Understanding: Children of psychotherapists often say that whatever they did, their parents always accepted and understood it. In the psychotherapist's words, they were "just going through a phase." Different versions of this theme are expressed in statements like "Oh, he's such a pre-teen," or "How typically adolescent," or "It is just your middle age crisis." These demeaning and discounting comments hurt loved ones even if accurate. The "total understanding" syndrome often manifests to the extent that therapists will excuse all behavior. In their mind the bully is insecure, the wimp has abusive parents, and the thief comes from a poor family. It may be difficult for children to share their frustrations and anger in the light of their therapist-parent's infinite ability to "understand."

6. Labeling and Diagnosing: These therapeutic techniques pose similar problems to those of interpretation and total understanding. Children and partners of therapists are labeled narcissistic, passive-aggressive, borderline, and many other DSM III-R diagnostic categories by their therapist-parents or spouses. Labeling is extremely injurious. Calling children "hyperactive" or "accident prone" is likely to encourage hyperactivity and accidents. Children learn who they are largely from their parents. If they are called offensive names, too often they will internalize and incorporate these labels as part of their identity.

7. Anonymity and Confidentiality in Family Life: The commitment to keep patients' identities anonymous prevents many therapists from sharing their professional lives with the rest of the family. This results in a wide gap between therapists and their families, as the rest of the family is neither aware of nor included in the therapists' professional struggles, pains, wonders, and joys.

8. The Public and Personal Split: The need of many therapists to keep their personal lives completely concealed from their patients often places psychotherapists and their families in difficult, stressful, and awkward situations. Many therapists avoid going to certain parties or joining health clubs, determined not be seen by their patients out of the office. This rigid split isolates and alienates not only the therapists, but their families as well.

9. Jealousy: Family members also may experience jealousy of the psychotherapist's patients. Clients who are anonymous and mysterious to the family have uninterrupted weekly time with the parent/spouse, share their most intimate secrets, and call the therapist at all hours of the day or night. Regardless of how demanding or disturbed they are, these clients are fully accepted by the therapist-parents. Many therapists' children and spouses feel neglected and deprived. Some therapists' children report that they want to grow up to be patients.

10. Responding only to Crisis: One of the most successful means of getting a psychotherapist's attention is to create a crisis situation. Psychotherapists are usually at their best in an emergency in which people are clearly in need of support. This skill is easily transferable from the therapy room to the home. After hours of listening to bizarre and dramatic stories, many psychotherapists are not eager to be ardent listeners to complaints about homework assignments or the car's funny noise. Physical illness, accidents, and other crises often provide, albeit dangerously, the attention that children or spouses of psychotherapists are missing.

11. The Home Office: Working out of the home office adds another dimension to the psychotherapist's already complex family dynamics. The home office can offer advantageous possibilities for therapists and patients. However, it becomes a liability if therapists enforce a rigid separation between patients and family members, and especially if this restricts children's freedom and spontaneity. Children whose parents work out of a home office seem to be much more resentful of their parents' profession due to the added limitations on space, time, noise levels, and general playfulness imposed by the home-office arrangement.

12. Resistance in Therapy: When the family dynamic has deteriorated to the point where outside help is sought, the therapist-spouse/parent may further complicate matters by creating obstacles to the healing process. Resistance to family therapy or marriage counseling is often an attempt to avoid negative exposure. It manifests through initial denial of the problem. Once in therapy there is reluctance to cooperate with the hired therapist. Competition, shame, or becoming a co-therapist are common ways to interfere with therapy. Many patient-therapists use sophisticated jargon during family therapy sessions, clearly an attempt to ally with the hired therapist. These un-constructive gestures support the original mistrust the therapist has evoked in the other family members.

13. Demeaning Tales: Sharing stories and tales about patients at the dinner table is a common activity in psychotherapists' homes. When the stories are not respectful of the patients or when ridicule is prevalent the potential of adverse effects on other family members, especially children, is great. Demeaning stories are not only a reflection of a failed alliance between therapist and patient, but also an alarming warning to the children about their parents' ability to demean others-including their own children.

14. Treating Family Members as Patients: The line between being an involved and loving spouse or parent and a therapist is often very thin. It should be walked very carefully. The danger of treating family members as patients is an over-arching concern and often the context for the many hazards mentioned above. If the therapist-parent takes on the role of therapist in the home, the spouse or child will most likely assume the role of patient and lean towards self-defeating and self-destructive behavior and attitudes. 

Reference: http://www.zurinstitute.com/burnout.html

HAZARDS OF THE PROFESSION TO THE THERAPIST

1. Emotional Depletion: The psychotherapy profession consists mainly of working long hours in isolation. Therapists deal primarily with people in crisis and pain. They are supposed to offer these people support, empathy, interpretation, explanation, direction, or advice. They are expected to give endlessly while expecting nothing in return, except the fee. Not surprisingly, this results in practitioners' emotional depletion, in the therapists' sense that there is nothing more they can give to themselves or to anyone else.

2. Isolation: Not only do therapists work mostly in private settings, but also a growing number of laws, codes, and regulations concerning confidentiality and anonymity exacerbate the therapists' sense of loneliness and isolation. In addition therapists work when most people are off work. Their free time frequently arises during mornings and afternoons when friends or spouses are often busy.

3. Helplessness and Sense of Inefficiency: Unlike carpenters, gardeners, or surgeons, psychotherapists rarely see immediate, profound, or tangible results from their efforts. The work is often slow, and with difficult or charactologically impaired people, they may never see improvement. Even when therapy is effective in relieving painful symptoms and termination is successful, patients leave. With them goes the knowledge of the long-term effect the work has had on their lives. In addition, the lack of easily available scientific and measurable ways to evaluate the outcome of therapy, leaves therapists wondering whether or not they are being truly effective and helpful. They may question their entire involvement with what Freud called "the impossible profession."

4. Grandiosity and Omnipotence: Patients often put therapists on pedestals. They may idealize the therapists, ascribing to them super-human abilities to see, understand, and heal. In the private setting of psychotherapy, these projections may repeat themselves every fifty minutes. Combined with a lack of critical feedback from objective sources, this may encourage in clinicians the development of what Ernest Jones labeled "the God Syndrome."

5. Depression, Sadness and Vicarious Traumatization:Working constantly with people in pain, who feel suicidal, or are grieving over the loss of loved ones, or those severely traumatized, often takes a heavy toll on practitioners. The psychotherapist can be infected with a patient's sadness; a condition Jung called "psychic poisoning." The term "vicarious traumatization" has been introduced in recent years and has become even more popular after the events of September 11, 2001. Vicarious traumatization refers to the cumulative effect upon the trauma therapist of working with survivors of traumatic life events. It is a process in which the therapist's experience is negatively affected through empathic engagement with clients' trauma material.

6. Confusion: While some patients idealize therapists, others put them down. The healer may be set on a pedestal only to be knocked off of it soon thereafter. In fact, the higher the therapist is elevated, the longer the fall and the bigger the crash. Without objective feedback therapists often end up confused and in doubt regarding their own qualities, qualifications, and even their sense of worth or self identity.

7. Constant Worry: Psychotherapists often leave their offices worrying about whether a patient is going to follow up on a suicide or homicide threat. Whether or not they report such intentions or make a suicide contract with the patient, sleepless nights and constant worry are significant hazards of the profession.

8. Grief Cycle: The endless cycle of introductions to new patients, conducting psychotherapy, and finally terminating the relationship takes an additional toll on practitioners. Therapists need to connect and disconnect on a regular basis. In many cases they never hear from their patients after termination. When patients terminate abruptly, therapists are left to grieve without sufficient closure.

9. One-way Intimacy and Voyeuristic Attitudes:While many patients disclose the most intimate aspects of their lives to their therapists, the therapist must share only what is appropriate and beneficial to the patients. Experiencing many such relationships can lead the practitioner to acquire extreme voyeuristic tendencies. It may also lead therapists to transfer the mode of one-way intimacy to friends and lovers outside of the therapy office.

10. Distraction: Focusing on other people's problems, which may be more severe than their own, often leads therapists to lose track of their own situation. The sense of power and invulnerability that often characterizes care-givers may also contribute to practitioners' lack of attention to their own problems.

11. Inability to Shut off the Therapeutic Stance:After being an expert and helper for many hours, some therapists find it hard to leave the therapeutic or analytic stance behind. Interaction with friends, family members, and lovers in a mutual way without jargon or a feeling of expertise and where power is equally shared, can be beyond the scope of the therapist.

12. Events that Affect Effectiveness: Therapists, like most people, go through life events, such as death of a parent, severe illness in the family, divorce, mid-life crisis, and accidents. Because the most important tool therapists bring to their offices is themselves, events that happen in the course of their lives affect not only them, but also their ability to be effective and productive with their patients.

13. Conflicting Clinical, Ethical, and Legal Considerations: The rapidly growing number of state laws, combined with the continual updating of ethical guidelines, leave clinicians in a quandary. The question of how to act when conflicting mandates are present (for example whether to act in the best interest of the patient, to follow the ethical guidelines, or obey the laws) may be difficult to decide. Regardless of the final decision, therapists are bound to feel stressed, compromised, and frustrated.

14. The Threat of Lawsuits: Living in a highly litigious society and working with disturbed people in the unwitnessed privacy of our offices leave therapists extremely vulnerable to lawsuits. As most situations boil down to a patient's word against a therapist's, the only proof of what therapists did (or did not do) is their notes. The only shield against litigation is clinical competency, a shield that can be easily shattered by shrewd attorneys and "hired guns," as there is very little scientific data to qualify any specific intervention as standard and effective conduct.

15. Split Personality-Public vs. Private:Traditional therapy emphasizes a rigid separation of the therapist's professional and personal life. With some types of people this differentiation is crucial for therapeutic and safety reasons. However, the preoccupation with such separation has led therapists to live isolated and limited lives and to exclude a sizable part of their community and their public lives from their experience.

For more reading about the therapist's healthcare and tips to improve it, click here.

Reference: http://www.zurinstitute.com/burnout.html