Clinical Resiliency: Strategies for Preventing Burnout in Therapists

Welcome, everybody to another podcast Sessions of

Sessions. Happy to have everybody as listeners, you know

that we take time to be able to dive in and hear the stories.

And clinically, we really get to investigate. And I personally

love to hear from people who are professionals in the field to be

able to talk about their experience and be able to glean

that and help others out, who are other professionals or

parents listening. So really excited to have Katie McCool.

Today, join us, who is a clinical director at I'll let

her introduce herself more, but she's one of our Clinical

Directors at one of our short term residential centers in

Pennsylvania, is that correct? Katie, tell us a little bit

about exactly where you're at would be great. Sure.

So I am located in White Haven, Pennsylvania. That

is more like northeast PA, northeast

PA and it's short term residential, maybe just give a

description of what is that level of care versus other

levels of care.

So short term residential, I like to call the

sweet spot, it's usually we like to be the medium before you have

to step into a higher level of care. Or if you're at a higher

level of care, it's right before you are discharging home to the

community. So our short term is somewhere between 75 and 90 days

stay. And it is intensive therapy. But we really use life

coaches and the staff to practice this experiential DBT

skills and other modalities that we have.

Great. The reason I wanted you to talk about it is

because I mean, for the average person hearing like the, the

actual the clients come and live there, like they're there 24

hours a day, that is really intensive, maybe it's talk a

little bit about that. It's a pretty captive audience, I would

imagine. It is,

um, it sounds really intensive. However, I

think that like our environment here is very homey. And we do

have like Coach staff that are here to support our students.

They're here 24 hours a day, seven days a week. And then we

have therapists here to help with individual and family

Sessions and group Sessions. It feels intense sometimes. But

really, once you start building those relationships with the

students and their families, it feels more like a family.

Yeah, I appreciate you saying that. I love that family

aspect. It's homey and, and some of the realities are is that

because some of the behaviors, and the emotional illness is

somewhat intense and acute, especially might, the behaviors

might exceed being able to keep them safe at home. And so they

actually need to be able to have that environment and immersion

into that environment. And I guess the reason I wanted I like

to talk about this and bring that up is there's lots of

therapists like yourself, who it's it can be a very daunting,

I should say, it's incredibly rewarding, I imagine but there

it's it's a lot. It's a lot all the time. It's not like you see

him for an hour, and then they then they go home. Yeah,

correct. I really feel like residential is its own

entity. It's not like outpatient at all. I mean, there are

intensive outpatient, right and PHPs. But every time you walk

into work, your students are here. You're living and growing

with them. So it is it can be pretty intense sometimes,

especially if one student is really struggling one day for

any reason. It can set off, you know, another student or we can

just be rallying around them like a community to help support

them as well.

And plus, you're doing individual Sessions, you're

doing family Sessions, you don't group Sessions. I know they go

to school there, they do a bunch of things. And yeah, the reason

I wanted to mention that is because our topic today is

really talking about clinical resiliency. And talking about

that's important because as you can imagine, we there's a lot of

therapists too, and we'll talk about this word a little bit but

use the term burnout. Burnout I know you've had I'm sure you've

had some experiences with with that. So let's go ahead and

climb in. Thanks for setting the stage. Katie, I really

appreciate it and knowing that you're certainly an expert in

understanding hi hi case loads intensive being a therapist with

intensive students and wonderfully we have very

involved parents. So that becomes its own can be a

stressor in its own. Right. So if we can let's let's clinical

resiliency we talked about this term resiliency is kind of out

in the world. I don't know that it's defined real well people

hear it but I So what are your thoughts on what? How would you

define the term resiliency?

It's interesting that you asked me to define it.

In the midst of researching what resiliency really is based on

all of these different studies that have already been conducted

for multiple years. And then each person has their own

definition of what resiliency is, I find resiliency is the

ability to respond to your environments, or simply put,

like, the bouncing back part of it. So you have a situation and

what's your ability to kind of think about respond and then be

able to function through it?

Oh, I like that definition. I appreciate that.

So just building on that, I would agree with you, Katie,

that there's been a lot of research on some of the research

base that I've done in looking at I love this definition that

they talked about resiliency, if you imagine that it is this sort

of cycle, that if we move from a place of baseline of positive

effect, that we can rely on that baseline as our Yeah, that's our

baseline. And then as we experience negative effect, we

actually circle through that and we get, we don't stay there. And

then we can go ride that through and experience it. And it

doesn't necessarily compensate us or dysregulated us to the

point where, you know, we're disabled in some sort of way, or

it's affecting our daily lives. And then we circle full back and

return back to that positive baseline of effect. I like to

use that term when talking about doing therapy with kids, because

oftentimes we think about kids is we want them to be resilient,

and how can I send my kid to you, and you guys really build

their resiliency? And I always like to say, Well, if we use

that definition, we end it is about a bouncing back and being

able to do that. Oftentimes, we have to assess what is the

baseline? Do they even have a baseline of positive effect or

stability or regulation? I wonder if you have noticed that?

Even with therapist do we have? Is that a helpful construct even

for therapist,

I think I think therapists kind of set higher

expectations for themselves than they do for their own students

and families. And oftentimes, it's unrealistic, because they

just find themselves that they have to have a higher standard,

right? Like I'm the professional in the field. So I should be

able to fill in the blank. When really That's That's not fair.

Setting, what we teach and preach to our families and our

students, we should be able to absorb for ourselves. And

something that I love so much about resiliency, is that it's

it exists in every single culture and population. It's

just, it's spoken in a different language, maybe it looks

differently, but the the essence of resiliency is it's there,

it's present for everybody. But what does it look like for you,

and you should be the person that defines your own

resiliency? Interesting?

Yeah. Like, I liked it. It's a universal concept.

Yeah. And I also want to highlight what you said that, as

therapists, they think we have these expectations of ourselves,

to be able to endure and be there for everybody. And I mean,

we're going to talk about vicarious trauma in a second,

but you're constantly absorbing, especially if you're a

relationally, attuned therapist, where there's a tremendous

amount of empathy, and that that can certainly inhibit it. And I

guess my point is, I wonder how much supervision do you have to

do where you talk to a therapist and say, how do you have this

baseline? How do you know how to get back to the baseline? Are

you even familiar with the what the baseline feels like? And

maybe that baseline I would, I would use the term rep

regulation to be able to return to this baseline. But yeah,

wonder your thoughts how much how much of your supervision

with therapist, so

with my team, specifically, I really like to

do like weekly supervision, where it's the structured you

sit down, and you talk about it. However, building relationships,

I think, is incredibly important for any human being to be able

to function through any event in their life, right? I mean, we

are meaning makers, and we thrive on relationships, and

that's developmentally what we need to grow and learn. So with

my clinicians, I love having any reason if their doors open, I

pop my head in and just say, Hey, how you doing? I need a cup

of coffee, want to go for a walk? So there is this

structured supervision that's very essential for them to be

able to break down and process like countertransference. If

there's vicarious trauma, like yes, we have all that and pull

them out of that element, and let them know I see you as a

human being, and you're allowed to be a huge and being with me.

So let's let's get out of this environment, so we can really

get to it. Sometimes I feel like people might deflect because

they have that unrealistic expectation of themselves like,

I'm the therapist, so I should be able to well stop being a

therapist for a second. People and let's just talk. Yeah,

love that. And then how do you notice? Let's just be

overt about the word. I hear this from therapists all the

time. I'm feeling burnout. Yeah. And burnout. And I'm always

curious, what is what is that mean for you? And what are your

thoughts about that term?

Again, I like to just a conversation, because if

we were to go by definition, it almost presents is like you're

done with the field. burnt out means I'm done. And I can't even

bring myself. But what is what is your burn out? And can we

define it? And can we rephrase it? I am a big believer that

language really helps. You're where you are mentally? And so

if you're using burns out, well, then how am I supposed to help

you come back around? How are you going to walk into work

today, and be present and show up for yourself in the fro your

clients? If you're tired? If you need a break? If you need me to

step in, like let's start defining and giving that a

different language and a different vocabulary than just

burns out because burn out to me means you're, you're completely

done and you're walking out my door. Instead of Katie, I really

need a break. I need help. What do I do I feel lost, I feel

detached. I don't know what to do with this case. Like, we get

very complex cases. And for you to feel that you just don't know

what to do is also okay, maybe you're not burnt out. Maybe you

just really need support.

Well, it seems like I like I really value that you're

using the term burnout, like I'm picturing this piece of wood

that literally is burned up and it's got no life left in it. And

you said, I'm done. And it's interesting how not just

therapists but I think as people in general, when they're feeling

this burnout, we have these interesting patterns to kind of

make the burnout worse, to perpetuate the burnout, rather

than knowing how to like, step out of it. Yeah. Yeah, maybe

speak a little bit about have you noticed that before? You

know,

I have, um, I feel like you get stuck. It's almost

like tunnel vision, like you can't picture any other way. And

maybe the intensity that you are experiencing is burnt out is

describing it all in one word. But really, it's so much more,

there's so many more layers underneath what the burnt out

is, but because you're fixated on burns out on burned out, it's

almost Well, what does that mean to you? Are you now I've had

some of my clinicians feel like, I'm burned out, I'm a failure.

I'm not good enough. What am I doing here? Can I really handle

this? And it's, well, yeah, you're a human being, and it's

okay to be affected by this stuff. How do we protect

ourselves emotionally, which we don't often think of when you go

into Sessions, and you hear this complex trauma all the time. So

again, like supervision is really important. And sometimes

it's your supervisor that has to pull you out of it, because you

get stuck, which is very normal.

You do get stuck. Yeah, we, we've certainly

noticed that people get stuck and I use the term they

perpetuate it, they kind of just stay in this burnout mode.

Oftentimes, we noticed that there's this interesting

projection of resentment, like my caseload is too high, or it's

the company or the expectations, or it's the parents or it's, the

clients are too acute and too demanding. And it just becomes

this. I would always say that that's a good indicator that you

know, you're headed towards being overwhelmed or

overstressed. Personally, I don't. I'm with you, Katie. I

think you're saying this. I don't like the term burnout.

Because it does mean there's some finality to it like, I've,

I've burned up all my fuel, and nothing's left, right. Like,

actually, I don't think that's actually the case. How do we see

it as maybe you got overwhelmed or overstressed? And then how do

we devise ways to mitigate that? And I one thing I wanted to say,

and I think you mentioned this, was that oftentimes we have this

expectation that we can perform, and we shouldn't get burnout and

do this. And we take it as some sort of moral failing. Like,

it's me as the as the therapist, I just, something's wrong with

me. I can't do it. And then it gets really convoluted with that

sense of self doubt. Maybe even shame turns into this

resentment, and I've heard this and maybe you have to, well, I

just need a better work life balance.

Yeah, sorry I did. I've said that before in my

earlier days. Being a therapist. So I don't mean to giggle, but

it's like, Oh, it's great for I have definitely felt that

before. Like, I need to be more balanced. Okay, but what does

that mean? What does that actually mean? You know, is it?

Is it the work? Is it? Are you burnt out? Are you blaming and

projecting? Like you said, Rob? Or is it I need better

boundaries, and I need to feel not as much guilt when I

implement my boundaries, because we're teaching other people to

have boundaries, we should have been for ourselves too.

And that's something, certainly if you're a therapist,

or your clinical director, that should be something that's

coming up in supervision, yes, to be able to discuss, you know,

our understanding of Yeah, where, where are our boundaries?

Why are we feeling overstressed? I? I like the analogy, what

somebody said to me, people like to say, need a better work life

balance, but I've rarely ever heard that it's, man, I really

need to spend way less time with my children or my family, I need

to spend less time I took way too much vacation this year.

Right? What? You never hear people say that, what do they

always say, oh, I need to cut back on work. I need to do that.

So I like to think about that. Like you're saying maybe it's

not about balance. It's reconceptualizing. What am I

doing? what's meaningful? What are what what's exceeding my

boundaries? Is it creeping into some time that I have away from

work or parents? Somehow? am I allowing myself to get in

meshed? Lots of times that comes up, especially when you have

really demanding high acute kids and parents? Well,

I'm what am I? What am I actually in control

of? Because sometimes it's if you're here, and you're

constantly working, then to have control of the situation, that

kid will do better, or the parents will understand or the

team will start doing this practice. And it's trust, you

know, what are you actually in control of and trusting your

team and trusting yourself that you've put the work in and

you're doing, you know, really good foundational work with your

students and your families that you actually have to give them

the opportunity to now practice it themselves beyond you just

being there? Take a step back, it's okay to do that.

So let me ask you, if I'm a therapist, what should I

bring to my we talk about supervision, super important.

Having regular meetings with a supervisor, you know, certainly

if you're in a clinical setting, whoever's your manager should be

able to approach some of that stuff with you. If you're a

therapist, what I don't want to do is just a rah, rah them into

like, oh, you know, here, just try harder and change. I don't

want to do that. What and I don't I know, you don't either.

If you're a therapist, what are some things that you might be

looking for, to recognize that you might be coming?

overstressed? Or you might be coming, developing some sort of

overwhelming feelings? Or what are the indicators, some of

these indicators? If I'm a therapist, or a new therapist?

What do I look for?

Okay, so I will do my best to give some because

again, I think that it's, it's really on the individual, but

any change in thought, so if you're usually going to work,

and you're in a good state of mind, um, most of the time, and

then you start kind of dreading work, or you're fixated on what

you have to do or worried about how the milieu is going to be

today, or I've got a lot of work or, you know, I would pay

attention to your thought patterns of that, honestly,

because that it's so easy to fall in to it without

recognizing it. And so self awareness of how you're even

thinking on your way to work is really important. I would like

you to remember to eat, it's really really important to eat

your lunch if you need a snack, eat

a healthy lunch. A healthy lunch

works. You yes, if you're a coffee drinker or water

drinker or something like realize if you've gone a couple

of days without eating your lunch. Okay, so what does that

say? Because now you're actually neglecting what you need for for

your body to function and for you able to do therapy and be

present for it. You know, I and I say it because I've actually

missed lunch a bunch of times, you know, in a week, so pay

attention to like, what are your habits? What are you doing? How

are you speaking to other people? You know, what are the

words you're using? How do you feel on a client? Can you talk

about it with your supervisor? Do you feel uncomfortable with

this client or talking about it or ask Do for help? Or how are

people responding to you?

Those are, those are great ones. I like one that you

mentioned up is recognizing. I always use some Carl Rogers type

of mindset if I'm shifting out of unconditional positive regard

for people. And I noticed that I'm getting a little bit short,

or I'm having inaccurate expectations, or this is coming

up. For me, I always like to tell therapists, well, if that's

happening for you, boy, well, you need to talk about because

that's one of the stepping stones, the gateway into this

term that you're going to use. I'm, I'm burnout, or if I'm

leaving work, and I'm slightly resentful, like feeling like,

ah, that Darren paperwork is just, I know documentation isn't

fun. Right? But when it's just like I'm behind, and I'm

procrastinating, I'm not staying on top of it. That's just part

of the job. Right? Oftentimes, that that's something too

that's, you're going to, you're going to use the burnout word or

have that mindset.

Yeah, absolutely.

Great, Katie, those are good ones. I appreciate

that. So I you talked about relationship, I'd like to bring

up we'll talk a little bit about flow state, but in your mind,

how does the therapist mitigate and see that this is reward? How

do I have more investment than I do withdraw? In my clinical

practice?

Recognizing progress, no matter how big or

small and who the progress is, where it's coming from, I think

it's those little wins in life that really keep you going. And

you have more little wins than grands ones, right? But

recognize the progress. And understanding that if you've if

you've worked with a family or a client, and or you're working on

yourself, and you've been making all this progress, and then all

of a sudden you stop, well, is it plateauing? Or is it

stabilization, and really think about that, because plateauing

could give like a negative thought to it. And stabilization

is, well, you're finally not in that negative behavior pattern

anymore, regardless of who that is. So recognizing that any

progress can be good progress.

I'm gonna ask a little bit of provocative question,

because I'm gonna reflect the work of Scott D. Miller, Dr.

Miller and his group is that how does the therapist and a

supervisor, how did they actually know that they're

making progress?

Is it the same? What's the same? When I, I like

to use data with my clinicians, because they are a little bit

more black and white thinkers. And if they listen to this, I

love you guys. But they are so they really respond more to like

data. And so any movement in our data, if it's moving forward, or

if it's not moving backwards, but it's been the same for a

couple of weeks, then let's bring that out. And any change

that is moving forward for the client or the families is

helpful. So

maybe define I love that you're using the term data.

If, if I'm just a clinician, I'm doing the standard practice, and

I'm not gathering a bunch of data. What are mechanisms that

you use when you use the term data? What are you really

referring to? So

there's data that I like to use for progress with

my clinicians, specifically for like, their job roles? So I do

like chart audits. And what if we're really struggling to get

our notes done on time, because maybe we are feeling

overwhelmed. And I do weekly chart audits with them. And I

can actually point out like, Okay, last week, maybe you were

only 89% on time, but this week, you're doing 98%. So let's talk

about the things that worked for you. When it comes to client

data, that we we have a lot of surveys that go out that the

clients and the families actually answer. And it's their

perception of how they're doing and with their symptoms and

functioning in their family, at school in their community. And

so it'll give us a number. And it's the movement of the number.

So do you want me to get into details of each one, like some

numbers, you want to be high in some numbers, you're actually

you're doing golf, you want them to be low? And so when these

specific surveys are showing us like, well, this is where the

clients coming in at their baseline, and then what's the

movement happening after they've been with us for a little bit?

So that's the type of data that we collect.

Yeah, I appreciate that. And just giving some

specificity to it is, for an example is where you would

administer Depression Inventory, or you would do in anxiety and

these are validated instruments, be it the PHQ nine or the GAD

seven or Even a measurement of well being like the WHO five,

you're administering this, while youth outcomes questionnaire you

actually have the parents do them as well. Yes, yeah. So

actually, what I'm hearing you say, Kate is, those measurements

give the client a voice. And that's a really great way to see

it on number of actual data on progress. Because let's let's be

real. Sessions can be hit or miss. And we think they went

really well or really bad. And the actual client might have a

different experience, or the parents might have a different

experience.

What I love so much also about the service that

we use is, very often we have people come to our program that

they, they feel a certain way, and they don't know how to put

it into words. And so how do you then find a baseline? How do you

then know what we're going to work on? How do we know what the

dysfunction of the family is and how to help like healthier

attachments and relationships with mom or dad or, you know,

whoever the caregiver is, and you don't know how to

communicate it, because maybe you've never learned it, which,

okay, that happens. So this survey actually gives us a

really great picture of, oh, so with a PHQ nine, which is your

depression survey, this person might have an elevated number

nine, which is like suicidal ideation is fleeting, or it's,

it's there, it's very present. But you don't know how to tell

anybody, because you just never learned it. Maybe you just felt

so awful that like it's you're blocking the ability to even

understand and absorb what you're learning in the past. So

it gives us a really good picture of understanding like

maybe where they're at. And then we start there, and then help

teach them how to communicate their thoughts and feelings

through that.

I'm really smiling, because it's such a beautiful

thing that I don't think most people think it's

counterintuitive, like actually, using objective data will

actually help to reduce this term burnout. Like, it's

actually objective, it takes some of this objective, am I

doing good? Am I not? I mean, it is just really amazing that we

actually can use that objectiveness to weave in to

increase resiliency, because now we can see it more objectively.

That's about Katie, really, really, I love that we got into,

like, wow, using using data, and we actually, there's actually a

therapeutic alliance scale that's used to maybe talk a

little bit about that. Why? Why would that help therapists,

so the therapeutic alliance scale, we have students

fill out their own survey, and we have, um, each caregiver

involves fill out their own survey from their perception.

And it also helps kind of tell the story. Honestly, the the

outcome tools that we use is like a storyboard for me so I

can understand. So you know, you could have a drop in therapeutic

alliance, meaning how well do I feel like I am heard or

connected to my therapist or the staff at the program? And if

there's a dip after, it's been pretty great. To me, I like to

look at that and talk about it, because the therapists often

think, oh, my gosh, what am I doing wrong? They don't like me?

And will. When do you have your family session? Because I'm

looking at these other tools? And did you? Did you hit a

button that maybe they haven't uncovered that topic before?

Because that could be? Oh, like, that's the nicest way to say it,

the family could feel like, why don't like this therapist, and

then they do drop in it. But maybe you're actually onto

something. So you don't actually want the therapeutic alliance

score to be high all the time. Because then we're not really

doing our job, we, we need to push the envelope and help them

discover what the core issues are. And in order for actual

healing to happen, you don't want to mask it. No band aids,

what's really going on? Let's get to the core of it. I told my

families, if you don't tell me you hate me, at least once, I'm

not doing a very good job.

But if you don't have the maturity of the experience,

or the objective data to know that you as a new therapist, you

might take it personally and like oh, everybody, everybody

hates me. My job's terrible. I'm not doing a good job. I thought

it was all about, you know, making people feel warm and

fuzzies. And you're saying, Actually, that's not it. This is

a different paradigm shift. Let's use objective data. And if

I'm hearing you, Katie, you're also saying that whole process

of doing surveys and all of that gives us a clear roadmap when

we're looking at treatment. So it actually gives us a more

accurate prescription and a more accurate roadmap that actually

is incredibly impactful for the therapist to have confidence and

not feel like it's this willy nilly subjective thing and I'm

bearing all the responsibility of it. Yeah. So, wow, one

incredible way to work on resiliency is to use the

measures and use more objective means to be able to do that.

Really terrific. Yeah. I really appreciate that. Well, along

those lines, I wanted to mention that doing therapeutic alliance,

I mentioned Scott Miller before and when we talk about

resiliency is often or reward or feeling burnout is often linked

to therapist overestimate their effectiveness by somewhat like

over the last 40 years, almost 85%, we overestimate our

effectiveness. And at the end of the day, it really is about

looking at patient outcomes long term, okay. And Scott Miller's

work and his colleagues in particular, all of their

research indicated that the therapeutic alliance was the

greatest percentage and greatest variance for actually affecting

that, that change, it wasn't specific to, I think the

modality in the intervention was less than 1% of the variance of

change. So I'm just pushing on the fact that knowing the

numbers, but really examining the relationship has the

greatest impact, not only in client outcomes, but I would

imagine for the therapists sense of success and competence, as

well.

Yeah, I agree. It's funny, because we we use

modalities, I find a lot of our families ask us, you know, the

modalities that we use here at the program, and I understand

why, because to them, it's like a comfort of trying to

understand what's going to help their child and it, the

modalities are important, right? We want to teach these skills,

but you can't learn skills from somebody you don't trust, you're

not really going to learn it, you're not going to absorb it,

you may not even listen to it. So why would you want to work

with somebody become vulnerable, and start really digging through

all of this stuff, if you don't trust the person in front of

you. So it really is relationship based? And we get

to use all these other tools as well.

It really value that. Yeah, thank you. Thank you.

Well, let's talk a little bit. We talked about ways to mitigate

it, I would just like to touch on a few things. When we talked

about being a therapist, I always like to ask the question.

As a therapist, one of the greatest ways to prevent this

burnout or this sense of resentment is what's filling

your well, or what's what's rewarding to you. I don't know

how you approach that with with your team. But I always like to

maybe your thoughts on that. Katie is D, how do you know your

clinicians? Or what's rewarding for them?

Well, knowing your what, or your why, you know,

depending on what theory you're coming from, but like what, what

brought you into this field in the first place? And how are you

working towards this goal, I think is really important. So

knowing if it's fulfilling or not any progress at all, that's

going towards your what I think brings them back. So knowing

your what is really important, knowing

your what knowing your why I have found maybe you too

is that somehow people get into this field thinking this this

altruistic life that I'm going to leave of just giving, giving

give where I noticed those are the people who usually have

nothing left to give very quickly, right? Like the well,

the well becomes empty pretty quick. And I'm always like, no,

let's change the framework, it actually this is you need to be

simultaneously growing and experiencing that growth, like

you mentioned before, and progress, as well as your

clients. And so I don't know, I always like to bring up this

term, I'm not sure how familiar you are with flow state, if

familiar with flow state. So flow state has been a long time

studied, it's this, I'll give you the three criteria. But flow

state is something that when you're doing it, there's three

criteria, that time transfer, there's a time transformation,

you kind of forget about time, time disappears when you're

doing a certain activity. The next one is that you're

appropriately challenged, your skill set is appropriately

challenged, where you're not overly challenged, or you're not

under challenged. And then the final one is called unambiguous

feedback. So I always like to bring up for anybody say chi,

what's an activity that you do that gets you into that flow

state? Can you think of one for you, Katie, I know I've talked

to a lot of people that like my son's a rock climber. He's like,

Dad, I love rock climbing. And we talked about it actually gets

him into the flow state time disappears. He gets immediate

feedback doesn't mean like you make a wrong hold. You

immediately get the feedback, which is great. And he's

appropriately challenged. He actually doesn't do the climbing

that's exceeds his ability or else he would get frustrated

with the activity. So I don't know if there's something for

you, that gets you into that flow state.

Well, I really hope you believe me when I say

I'm residential, being here. Yeah. My, my kids, you know, my

kids, the clients hear sorry, but when they come, it's family.

Time, time does kind of disappear, you get really sucked

into the environment and what you're doing and why you're

doing it. And I told them that I haven't worked a day in my life.

So my flow state is being here.

Yeah, and so on. Now, I like to put a label to it. And

I love that you're saying it's actually being in this

therapeutic environment is that flow state for you, that

actually, you don't leave and say, Gosh, I work too many hours

today, like I'm just resentful that I, I worked so many hours,

it's not about that the time actually disappears. And you're

appropriately challenged, right.

But more than others serve

some some days more than others, certainly, but, and

then you're constantly getting feedback from the clients, yes.

And the therapist, and it's unambiguous. It is so clear. So

I like to bring that up. So now we have a construct, especially

for those people listening or might be Clinical Directors, or

therapists or professionals, to be able to recognize that I

always like to say, to bring it up in supervision that a

therapist should be doing therapy that they actually enter

into this flow state. Because flow state, as you know, as we

defined it, you're saying, I don't really count it as work, I

counted as a integrated part of myself. Yes. And you're not

dividing it out. And that's ideally what we would want for

our therapist, to be able to recognize and identify Well, I'm

actually in this flow state, where it's rewarding for me. And

I have appropriate challenges, I meet the criteria. And that's,

I'm grateful for it, rather than resentful for.

Absolutely. Once you start becoming resentful

than I think we're starting to walk down that path of we're

very overtired. And using the burnout term, yeah.

And not that you're gonna be in flow all the time.

That doesn't happen. It's not flow all the time, but a little

bit of flow, because I'm amazed at how many people even from

clinicians, you ask them about flow, and there is no flow. They

can't identify. And then you know, the reason I wanted to

bring up that's a huge red flag, right? If there's no recognition

or awareness of entering in a meeting this criteria flow

state, I can guarantee you how long are they going to last?

Right? They aren't going to last. So thanks for letting me

bring that up. I really appreciate it. I think that's

one of those things that I want to make sure that we give some

resources to therapist and Clinical Directors to recognize,

gosh, am I getting burnout? What should it feel like? How should

it be rewarding? I think I think that's important. Well, Katie

thinks about that. So let's shift gears just a little bit.

Now that we understand we're talking about flow state, and

you've done so well to articulate Hey, some things to

be aware of and all that. Let's dive into vicarious trauma,

because this is one that as in the helping profession,

especially one like ours. We knew it going into it, didn't

we? Yes. It wasn't like some surprise that, like, I'm gonna

listen to people's troubles and their trauma, and all of this.

So maybe a little talk a little bit about Katie, how you like to

conceptualize vicarious trauma, and how that shows up with your

clinicians and with your practice,

I think, um, I mean, sometimes it's completely

evident to a person and they really feel it. They take it

home with them, it's an thoughts. It's you're trying to

cook dinner, and you're already thinking about maybe the things

that you've heard today, and it's really affecting you, and

you're not functioning as you used to. And sometimes I think

that it's not, I think that vicarious trauma can be

something that happens over time that you don't actually

recognize that you're experiencing until you have

someone from the outside say, are you okay? Because you don't

seen yourself lately or whatever that looks like for you. And so

I think it's important for people to recognize that I mean,

to me I of course, I broken into like two things very simply. But

sometimes you really feel it and it's in your face and you can

avoid and you're, oh my gosh, I don't know if I can work with

this case, because I'm having countertransference and

sometimes it's I've been working with maybe a specific population

for so long that I not recognizing that I'm now

becoming reactive to my clients instead of responding to them.

treating everybody as though this is the population, whether

it's colleagues, it's clients, it's outside people, you're at

the grocery store. So vicarious trauma to me is, it can be

sneaky. It's really important to have a relationship with

somebody that you work with that can kind of help you make sure

that like, you're regulating it, and you're really monitoring it

because especially in trauma therapy, you hear so much, or

you see so much, but recognizing what do you need for yourself to

just say emotionally protective?

Yeah, create definition. To add on to what

you're saying is that vicarious trauma, I like to add this piece

for most people is that it's a, it's a result of cumulative

exposure from somebody else's traumatic experience that I like

to say, it's sort of like you said, sneaky, I'll use an old

school analogy of the frog and the frog in the boiling water.

We as therapists, you know, the frog, you put them in some

lukewarm water, you turn up the heat, it boils, and the frog

doesn't know to jump out. And before it knows that it will

actually be in the boiling water to its own detriment. I think as

therapists you're saying kind of the same thing. We're the same

way. We're just we're hearing it, we're taking it in, we think

that we're dealing with it. But all of a sudden, like trauma

does, it starts to show itself and all kinds of peripherial

auxilary ways. Maybe even somatically, I'm feeling

tension, or I'm not like to say maybe I'm not eating right, or

my movement is or I'm getting headaches, or whatever it is. So

there's all this trauma that can be experienced. And we as

therapists have to know that it's actually part of our job.

Yeah. Like we are primed, susceptible. I mean, it's like

being firemen, but we have to go into the fire every single day.

Right? Yeah. So something to be aware of, in that. It's amazing

how much of that exists, maybe you're saying this to that

exists sometimes underneath the surface in a pre conscious way

for a therapist. And then sometimes it manifests in way,

like I'm getting irritated or I'm burnout. When they don't

even recognize, gosh, it's actually a build up of all of

this vicarious trauma and vicarious stress that I've that

I've endured. Yeah. So I really appreciate talking about it.

Because I think it's important that it's oftentimes burnout is

a cumulative effect of a bunch of different things.

Absolutely. And I don't, I'm sorry, I'm just gonna

say I don't feel like anybody is truly immune to it either. So I

gotta say, like, when I was, you know, entering this field about

17 years ago, I definitely went in with like, Nope, I'm fine.

Like, it's not going to affect me. And yeah, no, it really

does. So, don't think that anyone is immune to it, there's

no special thing to stay, you're, you're going to be

affected, especially when you put your heart into something.

And you're in your flow state, you're going to get affected by

it. And it's okay, but like, how do you take care of yourself?

That's a really important question to constantly evaluate.

So

maybe we can give as we close, Katie, this has been

so helpful to talk about maybe we can give some specific

things. I always like to tell even Clinical Directors or

anybody in the field. Boy, mentorship is really key.

mentorship, absolutely is a primary thing, what are some

other things you would say are real, specific things to do? In

the field.

I feel like I've said this a couple of times. And

I'll just keep saying it because it's part of my practice of who

I am as a social worker. But relationships are incredibly

important to me. So having a great supervision, very

intentional about it, having strong relationships with people

that you have someone to go and talk to, and and be able to

share that with therapists. I am a big believer that therapists

should have therapists, because who else can you say all of this

to and really lay it all out on the line and feel that

protection and that comfort and the openness and the space to do

it, having boundaries, knowing them and trying to feel minimal

guilt when you implement your boundaries? And we at least I

speak for myself, sometimes I feel guilty when I say no, I

can't do this right now because it's a boundary for me that I

need a break. But understanding that it's important for me to

take it or I won't be able to show up the best way that I can

show up usually.

And I can't support you enough to say structure and

boundaries is necessary to actually have accurate empathy.

This isn't a process. Therapy is so much integrated on empathy in

with burnout, with having vicarious trauma. Those are

things that erode our empathy. And then we tend to, we can get

in meshed and start to feel so I love the kid, you're saying, no,

no, you got to have structure, you've got to have some

boundaries, and get some relationships that support that,

right? And I'm saying, Get into a mentorship or a supervisory

relationship, or get with a therapist, if you know that to

help monitor it. Because if you don't monitor it, it often grows

like a weed. And then before you know it, you don't want to be in

the profession, or else you're trying to figure out how to get

a better work life balance, and then it kind of spins out in the

burnout just never goes away. And then your eyes how many

times I've seen therapists take vacations. And this is going to

heal my burnout. And actually, they come back and about three

days later, right back, right back to it and the vacation

magically didn't do anything. Rather than here. Do all these

other things.

It's a constant process. Yeah.

Katie, this been so incredible. Thank you so much.

Any final words to in regards to this clinical resilience thing

we've been talking about? It's been so helpful today.

It's okay to not be okay. As long as you go help

for it.

Really well said. Appreciate that. Katie,

everybody, thank you. Thank you so much for your time. This is

such an important topic, especially with all that's going

on in the world with levels of anxiety and depression. And we

know that there's conflict happening everywhere. I mean,

who's who's not feeling a little bit overwhelmed and can

certainly feel some burnout. So those have been super incredibly

helpful tips. I appreciate so much your time, Katie, and thank

you for all the listeners. Thank you for listening to Sessions.

And doing that. Please access these podcasts wherever you

access podcasts are great. So look forward to seeing everybody

next time. Bye bye