Dr Christian Jonathan Haverkampf, M.D.
Burnout is a type of psychological stress. Occupational burnout or job burnout is characterized by exhaustion, lack of enthusiasm and motivation, feelings of ineffectiveness, and often a sense of frustration and higher irritability. Efficacy within the workplace is usually reduced, no matter how much the individual tries to work even harder or more to counteract the symptoms of burnout. Treating burnout requires looking at a patient’s communication patterns and styles and creating greater awareness and understanding of them, which helps the patient to shape and use them more effectively.
Keywords: burnout, communication, communication-focused therapy, treatment, psychotherapy, psychiatry
Communication at the Centre. 4
The Interpersonal Dimension. 9
Values, Interests and Aspirations. 10
Communication-Focused Therapy®. 14
Ineffective Communication Patterns. 16
Values, Needs and Aspirations. 19
Meaningful Messages as the Instrument of Change. 20
Burnout is a very common condition. In a world which narrows and compartmentalizes communication, and where individuals no longer see their connection and contribution to the bigger picture, people lose the sense of meaning in what they think, do care about, and ultimately in themselves. This can lead to all kinds of problems, social, economic and personal. The sense of being able to have an effect on the world and change it for the better as well as fulfilling one’s needs, wants and aspiration is increasingly lost. The problem is not a lack of opportunities, as there are probably more than ever before. Rather, the fundamental problem lies in the fear or inability to communicate with oneself and others to the extent that one sees meaning and relevance in one’s professional and personal life. Burnout is essentially a disconnect, a deficit in effective communication with oneself and with others. (Haverkampf, 2013a)
Communication at the Centre
Communication provides the information and the skills on how to bring about change. Communication with oneself also helps to build greater awareness of oneself and greater confidence. A greater openness to the flows of information inside oneself and with the outside world helps greatly against Burnout. The reason is that information inside a meaningful message can bring about adaptive change and provide the knowledge and skills to more successfully pursue the own needs, wishes and values. It can also affect how one interacts with oneself and others, which is the foundation to getting one’s needs and wants met in the world, as well as helping others.
Communication follows basic rules and is organised in patterns for efficiency. Whether two people are on a date, in a business meeting or on a videoconference therapy session across continents, making oneself understood or asking a specific type of questions makes use of communication patterns that can be elaborate and complex or rather simple. These patterns organise how information flows internally and externally, and they may be helpful and adaptive to the person using them, or they may be maladaptive and unhelpful. While we are born with a basic set of communication patterns, many are learned over a life-time through communication experiences.
I could not remember one case of burnout in which a patient did not experience some level of frustration and despair in interactions with others, and often even more so with the own self. It is quite easy to overlook in an increasingly complex world, that if something does not work on an interpersonal or intrapersonal level, the whole elaborate edifice no longer works.
Poor Coping Mechanisms
Poor coping mechanisms can contribute to or result from burnout.  However, there is often too much of an emphasis on coping mechanisms, rather than on solving the underlying issues. Usually, when the underlying issues are resolved, better strategies and coping mechanisms are a result. At the same time, it can be beneficial to work on better strategies, as they can then have an effect on the communication patterns one uses.
Burnout is primarily associated with the professional world, but there is no reason to see burnout in other areas of life where individuals engage in exhausting activities which become increasingly less meaningful to them. One such example may be in a relationship context, another at school, college or even in a sport or recreational activity. People may even experience burnout on a long vacation. The fundamental components are exhaustion and meaninglessness, when an individual no longer sees the relevance of the activity to oneself, as conducive to one’s values, basic interests and aspirations.
Occupational burnout is thought to result from long-term, unresolvable job stress. In 1974, Herbert Freudenberger characterized burnout by a set of symptoms that includes exhaustion resulting from work’s excessive demands as well as physical symptoms such as headaches and sleeplessness, “quickness to anger,” and closed thinking. He observed that the burned-out worker “looks, acts, and seems depressed”. Burnout is now known to involve the full array of depressive symptoms, such as low mood, cognitive alterations, sleep disturbance.
In order to study burnout, a number of researchers developed more focused conceptualizations of burnout. Exhaustion and disengagement are often mentioned in various descriptions of burnout. Job-related burnout may be characterized by emotional exhaustion, depersonalization, and reduced feelings of work-related personal accomplishment. Burnout also has been said to compromise emotional exhaustion, physical fatigue, and cognitive weariness. However, none of these explanations offers an answer to the question why there is burnout in the first place. To answer it, one needs to look at what is happening from a communication perspective.
The economic loss from burnout is probably much higher than commonly estimated. The reason is that the state of greater disconnectedness with one’s work which precedes an acute burnout already goes with less creativity, initiative, motivation and energy in the workplace. It has been found that patients with chronic burnout have specific cognitive impairments, such as significant reductions in nonverbal memory and auditory and visual attention.  Still, the largest loss is probably the loss of quality of life to the individual.
Efficacy within the workplace is usually reduced if an individual suffers from burnout.  This also translates into a sense of loss of efficacy in the world in general, which has a downward influence on a person’s self-confidence and belief in oneself. The consequence is that there is a greater desire for distance from oneself. However, this in turn leads to an even greater disconnect from oneself and one’s work.
Burnout is not a medical, but it is a quite common condition which often comes with symptoms of anxiety or depression. It can lead to fatigue, irritability and a disconnect from one’s work or relationship, other people and oneself. Patients with burnout usually see less meaning in the things they engage in, such as in a job or in a relationship. The disconnect and alienation from self and others can over time lead to more serious mental health and general medical conditions.
The loss of meaning patients with burnout experience seems to increase the negative stress, which leads to a greater sense of exhaustion and fatigue. This can lead to a vicious cycle, in which greater disconnect leads to more symptoms, which then in turn lead to a greater disconnect. It is important to understand that loss of meaning, efficacy and a deterioration in how a person feels about oneself and others is intricately connected with how one communicates with oneself and others, and the sense of competence one has in doing so.
Communication with oneself and others is at the heart of burnout. To counter burnout effectively requires increasing the meaning individuals see in themselves and in the world around. This happens through learning about one’s interactions with others and the communication one has with oneself. However, it is not primarily about content, but about a person’s insight into the communication process and competency over it.
Fundamental to burnout is the disconnection individuals experience. One no longer sees meaning in the work one does or in the interactions one has with others. The disconnection can have a number of reasons. It can either stem from seeing that the work, for example, is no longer relevant to one’s own values and interests, or from not looking anymore. But the disconnection means in any case that information is no longer received and processed efficiently and in a way which helps the individual to make the best of the world he or she lives in.
Disconnection can occur at various locations in the communication cascade, whether one interacts with oneself or others. One may not attend to a flow of information or receive the information, there may be an inability to decode the message, or one may not process the information further and store it. If one falls asleep in a group, the information may no longer be processed consciously, or if one interacts with a colleague, one may no longer notice what her true intentions are because one is not available to decode the messages, or one has no spare resources for it.
Burnout can affect the communication cascade at any place, from falling asleep to being too fatigued to interpret the messages. Often this is a consequence because one no longer sees the relevance and meaning to oneself. On the other hand, burnout can be a consequence of missing information. If one does not get important information, relevance and meaning can be obscures, leading to even less messages being received and processed.
Basic interests and values usually do not change much over time. Often, burnout occurs in situations where there is uncertainty about them. One reason for this uncertainty can be the reluctance to look for them. This fear of connecting with oneself can have a number of reasons, but it decreases the relevance one sees in things and activities. The less one knows about something, the more the feeling of uncertainty increases. Knowing less about oneself, makes every activity or engagement with other people more uncertain. However, learning about oneself and other requires communication. Also, since observing communication and the sense of self are tightly linked, developing insight into internal and external communication, and the concomitant skills to use it, strengthens the sense of self.
Not a Medical Condition
Burnout is not a diagnosis per se. It is not listed in either of the main diagnostic manuals, the ICD-10 or DSM-V, as a distinct mental health conditions. This means one has to diagnose a condition that can best explain the symptoms, such as depression or anxiety. The problem with this is that they merely reflect the set of symptoms but say little about the underlying etiology. It would be better to regard burnout for what it is, a disconnect from oneself and others. It is after all the disconnect which causes many of the symptoms, such as anxiety and depression. The rational to find a new definition for burnout is that treating the anxiety or the depression without treating the underlying causes mostly leads only to a temporary therapeutic success.
Fear of Change
Change is a necessary aspect of life, but the prospect of new situations can bring about anxiety. How one deals with uncertainty, and the emotions it evokes, are often related to certain personality attributes and past life experiences. Someone who is more risk averse and had a parent with a violent temper, for example, may be more afraid of change than someone else. Thus, an aversion to change is often related to the communication patterns one has experienced in the past. Especially in situations where one felt helpless and communicating with the world did not seem helpful can lead to a greater fear of change.
The fear of change is usually lower in people who know more about themselves and about the world. This reduces the fear of change and helps in making better decisions. How to get there is usually through communication. By having a better connection with oneself and the world around the level of meaningful information one has can be increased. But this often requires reducing the fear of communication, the anxiety of openness with oneself and others. Openness is important because communication is inherently a two-way street.
Burnout often means that communication fails at some level. It may be the communication one has with oneself and with others. Difficulties in identifying one’s values, needs and aspirations make it less likely that one has the courage to change jobs or another situation in life. At the heart of this deficit in confidence in one’s effectiveness in the world is a low in trust in communicating with others and oneself. Adverse real-life experiences can contribute to this, but so can the fear itself.
An important communication failure is a disconnectedness with oneself, as internal disconnectedness can lead to external disconnectedness. If I am not receptive to the signals I am receiving on the inside, possibly as a reaction to an outside signal, I am not as good as I could be at decoding the outside signal. Our brain processes massive amounts of information and the narrower the focus becomes to the exclusion of most other information, the higher could be the chance of missing something relevant and meaningful. At the same time, one needs to be able to focus to identify and decode the components of a message. Burnout seems to rob a person of both, the alertness for meaningful and relevant information and the ability to focus on it. It is as if one has given up hope to find meaning and relevance in the heap of information one is confronted with.
As exhaustion, emotional detachment and cognitive impairment, as in the areas of concentration and focus, go hand in hand, the ability to work with and receive and send information is often severely impaired. It is not only that an individual withdraws physically from the world, but that there is also a withdrawal on the inside as the internal disconnectedness increases. However, the further one withdraws internally, the more difficult it becomes to identify relevant information and to work with it. The result is a vicious cycle form which one afflicted with it can hardly escape without external help, which may just be feedback about how one’s state appears to others.
A Vicious Cycle
Burnout is a situation of helplessness which arises if one sees no way out from a situation. In many situations, there are options, but they seem higher risk to an individual suffering from burnout than to others. As the burnout itself leads to feelings of helplessness, one feels even less well equipped to face change and new situations. The sense of ineffectiveness, especially in an interpersonal context, whether in the workplace or in a relationship, can add to the perceived helplessness.
When a person as a result of impaired communication feels not understood, separated, alienated and excluded, it often leads to more helplessness, anger, resentment and several emotions that try to increase the distance between the individual and others or an organisation to protect form further psychological hurt. If there are no other opportunities to communicate in a helpful way and the use of communication and communication patterns becomes even more unhelpful and maladaptive, the vicious cycle continues spiralling down. Optimism, openness and a basically positive belief in the world evaporate and make way for self-criticism, self-doubts and a sense of giving up on the world. To break this vicious cycle a renewed actual experience of meaningful communication is needed.
The fundamental process in burnout is an increasing disconnectedness from oneself and the world. However, most often people experience various somatic and psychological symptoms before reaching the point where they are becoming aware of the underlying process.
Symptoms of burnout in a medical sense often include
- loss of motivation
- distress, and
- feelings of ineffectiveness.
Even though that might not be as visible, an overall more negative view and understanding of the world can be added to this. It may be experienced by oneself or others as cynicism and chronic defensiveness, which does not further one’s interactions with other people.
The term burnout in psychology was coined by Herbert Freudenberger in his 1974 work on burnout. The term ‘burnout’ was probably based on the 1960 novel A Burnt-Out Case by Graham Greene, which describes a protagonist suffering from burnout.  It encapsulates the exhaustion, but it also visualizes on a metaphorical level that the uniqueness of the person seems extinguished. Healing from burnout requires the recovery of the sense of being and the experience of oneself as a distinct unique person. (Haverkampf, 2017c) Since the sense of self needs constant effort to be upheld in those suffering from a narcissistic personality disorder, much can be learned from the therapy of narcissism for the treatment of burnout.
The Interpersonal Dimension
Occupational burnout is typically and particularly found within human service professions. Professions with high levels of burnout include social workers, nurses, teachers, lawyers, engineers, medical practitioners, customer service representatives, and police officers.  One reason is probably the high exposure to other people’s emotions and problems, together with a high expectation for oneself.
From a communication perspective, the suffering one experiences in these professions is compounded by the fact that one works with people who have difficulties communicating their emotions. On the job an employee, for example, does not want to confront the boss about something that is making her angry or sad, or is just plain annoying, out of fear that this could have repercussions. A patient in a psychiatric hospital may have learned from his childhood experiences that one should not show emotions, including sadness. In both these cases the emotions do not go away and are then communicated less than optimally in other ways to a carer, teacher or anyone else who has no knowledge of the underlying causes for the emotion. The latter may then see the issue with himself or herself and take it personally, which leads to high stress levels because there is an urge to do something, while one cannot fix another person’s issues.
Development of Burnout
Burnout is usually a consequence of doing things one no longer sees meaning or a personal relevance in. One may remain in a job or a relationship that violates one’s values or be out of sync with one’s true wants and needs. Over time, this can lead to feeling like a hamster running in a wheel without any meaningful direction or any possibility at change and personal satisfaction. Achievements and one’s work itself become meaningless, which leads to emotional and cognitive disconnectedness from one’s work. The outward manifestation is less and worse interactions with others, which contributes to the social and individual problems of the individual suffering from burnout.
From a communication perspective, one no longer sees meaning in activities or things because there is a lack of information about them. This can be due to inefficient communication patterns, fears or a deficit in other information about the potential meaningfulness of the activities or things. However, in order for something to be meaningful to a person it has to be meaningful and relevant to the specific individual. It is possible to teach someone skills in looking for, receiving and processing information, but the meaningfulness of information to a person has to be discovered by him or her. This is one reason why simply saying what is supposed to be meaningful, as for example in a work setting, mostly does not work. As burnout is a condition that arises from an inner disconnect with core needs, values and aspirations, any prevention or therapeutic efforts have to address the dynamics of internal communication as well.
Values, Interests and Aspirations
Focusing on the individual’s values, interests and aspirations is effective in managing burnout and developing people. These parameters also play a role in depression and anxiety in the work by the author . Burnout is becoming a more common result as the modern workplace changes. The increasingly hostile and demanding environments in which employees work seems directly related to the loss in information and support which could help employees see meaning in their work, which goes beyond the financial rewards and transcends mere status or other superficial external validators. The primary objective should be to make patients see personal meaning again in what they are doing, and this should resonate with their own values, needs and aspirations.
The basic parameters on needs, values and aspirations change relatively little over time, and the feeling of stability can be significantly strengthened through the process of identifying them. (Haverkampf, 2017a) The needed inner focus of this process can also be helpful in the treatment of burnout by deemphasizing the need for external validation and shifting the spotlight on what is really important to the person, which also reduces feeling of being overwhelmed and lost in a chaotic situation.
In burnout, the own needs, values and aspiration are increasingly perceived as something dangerous and destabilizing, while it is in fact the increasing disconnect from them which is destabilizing. (Haverkampf, 2013a) Burnout leads to an increasingly narrower focus which may be perceived as stabilizing, but the deficit in communication and flows of meaningful information severely limits any autoregulatory feedback mechanisms and even compromise the sense of self, which is the experience of these communication flows. (Haverkampf, 2010, 2018a) As the communication with oneself and others ‘burns out’, the own person ‘burns away’. Burnout is thus not only a condition with depersonalisation symptoms, but one where quite literally a de-personalisation takes place. To reverse the process requires a re-personalisation, an increased connectedness with oneself and others and an exploration of true and authentic own needs, values and aspirations, which goes hand in hand with improved receptiveness to meaningful communication, internally and externally.
Demands and Resources
If the demands from an individual, whether internal or external, go beyond his or her resources, no degree of meaningfulness or personal investment in a task will be able to prevent an eventual burnout. A review by Demerouti and co-workers (2001) found that burnout can be explained by the two factors of job demands and job resources, and that exhaustion is correlated to job demands, and that job resources are negatively correlated to disengagement. They also showed that burnout is present in all types of jobs, and not just within human services. 
At this point it may be helpful to look at what are resources. One definition could be that they are personal attributes and capabilities which can help or sustain one in adverse circumstances. However, this does not seem to go far enough in explaining resources as something that is also positive to help in normal circumstances where one may want to achieve something. A broader definition would be a source of helpful information, which can be drawn on depending on the needs in a given situation. Since psychologically, a person’s resources consist of one’s knowledge (available information) and ability to process information, better internal and external communication patterns increase one’s non-physical resources.
Particularly in the case of burnout, there may also be a misinterpretation of the demands one is faced with. One may experience internal and external demands. Quite often, individuals who suffer from burnout put themselves under enormous pressure. A particularly stress inducing combination is setting very high standards for oneself, while having small hopes of attaining them. Especially if one’s self-confidence is low and self-image quite negative, a decrease in trusting oneself is often what triggers this divergence in standards with high demands and low expectations or hopes. A better connectedness with oneself and a clearer identification of own needs, values and aspirations as well as a better sense of one’s internal resources can reverse this divergence, and so reduce stress and ameliorate the typical symptoms of burnout.
The Stages of Burnout
Burnout does not follow a universal set script, but there may be attributes and symptoms that play a greater role early or later in the progression of burnout. It is helpful to be able to recognize the early signs to help preventively. (Haverkampf, 2013a, 2013b)
All forms of burnout lead to the already mentioned internal and external disconnectedness in relation to the flow of meaningful information. As the individual detaches increasingly from the own self and the world around, openness, flexibility and adaptability suffer, which make the patient more susceptible to miscommunication and conflicts with the environment. They also make it harder to fulfil own needs and aspiration because the interactions with others and with oneself suffer.
Herbert Freudenberger and Gail North have theorized that the burnout process can be divided into 12 phases. 
- The compulsion to prove oneself
Often found at the beginning is excessive ambition. The desire to prove oneself in the workplace turns into compulsion.
- Working harder
Because they have to prove themselves to others or try to fit in an organization that does not suit them, people establish high personal expectations. In order to meet these expectations, they tend to focus solely on work while they take on more work than they otherwise would. It may happen that they become obsessed with doing everything themselves to show that they are irreplaceable.
- Neglecting their needs
Since they have to devote everything to work, they now have no time and energy for anything else. Friends and family, eating and sleeping start to be seen as unnecessary or unimportant, as they reduce the time and energy that can be spent on work.
- Displacement of conflicts
They become aware that what they are doing is not right, but they are unable to see the source of the problem. This may lead to a crisis in themselves and become threatening. The first physical symptoms appear.
- Revision of values
While falling into a state of denial of basic physical needs, perceptions and value systems change. Work consumes all energy, leaving none for friends and hobbies. The job is the new value system and people start to become emotionally blunt.
- Denial of emerging problems
People may become intolerant and dislike being social. They may be seen as aggressive and sarcastic. Problems may be blamed on time pressure and all the work that they have to do.
Minimal social contact turns into isolation. Alcohol or drugs may be used as a release from obsessive working “by the book”. These people often have feelings of being without hope or direction.
- Obvious behavioural changes
Co-workers, family, friends and others in their immediate social circles cannot overlook the behavioural changes in these people.
It is possible that they no longer see themselves or others as valuable. Their view of life narrows to only seeing the moment and life turns to a series of mechanical functions.
- Inner emptiness
They feel empty inside and may exaggerate activities such as overeating or sex to overcome these feelings.
Burnout may include depression. In that case, the person is exhausted, hopeless, indifferent, and believes that life has no meaning.
- Burnout syndrome
They collapse physically and emotionally and need immediate medical attention. In extreme cases, suicidal ideation may occur, with it being viewed as an escape from their situation. Only a few people will actually commit suicide.
These phases usually do not occur sequentially, and it is also important to remember that they do not elucidate the underlying processes that lead to burnout. A compulsion to prove oneself means there is a need for this, which has underlying reasons. Clinical experience shows that people who are clear about their needs and have a well-working coherent set of values are less likely to be found in a burnout situation. Proving oneself for the sake of proving oneself shows that an individual either is unclear about the things that are truly meaningful to him, or that he does not believe that it is possible to find work that is meaningful to him. Often, this is not due to an actual lack of opportunities, but a consequence of a lack of openness, which can be a consequence of anxiety, maladaptive communication patterns and a number of other reasons. Communication, however, plays often an important role.
Communication is an important element in the treatment of burnout. Since problems in communication patterns and styles lead to the processes which ultimately lead to burnout, it is also work on communication which can help resolve the condition.
First, it is important to help a patient establish an awareness for the situation and the effect it has on her. This can raise anxieties and other defence mechanisms. Open communication about own feelings and imagined worries and problems can help to identify where they are coming from. Often, the pressure from the symptoms of the burnout and external factors, such as the risk of losing a job or a relationship, are strong enough to help an individual stay on course in treatment.
The next step is then to acquire the perspective and skills to effectively deal with the burnout. This requires looking at own interests, values, needs and aspirations to enable oneself to make decisions again and to say ‘yes’ or ‘no’ to situations. The reconnection with oneself, emotional and otherwise, also provides a greater sense for one’s own resources and a better sense of self-confidence. Looking at communication patterns and styles in a therapeutic session, and reflecting on them, also in the narratives about everyday life, help the patient to acquire a better sense of efficacy in interactions with the world and with oneself. This should not be rushed, but allowed to take the time which is necessary to attain a good level of stability and a better sense of self to deal with decisions and everyday life.
Communication-Focused Therapy (CFT) was developed by the author to focus more specifically on the communication process between patient and therapist. The central piece is that the sending and receiving of meaningful messages is at the heart of any change process. CBT, psychodynamic psychotherapy and IPT help because they define a format in which communication processes take place that can bring about change. However, thy do not work directly with the communication processes. CFT attempts to do so.
Communication is Life
We engage constantly in communication. The cells in our bodies do so with each other using electrical current, molecules, vibrations or even electromagnetic waves. People communicate with each other also through a multitude of channels, which may on several technologies and intermediaries. It does not have to be an email. Spoken communication requires multiple signal translations from electrical and chemical transmission in the nervous system to mechanical transmission as the muscles and the air stream determine the motions of the vocal chords and then as sound waves travelling through the air, followed by various translations on the receiving end. At each end, in the sender and in the receiver, there is also a processing of information which relies on the highly complex networks of the nervous system. Communication, in short, happens everywhere all the time. It is an integral part of life. Certain communication patterns can, however, also contribute to experiencing anxiety and panic attacks.
Communication is an autoregulatory mechanism. It ensures that living organisms, including people, can adapt to their environment and live a life according to their interests, desires, values, and aspirations. This does not only require communicating with a salesperson, writing an exam paper or watching a movie, but also finding out more about oneself, psychologically and physically. Whether measuring one’s strength at the gym or engaging in self-talk, this self-exploration requires flows of relevant and meaningful information. Communication allows us to have a sense of self and a grasp of who we are and what we need and want in the world, but it has to be learned similar to our communication with other people. We are born with the equipment, but it requires using it to become good at it and build new patterns and styles on top of it. This process of experiencing and building communication patterns and structures is the process in which one turns into a person with a unique personality. Out of communication happens the birth of the individual. (Haverkampf, 2010, 2018a)
The person and what is at the core of the self and at the core of the person are phenomena that grow out of experiencing communication flows (the self) and through external and internal communication (the person and its characterization in the form of personality). If autoregulation processes work all goes well and the development proceeds according to the rules of the underlying communication processes and its own rules. However, adverse external communication experiences in life, particularly in the early stages of life, can be associated with emotions that are no longer helpful in moving (hence ‘e-motion’) towards an analysis of the situation and a learning process, but instead cause overall fear of the communication process itself. This may also happen because the cognitive abilities at a young age to take a step out of a situation and observe it are not yet fully developed. The result is in any case that autoregulatory processes, which rely on flexible information transfer and processing patterns, are now suppressed and no longer effective as they are perceived as a danger by the neural network. (Haverkampf, 2017b, 2018c)
The individual suffering from burnout may feel that the current situation needs to be changed, but does not do so, out of a fear of change and/or the efforts associated with it. This makes it often difficult for people to admit that they are suffering from burnout out of fear that some change is needed which is perceived as increasing uncertainty and anxiety. But doing something about burnout actually lowers uncertainty and increased stability.
Burnout is a strong signal for change that needs to be taken seriously because it means that a person is stuck in a place from which extricating oneself is getting harder and harder. The longer a person has been in a state of burnout, the longer the fears and the de-personalisation has lasted, the greater is the anxiety and the stronger are the defences against effective treatment of the burnout.
The longer a state of burnout has lasted, the greater is the likelihood of secondary and reactive conditions (co-morbidity) of depression, anxiety, social anxiety and others. This may make it harder for the patient to build working and effective internal and external communication patterns, pathways and structures, but one needs to see that once the pathological impairments of the burnout condition are being removed, these apparent co-morbidities often dissolve. When working in therapy with a patient suffering form burnout, it helps to discuss that the symptoms of depression and anxiety are maintained by the broken communication systems of the burnout affliction. Rather than focusing on therapy against depression and anxiety it is more effective to work on the internal and external communication patterns, which also helps to clarify and elucidate the own basic parameters (needs, values, aspirations), while offering enough support to the patient that a temporary worsening of a low or an anxious state can be managed by the patient with the help of the therapist. This also improves the patient in herself or himself.
Ineffective Communication Patterns
Communication patterns are learned throughout one’s life. (Haverkampf, 2018b) Many are acquired in childhood and adolescence. Over time, they need more or less significant adjustment and finetuning. Especially if one’s life experiences have been unusual, there may need to be adjustment. If one has been beaten or abused as a child, there may be a tendency not to show emotions, not to talk back or overly try to protect oneself when interacting with someone in a role of authority, and possibly of the opposite sex. In adult life, using the same communication patterns can interfere with one’s job performance or relationships. One may be more likely to stay in impossible situations, rather than walk away and take the risk of being on one’s own or just to say ‘No’ once in a while. While such a strategy may have afforded some protection early in life, it is now a hindrance, which should be identified in one’s interactions with another, such as in psychotherapy setting.
There is often a focus on worst outcomes and strong fears which are caused by it. Underlying this are often strong emotions or conflicts which need to be defended against. The danger and uncertainty is quite frequently inside oneself, rather than on the outside. An individual with a fear of flying may be more afraid of not containing oneself and not being able to leave the plain than anything else. Anxiety is the fear of crashing oneself and the feelings of a dreaded uncertainty about oneself and one’s emotional states.
Communication patterns and structures are discussed in much greater detail in other publications by the same author. (Haverkampf, 2018b)
Fear of the Own Emotions
Often, people are more afraid of how an event will make them feel rather than the event itself. Especially if there is also an element of depression, the fear of being responsible for a bad outcome and having to blame oneself and feeling guilty for it are common themes.
In burnout, one’s emotions can seem dangerous because they press for change. If one is getting disconnected from one’s job and one does not see much meaning in it anymore, connecting with one’s emotions means realizing this fact. This is one reason why there is often a disconnect from oneself in burnout, because it could hurt too much to face this realization. However, disconnecting from oneself emotionally and suppressing this important internal communication is often responsible for many of the symptoms one sees in burnout. Especially anxiety is often the result of conflicting emotions one is not consciously aware of or is trying to suppress consciously.
Fears of Knowing the Self
One can feel oneself without being able to describe it. That is the sense of ‘self’. It is not at thing, but the perception of communication in the body. The billions of different information streams on the inside and between oneself and the outside world make life and success in life possible, and while sensing them leads to the sense of self and gives it texture. This means the concept of self depends on meaningful information. A repetitive fully predictable signal, for example, would not help an individual to better define the own sense of self, unexpected changes, and the own reactions to them, however, could.
In burnout, a disconnect from one’s emotions leads to a less complete perception of oneself, and vice versa. The less complete perception of oneself lowers the confidence to do things, especially to take a new direction and make changes in one’s life.
One reason people often try to disconnect from or suppress their emotions is to feel themselves less. Especially in situations where one does not see a way out, the urge to disconnect may be significant. However, a disconnect from oneself may also lead to an inability to distinguish what is meaningful in one’s life. However, engaging in activities that are meaningful promotes feelings of happiness or joy, while engaging in activities that are not relevant or meaningful to oneself can bring about uneasiness or negative feelings. Overcoming one’s anxiety of communicating with oneself, and also of communicating with others in a meaningful way, usually makes reconnecting much easier and almost automatic.
Individuals suffering from burnout often see less genuine meaning in the things they do. In therapy an important part is to rediscover meaning and find it in the things that are relevant to the patient. Relevant is anything that is close to his or her values, basic interests, aspirations, wants, wishes and desires.
Meaning can be distilled from interactions with another. The therapeutic setting allows to build a repertoire of skills and insights to engage in this process more effectively. The therapist is experienced at reflecting not only on content, but also on the communication processes taking place in a therapeutic session. This experience should help the patient to become more aware of them and develop insight into them. Since one gets what one needs and wants through communication with others, and finds out about what one needs and wants through communication with oneself, having insight into one’s communication patterns and thus being able to shape them leads to a more fulfilled life and a reduction in the symptoms from burnout.
Burnout usually leads to a narrowing in focus, or even a loss of focus. If the focus becomes narrower it is usually not on things one enjoys or that feel relevant or meaningful, which then often leads to a loss of focus and an inability to see and perceive things. The world itself becomes dull because communication with oneself and the world is significantly reduced. To increase a patient’s awareness of oneself and the world again, one needs to foster a greater interest in communication.
Awareness should be especially directed at the interaction with others, the communication pattern one uses in interactions with other people and oneself. Awareness of the flows of information can also help to clarify the roles one uses and how one is seen by others. Awareness of how one interacts with oneself and others can help to better formulate the own needs, wants and values and pursue them.
Experiencing the World
Perceiving more meaning also makes interacting with others and oneself more meaningful. This has a positive effect on one’s interaction patterns, how and in which ways one relates to one’s environment and exchanges messages with it.
Relevance comes before meaning. One will not decode a message if one does not feel it is relevant. The first step to make experiences in the world more meaningful is to make them appear relevant.
To find things relevant they have to resonate with one’s interests and values. This also means that the more knows about one’s values and interests, the easier it is to see relevance in the interactions, situations and things around oneself.
It is equally important, however, to develop communication patterns which make it easier to absorb potentially relevant information. This may require a greater openness, which can mean overcoming fears of interactions and the communication process.
Many people have a basic sense of what is relevant to them. Without reflection on it, it is likely that a significant proportion of this will be things that are important to other people. This can be a good starting point in some areas, but it does not include enough of the individual preferences and values. If it seems socially very acceptable to work as a lawyer, but it does not square with one’s personal preferences, this will not lead to happiness in the long-run. It is important to distinguish if this is a relevance based on one’s own values and interests, or on someone else’s. This is not to say that there is no room for altruistic deeds, rather the opposite, the altruistic behavior should be relevant to oneself.
Meaningful information is information which can induce a change in the recipient. This change may be small, a thought, a trace of an emotional signal, a memory which brings about change in itself. Meaningful information on a date or at a movie theatre may change one’s emotional state, for example, while it can lead to a new scientific insight in a research lab. For information to be meaningful it cannot be entirely predictable. Even if the information is a mere repetition of some other information, its occurrence or the setting in which it occurs must not be fully predictable. An addiction to a particular message, for example, renders the message meaningless.
Burnout requires a deficit in the experience of meaning somewhere. When we carry out a task or interact with another person, we receive and process information. If this is not meaningful within the context of the information we already have, particularly the information about our needs, values and aspiration, and seems irrelevant, we detach from the person or task, we experience exhaustion and over time burnout if we cannot also distance ourselves form the interaction or task physically.
Since burnout induces feelings of helplessness that impede the hope and search for meaningful information, and change can only be brought about by internal or external meaningful information, the individual finds himself or herself trapped in a vicious cycle without escape. The task of therapy is to break through this cycle by increasing the capability to communicate internally and externally in ways which increase the perception of meaning.
Seeing more options and opportunities to engage in often relieves current stress and makes it easier to change a stressful situation in the future. Options have to be available and meaningful. Burnout usually constricts the scope of options and meaning one sees in the world. Better communication patterns can make it easier to see more meaning in the world. It can give one a greater sense of efficacy in the world and make one see more meaningful options.
Values, Needs and Aspirations
Individuals with burnout often lose the sense for what they value, need and aspire to. This is part of losing connection with oneself and with others, because values and aspirations can only be determined in contact with other people. Even language has to be learned from others. Being able to receive and process information flows from others is therefore important to determine one’s values and aspirations. Even one’s needs, except for the most basic ones, such as food and drink, only make sense in a social context, which has to be learned from interactions, communication, with others.
Happiness, satisfaction and contentment, as well as many other positive feeling states, are a consequence of engaging in thoughts or activities, which are meaningful to oneself. This means they have to be relevant and the connection one has with them has to be perceived and understood. Work on communication pattern with oneself and others can accomplish this.
Meaningful Messages as the Instrument of Change
Communication is the vehicle of change. The instruments are meaningful messages which are generated and received by the people who take part in these interactions. In a therapeutic setting, keeping the mutual flow of information relevant and meaningful brings change in both people who take part in this process. The learning curve for the patient may be steeper in certain respects because he or she spends less time in this interaction style than a therapist.
However, any changes themselves induce further meaningful messages. This feedback cycle is important because it helps to fine-tune changes to re-establish a new stable equilibrium in the short-term and also enables the environment to adjust to the change. It is often as important in therapy to help a patient to interact in more helpful ways with the world as it is to help the patient rediscover the benefit of being open and receptive to feedback from the environment and oneself. The principle is to be able to make the most of meaningful information and to be receptive to it.
Often, sources of meaningful information have to be rediscovered, which can be furthered in therapy. Burnout leads to a tunnel vision, and in more advanced stages may even close of the tunnel. The person suffering from burnout then finds herself in complete darkness, a full disconnect from internal and external flows of information. There is no longer and helpful change or adjustment, and tasks are merely continued in a robotic way. The solution is to get more light into this place. This may be too bright in the beginning, but quite quickly a world of options and alternatives becomes visible. The fear of this process can be mitigated by pointing out that it is not only a greater connectivity with the world, but also with oneself, which leads to greater experienced internal and external stability in the long-run.
Real World Change
Once the internal change has happened, the external change is almost automatic. One gravitates more openly towards activities which are meaningful and relevant to oneself. This may not happen in the short-run, but only an openness to this the adjustment process has started often improves a patient’s mood, motivation, and strengthens the sense of self. Staying in a stressful situation in the short-run can be easier to bear if one knows there is light at the end of the tunnel.
The changes in communication patterns and interactions with oneself and others usually guide the changes that will ultimately take place in one’s immediate environment. It is important to remember that the network of social interactions guides the flow of information, but that it is the flows of meaningful information which drive and configure the network. In patients with burnout, one may be tempted to discuss the work arrangement and social networks a patient has rather than the communication patterns, the ways the patient exchanges meaningful information, which drives and shapes the connection patterns and arrangements in work and personal life. However, if one also pays attention to the internal and external communication patterns a patient uses and helps the patient to become more aware of, understand and work with them, helpful lasting change often results relatively quickly.
Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy and counselling in Dublin, Ireland. He is the author of several books and over a hundred articles. Dr Haverkampf has developed Communication-Focused Therapy® and has written extensively about it. He also has advanced degrees in management and law. The author can be reached by email at jo****************@gm***.com or at www.jonathanhaverkampf.com.
For other articles on burnout on this website, you may be interested in the following:
Communication-Focused Therapy (CFT) for Burnout (3)
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 Haverkampf CJ Communication-Focused Therapy (CFT) for Depression. J Psychiatry Psychotherapy Communication 2017 Dec 31;6(4):101-104.
 Haverkampf CJ Communication-Focused Therapy (CFT) for Social Anxiety and Shyness. J Psychiatry Psychotherapy Communication 2017 Dec 31;6(4):108-113.
Haverkampf, C. J. (2010). A Primer on Interpersonal Communication (3rd ed.). Dublin: Psychiatry Psychotherapy Communication Publishing Ltd.
Haverkampf, C. J. (2013a). A Case of Burnout. J Psychiatry Psychotherapy Communication, 2(3), 80–87.
Haverkampf, C. J. (2013b). Economic Costs of Burnout. J Psychiatry Psychotherapy Communication, 2(3), 88–94.
Haverkampf, C. J. (2017a). Communication-Focused Therapy (CFT) (2nd ed.). Dublin: Psychiatry Psychotherapy Communication Publishing Ltd.
Haverkampf, C. J. (2017b). From Neuroscience to Psychiatry (1). Retrieved from https://www.jonathanhaverkampf.com/
Haverkampf, C. J. (2017c). Healing Burnout.
Haverkampf, C. J. (2018a). A Primer on Communication Theory.
Haverkampf, C. J. (2018b). Communication Patterns and Structures.
Haverkampf, C. J. (2018c). Neuroscience, Communication and Psychotherapy. Retrieved from https://www.jonathanhaverkampf.com/
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