Communication-Focused Therapy® (CFT) for Burnout
Christian Jonathan Haverkampf, M.D.
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. Communication-Focused Therapy (CFT) is a psychotherapy developed by the author, which can be applied to a number of mental health conditions, including burnout.
Keywords: burnout, communication-focused therapy, CFT, communication, psychotherapy, treatment
Table of Contents
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.
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.
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.
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.
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.
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, because they are afraid of the change it may bring. But burnout is a strong signal for change that needs to be taken seriously.
Burnout, defined as a state of physical, emotional and mental exhaustion, typically occurs as a result of working with people over long periods of time in situations that are emotionally demanding. (Pines & Aronson, 1983) Empathy has sometimes be seen as a cause of burnout. However, it is more likely to have protective effects. In a study of 173 social workers that explored the relationship between the components of empathy, burnout, secondary traumatic stress (STS), and compassion satisfaction, findings suggested that components of empathy may prevent or reduce burnout and STS while increasing compassion satisfaction. (Wagaman, Geiger, Shockley, & Segal, 2015) The authors recommended that empathy should be incorporated into training and education throughout the course of a social worker’s career.
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.
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 to reduce 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.
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.
Communication patterns are learned throughout one’s life. (Haverkampf, 2018a) Many are acquired in childhood and adolescence. Over time, they require adjustment and finetuning. Depending on one’s life experiences one learns new ways of interacting with oneself and the world. After traumatic experiences, an individual’s trust in the world can change dramatically, which then also impacts how a person interacts with others. Weine and colleagues have shown how communication changes in refugee families, for example. (Weine et al., 2004) However, most of the adjustments in communication patterns happen as a result of the many interactions one has with others every day, as well as the interactions has with oneself internally. If these processes are flexible, open and adhere to adaptive learning principles, the individual’s abilities in interacting with others externally while regulating the own inner world internally increases, which leads to a better fulfilment of own needs, values and aspirations as well as a higher quality of life. In burnout, however, these adjustment processes cease to work properly as the flexibility and openness decrease and internal and external communication are increasingly restricted. The restriction on communication is probably a result of maladaptive protective mechanisms which are activated in the face of subjectively overwhelming stressors.
There can be several psychological predisposing factors for burnout. The most insidious one is probably having experienced interactions with others as basically, which makes communication as the fundamental autoregulatory mechanism inaccessible due to fear. 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. The attempt to make the memory of an own negative past experience go away by always being there for others may be another example which often leads to burnout. The problem here does not lie in caring for others, but the sense of not being able to choose to do so freely because of the deeper meaning one sees it.
The concept of personality is closely tied to how and what one communicates, and thus the communication patterns. As one has a social persona which plays a significant role in interactions with others, changes in communication patterns can often lead to anxiety. This may be based on a misunderstanding between a social person, personality and self. Who we feel as and perceives ourselves us at the core is the sense of self, which is really an overall sense of the information flowing within oneself. The sense of personality, however, is more closely linked to the communication strategies one uses. It is thus more detailed, but also potentially subject to some change. One’s personality is still relatively stable over time because the communication patterns and strategies one uses also have to align with and be effective in furthering own need, values and aspirations, which are basic parameters that change little over time, if at all. (Haverkampf, 2018b)
The instability inherent in ineffective or maladaptive communication patterns can make the feelings of anxiety and helplessness in burnout worse. If a situation already seems overwhelming, making changes in something as basic as how one interacts with others and oneself can cause even greater anxiety. Underlying an adversity to change, flexibility and openness are often strong emotions or conflicts which need to be defended against. The danger to safety and stability is perceived within oneself, although it is projected into the outside world. If someone feels anxious about changing strategies, it seems like a fear about some external event or situation, like the workplace or a personal relationship, but in truth it is a fear and uncertainty about oneself. To take the fear requires more rather than less connectedness, with oneself, to find one’s own basic parameters, and with others, to get back the sense of efficacy and optimism in meeting one’s needs, values and aspirations. An individual with a fear of flying is usually mostly afraid of the own feelings, emotions and thoughts, often more so than about the outside world. Anxiety is the fear of crashing as a person, as a self.
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.
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.
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 constant transmission of information in mind and body is a feature of life, but the ability to consciously sense it gives rise to a sense of self. This means the concept of self is associated with information. Connecting with oneself, with the flows of information, also leads to insight about oneself.
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. In communication-focused therapy, connectedness with oneself and others is increased through a focus on adjustment and change in the communication patterns a person uses in exchanging information with oneself and others.
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.
The relevance of various aspects of meaning in people’s efforts to cope with unwanted life events and aversive life conditions has been described widely in the literature. This body of work indicates that a number of aspects of meaning may be critical in people’s adjustment to stress. However, there is great diversity in the conceptual and operational approaches to meaning in the context of coping and adjustment to stressful life events and conditions. (Park & Folkman, 1997)
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. These parameters can be identified through
- reflection on the feelings associated with past experiences and
- one’s communication patterns and styles in the present.
Meaning is information that can bring about a change in the recipient. It is information that at the minimum leaves a trace in memory, but it also has the potential to make other information meaningful. It is this ‘contagion effect’ of meaningful information which plays a large role in how it can cause change. In burnout, the meaning making process largely comes to a standstill.
Park and Folkman developed a meaning-making model of coping. This model distinguishes between two levels of meaning: Systems of global meaning and the appraised meaning of specific events. Global meaning includes global beliefs and global goals. Global beliefs are the basic internal cognitive structures that individuals construct about the nature of the world. These structures guide people throughout life by influencing their fundamental ways of construing reality and by structuring their global goals. Global goals are the basic internal representations of desired outcomes that motivate people in their lives. (Park & Folkman, 1997)
Meaning can be identified in interactions, whether with oneself or with others. The therapeutic setting allows to build a repertoire of skills and insights to engage in this process more effectively. The therapist’s experience with a variety of different communication patterns and situations should help a patient to become more aware of their own and build 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.
Pines and Aronson conducted a small study in a workshop. Interestingly, as the awareness of the relationship between various work features and the experience of burnout increased, burnout decreased and supervisor and customer satisfaction increased. (Pines & Aronson, 1983) Self-awareness can build greater competence, increase the individual ability to build healthy boundaries and prevent burnout. Developing a professional self, which requires self-awareness, also seems to protect against client violence among social workers. (Urdang, 2010)
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. As one sees more ‘value’ in the world and in oneself, self-confidence increases, and it is easier to draw boundaries, which help to protect from unhealthy stressors and situations that cause and maintain burnout. It also changes the communication dynamics, as one attaches a greater weight to the information from within oneself, reflecting own needs, values and aspirations.
Better communication patterns increase perceived relevance, as there is also more information available about messages that are received from the environment. If one not only has the information contained in a sentence another person utters, but also information about the situation and the other person as well as a set of non-verbal cues, the sentence may not only yield a different meaning, but it can also become more relevant which increases the receptivity for meaning. One will not search for information if one does not feel it is relevant. However, the better one communicates, and the more meaning one sees in aspects of the world, the more the world as a whole becomes relevant and meaningful, which is the inverse of the direction that leads into the burnout.
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. Much of this will be shared with other people, as humans have ultimately much more in common than what sets them apart. However, an insight into the individual needs, values and aspirations is important. For example, even if it is socially acceptable to train as a lawyer, it may not square with one’s basic preferences, which over the long-term determine the level of satisfaction and happiness one will derive from one’s job. It is important to know the source of validation one is looking for, and what one needs it for. A need for external validation to fill an inner void is unlikely to lead to decisions that will bring long-term happiness. Resolving such a dilemma is, however, quite easy. It only requires awareness as a first step. The rest follows almost automatically.
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.
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.
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.
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.
Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at firstname.lastname@example.org or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.
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