Christian Jonathan Haverkampf, M.D.
Burnout can have a devastating effect on individual well-being and on a society as whole. Unfortunately, burnout develops gradually and most individuals suffering from it do not realize they have it until their job or relationship are in danger. Fears can make it difficult for an individual to seek the help that is often desperately needed.
Healing burnout consists of straight forward steps, which are also described in the author’s works on communication-focused therapy (CFT). The focus is on finding relevance and meaning again in various areas in life and in reconnecting emotionally and cognitively. Awareness of internal and external communication patterns is important to initiate the change in them which improves the interactions one has with the world and oneself.
Keywords: burnout, treatment, psychotherapy, psychiatry
Table of Contents
Burnout is largely a product of the society we live in and our interactions with it. The more we are in communication with others, the more messages we receive and send, the higher is the chance for collaborative success, but the greater is also the risk of burnout, especially if we do not know what goal we are chasing or why we are doing our daily routine. The problem is most often not that the world is faster or more interconnected, but that many people do not know the reasons they are going after their daily for. The solution for burnout has to do with meaning, but especially with true values, interests and aspirations. The road to get there is to develop awareness for communication processes and to work on improving them. This helps in getting what one needs, desires and aspires to, and improves the sense of efficacy in the world.
A loss in seeing meaning and relevance in the world often lie at the heart of burnout. Reconnecting is an effective way to get out of it. This may require some changes. The first important change is often an adjustment in perspective, which then leads to other changes. Focusing on communication patterns a person uses makes change easier and longer lasting than if one tries to force a change in thinking or behaviours. The reason is that changes in communication patterns tend to perpetuate and entrench themselves.
Many people may prefer easy fixes, such as manualized techniques to change their thinking and behavioural patterns. However, these techniques often do not lead to the long-term effect that is required to ensure lasting change. They also do not address any problems with the sense of self and the self-image, which requires a communication-focused approach as the sense of self results from a perception of internal communication flows.
Burnout was probably rare in stone age societies, and it takes highly artificial conditions to induce burnout in animals. While it is possible to induce some symptoms similar to a human burnout in lab rats when they are exposed to persistent stimuli causing high levels of negative stress and arousal, this is unlikely to occur outside the lab. However, under these conditions the animals show symptoms that are quite similar to humans suffering from burnout, including apathy, hypervigilance and disturbed eating patterns and sleep-wake cycles. They have low tolerance for even minor stimuli, such as noise, and seem to experience helplessness and high levels of psychological distress. Their life expectancy is reduced, they no longer eat regularly, often lose weight, show signs of exhaustion and after a while suffer from bodily conditions that ultimately lead to an early death. They seem to have learned that they are helpless and that their avoidance behaviour is ineffective. Like people they seem trapped in a hopeless situation, but, unlike humans, they really are.
It may be difficult to experience the feeling of helplessness because it only seems to increase anxiety and fears. However, an important step to emerge from a state of burnout is to reconnect with one’s emotions, and that means all of them. The reason is that all emotions are signals. There are no ‘bad’ emotions and they all can provide valuable information about oneself and one’s interaction pattern with the world. The key is to interpret these signals and gain insight into what is ‘out of sync’ in the present and where they want to take one in the future. Just the process of doing this makes the feeling of helplessness disappear.
Burnout does not mean having to change one’s personality, needs, values or long-term aspirations. It requires more awareness of them, and strategies and skills to make them work in the world. Since communication is how we get them met, working on one’s communication patterns, both the internal and external ones, is a crucial step in reversing burnout.
Many people go through life without thinking about their values, interests and aspirations. Some may not have to think about them consciously, but many others are probably not thinking about them because they are afraid to do so. Frequent are fears that one must change one’s life from one day to the next or that one has wasted part of one’s life in the pursuit of things that do not matter much to oneself. However, these fears are misplaced because we all do things for a reason, so that also our past actions, thoughts and interactions were for a reason. The more important question is what can be learned from past experiences about one’s needs, values, aspirations, what was enjoyable and what was not, which strategies worked, and which did not. Life is a learning experience, even when it comes to finding meaning in it, the world and oneself.
When thinking about meaning, it is important to ask oneself whether this is a constructive process, or the ruminations are just for the sake of ruminating, which can in some cases even be a form of avoidance or escape. To find meaning in things, requires disengaging from anxiety and fear but engaging with one’s feelings to an extent that makes it possible to really know how one feels about a thought, an activity, a situation, an interaction with another and more. Meaning is as much built on emotions as it is on cognitive thought. They all contain information which lead to a person’s perception of meaning.
Doing things that bring enjoyment, happiness, satisfaction and contentment are the antidote against burnout. While professional and personal life requires us to do things we may not enjoy or even consider a nuisance, there should be a medium- to long-term expectation of positive feelings in life. The reason for negative feelings is that they put us back on the right path. The tendency to ignore the own feelings, and thus disconnecting from oneself emotionally and cognitively, is understandable. However, a change in perspective that lets one see more meaning in the world is hardly something one needs to be afraid of. Just the opposite, a richer life leads to more positive feelings and greater happiness in the long-run. A better connection with oneself and the world is a means to achieve this in a more permanent way.
Several techniques to reactivate meaning are described in reports on the use of communication-focused therapy (CFT) for anxiety, depression and other conditions. (Haverkampf, 2017a, 2017b, 2017c, 2017d, 2018). They equally play a role in burnout, which revolves around a deficit in perceiving meaning at the work place, and mostly also in other areas of life.
Values, needs and aspirations reveal themselves in the actions and interactions someone has with the environment. What one considers meaningful, valuable and relevant shows in the messages that one communicates internally and externally, and especially in how they are communicated. The therapy session is a place where skills can be practiced engaging in and reflecting on communication, which can bring about the needed changes in perspective.
Some professions require more effective boundaries than others. A desk job exposes a person less to the issues of others than does a job where one is constantly exposed to other people’s problems. The training of a psychotherapist largely aims at acquiring tools and skills that help to draw healthy boundaries.
Being a care provider or teacher in a less than ideal environment often leads to burnout if one has a need to ‘give it all’ and ‘care for others as if there is no tomorrow’. Although burnout can occur over time in a variety of situations, it is mainly triggered by events in the workplace or in a relationship. There is usually an element of perceived pressure somewhere in the development of burnout. It may be because one feels responsible for something which is not under one’s control, or only partly. At some point taking on a task may have been seen as necessary, even though one had better said ‘no’ to it. The pressure to do the impossible or just barely possible often comes from an internal locus of felt uncertainty, which leads to a situation where one just does something to be on the safe side. Burnout thus begins with a combination of risk aversion and lack of quality information about the situation and about one’s needs, values and aspirations. Better communication can provide this information and enable one to draw clearer and more robust boundaries.
The external cause is usually a prolonged external stressor, such as a mobbing situation or an unhappiness with the current job or relationship. The internal causes are often preconditioning personality aspects, such as the inability to say ‘No’ or to keep an appropriate distance to other people’s problems. It almost always requires both, the external and the internal factors, to lead to a full-blown burnout. If one feels secure and confident with oneself, one might just leave the job which does not work for oneself or draw better boundaries, if change is possible, and so avoid burnout. On the other hand, working in a loving and caring environment will probably not lead to burnout, even If one has difficulties in saying ‘No’. Healing burnout also means making life easier by choosing environments that conform better with the own personality, values, interests, needs and aspirations. While learning to fight back and defend oneself can be an important skill to learn, one may still not enjoy it if fighting in any form does not agree with the own personality, and over the long-run there is no point in repeatedly having to do things one does not enjoy.
The skill to draw boundaries is built and practiced through communication, both with oneself and with others. More accurately identifying which is one’s own issue and which is that of another person can make it easier to get drawn into the internal emotional dynamics of another person. Since they belong to another person, one cannot change or influence them any ways. Assuming an observer’s viewpoint can also help against getting sucked into own fears and anxieties and losing sight of what they are, why they are there and what could help to resolve them. Drawing boundaries is not about cutting off communication, rather it is about making communication more helpful by letting through meaningful and personally valuable and relevant messages while not becoming a sponge for other people’s issues.
Burnout often comes with the sense of hopelessness and helplessness, which tends to make ‘self-help’ difficult. It also makes it more difficult to step into a therapist’s office. Rather than connect better with oneself and the world, an individual suffering from burnout withdraws and disconnects from oneself and others more and more. Burnout can be solved through communication. However, fears and anxieties often lead one to steer into the exact opposite direction, less communication and more isolation.
Patients with burnout have lost touch with themselves and others. Humans need communication with meaningful messages, that they can use to regulate themselves and change the world around them. In the case of burnout, one often observes a freezing of the personality as it becomes rigid and brittle in the face of change. Frequently, there is also a fear of potential fragmentation and disintegration or even disappearance of the sense of self. A formerly healthy sense of self and efficacy in the world becomes imprisoned by the situation, and communication dies down as the burnout sufferer becomes increasingly fearful of change. Maladaptive communication patterns with rigidity and an aversion to change are the result
Through the interactions with a therapist unhelpful communication patterns can be identified, such as an inability to say ‘No’, and new communication strategies and patterns be developed. Important is also that in a meaningful exchange own values, needs, interests and aspirations can be identified and explored. The therapeutic setting should be a space for experimentation, where new ideas and interaction styles can be developed without the fear of judgment or repercussion. Overcoming fear and anxiety when it comes to social interactions is an important part of therapy. Over the long-run, a patient should become his or her own therapist, having acquired the skills and the insight to use any internal or external exchange of messages as an opportunity for growth and individual development. Still, helpful communication spaces, situations and people should be part of the new set of strategies.
Healing burnout requires long-term changes, and many of those involve finding the environments, people and activities which fit one’s own basic parameters, the values, needs and aspirations one has. These parameters change little over time, and it can be helpful to explore why one engages in activities that do not seem to add to one’s individual happiness. Maybe one tries to fulfil someone else’s expectations? Can we really know what someone else needs and wants, unless that person actually says it? Does the other person actually know what makes him or her happy? All this reverts back to communication. If everyone tries to be happy for themselves, would not everyone be happy? Is it possible to force another person to be happy? Helping others makes happy, but when it comes to burnout, the work needs to begin with the focus on one’s own values, needs and aspirations. This does not mean other people do not play an important role. One learns about oneself from one’s interactions with others.
There are a few central steps that need to be taken, whether one tries to deal with the issue oneself or works with a professional, all aim at a more flexible and open communication that allow the individual the freedom to look at what it is really important to him or her:
First, it is important to realize that one is experiencing an actual or potential burnout situation. Without this acknowledgment it is difficult to face the resistance not to touch one’s routines, thought and behavioural patterns. It also helps with the aversion to change. There may be fears that one may have to make undesirable changes but doing almost anything that creates extra breathing space to think and reflect and avails room for change, effectively counters the sense of hopelessness and helplessness that is central to burnout.
Secondly, assessing one’s values, needs, wishes, dreams and aspirations, and having a vision of what life might look like in the future paves the road to successful change. It also means assessing and analysing the feelings that are associated with thinking about the future. Depressed thoughts and negative emotions are relatively common in burnout and thinking about the future can seem meaningless or even painful. Assessing one’s situation in the safe environment of a therapy session does not have to mean immediate change, but it helps to fight the hopelessness and helplessness that are associated with burnout.
Thirdly, since burnout manifests in the interactions and relationships we have with others, it requires looking at one’s own communication patterns and how best to respond to someone else’s unhealthy communication style. How we interact with other people is shaped by our past life experiences, and if they have not been so good, they can make us fearful even in the present. If your father was given to unpredictable emotional outbursts, you may be fearful in situations with your boss, a (male) authority figures. Since the father’s behaviour was not predictable, you feel helpless. Feeling helpless and hopeless, you are unlikely to reflect on how to defend yourself effectively and on understanding the dynamic between you and your boss, which could help both of you. The world has become an unpredictable place, you are on constant alert at the workplace and this will ultimately lead to burnout when the exhaustion takes its toll. Maintaining the space to take a step back and reflect on the situation can prevent this.
Building new communication patterns requires insight in the present ones, which can be developed through reflection in the therapy sessions. Good communication patterns and a sense of knowing where one stands and where one would like to go next are affective antidotes to burnout. Change should occur in steps that can be planned and reflected on. The future does not have to be mapped out in any detail, as this deprives us of the possibilities that are not yet known to us. But one should sort out one’s fundamental values, one’s needs, and the things one would be unwilling to compromise on, as well as have an idea in which general direction the journey should go next. A lack of sense of direction makes one more susceptible to stress, pressure and burnout. Have the courage to visualize the future.
Fourth, it is important to determine the relationships and things which are helpful, and which are not. This may not always be easy to tackle because of fears that this could lead to people turning away or even loneliness. But there is no reason to threat it, because it really means taking control of one’s social life rather than losing it. Meaningful change is good, hasty decisions almost never.
Fifth, as you become clearer about yourself and your interactions with the environment and your communication patterns improve, you will gain trust in your ability to shape your environment. You will also notice a greater attraction on other people. The negative voice in the back of your head telling you that you don’t know what you are doing dies away. As you gain greater trust in yourself, you have more faith in your internal compass, and this effectively prevents anxieties, burnout and a number of other conditions. This will also bring greater clarity about the values and interests that are important to you. This makes decisions easier and helps you orient yourself towards the future.
Self-confidence is best built by not thinking how to get it but doing the things you would do if you had it. This requires thinking about the things you like to do, as well as your values and aspirations. What challenges you in a positive way? What gives you pleasure? Achievements only improve your self-confidence if they resonate with your values, needs and aspirations. Many people are afraid to look deep down into themselves to find answers, not necessarily because they assume there is something unpleasant, but because they fear they might encounter a void. This is why it is helpful thinking about one’s values, needs and aspirations, because they are there no matter what.
Sixth, taking new perspectives on the world and developing greater openness to the good things in life develops automatically if you do not give up and get the help you need. Take a new look at the world and be open to what it tells you. Burnout is a closure of the mind, and the best antidote to it is to open one’s eyes and engage with oneself and the world.
Since we have discussed mostly changes and perspectives and skills the changes usually last as it is impossible to unlearn a new perspective or skill one has acquired at some point in time as long as the memory of it lasts. However, several psychotherapeutic approaches which focus on techniques, as cognitive behavioural therapy (CBT) does to an extent, may not have the lasting effect of those that focus on internal change, such as psychodynamic psychotherapy or communication-focused therapy (CFT) which was developed by the author. (Haverkampf, 2017a, 2017b)
In the long run what counts is that someone who suffered from burnout at some stage in life does not get in situations again, internally and externally, which lead to a burnout. Having a sense of the own basic parameters, the values, needs and aspirations, over the long-run protects very well against burnout. Making the right decisions in life is much easier once one knows where one is going.
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 jo****************@gm***.com or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.
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