Namita Kapoor* has been working as a counseling psychologist with a mental health organisation in Mumbai for about a year. Kapoor’s day starts around 11 am and ends at 10 pm. In these 11 hours, she talks to about 10 people – more on some days – about their mental discomforts, illnesses and traumas and helps them take steps towards overcoming these. Kapoor is good at her job as is evident from the gratifying feedback she has received from clients. However, the job has very quickly taken a toll on her own mental well being and she has been spiraling towards burnout.
Therapist burnout is a phenomenon in which mental health professionals experience stress, trauma, anxiety, emotional fatigue, lack of focus and decline in empathy. Psychiatrists, clinical psychologists, psychiatric social workers and psychiatric nurses are all susceptible to such these symptoms as side-effects of countless hours of working with individuals in psychological pain.
“Other than one-to-one sessions, I also consult clients over the phone,” said Kapoor. “There are times when they are in a dangerous state of distress, sometimes even suicidal, and I have to talk them out of it using all that I have. It takes a lot out of you and leaves you in an exhausted state at the end of the day.”
Within a year of working, Kapoor began to notice that she was feeling desensitised to the severity of her clients’ problems. “Because I spend too much time listening to the most traumatic of stories from people, I am starting to become immune to them which I believe isn’t good for my emotional health,” she said.
What Kapoor describes is called “compassion fatigue”, where the therapist tends to become numb and divorced from the problems they are required to address. About 90% of all health professionals – physicians, emergency response personnel and psychotherapists – experience compassion fatigue.
According to research in Europe and the United States, burnout accompanied by compassion fatigue among mental health professionals has recently been recognised as a global healthcare problem. Following the suicides of two psychologists in 2008, the American Psychological Association set up a committee to check for possible occupational hazards. The committee found burnout, anxiety and depression to be dominant stressors, becoming possible triggers for suicide, among therapists.
India has a severe shortage of mental health professionals and the experiences of counsellors like Kapoor raise the question of whether there is a wave of therapist burnout in the country. Unfortunately, there has been no research to indicate the extent of the problem in India.
Secondary trauma
Jagruti Wandrekar is a therapist with a women’s health organisation and most of her clients are victims of domestic violence. “Burnout is very prevalent in the field where I work,” she said. “The cases you see are really horrific, especially cases of violence and abuse.”
These cases take a toll on therapists. As far back as 1995, two researchers from the University of Minnesota in the US carried out a study of female counsellors working with survivors of sexual violence. They reported that counsellors working with a larger number of survivors reported more symptoms of burnout than those who worked with fewer survivors. Mental health professionals and social workers dealing with trauma victims experience vicarious trauma – trauma that is inflicted not directly but through someone else’s experiences. This vicarious trauma secondary trauma manifests as anxiety, fear and immobility.
“If you have a history of trauma yourself, the possibility of secondary trauma is high,” said Wandrekar. “Despite your best efforts, often there are poor outcomes simply because there are many systemic factors, such as patriarchal families, police or judicial procedures that you can’t control. So you can end up being really frustrated, angry and distressed.”
She believes that therapists need good support structures at their workplaces like having staff counselling and peer support groups.
Broken systems
In the United Kingdom, the crisis among the mental health workforce is largely due to the health service market pressures on psychologists to reach targets, and poor support systems. The crisis in the Indian mental health community is largely because of a shortage of therapists. India’s mental health professionals also do not have a forum in which to raise these matters or a governing body to address them yet, even though the Mental Healthcare Act 2017 sets the grounds to establish national and state mental health authorities.
“The lack of therapists here is more alarming than we think it is and people aren’t realising that,” said Kapoor. India has more than 70 million people struggling with major and minor mental illness and only a small fraction of the required mental health workforce.
“Something that we love and want to do becomes overwhelming because there are just so many people who are in need,” Kapoor added.
With this large and growing patient burden, hardly anyone is paying attention to the health of therapists. For instance, Smruthi Nair never heard of compassion fatigue in the six years she worked as a psychotherapist in India. Nair has now moved to Melbourne, Australia where she sees big differences in the way mental health professionals approach their work and such work perceived in society.
“It shouldn’t be hard to understand that therapists need a support system for themselves,” she said. “The Australian fraternity has preventive management for this. Every professional has to see a senior therapist on a regular basis and discuss their style [of counselling], issues and learnings. Then there are things like indemnity insurance, which limits our professional liability in case any error occurs during practice.”
In India, therapists are left to fend for themselves. Kapoor struggles to make amends for the effects of her work. “Outside of work I am barely left with any energy to engage with other people and family,” she said. “It has started to affect my social life because even if you are out with friends you end up talking about your work.”
*Name changed on request.
The writer is a student of psychology, a researcher and a mental health activist.