At Their Limit
Therapists dedicate their lives to helping, but what happens when that help exacts a toll?
By Denio Lourenco
When Drena Fagen started her career as a social worker counselling at-risk and formerly incarcerated teenagers, she knew she would see suffering. She just didn’t know how much.
Every one of her clients brought with them years of pain and abuse, and were coping with multiple serious traumas. But like doctors, teachers, therapists and others charged with helping those most in need, she soon found herself juggling hundreds. Like many, 40 hours a week bearing witness to the horrors of others began to take a hidden toll.
“My clients tell me these stories in extreme detail as part of their treatment, and I have to listen,” said Fagen, the co-founder of New York Creative Arts Therapists in Williamsburg. “Stories where an alcoholic father was repeatedly banging his daughter’s head against a Kmart store window because she asked for some water — I have hundreds of stories like this.”
She wasn’t surprised to find herself sad. But more distressing — and for many of those who dedicate their lives to helping, far more corrosive — was the anger.
“I remember one case where this little three-year-old girl wasn’t listening to her mother, and so the mother decided to put her child in a cold bath as a punishment, and I got really mad at her,” said Dr. Nerina Garcia, a clinical therapist and trauma specialist who practices a few blocks away. “Then I thought: it would do nothing for me to explode on the mother because that’s the way she was raised and she thought that was an appropriate form of punishment. So now in addition to being angry I just remember feeling disbelief and helpless around this cycle of violence and how difficult it is to change.”
According to a 2012 review in the journal, Administration and Policy in Mental Health and Mental Health Services Research, up to 67 percent of workers in her field experience a “high level of burnout.” What Garcia described is so common, in fact, social scientists have given it a name. Compassion fatigue is an umbrella term for symptoms which reduce a caregiver’s ability to help, often stemming from secondary and vicarious trauma. It’s what inspired Fagen, the art therapist, to open her practice.
In 2009, Fagen began developing a program at her practice called “Preventing Burnout for Helping Professionals.” The program is targeted towards therapists, social workers, special ed teachers, and other caregivers who work with challenging clients. Fagen and her team integrate traditional talk therapy with visual art, music, and drama as a means to help people with their problems.
“Art is a great venue for trying something new,” the therapist said. “If all you do is go to therapy and talk about the same old thing, then you’re not accomplishing anything. People are frustrated by the traditional structure of therapy where their therapist is not interactive, and for creative people, art therapy may be a natural mode of communicating.”
Fagen admitted that she created the program because she had begun to feel burnt-out herself.
“I worked at CASES (an organization that helps young teens at-risk of incarceration) and when someone would be murdered or something terrible would happen the case managers who worked there would be so nonchalant about it,” she explained. “I didn’t understand how that was possible. Why was everyone acting like this guy stubbed his toe when in fact something really horrible has happened?”
She noticed a pattern, and began searching for similar stories from the field. What she found, over and over, was compassion fatigue. The more she read about it, the more the diagnosis fit.
“I was like, oh my God, everybody has this,” she said.
Like her colleagues, many therapists burnout when they feel they’ve done everything in their power to help a patient who still doesn’t get better. Those feelings of helplessness can cause professionals to doubt not only their performance but their entire lives. Ironically, this happens because they empathize too much with their patients and end up absorbing their trauma.
“Suicidal clients can be anxiety provoking,” said Dr. Garcia, the trauma therapist. “After hours there can be a little thought in the back of your head wondering if that client is following your treatment plan, or if they’re going to hurt themselves.Those clients take a lot more energy because you’re also hurting for that person, too.”
Still more frustrating are the clients that lash out. Garcia described a recent incident in which she tried to say something compassionate and her client had misunderstood. The client started screaming at her.
“In my head I was like ‘why are you yelling at me?’ but I can’t react like a regular human being,” Garcia explained. “I’m a therapist and I knew that person was hurting and felt misunderstood and that’s a terrifying place to be in.”
By the time they get to New York Creative Arts Therapists, most clients are so overwhelmed by the demands of the people they’re trying to help that many are ready to quit. In a typical weekly group session, Fagen might hand her client a marker and ask them to draw themselves as an animal. Then she asks them to draw their boss. If they draw themselves as a rat and their boss as a lion, that’s a clear problem.
In addition to the weekly sessions, Fagen recommends her clients make small adjustments in their daily lives. Treatment can be as simple as going to bed and waking up at a reasonable time, creating proper boundaries, eating well, exercising, or doing the right amount of work.
But just like their patients, professional helpers have a hard time following their treatment plans. ER doctors still work 24 hour shifts. Social workers still take their cases home. Therapists in particular can’t call in sick without fear that, in the case of a suicidal patient, their mental health day could mean the difference between life and death.
“We’re like a human well, and if people keep taking from our well and we don’t replenish it, then we run dry,’ Garcia said. “We only have so much to give.”
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