July Membership Meeting Write-Up — Kirstin Carl, MS, LMFT

Sacrificial Helping Syndrome:
Why do we give more than we have?
presented by Katie Vernoy, LMFT

Katie Vernoy, LMFT is passionate about supporting mental health professionals in avoiding burnout. First, she discussed sacrificial helping syndrome as frequently afflicting mental health professionals. She also discussed that many of the reasons we develop this syndrome are the same reasons that we become helping professionals. She mentioned what leads to sacrificial helping, its consequences, and what we can do about it. She wants to make sure that we can maintain our careers. She does coaching and speaking to help give professionals the tools they need so that they can have sustainable and meaningful careers.

She asserted that sacrificial helping syndrome involves ignoring your own needs; not saying no well; having your whole identity caught in the helper; and having a big culture of humility. She stated that there also is a martyrdom phenomenon that happens in our profession — that we should be doing this out of the goodness of our hearts, and that how dare we want money or to say no. Therapists are often so focused on the day to day grind that they neglect activities that train them become better clinicians. They are also frequently overwhelmed; there is too much to do, and they are just exhausted all of the time. This leads to burnout, vicarious traumatization, and compassion fatigue.

Who becomes helpers? There are individual differences that determine if we are going to become helpers. There are also early life events, and inherent capabilities. Then there are personality characteristics — we are more empathic and intuitive than those in other professions, and constantly looking to others' perspectives. There can be downsides to this if it is out of balance. As a profession, we are more feminine, more ethnically diverse, have bigger hearts, and are more open to others' experiences. Early adverse childhood experiences, and roles we play in our families, influence us in becoming therapists. About 73 percent of us have had adverse childhood traumatic experiences that change our lives. There is also the family dynamic of parentification. Helping professionals often have the family role of parentified child. We are often working through our own stuff in the work that we do.

So then there is our capability- the innate ability to be resilient. If we were destroyed by those early adverse childhood experiences, we wouldn't have the capacity to help other people. We have more resilience — more ability for post-traumatic growth. We have a new perspective on life because we've been there, and we understand what it's like to be on the other side. We can become so passionate about what we do because it's personal.

She encouraged us to reflect on the question of, why did you become a helper? Take some time to write a personal mission statement that laser-focuses on what you do. Staying grounded in this can help us to not become sacrificial helpers, and to recognize it when we do. Sometimes it can help in your pitch, or what you write on your website. Having a clear picture is the first step.

So let's talk about what leads to sacrificial helping. In our most envisioned place, we are empathic, warm, and non-judgmental in helping people. When we are burned out, we are angry and irritated, fishing for no-shows, and counting down to the weekend. She discussed the role of the helper. If we find value and meaning in being a helper, we can compulsively help. It feels so good, so we keep doing it. It can be very hard to say no, or your crisis isn't my crisis. We are often creating mastery over our own wounds. It becomes important to be in our own therapy. It can feel very good when we have our boundaries, and we have our armor on.

She also discussed how important our work is as therapists. We are literally saving lives, and everything else can feel a little less important. If we have crisis response, we can be stuck on high alert. That material can be very difficult to let go of, and to turn off. We also have a unique role as therapists. We spend the whole day selflessly listening, receiving, and giving of our help. Our clients are not here to support us. Thus we are constantly in an uneven role. We are not allowed to complain and seek out support from the people we are caring for.

Then there's the impact of the client's material. There is vicarious trauma. If we don't take care of this, it leads to compassion fatigue, which leads to burnout.

Then there are legal and ethical dilemmas. When we are exhausted, all of these dilemmas become very overwhelming, and they have to be handled in the moment. There can be a lot that can happen that can contribute to us not turning off well.

Society also expects us to do our work out of the goodness of our hearts. There are funding cuts, and not getting any raises from insurance companies in 30 years. That is not allowed in any other profession. And insurance companies also often try not to pay us. Then clients want to slide our scale very low. As we are more and more feminine as a profession, wages go down. This lowers the monetary value of our work.

Katie then discussed the personal and professional consequences of lack of self-care. There is vicarious trauma and compassion fatigue. Therapists can stop caring because they are so disconnected. And burnout is something that many of us have experienced at one point or another. Burnout can sneak up on you. It can happen when you feel like you have very little control over what you do. In many agencies, you may feel this.

And if you go into private practice, you become burned out for different reasons. There is decision fatigue that happens when you are an entrepreneur. You have to decide when work starts, when it ends, what is work, who do I want to spend time with, and how do I want to promote myself? There are so many decisions that you have to make, and so much that is out of your control, that you can feel burned out because you are running full tilt, and you don't know if you are making any difference. You don't put in time for yourself. You fit in an extra client at lunch time, and you don't eat, or you eat in 10 minutes. It's harder than we think, and we feel like we are doing things wrong. Whenever you feel unsuccessful or out of control, burnout is a real risk.

We can become hyper-aroused and develop medical problems. Also, it's when we are so depleted and so overwhelmed that we may make poor decisions that can threaten our license. Taking care of ourselves is both a legal and ethical responsibility; and also, we are not our best selves if we don't have anything left to give.

Katie then discussed clinical and societal consequences of lack of self-care. The first is decreased trust. If you say you are going to do something and don't do it, you are no longer trustworthy. In our profession, we need to be trusted. If we are not holding ourselves accountable to self-care and boundaries, this could lead to clients losing trust in us. The second is access and quality of care. If we're not present, if we are not taking care of ourselves, we are not the best clinicians that we can be. And if we burn out completely, there is a huge decrease in access, and this impacts communities and leads to poor treatment outcomes.

We need to build a solid foundation — self-care, balance, resilience, clinical skill, and a nurturing work environment; and execute these elements like a boss. It's about our mindset toward self-care. We need to think about ourselves as the mechanism of help. Part of resilience is having those quiet moments to be aware, and being able to assess what is happening. Part of competence is improving our clinical skill. Make sure you are constantly evaluating what you are doing.

Katie then discussed time management. We need to feel like we are actually following our mission. We need to make sure that our schedule is based on time and energy. Each person is capable of seeing different numbers of clients per day. Do creative activities when you have the most energy. Use time-blocks and buffers. Make sure you have enough time between calendar items, because if something happens and you are running late, that can increase your anxiety and lack of competence.

Lastly, Katie encouraged us to make decisions like a boss — bold, objective, selective, and strategic. What is your mission? What are the things that drive you? Do you have the time to do this? Saying yes means saying no to something else. A lot of big ideas that are do-able sit around and don't get done, such as writing books. Put big ideas onto the calendar. Make a plan with all the little steps that will get you there.

As you can see, Katie's presentation emboldens us to become our best selves and thrive where we are planted.

Kirstin Carl, M.S., LMFT, has a private practice in Encino, specializing in trauma, faith-based therapy, and adolescents. Practicing for over 10 years, she is passionate about her work. Currently seeking certification in Emotionally Focused Couples Therapy, as well as participating in training on Voice Dialogue Therapy, she remains strongly committed to her development. You can reach her through her website kcarlmft.com, or at 818.593.9047.