Caregiver burnout is real. And it sucks.

Caregiving is a gift. The ability to take care of someone you love, at home, with relative comfort and routine, can be a beautiful and rewarding experience. It can also be a living nightmare. Most of the time it’s both, by turns.

Caregiver burnout doesn’t just appear one day, though it can feel like that: one day you’re fine and the next day you’re not. In truth, it’s not that dramatic; instead, it creeps in over time, slowly and steadily, until one day you find yourself overwhelmed, exhausted, frayed. It can be easy to miss or ignore the signs of burnout at first because caregiving is a full-time job. Additionally, you might also have a regular job and a family and friends and you know, a life. Or you did, before you became a caregiver. Slowly those other parts of you become buried underneath the weight of being someone’s sole care provider. It’s no surprise then that one day burnout hits you like a ton of bricks, in the form of exhaustion, irritability, anxiety, guilt, a miasma of shitty feelings.

You aren’t alone and it’s not unfixable. There are, in fact, both big and small steps to take when you discover that you’re burnt out. Before we explore those though, I would be remiss if I didn’t note that there are big systemic problems here that can make accessing those solutions tricky. For instance, one solution is to hire private help. However, for many people, hiring someone to help out is simply not a choice. There are programs through the county and state that will subsidize the cost but they’re means-tested, which means you have to come in under a certain income and asset level to access those programs. The result is, a lot of people fall into the middle ground of not rich enough for private care and not poor enough for state assistance.

That being said, there are still options. Maybe you can’t afford 24 hour care but you can swing a few hours here and there so you can take a break (an old client once called this Granny sitting, a phrase I find delightful). Maybe you can call on some nearly grown grandkids or other family members to take the occasional overnight or midday shift so you can rest. Maybe you’re resistant to that idea, and for good reason. But I would encourage you not to dismiss the idea of asking for others to step up out of hand. Sometimes someone becomes so stuck in their role as a caregiver, they don’t hear the other people in their lives who are offering to help. Or they decide not to ask for fear of hearing no. But if you don’t ask, you definitely do not receive.

Beyond that, there are other, smaller remedies. Who were you before this? What brought you joy? This is important because you cannot pour from an empty cup. In order to be someone’s caregiver, you have to be in good working order yourself. Meaning it isn’t selfish to take a shower or eat a hot meal or exercise. It’s actually a necessity that you do things for yourself so that you don’t become a shell of a person who resents what started as a gift: caring for someone you love.

There’s more to say here, namely about what happens when you’re caring for someone you don’t love or even like that much. But that’s another story for another day. Today, if you’re a caregiver, I want you to consider what things you do to keep yourself healthy and sane. If you can’t think of anything, it may be time to take a real break and take stock, and yes, consider therapy. Caregiving should be a gift, not a prison sentence.

When your body betrays you

Last week, I wrote about grief. I was mostly referring to the grief we experience when someone we love dies. But there are losses throughout our life cycle that don’t necessarily have to do with death.

For the majority of my career, I’ve worked with people experiencing life-changing and often chronic illness. The prognosis doesn’t have to be terminal for the symptoms of being ill—of having a body that doesn’t do what it used to do—to be devastating and isolating. Your friends and family can’t understand what you are experiencing. It’s difficult to explain pain or fatigue or some other unquantifiable symptom to someone whose body is not sick. In a misguided attempt to help, these family members and friends may tell you that your situation isn’t as bad as it could be; that you just have to push yourself harder; that you need a second, third, fourth opinion.

Their hearts are in the right place. They’re hoping that the power of positive thinking will do the trick and cure you. But not everyone is helped by the relentless positive thinking memes that social media throws at us: believe you’ll get better and you will! Trust your body! Mind over matter! Et ceterra, et ceterra, until you start to doubt your own feelings. Among these feelings, of course, is the grief of what you have lost.

Because although you are still here, your body has betrayed you. Illness takes from us. Maybe you aren’t able to exercise anymore, or even get on the floor with your kids or grandkids. Maybe you can’t drive anymore. Or your brain fog is making it hard to concentrate at work or school or in social situations. Those are big losses to bear by yourself.

Therapy is not going to cure your illness. Further, your therapist will not be able to tell you how long you’ll be sick or if any of what you’ve lost will be returned to you. Your therapist can’t tell you that everything is going to be ok. What therapy can do is meet you where you are. You can grieve. Then you can start to rethink and rebuild your life. Then grieve some more and then rebuild some more… You can be hopeless and hopeful both at once. And you do not have to walk this path alone.

Burning out, taking care

I don’t want to write about burnout.

I don’t want to write about self care.

I don’t want to reiterate and review what we all understand, not only as social workers but as parents trying to maintain some normalcy for our children; as professionals attempting to be effective and innovative with new work challenges; as adults navigating how to safely socialize with our loved ones. I don’t want to acknowledge that I have hit a wall because we are six months into a global pandemic and in the midst a political horror show and I have two little kids and three jobs and it’s honestly just too much.

The thing is, it’s not hard to write about burnout and self care: they have become meme-ified and pop cultured to death. There are articles and BuzzFeed lists and Tik Toks (I would imagine; I’m too old for Tik Tok) that explore these topics. But because the internet eventually blunts the edges of nuance from anything, these concepts feel more like buzz words than complicated and fraught issues. But there is nuance to be found. There are levels of burnout; there are different forms it takes, different ways it manifests, not just in our professional lives but in our personal lives. There are ways to talk about self care, too, that are complicated, that force us to consider the complicated nature of society and privilege, that go beyond “make sure you’re getting your 8 hours of sleep a night!” There may be nothing new, exactly, for me to say about burnout and self care, but here I am. Again.

I am tired. I am tired of a pandemic that has robbed me of the most basic joys of my life: overscheduling our weekends with out of town visits and parties and tertiary friends. I am tired of a political discourse that is disappointing at best and disgusting at worst. I am tired of a scary and unknown future that awaits us with climate change and racial violence and injustice. I am tired of the news, every day, of people in power doing the objectively wrong thing. I am tired of checking off the box on my psychosocial assessment that says I provided education about self care to the patient and their family. Did I do that? Did the words ring hollow? They ring hollow in my own mind so I imagine they aren’t coming across full of vitality and assuredness.

I am sleeping; I am eating; I am exercising (kind of; running up the stairs twenty times a day counts, right?). I am doing the self care things but I am still in the burnout place. That’s why I keep returning to these concepts. It is not as easy as saying “treat yourself” and getting a pumpkin coffee. Self care is complicated and difficult because the majority of us cannot just turn off. In fact, I know I’m luckier than most. I can’t write about self care and burnout without also acknowledging my great privilege. When I am exhausted, I have a partner who can pick up the home and kid slack. Although I am enraged by the lack of justice for my Black brothers and sisters who have been murdered by police, my whiteness allows me to be only angry, not traumatized. When I have reached my limit at work, I can schedule an easy day or call out sick. But I am still struggling.True self care does not feel possible in this environment. I keep thinking to myself, there is a way to be restored. But what is it? How do I find it?

This is the part where I should review the signs of burnout and tell you some of my favorite self care tips. But I don’t think that’s what we’ll do today. Instead, I want to thank you for reading; I feel better after the words are out of my head and released into the world. And I want to say, too, that I think it’s ok to hit the wall once in awhile. Sometimes doing the best you can is to let go of the best and just, you know, do.

Be well this week; I’m certainly trying to be and I hope you are as well.

Swinging back and forth

Well, things have taken quite a turn, haven’t they?

I don’t have any special answers, any more than anyone does. I’m doing what everyone is: trying to balance childcare and work and self-care and watching the news (though I do less of that because self-care). I’m providing supervision and some therapy virtually; I’m seeing hospice patients in their homes, wearing a mask and sitting several feet away. I’m trying to provide some structure for my little girls, who are really too young to have a grasp of what’s happening but who still need reassurance after their lives have been changed significantly. I am video chatting with friends and family and having the occasional crying jag. I’m doing what we’re all doing. And in the midst of it, I am grieving.

I’m sure you’ve seen a lot about grief in the past few weeks. It seems to be the best descriptor a lot of people have about how they’re feeling. In addition to the anxiety and stress and depression many of us are experiencing is a heavy helping of grief: for the normalcy we’ve lost, for the suffering of others, for the waves of deaths around the world. We are all experiencing loss.

I have a favorite theory of grief. (If you’re a social worker reading this, or a hospice worker, I know you just nodded your head in understanding. If you’re not, I’m sure this blog is already a weird read for you so you shouldn’t be too surprised). In the past few weeks, as we’re all trying to come to terms with what’s happening, I’ve found this favorite theory to be a great comfort. It’s called dual process theory and I hope you find it helpful, too.

Imagine a pendulum swinging between two orientations: loss and restoration. When the pendulum swings into loss-oriented thinking, that’s when we’re actively grieving: experiencing our pain, adjusting to the “new normal” (a phrase I have grown to truly despise), and accepting our losses. We can only live in that space for so long though; it’s sad there and our brains can only tolerate so much sadness. So imagine the pendulum swinging again, this time to the restoration orientation. This is a state where we’re becoming comfortable in our new roles, being distracted by other needs, and paying attention to the ways in which our lives have changed rather than just our losses.

It’s not a linear theory; that’s part of its appeal, if you ask me. Instead it imagines the pendulum swinging back and forth over time, as we experience both states of being. There’s no timeline for grief, you see. There’s no normal way to do it. We’re all just swinging back and forth between the mundane tasks of daily living and the profound grief we are experiencing as human beings in the midst of an unprecedented crisis.

I hope you’re caring for yourself, however that looks. I hope this theory or this blog is helpful to you, or to someone you love. I hope that you are able to see the light that shines in darkness and that you can forgive yourself when you’re not able to; it is, after all, an ongoing process. I hope you are safe. I hope this ends soon. I hope you I hope and hope and hope.

Be my witness

I’ve had a lot of trouble writing this post. Not because I don’t know what I want to say; the words have been pouring out for days. It’s more that I can’t seem to get them into a coherent order. I’ve been struggling with my work—not my job, but the actual work of being with grief and illness and death. I’ve been thinking for weeks about what it means to witness the suffering of others.

It’s a heavy topic, and I’ve come to imagine it as an actual weight. When I’m with my patients and their families, I take their weight for a little while, to give them a rest. Then I hand it back before I leave the house. I literally leave, which helps separate me from the grief I’ve witnessed. But lately the weight has seemed heavier, not as easy to release when the visit ends. And because this blog has become a key part of my self-care, I’ve got to write it out so I can move on.

The other day, I mentioned to my husband that I had met someone who had lived the life of Job. He had never heard that expression before, which makes me think it’s an old-fashioned one (I have an old soul, you guys) so I will elaborate. Skip this paragraph if you’re familiar with our friend Job of Old Testament fame. Job was some poor soul that God used to prove a point to Satan. (Old Testament God made some upsetting choices, honestly). God not only stripped Job of his earthly possessions and killed off all ten(!) of his children, He also gave the guy a horrid skin disease. This was all to prove to Satan that Job would continue to love God under any circumstances. There are more details, of course, but you get the gist: Job’s suffering was incredible.

I sometimes meet people who have suffered so much that a part of my brain thinks, this cannot possibly be true. Their losses have added up so significantly that it is almost unbelievable that one person could have bad luck like that. There are times that I am faced with such tragedy and pain that it nearly takes my breath away. In those moments, I wish I didn’t choose to be a witness to suffering.

And yet, I did. Or it chose me, whichever. The point is, I am honored that people trust me enough to tell me about their trauma. I feel that it is a gift that I can bear witness to someone else’s pain and briefly hold it for them so they can get a break. I don’t have to live with it, myself (I have my own tragedies to carry). Anything is bearable for a few minutes and I usually can let it go.

But, like I said, lately I’m having trouble releasing the weight. I imagine myself being pushed down, little by little, as I hear sadder and sadder stories. Picture me up to my knees in the ground, carrying something heavy on my shoulders. That’s what it feels like: I’m standing upright but I’m sinking.

It’s hard to admit that. I pride myself on having excellent boundaries and solid self-care. It’s difficult to tell you that my usual stuff is not totally working at the moment. But the best disinfectant is sunlight; it’s better to admit that I’m struggling. So what will I do? In these times, which come along with the territory of the work, I allow myself to feel overburdened. I let my heart feel heavy. I go to church. I look into the beautiful, healthy faces of my daughters and try to be present with them. I read celebrity gossip. I take deep breaths. And I wait, as patiently as I can, for the weight to lift.

There is great tragedy in the world but also great joy. Even Job received his rewards (questionable whether the pain was worth it, but again, Old Testament stories are wild). I can still see the good. It exists in the warmth of strangers, in music, in bright sunsets, in my children’s laughter. It exists in my work, which can be deeply, profoundly sad, but also wildly, touchingly beautiful. It is heavy but I have chosen to carry it. I am still grateful.

Speaking of which, thank you for being my witness today. I hope you find an easy road today. Be well.

Compassion Satisfaction

I’ve started—and subsequently wandered away from—a handful of blogs about secondary trauma and compassion fatigue. I’ve managed to write about the beginnings of burnout and a lot about self-care and self-reflection. But I was having trouble writing about the intense issues of compassion fatigue and vicarious trauma. Let’s face it, these aren’t the cheeriest of topics. But last week I was fortunate to attend a continuing education program that inspired me to finally finish a post about the emotional risks we face as social workers and how to manage those risks.

The event was offered by my hospital for social work month. We watched a deeply moving video about ow to heal caregivers. First responders, firefighters, police officers, nurses, and, of course, social workers spoke about their experiences with secondary trauma. I cried a couple of times, feeling the pain of strangers who joined a helping profession to help and found themselves mired in suffering. They talked about how their bodies reacted to stress over time or how they found themselves unable to sleep. Each of them showed an enormous amount of vulnerability as they shared some of the low points of their careers.

It was riveting. And it also showed me some beautiful interventions for combatting vicarious trauma. What follows are some takeaways from the video that have really changed my perspective; I hope you have a similar reaction.

• Do you have a safety plan for burnout? We use safety plans for our patients all the time: for those who live with abusive partners or those suffering from suicidal thoughts. It never occurred to me that as helpers, as witnesses to that kind of intense suffering, we too could benefit from a safety plan. It doesn’t have to be dramatic: my go-tos have always been long lunches and journaling. The occasional root beer float has also greatly helped me on the hardest days.

• Do you honor your grief? The program’s facilitator pointed out that secondary trauma and compassion fatigue are often grief. We use ourselves in our practice: we open our hearts and humanity to others and share their pain. It only makes sense that over time, the grief begins to pile up. As helpers, we need to honor our losses. I can tell you the names of patients I loved, who touched my heart and changed me; I honor those relationships by holding their memories close, by telling stories about them and smiling.

• Do you celebrate your successes? My favorite part of the program was hearing the phrase “compassion satisfaction.” Of course there is fatigue in caring for others, but we are also drawn to this work for a reason. As social workers, we are trained to constantly reflect on ourselves and our work but I think we tend to reflect on our challenges and our failures. Instead, the facilitator of this presentation encouraged us to focus on our successes. I challenge you to do the same: what have you done well? What joy did you get to take from your work?

I love being a social worker. It is one of the great pleasures of my life to do this work. As we end social work month, I hope you feel honored by your co-workers and by our profession. Share your joy; we are helpers and healers and we deserve to be recognized for our good and useful work.

The body knows

I had a tricky interaction with a patient a couple of weeks ago. A patient of mine (who has an extensive trauma history) made some comments about my children not being safe in daycare. She knows I have kids because she asked once and it’s such an innocuous question, I didn’t even think about answering it. In fact, I don’t generally have strong feelings around self-disclosure; sometimes I think it can be helpful to build rapport and trust so I don’t worry about answering mild questions from patients. This is all to say, I had no problem with this particular patient knowing a little personal information about me. That is, until she hit me with this nonsense about my kids being in danger because I’m not at home with them full-time. This is a touchy subject for me, because it’s a deeply personal choice that has several variables and the judgement around it feels absurdly sexist. When she said that I should be careful, that bad things could happen to them because they’re with strangers most of the day, I had to work very hard to be still and not let my face betray my internal, white-hot rage.

In the actual moment, it passed fairly quickly. I squashed it down and told myself that this woman thought she was being helpful; she wasn’t intentionally being cruel. (She even told me that she was being grandmotherly with her concern. Ok, lady). It was later, when I brought it up in supervision, that I realized just how very upset it made me. Telling my co-workers about the experience, my hands started to shake; I felt my breath quicken and my face get hot. And I realized, I was still really worked up about those few minutes!

It got me thinking about how we listen (or don’t) to our bodies when we’re working. I’ve written before about working with frustrating patients and suddenly becoming aware that my shoulders are up by my ears and my fists are clenched. How does it sneak up on me? Because I’m not really paying attention to my own body. There’s a lot we have to do when we’re with clients: listen actively, reflect back, read their body language, etc. But we also have to listen to what our bodies are telling us; often we react physically before we’re able to name what we’re feeling.

Personally, I especially struggle with being in touch with my physical self when I’m uncomfortable with the energy in the room. Give me someone on a crying jag any day; I can sit with that heaviness and have no problem being in my body: breathing deeply, being still, creating a space for vulnerability. But when a patient touches a nerve (usually unknowingly), my fear or discomfort or anger arrive first in my body, try though I may to ignore those feelings. In those moments, I’m trying so hard to reserve judgement and be still and present that I ignore the warning signals that I’m about to emotionally check out. When I feel my toes curl in my shoes and my hands grip the sides of my chair, it’s usually a sign that I’m not going to be at my best, clinically. In those moments, I have to recenter: I take deep breaths; I practice stillness. Then I take my ass to supervision, because clearly I have some things to work out!

The body knows; we do better when we remember that and listen to what we’re being told: to slow down, to reflect, to breathe. And to utilize supervision!

Crispy around the edges: Avoiding and recognizing the dreaded burnout

I have started this post about burnout about five different times. I'm having a hard time figuring out where to begin, partly because I've been considering burnout since before I even became a social worker. In fact, I sort of decided to become a social worker because I read an article about burnout when I was fifteen years old. Seriously.

The internet was such a new thing when I was in high school that an offered elective was something called "Electronic Fiction." For real. The basic point of the class was to look things up online and write about them. (This seems hilarious now but it was the late 90s!) One of our assignments was to pick a future career (a daunting task for a 15 year old, by the way) and do some research about it. I took this task way too seriously. In fact, I distinctly remember a classmate telling me it was just an assignment; I didn't have to make a lifetime decision in that moment. But apparently that was lost on me; I had to decide right that second what I wanted to be when I grew up. I put a lot of consideration into what kind of work would appeal to me. As I mentioned last week, doctoring was not for me; too much science. Professional acting seemed good but, you know, really hard. My teacher asked me what I thought I liked doing and I said, earnestly and honestly, "I like to help people." She told me to look up social worker.

It is very telling that the first article I came across after I searched (I swear this class was even pre-Google, I think I used Lycos) was an article about burnout. I was immediately drawn to this concept. It hadn't occurred to me that doing something good could make you feel bad. I was enthralled by this article. I printed it out and highlighted it. It stayed in my mind for years. And so, I started my social work career thinking I had all the tools to combat burnout. I read an article when I was 15! I'm ready!

There are many ways to combat burnout. Blind optimism is not enough, it turns out.

Part of the reason burnout creeps in, despite the walls we build as professionals to keep it out, is that it's systemic. As social workers, we work within systems that are lacking: lacking in funding, in staff, in resources. We spend a lot of time, no matter if we work in a big health system or for a small non-profit, struggling against a system that mostly says no. That is exhausting.

Add on to that the stresses of bearing the weight of other people's struggles. It is virtually impossible to spend all of your working day listening to people explore loss and pain and sadness without starting to feel like you have heard enough. I can always tell that I'm getting crispy around the edges when other people's emotional pain starts to seem... irritating. Like, I get it, you're sad. I am always startled when I have that thought but when I do, it's an eye opener: I am tired. I need a break.

Breaks are good! They are a vital part of preventing burnout and recovering from the stress of this very difficult work. But if you don't have any precious vacation time right this second, there are other options. You can Google (we've come a long way from Lycos, guys) tons of lists and articles about how to avoid burnout. What follows are some of my favorite tips.

One is to have a real life. I've been asked many times over the years how I do this job and one answer is that I have created a beautiful life outside of work for myself. I learned how to cook (do not listen to my old roommates about my culinary abilities, please. I've gotten much better!); I have lovely friends who live all over the place and are happy to have weekend visitors; I like to read and still go to the library to borrow books. There are lots of ways I spend my time that have nothing to do with social work. 

Burnout needs to be combatted at work as well. To that end, another invaluable way of keeping yourself sane is having a work best friend. It is imperative that you have someone at work you can call or someone whose office door you can close and say, "holy shit, this day." Having a partner you can share your frustrations and successes with is key. When I worked in hospice, I did a lot of joint visits with nurses and developed some great friendships. They helped me feel less isolated when I was driving all over creation. I also appointed myself as the social chair of the social workers and demanded monthly happy hours. Amazingly, this worked, and a good sized group of us got together monthly over drinks. We even managed to talk about stuff besides work a lot of the time! Thus I managed to combine having a life with having work friends. 

Finally, another very important tool to combat burnout (and also the whole point of this blog): supervision. Sometimes we don't have the answers, especially when it comes to ourselves. We can't see what's holding us back with a particular client or why we're so frustrated with our work. It takes the objectivity of a supervisor combined with a good working relationship to help us clarify not just cases but our own feelings and struggles at work. Something I've always valued in supervision is having someone say to me, "Yes. These are valid feelings. You are entitled to them. Now what can we do with them?"

There are so many articles like this blog post, that give you advice on how to avoid, recognize, and address the symptoms of burnout. I added to them because I believe it's important to keep talking about it. But the fact of the matter is, you have to find the tools that work for you. And you have to do that work so that you can survive doing this work. Take care; it's the best thing you can do for yourself and for your clients.