The 5 Different Types of Burnout – And How to Prevent Them

[00:00:00] Rachel: When was the last time you were able to take a full break, have a coffee with a colleague, or perhaps just sit and think for a few minutes? Have you found yourself doubting your ability to cope or have you found yourself getting cynical and detached from the job? If so, or if you’ve seen these signs in a colleague, this is the episode for you.

[00:00:18] Rachel: This week I’m joined by Dr. Paula Redmond, a psychologist who specializes in burnout. She hosts the When Work Hurts podcast. Now we often think of burnout as a scale or a spectrum, but Paula sees it more as a collection of different patterns or profiles. So in this episode, we look at these five different profiles, and it might help you start to work out what’s going on with you and get the right help that you need.

[00:00:40] Rachel: Now if you are really struggling, there are loads of ways that you can get help, and we’ve put lots of links in the show notes for you to get more resources. And hopefully this episode will give you the tools that you need to catch burnout early, before it really starts to affect your work or your home life.

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[00:00:56] Rachel: If you’re in a high stress, high stakes, still blank medicine, and you’re feeling stressed or overwhelmed, burning out or getting out are not your only options. I’m Dr. Rachel Morris, and welcome to You Are Not a Frog

[00:01:14] Paula: I’m Dr. Paula Redmond. I’m a clinical psychologist and I specialize in working with burnout and, uh, work-related trauma specifically with health professionals. And I’m also the host of the When Work Hurts podcast, which takes a psychological look at the impact of working in healthcare. And I also run, co-run a company called Creative Restoration, which, we offer courses and workshops around nurturing psychological wellbeing through craft and knitting specifically.

[00:01:45] Rachel: I so much to ask you about that. But, uh, we’ll, we’ll save that, we’ll save that for a little bit later. But Paula, it’s really great to have you on. I know we’ve been trying to get this, this podcast recorded for a long time.

[00:01:55] Rachel: Because this, this thing about burnout, I mean, burnout is, is such a, a big topic at the moment. Lots of people are talking about it, lots of people wanting to pre prevent it. Lots of people wondering if they have it. So should we just start right at the beginning? There’s obviously the WHO definition of burnout, but how would you describe burnouts?

[00:02:14] Paula: I guess, and it’s such an interesting one because you know, burnout isn’t a mental health diagnosis. It’s not in the DSM, but it’s certainly an experience that I think we can all relate to that everyone will have an idea of what that means and, and feels like for them.

[00:02:31] Paula: And as you said, you know, the WHO defines burnout in relation to work. It’s, it’s defined as an occupational phenomenon. But I think the experience is broader than that too. You know, certainly, challenges around parenting or caring responsibilities can absolutely result in burnout for sure.

[00:02:49] Paula: So I suppose for me, when I think about burnout, it’s an experience of, when we’re talking about, uh, I suppose a kind of clinical level of burnout, of an internal collapse, I think and a sort of overwhelming exhaustion that really impacts our ability to function on very basic levels.

[00:03:14] Paula: And the experience of that is often a shattering of, of self-trust, that, that people find it really difficult to understand how they have come to be in this way, because the people who suffer from burnout are people who have been hugely invested in their roles, whether that’s work or parenting or caring. So those roles are. Really integral to their identities, to what matters, to what’s meaningful to them. And finding yourself in a place where you can’t do that anymore is quite shattering to self. And it can be very terrifying being in that place and not knowing what the rest of your life is going to look like if you can’t do the things that really matter to you. If those things that really matter to you have kind of caused you so much harm to be in this place of collapse, what, where do you go from there?

[00:04:15] Rachel: I have never heard it described like that before. And it makes so much sense, an existential crisis and a shattering of self trust, presumably brought on by this sort of overwhelming exhaustion of working in the environments that you are working. And when we talk about work, yeah, a hundred percent. It’s not just work in work, it’s the work you do outside of work, isn’t it?

[00:04:38] Rachel: And a lot of the time, that’s almost more stressful than the work you do in work, particularly you’ve got small children or we’ve got aging parents, or you are caring for somebody else with a mental health problem or disability or stuff like that.

[00:04:49] Rachel: So. That’s really interesting. ’cause obviously they sort of trott out these three things. The three things are burnout, which is, you know, exhaustion and, uh, cynicism and poor performance. But yeah, those are just like the symptoms that, that that people can see externally, I presume?

[00:05:06] Paula: The experience of it, yeah, i, I think is quite a shattering one. You know, to, to find yourself so exhausted, to not have faith in yourself and to be detached from the things that once gave your life meaning and richness is devastating place to be.

[00:05:27] Paula: So very easily we can see how that can then cause mental health problems. You know, that’s not far to move into depression, anxiety. You know, there’s very closely linked experiences.

[00:05:41] Rachel: I just want to ask you, ’cause we talk about, and you just talk about levels of burnout, you know, and and I know there’s a, there’s a paper I quote a lot that, you know, healthcare professionals, I think it was GPS with higher levels of burnout, uh, 60 something percent more likely to make a medical error.

[00:05:57] Rachel: Is it that we have these levels of burnout or is it an all or nothing thing? You’re either stressed and then it goes into burnout, or are you stressed and then you’ve got the different levels? I never quite know. Is it a continuum or do you see it as a black and white thing?

[00:06:10] Paula: I guess my experience is that it’s a bit of a slow burn so that it kind of creeps up on people in a chronic way that it takes a long time for people to get to that point, but sometimes, often there is a particular triggering incident that is like the straw that breaks the camel’s back, and kind of tips people into a state where they just cannot continue anymore.

[00:06:43] Paula: And often that experience is not an extreme one. It’s not a massive or necessarily traumatic event. And that can be part of what’s difficult is that people can struggle to understand why they’ve reacted so strongly to this little thing, you know, relatively small thing like, you know, making a minor mistake at work or annual leave, not being approved or, just not being able to meet a deadline or just kind of hearing a, a comment that’s perceived to be critical can be the thing that.

[00:07:21] Paula: You know, quite a common story is people driving to work one day and not being able to get out of the car. And, you know, kind of being really upset and just realizing they literally physically cannot get out of the car and go to work.

[00:07:33] Paula: So I, I think, people can in that state look back and see in hindsight how things have, you know, like you’re the frog, you know, it’s been a slow boil, up until that point, but often the, the kind of burnout, kind of tipping into the recognition of burnout happens quite suddenly. And it, it, it can also be a physical illness that suddenly people experience something very significant physically that makes ’em stop and, and take notice.

[00:08:07] Rachel: Interesting because the, the reason I ask the question is because we’ve had lots of people that, that write into us and say, I’m feeling really stressed and I, I think I might be burnt out. And I went to see my GP, I went to see occupational health and they say to me, right, well that’s it, yeah, I can sign you off work. But they say, but that’s the absolute last thing I want. It’s the last thing I need right now. ’cause actually I know that’s gonna make it better.

[00:08:28] Rachel: And, and you know, we are told that if someone’s in burnout, they can’t work. You know, they’ve got to just stop. They’ve gotta get themselves out in the environment and that’s all very well and good. But if there are these different levels of burnout, then is there some circumstances where people might be in burnout, but actually it’s okay for them to keep working and keeping working is what they need to do, versus some people who are in that very sort of unfunctioning burnout is, it’s what you’re talking about there that I can’t literally get out of the

[00:08:53] Paula: yes, yes, yes, for sure. And I suppose what we want to do is to be able to catch the people before they get to that state, and we want people to be able to notice that for themselves.

[00:09:03] Paula: I think it can be more helpful, to think about sort of burnout patterns and burning out profiles rather than levels. Because I think that helps to answer this question of, of should I start working or, or should I not? Because I think people’s, experience of burnout can be different and it can be caused by different things and therefore needs a different sort of intervention.

[00:09:28] Paula: So one of the things that I’ve put together is a burnout toolkit, which people can download, uh, on my website. But it looks at, breaks down sort of five common profiles of burnout and helping you to identify which is your kind of pattern and therefore what kind of, in this case, psychological, um, approaches might be specifically useful for what you are experiencing now.

[00:09:56] Paula: So those five patterns, uh, correspond to those kind of three, parts of the definition of of burnout, as well as thinking about trauma and moral injury, which I think in the context of health professionals is really important to consider. That is different to other professional contexts.

[00:10:17] Rachel: What you’ve got me thinking about Paula is, uh, we often think that burnout is an illness in itself. A bit like, you know, you’ve got diabetes, you’ve got burnout, but burnout is a symptom of the underlying illness, right? So it’s like pain, burnout is like pain. Pain can be caused by all sorts of things. It could be caused by osteoarthritis, by muscle pains, or, you know, neurological pains. And I think if we think of it as it like that, yeah, then we can start to actually look for the root cause and, and cure it.

[00:10:43] Rachel: And I think one of the mistakes we have made in, in the workplace is saying, yeah, burnout is just caused by workplace stress. But of course, I mean, that is so all consuming, you know, that can, workplace stress can be caused by, again, lots of different like psychological profiles and things like that. So I really love this approach. So, yeah, I’d love to hear about the, these, these different burnout patterns that, that, that you talk about.

[00:11:05] Paula: Yeah. So the first one um, I would think about is the self-doubting pattern. So this kind of corresponds to the lack of confidence. And that’s often a, a very strong kind of presenting position that people seeking therapy, for example, might come with that. Their confidence in their ability to cope with their work is really shattered. They’re not feeling able to make a positive difference, really doubting themselves, not feeling that they can accomplish things.

[00:11:39] Paula: And that’s very painful for health professionals in particular because often, people have been, you know, very driven, very high achieving, and you know, really then struggling with a sense of, of not being good enough, is very hard.

[00:11:56] Rachel: Can I just ask, does that get worse as you get older? So, you know, I, I think I’m just thinking of women, women of my age as well. You hit the menopause, you get older, you get these bright young things coming in. Brain’s not working quite as well. You’ve got the lack of eastern all, all sort of stuff. So it’s not about, it’s probably not directly related to your ability. It’s di relate can be related to lots of different things. Right.

[00:12:15] Paula: Yeah, and I guess it’s contextual that if, if your life is, is kind of feeling a bit out of control in, in, in lots of ways, then that’s an important context that all of those things can collide in one time and there’s like nothing you’re feeling on top of, you can’t handle any part. Whereas I guess when we’re younger, we’ve got less to juggle, there’s, there’s less yeah, less can go wrong maybe. I don’t know.

[00:12:43] Paula: And often what people do, you know, really conscientious people who, you know, attracted to this kind of work, often cope by doubling down by overcompensating, overworking. So there’s a double whammy there of the, increased kind of pressure and load from trying to compensate for that perceived lack.

[00:13:06] Paula: And also just the constant strain of self-doubt and anxiety, is really difficult. You know, then people, you know, struggle to sleep, and, you know, might start either, as I said, overcompensating or avoiding stuff. And that just, the load kind of grows and grows.

[00:13:27] Paula: So in that spot, what I’ve done in, in my toolkit is kind of identified what the core psychological task is for each of these profiles. And then also outlined some psychological strategies that specifically support those.

[00:13:43] Paula: So in this profile, the core task is about continuing to find a way to strive for excellence. ’cause that’s gonna be important and we can’t pretend that’s not going to be important. And that’s, you know, often a key value, while also having compassion for yourself, when you don’t have all the answers or when you make a mistake. So trying to find ways of, of holding. Both those positions.

[00:14:08] Paula: And that can be incredibly challenging if you work in a very punitive environment where mistakes are not tolerated, where lame culture is rife. And there might be times and places where as a person those environments are more or less tolerable, you know, that maybe you could cope with that personally, until you reach a point where there’s so many things to juggle that working in that kind of environment is just not sustainable anymore.

[00:14:41] Paula: The second profile is I’ve called the detached profile. So that’s this kind of, uh, cynical sort of, you know, lots of overlaps there with compassion fatigue, and just feeling like you don’t really care anymore. You might feel quite cut off.

[00:14:58] Paula: So that’s a very different experience if you think about that compared to this first one of being really anxious and worried. This kind of cutoff don’t care, is a very different experience, but can be just as troubling and just as distressing, because. Being a caring person might be very important to you. It might just mean really unfulfilled. You know, if work has been a source of enrichment and it just no longer means anything to you, you know, that empty feeling can be really difficult.

[00:15:29] Paula: And that can show up sometimes as acting harshly towards colleagues or patients, which is never a nice place to be.

[00:15:39] Rachel: That’s really interesting you’re saying that because I, I can think of countless examples, you know, from my own life, colleagues I’ve worked with, clients that I’ve worked with where yeah, they’ve said to me, the most common thing is a GP practice will come to me and say, we need some sort of team coach, we need an away day. And I’ll say, well, what the issues are? Any elephants in the room? They’re like, well, we know our senior partner is burning out. He won’t admit it. And I’ll go, well, how do you know? And they’ll go, well, he’s, he’s really cynical. He, you know, is a real troublemaker. He started getting complaints, he’s being rude to everybody, he won’t tolerate anything. And I’m thinking, gosh, that, that, that’s that poor, poor person, poor person. Because they’re always, they’re feeling awful. But then your behaviors are probably isolating you even more from your colleagues. Just when you need, just when you need their support, right?

[00:16:26] Paula: And there are some overlaps here with another concept called rustout. You know, different to burnout, but this idea of like getting bored with work, and boredom is a horrible feeling. It, it can be really uncomfortable. And so sometimes a change is really important.

[00:16:44] Rachel: I love the fact that you’ve raised that, ’cause I was thinking, I was listening to some, listening to some stuff about ADHD yesterday and how sort of boredom is a real kryptonite. It’s kryptonite for everybody, isn’t it? People hate being bored. But I remember when I, when I was in one of my jobs, I was incredibly bored, but I was incredibly stressed.

[00:17:03] Rachel: So there was a lot, there was a lot to do. There was, it was a high pressure, but the work was so unstimulating and boring, it was just more of the same, the same, the same, the same. So I think we often make the mistake of saying to ourselves, well, I, I can’t be bored ’cause I’ve got too much to do. I’m not getting to the end of it and I’m really stressed.

[00:17:19] Rachel: Whereas recognizing that boredom’s not about, about the amount of work you’ve got to do, it’s, it’s about the, the challenge of the work and the interest for you in the work, presumably.

[00:17:28] Paula: yes. Yeah. And that sense of fulfillment.

[00:17:32] Rachel: I guess lack of personal growth, right? If you’re not, if you’re not growing or developing, then you get bored. Yeah.

[00:17:36] Paula: Yeah, yeah, yeah. And I guess what people often find particularly difficult in this space, this kind of detached profile, is finding that spilling out into their out of work life. So starting to feel like other people, their friends are a burden, can’t be bothered, you know, spending time with people don’t wanna hear about it, it’s too much. And as you were saying that, you know, becoming withdrawn from life, not just work.

[00:18:05] Paula: So in this, in this, uh, kind of profile, the core task is about trying to maintain a compassionate connection with your work, while at the same time protecting yourself. So how do we work to find meaning to, to hold on, to compassion, while maintaining a kind of healthy detachment? ‘Cause, you know, detachment in itself is not a bad thing. We need that in healthcare. But when it, it’s when it goes too far. So finding this, this balance of maintaining connection and compassion and protection.

[00:18:39] Paula: And so sometimes that is about making a change, doing something different. So certainly in this kind of case, maybe taking, you know, time off work just in itself may not help. But it may be doing a different type of work, you know, taking a secondment in a different space or exploring other identities that are not about helping.

[00:19:02] Rachel: Yeah, that makes sense. That makes absolute sense. You know, you, you’re trying to challenge yourself in different ways, aren’t you? Because I think that is a mistake we make. We go, well, because I’m burnt out, it must mean I’m stressed there. I need to stop doing stuff. But if you’re that detached type and you are actually bored and there’s no interest, if you stop doing everything, that’s gonna make you burn out worse, you actually need to, to stimulate your brain and grow and develop in, in different ways.

[00:19:25] Paula: So the third one is then this overloaded pattern, which is probably the one that we most commonly think about, this sort of overwhelm. Um, so feeling really like you’re drowning under these kind of, you know, relentless, unrealistic demands. You can’t recover on your days off. So that experience of, you know, weekend is never enough, you know, a holiday isn’t enough, that, that kind of real sense of exhaustion.

[00:19:50] Paula: And, you know, again, this is difficult because people are really, you know, committed to this work. And, you know, the, the relationship that people have with the work is kind of an intimate one. Like work takes up a lot of our, our emotional and thinking life. And it’s very hard to find that balance. And, you know, often people who are, are most likely to, find themselves in this space are those kind of, self-sacrificing, putting other people’s needs first. And those are us, you know, are people who are unlikely to only do that in work. They’re likely to be people who are doing that in multiple areas of their lives. So, the load that they carry is big.

[00:20:37] Paula: And it’s, it’s very difficult, I think, in, in this situation because we have this tension between this idea that, burnout is a workplace phenomenon. It’s, uh, when the resources are not adequate to meet the demands and the solution is a systemic one. We need more resourcing. We need more psychologically healthy work environments. We need adequate breaks. We need to be able to meet our basic human needs.

[00:21:08] Paula: But as one individual, you don’t have the power to change that stuff, and that can be a very helpless place to be. So the conversations around this are tricky because we know that systems need to change, but as individuals, if that’s the only option, you know, we are, we are just drowning

[00:21:28] Rachel: We’re stuffed, aren’t we? But it’s that frog thing, you know, your only, the only option you’ve got is to burn out or, or to leave. I mean, literally. Yeah. I’m totally on the same page. If, if the, if you’ve gotta wait for the system to change, to beat our burnout and our stress.

[00:21:42] Paula: Yeah.

[00:21:42] Rachel: yeah, we’re, we’re screwed,

[00:21:43] Rachel: aren’t we?

[00:21:43] Rachel: There’s nothing we can do.

[00:21:44] Paula: Yeah, exactly. And that’s very different, though, to suggesting that people aren’t resilient enough to cope with the system. It’s about resourcing and empowering people to make decisions that are right for them. Not about saying they need to be stronger in this context.

[00:22:03] Rachel: Yeah. And we, we find a lot that, that this whole concept of resilience, victim blaming is just, you know, I guess it’s rife, but I think that with the best one in the world, most organizations are trying. They get it wrong. The problem is, most of our organizations, particularly in healthcare, are filled up with people who are also under pressure and burning out themselves.

[00:22:22] Rachel: And I think when people feel the most resilience victim blame is when. Interventions are put in that are just so unhelpful. Like, let’s have a, a yoga session at lunchtime .Right, now, I love yoga, brilliant for wellbeing. But if you’ve got a surgery and you’ve gotta go see your patients at lunchtime, well that’s the only time you can meet with your colleagues, a yoga session, lunchtime is the last thing you need to do. And it’s just insulting and it feels really annoying. And then of course, the, the response is, well, you know, if you didn’t give us so much work to do, then, then we could, we could survive it.

[00:22:52] Rachel: But I think yeah, absolutely. It’s, it’s just this thing about there’s always gonna be too much work to do and I think people are capable of burning out in a, even in a system that does have lots of resources, because it’s so internal about the pressure we put on ourselves. And likewise, there are some people that don’t burn out even in the most difficult system.

[00:23:11] Rachel: And so if there’s only one thing. There’s two things you can change. One thing is yourself and one thing is the system. Well at least try and change yourself. And then if the system is so toxic that even changing yourself is not gonna be able to cope, then, then you need, then you know, it’s time to leave. And there’s, by the way, there’s no shame in leaving, changing your pan or whatever. And sometimes it’s absolutely a hundred percent what you need. Sometimes actually you’re just in the wrong bit of the system. And I’ve done that before. I’ve changed practices and it’s made a huge amount of difference, ’cause the practice I was in didn’t suit me. It actually suited other people’s psychological profiles. It didn’t suit the way I, I worked.

[00:23:43] Rachel: But yeah, absolutely. So we have to get away from this, blaming the system thing. And I think when people are feeling very, very helpless and they are demanding that the system changes to accommodate them, then you just know these are the people that are never gonna be able to survive the system because it’s all about the external changes, and that’s not letting the system off the hook, it’s just, it’s really hard to change an external system where there’s no one person in charge, either. Particularly the NHS. Like it’s a series of lots of little things with lots of trust people in it.

[00:24:11] Paula: And I think it’s also about how we internalize that that system. You know, I’ve worked with a lot of psychologists who, like myself, have moved into independent practice and we bring the same stuff with us. Um, You know, the overworking, the, you know, setting our own system up in ways that, doesn’t, you know, allow for our basic needs. It’s like, how do we do this?

[00:24:38] Paula: So, you know, and I, and I think we’re socialized, you know, if you are trained and kind of grow up in, uh, an institution like the NHS, which relies on self-sacrificing schemers in its employees to get by, there’s this real, you know, interplay between what. You know, how we are selected, chosen, uh, crafted through our training and our work and what we internalize.

[00:25:07] Paula: So there’s a lot of room for understanding our own processes that can empower us to do the social justice work that still does need to happen within the system to make it a, a decent place to work and for patients too.

[00:25:25] Rachel: I’d love to hear what the mindset shift is. How do you do that as a psychologist?

[00:25:29] Paula: it often starts with clarity around values. That what are your values as a person, as a professional, and a challenge to apply those values equally to yourself as to the work that you do.

[00:25:45] Paula: So if we think about values as like a quality of being, like, I want to be a compassionate person, that has to apply as much to your relationship with yourself as to your patients. So there’s often some challenging that needs to happen around, you know, if your values are serving others, how, how, how do you do that? You know, what does it take to serve other people? Can you do that if you’re not looking after yourself?

[00:26:14] Paula: And it, it raises discomfort because we have these ideas of that being selfish or lazy or something. So we’ve gotta sit with that. We’ve gotta make room for that discomfort in the service of our, our values.

[00:26:28] Paula: And I don’t think it’s a coincidence. I think that, you know, in order to, uh, get through training, you’ve gotta sacrifice a lot, you know, personally. And you know, if you’ve decided earlier on this is not worth it, you’ve, you’re gonna make a different choice.

[00:26:45] Paula: But certainly, you know, the conversations that you have, you know, with people in other fields, you know, people are like I, you know, changed my job because I, I was bored or it wasn’t paying me enough, or, didn’t like it, and that’s just it.

[00:26:58] Rachel: No guilt there. Just like that’s

[00:26:59] Rachel: what I

[00:26:59] Rachel: that’s what I

[00:27:00] Paula: it’s not, it’s not working for me.

[00:27:01] Rachel: Can I leave my job in the healthcare because I’m a bit bored? Oh, that’s, I’m such a dreadful person. I ought to carry on. Yeah. I was talking to a coach the other day in a completely different field, not healthcare, and she was running a workshop. And, uh, she said, well, what are you talking about? So I’m talking about saying, no, St. Pam. She’s like, oh, she had the thing, I did this workshop and this, this coach, she made us get a piece of paper on, on one side, we wrote the word yes and on the other side, we wrote the word no. And she told us to hold it and look at each, uh, look at someone else. And so every time we say yes to someone else, we’re saying no to ourselves.

[00:27:33] Rachel: It was so powerful. And I thought if I did that in healthcare, they’d be like, oh my great, I’m saying no to myself, but then see that as a badge of honor. I said, that would not work in healthcare because to say no to ourselves, that is what we are taught we should be doing. Or not taught. It’s the hidden curriculum.

[00:27:50] Rachel: The hidden curriculum of I sacrifice every, the patient always comes first. And yes, the patient does come first in terms of treatment and stuff, but if you sacrifice yourself so much, you can’t be physically present or you make a mistake or you’re cognitively not functioning properly, that is just, again, it, it’s, it is actually unprofessional. We need to start changing language and call things unprofessional, uh, and, and stuff that doesn’t work, rather than thinking of it as selfish and self.

[00:28:15] Rachel: I just was reflecting on how interesting that was, that it had such big impacts on her and I’m thinking that I don’t think that would have much of an impact to the leaders that I talk to in healthcare. I dunno if your patients that you see would be like that.

[00:28:27] Paula: Yeah, for sure. It’s, it’s really challenging and, and people can, you know, be very psychologically aware that they’re totally depleted and really struggling. Um, it’s not that they don’t know that, it’s not that they don’t know that they have neglected themselves. They just don’t know how to do it. And it raises a lot of discomfort to even go there.

[00:28:50] Paula: I think it’s such a core part of identity and self-esteem to step aside from that. And I mean, you know, even in psychology, the like conversations around stepping away from the NHS are like scary. You, you sort of are like, you know, I work in private practice or um, you know, hide in the shadows, because there’s shame. Huge, huge shame attached to that, which is weird. Like, you know, we should be able to. Train, be highly skilled, dedicated professionals who can choose to work in ways that are fulfilling to us without it being a moral judgment. And I find that really fascinating. You know, the, the question is not how can we make the NHS a nice place to work? It’s like, how could you, how could you, what kind of a person are you that you would leave to pursue a healthy working life?

[00:29:54] Rachel: How could you leave? Yeah. And, and, and I’ve had people tell me it’s self-indulgent to think about thriving and self-care, which is just utter, utter rubbish. But it just shows the mindset that we, we, we get ourselves in, I presume the further into burnout you go, the more warmth your thinking gets as well, and it just gets worse. And then, then you’ve got that guilt, you’re self-sacrificing. Then you’ve got the guilt that you’ve even started to think about leaving.

[00:30:15] Paula: yes. And it’s not all internal. ’cause those messages can be very explicit, in our context that that is not okay.

[00:30:23] Rachel: So with this self-sacrificing thing, what are the, the strategies you talked about helping them sort of interrogate, you know, is, is is this really helpful to, to the patients that I work with?

[00:30:37] Paula: Yeah. So I think this in this kind of overloaded pattern, this core task, which is easy to say in one sentence, but it’s about, you know, balancing your needs and rights with those of your patients. And I think there is something I often talk about social justice in this context, that the system can be a very exploitative one, um, and we can lose sight of that. And that has an impact on patient care.

[00:31:07] Paula: So if, you know, if those values are around being a good healthcare professional, supporting patients, if that’s all you can access at the moment, we know that in order to do that well, you need to be well. And what is it that you need to, to do that? And if we need to be thinking, you know, in very concrete terms about workplace, uh, kind of psychological health and safety, that’s one route in.

[00:31:34] Paula: But there’s also something about being able to, as you were saying, kind of interrogate your own process, making room for the discomfort that will show up. Asking for help, really difficult for health professionals. And you know, going back to boundaries and thinking about where those sit for you, what is the cost of continuing like this? What does it mean for, for your personal life, for your health, for your family? it may feel really painful to think of stepping aside from this work or taking a break and not what you want, but when we think about the cost of continuing, we may find that it’s too high.

[00:32:19] Rachel: I love that. And I think that question, yeah, what’s the cost? What if a question I often use, and that sort of webinars and training we do is, is what, what is your current job doing to you as a person to your relationships, to your enjoyment of life? Because. When we start to look at that, like, okay, this is a, this is a huge cost and it’s not just a cost to me, it’s a cost to the people that I love, not just my patients as well.

[00:32:43] Rachel: So you’ve got your, your first type, which is the, the, the self doubt pattern. So that’s, you’ve got, you’ve three main things with burnout, haven’t you? It’s, it’s the feeling that of poor performance. So the first one is like you feel that you are performing badly. The second one is sort of cynicism and, you know, detachment from your work. That’s your detached version. And then the third one is just the, the fatigue that’s not sorted by rest. So that’s your third pattern. So what are the, what are the final

[00:33:07] Paula: So the other, so the next one is traumatized. And so this is about recognizing the impact of, chronic exposure to other people’s distress. So not so much in relation to a single traumatic event, but thinking about chronic exposure, and whether that’s directly, you know, thinking about resuscitation or, you know, working in really acute settings when you’re exposed to Stuff that’s not normal to be exposed to in, in normal people’s everyday life, where your nervous system is freaking out because it’s a life or death situation.

[00:33:46] Paula: But also if you’re, you know, working as a GP or as a, a therapist or, you know, another context where it, it’s not the kind of crisis and, and you know, blood in front of you, but it’s hearing people’s stories and, uh, you know, having this view into the world that you write not normally have so much exposure to, you know, stories of, of abuse and neglect. And, and the impact of social problems, of poverty and, that’s very wearing, uh, if you’re exposed to that over a long period of time.

[00:34:26] Paula: And I think, you know, if you, if you are a, you know, some professions are better at it than others at just recognizing that and safeguarding around that. So, you know, thinking about psychology, although we’re certainly not, uh, immune, but you know, clinical supervision is mandatory and, and you know, part of that. And that’s not the case for, uh, many health professions that just the acknowledgement that this is a factor that you are encountering is not there.

[00:34:58] Paula: So, often just people don’t understand why they might be feeling and responding. In certain ways and use the word burnout to describe that. But we’ve gotta think about trauma in this context. And, you know, thinking about making space for our body’s really natural processes to help us support with that.

[00:35:26] Paula: Because clinical environments are often the antithesis of what our bodies need. You know, the unnatural lighting, the noise, the lack of space for rest, for connection, for nature. So just thinking about how we can be really intentional about making space for processing what we’re exposed to.

[00:35:49] Rachel: How important is talking to someone else to process that stuff? Because I, I’m totally gobsmacked that there is no formal requirement for, say even just doctors to have any psychological support. You know, GPs, if you’re seeing 30 patients a day, you, you work for, you know, eight clinical sessions a week, that’s 120 patients. A, a, a week that you are, that you are processing and more with people. But you know, because the demand is huge at the moment. There’s plenty, plenty of doctors that never had a therapy session in their lives.

[00:36:18] Rachel: And if you were, if you were now setting this up as a profession, there would be mandatory debriefings, I have, I have no doubt about it. And I can remember, you know, sitting, you know, in tears as patients leave because of the stories they’ve just just told me and have nowhere to go with that.

[00:36:34] Rachel: So is the only way to process this through talking to a therapist or are there other ways that we can do it given that, you know, there’s lots of doctors, probably not enough therapists to go around.

[00:36:44] Paula: No. I don’t think so. I think that we naturally have mechanisms to process this stuff. So some of that is kind of individual in terms of, you know, these things about connecting with nature, about movement, about creativity, about expression. Just attending to what that does. You know, do we need more rest? Do we need fun? You know, what is it that we need? And often it is about making space for things to move through us. So either very physically, you know, I mean, whatever, exercise or walking, but also that creative expression in whatever form that takes for you.

[00:37:27] Paula: But there’s a really important role for co-regulation, which is about how other people can help us regulate our nervous systems. And that doesn’t need to be a professional, you know, and this is where teams are so key, you know, just being able to debrief with a small d you know, with colleagues, just have a, a rent, you know, uh, uh, you know, the purpose of that is the response that you get from someone else saying, I hear you, I see you yeah, that’s hard, really helps.

[00:38:00] Paula: And we can do that in other ways. Obviously our work doesn’t enable us to talk in detail with people often with confidentiality. So outside of colleagues it can also just about being with people who make us feel good and can help co-regulate the impact on our nervous system. Doesn’t have to be words. But obviously as a psychologist, I feel there is a place for a kind of intentional space for talking. And I think that, obviously that is helpful and, and for some people being able to have that protected time and space is really important. And I think it should be part of, everyone’s practice.

[00:38:39] Paula: But I don’t think, if we’re able to access other, more natural, normal ways of, of responding, that we don’t necessarily always need professional intervention.

[00:38:51] Rachel: Do you have any suggestions for what you might do in those. Informal debriefs with a, with a small D? I’m just thinking of, you know, a time when I was working in a and e and it, it had a very traumatic road traffic accident come in and at those points, no psychologist anywhere to be seen anywhere near the hospital. And then the patient went off to theater and I remember just sort of me and the nurse was lying down on one of the beds and re recess going, oh my goodness.

[00:39:15] Rachel: But you know, in that situation, if there’s like a couple of you, or two or three of you and you go and have a cup of tea, is there a particular question you could ask each other? Or what should you say to each other? What would be helpful at that point?

[00:39:26] Paula: I guess it’s the kind of thing you might just think about making space for what’s there, like, not necessarily needing to say anything in particular, but being able to hold the space. And what’s difficult about that is if people have been together, you know, if both people are traumatized, for want of a better word, by an experience, and that can be hard because you’re both holding it. So there’s something about having a, a containing person who can do that, regulating who isn’t also in it, which is useful.

[00:40:03] Paula: But I guess it’s a focus maybe on, you know, just what you’re feeling right now, you know, and that that’s okay. That it’s understandable. It’s a normal response. You’re freaking out because you’ve been through something terrible. It feels hard because it is hard. This is not a sign that there’s something wrong with you and that you’re not a good clinician.

[00:40:25] Paula: And I mean, on a very practical level, we know that things like playing Tetris, uh, you know, soon after an event really help because it interrupts the embedding of traumatic images in particular. So a visuospatial So there has been actual research on playing Tetris soon after a traumatic event, reducing the likelihood of traumatic imagery being. Kind of getting stuck for you.

[00:40:52] Paula: I’m obviously a big fan of knitting. I think that every staff room should have, a basket of knitting available so that people can pick up and, you know, that that kind of bilateral stimulation of, of doing some repetitive, soothing task if, you know, it’s not always soothing if you dunno how to do it yet.

[00:41:11] Paula: But yeah, just, just having access to, activities that, you know, just like you said, making a cup of tea. Like that’s a normal thing. If something happens in your normal life, you’re gonna do that. We, British people will do that. But we need time and space for that.

[00:41:28] Rachel: Yeah. So often we’re just moving from one to the next thing, the next patient, the next patient. Part of it is just recognizing and going, right, you know what guys? I’m sorry. This is, this has just happened. Let’s, let’s take 15 minutes or even half an hour. And you know what, if there’s other patients waiting, you’re not gonna be any good for them anyway because your brain’s not gonna be working properly. Let’s properly sit down, have a cup of tea, feel what we need to feel, play some Tetris or what, whatever it will, or knit, or just do something mindful. I don’t know. Go for a walk. ’cause that is really important, long term. Then, then the, then the mountain of tasks and the patients in the, in the waiting room.

[00:42:05] Rachel: I just want to get before we finish though, to get to the fifth, the fifth one. So what’s that?

[00:42:09] Paula: So this is the morally distressed profile. So this is kind of distinguished from trauma but closely linked. And the idea of, of moral injury and moral distress comes from psychologists working with Vietnam veterans who found that often what was most distressing for people was guilt around things that they witnessed and didn’t stop, or things that they felt complicit in doing. And that was the thing that stuck with them and was so damaging.

[00:42:46] Paula: And I guess one of the really common experiences that we have working in the healthcare system like the NHS is frequent, experiences of, of. Inadequate provision of care, of not being able to do a good enough job. Not for our own fault, but because the system won’t allow it.

[00:43:10] Paula: And that’s very painful when you’re someone who really cares about your patients and you really care about doing a good job. And it’s like this horrible feeling of being part of something that you know on some level is, is wrong.

[00:43:24] Paula: Um, so in mental health context, you know, that often shows up with you people having to sit on waiting lists for years where they’re in a mental health crisis or you know, not being able to receive support unless they’re actively suicidal and you’re turning people away. Or they sit on a waiting list for two years and then they’ve got six sessions. You know, it’s, it’s, it’s not good enough, but it’s the best we’ve got. And that, sitting with that, and if that’s your job every single day all the time, that’s really hard.

[00:43:55] Paula: Or being, you know, that sense of the systemic issues around, you know, problems with, adult social care or, you know, just thinking about the paramedic sitting in ambulances outside of hospitals for hours just, so tough.

[00:44:13] Paula: So, you know, that can be very, very painful to live with and, and be very depleting, and can show up in similar ways to burnout. So, again, something, you know, people, can, be feeling this, it’s almost a spiritual wound that people. Can experience that isn’t so much about workload, but it’s about their relationship to this work. And are they, are they, are they a good guy or a bad guy? You don’t know.

[00:44:38] Paula: And the task here is about being made, being able to make space for this moral pain. ’cause that’s really important. That’s part of what makes you human. That’s, you know, really speaks to your values. But without getting stuck in self-sabotaging behaviors, which might be you know, squashing feelings, for example it might be leaning into that kind of detachment or, you know, coping email, adaptive kind of coping strategy. So how we make room for that pain, hear that pain, express that pain, be compassionate towards ourselves for that, and take values aligned action, which is very difficult. ’cause what does that mean in a system that’s really struggling? Do you stay? Do you go, are you part of it? Are you not? Can you support change? It’s hard.

[00:45:30] Rachel: That is really, really hard. So I’ve heard someone talking recently, I’m just trying to think who it was they were talking about this values aligned action that they often thought that, you know, in the past they’ve thought, oh, I know it was someone in a religious context about misogynism and patriarchy in a religious context. And they thought it’s better to stay in the system and try and change it. Now realiz, no, it’s better just to, just to get out. ’cause actually it’s, it’s not worth it. But in healthcare that’s very nebulous. You know, you, you’re seeing this stuff that isn’t right. You’d love to, to do so much more, but if you leave, it’s gonna get, it’s gonna get worse and it’s gonna be more harmful.

[00:46:04] Rachel: So when you talk about values aligned action, what examples could you give about some sort of helpful values aligned action that people can take?

[00:46:14] Paula: I guess one of the, a sort of starting point is to be thinking that in order to do that you need to be resourced. So you need to be able to, again, going back to this, looking after yourself in order to have the energy to do the work. And again, this, you know, is related to any kind of social justice work, you need to, to be looking after yourself. So that, so values aligned action can be. Self-care is self-care in this context. Starting from that.

[00:46:45] Paula: And I guess it’s thinking about how you can, within your context and within your sphere of influence, enact those values. So if it is about you know, equality or ensuring compassionate care, what opportunities are there for that in your world? You know, is that about how your team speaks with each other, how you operate? Is there need for a real, like, stepping away and having this conversation, saying this out loud together? Like, what are we doing here conversation?

[00:47:21] Paula: Are there opportunities, even though we can often be really cynical about, you know, initiatives and transformation in the trust, but are there opportunities for meaningful involvement in something that really matters to you?

[00:47:35] Rachel: I guess it’s doing what you can rather than what you can’t,

[00:47:37] Paula: Yeah, and community, joining with other people in it, and, you know, it’s, there’s no easy answers and that’s the problem, kind of being able to hold this messiness without it hurting you so that you can act where it’s possible and that’s hard on your own.

[00:47:56] Rachel: So we’re back to finding your tribe, finding people around, connecting, all that sort of stuff. What things would you be recommending that people do first, that come to all of them if they think they may be in burnout, no matter how far along the burnout path they are? What, what things would you say, actually, this is the thing that has helped my clients the most?

[00:48:16] Paula: So my three things are three C’s, compassion, connection, and creativity. And I think they’re relevant, like you said, across the spectrum. Because we start with compassion and if we, conceptualized compassion as a sensitivity to the suffering of self and others, and a commitment to alleviating it, we need to start with being sensitive to our own suffering in this context and really attending to that to stop and notice where we are, what’s happened, how do we feel, what’s going on.

[00:48:52] Paula: Sometimes we need someone else to do that with us because we’re not very good at being sensitive to ourselves. That can then open up and enable connection, which is, kind of reestablishing what is meaningful to us in life? What really matters? What is the life we really want? Who do we really want to be? What really matters to us?

[00:49:20] Paula: And this will be different for everybody, but often it’s a connecting to our bodies. Like what does our body need now? Connecting to the natural world, connecting to people, our people in work, outside of work, and our values. And if people are really in burnout, it’s baby steps there. You know, it’s really just thinking can you look out of the window? And you know, as with any kind of mental health thing, it’s, it’s the, it’s the small things. It’s the sprinkling of that.

[00:49:49] Paula: And when we’re able to connect with meaning and value and what’s really important, it can open up creativity. And I mean that in the broadest sense of the term, not art, but like a life force in you that is connected to, joy and making and bringing something into the world. Whether that’s, you know, how you dress up your toast or, make literally making something. And I, and I think making things with your hands is really, really good for us, whatever that is.

[00:50:21] Paula: And I feel creativity is the antidote to burnout. You know, burnout is a deadening of our souls and creativity is, is kind of lighting that spark again. And it’s both, you know, a, a wonderful sign when people can hold on to that creative part of themselves that, you know, recovery is there, that part can, can show up and, and be around a bit more. But also creativity is a tool for processing, and supporting our nervous systems.

[00:50:55] Rachel: Thank you. If people wanna find out more about you and your work, how, how can they find you?

[00:50:58] Paula: Yeah. My website, drpaularedmond.com is probably the easiest way.

[00:51:03] Rachel: I think that’s so much food for thought. And you know, I just recommend that everybody, even if they’re not burning out right now, actually identifies what pattern they might be most prone to. Right? Because presumably prevention’s better than cure.

[00:51:14] Paula: For sure. Yeah.

[00:51:15] Rachel: Let’s see what you need to do. And there’s so much stuff that you’ve told, talked about that we can do ourselves, that we don’t need to wait for the system to change. But if you are in a system that is really, really toxic and you rec can recognize yourself in this, please, please go and get help. Don’t just wait, for someone else to give you permission or till you get really, really bad. Go and access to help that you can get now. And there’s loads of free NHS resources. There’s, there’s loads of stuff around practitioner health, NHS People, all that sort of thing. And of course you can contact Paula, there’s lots of, lots of stuff out there, so thank you, Paula, and we’ll speak again

[00:51:49] Paula: My pleasure. Thank you.

[00:51:52] Rachel: Thanks for listening. Don’t forget, you can get extra bonus episodes and audio courses along with unlimited access to our library of videos and CPD workbooks by joining FrogXtra and FrogXtra Gold, our memberships to help busy professionals like you beat burnout and work happier. Find out more at youarenotafrog.com/members.