“The clients that get under your skin are the ones that you can see your life mirrored in,” says Melbourne-based psychologist Lucy*. Given she had worked mostly in the trauma space over the span of her 20-year career – and had never experienced trauma herself – that didn’t come up a lot. “Listening to them was difficult, but it never felt like something that was happening in my life.”
That all changed with the pandemic. Suddenly, “my life was the same as my clients”. They mirrored Lucy’s exhaustion, uncertainty, fear. “I didn’t want to talk about it any more and yet I had to go in every hour and talk through different versions of the same experience.”
She pushed through, conducting back-to-back telehealth sessions in her back shed, away from her small kids, housebound in lockdown. Eventually she emerged from her back yard and returned to the ward of the Melbourne-based public hospital where she worked. Then the adrenaline wore off. Lucy started dreading the prospect of some of her clinical work, mostly the evening private practice sessions she’d set up part-time. “I found myself hoping people would cancel.”
Eager to avoid complete burnout, she quit private practice, reduced her clinical hours and took on a new role at the hospital working with new graduates as part of a new Victorian government program of workforce reforms recommended by the royal commission into Victoria’s mental health system.
She felt energised by her colleagues and the graduates’ new ideas, buoyed by the “hopeful idea of maybe we can supplement the mental health workforce so that there won’t be those huge wait times”. She was also encouraged by the hospital’s commitment to taking care of the early career psychologists she was working with. They had reduced caseloads, extra training, peer support. But still, she felt so tired. The wait lists were so long.
“I’ve had three separate people say to me in the last couple of weeks: I can’t do a good job when I’m this busy. And the clients are so much more unwell than they ever have been before because every service is backed up.
“I have to keep telling them it won’t be like this forever,” says Lucy. But she also sometimes asks herself: “Can I do this any more?”
With no time to catch their breath from the peak of the pandemic, psychologists across Australia are dealing with soaring demand for services and a lack of colleagues to provide them. According to the Australian Psychological Society (APS), before the pandemic one in 100 psychologists were unable to take new patients. It’s now one in three.
The APS reports that the federal government is meeting just 35% of its psychology workforce target, the largest workforce shortfall of any mental health profession.
“Our profession has been on the frontline of an incredibly challenging time in our nation’s history, with the pandemic, natural disasters and a cost-of-living crisis affecting Australians like never before,” says president of the APS, Dr Catriona Davis-McCabe. “Burnout is running rampant in psychology with many having to consider leaving the profession or reducing their hours to safer levels.”
Burnout isn’t exclusive to the psychology profession, but it can alter the way practitioners do their job – it can mean physical, emotional or mental exhaustion working hand in hand with “increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job, and reduced professional efficacy”.
For psychologist Dr Ahona Guha, who specialises in trauma in the public system, it took a long time to recognise burnout in herself. “Those of us who work in the field have a sense that if things were to get bad, we would know, but the signs were quite subtle to me,” says Guha.
Guha had stopped questioning the intense sense of tiredness and strong physical fatigue that she regularly experienced. Given she’d managed the feeling all through the pandemic, she’d just begun to assume it was her normal setting. “Until I realised this has been happening for about three years now,” says Guha. “And maybe this intense, crushing fatigue isn’t normal.”
She had “dreams about clients, dreams about work”, was uncharacteristically irritable, and carried a sense of general resentment. “I noticed that when I’m more burnt out I can find it difficult at times to hold the same level of compassion,” says Guha.
It wasn’t just Guha’s approach that was changing, it was the nature of the work. “There’s been a sense of helplessness over the pandemic … with the way things in the world are at this point in time, there’s a lot of client distress that we can’t always change,” says Guha.
Carlye Weiner has worked in a solo private practice, a public hospital and several major not-for-profit mental health organisations. At various times she has felt “exhausted, despair, helpless, sadness, anxiety, isolation” and finally, dread. “People’s problems were suddenly too widespread to provide treatment as I normally would and the end was never in sight.”
She felt like she was failing people. “I had to say no to the public [hospital] a lot which created a huge moral dilemma. Having to tell people ‘I’m sorry I can’t help and I don’t know anyone who can’ for months on end led to anxiety [about] checking my devices and returning calls.”
Dr Joanne Peters oversees more than 55 psychologists as the psychology discipline senior in the mental health division at the Austin hospital in Melbourne. She’s responsible for everything from recruitment and retention to professional development and supervision. “Healthcare workers are amazing people. They’ve got this significant level of loyalty and they just keep on getting on with the job. They’re so dedicated – it’s very powerful. But we’ve got an obligation to look after our staff.”
She’s acutely aware of how hard the work is at the moment. “We’ve got a greater number of referrals, greater complexity and acuity of presentations, and a greater number of first-time presentations. It’s also been really hard for public health clinicians to refer clients back to the private sector after an episode of care because of significant wait lists for private practitioners.”
Peters’s department offers a range of ways to support staff including reducing hours when needed, urging them to take annual leave, encouraging exercise and supporting some staff to work from home, all in addition to providing the essential scaffolding of supervision and debriefing – but she also recognises that sometimes it can be hard for staff to admit they’re struggling.
“There can be a fear of being judged,” says Peters. “I think that as leaders, we need to model problem-solving, coping and even vulnerability. That’s just part of being a person.
“The feeling that I should be able to cope, the worry that others will judge, the guilt that you’re then passing your problems on to another who’s probably feeling it just as you are is real,” agrees Weiner. That stigma is starting to shift, she says. There’s a recognition that psychologists need to find a way to sustain themselves but also to “recover from what we’ve been through”.
Part of Guha’s self-care plan has been to see her own psychologist. She reckons it’s really important to “normalise the health-seeking process”. Her psychologist has “been absolutely crucial because I’ve worked with her for a long time and she kind of knows my drive to keep going. It’s really helpful for me to be given permission to sit down.”
The simple objective to keep going seems to be the overriding ambition for many psychologists. Pacing is key. After the sprint of lockdowns, the next phase is all marathon.
“Covid hasn’t gone away. Cost-of-living pressures continue to rise. There is a lot of distress within the community. And that’s not going to go away for a while, if ever maybe,” says Guha.
“You have to go into self-preservation mode,” says Weiner. “You ultimately won’t be available to anyone unless you set limits on what you can give.” Weiner plans to further decrease her client hours. “I need some time and space to reinvest in myself ... I love this profession and this is a gesture to sustain myself for the long haul.”
Changes in the system could relieve pressure on individual practitioners by addressing the most pressing need – boosting workforce numbers. Increased funding for postgraduate psychology training so universities don’t lose money by offering these programs would have immediate impact. For those already working in the system, an emphasis on working within teams and peer support is vital, as is breaking down the stigma of asking for help. That’s harder for those in private practice, which can be isolating, especially if there is a pressure to work a certain amount of hours to cover the cost of running a small business.
For now, beyond blocking out the diary, some psychologists are trying to take heart in the little wins.
“It feels a bit helpless sometimes,” says Guha. “But I think the hope for me is thinking about how far things have come, the treatments we can offer. Seeing the people who are really dedicated to making a difference. Knowing that we can all do our part. And like I say to all of my clients, we can’t control the outcome, we can just work on the process.”
For Lucy, having a good session reminds her why she sticks with it. In the lead up to Christmas, she had more than a few clients tell her how much better their year had been, and how much they appreciated the work they’d done together. “That’s why we do it, right? Sometimes people get better and they really appreciate it. And sometimes you’re the only person they’re talking to.”
• * Not her real name
• In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and ChildLine on 0800 1111. In the US, Mental Health America is available on 800-273-8255