How Many Clients Are Too Many? 3 Signs of Burnout

We’ve all looked at our schedule for the coming week and wondered, “How on God’s green earth am I going to get through this?” But somehow we manage to start the coffee brewing and get our game faces on because the fact is, people– people in need– are counting on us.

And for the most part, we don’t complain, we’re grateful to do the work we do. No one ever said this job was easy— but sometimes it can be daunting. A full time case load in Illinois is officially 22-24 clients per week, but many clinicians see upwards of 30, especially those of us who work in public healthcare or who simply struggle with the word “no.” For some, this is ok. I have a colleague who routinely takes on something like 34 and still has a kick in her step as the last session is winding down. For others, though, it’s too much, and whether we get over scheduled because we need to maximize revenue, thanks to the pressures of a less than sympathetic boss, orbecause we legitimately havea hard time not helping when someone is suffering, it can impact the quality of both our practice and our personal lives.

How do we know when enough is enough? Like everything else about counseling, it comes down to self awareness. There are three signs of burn out I trust as an accurate measure that I’m losing it, or am about to.

Physical pain

Lack of empathy

An inability to stay present

Let’s consider each.

Physical pain

I’m a big believer in the idea that my body has at least as much wisdom as my mind— not surprising, given my background in yoga and meditation. So when my body starts complaining, I’ve learned to listen. Not every complaint is saying the same thing; if my back hurts, that usually means I’m getting too focused on a single task. If my eye starts twitching, that’s anxiety. If my neck stiffens up, I’m probably internalizing someone else’s experience. Conversely, if all of my body feels reasonably well, so does the rest of me.

As clinicians, it behooves us to listen to the messages our physical selves send, as they can help guide us toward more effective self care. Of course, as we all well know, physical discomfort is an unavoidable a part of our profession, but when it starts to sound like a shout rather than a whisper we can stop and wonder, what does this really mean and how can I help myself feel (and do) better?

Lack of empathy

Empathy is a therapist’s modus operandi, and our ability to feel it is one of the things that calls us to our work. So it’s fairly disconcerting when we find ourselves sitting in a room with someone we’ve been entrusted to help, and realize we feel irritated, angry, or worse, nothing, towards them. It isn’t surprising that this occasionally happens. After all, when any human being spends a major part of their lives absorbing and processing other people’s thoughts and emotions alongside them, they can get battle weary. But too much of that state of mind is a clear indicator that we need to reset, refuel, and maybe reconsider what we’re able to handle.

It is also important to notice, not just a creeping sense that we can’t be generally empathetic, but if there are specific times, issues, or clients that are more problematic. Somewhere along the line I figured out that I just couldn’t be in session after 7pm no matter how well treatment was going. It was hard for me to stop offering times later in the evening, but once I did it felt like the sun shining. It was the same for certain people— some triggered so much counter transference that no matter how hard I tried there was a part of me that just needed to shut it down. Giving myself permission to refer such cases out has been liberating, as has allowing myself to focus on the client populations that most interest and invigorate me.

Inability to stay present.

It happens almost without us noticing it; one minute we’re fully present in session, and the next we’re going over our grocery list or thinking about what’s for lunch. A certain amount of this is unavoidable, and for the most part we can rein ourselves back in, but when we can’t sustain our attention with a client for longer than a few moments, it can be maddening. Like meditation, effective treatment requires great skill in mindfulness, and when that begins to erode, so does our ability to help our clients. Similar to a lack of empathy, a lack of mindfulness will be exacerbated by certain clients more than others, and will wax and wane with the hours of the day, but if it happens with increasing frequency, or if it happens with clients who are ordinarily pretty captivating, that’s a big red flag.

So how are we supposed to handle burn out? It’s not like we can do without a living wage, start calling in for personal days, or refer out every single person we struggle to treat (though as I said earlier, in some cases that is the best solution.) I think the answer lies in knowing ourselves well, and treating ourselves with the same compassion we offer patients. We need to build in breaks throughout our days, prioritize our physical health by eating well and moving our bodies, have a strong support system in the form of colleagues whose opinions and ethics we trust, build case loads with clients we are excited about treating, and honor our own limitations without self reproach. In short, we need to be meticulous about self care. By being so, we not only keep ourselves sharp, strong, and effective clinically, but we model such behavior for our clients— whether they are conscious of it or not.

Being someone who has chosen to help others on the arduous journey of self discovery and healing requires a great deal of fortitude. Like a singer who uses their whole being to create a song, so we ourselves are the instrument of our work. This is a gift, as we get to engage in our profession in a way that few people ever will, but it also comes with a special responsibility. Caring for ourselves well means we care for others better, and at the end of the day, that’s what we all dream of doing.