Before burnout begins…
First, let’s define “client load.” Number of clients is part of it, certainly. Number of clients divided by number of available sessions and days at work is also a part of it. (Having 16 clients in 16 session spots over two days is way different than having 16 clients in 35 session spots over 5 days!) But clients aren’t all created equal. So, a lot has to do with combinations of clients, your own feelings of effectiveness and meaningful work, diagnoses and personality types you work with best, if you’re one of those clinicians who gets energy from couples/families vs. finds them to be energy vampires. So, how many clients we have often has very little to do with if our client load is too high.
I think we’ve been trained to notice when it’s already too late. You know the signs of burnout, right? You have trouble getting out of bed for work, you’re “phoning it in” with clients, you can tell you should care but you don’t, you are isolating from colleagues, you’re catastrophically behind in your documentation and yet not making headway, you’re emotionally numb or nonreactive.
And before burnout comes overstress. That’s when you wake up anxious before work, “bring clients home” with you mentally, begin dropping behind on documentation and feel pressured to catch up, having trouble shutting your mind off, are cranky or a bit emotionally reactive even at home.
It’s also quite good to notice this before you really get all the way to overstress and/or burnout, because if it gets that far, and you need to reduce your load, that can be another additional stressor.
I’d like to share a few ways I notice when I’m reaching my effective client load limit.
- I’m not learning something new for a client
- There’s never a time when I have a case load that is so low or clients who I know so well or I’m so “knowledgeable and competent” that I don’t have something to be learning outside of session. Sometimes, that’s psychotherapy theory or skills related; sometimes, it’s learning about something that’s relevant in a client’s world (e.g., the path to professional soccer, the pokemon universe, and Japanese cultural mores around drug use have been things I’ve learned about recently). If I don’t have the mental space and time outside of session to be learning something for a client, it’s a sign to me that I’m needing to use all of my non-client time for family and self-care. That means the next thing that will slip will be client care!
- I’m bored or distracted in session (with a client I’m not usually bored or distracted with)
- Some clients are boring, and that’s good clinical information. Some clients are distractible, because it’s part of their diagnosis. And I get distracted in a way that’s normal for me, that’s session related. But when I get bored with a not-boring client, or distracted (especially by thinking about other clients during one client’s session), that struggle to “stay present” is an early sign to me that client load, in the mental capacity way, is getting too high.
- It’s takes more than 20 minutes at the end of the day to finish notes
- For me, I almost never take notes in session after the intake. Also, I’m quite bad at letting clients out at the :50. So, I usually end up with about 3-6 minutes to write notes, read last week’s notes on my next client, and maybe do one other thing (this is either run to the restroom, refill my coffee, or do a super quick meditation or centering exercise). My notes include two main parts – a summary of the important session material (so I can read it next time before session), and “the boring stuff” – client name, date, session #, MSE check boxes, treatment plan updates, etc. So, I write the summary in my 3 minutes along with the client’s name right after session and then I leave the “boring stuff” for the end of the day. It’s no problem to finish the final note and 6 “boring stuffs” in 20 minutes. If I’m not able to, it’s because I mismanaged myself during the day, and that’s usually because my client load is too high. I’m keeping clients extra long and then running behind, I’m not taking time for centering, or I’ve struggled to summarize.
Noticing is one thing. Committing to doing something about it is another. Ask your favorite colleague, your best non-work friend, and the person you share a budget with (if you have one) to all help you commit to delivering excellent care by acting when you’ve noticed you’re approaching your limit, not past it!
Comment below with the ways you notice you’re approaching your limit!