Burnout
THE VALUE OF AUTHENTICITY IN ACCOMPANIMENT
by STEPHANIE MUNCY
I fell in love with the lost art of baking from scratch after coming home from an internship in Rwanda. There was something about it that spoke to me.
Maybe it was because of the way art and science are so intertwined. Baking from scratch is a process of radical transformation requiring strict adherence to a formula of sifting, kneading, separating, resting, rising and whipping (amongst other techniques). But there is also a mystery to it all. How egg whites can be whipped into stiff peaks or how coffee, of all things, can be mixed into chocolate cake batter to enhance its flavor is, at the very least, counterintuitive. Or maybe it was the symbolism that got to me. It was exhilarating to be able to create something - to blend multiple separate parts into something unified, beautiful, enjoyable and whole, a process not unlike what I was learning from the courageous Rwandans working to heal and reconcile after the 1994 genocide. Maybe it was the joy of sharing what I made as a gift to be partaken with loved ones. Or, quite simply, maybe I loved baking because, in the end, it tasted better.
Well, whatever the reason, baking is absolutely related to why I wanted to become a mental health practitioner and the reason why I hesitated to do it. Let me explain.
Throughout the education and formation process of becoming a mental health practitioner, I was concerned about my ability to navigate the pain and trauma of others without sinking myself under their weight. Would I be alone and unsupported, with some instruction and an unfamiliar process, regretting that I started without a terribly painful way out? This concern remained despite being constantly assured that I could be taught this skill. And it remained despite the many lessons on self-care and its ability to ward off burnout.
“I struggled with the reality that many graduate programs (including mine) do not include a thorough training of personality.”
I remember filling jars with ideas of how we could engage in replenishing activities such as spending time with friends and family, exercising, creating art, watching movies, going to the spa and on vacation, praying, and spending time in nature - all to aid us in staying afloat so that we could maintain our own lives and continue to care for clients. However, as I began my field experiences, encountered clinicians, and paid closer attention to their stories and experiences, I grew more concerned about the viability of engaging in this work sustainably. I met deeply caring individuals with tremendous hearts and strong work ethics that were suffering. Not only did they lack sufficient support to cope with the daily stressors of their jobs, but they also were not equipped with an adequate understanding of how to grow in awareness of their own psychologies, and engage in ongoing deeper work that would be beneficial both personally and professionally.
This was confusing for me. I struggled with the reality that many graduate programs (including mine) do not include a thorough training of personality - and not just personality disorders, but traits that everyone has somewhere on the spectrum. Being human myself, I have relational patterns - ways I have learned to relate due to my own experiences - just as my clients do. Certainly, I would experience countertransference and have reactions of my own based entirely on my own woundedness, right? Wouldn’t it then follow that growth in discerning the difference between my own baggage and what was solely elicited from the therapeutic relationship would be helpful?
Perhaps even more troubling, in graduate school, I was encouraged to practice approaches to therapy that insurance companies would be more likely to support. These approaches tended to be more surface-level and short-term in nature, typically discouraging a delving into the histories of an individual, and cautioning the clinician away from permitting the individual access to their authentic responses. I was put off from practicing forms of therapy that would be able to identify and address root causes of an individual’s suffering specifically because they would mean exploring experiences in relationships throughout their lives. Relationships in which someone may have learned that they had to be funny to receive attention, or assume more responsibility than necessary, or engage in disconnecting and damaging behaviors to prevent abandonment or rejection, or any number of unhelpful and painful experiences. While we know that genetics certainly plays a role, I often wondered, “Does one’s environment matter too?” I was told that longer-term forms of treatment are less scientific as it may be challenging to prove their effectiveness. However, without attending to the impact of the past, it seemed to me like therapy was more about providing band-aids than healing the wound itself. We all need band-aids at times, but if care stops there, then wouldn’t challenges for the client likely resurface not long after treatment ended?
Something didn’t add up for me.
“We are formed in relationship, wounded in relationship, and it is through relationship that we are healed.”
I am not suggesting that clinicians that practice and teach shorter-term, less relationally based treatments are just trying to take short-cuts or aren’t willing to put in the work - quite the contrary. There are systemic issues that make it very challenging for clinicians to provide long-term relational care, and clients to be able to afford it. Yet, we know God’s ways are not that of efficiency. What is efficient about forty years of wandering in the desert or thirty years of the Messiah’s life lived in ordinary hiddenness?
I’m also not suggesting it was anyone’s intention that I receive the message that I, as the clinician, should not actually be present for therapy. But it certainly felt that way throughout the formation process. Aside from non-judgmental acceptance and unconditional positive regard, it seemed I should make every effort not to exhibit any other emotional experiences to the client. However, at the same time, I needed to be responsible for the inevitable emotional toll of bearing the burdens of others. From that perspective, it wasn’t altogether surprising for me that I struggled to find clinicians that could care for themselves well amidst their steep caseloads that included never-ending documentation. So, without convincing role models and serious guidance as to how to engage in the work of psychotherapy in a healthy way, I was not confident that I would continue my clinical formation after graduation.
My baker’s heart told me there was a deeper, better way than what was being offered.
We live in a fast-paced society that values efficiency and effectiveness over quality and faithfulness. It’s true in baking and it’s true in mental health care. While I love a box of Ghirardelli double chocolate brownies and appreciate the convenience of a cake mix, I also know the difference it makes when I take the time to put forth the effort and care to skip the jar of frosting on the shelf and beat the simple ingredients of butter and sugar together to make the best buttercream frosting. When I do more than add some liquid and stir, I learn about how different ingredients interact with one another. When I wait out the long process of folding and rolling again and again to create fluffy buttery croissants, or see the less than pretty process of bread dough rising and falling before it comes out of the oven with a crispy crust, I am able to witness the power of doing the deep work, of working from the core of things, and patiently allowing the mystery of transformation to unfold in its own time.
“In retrospect, it seems my early clinical formation was similar to that of a frustrated, inexperienced baker fumbling to figure things out without much guidance.”
If all of that is true for transforming ingredients into a delicious pastry, could it also be true for transforming the human heart?
As Catholics, our faith says yes. To heal our brokenness, God didn’t send us Socrates to ask us questions. He sent us his son, Jesus, to be in relationship with, to be a branch to his vine.
We are formed in relationship, wounded in relationship, and it is through relationship that we are healed. Once I finally found a place that gave permission to look at the connections between someone’s relational history and their current distress, and allowed my own self to be part of the work, the unnecessary dilemma was solved. What I already knew from my faith was confirmed: the relationship itself is the healing vehicle. In relating to someone in a new way, contrary to the ways in which they had been hurt, I could provide corrective emotional experiences that could actually help rewire someone’s brain, interrupt outdated ways of relating that were contributing to their distress, and help them become more connected with themselves, others, and God - for which we’ve been created. It makes all the difference to understand where we’ve come, what we need, and where we’re going - which is all relationship. Without a sound Catholic anthropology (that is in no way in contradiction with science), our efforts lack a solid basis. I now understand why I was dissuaded by my graduate training that taught me to offer what felt like half-baked (pun intended) guidance, rather than learning to make a true gift of myself.
As the relationship is the healing vehicle, it means that I, as the clinician, would be an integral ingredient to the healing process. Not just questions I would ask or challenges I’d provide, but my actual involvement in the relationship. I found the most effective way to truly understand what someone was experiencing in relationship was by paying close attention to how I felt interacting with them. I learned to become a diagnostic tool. If I felt that someone was exaggerating or acting theatrical, that helped to understand that they deeply desired to be seen, and that they unfortunately were not seen in the ways they needed in their past. If I felt pressure to be a perfect clinician, that could indicate to me that my client learned they needed to be perfect to be loved, and actually truly needed me to model peace with my own imperfections. Inevitably, how those in my care related to me would help me understand how they related to others in their life as well.
Rather than hold onto my emotional experiences and deal with them outside of the therapeutic relationship, I learned that I often owed it to my client to share with them how I felt, albeit from a place of awareness and discernment. In doing so, I would aid in the development of emotional intelligence, model healthy human behavior, and provide connection - all of which contributes to the generalization process that permits the client to experience healthier relationships outside of the clinical space. Secondarily, I would not be encumbered with unnecessary separation of personal involvement outside of the clinical space. Such disintegrated harbored feelings have deleterious effects such as anxiety and depressive symptoms that cause burnout and overwhelm for many clinicians. In addition, it is easy for resentment and bitterness to grow for providing such unidirectional care while pretending we’re not a part of the process.
In retrospect, it seems my early clinical formation was similar to that of a frustrated inexperienced baker fumbling to figure things out without much guidance. It seemed I was only offered certain ingredients to the process of accompanying someone in their pain, while missing crucial parts of the recipe that would lead to the best outcome. In addition, it was as though I was given an over-abundance of flimsy tools and decorating materials rather than the core quality instruments and richest of ingredients. The shortest and swiftest methods of baking and psychotherapy both yield results, while saving time and energy. It might be long, repetitive, and harder work in some ways to learn how to bake from scratch and do the deeper therapeutic work, but is it not worth it?
After years of this investment in personal formation and development, my experiences in baking and clinical work continue to parallel one another. There is nothing like witnessing the joy of a friend enjoying something I made from scratch, and there is nothing like participating fully in God’s plan in the transformation of men and women into who God made them to be. That can and should be the standard for all mental health practitioners.