The title of this article caught my eye, “Mental health professionals are the ones taking care of us: Who’s taking care of them?” It somehow struck a chord (a painful one, if I may add) because it rang so true. Even though this is written in the US, I feel it may apply to mental health professionals globally, those of us who have worked through a pandemic, who are now talking about burnout, guilt, and the after effects of working with people who are anxious, depressed, stressed, suicidal, those whose lives have been ravaged by the pandemic.

My life’s work is about understanding, empathizing with and finding ways to improve the quality of life of those with psychological suffering, chronic mental and physical illness, or disability. And then along came the pandemic and changed the course of the conversation, having us talk about the collective ways in which the pandemic affected all of us, and that included me. How I was worried for my octogenarian father, for my loved ones, but of course I had to put my own fears and anxieties aside, roll up my sleeves, and get to work with the people who came with debilitating mental health symptoms which impacted them personally, their relationships, and their work.

It’s one thing that I am helping individuals cope with crises, and I may not have time for anything else besides taking care of them, my immediate family and close friends, my own overall health so that I get to work re-energized the next day and give my clients my best, but when I am subjected to judgments by people close to me, I really began to wonder who has my back.

“You’re not as social/You’ve become so boring because you don’t meet”
“You’re too busy that we’ll need to take an appointment to see you.”
“You don’t return calls/don’t respond to messages, you don’t meet.”
“You’re often online on Whatsapp, but you don’t respond to my messages in real time.”
“What will you do with all that money you are earning?”

And if ever I mention the stress or the compassion burnout which in all likelihood would be the reason for my absence, I clam up when I hear, “But you’re a psychologist, you shouldn’t  be feeling that way.”

It's like saying a cardiologist can never have a heart attack.

And yes, I am human too. I thought, and then thought again, if I should write this piece, but then decided to go ahead with it, because the voices of mental health professionals like me need to be heard. Those like me again, who have a lot on their plate managing work, home, and life in general, and who feel lost, lonely, and burnt out because of their commitment to work, and the constant super human efforts they are expected to summon up every moment by family and friends. Trust me, sometimes just to be our usual selves takes a monumental effort.

So anyway, I can count on one hand the number of messages I get of care and concern.

“Hey Doc, I know you’re busy, but I just wanted to check if you were doing OK, and are taking care of yourself the way you take care of us.”

“Hey, just wanted to send you a big virtual hug. For being the awesome you.”

“Hello Dr. Sahib. Just wanted to tell you that I am doing well and I hope you are too. With immense gratitude…”

And this, from someone I didn’t even know: “Good evening, doc. I have approached you after a reference loaded with appreciation but more than that I am so thankful for your work in your specific field. I understand you must be very busy taking into account the satisfaction you must be spreading, but if you could spare a few minutes for me so that we can figure next steps regarding the issues I want to discuss with you, I would be really grateful.”

And then of course there are kind gestures of handmade goodies being sent my way :)

These messages are from people I work with professionally as you can probably see, and other than my inner circle, I am rarely asked, “Hey, how are you holding up? Is there something I can do for you?” I know we are all so caught up in our own lives, that just reaching out to check on each other seems to become lower on our priority lists.

And on those rare occasions when a friend does call after months and years with that question upfront, it is soon followed up with, “Hey listen, I’m going through this difficulty and I needed your help...” I would of course do what is needed and provide that support, but I can’t help feel that I am back to work again, because this call would have been squeezed in between sessions, in the time where I usually take a breather to get ready for the next person I am going to be working with. And when I haven’t been in touch, it’s perceived as because I may not care, which couldn’t be further away from the truth. I am in a lose-lose situation constantly :)

For the uninitiated, my day starts at 5 AM, and now that summer is fast approaching, my stressbuster—my runs would  start at 5:30 AM, and after getting ready, I am at my workstation by 8 AM and soon after into sessions. The sessions end at 7:30 PM, and then it’s dinner and time with family till 9 PM, following which I will take one last client call in case it’s urgent, before wrapping up for the day at 10 PM.

Therapy is not just the one hour that goes into the session, it is often going over assessments clients have filled out, crafting their treatment plan, going over their journals or voice notes, talking to their loved ones for history taking and/or reassuring them, collaborating with the psychiatrist on calls to discuss progress, working through their reflections and assignments between sessions, and of course documenting the details so that it is a seamless delivery of services. Imagine that a few times over in the day, when I see clients till the evening, six days a week. Not to mention the in-between SOS messages and calls from them, when thoughts of self-harm make them reach out for safety. This is just the clinical side of the work, but when you are a solopreneur like me, the administrative stuff begs attention only to be found time for post sessions and/or on weekends.

Empathy, compassion, being an effective listener, demonstrating patience and understanding, being able to sit with the client through an emotional upheaval, to have them ride the tide, to share perspectives, and create insights, and lead them towards their goals requires a constant, unending supply of energy…energy which ebbs and flows, and often gets depleted to dangerously low levels when we are working tirelessly, constantly, without paying too much attention to our own needs, desires, wants, and most importantly are grappling with time for rest and rejuvenation.

Even an inanimate computer, with its continuously charging electrical circuits when plugged in can get a little too heated up and shut down unexpectedly when overused. The human brain—a far more complex organ with exponentially more circuits and neurons—is prone to the same risk, of overheating (even just physiologically speaking) with overuse and shutting down unexpectedly.

So when I am not able to afford that luxury of paying attention to my own needs of rest and rejuvenation on some days, it often leads to missing out on life outside of work and sometimes guilt imposed by demands that I may not be able to keep, and those lost opportunities to connect on a personal and social level. There used to be a time when the guilt would be strong, but I have accepted it and made space for it, so that I can function better. But the hope remains that people around me would understand what compassion fatigue is all about.

Why does compassion fatigue make its presence felt periodically? Imagine hearing about suffering and pain day in and day out and working through it. Then there are feelings of self-doubt and inadequacy when a client feels stuck and is making no progress in therapy, however much we learn to detach, or feelings of frustration when our time and expertise is not respected but we still have to compassionately deal with the client hoping to reduce their resistance and bring about an openness. I often remind myself to see clients as rainbows and not roadblocks which brings about a needed shift in the lens we view them through so that we continue to work through the challenges, and not around them. It requires persistence and fortitude.

I often take small breaks between sessions to centre myself, to get ready to start with a clean slate with the next person I am working with. Sometimes it takes a few extra minutes to calm down, after a particularly emotionally intense session. But the next person you see would not get a whiff of the turmoil you have just moved on from. Sunday is my day and I am fiercely protective of it, choosing to engage in life based on what needs come up in that moment.

So please understand if I am unable to return social calls when I am coming up for air. If I am online on a chat engine and I am not responding to messages instantly, it’s because I am working with someone on chat too. A lot of people feel safer and less vulnerable when they type their thoughts and feelings out and can eventually speak up when they have built their trust in their therapist. The explanation is as simple as that. I will still commit to working on communicating promptly because I admit that is a lacuna I have found glaring at me.

“What will you do with all that money you are earning?” is another taunt I get. This one bothers me the most.

I chose this line of work. It comes with its challenges and difficulties but it is immensely satisfying when you see people emerge stronger from their struggles and suffering. Every tear I have wiped, to every panic attack that I have sat and stayed with a client through has been worth every bit of my time and effort. And if in taking care of my clients, I also focus on my own well-being so that I can serve them better, that too is my choice. And if I choose my work, my family, my loved ones, and my own self-care over socializing, then that is a choice I am making willingly and am very happy with. I have finite physical, mental, and emotional resources and finite time and I will use that wisely.

The ability to empathize, I also am beginning to question and wonder, has a finiteness to it. I ask myself if therapists lose a bit of themselves in taking such exemplary care of their clients, that they become jaded, and worn out, and their ability to be there with as much spirit and gusto as they demonstrated earlier may begin to falter. But given that empathy and compassion comprise the bedrock of my therapeutic approach, how can I allow those resources to fade away? And so, come hell or high water, I tell myself, I have a standard to maintain, a commitment to fulfil, and a promise to keep.  

It is often an expectation that we therapists would be happy, shining, bouncing, compassionate, Zen, and available for others. ALL. THE. TIME. And when we are not, we are on the receiving end of displeasure, in various ways.

“The world is getting so increasingly selfish and self-centred. We are only watching out for our own best interests.”

This was a  recent client in therapy, his disappointment palpable as his family was caught in the midst of a feud. I could understand where he was coming from.

I falter. I make mistakes. I admit that. I am an introvert. I like my solitude, but I also like the company of close friends and family when I have the bandwidth, like this Sunday, when I hung out with my cousins and friends, because we talked about life outside of pain and suffering, and I found immense healing in their hugs, smiles, and conversations which was so refreshing. I was myself, and was not forced to don the psychotherapist hat. I wonder if most people still see me, as just the ordinary human being as well.

If I am expected to empathize with the world around, wouldn’t it be nice to also be a recipient of it? Where people would step into the other person’s shoes and understand the roller coaster journey they have been on for a year and counting? Where instead of judgments and short fuses based on assumptions, one gets care, compassion, and a bit of understanding? And if all this is too much to ask for, at least let go of the taunts, sarcasm, and judgments. I’m OK with silence. That’s all I ask.

And yet, it will fade as writing in the sand, that Covid-19 hit our home, or that Dad was in the hospital for a cardiac procedure, or that I was doing my best to manage it all, through my own struggles in the midst of a pandemic, managing work, home, friends steeped in difficulties, and myself even through illnesses and injuries. It’s been a lot to juggle, and I would do it over and over again, willingly. 

“Mental health professionals are the ones taking care of us: Who’s taking care of them?”

The answer to that is: Mental health professionals are taking care of themselves. They are struggling, they are doing their best they can to serve a troubled world globally, they are burning out, but they are there. There for the ones who need them. And there for even themselves. Some may even be in therapy of their own.  

Please make their lives a bit easier by extending your empathy, understanding, support, care, concern, and by respecting their needs, and their spaces. It’ll go a long way.