Clinician’s stress

It was 9pm in the evening, 5 hours after the end of my “official” work day. I was far from home at an inpatient psychiatric ward at a local hospital, where I worked as an intern psychologist.  

I was in the midst of filling up some endless documentation when I was interrupted by a gloomy and pale youth – my patient.  

She stood shivering in her hospital gown, almost on the verge of tears. Even though it was time for me to return home, I could not ignore her. My heart was torn in two between the patient in front of me and my children waiting for me to return home.  

The patient wanted me to answer her questions on our therapy session earlier. Ultimately, I left half an hour later and when I reached home, my children are already asleep. 

I wondered if it was the right thing to do – if sacrificing the scarce time I had with my children to answer a question from my other equally needy “child” was worth it. 

I consulted a colleague, who dropped the insightful (and perhaps controversial) line: 

“Your children will be the next at the hospital at this rate.” 

The sentence cut sharply into me. I was consulting him not for wisdom, but for validation. It was not the line I had hoped for, but a line that would help more. 

The struggle of balancing work and life is universal to all clinicians. The school counsellor sacrificing sleep to calm their distraught students over the phone at 2am; The therapist thinking about her clients while on vacation with her family; and Myself, who continues to do therapy in my dreams. 

The load on our shoulders is incapacitating. 

I have been practicing as a clinician for more than a decade. I have thought of quitting many times. I can’t blame myself, can I? My dream job includes being a cashier. I won’t need to deal much with other’s emotions in this job. 

Here’s three of my favorite mottos that has helped me greatly to stay on this job. 

1. I allow myself to be ordinary.  

Family physician Gabor Mate, who wrote many famous books about trauma, use the term “spectacularly ordinary”. When I feel the pressure to squeeze one more case into my full schedule, I tell myself I can be an ordinary psychologist who cannot fulfil her client’s wish to see her at a very short notice. This also applies when clients are not improving “fast enough”, when I don’t have a certain knowledge or when I can’t volunteer for a certain project. When I allow myself to be ordinary, my stress reduces and I am actually more effective than trying to be a nice, kind, warm, fast, smart, self-sacrificing psychologist.  

2. I move at my client’s pace.  

I once attended a training course by a senior CBT psychologist. She said,  

“Doing therapy is like a seesaw. When the client is motivated and move towards you, you move towards them. When the clients move away from you, you move away to keep the balance.”  

Once out of balance, the whole structure will collapse. This simple yet profound insight, allows me to stop taking all the responsibilities and share with the clients. Which means that if a client is not convinced that therapy will work, I will suggest stopping therapy. I let go. What a relief!  

3. I set realistic expectations.  

A colleague told me that it takes four sessions for the real issues to come out in therapy. I can’t agree more. In treating trauma, it usually takes anywhere between a year to three years to make meaningful changes.  

However, our clients frequently come to us in crisis situations looking for results in a short time. If we collude with their belief that we are magicians, the pressure to perform is tremendous and counterproductive.  

Written by:

Nyein Nyein

Master of Psychology (Clinical) (NUS)

BSocSc (PsyHons) (NUS)

MSPS, Registered Psychologist