Therapist Burnout

Therapist Burnout

“Why isn’t he making any progress?”

“He has completely regressed this week.”

“I tried that… it didn’t work.”


It can happen to anyone – therapists, parents, teachers, caregivers, students, clients, stars in the solar system…

People get tired as they are pulled in every which direction. There might be too many kids that don’t listen, too many clients that don’t make progress, too many parents that don’t follow through, or too many people that don’t seem to care when you have cared way too much.

Every once and a while I’ll feel the wave of burnout moving in; I won’t realize it’s coming until one little event pushes me over the cliff into the land of “I’m done.”

Our jobs as occupational therapists are challenging… mentally, physically, and emotionally. I don’t think that everyone realizes that. We aren’t medical robots programmed to “fix”. It hurts when a child bites, it’s depressing when a parent yells, and it’s amazing when even the smallest goal is achieved. We are people with bad days, good days, and everything in between. Don’t tell me you haven’t had a day that you just wanted to pull your hair out, quit, and never think about OT again. What, only me?

Don’t get me wrong here, we have an amazing profession that I love; however, it can take a toll. So many OTs out there are beyond amazing. They treat patients, they blog, they advocate; living, breathing, and embodying OT. Thank goodness there are people like that out there, those little OT Super Heroes. (I’m talking to you, Mama OT, Miss Awesomeness, Tonya at Therapy Fun Zone, Notes from a Pediatric OT , Dr. Zachry’s Pediatric OT Tips, and probably several others that I haven’t even had the proper time to check out.) But that day comes when you need a break, a reprieve, an attentive ear to listen and say, it will be OK. You are making a difference.

Starting this blog began as therapy for me; a way to express my opinions in a way that I couldn’t normally do. For those that have been following, you may have noticed that I took a solid month or so off. (And thank you to the ones that sent messages of encouragement while I did so.) I didn’t tweet, Facebook, pin, or write a single word related to OT. I came home at night and just relaxed. I needed it.

Because as the wave of burnout passes, either with time, a new job, or just a really good day, you realize the joy of being the one to teach a parent or child something new, and it pretty much makes it all worth it.

With that in mind I wanted to share a short story that was sent to me that seemed to embrace the daily rigors of a therapist and child interaction. Check it out below and see if you can relate.

A Second Opinion

(Submitted by an OTR)

           We stop in front of that place again; the place Mom always brings me. I don’t want to be here.

They’re here. And only seven minutes late this week. Please God, let it be a good day. I force a deep breath as he emerges from the van.

“No, no, no, no, no!” I use the strongest words I have; the ones that let me go home.

He just screams at his mother as she drags him by the hand. Her eyes glaze over, the focus clearly set on getting inside the building.

That’s when he’s my responsibility.

His shrieks are all too familiar, yet they still command my stomach to clench in protest. I don’t want to do this today; I can’t do this today. But instead of giving in to my reluctance, I contort the muscles of my face to create some semblance of a smile. After all, he is only my first patient of the day. “Hi Johnny! Let’s go play!” My voice is a direct contradiction to the situation; a false hope that it will somehow change the outcome of our session together.   

The words aren’t working. She is taking me back there. I want to go home. Don’t make me stay here. I want to see Animal Adventures. “Animal Adventures! No! Animals!”  I pull my hand away.

It’s escalating quickly today. Already with the Animal Adventures requests and we haven’t even made it out of the waiting room. “No Animals, Johnny. First work, then Animal Adventures.” I say the words out of habit, ignoring their lack of gravity.

Work? No Work. I said I wanted Animal Adventures. I said it. I see it in my head. I see Dave the Forest Ranger and his map. He has work to do too. “Ranger and map and let’s go!” I can see him crossing the bridge and he has to choose the right way. “Which one?”

I am a broken record in every sense of the phrase, repeating the same question over and over and over. “What do you want, Johnny? Say ‘I want’…” I stare, searching into the glassy reflection of his eyes. The cues do nothing- he is gone. Autism is boasting its control now, locking him into his own head to script the words of some television show. At this moment he has no idea that I’m even here. I scrap the questions, accepting a sliver of defeat. Instead I hold up two pictures, giving him one last chance. “Swing or trampoline?” I raise his hand to touch each picture, forcing him to interact in some way with his environment. His eyes transfix past me, seeing a world that I can’t. His arm is heavy and limp as I let go.

He needs to get across the bridge. “That way! Good choice!” Dave the Forest Ranger smiles at me. He is happy. My arm falls down and I look at it. I am in that room again. The girl is here and I don’t like it. I push everything away.

“Great! You chose the trampoline!” I am over the top in my enthusiasm, desperate to reinforce anything, even if it’s incidental contact with a picture card. I place my hand under his arm, pulling up with intention, but he doesn’t budge. “Let’s go to trampoline. Stand up.” This time he sets himself in motion.

I want to see Dave the Forest Ranger again. He bounces on a trampoline with the kangaroos. He is in a race to win! I jump too. I am just like him. “Jumping on the trampoline!”

“Good using your words! You are jumping on the trampoline. Jump, jump!” Maybe this is what he needed; he seems more tuned in. I press my luck by reaching for a puzzle. “Look, let’s sit on trampoline. I see a puzzle.”

I don’t want that puzzle. The letter “M” is gone. Get it away. I want to go home. “No, no, no.” I want to go home.

Of course, the second I place a demand he withdraws. How am I supposed to document progress from thirty seconds of structured activity a week? “First work, then home.” I point to the visual schedule I spent ten hard-to-come-by minutes piecing together. More wasted energy. I get that feeling a lot these days.

I don’t want to work. I want to go home. Why doesn’t she stop? I said no. I already said no. The list has lots of pictures. I see home at the bottom. I reach for it.

“No, stop. Not yet. First, puzzle.” I point to the first picture on the list. He keeps reaching to tear the pictures off, so I toss the whole thing to the side. He is about to lose it, I know, but I can’t let him have it on his terms. He will never learn if I back down. So I stand strong, holding my ground. “First. Puzzle.”

She takes the picture of home away. It’s gone. Home is gone. I am mad. Like Henry the Grumpy Groundhog. He is mad. “No Henry Groundhog!” Home is gone, so I reach for the puzzle and throw it far away. She tries to bring it back, so I squeeze her arm. I squeeze and I pull. I don’t let go. She yells. It will be done soon. I will go home.

I let my guard down for a second and pay the price. My arm burns on fire along with my barely caged anger. The sensation boils over as his fingernails break the skin, tearing down the meaty flesh of my forearm. I pry his hand away, taking a leap backwards in self-preservation. He will not win on his terms. I choke back the tears so he won’t see me in pain. I don’t even look at my arm, the throbbing ache already alerting me to the damage. He won’t see me cry. “Johnny, no! No scratch!” As he registers my voice, firm with a hint of tremble, I take an instant to collect the puzzle. I hold up a piece in declaration. “First. Puzzle.”

It didn’t work. I am still here. I am Grumpy Groundhog. “NO!” I yell so loud that they have to hear me this time. I yell until it hurts.

I am losing him again, but I cannot give up. I am the therapist here. He will never progress if we can’t get through this. The clichéd mantras continue as I swallow hard around the knot in my throat. The pain fuels anger, but I push it down. Not now. I have a job to do. I take another step back, letting him flail around on top of the trampoline. I let him scream it all out. A luxury many of us can’t afford.

I kick, I scream. I want to go home. I don’t want puzzles. I don’t want letters. I don’t want jumping. I want home. I kick, I scream. I kick, I scream. I stop. Did she go? I sit up fast, but she is there. She is still there.

“Nice job calming down.” I take an apprehensive step forward. He didn’t think I would wait him out. I remove all of the pictures from the schedule so only two remain. I point slowly, speaking with as much authority as I can muster. “First. Puzzle. Then. Home.” Another step forward; I set the schedule down.

Home. She said home. I see the picture.

Taking advantage of his momentary distraction, my unsteady hand reacts. We quickly place the puzzle piece in the board together– hand over hand. He pulls away in protest, but it is too late; he complied without even realizing it. “Good work, Johnny! You did puzzle!” The Velcro rips loudly in celebration as I pull the picture away. “Now home!” I glance at my watch: forty-two minutes for a single puzzle piece. What am I doing here? As we head to the waiting room our roles are abruptly severed. Both of us are now content to walk as equals. I take the moment to examine the deep purple bruise, wincing as I accept the mark. I have to believe we accomplished something or I will collapse in self-pity. Today I’ll say that I won.

I am going home. I am happy Dave the Forest Ranger. He wins.


About TheAnonymousOT

Pediatric Occupational Therapist
This entry was posted in Insider Information, Lessons Learned, Occupational Therapy and tagged , , . Bookmark the permalink.

8 Responses to Therapist Burnout

  1. Allgood says:

    I can so relate to your challenges & celebrating incremental accomplishments…retiring this month after 35 years of increasing workload, decreasing resources & kiddos more complicated than ever!

    • Kerry Margaret McCracken says:

      i finally reisigned after 21.5 yrs of school prqctice. When I told director it was over u reasonable demands from one district and no support from supervisor. The director told me my supervisor told me we had talked over my poor performance and no other districts wanted to work with me. I had only been on 5 of 14! My last eval had been good and she hadn’t told me I had poor performance! Work demands have increaded, children more complicated. Teachers often wouldnt talk to you and instead report behind your back. Sad and glad I’m gone!

  2. canuck says:

    Yep, that story certainly sounds familiar… and not just with the autistic kiddos. I always wonder how to make the best use of therapy time when the child is just SO clearly not in to it – session after session after session – yet the parent is eager to have them come and wants the time to be used to maximum effect. Something I’m still trying to figure out…

  3. Carly says:

    That story bums me out. I have read it twice now. I see the “accomplishment” in getting the child to do the one puzzle piece, then see the child’s perspective and I’m almost embarassed. I, too, work in a pediatric clinic and TOTALLY relate with it. The other 9 kids I see during the day that aren’t as demanding as “this child” balance things out, but it’s amazing how taxing some therapy sessions can be. This is why I practice yoga!

  4. NIFOT03 says:

    As a relatively new therapist, I really appreciate this story. I can definitely relate to it as I work in a pediatric clinic with children with autism, behavioral/sensory needs and developmental delays. I have been wanting to find a blog like this for a while now because it is such a great outlet to be able to express yourself and have others actually UNDERSTAND what you are talking about. Talking to someone who’s not an OT is hard because they just don’t understand our everyday troubles…The boy’s perspective was my favorite get-away point of the story and it makes you realize that sometimes there are days that we won’t get “into” their world or they won’t get into ours…and that’s okay. He still transitioned in, he did do something by bouncing on the trampoline. There were times in the session that the child did feel accomplished which is the most important part. Keep your head up and realize the little bits of participation make a huge difference!

  5. MoTrax says:

    I also really appreciate this piece and your effort to relate the very normal experience of burnout. I am not yet an OT, but I do work daily in early childhood special education and can relate vary well to the scenario presented by the author. I have to catch myself when I conclude that a kid isn’t making progress, had a bad day or that I’ve tried everything (all things I’ve said out loud). When I truly reflect on the evidence, I often times find this isn’t the whole picture. I find instead that it is my own fatigue that led me to this conclusion and that the day was no worse than the one that came before it. If I focus out and take a broader perspective I can normally find progress in an other area performance or over a longer period of time, but this requires energy that I don’t always have.

    I’ve also found that it helps to focus on the extent of the child’s satisfaction and not one what we accomplished that day, but perhaps that isn’t a realistic expectation for OTs in a healthcare system focused on efficiency and outcomes as means of accountability. I still have a lot to learn about all of this.

    Another thing: It is so easy to get into the mindset of fighting a battle against the child when what we really hope for is a collaboration with the child. This can seem impossible when there are barriers to communication and active engagement, or when the child lacks motivation beyond a narrow range of occupations. I find that framing the interaction and situation as having a winner or loser is especially tempting when you have such a limited amount of time to spend with the client, leaving you with no time to find motivation for naturalistic occupation. Oh, the dilemmas!

    I’m glad to have come across your blog. Thank you and keep up the good work everyone!

  6. Diane Randall says:

    This is so accurate! Describes many of my tx sessions! Now I know I am not alone.

  7. Jennie S. says:

    Wow, yes this was my life doing outpatient Peds. “42 minutes to complete a puzzle piece- what am I doing here” That was my refrain nearly every day.


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