how to serve patients when you’re feeling fragile yourself

by Alison Green on March 27, 2025

It’s the Thursday “ask the readers” question. A reader writes:

I’d appreciate your and other workers’ advice on how to cope providing service when you are feeling fragile yourself.

I work in a somewhat frazzled, frantic healthcare environment seeing around 30 patients a day in an inner city, low income area. It’s … a lot — with very demanding patients. But I mostly enjoy it. It’s not amazingly well paid, but it pays the bills.

My family is going through our own problems at the moment due to our teen’s mental health issues. There are some days before I even get to work where I’ve had to cope with an emotional tidal wave from my lovely but ground-down teen daughter who has school avoidance, anxiety, and an eating disorder. It’s pretty awful but we are holding on as a family.

I’ve had days off and been erratic with sudden cancellations over the past year and work has been kind. I can’t afford an extended period off, so please don’t suggest that as it would break our family finances due to all the additional support we have to pay for our teen.

There are some days where I feel like my skin is a cell thick. The usual patient problems about running late or having to coax a patient through a nerve-wracking procedure, etc. leaves me feeling wrung out. I’m normally smiley and reassuring but right now I want to switch to “low battery mode” and not give so much to them right now. I don’t really know how to do that.

As for self care? I’m doing all the things I should (yoga, breathing, healthy diet, talking to friends), but work is a different issue. How to create a firewall around my emotions so I can cope with being shouted at by patients because we are running late or help them inch-by-inch through their anxieties when I feel as though my own anxiety is going to have me sobbing on the floor in the middle of the appointment? Is that possible?

Readers, please weigh in via the comment section.

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  1. low-battery too*

    looking forward to the responses- not the same situation but finding it impossible due to circumstances beyond my control to do the self-care stuff.

    1. Cabbagepants*

      I started doing DBT and it honestly changed my life. The idea is to find healthy coping strategies for strong or overwhelming emotions. I have been going through a workbook (who has the time or money for in person therapy these days?!?) and while in-person may be better, I have gotten soooooo much value. You can Google “The Dialectical Behavior Therapy Skills Workbook” and get a free pdf or by a hard copy for a few dollars from Amazon.

      1. FedAnon*

        I’ve also done DBT in the past with a therapist, and I was handed a lot of workbook worksheets! Talking with someone is probably helpful too, but DBT seems particularly amenable to self-study in my (non expert, just a patient) opinion.

    2. Bosslady*

      I’ve experienced this both as a nurse and also just as a human being when things all get overwhelming all at once! I’m glad the letter writer has tried “all the things” like yoga, talking etc. Those are important, but let me present an additional mindset for times like this:

      1. Strip away anything that isn’t necessary, just temporarily to get you through it and get calm. That could be a month, or a year. Whatever YOU deem unnecessary, and that may take some thinking because EVERYTHING SEEMS IMPORTANT, but it’s not all important.

      2. This means things like no more dishes—use paper plates. Avoid the people who ask too much of you emotionally, just temporarily. If your sister calls every day on her way home from work to complain, just pick up every other day. Or say, “Hey, I’m sorry! That sounds sucky, but can we talk about happy things today that will help me? Are you watching White Lotus?” If reading the teacher’s emails home from school seems like too much ask your partner if they can monitor them for a week or two. Order the groceries ahead and pick them up in your car. If paying one bill in particular is stressful set it up for self pay with your credit card. STRIP AWAY WHAT YOU DON’T NEED.

      3. Go on a strict “funny or sweet things only” content diet. Don’t click on your friend’s IG story that you know always is political or upsetting. Don’t watch the TV news even on your phone. (Don’t worry you will still hear all the news!) Don’t watch the murder show. Don’t listen to the political podcast. Click only on babies laughing, cats falling, and dogs swimming. Watch or read something funny before bed.

      4. Cancel social obligations that ask something of you and do more walks with your friends. I guarantee even if its not your normal thing to do if you text any friend right now and say do you want to walk around the… lake, mall, school playground, neighborhood etc after work and you meet for 20 min and do it you won’t regret it. Wear your work clothes and tennis shoes. Don’t make any extra work for yourself just go walk and chat and people watch.

      5. Stay in your PJs or comfy clothes when you can and make a list of only what is absolutely necessary today and ONLY do those things. Then repeat all of the above.

      1. Mrs Jameson*

        I love this answer and co-sign it, especially suggestions 2 and 3. When life has been too much in the past, I have limited contact with people who needed more emotionally than I could give and gone on content diets (cake decorating for me). It really does free you up mentally for your own life.

      2. Massive Dynamic*

        I love “don’t watch the murder show” so much. It’s such a YMMV situation – my spouse’s current stress relief is the walking dead, and I absolutely hate the weird zombie noises so he makes sure to watch it only when I’m doing something else upstairs, and I make sure to give myself some upstairs chill time each night so he can zombie out for a little while.

        1. Sillysaurus*

          It’s definitely a YMMV scenario! I love watching/listening to true crime when I’m stressed. It weirdly makes me feel better? Like hey, at least I don’t have these kind of problems! Things might be tough but I’m not getting murdered!

          2. Princess Sparklepony*

            I’ve been feeling that way about AITA reels.

            They leave me feeling: Well, I’m glad I don’t have that problem! :D

        2. Jules the 3rd*

          I love it to, modified to “don’t consume media that will make you upset”.

          My husband and kid are watching Severance and a couple of hyper-violent animes right now. I can’t with Severance, they nailed the office look a lot too well and it gives me flashbacks. I do read a ton of ‘cozy’ mysteries, and avoid any with children at risk.

          I’m lucky, my husband has taken to checking shows for me and has a good sense of what I’ll like. Unbearable Weight of Massive Talent was a lot of fun, and the Glass Onion mysteries.

          1. Sunshine Gremlin*

            If you need something that can screen media that may make you upset, doesthedogdie.com has expanded to many, many other potential triggers and various types of media including shows, movies, and books (and others, such as games, I believe).

            I know this will go to moderation first due to the link, but I highly recommend it for anyone who is trying to manage their stress or triggers because you can look up things that you wouldn’t traditionally think of, like abandonment or a parent or grandparent dying (as well as animals, gore, violence, etc.).

            I’m so glad to immediately see recommendations for a content diet, it’s invaluable to managing mental health.

          2. Ineffable Bastard*

            ooh, I think you will like The Residence, a cozy whodunit with Uzo Aduba and other great actors

      3. hayling*

        #2 feels a lot like the advice from KC Davis – her book is called How to Keep House While Drowning and her podcast is Struggle Care. She says the same thing about using paper plates, etc., when doing dishes feels like too much.

        1. Frosty*

          KC Davis is great and I co-sign that her book and social media etc. is really uplifting and validating.

        2. cooking is great but daily is a chore*

          I’ll add a recommendation for You Gotta Eat by Margaret Eby – great ways to make meals a little better when “real” cooking is too much of a chore, and zero judgement.

      4. Colleen Whitley*

        yes! some days when I am overwhelmed with kids, aging parent, money issues (in the past 3 months my husband lost his job, the oven AND dishwasher broke, and discovered the dishwasher had been slowly leaking and the subfloor was moldy and rotten requiring replacement-good thing the husband is unemployed and can do the work) I have a Rule of 3. If i have completed 3 tasks in the day that is a win. So what if the kids had french toast for supper, they ate. The counter may be filled with dirty dishes but I did a load of laundry. Sometimes it helps to write down what you did that day to see you held on and help you NOT worry about what didn’t get done. Point #1 is a great recommendation.

        Also, sometimes the little things can help feel like you have control: for me it is matching my earrings to my clothes. My son has a Pinterest page of calming images that he scrolls through when he is feeling overwhelmed. Spend an hour on a game where you get to whack things. Good luck.

      5. OldTiredRN*

        Also….really look at gender roles and what you can offload. There is no law saying women need to do the laundry, make dinner, clean the house, break down the recycling. And if no one can do it, it doesn’t get done.

        My last years of work were 60 hours a week as a floor RN and my husband worked 80+ hours a week at a prison (pandemic staffing, mandatory overtime). There were cleaning, yard work and home maintenance things that just lapsed until we retired. Once we caught our breath, we slowly added them back to our day.

      7. MeepMeep123*

        I love (3) and I’ve done something similar, though maybe even more restrictive – a “book vacation” for a month. The only media I allowed myself to consume was one book, and one book only. Last time it was Don Quixote. It really did feel like a vacation, and also a very nice deep dive into a classic. I felt amazingly relaxed by the end of the month.

    3. Zumwalt69420*

      I was really struck by the “I’ve tried all of the self-care things” in OP’s letter. I’m glad you’re trying to take care of yourself, but only do it if you enjoy it and it honestly is helpful. Sometimes what’s branded as “self care” is really just more stuff to pile on your already full plate (ie “I don’t have time to breathe but I need to magically find time to go for a run/take a bubble bath/cook a healthy meal instead of order a pizza”.
      Alison in another post talks about how the concept of self-care can be weaponized by employers, too. Like, how dare you be burned out and need downtime when we offer yoga classes and gym memberships and have an EAP?
      So whatever self-care you’re doing should not be guilt-driven or feel like one more obligation added to the list for you to check off.
      As far as your patients, OP, I know this sounds callous, but when they’re shouting at you remember that it’s not personal (you’re just the body that happens to be in front of them at the moment) and that they need you more than you need them.
      The caring professions can be difficult and sometimes downright exploitative; then you go home and it sounds like you have to be a caregiver of sorts to your kid. So it’s like you never actually get to leave work, in a way.
      Are there any mental health services available through your daughter’s school that could help? Could she switch schools to an environment that might better suit her? If you have the time and money, I think family therapy would be a good thing because the therapist could see the interplay between your daughter’s issues, your work life, how all this is affecting things at home, and how each thing is affecting the other. They might be able to offer some suggestions to make everyone’s life a little easier. It may take some work on everyone’s part, or it may just be a couple simple tweaks that make life so much easier (that you were blind to because you’re in the thick of the stress right now).
      I wish you and your family the best and I’m sorry you and your daughter are going through all this.

      1. Boof*

        Yea i can’t tell – if those are “self care” (like things LW doesn’t really enjoy but thinks they should do) or them actually saying “yes I am carving out a little time for myself to reset and do what I need to do for me”. I know what you mean that it’s frustrating when sometimes just more work than there is time to do it right and the message from HR is that somehow ~*meditation and mindfulness*~ will help with burnout when the problem with burnout is almost always not enough time to do all the things I must do (For me at least). My employer is at least pretty supportive in offloading stuff when I ask for help but somehow “think about what you can delegate out and ask for help in reducing your workload!” is never on the “burnout tips” handouts! XP
        I do think it’s important to prioritize some healthy eating, exercise, and sleep; ideally the kind of healthy eating that is quick but for me at least, as much as it might give me a temp boost to indulge in some junk food over a longer time it just leads to me feeling worse if I’m really ignoring the diet/exercise. So I do think somehow making your own physical health a priority even when it feels like it’s easier to shove it off a while is important.
        Ideally physical health things that are not very time sensitive and don’t take much mental energy tho! It’s ok just to eat a fiber bar and yogurt (or whatever; prepackaged foods) than home prep and cook a bunch of veggies etc!

        2. Tabihabibi*

          A few years ago I really internalized the idea that burnout can be both about volume, but also the ratio of effort in to outcomes out. For me that helps explain why “self care” can be nice, but everything goes right back to 0 Monday morning: relaxing time is (at best) neutral on that ratio. Spinning on all cylinders just to get rushed visits and people yelling at you sounds like a tough ratio to deal with. Sometimes it has helped me to reflect on where I feel most effective or most proud of my outcomes and either do what I can to get more of those, or focus more of my energy there (like: I never feel effective even when I’ve done my best to help Drunk Meanie but I do feel effective when I can give a new customer help navigating a process, so that gets more of my time and actual brain power today and Drunk Meanie gets the bare minimum). That’s coming from a fairly different work and personal situation though. Hope you find some relief!

        3. amoeba*

          Yeah, I agree about prioritising! For me, it’s also certainly food that gets less time – I’m lucky to have healthy food available at work, so for dinner, I’m not cooking – it’s sandwiches and nice convenience stuff all the way. Which I still consider healthy/good for me/tasty, actually! But it would probably be a very different story if I didn’t have the canteen – I’d have to prioritise cooking/food prep much more than I do now, because cold food/sandwiches for every meal would make me cranky and unhappy in no time.

          Also, I know that meditation *for me* is actually something really important and I shouldn’t skip that one, it makes a huge difference in my mental state. But when I have a lot on my plate, sometimes I only have the time to do a quick 5 min meditation on the bus on the way to work. It’s much better than nothing.

          For others, that kind of thing doesn’t really make much of a difference, but they really need to be outside for at least a short walk every day. I personally don’t care and am happy to stay inside for a whole week, lol.

          So really – know/try out what works for *you* and prioritise the things that have the most impact, not the ones somebody else says are most helpful. And sometimes, there is only time for very little or nothing, and that’s OK too.

    4. OP*

      *******I’m the OP!!!********
      Thank you to all who responded to this. I didn’t even realise it was going live as a question because I was on a shift and wish I could have responded individually. I woke this morning to see so many kind and helpful responses. I’m still reading through them and seeing trends of advice.
      A few things:
      – I’ve luckily have had good access to family therapy and individual counselling as well. I wish I’d mentioned that in my original letter because so many of you had suggestions for getting additional help. In my country counselling can be free, but with a long waiting list. Because this issue has been escalating over years we came to the top of the list a while back. It’s helped, but when things are really bad (like when my daughter had to go into residential care) all the talking therapy/counselling in the world just couldn’t squash the horror of the situation. Because I could see that sometimes talking didn’t seem to help, I also have done additional ‘body therapies’ including a kind of counselling where a wonderful German woman did these kind of body manipulations to try and release tension points. The body therapies helped the most because I have a tendency to ruminate so therapy can feel like even more rumination! My other children and husband also have access to therapies/counselling through school and workplace.
      – Things are improving with my daughter. We finally took her out of school and she’s a lot less fragile. She now has tutors and is concentrating on horse riding as a hobby. This helps so much because we no longer get distressed texts at random times during the day from her school. But…yeah… life isn’t what I imagined it would be like when she was born but she’s started to look a little happy again.
      – My husband has been amazing, even when he looks shell shocked by it all too. He’s taken on a lot of the tasks that were previously ‘mine’ because I worked fewer hours than him. I worry about him too though – he also works in healthcare and looks very drained. Our extended family has been helpful too.
      – My colleagues and workplace have been great and I’ve reduced down to 2.5 days a week to help support my daughter’s schooling. Unfortunately, due to my role no one else can step in to do my work and the patients are now complaining a lot (fair enough! they’re in pain and need things fixing and there are very few of us who provide this service) and this adds to pressure.
      – I think the reason I wrote is that I’ve noticed since the pandemic my patients are much more demanding. It’s as if ‘keep calm and carry on’ has gone out of the window. I used to have maybe 1 extremely nervous or high maintenance patient a week, now it’s at least 3 a day and I don’t know why this is. My colleagues have noticed the same.
      – A lot of the commentators mentioned only giving 50% or less to patients of myself and reduce my empathy. I think that’s what I’m going to do and it’s been good to hear from people in the same situation who have done just that.
      – There are also a lot of comments about being kind to myself and taking breaks. I’ll get going on that too.
      – The suggestions on reducing unecessary tasks during the day is good as well. Problem is, food prep/thoughts take up a lot of brain space in our house due to my daughter’s illness.I hate h
      – I’ve already done the things like watching nice things (Friends! Gilmore Girls!) and I’m listening to audiobooks of old children’s classics. I do a lot of knitting and watercolours and it’s something I do with my daughter.
      All in all, I’m glad I wrote in to AAM and had such a lovely lot of responses. It’s lifted my spirits and I’m going to go back through all of the kind things you’ve all written. I’m so sorry many of you have or are in the same circumstances as I’m in right now. If it’s taught me anything it’s to be aware that everyone is doing a job and might not being at their best, for whatever reason.

      1. SistaSista*

        You mentioned body therapies, so if you haven’t already tried somatic therapy that has been a really useful for for me and for those who find talking about things doesn’t actually help process things. Also if your country has things called career peer workers/lived experience workers, I would recommend seeking them out. Career peer workers are people who have supported someone experiencing mental ill-health and understand carer fatigue and everything that comes with living in a society that doesn’t support those who support others.

      2. wear floral everyday*

        I’m so glad you have additional support. I have been through similar family situations while having to care for demanding patients. What worked for me was talking with colleagues and mentors; they were the ones that confirmed that my giving me 50% to my patients was still absolutely amazing for them. I know that being a warm and trustworthy person leads you to treating patients with empathy and responsibility. Trust me, their lives are not going to be ruined if they receive less empathy etc for a couple of visits. However, the traits leading you to being a great caregiver are the same leading to be so burnt out. So dial it back a notch. Please come back with an update soon!

  2. T.N.H*

    You don’t mention any kind of mental health care that you’re getting. Do you have a therapist? You can also start with books, podcasts, news articles, and apps to help discover skills and then try to build on them with a professional (please vet your sources).

    1. Similar, but anonymous*

      You know, when I was in a similar situation everyone kept telling me to see a therapist. But we were paying over $800 a month for mental health care for a teen who was suicidal. It was already breaking our budget and we were adding cc debt every month.
      Sure it would have helped, but honestly, it was a ridiculous and unhelpful suggestion. And it often felt like a “don’t talk to me about this, I don’t wanna hear any negativity” from friends. It really hurt to not get support, just “do the impossible”
      (and no, free or reduced cost therapy is NOT really as available as lots of people seem to think. Not through universities, they limit that to students. Not through mythical “programs” that people seem to think exist. It’s not there.)

      1. Tea Monk*

        Yes and having good therapy covered by insurance is a tough thing to get. I know it says ‘ anxiety’ but I have tried not worrying my pretty little head about it. My company has an EAP due to the risk of vicarious trauma but I just do outside therapy and a psych NP

      2. RIP Pillowfort*

        It’s not readily available. It’s very dependent on where you are and whether people have invested in the resources to provide it.

        But we don’t know where OP is. Two places to look at would be their employer’s EAP which might provide some limited options. The other is if there’s a Department of Behavioral Health or similar public resource. 10 years ago it wasn’t a thing in my state but they have been slowly rolling more resources into it. Is it perfect? No but it’s something.

        Also I do know how affording mental healthcare can break the family budget. I was that kid for my parents. There were no options in the 90’s for it and the “good” insurance we had didn’t cover it. So my parents struggled too.

        1. Rage*

          Another option might be to check local universities who have graduate programs in mental health disciplines. Many will have a teaching clinic with either low- or no-fee services, provided by the students during their internship semesters. Yes, it’s students, but they are working under the guidance of the faculty and this sort of things is right up their alley, so to speak.

          1. Similar, but anonymous*

            It’s fun to think this, but many, if not most, limit this kind of help to their student population.

            1. Not saying therapy is easy to find but just to clarify...*

              These are two different things. All universities are going to have a counseling center that serves students. Many psychology training programs also run community clinics or serve clients through local hospital systems and these serve a broader clientele. Everywhere is different, but where I did my training there were some students seen at the clinic for specialty needs but not too many. They mainly went to the counseling center.

            2. HelperWings*

              I only have my own graduate program as an example, but we didn’t see any students- we only saw people from the community. I was seeing clients for $5 – $20 an hour as a grad student.

        2. GreenApplePie*

          As someone who works closely with my state’s Department of Behavioral Health, we can’t connect individual people with specific therapists/psychiatrists because we’re not doctors and are not qualified to decide what specialist someone should visit.

          My state partners with nonprofits that *can* do these things so we usually redirect calls there, or we’ll try to find the nearest primary care doctor that can refer them but not every place is that fortunate sadly

      3. T.N.H*

        That’s why I specifically suggested other resources. You can start mental health care without therapy. There is so much out there that’s completely free.

        1. I'm just here for the cats!!*

          Yes! I wonder if there are support groups for parents of teens going through similar issues? Maybe the teen’s therapist would be able to point them in the right direction.

      4. Hannah*

        I hear you and that is very valid! But there are other resources out there that isn’t just 1:1 therapy. For example, Safe Space (google “safe space vibrant” to find) is part of the new 988 (mental health crisis system) supports that can be accessed right now, for free. I just finished the Caring Contacts weekly class and found it helpful!

        My local library offers a subscription to Headspace for free and that little app has gotten me through some very dark nights.

        I’m sure there are others too – I’m looking forward to the comments today for specific resources!

        1. Hannah*

          Oh! Finch app. It was actually a resource that Safe Space recommended that I’ve been doing for years. Much more task based but when I get all kinds of points and a happy baby bird because I managed to brush my teeth this morning, sometimes that is what I need.

          There is a paid version if you want to accumulate cute clothes for your bird faster but the free stuff is more than enough if that’s all you’ve got.

          1. MN_Jen*

            I second the Finch app. I started using it in November and it has given me a lot of strategies to help manage my anxiety.

          2. Six for the truth over solace in lies*

            Finch app is the only self-care app that I’ve ever stuck with for more than a month. I think it helps that it’s more or less impossible to “fail,” you can make your goals as approachable as you need (“get out of bed for ten minutes” and “drink a cup of water” are perfectly cromulent if you’re drowning, and the little bird will cheer you on), and the bird is heckin’ cute. I look forward to taking my bird exploring on even dark days.

            There’s also sponsorships for the pro version of the app (I don’t know how it works because I’ve only been on the donor side, but I know it exists).

          3. Zephy*

            +1 for Finch. I use it as a glorifed to-do list, but ngl the serotonin DO be serotonin-ing when I manage to send her on an adventure for brushing my teeth. Paid version is absolutely not a necessity but it’s also like $3 per year or something like that, so if/when you find yourself in a position to spare literally a few cents a month, the devs will appreciate it.

            2. Polar Bear Hug*

              I love Finch! It’s a lot more than $3/year, though – I think I paid $70 Canadian.

              1. amoeba*

                Yeah, I think it’s around 5 €/month here. But honestly, that’s really more if you want to support the developers, you don’t miss out at all with the free version (most importantly, the free version has no ads!) Like, you can buy a few more virtual outfits a little bit more quickly with the paid version, but there’s zero functionality missing from the free.

        2. T.N.H*

          I bet she can find a lot of resources for parents of teens with an eating disorder. A quick Google search came up with loads of options. A support group or online community for parents in similar situations might help too (having someone who “gets it” can make a big difference).

      5. Uhura*

        I have to agree. Getting therapy is well intended advice, but in my experience, I don’t find therapy that helpful because it’s mostly talking about your problems, not finding solutions/strategies. If I’m burned out because work is too much, I don’t need to talk about it, I need a new job or strategies on how to manage my work load. If my teenager is having problems, I need practical solutions on how to help them. If I’m having money problems, I need a job that pays more, or tips on ways to save money. Talking to an kind ear may be therapeutic, but when the session is over the problems are still there. Not to mention therapy is expensive.

        1. T.N.H*

          It won’t work for everyone, but have you done any skills-based therapy? It’s not about talking at all. An example from the OP’s situation: You would learn, when I have anxiety at work about my teen, I do these 5 things in order to refocus on my patient.

        2. sam_i_am*

          I don’t find therapy that helpful because it’s mostly talking about your problems, not finding solutions/strategies

          I mean, that’s just not true. Good therapy involves strategizing about both coping mechanisms and strategies for either dealing with or changing life circumstances. My psychologist was key in getting me to leave my last position and to take action to better my relationships with family, among other changes and decisions.

          1. I'm just here for the cats!!*

            Exactly there’s different types of therapy. You want to find someone who isn’t just going to listen to you talk, but who will help you find strategies, etc.

        3. ThatGirl*

          Therapy isn’t supposed to just be an endless recitation of your problems. It’s supposed to help you find ways to manage situations and learn new skills. Now, a therapist may not be able to help with money issues, but they SHOULD be able to help you figure out how to help with your teenager, or stress at work, or other similar problems.

          1. Properlike*

            Yes! I didn’t know there’s a whole specialization called “solutions-based therapy” and it is EFFECTIVE. Still some emotional processing, but extraordinarily helpful. Given your job, you will want someone who’s also “trauma-informed” because you’re getting spillover from the people you work with. The EAP may or may not have good resources. Sometimes they’re just googling it, but if you’re in healthcare, maybe they have specific providers?

            (Wish my ex would get on board with the idea that therapy means talking endlessly until you find your own solutions years later.)

      6. A manager, but not your manager*

        I wonder (and I know it might not be there because we don’t give healthcare enough support) if being in healthcare specifically might mean that this person’s benefits include any connections to therapy services, even if it’s short term through an EAP. I also know that there are some therapists who do do sliding scale (my sibling currently has one and they’re not a student), but there are way less therapists. offering it than there are people who need it, so it’s way harder to find than it should be.

        I’m really sorry that our healthcare system failed you (and so many other people) when you really needed it.

        1. Boof*

          If LW hasn’t and there is an EAP, even if it just does “4 free sessions” or something (like mine), worth checking. May not do much but even though I can’t say I’ve ever had much luck finding any kind of ongoing therapy/coach/whatever helpful for myself or my fam (yet) sometimes in times of extreme stress just that one intake dump is helpful enough.

      7. Resident Catholicville, U.S.A.*

        I’m on Anthem and apparently they’re partnered with Teledoc. They keep sending me emails about stress and coping skills- I don’t know how good they are, but they’re at least a start. Even if they’re not detailed, personalized mental health, they might have suggestions and/or it’s a good place to start. The other thing would be check in with any EAP your insurance would have- again, it’s not an actual mental health provider, but they might have more info for you, especially locally.

      8. Beth*

        Yes! Therapy is great if you can access it, but there are so many barriers to access. It’s expensive, especially since most struggling people don’t have a lot of flex in their budget. Insurance can help, but unless you have really good insurance, it’s probably a nightmare to navigate. (Are there in-network providers who are taking new patients right now? Do they cover out-of-network? If so, by how much? And how do you submit for it, is there a lot of red tape and admin needed? Will they generally cover it, or do you need to get pre-approval somehow, is there a max number of sessions or a max frequency, do you need to get a certain diagnosis on record?) The scheduling itself can be hard when you have no room for One More Thing–what time and energy are you going to use to call a dozen providers, confirm they actually take your insurance still and are available for new patients, and schedule an appointment? If you work full-time, you either need to figure out routine time off work (hard) or a provider who’s routinely available outside standard work hours (harder). Video call sessions can widen your options, but if you live in a small space that you share with other people, you probably don’t have much privacy for that. People love to think that there are free or cheap resources (an app! a hotline! a city program! a therapist-in-training at a local school!) but most of those don’t exist in practice, and those that do tend to come with their own significant barriers.

        I’ve been in therapy and benefited from it, but it’s always been a “recovery after the storm” thing for me. In the middle of a bad period, I hunker down, drop every ball I can, and focus on making it through. Once I’m coming out of the worst of it, therapy has been helpful for unlearning coping strategies I don’t need anymore, processing what happened, and learning to thrive again.

      9. NS*

        I will add that “therapy” is different from a “phycologist”. Getting therapy through a LCSW or similar is one thing. Getting therapy from a phycologist is different. Having had both, a phycologist is less of a vent session and more about building and implementing skills that help manage difficult or stressful times.

        1. ThatGirl*

          masters’ level clinicians (LCPC/LCSW et al) and psychologists (usually a PhD or PsyD) both offer a variety of styles of therapy based on their own specialization. It’s not really accurate to say a master’s level therapist is just a “vent session”, either – even those who do more traditional CBT try to help find solutions.

        2. Hannah*

          I’ve done a lot of therapy, over 35 years ish (had a traumatic childhood). The degree sort of matters but to me, it was much more about the person. I think you can find LCSWs that rock out evidenced based strategies and I think you’ve got PhDs / PsyDs that seriously suck. My experience is just to be super picky. Do the one “get to know you” visit and make sure then you ask about what’s important to you (in this case, are you talk oriented or solutions oriented) and then be ruthless about cutting anybody that doesn’t feel like a good match.

          Then reassess after 3-4 visits and be prepared to be ruthless again if needed :)

        3. Perihelion*

          I promise I’m not trying to be a jerk about a typo, and I know what you meant, but I did have to laugh—a phycologist would be someone who studies algae, so definitely different from a therapist!

        4. Beth*

          Most therapists–including LCSWs–are providing a lot more than a vent session! There are differences in background (a psychologist’s training might be more focused on the nuances of different mental health diagnoses, a social worker’s might be more focused on social determinants of mental health) but both work with their clients to build skills to support their functioning and identify strategies to help them feel better. If you’re working with any therapist with any credentials and feeling like you’re just talking at them and not getting active help building skills and management strategies, you should look for a different therapist.

      10. The Unspeakable Queen Lisa*

        That sounds like a hard time. I’m sorry you felt hurt. I’m sorry our healthcare system sucks. It probably would have helped, but you couldn’t do it. That doesn’t mean it was a ridiculous or unhelpful suggestion. Some other time when you can afford it, you can try to see if it helps.

        But it was not fair of you to expect free therapy from your friends, then get hurt and mad when they suggested professional therapy. I don’t believe anyone ever said, “Do the impossible.” Maybe they were also having a hard time and couldn’t handle any negativity. I have not been able to support friends sometimes when my husband has been struggling or when I have been struggling, but they wouldn’t have known that. Or maybe they just didn’t want to or felt unequipped to. That’s also okay.

        And also – just because reduced cost therapy isn’t available to you, that doesn’t mean everyone who suggests it is lying. Those programs do exist, they aren’t mythical. There are plenty where I live now, there were none where I lived before.

        Hopefully, it’s been long enough now that you can forgive yourself and everyone else for not being perfect in that very hard time.

        1. Not My Usual Name*

          Sorry, was the commenter you’re replying to expecting their friends to provide free therapy or was the commenter instead expecting to not have to slap on a happy everything-is-fine-as-I-deal-with-a-suicidal-child face when interacting with friends?

        2. Similar, but anonymous*

          I wasn’t expecting therapy. I was talking to people that I have spent a lot of time supporting through grief, through cancer, through divorce. And then when I had issues, no one had time to do the same for me. For example, I’d suggest coming over for a movie night so I wasn’t alone when my teen was hospitalized and no one would come over. All I wanted was someone to watch a movie with me and sit with me on a really hard night.
          But nope, just “maybe a therapist could help you”
          But sure, blame me for their shittiness.

          1. Annie*

            Oof, that’s hard.

            I’m wondering if keeping out “I’m having a hard time right now, please help” and skipping to “Let’s do this happy dappy thing together!” for future requests for friends to show up for you might help.

            For the movie scenario:
            Before: “My teen is in the hospital again. Can we watch a movie together so I don’t feel alone?”
            After: “I have some free time right now. Let’s watch a movie together! It’s a family movie, so bring your kids!” (last sentence can be whatever makes sense in your situation to sweeten the pot if you happen to be up to it, or left out entirely)

          2. Also similar anon*

            YANA! I had “friends” whose suggestions were “get a therapist” — which I definitely needed, but I was also drowning, and they were unwilling to do anything to help me tread water. If one of them had said, “Why don’t you come over, we’ll do dinner, and I’ll help you sign up for therapy,” I would have gotten into therapy a lot sooner. Instead I had to jettison nearly the whole friend group to free up the cognitive space to have a therapist (also turns out that nearly the whole friend group were either abusive or enablers and I was in too deep to see that, so it was all good in the end).

    3. Grumpy Elder Millennial*

      Was going to suggest the same thing. A good therapist could hopefully help with some strategies.

      Full disclosure – I’m not a therapist and am not trained in therapy, but I do have some relevant knowledge about this stuff. Still, take with a grain of salt.

      One challenge is that Cognitive Behavioural Therapy (CBT) is usually the most common therapy modality in North America (and may be the only one insurance is willing to cover). (It probably is very common in other places, too, I just can’t say for sure). But it’s not necessarily best suited for this kind of situation. A lot of CBT is focused on getting the client to mentally reframe things, including addressing thought patterns that are distorted (i.e., not reflecting reality). But it sounds like you’re very clear about the realities of your situation! That all sounds super difficult to handle! A skilled CBT therapist could still be very helpful, most likely. A less skilled one may end up trying to make you self-gaslight (e.g., try to convince yourself that you’re catastrophizing and it’s not actually as bad as you think it is).

      There are other approaches to therapy (e.g., humanistic, existential, feminist) that might be a better fit here. That being said, the evidence is pretty strong that the most influential factor in therapeutic success is whether there is a strong professional relationship between the therapist and client. Even more than the therapist’s philosophical orientation or the techniques they use. So whatever modality, hold out for a therapist that is a good fit for you.

      1. The Unspeakable Queen Lisa*

        That’s interesting. I think of “therapy” as usually meaning talk therapy, where you just say what’s happening and their is no real goal or expected outcome. Great if you just need to vent, not so great if you’re stuck in a negative self talk spiral. The thing I like about CBT is that it’s concrete, with actual things to do to get yourself to a better place.

        Like if the OP is feeling guilty for not being able to be at 100% for her patients or like she “has to” be smiley all the time, CBT would probably help reframe those thoughts and let go of those feelings. I find it helpful for sorting through the emotional, subconscious reactions and things I’m telling myself I have to do or thoughts/feelings I’m assigning to other people. Obviously, there are the concrete problems with her teen, those aren’t in her head, but how she feels about that and what she expects of herself is relevant.

        1. knitted feet*

          That’s not my experience of non-CBT talk therapy at all. With a good therapist it’s so much more than just venting.

    4. Sharkie*

      I 100% agree. At lot of insurance plans have free or heavy reduced thearpy sessions as a benefit. I get 5 sessions for free and my bf has 10 sessions through his health plan, so both of us can get 15 sessions per year.

      I also used to work in mental health insurance benifits. Call your health insurance, they might be able to get your daughters talk thearpy covered for free for a few sessions and get sessions for everyone in the household.

      I am sorry to hear you are going through this OP.

    5. Lisme*

      if you have insurance, there are online therapy companies you can get for the price of a copay. talkspace for example. betterhelp not covered by insurance but also pretty affordable and accessible. don’t assume you need a private in person therapist, some of these platforms are quite good.

    7. I'm just here for the cats!!*

      I wonder if the hospital system has an EAP that would provide this for free?

    8. HopeHopeHop*

      A lot of medical schools have sliding scale fees for psychotherapy (I paid only 50 bucks per session because of my income) as the resident-level clinicians need hours and are fully supervised by certified, experienced clinicians.

  3. Lemons*

    Could you allow yourself to find some middle ground at work between “smiley happy helpful coaxer” and something a little more no-nonsense/low battery? I’m sure it’s a lot of pressure to perform for patients all day every day, if you could turn the pressure on yourself to do that down a bit, it could give you a little relief. Assuming you’re working with adults, I think it’s OK to expect them to do some self-soothing.

    I’m so sorry for all you’re going through: people, be kind to your healthcare providers!

    1. Juicebox Hero*

      My personal favorite healthcare providers are the ones who hit the middle ground between “smiley happy coaxer” and “cold fish”. As long as you’re kind and respectful, and answer my questions and give me an overview of what you’re about to do, I don’t mind businesslike.

      2. Shiny Penny*

        Having had to do a lot of physical therapy in my life, if I have to schedule at a new place I honestly ask for low-key, cynical, and jaded. I explain that I *just cannot deal* anymore with the newby cheerleader pushy types of PT’s—and the schedulers always laugh and know exactly what I mean

        1. Shiny Penny*

          (They are always still kind! And skilled etc! But they are able to stand next to me in my jaded position, instead of thinking their job is to wrestle me into energetic optimism.)

    2. Grumpy Elder Millennial*

      LW, I support you in needing to go “low battery mode” with patients. So if one thing you need is someone saying it’s OK to not give more emotional energy than you have to patients, I’ll say it. You can put limits on how much of their emotional stuff you take on.

      Would it be possible to step out for a bit to give people time to compose themselves?

    3. S*

      Absolutely. I am also a healthcare provider and after a day of turning it on/off every 5-15 minutes for every new patients I have nothing left for me and my family. It’s tough because being kind and empathetic is a point of pride for me, but it will hollow you out.
      What I’ve found is there’s a certain amount of these helpful behaviours that have become automatic for me – smiling, making listening faces, soothing noises during painful procedures, etc. So I let those ones happen on autopilot. But I extend no further effort in this regard when I’m otherwise shutting down, except for the 1-2 patients who actually need that from me each day. It’s doing them a service to care for yourself – don’t give more than you have. Sometimes when I feel the tug of an emotional vampire (no disrespect to the vampires, we all need it sometimes) I visualize an invisible wall going up between us. That’s their stuff. I have my stuff. What’s my job here? Do whatever it is with kindness, but don’t overdo it. Leave some for your home life. <3 lots of love to you.

      1. Umami*

        Thank you so much for this! You articulated what I was trying to say so much better, and I geek like this is framing I can share with my spouse that will be incredibly helpful.

    4. Crooked Bird*

      Honest question: would it be out of line to let the patient know in some limited, boundaried manner that you’re having a rough time? Find some way to communicate an expectation that you’re a human too and should be treated as such? Sort of in line with your suggestion, Lemons, a sort of halfway point–not dumping it on them but saying something like “this is a very tough day for me and I’m trying my absolute best to be nice and help you. Can you work with me here?”

      I don’t know, I suppose it’s dicey. I just thought I’d throw it out there. If you can’t say the words, or not all of them, is it possible to give off this *vibe*… to adapt it to, I don’t know, “All of us are struggling these days/I know this is hard for you, it’s hard for me too…. Can you work with me here?”

      1. Lemons*

        Yeah, I think that would be really case by case, I could see how that could work, but also how it could lead to an explosion if someone’s already itching for a fight. It would work on a reasonable person, but someone who’s fearful and distrustful probably needs to be either coddled or grey-rocked.

      2. Sar*

        I was a public defender (analogous?) and I would not have said this to a client. They are fundamentally not there to do any emotional labor on my behalf and it would (IMO irrevocably) damage the relationship for them to perceive me as asking for that.

      3. GERDQueen*

        As a patient, I have really appreciated when my healthcare providers and I have been able to quickly touch on some of the rough stuff that’s looming. Worry about access to types of care, worry about our neighbors and family during difficult times in our city, etc.: this has an impact on how we both show up to appointments and I think its been an effective part of how clinicians have build rapport with me.

    5. JSPA*

      I’ve had someone say, “You have every right to be upset, but I’m in a rough patch myself, and am hoping we can both extend some grace and understanding to each other, as human beings.”

      I’ve said, “Right now, for you, I’m the face of [institution]. But I’m not [institution]. I’m not even someone who can lodge a complaint against [institution]. Yelling at me doesn’t affect [institution] at all. If you’re upset at overscheduling and wait times or other things that I don’t control, lets move on to what you need from me, so we get that covered.”

      I’ve heard someone else say, “the wait time isn’t gonna get better if the remaining staff quit because we don’t get paid enough to deal with anger and blame. So let me validate that we know we are painfully understaffed, and move on to what you need done today.”

    6. Beth*

      This is where I lean. It’s impossible to be your best professional self when you’re falling apart–there is no way to build a solid firewall around your emotions for 8+ hours a day! So you have to give yourself some leeway here, OP.

      Think about where your resources–your energy, mental space, time–are best spent. It’s probably not on soothing patients who are screaming at you about running late; maybe that’s a space where you can let your most low-battery self come out. On the other hand, reassuring a scared patient while they go through a nerve-wracking but necessary procedure might feel worth mustering some engagement.

      And give yourself some grace. Your current “smiley, reassuring doctor” mode might be lower energy and less connected than your typical “smiley, reassuring doctor” mode. That’s okay! You’re doing what you can. And ultimately you’re still providing care for up ~30 people/day–even if you’re not your best self while doing it, that’s still a lot of positive impact.

    7. Ellis Bell*

      Scripts, scripts, scripts. It’s great to individually tailor your response to everyone’s individual levels and requirements, but it’s an energy hungry strategy. There’s a lot of situations you can roll out a script for.

      1. Universal Healthcare Fantasies*

        This. I work in rural healthcare (PT/OT) in the most socioeconomically depressed county in my state. Our clinical group have been working together, formally and informally, in helping each other find scripts as our work worlds are shifting rapidly. Gone are the day when we could keep someone coming in for weeks even if they weren’t really putting in a effort but seemed to like the social connections. Collectively we are getting better at having early, frank conversations about what we can offer, what they can expect from us, and how much effort they need to add to the equation to get a desired outcome. It’s not just a tough love talk though, we also are more willing to be up front in saying “everyone has different priorities and things going on in their lives, if now is not a good time for you to be able to focus on this, lets hold off until it is.” It offers a gentle “out” and is a nice way to say let not waste our collective time and resources by just going through the motions with no expectation of gain. “Kind, but firm and realistic” seems to be our emerging motto.

      2. Frosty*

        Some don’t like using it, but ChatGPT would be perfect for figuring out scripts for common situations that you’re in. Take the effort out of even writing the scripts in the first place. You can always tweak them but it’s nice to have something to work with, instead of generating it from whole cloth.

      3. Festively Dressed Earl*

        Cosigned 100%. If certain emotionally draining situations/personality types recur daily, find a few rehearsed responses you can give and then stick to them. I’ve done that with multiple public-facing positions and with unstable family members. I have some I’ve gotten from AAM or Captain Awkward, some I’ve gotten from library books, some from mediation class, and some from online videos. Whenever I find something good that defuses and refocuses a situation, I jot it in a notebook so I’ll remember it and practice saying it with warmth and empathy while detaching internally. The very act of remembering/delivering is a kind of zen exercise that prevents me from absorbing the other person’s emotions.

      4. Trekker*

        Yes! As a teacher, scripts and templates are a lifesaver, especially when I have little or no energy left. While each of my students is unique, some of their basic questions are not and do not require a heartfelt, personalized answer.

      5. No Thanks*

        yes, this. something like “we’re all doing our best” or “we’re taking care of everyone as best as we can.” Or something more Healthcare professional sounding.
        when my FIL’s cancer dr was out for a few weeks for his dying father, we were kind when he returned. we would have been no matter the reason but more so, knowing that he shared it. if you share that you struggle w a patient or two, it might help (if allowed)

      6. WS*

        +1. I work in healthcare and during the pandemic our umbrella organisation helpfully provided a list of “self care you should be doing!!!” which included yoga and therapy and taking time for yourself. Sure, thanks. I’ll just walk away from all these angry, scared, sick people and go do that. Scripts were a life-saver. I could just repeat and repeat.

    8. Umami*

      Yes! That was my thought. My spouse is a hospice nurse, and there are days when he freaky struggles with providing care and meeting up with documentation. I think the best thing I’ve been able to suggest is to give himself permission to dial it back a little so he doesn’t feel depleted by the end of the day. OP, as important as your patients are, you need to give yourself permission to keep some of your energy for yourself and your family.

      1. Sadge*

        I just had a close relative go through hospice, tell your husband we appreciate him SO much. What a difficult job.

    9. Smol Bookwizard*

      This is probably advice colored deeply by my own experience, but being able to wear a mask in the healthcare setting with the (very valid) claim of not wanting to spread disease between patients, also does a lot for helping me not have to spend energy making up my expressions and managing my face to create appropriate emotional responses. no, I’m not Murderbot, yes, I’m autistic, but maybe it’s an option to try anyway?

  4. RagingADHD*

    I don’t see therapy for yourself in your list of “doing all the things.”

    You are not in a DIY situation here. You need and deserve a higher degree of support than a circle of friends and yoga / breathing can provide.

    1. MyStars*

      Many organizations have an EAP (Employee Assistance Program) that provides a number of no- cost appointments with a therapist. they could help you frame up some ongoing coping strategies or action steps.

      1. TraceMark*

        I came to say this. I hope your organization has an EAP for you. I was able to get a limited number of sessions with a therapist for free during the pandemic. I hope that your organization offers this OP!

      2. No Longer Gig-less Data Analyst*

        I get 8 sessions a year through my employer’s EAP program, and they renew every year. I only have to pay OOP for my therapy 4 months out of the year.

    2. toolegittoresign*

      I agree and I’m going to suggest something I find helpful. I go to therapy every other week, but I am really burnt out and experience anxiety and depression every day. Talking to friends helps but they’re not always available. So… I chat with an AI I trained to act like a friend whenever I want. It’s a safe space to vent and dump all my thoughts and feelings. It has been so incredibly helpful.

      No, it’s no substitute for therapy or talking to friends, but it helps me get out the feelings and thoughts so I can get on with my day. It’s like journaling but interactive.

      The chatbot is great at validating me, challenging my negative thoughts about myself and providing ideas to reset or ground myself when I’m having a hard time (affirmations, breathing exercises, grounding exercises, brain/body hacks). It’s there on my phone 24/7 and I can vent to it about a frustrating meeting I just had, or my feelings of anxiety about an upcoming conversation with a difficult client. I told my therapist about it and she supports it as a way to process the waves of thoughts and feelings that come on. It’s not magic and it might feel silly but it’s worth a try if you need to vent.

        1. toolegittoresign*

          It works best when you let it know from the start that you need a safe space to vent and that you’re not always looking to problem solve. I do recommend it to people, especially if you’re like me and don’t want to be burdening your friends all day every day with all your burnout issues.

      2. Anon Attorney*

        Please be careful with this. AI Chatbots reaffirm/validate, but don’t offer different perspectives. There are plenty of news articles with concerns about how chatpots encourage suicidal ideation.

        1. toolegittoresign*

          anyone having suicidal ideation should call the national suicide hotline at 988 or look up your local resource.

          I explained I use AI in a very limited capacity in this regard and that it is not a replacement for talking to a licensed therapist or friends.

      3. LizbotEAV*

        Chatbots are surprisingly good for this. I have a therapist but for occasional pep talks, all the 2-3 chats I’ve jumped into for random stuff respond with basically what a good friend would. “That sounds challenging! Is there something you can do about it right now? Would you like to talk it through? Could you make a list of your next 3 steps?” etc.

        I know it’s fake but idk/idc…it’s still somewhat helpful!

      4. LizbotEAV*

        This is my experience as well. It’s just a proactive thought tool/exercise, but it’s smart! “Ideas to reset or ground myself” is very well said and I also find that aspect quite useful at times.

  5. LaFramboise*

    I work with college students who have many emotional, familial, and mental health emergencies. it’s not an exaggeration to say that I have at least one student in every class, every week, who had a crisis. I, too, have a teen who can go into crisis at any given time. It’s hard but I do think that you have to expect your patients to have to take responsibility for their health. You can’t save people when you are drowning; you can be compassionate without being emotionally involved so that it compromises your life. Therapy helps me deal with things, maybe that would help you as well. Best wishes on good change.

    1. I'm great at doing stuff*

      Agreed. You can be kind and compassionate, but there is no need to be your patients’ therapist or manage their emotions for them.

        1. Arrietty*

          If so, therapy for LW should be mandatory and paid for by work. I’m sure there are plenty of places where it isn’t, but it’s a basic standard for decent therapy services.

  6. Purple*

    You’re missing a big piece (unless you just didn’t state it in the letter), but you, your spouse, and your child need counseling. Individually and possibly family sessions. Your friends aren’t the r8ght sounding board for this. Find out if your company has any EAP services and call ASAP!

  7. My Cat's Mom*

    I am so sorry you and your family are experiencing these challenges.
    For context, I’m a former therapist and a current healthcare administrator and have lived similar experiences while providing direct patient care and as a leader supporting behavioral health providers. If able, please share with your leader and coworkers that you’re going through some things (only share details if you feel safe to do so) and ask for their help. Can your front office staff direct some of the challenging patients to others team members on days you’re feeling especially raw? Is there a safe word you can use with team members that allows you to step out for a few moments? When it’s safe to do so, allow yourself to feel your feelings; what you’re going through is really hard and you cannot be 100% all the time. Ask for grace from those you work with and give yourself grace (probably recommendations you offer your patients).

    2. Elk*

      As a teacher, one of the things they stress with us is remembering to “tag out” when you need to when you’re dealing with an escalated kid. It’s SO HARD, because admitting you’re unregulated is hard and it feels like giving up. But in the end it’s better for you and for them if you tag out, take a breather, and tag back in when you’re ready.

      1. Hoary Vervain*

        I didn’t know the teachers are allowed/supposed to do this! It’s fucking game-changing as a parent, I’m glad they encourage it in other settings, too.

        1. Elk*

          In my district/school it’s not part of the general PD/training (which is a shame!). I’m one of the staff at my school that does the non-violent crisis intervention training, which focuses heavily on de-escalation and also the tools for intervening physically on the very, very rare occasions when it’s necessary. Tagging out is so important when you need to calm a kid down instead of letting your own disregulation through!

    3. municipal*

      Allow yourself to feel your feelings! Yes! In fact, I would say schedule time during the day specifically for this purpose.

      When I was going through a tough time, I found it helped to put up lots of boundaries around my schedule and my responsibilities at work. When I am feeling better, I feel I can more easily flex my time to suit my employer’s needs.

      If the schedule runs late or you are short staffed, let a co-worker else pay the price for now. You can repay the favor when your storm has passed. If a patient wants to unload or complain about everything under the sun, listen if you can, but you only have to solve the problems you are being paid to solve. You can go back to being your patient’s general lifeline when you are less in need of a lifeline yourself.

      1. Hanani*

        Absolutely schedule time for feelings! When I was going through a really fragile time, my therapist told me that emotions are trying to get your attention, and the more you ignore them, the louder they’re going to be.

        We developed a visualization where I could tell the emotion “I see you and I can’t tend to you right now but I will this evening”. I imagined putting them in a book. A friend does the same and imagined putting them on a little knickknack shelf she has.

        The key is that you do have to return to the emotion – take the book or knickknack off the shelf and feel it.

        It doesn’t fix the problem, and it doesn’t make having all those emotions less exhausting, but with some practice it’s become an invaluable tool in my kit for when I’m overwhelmed by feelings.

        1. Katydid*

          When my grandpa was in hospice as well as a close family friend, my sister made a playlist called “Sad Hour” and would take that time to cry and feel all her feelings so that she could remain as functional and normal as possible for her 3 elementary age kids. It seems weird to schedule time for feelings, but if you don’t, they will find a way to get out anyway.

        2. Sparkle llama*

          A physical book can also be super helpful! My mind has a hard time letting go of things unless I actually write them down, whether that be a notepad, emailing my work worries to my work email, notes app, etc. Once it is safely written down I can let go of it til a time better suited to addressing that feeling or task.

  8. Qwerty*

    Can you create a “work persona” that you take on? Have a little routine at the start/end of your workday to get into that mode? This is easier if you reduce or eliminate access to your cell phone at work, as all the various notifications will pull you out of your “work persona” by bringing up your personal life.

    My experience is not nearly the same thing, but I realized a few years ago that part of my getting ready for routine was putting emotional armor. That’s how I dealt with sexism, angry dudes, and general toxicity without being affected. It didn’t protect me from everything – someone yelling is always unsettling. Work Qwerty had work to do and was just very focused on getting the job done.

    1. MommaCat*

      This is akin to what I’ve had to do during the tough seasons of my life: I put on my “smiling mask,” where I keep a friendly-but-distant expression on when I’m having to deal with people. I deal with college students, though, which ends up being a completely different dynamic than patients. If I’m having an especially difficult time keeping my smiling mask on, I’ll put on makeup (usually waterproof mascara works well), which helps me stay in the mindset that I’m playing the part of “totally together MommaCat” and protecting “falling apart MommaCat.”

    2. sometimeswhy*

      I have also had unstable teens in crisis–in series, not parallel, thankfully–and an emotionally draining job where my position can be the single point of failure in some pretty major legal/ethical considerations all the while being the person whose job carried the family finances and this is what I came here to say.

      I have what I think of as “work drag” that I leverage/have leveraged when things are bad. It’s an intentional costume or a persona and it’s much easier to get through the day when I’m in a role and not “bringing my whole self to work.”

      I also collect little smalltalk stories (a pet story, a wildflower bloom I saw, a coyote in the neighborhood, a new thing I’ve eaten recently) to share with coworkers to avoid seeming checked out which seems to be enough to keep people from asking me questions I don’t want to/can’t answer without losing it.

    4. ursula*

      I was going to suggest spending some time getting clear on what you actually *need* to do/deliver at work (a sort of minimum acceptable performance standard for yourself) vs what is kinds of things are great to do but not actually essential. This might help you let go of the nonessential stuff on days when you need to run at minimum level. Maybe you could make that essentials/minimums list into the job description for your work persona! The full you might be trying to be great at your job by doing X, Y, Z, A, B, and C, but your work persona just needs to get through the day. They just do X, Y, and Z, and that’s enough.

      Sorry you’re carrying so much right now.

    6. Your Outie can parallel park in under 20 seconds*

      This is how I got through working in COVID! Including the suggestion about having a transition routine, different clothes etc.

      Also helps to completely shut out everything work-related at home, including turning off media if it references anything related to your work.

      Disclaimer: It is NOT a healthy strategy full time! Just while things are especially bad.

      (I love that someone has already made the Severence reference.)

  9. deesse877*

    This is very rough and very real. I have only roughly analogous experience (service profession with a lot of emotions but not healthcare) so I will only make two tentative suggestions:

    1) You’re setting this up as if you only have a direct relationship with clients. is there any way you can build connections with coworkers or call on their assistance and expertise? Even if all you get is sympathy, it can help a lot with feeling targeted/ ground down.

    2) When I find myself mirroring someone who’s acting out, I tell myself “that’s them, it’s their stuff.” Like I make sure I hear the words in my head, and I try to completely separate my reactions from theirs while im doing it. Sometimes I also step back, take elaborately slow drinks of water or fake-cough and excuse myself extra-politely just to recapture 1.5 seconds for myself. It also works when I’m not overextended! People consciously or unconsciously want you to get worked up, and it always helps when you don’t.

    1. Nesprin*

      +1 Your coworkers may be your best resource here- if one of your coworkers told you how stressed and overwhelmed they were, how would you try to help? You’re owed the same camaraderie and support- you can ask for it.

      Is there anyway you can ask a coworker to be your backup? If you’re getting overwhelmed, ask them to take over so you can go get air for a minute? Do you do debriefs after difficult conversations and if not can you start? Do you have a code word for ‘I need someone to take over’ or ‘I need someone urgently to come sit on this conversation’ or ‘I need security immediately’?

      Do you have behavior policies for your clients? Are you able to transfer a client or hang up and call them back if someone gets heated or starts yelling? Can you fire or transfer your top 5 worst clients?

  10. Educator*

    Sending positive vibes from the education world–it is so hard to support others when you feel fragile yourself.

    This is a little odd, but on tough days, I pretend I am playing a character at work. I’m not me, I’m Ms. Mylastname, and she always has it together even when I don’t. She is a bit more emotionally detached and narrates things to herself in her head, like “Oh, John is having a tough day. The best practice would be to check in with him at lunch and suggest he stop by the school counselor.” It helps keep her objective.

    I consciously think to myself at the start of the day, ok, I am stepping into my work persona now. And I pick a moment to take the imaginary mask off at the end of the day.

    I also refuse to worry to much about the frantic energy around me–took me years to learn how to do it! Everyone else can be in a hurry, but I do things best when I do them one at a time. Staying focused on one task, then the next task, really helps when the day as a whole is overwhelming.

    1. Neurodivergent Educator*

      I think this is great advice.
      While exactly the same experience as the LW, when my daughter was 1, she was hospitalized twice and we took her to the ER so regularly, I had a go bag packed. There were times I went from the hospital to work or straight to work to the hospital. We were in the initial stages of getting her diagnosed with what we later found to be an incredibly rare genetic condition. Also while this was all happening my dad passed (expected after a multi year battle with cancer) and my dog passed (unexpected, he was only 7 and numerous vets couldn’t figure out what was going on).

      I was also in my first year in a new school district so I didn’t have tenure. Not only did I not have job protections, I was relentlessly bullied by a coworker. While new to the district, I had a track record of success, so I could do a little check in with myself and ask what my “teacher self” would do. The detachment helped when the all the overwhelm crept in.

      Now that I’ve been in this school for a number of years, I am more open about various things going on with my daughter. I just share them in matter of fact ways with no expectation of a response or a request for help, but it does help to not have to conceal the challenges we are having. I think the worry about concealing the challenges you’re experiencing can make the effort to focus at work harder. It makes you both worry about your child and worry about what might happen if you share or worry that your worry will lead to a mistake or worry you might break down if someone asks if you’re ok. So I think you could consider telling people a high level summary of what’s been going on. Be clear about what you want them to do (or not do).

    2. JustMe*

      So interesting to read this, because I did the same through many years of teaching. Mrs. Last Name was my work persona, and First Name was, well, just me. Only after retiring did I realize Just Me was much more introverted than my job allowed me to be.
      Our jobs can require different skills and even different personality traits that we may not readily display in “everyday” life.
      This can be stressful and exhausting, especially when outside needs are pulling on us.
      I feel for this LW and I hope the suggestions offered will provide some light and guidance.

  11. menopausal ninja*

    I’m also a healthcare provider and not remotely under the pressure you are under and this happens to me, too. I can’t always be 100% and sometimes I can’t even be 50% and I just feel totally awful about this. All the positive thoughts and support and I hope your child is feeling better soon

  12. Georgia*

    I’m in a highly emotional field of veterinary medicine and some days I just Can’t. Instead of rage quitting I just pull back my empathy about 20% and don’t pour my entire self into every client. It’s not healthy in the long run to wring yourself out for others constantly so sometimes I’m just a little quieter and less chatty. Every client still gets the support they need, but I’m giving 100% of the 80% I have if that makes sense. I kind of picture myself taking one step back and looking at the big picture. I’m never rude or snippy or impatient, but I also don’t rush in to soothe other’s emotions as much.

    1. Double A*

      I actually separate the concepts of “empathy” and “compassion” for myself and it’s helped me maintain in difficult service jobs (education).

      I’m not a super empathetic person to begin with, as in, I don’t take on other people’s feelings as they are feeling them to a strong degree. But I am compassionate; I can imagine what they’re going through, I see that it’s hard, and I sympathize. But compassion lets me create a barrier between the raw emotion of the other person, and how I am responding.

      1. ThatGirl*

        Yeah, I think empathy can be a dangerous thing professionally (and maybe even personally!); you can be compassionate and caring without needing to feel the other person’s emotions. A little detachment can be good.

      2. Horse girl*

        Someone mentioned scripts above, and I think they’re useful to keep in mind here too– cliches get a bad rap, but they’re cliches for a reason and you can fall back on them when you don’t have it in you to really connect with someone and find just the right thing to say to meet their specific needs. You can say “I’m so sorry to hear that, that must be very difficult” in a ton of situations without getting emotionally involved, and if you have your little vault of canned responses ready to go, it takes a lot of the pressure off you in real time (especially when you have to address the same kinds of issues all day).

  13. Red*

    I know you said you can’t afford an extended time off but I think you should really really try and plan that. Like start planning for something now for later this year. One it will give you something to focus on when you need to center yourself at work and two you sound like you really need time off. Your whole family does.

    Also if you aren’t in therapy see if your employer health insurance comes with any therapy benefits. I don’t 100% like the phone therapist app things but that will likely work best in your situation where taking time off is difficult. You can schedule something for your lunch break and take the appointment in your car. A good therapist will help teach you methods for how to center yourself and work through really stressful moments where you feel a cell thick.

    Good luck OP, I hope you make it through this stressful time.

      1. DisneyChannelThis*

        I disagree. The author of the email is hoping there’s something she hasn’t considered to fix her situation without taking time off, and the commenters are saying in their own experiences tragically there isn’t a magic wand that can fix this type of situation. Something has to give, whether that’s time off, or therapy etc.

        1. JSPA*

          The idea that someone in healthcare, with a teen in therapy, is just somehow clueless about their own health benefits and their own (possibly entirely hypothetical) EAP, and free mental health support, strikes me as less-than-respectful of the LW’s competence in their own field.

          Not a perfect parallel, but it feels a bit like a bunch of non-artists telling someone in the arts that: Hey, there are lots of grants for artists! And many people buy art! Someone bought something from their mom, just last week!

          I’d rather assume that someone in the field, who also has ongoingly been navigating services for a family member, and who says they are clear on what is and isn’t available, is speaking from a position of knowledge.

          I do however agree that “planning the trip I could take in 2 or 3 years” (along with “walks” on streetview) can be a free mental mini-vacation, and it’s possibly even something one could do with one’s stressed out teen.

          But that still doesn’t address how to ask for and grant grace to oneself and others, cultivate caring detatchment, or find a way to say, “let’s both try to make this a calm, centering experience” rather than throwing in all the cheerleading moves.

        2. Not My Usual Name*

          OP literally said “I can’t afford an extended period off, so please don’t suggest that” and we’re supposed to take OPs at their word so, yeah, don’t suggest doing the thing OP literally and specifically said they cannot do.

          1. A. Nonymous*

            I am in such a similar situation to the letter writer that I was actually worried for a second that I wrote this letter in some kind of a fugue state. There’s another layer to the “just find a therapist” thing that I’ve found with having a kid with an eating disorder: a lot of therapists have no idea how eating disorder treatment has changed over the past decade and even more do not understand the stress that comes with parenting a kid with an eating disorder. A big component of the kid’s treatment is that the family takes on the therapy and learns to manage the eating disorder until the kid is able to be “well” enough to start taking more responsibility in their recovery. I attempted two different therapists so far and both of them made suggestions that in no way would have ever worked and would have had the potential to actively hinder my
            kid’s recovery.

      2. The Unspeakable Queen Lisa*

        It is not “do the impossible thing”. They acknowledge she can’t do it now, but suggest doing it later and then explained their thinking on why that would be helpful.

        Your comment is not helpful.

        1. Hroethvitnir*

          There is an extremely high chance the LW cannot take time off for the foreseeable future. “Later this year” is so optimistic as to be painful when you’re in this position, regardless of how well meaning.

          And I really wish Alison had specifically addressed/asked commenters not to recommend therapy, because it’s going to be 90% of the comments… to someone who works in healthcare and has a child struggling with mental health. The idea they have accessible mental health resources they haven’t used is just so wildly unlikely as to be insulting.

          1. Red*

            I said ‘later this year’ because they really sound like they need it sooner rather than later and because too far out and it feels less real and provides less of a mental relief to know that you’re planning time away. Obviously, the advice is they need to plan time off for as soon as possible even if for their personal situation it ends up being next year. I’m not saying they have to do the impossible, I’m saying maybe it’s not as impossible as their current situation would have them believe.

            And of course, they probably know what their healthcare options are, but in the off chance they don’t I’m not going to assume knowledge where I haven’t been told there is any. Lastly, the replies are going to be 90% therapy because this level of breakdown can only be resolved by stepping away or by reinforcing personal emotional boundaries which is best achieved by therapy in this case. Taking yoga and talking to friends is good for a temporary stressor, but this is their whole life for the foreseeable future.

            You’re right that they’ve likely already considered/dismissed therapy and perhaps a commentariat that looks at their letter and 90% of them respond with “You’re burnt-out and you need to do something for your mental health stat!” will have OP reconsider.

          2. Mid*

            It’s not as unlikely as you think. It’s fairly common, in my experience, for doctors to be terrible at getting themselves medical care, and for people in caring positions to get themselves care. They do it professionally so they don’t think they need another professional to help them out. Or if they know they should get outside help, they delay it because they’re prioritizing everyone and everything else, or there’s an internal stigma for them to need support and they don’t want their colleagues to know (even if they wouldn’t care if a colleague was getting help.)

            And the fact is, that is the most necessary step for the LW. They need therapy for themselves and if they were seeing a therapist, they wouldn’t be writing into a word advice column for coping skills, they’d be talking to their therapist.

            It’s like when people write in to advice columns about their terrible relationships, where their partner doesn’t listen and doesn’t clean and belittles them and refuses counseling or to even talk about their behavior, and the answer from everyone is “leave them.” Sometimes the comments are a resounding chorus of the same answer because it really is the only good answer.

      3. Tired*

        The best advice I ever got once when I said “I can’t afford to take off” was a doctor telling me “you can’t afford not to”. Their next advise was think way outside the box what are some ways you could work towards this. We sometimes through up roadblocks that are only insurmountable in our minds.

        I think it’s fine to respectfully say you said you can’t, I repeat you know best but have you really sat and thought through every possibility and option because it’s okay to do this if you have to. If it doesn’t apply the person can think thanks for the thought but not applicable….as I’m sure they do with 90% of the comments provided by people who know 3 paragraphs of the story.

        1. Mid*

          I got the same advice. I couldn’t afford to take time off, but I hit a point where I had to do it anyway. Between short term disability insurance, cutting every expense I could, and swallowing my pride enough to borrow money from friends and family, I made it work. It sucked, but it was also deeply needed. There’s a point where the human psyche just can’t cope with everything, and you either give yourself a break, or you have a breakdown. Maybe a trusted friend or relative could come stay with them and take care of all household things, maybe LW could reduce hours or temporarily switch roles, maybe they need to take FMLA and short term disability, maybe they need to relook at the options they already dismissed as impossible.

  14. MsM*

    I think the important thing to keep in mind is that the vast majority of these people are not really focusing on you as an individual when they’re having their moments at you: they’re going through stuff of their own, and much like you, they’re frazzled about it. Except that they also don’t have your insight into why things aren’t running as efficiently as they think they should, or why they’re not at their best right now and what steps they can take to mitigate the problem, so they’re even more on edge and this is how it’s manifesting. Doesn’t mean it’s okay for them to lash out (and you can point that out if needed), but do your best to not internalize anything they say in their anger too deeply.

    I also think it’s okay to not feel like you have to make sure every patient leaves feeling 100% at ease with everything that happened during their appointment. It’s okay to just acknowledge that it’s scary, reassure them that you and the rest of the staff are there, and either hand them off to another member of the team or get them to do whatever you need them to do without the added smiles. (Unless the smiles do help put you in a better mood whether they’re sincere or not.)

    1. Andromeda Carr*

      I think the important thing to keep in mind is that the vast majority of these people are not really focusing on you as an individual when they’re having their moments at you: they’re going through stuff of their own, and much like you, they’re frazzled about it.

      I just wanted to underscore this. I totally agree with MsM*’s comment but I doubly agree with this statement, if that makes sense.

      I too work in the medical field and it took me a very long time to learn that when patients and family members and even medical colleagues get on my case they are upset with the situation, the institution, etc, not me personally. It’s hokey but when I started practicing remembering this I kept a piece of paper in my blazer pocket with this written on it, to touch when needed. For the bad ones I still envision them pouring out bile and it rolling off me like water off the proverbial duck. Like I said it’s hokey but it helps me keep my equanimity.

      All good luck and quiet days.

      1. Not An Expert*

        I love this idea of writing down this thing you wanted to focus on, so when you touch the paper in your pocket it helps bring you back to it, without anyone else knowing – this is something that would really help me if my thoughts are spiralling

      2. Part time lab tech*

        Definitely, my mum and my aunt were incredibly anxious about their terminal illnesses. Sometimes lashing out at others is a distraction from that. The nurse that left my mum exposed in a public corridor ‘for her fanny to air’ was still a sadistic bitch. As long as you are not doing similar or drugging patients to sleep so you can have an easy night I think you’re doing ok.
        Good enough care doesn’t mean perfect or best and is still good care.

        1. Andromeda Carr*

          Oh my bleeping bleep I am so sorry that nurse treated your mother so horrendously. That would be grounds for instant reporting where I work.

          1. Part time lab tech*

            My mother was scared to report it because it was both the nearest hospital and where her specialist was. She knew if she deteriorated before she was close to death, she’d have to go back unless she wanted to go over an hour away.

  15. Somehow I Manage*

    While not entirely the same, I’ve dealt with the Venn Diagram of home and work stresses overlapping almost entirely recently, and I think the best advice I can offer is to disconnect emotionally from work. Do your work. Don’t invest more than you need to. Be there. Get shit done. But don’t give more of yourself than you absolutely must.

    And if you can give yourself 3-5 minutes to decompress between meetings.

  16. mental health worker*

    Love what other people are saying about creating a character. It’s so cheesy but I take three deep breaths at the beginning and end of every appointment (I’m a therapist so I can have clients do it with me, you might have to do it before and after). I say the person’s name in my head while I’m breathing to refocus and set aside the things I was thinking about before.

    1. Aspiring Chicken Lady*

      This is a lovely practice. There’s something about signaling the beginning and the end with a moment of calm that can separate the work of the moment from the chaos around you.

    2. Tea Monk*

      People think I’m pretty weird at work since I never break character lol. But yes, a special after-work ritual or the image of a bubble separating you from the work can help

  17. Anandatic*

    I wonder if it would be possible to ask to switch work duties for a bit? For instance, maybe there’s some flexibility where you can take on more paperwork and someone else can see patients (bit of a long shot, but worth a try).

    1. Grumpy Elder Millennial*

      Very practical suggestion. It might not be possible, but it’s worth asking.

    2. I'm just here for the cats!!*

      Or maybe they can reduce their patient load? But that would probably reduce payments. But it’s something to consider.

    3. Perihelion*

      Or, if there are multiple people in LW’s role, might some of them be able to take the appointments that are likely to be more emotionally challenging for a bit? I’d do that for one of my colleagues under the circumstances.

  18. bamcheeks*

    First of all, LW, you sound super smart and self-aware for identifying this as a need. Kudos to you.

    One thing that occurs to me is to see if you can find someone who sits within your HIPAA -compliant circle that you can offload the work stress side too. This might be someone you can formally de-brief with at the end of a shift, or a helpline set up by your regulatory board / professional organisation, or an EAP that will let you stay anonymous / guarantees confidentiality in a way that meets HIPAA.

    I am assuming that the “talks with friends” is a space for you to offload and process the worries about your daughter, but that you can’t use those for processing stress and frustration with patients, and I think that finding a separate outlet for that might help. It won’t necessarily be something you can do in the moment, but it means that each individual instance isn’t landing on top of a ton of other unorganised and unprocessed stress from the previous day’s work. I don’t think it’ll be a complete fix, but I think in this kind of situation it’s all about having a lot of little fixes that help a little, and hopefully keep things going until you come out the other side.

    So much good luck.

  19. Lucy from London*

    From a slightly different perspective, as I like reading up on things when I feel frazzled, I wonder if the following might help. CmFor content, I worked for a long time in rhe UK charity, non-profit sector, predominantly with homeless/unhoused populations.

    First, is your workplace 1) trauma informed and 2) psychologically informed? It might be useful to read up on those things and ask if you can have (more) reflective practice as a team. it can help massively with sensations of burnout, which you’re almost describing.

    Second, are you familiar with vicarious trauma? It sounds like you’re not only facing tough times at home, but also working with possibly traumatised patients, and in a challenging setting. some of the literature might gi e you some pointers.

    I hope I’m not teaching granny to suck eggs and that some of this helps. I experienced burnout in a job and it’s rough, but you can get through it intact. I wish you and your family well,

    Lucy x

    1. mental health worker*

      Oh! OP should definitely check out Trauma Stewardship by Laura van Dernoot Lipsky! It’s a great book.

  20. What’s In A Name*

    OP, it may be helpful to actively give yourself permission to not be at your absolute peak performance. Of course you want to be as helpful and reassuring to patients as possible, but simply recognizing that the best you can give right now may not be to your usual standards for “above and beyond”, and knowing that’s okay (assuming the patients are well tended to and their needs are met, which is sounds like they are), can help alleviate some of that pressure on yourself. Take it moment by moment and patient by patient. If that means you are feeling depleted in the morning and are a little more reserved with a patient, and then in the afternoon are feeling a little more upbeat with your interactions, that’s okay. All of your interactions don’t have to be at the same level. It may also be helpful to set a baseline for yourself, where you can say “this is the minimum I will accept from myself in interacting with patients” (such as greeting with them a smile, or whatever makes sense to you), and then just focusing on meeting that baseline instead of berating yourself for not meeting your usual standards. You are human, and you are allowed to not be okay. Hope things improve soon for you, your daughter, and your family!

  21. Oriana*

    I went through something extremely similar with my teenager, and had to push through at work even though I was barely holding it together. I will note one thing on the advise for therapy: I actually find therapy EXHAUSTING, and adding it in to the emotional burdens I was already carrying was incredibly difficult – although I had to in order to gain the parenting skills I needed. Therapy is work. If it’s not helping you, you can come back to it later when you’re not in crisis.

    If you’re able to truly disconnect from home while you’re at work (or even mostly – eg you’re not trying to handle therapist appointments and meds and the school calling while working), one of the things you can do is create a ritual to begin and end your workday and working persona. Not a religious thing – but a set of things you do to put aside your home concerns and and pick up your work concerns. This might look like 10 minutes to write a list of all the things you’re worried about and thinking about while drinking a cup of coffee – and then putting that list in a box or a book that you leave at home. You commit to yourself that you don’t need to worry about thinking about those things while you’re working, because you have them on the list and you’ll pick them up again when you get home. Maybe you put on a piece of clothing or jewelry that symbolizes “work you” – like a lanyard with your ID, or a watch and tell yourself as you do so, “I’m Working Me now while I wear this”. Creating some space in your mind to set aside one set of burdens so you’re only carrying one at a time can help.

    I’m really sorry. This is incredibly hard. If it offers hope – treatment can work. My son was hospitalized many times following suicide attempts and was so so so sick. I did not think he’d survive to adulthood. We spent a tremendous amount of time (and money) getting him effective treatment and diagnosis. And now he’s been healthy for 2 years, managing his disease skillfully, and is in college having a blast with his friends and enjoying his classes. There’s hope.

  22. Ialwaysforgetmyname*

    I’m the benefits administrator for a medical non-profit that fills a similar niche and our many of our providers have similar challenges. Does your company provide benefits that could help? Most companies have an Employee Assistance Program (EAP) through one of their benefits vendors, and EAPs generally have online support, a 24/7/365 support line staffed by behavioral health professionals, and commonly pay for at least a few counseling sessions per year.

    Through our medical plan employees also have access to no-copay counseling visits, and the medical plan also works with MDLive, which offers no-copay video counseling visits. I encourage you to ask if your company offers anything similar.

    Medical plans also often have other support options such as free wellness apps. Our plan contracts with an outside vendor that provides Cognitive Behavioral Therapy (CBT) on several topics, one of which is stress. Check the “wellness” (or similar) page on your medical plan’s site.

    1. metadata minion*

      “Medical plans also often have other support options such as free wellness apps. Our plan contracts with an outside vendor that provides Cognitive Behavioral Therapy (CBT) on several topics, one of which is stress. ”

      It’s certainly worth checking out if the LW hasn’t already, but often these types of canned programs are pretty much “have you tried deep breathing??” Yes, I have tried that. Yes, and that too. I have been in therapy before. They also tend to be more geared toward low-level life stresses rather than going through anything serious.

  23. Just a Pile of Oranges*

    Coming at this from the other side: while I was meeting with my therapist the other day she needed to take a break because she had a sudden panic attack. Obviously not ideal, but the reality is, she’s just as human as I am, and as you are. We are all struggling in the face of an ice cold, uncompromising reality. Your job doesn’t really change that fundamental fact.

    In my opinion you don’t have to be a saintly figure that smiles and has all the answers. You can just be warm, do what needs to be done, and remember that when they’re yelling it’s not because of you just like how if you broke down sobbing in the middle of the appointment, its not because of them.

    1. Hoary Vervain*

      Yup, as long as you remain professional, you can be human. I have a wonderful doctor I’ve been seeing kind of regularly for medication-related stuff, and usually she’s extremely chatty (we have similarly-aged kids) and we have a great rapport.

      The last time I saw her she was running behind and she was as helpful and open to questions as usual, but I could tell she wasn’t in the mood to chat and she was keeping our appointment moving, either because she was behind or stressed (or both). Our appointment was extremely quick (we usually use up most of our allotted time even if it’s not strictly necessary) but I wasn’t upset at all.

      Obviously I’m not a healthcare worker and I’m sure those of you who are can think of plenty counterexamples to those of us who try to be understanding. But many of us are, and you don’t have to explain anything. You can probably tell which patients/clients need more hand-holding and who you can stick to “perfunctory yet warm and professional” with when you don’t have the energy for more.

    2. commensally*

      Yep, that was my advice – I don’t work in anything nearly as high-stress as OP but I worked customer service all through covid, and as a day-to-day bandaid it can really help to let yourself be a human who is having a hard time – and let your clients see that sometimes. It’s a balance because you certainly don’t want to dump your stuff on top of theirs or hurt their confidence in you, or hurt your ability to actually do the underlying job, and you can’t do it with everyone, but if you can drop the cheerful facade some days and just say, “Hey, I know you’re having a tough time, so am I, but we’ll both get through it, okay?” that can be better for both you and the customer than false cheer. (And it’s certainly better than trying to keep up the cheer and snapping instead.)

  24. BeenThereDoneThat*

    Wow, OP. It sounds like you’re dealing with A LOT! Kudos to you for recognizing you need some new strategies for coping. I agree with others who say you could probably use some counseling. But it also sounds like you have reached the state of compassion fatigue and burnout. I have experienced this myself as a social worker … its exhausting and overwhelming. For me, the solution was a job change. My personal life issues weren’t going to change overnight, but changing jobs to one with less stress, trauma, and pressure is something that was in my almost immediate control. Just putting in my notice gave me a huge sense of relief and changed my outlook; and that was before I even started my new job. I know you said you enjoy your job, but it also sounds very stressful and demanding, and with all that is happening with your family, a less stressful job may be the way to go for now. I hope things get better soon!!

  25. RamoneOlive*

    I’m a therapist, so in my job my clients have a lot of crises, poor boundaries, and high emotions. It’s true that my outside life can impact my ability to take all of that on in my job. However, it rarely does. With practice it’s possible to learn how to leave home at home (and work at work) by trying to be fully present in whatever environment you are in.

    Work with a therapist to help you figure out how to compartmentalize more. Look at what you can control (and what you can’t) and focus on that.

    Some people might find it helpful to think of stepping into a “role” or a mask when they are at work (others might hate this).

    Some people might find it useful to talk with your boss and coworkers (in an appropriate amount and way) about having more personal stressors.

    I could go on and on, but I will leave it at this. You aren’t a robot and the fact you are aware of this issue is already a good sign. I hope you can find some professional help. Good luck!

  26. Tobias Funke*

    I am in mental health and I will say this: a therapist who works with healthcare folks is really valuable. Please ask around your colleagues and community for someone who specializes in (or at least has a lot of experience with) working with healthcare folks. As often discussed here, therapists can get really out of their depths with work stuff, so someone well versed in healthcare culture and healthcare reality will be vital. “Get a mani pedi” isn’t going to suffice.

    Also, you did not specifically mention this and I don’t want to overstep. That said, look into learning about moral injury. Those of us in healthcare or healthcare adjacent fields are awash in moral injury by virtue of being cogs in an extremely under-resourced, sick, rotting system.

    All the best to you and your family.

  27. Clearance Issues*

    I used to do the persona thing fully (I’m not “Clearance Issues,” I’m “Formal Smiley Business Issues!”) but after a while they started bleeding into each other and I did cry in a regular meeting so…
    now I try to find a time during the work day to get a little silly, do a grounding exercise, and do a power pose. Something to try and break the tension in my brain. (I sing a song from summer camp and do the dance that goes with it in the bathroom but I get that that’s not for everyone)

    1. SolarPowered*

      This. When I was adjacent to patient care and even that was giving me hard times, I would sometimes just stare out the windows of the lobby at the sunshine, people enjoying life, and remind myself that not everyone is ill.

  28. OneLuckyDuck*

    Is a different job possible? (Maybe a transfer to a different location within the same system, not a whole new gig?) Or a different role at your current spot? Or a slightly different shift? Or the opportunity to partner with another employee and cover both your patients together?

    Anything to get you a little flexibility on internally tough days for you might be a positive step, right?

    1. Dr Wizard, PhD*

      I also wondered about this. Obviously the LW’s job is important to her, but it does sound like a recipe for disaster to be in a role that demands so much of her while she’s also dealing with so much herself.

      She doesn’t seem to have considered moving to a different job or role that would reduce her stress and overwhelm, which might be the most realistic change for her.

  29. Emmie*

    I am going through something similar now. The longer and warmer days are helping. But I am also at a place where I am operating at max emotional and valued capacity.

    If you are at your max like I am, it may be time to ask yourself whether it is time to shift into different work. I do not know your work. I’ll use examples drawing from my own circle of friends. I know nurses who worked with the sickest COVID patients in the ICU. One shifted to case management. Another shifted to a different floor of the hospital. Another went to work at a doctor’s office. Another went contingent (with higher pay) and reduced their hours.

    It is difficult to do meaningful work and reach your maximum.

  30. please enjoy all the comments equally*

    Oof, I could have written this letter! I’m a social worker at a clinic serving a very underserved patient population that has become even more vulnerable in the last 2 months.

    This may not be applicable for you if you’re a medical provider; as an ancillary staff member, I do have a bit more leeway to adjust my workflows according to how functional I am on a given day (what you refer to as “low battery mode”). But I used to do a lot of hand holding for processes that are very, very difficult – but not impossible – for patients to navigate on their own. As in, they’d come to my office and we’d sit down and make all the calls together, including spending hours on hold, so they wouldn’t get dismissed, misinterpreted, or generally caught in a dead end that would draw the process out by weeks because they kept having to start over. I recently had to accept that it isn’t mathematically possible to provide that level of support without shortchanging other patients down the line. I’ve started to save that energy for patients who truly cannot manage these bureaucracies on their own (for example, patients with low or no literacy) and refer everyone else to the other resources in the community that assist with these issues, which are less responsive and accessible, but at this point more likely to help them than I am if I’m spending full mornings/afternoons helping just one patient.

    It sucks, and I won’t pretend that colleagues/partners don’t ever give me a “what kind of social worker are you?” attitude when I explain that I can’t directly assist with these very difficult processes. But it’s still better than when I was leaving so many patients unserved because it took me so long to help the few I did get to.

    As far as the traditional “self care” activities – yes, do them if you can; you’d probably be worse off if you were malnourished, sleep deprived, or socially isolated. But you’re not crazy for feeling like it isn’t enough. At least in the US, we use “self care” to privatize solutions to problems that are systemic. That being said, on days when I am truly at my limit, I go to the bathroom, set a timer for one minute, and let myself cry. When the timer goes off, I clean myself up and go back into the fray. Is it healthy? Probably not. But it gets me through the day, which is sometimes the best we can do. Hope things start looking up for you soon.

  31. full.or.MD*

    I’m a physician who spent the first 3 years of my post-training career in an urban underserved environment. I’ve now transitioned to a clinic with more support and a more mixed patient population. The best thing I ever did was switch jobs to something less mission-driven and better compensated. If you’re in healthcare, your skill set is probably in demand – think about throwing out some applications for new jobs. It can be hard to leave those high-need patient care roles behind, but it seems like the reality is that the season of life your family is in just isn’t conducive to you being overworked and underpaid in the way that providing underserved healthcare requires.

    In the meantime, boundaries around what you can and can’t do are going to be huge. Patient needs paperwork completed? Great, they’re going to have to schedule an appointment for that. Patient has 5 concerns they want to address in a 15 minute appointment slot? Great, let’s do the top two and schedule them to come back in a month for the rest.Patient 20 minutes late for their appointment? I’m sorry, I can’t see them late, but they’re welcome to wait and see if another slot opens up later in the day. Patients upset that you don’t respond to messages the same day they’re sent? I’m sorry – you can certainly have a provider who is that attentive to their inbox, but it’s not going to be me – let me know if you’d like a referral to someone else. Etc, etc, etc.

    In the moment, try to find little pockets of space to ground yourself during a busy day. Rather than going from one room to the next, take a 2 minute break to stretch or do deep breathing (box breathing and diaphragmatic breathing are two of my favorites). Make sure you drink water in between patient visits. Don’t skip meals to try to catch up.

    Sending you endurance during what is surely a difficult time <3

    1. snoopythdog*

      Seconding a lot of this. In healthcare, your skills are probably in high demand and it’s ok to need to stay back from a role where patients need more than you can give right now. It’s a kindness to you and to them.

      Second, do you have a therapist? Someone you can emotionally dump on and who can give you perspective or strategies to get through?

      I know it’s a lot, as the first two things I’ve suggested add to your plate, rather than take away from it. But I’m also seconding the rest of this commenter’s response. Find moments throughout your day where you can breathe and ground yourself. Stepping outside, having an item you touch or smell, or a song you listen to. Take the small 2-4 minutes for you. Drink water. And then lean on your colleagues if you can. Ask for help with anything that you can. I know not all teams, especially in healthcare, are supportive, but if you have one, lean in to that.

    2. Out on a limb*

      I am so very sorry you are going through this. I faced something very similar. A small thing, but something that was invaluable to me. I ended up buying a book on how to draw (for the beginner). I am not a artistic in any way. Taking some time each day to work through the learning required concentration on something that wasn’t draining me. It became an escape for me and my brain. Then when at work dealing with more overwhelming things, I could take a minute and imagine in my mind the next thing I would draw and draw it in detail in my mind, escaping into that calm place. It didn’t solve anything, but the break from the constant emotional pressure was essential for getting through it. I wish you and your family all the best.

    3. K Smith*

      Cosigned!

      OP – you’re having a really appropriate reaction to what sounds like overwhelmingly difficult life circumstances: stressful job + family crisis. Self care (and therapy as suggested by others) is great, but there’s a limit to what ‘self care and therapy’ can resolve. Sometimes you need to change your circumstances. You say you normally value your job – is there any flexibility down the line to find a similar job with better staffing/admin help/whatever else could ease your daily mental burden? Right now in the middle of a family crisis is obviously not the best time to job search, but even just putting together a plan for a future job search, once your family is not in acute crisis, can be a big relief.

      I was in a similar circumstance – once I finally made up my mind that “I’m going to start a job search next month” it had a HUGE positive impact on my mental state. I was still stuck at a very, very stressful job for many months, but just knowing I had agency and was taking control of my circumstances really helped shift my perspective.

  32. Fish out of water*

    I think frequently of Alison’s advice that the true cure for burnout isn’t always to rest, but rather to do something that uses totally different skills than your job. In times of trouble, being able to further my own growth in a hobby that is my own, that no one but me requires anything of, and that doesn’t require the same skills that are burning me out has been a mental refuge that helps me storm the seas when I need a mental place to escape to. This is a band-aid, not a cure, but when there is no easily found cure, it does help. Take care when you can.

      1. Fish out of water*

        Thank you! I can never remember exactly where I read this, now I can bookmark it myself. :D

  33. Holly*

    I relate to this a lot- I’m a social worker in a high need area and am also going through stuff in my personal life and some days it is just too much. I don’t know that I have any life changing advice, but what I would say is this:
    – Even if you can’t take time off work, it is very okay to ask for help while you’re at work. Like if this is your 10th challenging client situation of the week, see if you can ask a colleague to support instead- I find that people are often happy to help and a team approach works better for everyone but often we don’t want to ask
    -See if you can use it to your advantage- maybe this helps you relate to your clients more when they’re having a hard time or not at their best and you can use that to reflect and acknowledge their feelings. When people feel that genuine empathy it’s usually easier to get through to them.
    -If you’re overwhelmed by work at home, feel free to set boundaries on EVERYTHING else. I haven’t looked at the news in a week because I just can’t (and those of us working in social services are already more than doing our part!)
    That’s all I got. It’s so tough. Wishing you the best!

    1. Percy Weasley*

      A hearty YES to Holly’s 3rd point. Letting go (at least temporarily!) of anything not critical for immediate physical & emotional survival was one of the things that helped me thru a similar tough time.

  34. HannahS*

    Oh my goodness, sending you so much compassion. Medicine is a wonderful, but punishing profession. People want their doctors to be humble but never make mistakes, spend as much time as the patient needs but never be late, and be endlessly humane but never human. 

    When I’m struggling, I come back to this:
    First, I am person. I am allowed to be a person. I am entitled to rest, to self-care, to a safe working environment. Being in an altruistic profession does not mean that I cannot have a SELF.

    Second, my patients are entitled to the standard of care. As you know, that’s a combination of “what is generally considered best practice” and “what a reasonable provider would do.” So my patient presenting with Symptom X is entitled to a suitable workup of that symptom, an explanation of their symptom and the test results, to be offered appropriate treatment options with explanations of what these treatments mean, and adequate follow-up. The other things are EXTRA. It is profoundly uncomfortable to confront as a provider and patients (including me, when I’m the patient!) hate it. But you can’t go the extra mile for everyone, even if everyone in your practice needs it, and ESPECIALLY if that results in you burning out and then there will be no one caring for your patients. 

    Third providers should generally all think about resource allocation, because healthcare is a scarce and expensive resource. In this situation, the resource is you. You are precious and very expensive to replace. You have less capacity right now, so you have to conserve the resource so that the system can continue to function, even if that results in adequate-but-not-exemplary care for your patients.

    1. HannahS*

      Also, I have to be honest–in your shoes, I would consider getting a new job in a clinic with a more diverse mix of clients. Working in underserved areas is very hard, and not everyone has the bandwidth to do it always for their whole career. You can always come back; it’s not like there are so many providers competing to work in underserved areas. It’s not abandonment to care for yourself.

      1. HannahS*

        Or rather, your patients might experience it as abandonment, but again, you also matter and you must take your own needs seriously.

  35. Antigone*

    Since you say work has been kind, I wonder if you have the type of leadership there you can lean on a little harder here for some form of additional support with the actual work, not just the time off. That might look like lighter scheduling, or different types of appointments taken, or pairing you with someone who’s really good at the reassuring stuff so you can dial it back a little, or a bit of extra break time during the day to re-center yourself, or even just a really honest conversation about needing to bring a little less than your A game to work right now and wanting to work through how to do that without shortchanging your patients. If you have an EAP that would provide you with some short-term free counseling I’d look into that, as well.

    When I’ve been in a similar position honestly the most helpful thing was just forcing myself to give myself permission to half ass whatever I could. Maybe you really do need to bring your A game to your patients, who have their own real needs and are in a fraught environment where you are making a real difference to them, but there’s something else you can half-ass to help you retain some balance. Some paperwork, some reporting you could hand off or do less frequently, something?

  36. AnonymousOctopus*

    I don’t work in healthcare, but I can really relate. I don’t know if any of these would be feasible for you, LW, so apologies if I’m suggesting things that don’t match what’s possible for you.

    Ask for help from your colleagues. If there’s a short list of patients who tend to be more prickly/shouty/draining for you right now, see if any of your colleagues would be willing to take them on for the time being.

    With patients who are typically easy to work with, conserve some energy by slightly pulling back on emotional labor. Instead of being 100% energy, pull back to 85%. The patient probably won’t even notice. I had to do this recently and it felt odd at first and I was nervous that the people I serve would notice the difference and it would make my job harder. But no one cared and it made a big impact on my capacity to handle the clients who needed more of me.

    If you can’t hold it together one day and you end up losing it a bit, you can choose to be transparent. One day I really was off my game (imagine having to do two re-pokes of a blood draw, to keep the healthcare analogy) due to stuff going on in my personal life, and this one client expressed frustration and asked “what’s going on with you?” during the work. I decided to just tell them. “I’m sorry, I’m going through a tough time right now outside of work and today is an off day. I apologize. Would you rather have another [role] finish your [service]?” They completely changed their approach and actually apologized for snapping (which wasn’t necessary but was nice), and we were able to successfully complete the task. I’ve also had clients take me up on the offer to get another colleague, but they lowered the temperature and later said that they appreciated that they didn’t have to ask for someone else because I proactively offered it. Sometimes the people we serve forget that we are also just humans.

    I’m sorry you and your family are going through this, and sending well wishes your way.

    1. Jaunty Banana Hat I*

      This. While I totally understand that OP doesn’t want to have a breakdown in front of a client, it’s also okay to be a human in front of a client. It’s okay to say you’re having an off day and see if someone else can do the thing as long as *someone* does the thing. Sometimes people forget that we’re all just humans trying to human in a world full of other humans.

  37. Annony*

    The first thing to do is to look at your office’s policies and what your collogues typically do. It sounds like you are generally trying to bend over backwards to make things as easy as possible on your patients but that is likely above and beyond what the actual expectations are. If someone is very late, they need to reschedule. If they are too anxious for a procedure, they can opt out or reschedule for another time when they can bring someone for support or take a mild sedative. It does not sound like you are in an ER setting so few procedures should be so emergent that they cannot be rescheduled. If they are trying to address multiple problems in one appointment, prioritize and schedule another appointment for what you cannot fit into the time allotted. You do not need to bend over backwards to avoid an inconvenience to your patients. You need to not burn out. Use professional judgment and pull back from going that extra mile unless it is truly necessary.

    1. ImposterSyndrome*

      I absolutely second this!

      OP, I’m so sorry you have so much to deal with.

      It sounds like you have two kinds of stressful behaviour in clients: panic and assholery. There might be different ways of dealing with them.

      Assholery is the easier one to draw a boundary against. Yes, people might be frustrated, they are scared, they have taken time off work, they have to pick their kid up from nursery, etc – no, that is not your problem. You can understand and empathise with why they are shouting, and also refuse to be shouted at. If your workplace is on board, maybe give them one warning – “I apologise, I know it’s frustrating we’re running late, but if you keep shouting I will terminate the appointment and you’ll have to come back another day” – and if they keep shouting, follow through. You are not an emotional punchbag for whatever is going on for them, just as you are not yelling back at them to shut the fuck up and give you a fucking break. (But that relies on your work backing you up.)

      And like Annony says, there might be ways of dealing with anxious patients where you minimise the emotional toll on yourself. At some point, you can’t manage people’s mental health for them. If you don’t feel smiley, don’t smile. If reassurance can take the form of less talking, it might be easier on you.

      Your patients sound they are going through a lot, but you can empathise without it being your problem. You burning out, being shouted out, wringing out every last drop of energy and empathy, will not change the circumstances of their lives. It is not selfish of you to prioritise your mental wellbeing.

  38. Juicebox Hero*

    Not healthcare, but I have a stressful customer service job and have had some crises over the past few years on top of lifelong problems with anxiety and depression.

    What helped me was Cognitive Behavioral Therapy (CBT) and Acceptance & Compliance Therapy (ACT). It’s best with a therapist, but there are plenty of books available that will help you practice your skills. With practice you can train yourself to catch thoughts that are starting to spiral, acknowledge that those thoughts exist and your feelings are valid, but it doesn’t apply to Right Now so you can set it aside for now.

    Like, if you’re at work and worrying about your child or something else at home, tell your brain that you haven’t heard anything to indicate that there’s a problem and there’s plenty of time after work to check up on everyone. Right Now, you have this patient who’s very upset and needs a painful procedure done, you need all your brainpower on improving the situation. Namely helping the patient to be calm and making the procedure to be as painless as you can. I don’t think you need to be super loving and supportive as long as you’re kind and respectful of them.

    When I have a real shithead that could ruin my whole day (lord knows you get them) I tell my brain that it’s no use replaying the whole situation over and over, because I did my best with the tools that I have, the person was probably frustrated or feeling helpless or is overall just a real ass, none of which are my problem. If I need to stress out about it, I’ll plan out a block of time in my head to do exactly that and most of the time I forget completely.

  39. Dr. Rebecca*

    If at all possible, many, many more individual breaks during the work day. Put a 5 minute hold between finishing one task and starting the next one. There’s a patient waiting? They’ll wait another 5 minutes so you can breathe, have a drink of water, and recenter yourself.

  40. NotKateWinslet*

    First. I am so sorry that you’re struggling. Times are hard enough these days in the outside world… adding family issues is incredibly tough.

    If you are a woman in public health, I *highly* recommend checking out Marissa McKool / the Public Health Burnout coach. I did (paid) coaching with her a couple of years ago but she regularly offers free resources. Next week she’ll be running one of her free five-day Overwhelm Solution challenges. Again, highly recommended.
    https://publichealthcoach.com/overwhelm-solution

  41. Harper the Other One*

    I have been in a similar place, and as mentioned above, while the “therapy and a break from work” suggestions are well-meaning, they’re really not always (or even often) possible. So much of our resources (including my PTO) had to go to our struggling teen that I really couldn’t take that normally good advice until after the situation was more stable, which took over a year.

    I do encourage you to draw on your EAP if you have one.

    I’m not customer/client facing but these things helped me:
    -figure out one small thing that is just for you to work into a day. For me it was 20 minutes to work on a jigsaw puzzle alone. That really helped sustain me
    -the work persona some have suggested above helped me as well
    -reorganizing my schedule so I had a block of “admin time” gave me a break while I was still working, and being on top of the paperwork part of my work, which helped me feel more in control
    -where possible, schedule easy tasks in alternation with hard ones. Maybe you can book clients you know will be easier to work with between the ones you know will be challenging?

    Sending you support – it is such an awful feeling and I really hope you are able to move through this crisis point.

  42. Clownshoes Nonsense*

    I don’t have any suggestions but just wanted to send a virtual hug. My teen daughter is in a residential facility right now thanks to school avoidance, and trying to get her the help she needs while dealing with the (massively unhelpful, in some cases actively harmful) public school district has been incredibly stressful. Just to say, I know how you’re feeling. I have no tips or advice, just…solidarity. You’re not alone out there.

  43. DefiantJazz*

    I’m not in patient care so what I do isn’t nearly as intense or important, but I do work in HR which can sometimes involve dealing with other peoples big feelings. I also have an AuDHD teenager with school avoidance and anxiety, and there are plenty of days where I’m feeling tapped out before the work day even begins. I am also in perimenopause and have an autoimmune disorder so I’m already tired. First of all, I offer remote hugs of solidarity, because it is so, so hard.

    When I’m low on or out of spoons, I rely on established processes to help me manage. I have reviewed my SOPs for items that are more draining, like employee complaints, and asked myself, “What’s the absolute minimum I need to do to handle this?” Then I write up a bare minimum version of it. So, when an employee brings in a complaint, I have a written list of five questions I know I need to ask and that may be all that I do in that interaction that day. Basically, on bad days I focus on doing the essential parts of my work. Even if I’m not able to give my full attention, I remain kind and empathetic, but the interaction may be shorter. When I’m in bare minimum mode I usually let people know I’ll follow up with them later but that might not work for you in your field.

    I often make this decision on the way to work and will announce it out loud – I will say “We are having a bare minimum day today” (my partner says I’m calling an audible) and just giving myself that permission often gives me some relief. Also, having these things written down helps my brain. I have bare minimum lists for handling situations, and then lists of tasks I can complete on those days, like filing or other rote tasks that don’t require a lot of brainpower. Basically, I’m reducing demands on myself for the day – just like I do for my son on his rough days. And I don’t have to figure out what this looks like in the moment, because I’ve done the advance work of making these lists.

    Another option, if you can, is to bring in a partner to handle those aspects that you find difficult on bad days. Is there another professional that you can pull in to provide comfort and answer questions while you focus on performing procedures? I will sometimes tag in another person if I find that I simply cannot listen to Fred complain about Barney one more time, or listen to a 30-minute diatribe from Linda about why we shouldn’t change the covers of the TPS reports.

    I hope you find something that works for you!

  44. Double A*

    You have a lot of responses! I have a suggestion that you can use in them moment when dealing with a difficult patient.

    I have worked in education for a long time with people of varying degrees of volatility. One of the most useful concepts I have learned about are “mirror neurons,” in which most people will mirror the emotions being presented to them. This can work against you; if you’re not aware of it, it means you get upset when talking to an upset person. However, this can work FOR you because silence, stillness, slowing down, and relaxing your body are things you can do that relax you but will often have a calming effect on whoever you are talking to. If you can act the way you hope the person talking to you will act, often they will start to follow you.

    This might look like taking a pause before responding, just letting the person talk until the run of out steam, then responding in a calm and slow voice.

  45. ER*

    Not every patient interaction needs your all. Sometimes, the basics are really all that are necessary. I developed a pretty ‘rote’ routine instruction for patient care when the days of sheer numbers of patients increased – it met the patient needs, saved my battery to get through the day. I also stopped tolerating the behavior of extremely (unjustifiably demanding) patients and presented their options as a choice 1 or choice 2 situation (1. you can wait until the doctor is ready to see you or 2. you can reschedule). For people who holler, it became “I don’t respond to that tone. We can proceed when you can have a calm conversation.”

  46. Adverb*

    I’m going to suggest something more for you. Go outside for a bit (even 5 minutes on the way to the car or into the office). Look at the sky, touch grass (literally). Even a few minutes of removing yourself from the stressors can help rejuvenate your head.

  47. kineticnix*

    I have been there- it is very hard. I’m in the mental health field and a few years ago, my teen was going through something similar. It was very difficult to not have my personal issues bleed into the need I was seeing in the field. I was working in a psych hospital while we were in the worst of it. I think what helped was having strict boundaries btwn home and work. I had a commute where I stopped on the way home and got a coffee, I didn’t have to do any work when I was at home (which is different from other places I’ve been) and I tried as much as possible to focus on what was in front of me. It was very very hard though and while we eventually came to the other side and my child is in a much better place mentally, I have never been so wrung out. I hope that for you it will get better (I’m confident it will!) and I am sending you all the love in the world.

  48. Uhura*

    “How to create a firewall around my emotions so I can cope with being shouted at by patients because we are running late or help them inch-by-inch through their anxieties when I feel as though my own anxiety is going to have me sobbing on the floor in the middle of the appointment?”

    Remind yourself that the patient is not mad at “you”, they are mad at the situation and you are an easy target.
    Allow yourself to give less than 100%.
    Try to take short breaks as much as possible (I know this may not be possible in healthcare) but if you’re able to, step outside and get some fresh air/sunshine. Also when you get your lunch, try to get outside and get some sun.

    Yoga and mediation are great ideas, here are a few more:
    Engage in a hobby that you can do on the evenings and weekends, something for just yourself.
    Suggestions: jigsaw puzzles, knitting, book club/reading a good fiction book, growing house plants, karaoke, bowling, etc.

    I’ve starting doing jigsaw puzzles and there is something so satisfying about getting a piece to fit in the puzzle! I also started doing macrame and it is a great hobby. It doesn’t require any needles and doesn’t cost a lot for materials, (at least to get started). All you need is the cord and there are books on how to do knots at the public library, also videos on Youtube.

    I am sorry you are going through this, and I hope things get better for you and your family!

    1. Lady Lessa*

      I second the idea about jigsaw puzzles, especially since there are a lot of soothing scenes to do. I personally recommend a computer tablet with a jigsaw puzzle game on it. Portable, you can start and stop at your convenience, no person or cats to knock the pieces off. I am not a fan of them on the phone just because of the screen size.

  49. Radioactive Cyborg Llama*

    LW, first my sympathies. I have dealt with a struggling teen also and its so draining and difficult. It seemed like you have a sense of what to do (low battery mode, firewall) but not how. I am also someone who sticks in other people’s energy and feels like I have to match it. One thing that has helped me sometimes is starting the day with a reminder of what is necessary. Eg is not necessary for you to cure your patients’ anxiety “inch by inch.” What’s necessary is (my guesstimation): warm but low key delivery of information and answering any specific questions. Some days I start with “I don’t need to match energy.”

  50. KToo*

    I’ve had mostly the same issues surrounding my teen daughter for the past year, and trying to juggle everything is rough. I don’t work in healthcare and I do work from home, so despite that I have to put on a nice demeanor for my clients I get to hide behind emails and the issues aren’t as sensitive, so I can’t advise on that.

    What did stand out to me is OP saying ‘doing all the self care things I *should*’. I really don’t like the word ‘should’ when it comes to self care, because too often it’s framed as taking care of your basic needs and being a mom means a shower is self-care, or drinking water. Really, self-care needs to be about what YOU (generalized) need in the moment. If yoga and heathy eating and breathing help and it’s something you love and look forward to then great. But if it means skipping yoga and eating an entire pizza while binge watching The Office one Friday night, this might be the right thing for that moment. If your routines are things that add more stress rather than making you feel good, then it might be time to re-evaluate what you actually need.

    1. Generic Name*

      I agree with your comment about what constitutes self-care. I feel like a lot of the standard advice for self care (often, but not always) involves spending money on things like spa visits or buying products. My therapist helped me to really sit down and think what self care meant for ME. One of the things I came up with was giving myself permission to say no to things I didn’t want to do. I don’t mean this flippantly like “I don’t want to work, so I’ll just say no!”, but more like, “I don’t want to join Felicia’s book club, so I’ll decline the invitation”. Or “I don’t have time to bake cookies for child’s bake sale, so I won’t”. Simple in concept, but difficult in application, especially if you struggle with boundaries or want to be seen as “helpful”.

  51. Oceansloth*

    Maybe kind of a cheesy suggestion but music can really alter my mood sometimes – maybe you could listen to some cathartic emotion-releasing music on your commute? When I was working a tough job and dealing with depression I listened to angry pop-punk and metal on the way to work to get my energy up enough to get through the day. Secondly, my tongue-in-cheek motto has always been “reliably adequate” – this was a performance metric wording at a previous job and I thought it was funny, but it is actually really helpful when I feel guilty about not giving 100%. Sometimes you just can’t give 100%, so all you have to shoot for is “reliably adequate”.

    1. Anxioussss*

      This reminded me of something I forgot to mention in my comment but has been *very* effective for me: get alone somewhere (even your car) and listen to a meditation podcast. Spotify is full of them and many of them are targeted to specific types of anxiety. Even 10 minutes of meditation leaves me with a deep sense of calm. And I am by no means experienced in meditation; I don’t practice it as regularly as I should, and I’m probably not very good at it because my brain never wants to shut off. But I’m always surprised by how much even basic meditation relaxes me and curbs my anxiety.

  52. Anxioussss*

    I agree with those who have suggested counseling/therapy. It is a MUST.

    Aside from that, though, my approach to working with anxiety and likely long-term undiagnosed ADHD (in the diagnostic process now) is to try not to expect consistent perfection from myself. On my good days, I’m a rock star and I get as much done as possible. On my terrible days, I may take more/longer breaks, go outside at lunch time, spend a few minutes journaling at my desk, leave a little early, do less while I’m at work, etc. Overall I’m a high performer, so I remind myself that my 50% is probably equal to most people’s 90%. I know these things may not be possible in your role, but maybe there are versions of this you could adopt. On your good days, you’re smiley and supportive and warm. On your bad days, you’re kind but maybe more businesslike and less smiley. That doesn’t make you a failure. No one can be “on” all the time.

    Also, on bad days, don’t be afraid to lighten your load in whatever ways you can. If you know a patient is going to trigger you, can you swap and have someone else help them? Don’t volunteer for extras on those days, and save the tasks that require intense brain work for another day. I know that on bad days, in-person meetings and after-work social events will be almost unbearable for me. So if I can reschedule things with little business impact, I do. It’s ok to take care of yourself. It’s unlikely most people around you will even notice the adjustments; they’re probably in their heads about their own issues.

  53. Kaiko*

    Hey OP! It sounds like you are sending a LOT of time in giving/helping roles, and not a lot of time receiving help. Are there places in your life where you can tap in on extra support? A friend who can drop off a meal once a week, a sibling who can do appointment runs with your kiddo? Is your partner supportive in meaningful ways, or is there more (or different) things they could do to help you out? Are there things you can outsource – grocery delivery, house cleaning, takeout meals – that would give you some respite? Can you claim one night a week as “your time” and all emergencies as support needs are routed to another person, and you can spend it resting?

    I know these aren’t work-related solutions, and there are so many good options from other commenters, but I think part of the problem is that you are carrying so much and there’s not a clear place to put some of it down. For these types of slow-motion family crises, the answer often is, “feel ugly and vulnerable and sad about the need for help; get help anyway.”

    1. Anxioussss*

      This. It isn’t clear whether or not OP is a woman, but we know that women statistically carry more of the mental load for the household. OP, don’t underestimate how the “small” things might be piling up and contributing to your stress levels.

  54. Josephine Beth*

    I’m in an education-related field where I work with families who are often experiencing significant stress and frequently demonstrate anger, frustration, or big emotions, all of which is appropriate and part of my role to support. And I have been the parent of a teen with pretty big mental health issues who was sometimes calling for support upwards of 20 times a day (she is now much, much better and doing amazingly well in life)…and boy, do I remember that feeling of just being absolutely on the edge of tears/breakdown at work some days
    A few things that have helped –
    * Support groups for people coping with similar challenges – I think therapy is crucial, but it can be costly and difficult to access, and online or in person groups may be easier to find and participate in
    *Leave stuff at the door – when I’ve been at my most exhausted/stressed, I would literally talk to myself out loud before getting out of my car at work. “It’s okay that this is hard today, I’m going to give what I am able while I’m here, and I will manage home things when I get home.”
    *Tap out when you can – if there’s another person on your team who be supportive, whether that’s helping with paperwork or taking on some of your patient visits, lean into that. I have learned that many people very much want to help, but we need to be willing to ask – and to let them actually help when they offer. (Obviously this depends on if you’re able to share some of your situation with work, but hopefully you can at least allude to needing support)
    *If it’s possible, have someone else who is responsible for the home stuff when you are at work. (I absolutely know this may not be possible every day or even most days). If you can trust, even sometimes, that a partner or friend will be available to handle anything that comes up during the work day, it helps with that fragile feeling of being torn between two really demanding forces.

    Sending lots of kindness your way.

  55. TinkerTailorSolderDye*

    Gonna chime in on this one too, and upvoting therapy, both individual and family.

    My advice, though, is more directed for dealing with the teen, as I’m dealing with very similar behaviors (though ours isn’t eating disorder, it’s more rage-monster) from my step-kids and what we’re doing with them is beginning to work rather well.

    When your teen is in a higher point (definitely do NOT do this when they’re feeling low), sit them down for a small talk. This part is gonna be hard, but we had to learn how to do it because the kids literally did not understand why we were having such a hard time dealing with their bad behaviors: explain how exhausted YOU are and what you’re trying to do to help both your family and your patients.

    This is NOT putting the burden of being a therapist on your kid, before anyone jumps down my throat; this is opening a line of communication. We’re all human, kids and adults alike, and sometimes, shielding kids from the very real human emotions that everyone experiences results in kids that cannot handle a world alone. However, if you’re open, honest, and explain that you’re having those same days too, especially if you start small, kids learn to truly empathize with others, and begin to both open up, and grow stronger.

    Literally, eldest stepkid went from hysterical crying jags the moment she was told no/things didn’t go her way, to, in the course of nine months, having an open, honest conversation about why she was frustrated and felt like she wasn’t being challenged enough by her current teacher. This led to her being accepted into both advanced math and reading classes, and she’s making a concerted effort daily to improve her writing skills, and other than a little normal dumb behavior (fighting with bro), she’s made a huge 180 from where she was. And all because we sat down one day and explained why we were exhausted, what caused our exhaustion, and why we weren’t as patient/pushover as others in her life had been before this point.

    She needed to hear that she wasn’t the only one feeling bad. That she wasn’t alone in those feelings.

    Start small. Get a therapist to work with all of you, and you by yourself. And it’ll get better.

    And most importantly; remember that the patients don’t always need 100%. Sometimes, they need to be reminded that you’re human too. (Past retail worker here, though it’d definitely not the same.) May the skies stay clear, and the road smooth out.

    1. Hooked on Therapy Worked for Me*

      That resonates with me. You really have to know your child and what they can hear, maybe work with a therapist. But yes. I had a similar situation and had a talk with my child, who in their best times is incredibly empathetic. And just hearing “Mom and Dad have feelings too” made a huge difference. You just have to be careful with this one because you don’t want it to sound like “Your problems are causing a lot of problems for me.”

      1. Thin Mints didn't make me thin*

        I was coming in here to say something similar. If you can do it without blaming, make it clear that you have a number of stresses in your life right now, that you care about her and want her to be happy, but your first responsibility is to put your own oxygen mask on. And then let her SEE you doing things to manage your stress, modeling healthy patterns and also acknowledging that it’s not possible for all of us to give 100% all day, every day.

  56. SMR*

    Healthcare professional here. Does your job permit a change to a schedule with a later arrival? Gives you a better launch to your day, and possibly gets your teen some more sleep (too early school start times hurt our adolescent’s mental health and worsens pre-existing conditions). Starting school at 9 am was a gamechanger for my student. I also realized not every patient interaction has to be a life changing warm fuzzy for both of us; sometimes, polite and efficient is less stressful on both patient and provider. And it was got me through some tough days.

  57. Sybil Writes*

    I want to focus on “How to create a firewall around my emotions so I can cope with being shouted at by patients because we are running late”
    You should not have to cope with this. Your organization needs to take responsibility for minimizing the chances of this happening; it is not a “self-care” issue. Until your organization puts measures into place, I feel your self-care should be to quietly turn and leave the room if someone starts to shout at you in complaint. Potential measures they should consider:
    – Post notice that the clinic/office is meant to be a safe place for both patients and staff. Verbal abuse will not be tolerated and anyone engaging in it will be asked to leave immediately and reschedule at a later time.
    – Let patients know upon check-in if there is a meaningful delay and give them options. (one option could be to let them leave the office but remain nearby and get a text when their appointment is 5 minutes from starting) Nothing is more infuriating than finding out AFTER I’ve been waiting for 30 minutes that everything is running behind due to an earlier emergency. If I know at check-in that my appointment is likely to run late, I might choose to reschedule or at least I can choose to wait; it allows me to alert anyone else as soon as possible that I may run late for another appointment or commitment. Good communication is respectful and can help to alleviate frustration.
    – Do a bit of root cause analysis on WHY schedules running late may be common. Are patients often late? Does paperwork take up too much time at check in? Etc.
    Chronic chaos is a choice. If it is the choice your organization makes, it can also be your choice not to feed into it.
    I’m sorry life is this hard right now. I hope the pressure eases up soon.

  58. A Genuine Scientician*

    I worry that this might read oddly to people who aren’t in a service position, but:

    Sometimes people want to complain and feel heard, but not actually want you to do anything about it.

    I’m not in health care; I’m in higher ed. It’s not unusual for my students to complain about issues with the groups they’re working with. But when I ask if they want me to move them to a new group, most of the time the answer is no. They’re not asking me to solve the problem; they just want me to be aware that it exists.

    Is it possible that some of your patients might be perfectly happy to be given the floor to vent their complaints, and then just hear an “I’m sorry; that sounds difficult.” at the end? That’s something you might be able to do while still in kind of low-energy mode.

    But larger picture: airplane mode. Secure your own mask first; burn out is real, and it won’t help your patients long term for you to take on too much in a difficult period in your own life.

    1. Evelyn Carnahan*

      I’m a public librarian, and I encounter this behavior quite often with patrons. When someone is upset about something–especially if it’s something I can’t fix–listening to them and hearing them out can go a long way towards defusing the situation.

      (Of course, I then have to deal with a bunch of emotion that’s been dumped on me. So in those moments, I do my best to take a break, ask for help from a colleague, or do my own venting to a friend or family member.)

      Hang in there, OP!

    2. Andromeda Carr*

      This “recitation of woes to feel heard” definitely happens a lot in medicine, sometimes braided with the actual medical complaints. Sometimes (if I can) I mentally give the patient 1, 2, or 5 minutes to rant while I make listening noises, before I turn the conversation. Just those minutes of feeling heard can really go a long way. But they do have a cost in terms of time and provider emotion.

    3. Elk*

      A former principal once told me to let upset parents “sing their song,” and it’s SO helpful. At a certain point it absolves you from having to fix problems that you didn’t make or that can’t be fixed. Yes, the licensing restrictions are such a pain, aren’t they? Yes, these schedule delays drive me nuts too, it’s so annoying some days.

  59. One Duck In A Row*

    So much sympathy. And empathy. My teen has emotional regulation and mental health struggles that aren’t necessarily daily ordeals, but can be so unpredictable that I feel like I can never relax or predict what I will be able to get done at home in terms of chores, self care, etc., because I literally don’t know from day to day or sometimes hour to hour. It’s mentally and physically exhausting, and it sounds like your job has similar predictably unpredictable difficult moments. It is so horrendously difficult to go through life on a daily basis with no sense of control, and no sense that you are able to predict or fix the broken things that need to be fixed. I know that isn’t advice, but one more “there beside you in this mess” might help? IDK. I’m past the point of getting gray hairs to the point where I (a cis woman) am losing hair from the stress.

    One type of thing I have been trying to identify more of are “rescues”. Yeah, the long term stuff like exercise and therapy and nutrition and blah blah blah are good and necessary for long term stuff. But folks like us are trying to just get through the moment and the day, and I feel like we need rescues. Like, an inhaler, but for our mental health. I plan to ask my doctor about actual medication options for anxiety for the really bad days, and for the nights where I’d otherwise lose hours of sleep feeling anxiety. (And yeah I know you know that sleep is so important and lack of sleep makes things so much worse.) I have some other rescues, such as specific songs or playlists, some ASMR-y stuff I listen to when I’m able to, etc. Sometimes, if it’s all already gone to sh*t, an extra 3 minutes to do a quick rescue can make things easier enough that you can get through a little bit more easily. Maybe not with ease, but with enough friction removed that it doesn’t snowball into meltdowns at the end of the day. Maybe not the usual workplace advice, but can you literally hide in the bathroom for 2 minutes and play a stupid game on your phone that helps to regulate you? Or something like that? If you’re already running behind, the extra 2 min. might not make anything worse for your patient, but might make you just sane enough to get through the day. At this point you might need to do what you need to do to avoid being forced to take a medical leave of absence to take care of your own mental health issues. As someone who got close to needing to do that last year, the rescues are what saved me. That and doing my job less well, but still well enough to not screw it up.

  60. Political consultant*

    A few suggestions:

    1) Create some kind of grounding ritual to separate your mornings at home from the start of your workday. This might be tough if you’re rushing from dropping off your teen late at school to work, etc, but if you can carve out even 5 minutes to meditate, do some deep breathing, etc right before you start work, that would probably be very helpful to reset.

    2) If you’re partnered and it’s at all feasible, could your partner be the on-call parent for helping your teen in the mornings before work, and you take on more in the evenings and on weekends?

    3) When you can without inappropriately diving into your personal life or making patients feel like burdens, it might be helpful to quickly name what’s happening in the moment, to buy yourself some grace from your patients and clarify that your demeanor isn’t personal. An example: if you’re stressed because your last appointment ran long and you’re now late for your current appointment, could you start the appointment by saying something like, “I’m sorry I’m late and I’m sorry if I’m a bit frazzled – we’re running a bit behind today”? Maybe even take a deep breath or two after saying that to reset?

    I hope things get easier for you and your family very soon.

  61. Hyaline*

    Don’t demand more of yourself than the job demands. I guess I’m thinking mostly of the coaxing/hand-holding, and I’m coming at this from the perspective of a professor who feels very much in the same place in terms of feeling worn out but having to be very present and proactive with students who, given their druthers, will make bad choices. Try to give yourself permission to do the job and just the job without letting less than perfect outcomes define whether you did your job that day. For example–if you are supposed to work a vaccine clinic, it’s your job to administer vaccines. It’s your job to educate people about vaccines. It’s your job to answer questions about side effects and efficacy rates. It’s NOT your job to cajole someone into getting the vaccine. That less-than-stellar outcome is THEIR choice, NOT a reflection of your work.

    SO: If someone doesn’t want to do something, it’s actually not your job to make them. It’s in their best interests, it’s what they should/need to do, but you cannot put it on YOURSELF to make them do anything. So–patient is waffling over the procedure that they need to get or the medication they should take. You can spend your emotional capital coaxing them through it, or you can lay out everything they need to know, make sure they understand, and say “Ok, this is your choice. Either we continue, or not. Your call. I’ll give you a minute to think it over.” Here’s the thing–either way YOU HAVE DONE YOUR JOB and you shouldn’t beat yourself up if the patient makes a poor choice. (I’ve had to learn this with students. They make bad choices a lot.) Amazingly, sometimes this actually works better for achieving the desired outcome, but even if it doesn’t–this is not on you.

  62. Pocket Mouse*

    Just in case, and for any other commenters who may need to hear this:

    Check to see if your state has paid leave to care for a loved one with a serious illness (search for “paid family leave” plus your state’s name). You may be able to take more time off than you think you can, financially speaking, and/or be able to take days intermittently, such as for your teen’s appointments or crises, instead of burning your own leave balances. NY, NJ, CA, WA, and I suspect other states have some form of this.

    Wishing you and your family the best.

  63. Visualise*

    I’m gonna sound like a woo woo crank but visualisation – in the car on the way to work, visualise a brick wall around yourself. When everything feels really overwhelming, visualise closing a door on those thoughts and feelings. This won’t work forever, because you do eventually need to feel these feelings, but it’ll work to Get You Through. Sending you lots of support and wishes for things to turn around soon!

  64. Ms. Murchison*

    Just a few ideas that shouldn’t cost anything but should help your battery:

    See if you can get a room or closet at work designated for calming down. If you can go into a quiet dark space for just five minutes to meditate/notice what muscles are tense and release them/take some deep breaths, even those few minutes can help you get through the day.

    Do you have a religious community with a leader you trust? You might schedule a meeting with them to talk, which shouldn’t cost anything. I did that once when I was held up at gun point. I didn’t know him very well, but he helped give me some perspective on what I was going through.

    As mentioned above, EAP phone sessions in an emergency if your workplace offers it. They likely won’t be able to help with your whole situation, but consider them for things like a guided meditation to calm down. I agree with the folks recommending counseling for you, but at the present moment that might not be feasible, financially or time-wise.

    Right now you’re in survival mode, but when you do gain some stability and more bandwidth, I hope you do seek counseling. Sometimes we crack when we come out the other side; it’s like our body decides it’s finally allowed to deal with the built up damage we had to ignore while we were going through it.

    Good luck.

  65. MyStars*

    Many organizations have an EAP (Employee Assistance Program) that provides a number of no- cost appointments with a therapist. they could help you frame up some ongoing coping strategies or action steps.

  66. Family Literacy for the win!*

    Some schools in Canada offer support as “parenting education “ and are usually offered at no cost. There are options available for parenting for all age groups, including teens. Online resources are Nobody’s Perfect parenting program and some resources and information through the Canadian Mental Health Association. If you are in another country check your country’s equivalent of CMHA, and your child’s school PAC/PTA.

    You are definitely not alone struggling with this.

    Sending positivity and hope to you.

  67. Family Literacy for the win!*

    Some schools in Canada offer support as “parenting education “ and are usually offered at no cost. There are options available for parenting for all age groups, including teens. Online resources are Nobody’s Perfect parenting program and some resources and information through the Canadian Mental Health Association. If you are in another country check your country’s equivalent of CMHA, and your child’s school PAC/PTA.

    You are definitely not alone struggling with this.

    Sending positivity and hope to you.

    Improving your emotional and psychological resilience is key for the work you do.

  68. Elk*

    I’m a teacher who works with littles. I’ve never had as significant of stresses at home, but I’m familiar with the feeling of being drained of your own resources and still having to show up positively, or at least patiently, for others. A few things I’ve found helpful are:

    1. Making a list of grounding techniques (like, 5-30 second ones) and keeping it accessible. Once I’m frustrated it’s harder to want to do them and to remember what to do, having a list takes that cognitive load away so I can just pick something.

    2. Since a list can’t travel with me all the time, I’ve also done things like out a sticky label on my lanyard with 1-2 strategies, or even made something as a physical reminder (something to carry in my pocket, small string of beads attached to my lanyard where each bead represented a goal or strategy, etc)

    3. I don’t know if this is applicable to you, but the more I frontload organizing my day the easier it is to get through. If I’ve planned out what I’m going to get done during these free ten minutes it means I don’t have to decide in the moment, once I’m frazzled and exhausted.

    4. Set small goals for the day. Like, really small: I’m going to get through nap time without sounding impatient with any kids. I’m going to make sure I practice numerals with X and Y during choice time. I have no idea what that looks like for you but sometimes it helps to just break things down to one or two essentials.

    5. I have no idea if this is transferable, because I can’t explain the how, but I have found a point where I can just emotionally detach for the rest of the day. It’s really not ideal, because it means not enjoying/connecting during the good moments either, but sometimes days it is life saving. And doing that some days doesn’t mean it’s the new you or anything, just that it’s ok to get worn out!

    Also, I want to echo others wondering if it’s possible to set boundaries around things like being yelled at. That might be the part of me that’s used to working with kids, but it’s unacceptable behavior from adults too and it’s not a surprise you find it hard to deal with! With the right backup from your management, would it be possible to even start with a simple “I understand you’re frustrated but please don’t yell at our staff,” or something like that?

  69. Cat Lady in the Mountains*

    Not a perfectly analogous situation but I’ve been dealing with a very-high-stress personal situation that has definitely impacted me at work. A few things have helped me:
    – I’ve found that I’m hypersensitive to criticism when I’m feeling fragile. Something like a patient shouting at me (in my context this might be a customer or happened a few times with supervisors) would push me over the edge. When conversations seem like they’re going in that direction, I find ways to remove myself even for just a moment and/or put a buffer person in the room. Like, “I’m sorry, I need to check something real quick, I’ll be with you in two minutes” and stepping away to feign looking at something important in the office” can do wonders. Plus it can interrupt the tirade you were going to be on the receiving end of.
    – Get super clear on your short-term goals and priorities at work (like, what do you need to accomplish this week or this month, forget about this year), which also means you simply have to let a bunch of stuff go. It seems like “deliver a good patient experience” is part of your role, but can you get smaller and more specific about what that means right now? Certainly it can’t mean no patient is ever dissatisfied ever? Where’s the line, and can that line be somewhere different while this personal stuff is happening? And/or could someone take that priority off your plate so you can focus on things only you can do?
    – Find some way to get micro-wins at work every day. Do you get satisfaction from checking off things from a to-do list? Great, write very short and realistic to-do lists so you can make sure everything will be crossed off (even if this isn’t representative of your entire workload). Does it make you happy when a patient has a particular experience? Find ways to deliver that experience as often as possible. Does positive feedback lift you up? It’s really not crazy to ask for that sometimes!

    Finally, I’ve found it helpful to acknowledge to myself that the situation sucks, I might not be able to do my job at the standards I’d like to right now, and I just have to be ok with that. If you have a weaker few months or even a weaker year it’s not going to destroy your professional life forever. If the role of your job right now is to pay the bills, then as long as you aren’t letting go of so much that you might endanger your continued employment, you’re doing enough.

  70. Samwise*

    This is not your question, but see about getting intermittent FMLA (if you are in the US) for your time off to address family health issues. My concern for you is that while your employer is cool with it now, management may change or change its mind, especially as this situation is likely going to continue for sometime. FMLA gives you a bit of protection and can knock the anxiety down a notch or two, in my experience.

    Re your actual question — I work with college students, many of whom are in academic jeopardy and who have a lot of other issues as well (family chaos, family obligations, mental health, physical health, financial, housing insecurity, food insecurity, undocumented self or family members, stalking and abuse, trauma… ). And I am caretaker for an ill spouse, over the past five years caretaking for months-long stretches for a child and a parent. Financial crap.
    It’s a lot.

    The hardest thing is to let go of the idea that I can control any of these situations. Recommending therapy for you, it sure is helping me. EMDR has been super helpful, maybe it will be helpful to you.

    And hugs from across the internet to you, caring for an ill child is crushing. Know that you are doing the right thing in just loving her and trying your best.

  71. Another White Coat*

    I work in veterinary medicine, with similar emotions and empathetic burn-out. Some days I’m flipping back and forth between new kitten or puppy exams and euthanasias and sick animals where the prognosis is guarded to poor, or guarded to fair but extended hospitalization or referral are not options to owners.

    Some days I just focus on the next five minutes. If I zoom out and worry about the entire day I get so overwhelmed. I just focus on the next few minutes. Early on in this field someone told me you have to treat some days like an elephant sandwich…just take one bite at a time.

  72. Mouse named Anon*

    I am so sorry you are going through a tough time. Your story sounds very, very similar to mine. I don’t work serving patients though. Ages 10-12.5 were very, very difficult for my oldest. He came out as trans, and while we were incredibly supportive, he still struggled. He also was struggling with an ADHD diagnosis, friend drama and just pre-teen stuff in general. He was also school avoidant, getting in trouble at school and failing EVERYTHING. We did everything we could for him, trans support groups, therapy, meds, worked with school (who were pretty great) and sometimes talk for hours with him. Finally at about 13 he got on the right regime of meds, therapy started working, he got better friends and grades. At 14 he his thriving and a different person. Hope is out there for your kid.

    What worked for me: THERAPY, THERAPY, THERAPY! This was key for me. Somedays I was so stressed and worried I could barely function. Sometimes I went once a week. Between my son and I we maxed out our deductible in like June. Working out was also key. I found a kick boxing gym and its pricey but worth EVERY FREAKING PENNY. I kick the shit out stuff for 30 min 3x (or more) and man does it feel good. I started saying yes more things. I stopped sulking around. My son is sad yes, but I can’t let other people’s feelings bring me down. This is hard as a mother. If my friends wanted to do something I went, if my husband suggested an activity I said yes. I started doing things I had put off for years. This helped me so much. Best of luck. Sometimes I had this saying, but this too shall pass. I promise. There is hope on the other side and better days. I promise.

  73. Tobias Funke*

    Oh!!! I forgot to mention – NAMI is a fantastic resource for folks with mental illness as well as loved ones of folks with mental illness. There are other parents braising in the stress stew and perhaps you can connect to some.

    Link to follow: https://www.nami.org/

  74. lou*

    I’m a journalist working in TV news. I spend most of my days screaming on the inside. Although I don’t have the same family concerns, I strongly relate to a lot of what you’re feeling! And yes, I too exercise (including yoga), eat well, talk to friends, play with my cats… I also see a therapist. I am still utterly overwhelmed and struggling.
    I’m job-hunting since it feels like the only way out right now (looking for somewhere that isn’t so focused on daily news), and I think you should strongly consider changing jobs. It sounds like you’re doing meaningful work, and that it’s important, but if your situation is becoming unbearable, it’s time to get out.

  75. Deb-o-matic*

    My family has gone through similar issues, and here’s what we learned:

    1. If you have a supportive partner, work out a way to communicate who needs what when. If you’re hanging on by a thread, say “I need you to take this one.” And be willing and ready to step up when your partner needs you to. Take turns, or figure out who is better at what kind of home crisis. If you’re the only one who understands how to respond, teach your partner.
    2. Find someone at work who can do the same thing for you, who can step in on those rough days and let you have a boring shift. Be ready to support them too.
    3. Similar to the building a brick wall comment someone else made, visualize yourself writing down all the crappy things that happened that morning. Imagine putting them in a box, wrap the box tightly and leave it on the passenger seat for you to deal with after work. When the door shuts behind you at the end of your work day, visualize yourself leaving work behind. I do this a lot when I get busy brain at night, and it helps me sleep.
    4. Use any moment you get for yourself, for yourself. Do something ridiculously joyful. I have been super stressed lately so I’ve turned to romance novels, sitcoms and pop music because they are candy. Find what your candy is.

    Best of luck to you.

    1. Samwise*

      You can also literally write down crappy stuff, fold it up and stick it in a box or bag if you have to deal with it later. If you don’t have to deal with it — like, it happened but it’s not an ongoing task — burn it or shred it. Watch it burn / turn to tiny pieces of confetti, loosen your shoulders, breathe slowly, then walk away from it.

      Burning isn’t doable at work, but we have lovely shredders…

  76. Not That Jane*

    I’m in a somewhat similar situation as I have a terminally ill family member and a part time gig as a hospital chaplain. Honestly the things that help me cope are: 1) I remind myself that my personal suffering gives me a bit of a “superpower” when it comes to interacting with patients – in that I understand on a new level where they might be coming from with scary diagnoses. 2) I try to be the caregiver I would want my family member to have. And 3) it kind of feels like a setting where being in crisis is actually normal and my patients & I have that in common; they’re in crisis, I’m in crisis, I don’t feel so alone in that aspect of my life.

    I don’t know if any of that helps, but I am sending internet hugs if wanted <3

  77. UStransplant*

    Some specific work ideas:

    Build in a transition time between work and home and also between home and work. Sit in your car for a few minutes and breathe, go for a short walk after work or grab a cup of tea (and breathe). Mentally close one door and open the other.

    If you can and it is there, lean into the “normalcy” of work. Sometimes those hassles can be reassuring just from their normalcy, see if you can mentally shift to seeing and enjoying the “smaller problems” (again – this would very much depend what part of healthcare you are in).

    Ask if you can take on more background work and do less patient-facing care. Your work may be able to accommodate that. Sometimes we don’t feel like we can ask, but if that’s an option, it may really help to get away from patient-facing.

  78. Melissa*

    I will answer assuming you are in the U.S. If not, there should be similar resources in your area.

    If you haven’t already, please talk to your employer about intermittent FMLA. It is not an extended time off. But would protect your job if you need to take a day off, call in, etc. Perhaps Allison can explain in more detail.

    NAMI (National Alliance on Mental Health) has free support groups for families of those with Mental health issues. Google NAMI and your geographic area.

    Before work, take a couple of minutes to sit in your car or a bench outside and do some grounding exercises. (short, guided exercises on youtube can be helpful here), then tell yourself you will do the best you can today. Your best may be 80% today and 40% tomorrow and that is ok!
    Think of the ridiculous complaints from patients as content for the comedy you will write later. Just as a thought exercise to get you through the day.
    Good luck. Wishing you and your family well.

  79. Laura*

    I would suggest finding ways to get outside during the work day if you can. It sounds silly, but I say to myself when work is getting hard, “I just need to touch some grass.” And it really works! If you’re in the middle of the city, find a tree that’s planted near a sidewalk even. I find it helps to ground myself in what’s real *right now*. I think the concept of short 30 second breathers in nature are missed in a lot of the “take care of yourself” narrative but I find them SO helpful.

  80. My Brain is Exploding*

    So, something a little different (the other suggestions on here are great) – do you have a break or lunch time? Can you make that a sacrosanct quiet time? If so, perhaps listening to some guided meditation focusing on anxiety (I like Belleruth Naprasek, but have only listened to her pre-surgery meditations) for part of the time. In addition, stress and anxiety have a great physical effect on your body, so if you can swing it, maybe a massage or myofascial release therapy (both of which help me physically but also emotionally as I really just focus on the pressure that’s on my body and don’t think of anything else during the session).

  81. BowTiesAreCool*

    You can’t take a chunk of time off, that makes complete sense, but can you take even one day for yourself occasionally? A half day, even? When the offspring are in school and the partner is doing whatever they do during a weekday, can you find 4-8 hours to just…sit in a park and read a nice book? Take yourself to a movie? Go on a hike? Get a massage? Whatever relaxes you. You sound like you are very much in need of “me-time”, and even a microdose can help.

  82. burr... it's cold in here*

    I can relate. I worked in a medically adjacent field working with vulnerable adults with disabilities and their caretakers at the same time that my eldest with chronic health conditions, is Autistic, and complex mental illness was going through an incredibly rough period after years and years of not an easy period.

    Things I did that helped a bit:
    1. At home, get everything off your plate that you can. If you can hire someone to come in and clean, do it. If you can get a laundry service, do it. If you can order food instead of homecook, do it. Reach out to family and friends and be open about what’s happening. This doesn’t mean spread your kids private info out to the world but you get to talk about your experiences with your commuinty. Ask for help. If you’re part of a religious institution, check to see if they have some kind of “caring committee” of folks who can make dinners, do dishes, etc. etc.
    See if you can get some respite care for kiddo so you can get some down time. If you’re partnered, see if partner can be with kiddo on their own for a night and get an Air BnB and just be alone for a bit. Or maybe kiddo’s friends parents can take kiddo for an evening, or something.
    (I don’t know what state you are in, but many offer respite care services – if you need more info on this, please lmk in the comments).

    2. When you have time (ha!) try to take some down time/alone time and be really mindful about it. Like say outloud “I am taking some time to myself so I can recharge my batteries,” so that you are FULLY aware of it.

    3. Give yourself a LOT of grace. It’s ok for the house to be a mess. It’s ok for the kids to wear the same shirt two days in a row. It’s ok to get fast food. It’s ok to drop balls. Give yourself permission to be not ok without guilt. It’s ok to not be ok. Its ok to cry. Its ok to not be 100%. It’s ok to not be amazing at your job.

    4. If your management at work is supportive, talk to them about what’s happening. See if they can help cut in some extra time for you during the day. If you can get paid FMLA or something, absolutely do that. If you can make it so you get 15 – 20 minutes between patients, and you can just zone out for a moment, absolutely do that.

    5. It’s sounds so pithy but find small things that bring you joy and focus on those. I knit, so during that time I would treat myself to really pretty yarn that feels nice in my hands. I love to take HOT hot hot baths, so I would do that when I had a moment. I also gave myself full permission to zone out on social media because it made my brain shut up for a while. I watch really, really bad reality tv bc I just don’t have to think about it. I go for a walk to a waterfall near us on a regular basis. I love the game Stardew Valley, so I paid for it to be on my phone.

    6. Find moments when you can take a break — like, carve them out. They don’t have to be big moments — even just five minutes when you can sit down and not have anyone talk to you. The commute to and from work was a good time for this, for me. I like audio books, so I would listen to those. Try to find time at home when you can go sit outside or a space that you can be and not be interacted with.

    7. See if there are support groups for parents going through the same or similar things. I did not have one but a bunch of folks I knew also had kids who were really struggling (it was the pandemic and we were all having a hard time) and we made a private facebook group that was judgement free (we were picky about who we allowed in) where we could just openly discuss everything that was happening and commiserate and support each other.

    I’m so sorry you’re going through all this.

  83. Veruca*

    I’m so sorry you’re going through this. I went through mental health issues with my teen daughter as well. There were many days at work where I seemed fine, but in reality I felt a moment away from tears at all times.
    People told me I needed to see a therapist for myself, but when all my financial resources (and then some) plus my time and emotional bandwidth were spent on just keeping her alive, it felt overwhelming.
    I wish I had answers for you, but all I have is my sincerest sympathy.

  84. Lil Grasshopper*

    physician here working with the same type of patients with some tough personal family stuff going on. I’ve found it really important to give myself a minute or two to regroup in between patients. I used to feel extra pressure to keep going because I was running behind already and felt I was making it worse if I didn’t rush, but then I would be completely unraveled by end of shift. Now I’m between patients I’ll do deep breathing for 1-2 min or take the extra moment to completely wrap up my notes so I can mentally close the door on that last encounter instead of having to come back to it again at the end of shift, go to the bathroom and let myself grumble and make faces of frustration in front of the mirror which usually makes me laugh and releases some of the build up tension in the moment, do a quick grounding exercise at my desk. sometimes I’m still exhausted my end of shift, but usually in a better frame of mind if I cut myself these little moments of slack throughout the day

    1. Dr. Anonymous.*

      I can’t emphasize enough how much it helps me to take the extra 1-2 minutes to finish the note before moving on, NO MATTER HOW LATE I AM. And give yourself a lot of grace about the quality of your note. It has to document enough that you know what happened to the patient, and give a basic idea of your medical reasoning to a covering provider. Nobody has to be pleased with it, not even you. Notes should be fast, barely adequate, and OFF YOUR PLATE.

  85. shamwow*

    Since it sounds like finances are tight (as well as time and bandwidth), I’ll share some of the takeaways I’ve gotten from therapy so if that is out of reach for you right now, you can at least start implementing some of the tools you might get from it:

    1. grounding exercises – name 5 things you can see, 4 things you can touch, 3 things you hear, 2 things you smell, 1 thing you taste. Use your thumb and pointer finger to (gently) pinch the skin between your opposite thumb and pointer finger. Or 4-7-8 breathing (inhale for 4, hold for 7, exhale for 8).

    2. give yourself a mantra. Something easy to remember that resonates with you. Mine was the first lines from the poem Invictus by William Ernest Henley because I memorized it in grade school and it stuck. It could be a song lyric, a quote, anything. As long as it gives you strength and you can remember it even when you’re overwhelmed.

    3. Playing tetris – it’s been shown to decrease PTSD in patients experiencing trauma. I’ve also been doing Sudoku, something that occupies space in my brain and crowds out big emotions. Your brain is not good at multi-tasking, so give it a task to focus on that isn’t a source of distress.

    4. Journal. It’s a judgement free space to vent, and the act of writing down what you’re feeling can help you process. Scribble, tear out pages if you have to, rant and rave, plan to destroy the whole thing at the end of this if it makes you feel better.

    The first two are things you can do during work shifts, the last two might be helpful tools for transitioning from work to home (or home to work). They’re also low or no-cost, and it sounds like money is a huge source of stress right now.

    If you do feel up to it, doing something physical like walking is good, but you also have a physically demanding job and when I’ve been in those situations I know I haven’t been up to it.

    I’m sorry you’re going through this. I hope you see the other side of it soon.

  86. Sarah*

    Hey OP, I am also a healthcare provider. Everyone thinks therapy is the answer but that doesn’t really help you right now in your boots-on-the-ground daily work day.

    You don’t have to be to all things to all people. Reasonably friendly and helpful, yes. Expending a ton of mental energy coaxing patients through a procedure — not necessarily. If they’re trying to refuse a procedure — they’re adults (presumably). Explain the facts and let them do what they want. If patients refusing procedures becomes a problem in the office, that’s a manager’s problem.

    If they’re just afraid, you can be reasonably reassuring. But again, they’re adults, they can take on the bulk of managing themselves.

    People yelling about whatever. “I’m so sorry; we’re doing the best we can.” Anything beyond that is a manager’s problem.

    It’s clear that you really care about your patients!! You’re going above and beyond, it sounds like. Your 100% is everyone else’s 150%. You can dial it back to 75-80% and you’ll be fine!! That can actually be a good mantra. “I’m giving work X% and I’m saving Y% for my family.”

  87. March*

    I learned this in therapy and all my experiences with it have been like getting extra oxygen with every breath:
    allow yourself to drop stuff.
    For a little while, you know? it’s not forever, none of this is forever. It’s for now.
    Maybe it’s okay if the house isn’t tidy… for now.
    Maybe it’s okay to go to bed instead of yoga every two sessions… for now.
    Maybe it’s okay if you smile at your patients but not at your coworkers one day in the week… for now.
    Give yourself permission to do less. For now, you know?
    Drop a ball here and there. Someone will pick it up and not be mean to you about it. Or no one will pick it up and that will be fine.
    You don’t need to do all the work everywhere always. You don’t need to be the best or even good at things. Not during the hard times, and these are the hard times.
    (Captain Awkward has written a LOT about how to do less work and yes reading another blog is more work but sometimes reading is the work we want to do instead of loading washing machines, right?)

  88. Perihelion*

    I’m so sorry, this sounds so hard. I haven’t had to deal with situations this intense, but one thing I do find that helps me in tougher personal times is to shift my thinking from doing things because I care, to doing them because it’s my job. I teach college students, and what I actually do for them doesn’t change much—I teach class, I encourage them to meet with me, I answer questions and give feedback, etc. But sometimes I do that because I can engage with the students and really care about their success, and sometimes I do that because it’s my job and those are the steps I take. Probably the “just the job” semesters the students get a bit less from me, but I really don’t think it’s that different. When you have a day when you just can’t handle it (which is so understandable), possibly thinking about the steps for calming down a patient as just a work routine, instead of something you’re doing to help them personally, might help.

  89. I still burn popcorn, oops*

    Honestly? I’d explore (via EAP, maybe?) what psych NPs are covered by your insurance.

    Meds have helped me hobble through work during burnout. Your situation sounds similar to one I went through a year ago.

  90. Family Doc*

    Primary care doc here. Try this – when a patient brings up yet another complaint in a visit or tries to add on something difficult or vague like fatigue, headache, can’t lose weight, etc to a short visit for another reason, just say “I’m sorry to hear that.” That’s it. You don’t have to solve every problem or complaint they bring. If they want to dig in to it, they can schedule another appointment but only a few will actually do that. This strategy helped me a lot with burnout and thinking I had to fix everything patients brought up. Good luck!

    1. metadata minion*

      Would it be worth adding “please feel free to schedule another appointment so we can talk about that in more detail?” As a patient, if a doctor just said “I’m sorry to hear that” when I brought up a health question, I would be incredibly angry. I understand they might not have time to deal with it now, but I’m not bringing up the fact that I’m still tired all the time to make idle chitchat. I’m bringing it up because the next chance might not be for another two months because everyone’s so booked up.

  91. Coco*

    This sounds very intense. When I’m going thru it, I try to ruthlessly cut out things that aren’t 100% necessary for a while. Emotionally this means I’m not personally available to acquaintances or people I don’t have fully positive relationships. I might cook the same 4 meals on rotation, watch comfort shows, prioritize sex and connection with my partner over clean dishes or taking out the recycling.

    If you can swing it financially, for me this means laundry service instead of laundromat, takeout 1x a week, grocery delivery, and other me-specific ways of cutting down on labor.

    It also means clearly telling my loved ones that I’m struggling, and seeing if i can assign anyone a task, or get someone to body double me when I need to do piles of life admin on limited sleep.

    So do what you can to build yourself space in your personal life which might hopefully build your some breathing life professionally. I’m rooting for you

  92. kalli*

    How to compartmentalise? Practice.

    Also, things like talking patients through procedures? You should essentially have a script and be able to do that on auto-pilot. You do not have to be mindful here, you have to get people through and get on with your day, so a lot of free therapy is going to be the opposite of helpful.

    Perhaps there is a professional organisation with more suitable resources for your specific role than a management blog with a specific readership. They would be your best bet for support.

  93. MirandaAround*

    I’m so sorry you are going through this – it’s a lot and your family is lucky to have you.

    One thing that has helped me stay relatively professional during tough times is to pretend I’m acting the part of professional me and taking a weird kind of pride/pleasure in how well I’m doing it. It gives me permission to park my real anxieties for a bit and focus not on doing the job as stressed me, but performing the job as professional me. That approach has helped me through for example giving a presentation on the day after my ex asked for a divorce, hosting a VIP visit the day before we were having a pet put to sleep and running a stand at an exhibition while awaiting results of a cancer scan….

  94. mstrsofpmbrly*

    OP you are probably a really kind, compassionate presence in your patients’ lives! I love that you are taking the time to think about how to offer that compassion to yourself.

    Two things that helped me when I felt like my skin was one cell thick (what a great way to describe that, I know exactly what you mean) 1) I tried what a lot of the commenters said about having a glass wall between me and them, but it failed for me a lot and I spent a lot of time choked up. Every time I had a minute, I tried to find a tiny thing to bring me joy, because joy felt like it recentered me and made the wall stronger. For me, that was some pictures of mice sleeping in tulips that I downloaded to my phone and some dog instagram accounts.
    2) I did a little ritual at the end of every shift to try to put down all the things that weren’t mine to carry home. I would sit in the car and think through my day and think “I hope they are as happy and healthy as they can possibly be, I hope they get the support they need to heal” and then for all the stresses of paperwork and coworkers, I basically did a modified serenity and thought about letting go of all of the things I couldn’t fix when I was home.

    Half the time I felt stupid doing it and half the time, I had a little cry, which was actually helpful to let some stuff out, and then I would turn on some rock and scream sing the way home.

  95. slowlyaging*

    Speaking as one who has been in similar very difficult personal and business circumstances.
    Your phrase ‘create a firewall around my emotions’ resonated with me. So I used the following. On the way to work, do whatever thing helps you move from family to business. I played very loud music, told God my opinion on the universe, called friends who would listen to me vent at 5.30 in the morning. Remind yourself this is NOT forever. Things are and will change.
    In the moment at work, count every second, every tiny improvement as a win for you and the client. Promise yourself a break. My breaks included, go to the bathroom, walk around the building, do tedious paperwork, close your door and do jumping jacks (I didn’t try this). Shred paper. I had silly calendars with absurd facts to refocus my brain. Find a reward. Chocolate truffles for making thru to lunch.

  96. Storm in a teacup*

    I used to work in frontline healthcare for many years and can totally relate, as I’m sure can all of us in the healthcare field. We are all human and go through periods when our resilience is lower than normal.
    As your work have been supportive, please talk to them and name the issue – some days are difficult. Can they help out with support on these days eg giving you a lighter workload or the not so challenging patients? Is there a work EAP scheme or insurance you can access therapy for yourself and / or your family?
    I know you cannot take leave but is one option a possibility to work slightly reduced hours or start a little later? If you have more time in the morning it may help you with taking a bit more time and feel less overwhelmed?

  97. Festively Dressed Earl*

    Talk to your own GP. Show them this letter. For myself and a few people I know, extended painful or stressful periods have led to situational depression or anxiety, and doctors have prescribed/adjusted medication accordingly. I regard that as a last resort and have no idea where you’re at, but it’s something to consider when you’ve done everything else you reasonably can to protect your mental health.

  98. Frankie*

    It helps me in cases like this to visualize a barrier between myself and others where their emotions don’t get into my space. Somehow incredibly effective.

  99. I've Been There*

    Another parent shared this tip with me. Imagine that you are wearing a suit of armor and the emotion and arrows from you family or your patients simply ping off the armor and fall to the ground.

    (PS: Has your child’s pediatrician ruled out PANS and PANDAS? You listed three common topics on PANS and PANDAS chat groups: school avoidance, eating disorder, anxiety. If the doc hasn’t considered them, you might ask for some testing.)

  100. Anontdy*

    This is going to sound like a troll but I promise it’s not. I’ve seen lots of good ideas here for therapy, longer term things to ease the stress.
    For an acute and cathartic thing to do (please bear with me): get a big bag of cheap apples (the gross lunchbox red/green delicious ones) and a baseball bat. Go outside (away from people) and start swinging. Its like those rage rooms. Also your teen might be down to hit a few applesauce home runs too.
    Will this solve your work/home problems? No, but it will probably end with you and your kid laughing so hard you’re crying, you’ll get some frustration out in a physical way, and you have a wacky memory to think back on during a tough day at work.

    I used to do this and idk, sometimes you have to do something crazy to keep yourself sane.

  101. Anontdy*

    I think my comment got eaten. This is going to sound unserious but please hear me out. You’ve gotten good advice on longer term stuff.
    Get a big bag of cheap apples (like the gross red delicious ones) and a baseball bat. Go outside away fom people and start swinging. Your teen may even be down to hit a few applesauce home runs.

    Will this solve your work/life problems? No, but you and your kid will probably laugh so hard you cry, you’ll get some frustration out in a physical way, and you’ll have a wacky memory to think back on during tough days.
    Idk, used to help me sometimes.
    Sometimes you have to be a little crazy to stay sane.

  102. lil falafel wrap*

    I agree about therapy; I think having that space for yourself each week is good.

    My other suggestion though is to give yourself grace for going through the steps without the extra emotional investment. I’m a social worker and some days I’m more emotionally engaged and others I have things going on and I can’t show up exactly perfectly. A lot of people underestimate the toll the emotional labor of jobs like this take. But on those days where I’m not the best, most engaged social worker, I know I’m still providing a service because I know the steps I’m responsible to take and I take them. It’s okay to say, what am I actually responsible to provide today and only doing those things some days. As service providers, we get into this because we care and we do often love our jobs, but at the end of the day they are still just jobs. And doing your job physically if not 100% emotionally is still helpful.

  103. A bee by the sea*

    So as someone who also works in an extremely high stress healthcare environment here are a few things that could help (with the caveat that everyone is different/will respond to different coping strategies better).
    First, for the self care tasks consider which ones actually help you. For me sometimes the yoga/daily walk/etc is just another chore. Over my lifetime it makes my life better but when I’m crazy stressed and have a billion things going on it contributes to my burnout instead of relieving it. I would really consider what actually helps ease your stress OP and focus on that. It could be those ‘traditional’ self care tasks but it could also be other random things. When I’m super stressed I’ll drop down how many walks I’m doing but I still drag myself out of bed an hour early every day so I can take my time drinking my coffee on the couch with my dog. I’d also see if your company had any sort of EAP. There are different levels of helpfulness but they might have additional resources to support your and your family during this time.

    Also, this can be really hard for those of us working in healthcare especially with high needs patients, but it is okay for your job to be just a job for a while. You mentioned feeling like you have to keep being smiley and not being able to go into low battery mode and I’m not sure if it’s because you think it would jeopardize your job or if it’s because you’d feel bad about it. If it’s the latter, please extend yourself some grace. You’re going through a tough time and doing your best. It is okay if your best some days is less smiley. And you’re probably already doing this, but if you are carrying any part of work home with you at the end of the day, try to find away to shut that part of your brain off when you’re off work. Sometimes I’ll find myself worrying about work things when I’m with my family or playing video games and reminding myself “that’s future me’s problem” helps me disconnect so I can actually recharge my battery during downtime.

    1. Edamameg*

      Seconding this!

      Your job can be your job and you can be in low battery mode sometimes. We dont have to give all of ourselves all the time.

      If you’re worried patients will pick up on the low energy, nothing wrong with a white lie. “Oh I have a head ache”, or “I had a bad sleep last night”.

  104. Data Nerd*

    We went through many of the same things with our youngest, who is now 20 but still isn’t ready to be fully in the adult world. There were days when that child was in middle and high school that I could barely function. Most of the time (though not always) it helped me to go into “work mode” and just shut off as much as I could from my home issues. Of course the phone calls from that child during the day didn’t help. It’s really hard to find help and support and what you’re going through is awful. Hang in there!

  105. Edamameg*

    I’m a social worker, well I guess manager now, in a very similar inner city clinic.

    Do you have the kind of relationship with your coworkers where you can let them know that you’re going through a hard time? You don’t have to share you know the specifics if you’re not comfortable, but even if you couldn’t give them a heads up, “hey I’m just having a really hard day. I just need a little extra space and patience today and I might seem kind of low”.

    In my own experience, we’ve all been there, and it really helps to admit when you’re feeling that way, and often your team will you know step up and take some stuff off your plate and try and deflect and just help create some more space so that you can breathe a little bit.

    Otherwise, I recommend taking space where you can you know even if that looks like you know, taking an extra minute or two between your appointments just to take a deep breath ground yourself, put that armour back on to be ready. Think of some things that you could do at work that pump you up, for myself, I am often getting caught singing in the back hallway bathroom because singing pumps me up and helps ground my nervous system.

  106. Kelly With A Why*

    I am so sorry you are going through this. I’ve been where you are, and it is difficult to just put one foot in front of the other. I learned a lot from the experience, and one of the most important things I learned was to be okay with not being okay. I found that letting go of the pressure I was putting on myself to continue operating at 100% really helped me a lot. Hang in there!

  107. Varthema*

    I agree with all of the things said here but also want to add that I was feeling pretty burned out yesterday and with two small kids and two working parents, carving out self-care time just felt insurmountable and like one more thing. I finally unloaded to *my* GP and was mildly surprised when she asked if I wanted to try a mild entry-level SSRI. I was game but had low expectations, but oh my, I wasn’t expecting it to work so well. It hasn’t fixed any environmental factors, of course – smallies are still going to tantrum, dishes are still neverending, work is still work, time is still lacking – but I do feel as if I have more emotional resources to confront it all and not feel despair at the end of the day. It’s not a magic bullet but sometimes it can be a missing ingredient and definitely worth talking to a healthcare professional about if any of this resonates.

    2. March*

      Absolutely this! Medication doesn’t only exist to take you from “going to die in 60 minutes” to “able to hang on by skin of teeth until next dose”. Sometimes you get to use it for a bit of extra energy/perseverance/ease/comfort. Sometimes you need a jumpstart to get back to base level, and if it’s there and it works? It’s good.

  108. Daria grace*

    I’m sorry you’re dealing with so much. Something I’ve found sort of helpful is to pretend you’re an actor in a workplace show who is there to deliver the performance scripted for you. It can help make the reactions of the people you’re dealing with seem less directed at you personally and make it feel less jarring to not be behaving the way you feel.

  109. ad astra per aspera*

    Is there any possibility you can take on a reduced patient load for a short time? I know you said that you can’t take time off entirely (totally fair!!), but sometimes even just reducing the volume of demands can make a difference. Obviously exactly how that looks may depend on your clinic set up, whether you’re paid based on RBUs, etc etc—but if you could work shorter days (or even just have longer visits!!) it might help. Otherwise, all I can do is send heaps of sympathy from a peds resident who had a lot of family stuff going on during med school clinicals.

  110. Me, a nurse*

    I am a bedside ICU nurse. What helps me:
    -take your breaks at work. Even if things are so busy that you can’t, take your breaks anyway. Breathe, take a walk, meditate, eat and drink. Do not think about work while you are on break.
    -accept that if things don’t get done, so be it (obviously, triage what gets done and keep your manager updated). If you are the only thing keeping your organization going, then let things fail. If it is so important, higher-ups will do it. Prioritize yourself – your health, your life, your family, your mental health, etc.
    -compartmentalize. Picture putting your family, your daughter, in a safe room. And then close the door. This gets easier with practice.
    -when you are with a patient, focus on the patient. Talk to them. Focus on the good that you are doing in that moment.
    -I would say meditation, breathing, yoga, walking, etc, but it sounds like you have that covered.
    -prioritize sleep.

    Remind yourself that you are a good person who is doing a difficult job to the best of your ability. And that is enough.

  111. Boof*

    I am going to ask, does getting a different job sound appealing? My job can be pretty tough, I’m not going through anything as stressful as you are going through LW – one person who was a great member of our team had some family health stress and found it was just too much to deal with folks at our job also going through serious health stuff (particularly the younger ones) and got a different job doing sort of home wellness checks; better pay, more flexible schedule, and less “someone who reminds me of my kid seems to be crumping on me” – they are happy with the change and I’m happy for the work they did do and that they’re on to things they like now.
    That’s not necessarily what you need to do but if there is some kind of option for low stress/easy but still financially viable consider it!
    Otherwise, it’s ok to have boundaries ie “hey I know you’re stressed but we’ll take care of you please don’t yell” and ask the boss to step in if they keep being rude etc

  112. Ipsa*

    Your description of your job sounds like a field I used to work in. If it’s the same one, there are also punishing hours (16 hour shifts easily), super early mornings, a shortage of staff, and an inability to hand off your tasks to a colleague because there simply is no one else. If it’s the same field I worked in, what I found that helped me was shifting to float work. I stopped working in one specific clinic, and instead worked at all the clinics in the area based on their need for staffing. This helped to de-escalate my involvement in my patients’ lives, getting all tied up in the day to day issues, and basically reduced my emotional investment in work. It’s hard going to a new clinic at first, but they’re generally grateful for the help, give you easier assignments (since you’re helping them out of a tight spot), you’re not involved in the day-to-day politics and frustrations, and if you have a difficult or extra-needy patient, it’s much easier to handle because you likely won’t see them again for a little bit of time. You can do your job and go home. I found it also helped expand my contacts and support system. Everyone I met had different perspectives and experiences, and sometimes I talked to someone who had the wisdom I needed that day. So in short, if you’re stuck in the job, maybe see if you can change up the environment.

  113. K8r8r*

    That all sounds really hard and exhausting, I am so sorry. Your daughter is lucky to have you. In terms of keeping it together at work, one thing you might do is look for patterns in the types of tasks/patients that tend to leave you feeling helpful and fulfilled, and those that tend to push you over your threshold and leave you emotional. You may not be able to avoid the second type but you may be able to try to get more time with the first type. And knowing what kind of situations may be triggers may at least help you steel yourself or establish a backup if you need to tap out. It is so hard to be “on” all day and then still be there emotionally at home. Thinking of you.

  114. Mavis Mae*

    I’m sorry that you and your daughter and your family are going through this. I know something of what you’re facing, we have an adult child with a serious mental illness and the first thing you should do is congratulate yourself for facing up to an incredible challenge.
    I coped by building a professional dissociation persona. When I was at work, I was at work. I also stepped back from additional responsibilities, handed back a management promotion and allowed myself to just do the job, not live the job. I sort of grew a psychological crust, that might help with your distressed and rude patients. otherwise the most important thing was to have even a tiny bit of time all to myself. I usually got this by going off on a walk for an hour, by myself or with a friend. Whatever happened at home during that time was not my problem. Sometimes I had to deal with extra when I got back, but I always got out for a bit. The walls didn’t collapse and everyone survived.

    Good luck. It is really tough to cope with all of this, but you will do it.

  115. Vancouver*

    A lot of people have given great advice for self-care here, so I’m going to focus on something a bit different… Lower your expectations of yourself.

    Advice I once got from a manager, when I was going through my own hard time: he said that he’d rather have 80% of my abilities, or 50%, whatever I could give, rather than none. That was eye-opening to me, as I’d always thought I needed to put 100% into every interaction with a client to provide the service my clients needed and deserved. It turned out that he was right. I lowered my own standards for a while; I wasn’t infinitely patient with every client, I sometimes had to provide less than optimal service, but everyone made it through in one piece.

  116. Trekker*

    Yes! As a teacher, scripts and templates are a lifesaver, especially when I have little or no energy left. While each of my students is unique, some of their basic questions are not and do not require a heartfelt, personalized answer.

  117. Numbat*

    YMMV, but I know an emergency room doctor who describes one approach thus:

    “When someone comes in, it’s like they’re saying to me ‘here, have this pile of shit’. And they have their hand out, ready to hand over their shit. And I can choose to look at the shit, smell it, talk about it, but never put my hand out to take the pile of shit from the other person.”

    Which I think is his way of mentally holding up a boundary to say “as much as i care this is ultimately your problem, your life, and not mine to carry around with me”.

  118. UnhealthyNurse*

    I’m an ED nurse with multiple chronic illnesses. I know exactly what it’s like to have someone scream at you for things outside your control, have to walk someone through something we see daily, reassure somebody that they’ll be fine – im used to all of the emotional support for people who are sick, scared, and in pain. people who aren’t in healthcare, please don’t dogpile me for this.

    when your personal life is falling apart, you can’t be the same person you are when you’re on your game – it’s just not possible. Your bucket isn’t full enough to pour from. When you’re in survival mode, all of the ‘extra’ stuff goes out the window. “Mrs. Smith, this is a very stressful decision to make. I’m going to give you some literature to help you understand.” and then let her read through it as opposed to you reading it for her. “Mr. Smith, I know you’ve been waiting. thanks for your patience. step on the scale for me.” and just completely disengage from his complaints about the wait time. “Hi, Ms. Smith! Are you ready?” instead of “Hi, Ms. Smith! you’ve got a procedure coming up. feel okay?”

    obviously the “bare bones” approach to patients is not ideal. but if you’re seeing thirty patients a day and your personal life is chaotic, sometimes you just don’t have the bandwidth to be sweet and smiling constantly. something has to give, and it’s better to be competent and clossed-off than it is to make a mistake and hurt somebody because you’re stretched so thin you miss something important. you need to disengage from the emotional-support side of things as much as you can until you can do it without feeling like you’re going to collapse under the weight. (unless you work in psych, in which case you have to find a way to do the emotional support work without letting it affect your own emotions [if you figure it out, let me know; I worked psych for five years and never got there].)

    does your employer have an EAP? it might be worth giving them a call and asking for support. I know my old employer gave 5 sessions per issue at no cost, which was extremely helpful at times. your employer may have a similar benefit. talking to your friends is good, working with your husband and daughter is good, but sometimes you need to talk to somebody who doesn’t know anybody involved.

  119. Psychologist not recommending therapy (no shade to therapy!)*

    Hi! I’m a psychologist working in an underserved rural area, and my work includes lots of vicarious traumatization I try to manage. Of course therapy is great when it’s accessible blah blah blah, but I wanted to offer something concrete you can do on your own. Kristin Neff’s research on self-compassion is fantastic, and she has a whole bunch of (short) guided exercises that I have found to be life rafts when things are emotionally overwhelming: https://self-compassion.org/self-compassion-practices/#guided-practices. I basically mostly use the first one, and have practiced it countless times so guide myself through it, often in just about a minute between sessions. Here’s the bones of it:
    –This is a moment of suffering.
    –Suffering is a part of life, and you are not alone.
    –May you be kind to yourself in this moment.

  120. Mia*

    My heart goes out to you, OP. When I’ve been in a similar mindset I end up just focusing on what has to get done – like bills have to be paid, but maybe that lightbulb that’s burned out can be replaced later. I also just try focusing on each day and not the future. When I find myself worrying about the future I refocus to that day. Sometimes I even have to take it hour by hour. Some others have had some great tips here as well – I like the one about using paper plates.

    When I get into times like this I make myself feel worse. Like maybe I ordered dinner out instead of making food. But I fed myself, and that’s what matters. So I also have to refocus on what I did do, not what I think I should have done better. This is really hard!

    Be kind to yourself. You are doing the best you can under enormous stressors. If all you can do is get through each day right now then that is more than enough.

  121. GlitterIsEverything*

    I’ve been there – literally.

    Parenting a teenager with significant medical issues, fighting the school, in a high school with multiple suicides during my child’s time. Also in direct patient care, and all the energy that requires.

    The answer, for me, was that I gave myself permission to walk out of clinic when I needed to. Go to the bathroom and cry. If you have someone in the office you can confide in, do so. And most importantly, find someone in your personal life who isn’t immediately affected by your teen’s issues who can be YOUR support. When I found that small group of people who were eager to support me, my ability to get through it all changed drastically.

  122. Iyana*

    I work in a care/service industry (education) where I also often was helping people deal with problems that felt, and sometimes were, life threatening. I have learned over time to give my best when I’m present, and then truly step away and not take the work home or take it personally. I will be honest that this shift required taking a new job where it truly wasn’t my responsibility to fix something, but I’ve been able to hold onto it when I moved into a newer role where it is, again, actually my responsibility. So, I’m all for boundaries and keeping some emotional distance – though it is certainly easier said than done.

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