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Empathy burnout, boundaries and clinical efficacy

As a physiotherapist working with people with persistent pain and unresolved injures, ensuring that my empathy antennae are on full beam is very important. I work with people whose lives have been thrown upside down by pain and the restrictions that come with it and, although I absolutely love my job, there are times when it can be mentally and emotionally tiring. I believe that the best things in life often involve hard work but I also have to be careful not to end up with empathy burnout, and that’s where boundaries come in… or so I thought.

I got thinking about all this after a recent persistent pain workshop with the fabulous ‘Pub Scientifique.’ We spent time exploring the importance of constantly questioning our own perspectives, biases and assumptions when trying to understand a persons experience of their pain.

This topic is right up my street and fitted nicely into my comfort zone. The bit about ‘showing up’ as an individual and not hiding behind my professional title/knowledge was less comfortable and I’d be interested to hear your perspective on this.

In the first decade of my career I was regularly advised to set boundaries with my patients, in the form of an imaginary barrier. This was supposed to benefit of my patients and save me from empathy burn out. In fact, whenever I tried to do this, to my confusion, it achieved the opposite. I felt I was a less effective clinician and was more exhausted.

I think creating boundaries in this way could inhibit patients from sharing their full experience and therefore prevent useful information being communicated that could be used to make their treatment plan more effective. It also hindered my ability to be empathetic and prevented me from enjoying the freedom and comfort that comes with being authentic.

I believe boundaries are essential in all healthy relationships, whether professional or personal. It’s taken me a long time to get there but finally I think I’m realising that boundaries should be created for each individual therapeutic relationship.

Going forwards I’m going to consider boundaries not in terms of ‘me clinician’ ‘you patient’ and instead in terms of ‘me individual’ ‘you individual.’ I have a sneaking suspicion this is going to make me a more effective clinician and reduce empathy burnout.

I’d be interested to hear your thoughts on this too. If you are a clinician then is it something you’ve always done without thinking about it or do you also find setting boundaries challenging? If you are not a clinician how does all this resonate with you? I’d love to know.

All the best,

Lucy Macdonald


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