The Mental Health Crisis Among Therapists

The Devaluation of Feminine Labor

Nov 13, 2024

I debated writing this post, but I believe stories have the power to heal and sometimes, it is through telling our stories that we learn how to heal ourselves.

As a trained psychotherapist, empathy is at the core of all that I do and in my graduate program I was taught to reframe from self-disclosure in session with my clients. While this lesson is important and the counseling room should be a sacred space focused on clients’ experiences, I can’t help to notice the increasing number of therapists I know who are struggling with their mental health because we have no container to process our experiences.

Now, before you say, “But what about your own personal therapy?” or “it's your job to regulate yourself,” let me break down for you what the average day of a therapist in a mental health clinic looks like.

Typical Day for a Therapist

6am: You wake up exhausted from the night before, tossing and turning from lack of sleep and dreading how you are going to get all your notes done the next day.

8am: You arrive at work ready to do the notes you couldn’t complete from the following day and surprise! The receptionist has just scheduled you an 8am “emergency session,” or you had to fit another client into your schedule because of a mental health crisis.

8 a.m. to 12 p.m.: You are in back-to-back hour sessions, which means no time to do notes, running to the bathroom in between sessions, and barely finishing your morning coffee.

12 to 1 p.m.: You have a lunch break, which you spend attempting to complete your notes in your office or taking a nap because you have held four or more clients’ emotional pain that morning without even having a second to breathe, let alone focus on your own physical needs.

1pm to 4pm: You attempt to pull yourself together for our afternoon sessions, which you have 3 or 4 more hour-long sessions of, and if you are lucky, you somehow manage to block an hour out of the end of the day to do your paperwork.

5pm: (This is really closer to 6pm because you had to run a group that night or decided to stay late and work on notes.) You finally make it to your car to drive home. You’re so exhausted by this point you stop by the nearest fast-food restaurant, grabbing the greasiest food you can find as a source of emotional comfort. You make it home with your half-eaten meal, which you mindlessly scarf down in front of Netflix or HBO while scrolling on your phone and drinking a glass of wine (or 2).

9pm: You think you should go to bed, but your body suddenly has a burst of anxiety as you dread having to think about doing the whole process over again the next day. So inevitably, you end up watching more TV, having another glass of wine, and then doom scrolling until way past your bedtime, and then the cycle repeats all over again.

Sounds like an idyllic day right? Don’t therapists have such an easy job?! “All you do is sit around and listen to people.” If you are a mental health professional, you’ve heard these comments and other dismissive statements over and over again.

But this outline I just gave you is a GOOD day as a therapist, which is honestly quite rare.

The Ugly Truth

What usually ends up happening instead is that your boss or supervisor comes into your office for a “quick chat” which results in you having to take on more additional labor or see more clients. Insurance sends back a claim or denies it, and in between those 7-8 sessions, you have to sit on call waiting, trying to figure out how your client can be covered. This is a virtually impossible task for you to do when literally every hour of your schedule is completely blocked off with a session or some other task. So forget about writing notes, because how do you even have the brain space to sit down and write and formulate sentences when you are constantly task switching, and your body is in flight-or-flight mode trying to put out crises for your next client or attend to many bullshit administrative tasks on your to-do list.

This is all happening while you of course are expected to be human and to be present with your partner or children or friends/family members when you’re not at work. That second shift never ends, especially because psychotherapy is one of the few fields dominated by women (aside from nursing or teaching), which means these women often end up doing the majority of the house cleaning, cooking, and emotional labor within their homes. So, a therapist goes from taking care of all of their client's emotional needs at work, to taking care of their family or friends emotional needs as well. Without any moment for a break or self-reflection.

Oh and by the way, if you are struggling with your own mental health because maybe a loved one is passing, or you have a history of depression/anxiety/mental health concerns, or you are just fucking human who feels sadness sometimes you are expected to journal that shit out. Or go to the gym and “run it off” because self-care! Yet, when you need an ear to turn to, rarely does anyone have the capacity or want to hold space for you.

Now you might be reading this article and thinking “wow this woman sounds like she hates her job” and I could see how you would think that. But notice how I never mentioned anything about my clients or my sessions with them. Instead, what I described is a system that is not set up to support therapists. A system that is inherently patriarchal and, therefore, devalues feminine labor.

Feminine Labor

What is feminine labor you ask? Many feminist scholars describe feminine labor as traits that have been traditionally defined as “feminine,” which women are expected to uphold. Which often refers to the undervalued, invisible, and gendered work typically associated with women, both in paid and unpaid contexts. This can include things such as emotional labor (Like being expected to provide empathy or the ability to hold space/listen to others at a moment's notice.), domestic tasks, caregiving, and roles that require nurturing or relational skills. Such labor is often expected within households and workplaces but tends to be devalued in terms of compensation and recognition compared to traditionally “masculine” work (i.e., engineering, finance, etc.).

Thus, even in felids who are supposed to value feminine labor (psychotherapy, nursing, and teaching), the traits of empathy, relationality, communication, connection, or the ability to hold emotional containers for others are not seen as important or as if they are a “difficult tasks” for women to do because society has told us that these tasks don’t actually take much effort. This is one of the biggest lies within our society.

The True Toll of Emotional Labor

Paris Paloma hit song Labor is an excellent demonstration of the labor women feel pressured to fulfill and how the patriarchy screws us into performing these tasks without little to no recognition.

In a patriarchal society, we are told as women that if we performed “traditionally” feminine tasks, we would be rewarded. People will love and appreciate us, and even if we don’t make a lot of money in these helping professions, our feminine attributes will be rewarded because we are “doing it for a good cause.”

We were fed the bullshit line that we don’t need financial compensation or to be taken seriously because it is “good” and “feminine” to do this work out of the kindness of our hearts. Isn’t that a convenient little lie to tell women so that you don’t have to pay them for what they are worth? Or rather, maybe gaslight these healers on a societal level to make them devalue themselves for insurance companies and mental health clinics to demand more out of their staff when they are already pushed to the brink? Or if these individuals choose to work in private practice to have more work-life balance, most novice therapists start out making less than $25 dollars per hour of session, and you only get paid for that one hour of service. So, let's do some simple math here.

1 hour of therapy = $25

Average number of sessions as a new therapist a day 7 x $25 = $175 for a 7-8 work day.

$175 x 4 days a week (because most therapists can not afford to work 5 days a week or do not have a full caseload) = $700

$700 x 4 weeks = $2,800 a month

$2,800 a month x 12 = $33,600 a year.

To put that into context, according to the Department of Health and Human Services (HHS), the poverty line (which honestly is outdated and needs to be re-evaluated) for 2024 for a family of four was $30,000 per year.

Meaning that most pre-licensed or new therapists are not even making enough money to 1. Afford to live on their own, 2. Support their families, and 3. Barely have their expenses covered.

Furthermore, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimates that around 10-15% of healthcare professionals, including therapists, may struggle with substance use issues at some point in their careers. While I actually suspect that these rates are much higher, little to no discussion is given to therapists-in-training in their graduate training programs about the warning signs of substance use among therapists experiencing burnout. This is interesting, given that the NIAAA cited therapist burnout as a contributing factor towards these rates due to the demanding nature of therapeutic work and exposure to vicarious trauma, as well as emotional exhaustion from overworking, which can lead to using substances as a potential coping mechanism.

This was also found in a study by Cook and their colleagues where they found that novice counselors experiencing burnout led to greater dissatisfaction in their personal and romantic relationships, increased rates of depression and anxiety, substance use, and suicidal ideation among therapists.

While this study is concerning considering the impacts of burnout on mental health professionals, moreover, what I think contributes to therapists' substance use and mental health concerns is the fact they feel shame for expressing these human-like struggles to their peers. I can attest that I have done my own personal therapy with other therapists and that their discomfort with burnout led them to pathologize me and my difficulty finding work-life balance. These experiences led me to question my efficacy as a therapist, and I have actually considered leaving the field many times because of these interactions.

What Needs to Change

What is not being discussed among therapists is not that we hate our jobs or our clients for providing empathy, compassion, and support (all feminine attributes), but that we hate not being treated like humans for providing this work. We hate not being able to afford our bills and are constantly worried about paying off our student loan debt for our very expensive master's and doctoral training programs. We hate that we have to jump through so many organizational hoops with insurance and are forced to provide “evidence-based care” that focuses on pathologizing clients’’ conditions rather than seeing them as human. We hate not being able to spend time with our loved ones or friends or even have the energy to date because we are so emotionally tapped out at the end of the day. We hate that the chronic stress of our jobs leads to back pain, elevated heart rates, and chronic health issues, which can be traced to our bodies constantly being in a state of hyper-diligence.

We DON’T hate our clients, we love them and we WANT to provide good work for them. We are just tired, and our empathy resources are drained. We want our feminine skills of empathy, compassion, connection, and community to be valued as well. We just want to be able to do that work without killing ourselves or destroying our own mental health in the process. We want the systems that were supposed to protect us to value our work, to value the feminine, because the feminine in central to the healing process.

This blog initially started as a way for me to vent and journal to process my own burnout, but as I said above, stories heal us because we see our experiences reflected in others (another very feminine quality). It is time that therapists and helping professionals reclaim their feminine qualities for themselves, which means tearing down the old systems of internalized sexism within our organizational structures that reinforce the devaluation of the feminine. We need to create new structures as therapists and as healers so that the world begins to value our work because we are the hope for the future, and we hold hope for our clients. Without us and the feminine, the world cannot heal.

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