Psychologist burnout: spotting exhaustion and protecting yourself in private practice

Four notions that are often confused

People talk about burnout, compassion fatigue, vicarious trauma or professional wear and tear as if they were the same thing. These notions overlap, but they do not describe the same mechanism. Telling them apart helps you choose the right response.

Burnout according to the WHO

In the eleventh revision of the International Classification of Diseases (ICD-11), which came into force on 1 January 2022, burnout has the code QD85. It sits in the chapter on factors influencing health status, in the group of problems associated with employment. The WHO states that it is not classified as a medical condition.

The definition has three dimensions.

• Feelings of energy depletion or exhaustion.
• Increased mental distance from one's job, or feelings of negativism or cynicism related to one's job.
• Reduced professional efficacy.

The WHO adds that the concept applies only to the occupational context. Burnout should not be used to describe exhaustion linked to family life, for example.

In France, the Haute Autorité de santé (HAS, the French National Authority for Health) published a guideline in 2017 on identifying and managing burnout, updated in December 2025 for the part on returning to work. It points out that this syndrome calls for a diagnostic process, in particular to look for an underlying disorder (adjustment disorder, anxiety, depression, post-traumatic stress) and to assess suicide risk.

Vicarious trauma

The term comes from an article by Lisa McCann and Laurie Anne Pearlman published in 1990 in the Journal of Traumatic Stress, under the name vicarious traumatisation. The authors use it to describe what happens to therapists who are repeatedly exposed to their patients' traumatic accounts. They stress two sources, the content of the accounts and the therapist's own beliefs about themselves and others.

In practice, it is a gradual change in the way one sees the world. The sense of safety, trust in others or the way one pictures loved ones can shift after hearing story after story of violence. The trigger is the content of what one hears, more than the amount of work.

Compassion fatigue and secondary traumatic stress

Compassion fatigue refers to the wear specific to helping professions. The most widely used tool to measure it, the ProQOL, was designed by Beth Hudnall Stamm based on work carried out with Charles Figley. In this model, compassion fatigue has two components.

• Burnout, which usually sets in gradually and shows as a feeling of helplessness and difficulty doing one's job well.
• Secondary traumatic stress, which comes from repeated exposure to trauma experienced by others. It often appears faster and can be linked to a specific event (a particularly harrowing account, for example).

The same tool also measures compassion satisfaction, meaning the pleasure one gets from doing the work well. The two often coexist in the same practitioner.

Professional wear and tear

The French word « usure » (wear and tear) has no official definition. It is often used to describe a settled weariness that does not necessarily reach the level of burnout. It remains useful in conversations between colleagues, as long as it is not used to play down a situation that calls for a doctor.

• Burnout
  • Where it comes from. WHO, ICD-11 (QD85)
  • Main trigger. Chronic workplace stress that is poorly managed (workload, lack of control)
  • What you notice. Exhaustion, distance or cynicism, feeling less effective
• Vicarious trauma
  • Where it comes from. McCann and Pearlman, 1990
  • Main trigger. Repeatedly hearing traumatic accounts
  • What you notice. A change in one's view of the world, trust and sense of safety
• Secondary traumatic stress
  • Where it comes from. ProQOL model (Stamm)
  • Main trigger. Exposure to patients' trauma, sometimes one specific account
  • What you notice. Reactions linked to particular accounts or a specific event, often appearing quickly
• Compassion fatigue
  • Where it comes from. ProQOL model (Stamm, Figley)
  • Main trigger. A combination of burnout and secondary traumatic stress
  • What you notice. Both of the pictures above, to varying degrees
• Wear and tear (« usure »)
  • Where it comes from. Everyday language
  • Main trigger. Fatigue building up over time
  • What you notice. Weariness, less drive, with no precise definition

What the studies really measure

Figures on psychologist burnout are widely shared. They come from a small number of literature reviews, with limits worth knowing before repeating them.

The main published reviews

• O'Connor, Muller Neff and Pitman, European Psychiatry, 2018
  • What it covers. Meta-analysis, 62 studies reviewed, of which 33 were pooled (9,409 mental health professionals, all professions combined)
  • What it finds. High emotional exhaustion in 40% (between 31 and 48%), high depersonalisation in 22%, low personal accomplishment in 19%
• McCormack et al., Frontiers in Psychology, 2018
  • What it covers. Systematic review, 29 studies on psychologists (clinical, school and counselling)
  • What it finds. No overall figure. Emotional exhaustion is the most studied dimension. Workload, long hours and non-clinical tasks come up as risk factors
• Simionato and Simpson, Journal of Clinical Psychology, 2018
  • What it covers. Review of 40 articles, nearly 9,000 psychotherapists
  • What it finds. Just over half report moderate to high burnout. The associated personal factors are limited experience, lack of confidence in one's skills, and perfectionism
• Van Hoy and Rzeszutek, Frontiers in Psychology, 2022
  • What it covers. Systematic review, 52 studies, 38 of them on burnout in psychotherapists
  • What it finds. Higher risk among younger and less experienced practitioners, with a heavy workload and in the public sector. Supervision and personal therapy are cited as protective
• Hensel et al., Journal of Traumatic Stress, 2015
  • What it covers. Meta-analysis, 38 studies on secondary traumatic stress
  • What it finds. Weak associations with the number of traumatised patients and with personal trauma history. Social and professional support works in the opposite direction

How to read these figures

• Thresholds change everything. In O'Connor's meta-analysis, more than half of the variation between studies on emotional exhaustion is explained by the choice of the "high level" threshold. The publisher of the Maslach Burnout Inventory has in fact removed the cut-offs from its manual, as they lacked diagnostic validity.
• An association is not a cause. Almost all these studies are cross-sectional (a snapshot at a given moment). They show links, not causes.
• Little French data. The reviews mainly include studies in English, many carried out in the United States and the United Kingdom. Health systems and private practice work differently there.
• Not all psychologists are in the same boat. In O'Connor's meta-analysis, samples with more psychologists showed less depersonalisation and a better sense of accomplishment than other mental health professions.
• Private practice is no guarantee. Several studies find less burnout in private practice than in institutions, others find no difference. Private practice gives more control, but it can also isolate.

What can be said without extrapolating too much is that emotional exhaustion is common in these professions, and that it is mainly linked to working conditions that can be changed.

Warning signs in practice

The HAS describes symptoms that often set in gradually and insidiously. It also notes that denial by the person concerned frequently delays care. In therapists, these signs often show first in the way the practice is run, before being recognised for what they are.

In how you relate to sessions

• You dread certain appointments from the day before, with no new clinical reason.
• You check the time more often than before during sessions.
• You catch yourself feeling irritated or indifferent towards a patient you used to follow with interest.
• You struggle to remember what was said the week before.

In your organisation

• Your session notes pile up and the backlog weighs on you in the evening or at the weekend.
• You add slots without removing any, and the breaks between patients disappear.
• You put off supervision or peer supervision groups "for lack of time".
• You no longer take full holidays, or you check your messages while away.

Outside the practice

• Tiredness that does not go away after a weekend, sleep problems, diffuse pain (the HAS mentions fatigue, sleep disorders and musculoskeletal pain).
• Withdrawal, less contact with family, friends and colleagues.
• Patients' accounts that come back to mind outside the practice, or a world that seems more dangerous than before. This type of reaction points more to secondary traumatic stress or vicarious trauma than to burnout.
• Increased use of alcohol, tobacco or medication to "keep going".

A single sign on its own does not mean much. It is the accumulation and the duration that should raise the alarm.

A way to take stock (not a test)

The questions below are not a validated tool. They do not give a score and do not allow any diagnosis. They draw on the three dimensions used by the WHO and the signs described by the HAS, to help you put words to what you are going through. Answer with the last four weeks in mind.

1. Do you feel you end most of your days with no energy left, even when they were no busier than usual?
2. Is a weekend's rest or a short holiday still enough to get you back on your feet?
3. Do you sometimes talk about your patients, in your head or with colleagues, with an irony or coldness that is unlike you?
4. Do you feel your work is less useful than before, or that you have become less good at it?
5. Does an account heard in session come back to you outside the practice to the point of affecting your sleep or mood?
6. Has the way you see people, safety or the future changed since you started working with certain patients?
7. Have you cut back on what does you good (sport, friends, sleep, leisure) to keep up with your schedule?
8. Has someone close to you recently told you that you have changed?

If you have answered yes to several of these questions for several weeks, talk about it. To a colleague you trust, to your supervisor, and to your GP. The HAS points out that questionnaires such as the MBI or the CBI are not designed for individual assessment. They can guide a conversation, not replace it.

The two reference questionnaires

• The Maslach Burnout Inventory (MBI). Created by Christina Maslach and colleagues, it is the most widely used tool in research. The version for helping professions (MBI-HSS) has 22 items across three scales, emotional exhaustion, depersonalisation and personal accomplishment. It is protected by copyright and its use requires a paid licence. Its publisher presents it as a research tool, not a diagnostic tool.
• The ProQOL 5. It has 30 items covering the last 30 days, split into three scales of 10 items (compassion satisfaction, burnout, secondary traumatic stress). It is free and available on the official ProQOL website, including in French. It can be copied provided the author is credited, nothing is changed and it is not sold. It is the most accessible option for a professional who wants to take stock alone, bearing in mind that it does not give a diagnosis.

What protects, according to the literature

The reviews cited above agree on a few levers. None is enough on its own, and no study gives a magic number (a maximum number of patients per day, for example). Here is what is documented, and how to apply it in a practice.

Supervision and peer supervision

Regular clinical supervision is among the protective factors identified by O'Connor and colleagues. The review by Van Hoy and Rzeszutek cites five studies in which supervision or personal therapy acts as a buffer. The 2021 « Code de déontologie des psychologues » (French psychologists' code of ethics) points the same way. It asks psychologists to define their own limits (principle 4) and invites them, when facing a difficult situation, to seek advice from experienced colleagues (article 17).

• Set a rhythm in advance (for example one supervision session a month) and put it in your diary like a patient appointment.
• If individual supervision is beyond your budget, a peer supervision group is an alternative. Support from colleagues comes up in several studies as a protective factor.
• Keep a space for yourself outside supervision. Personal therapy, if you feel the need, is also among the protections cited.

Workload and pace

A heavy workload is the most consistent risk factor in O'Connor's meta-analysis. In McCormack's review, the number of hours worked is associated with more exhaustion and depersonalisation. For secondary traumatic stress, what matters is the share of traumatised patients in the caseload (Hensel et al.).

• Decide on a maximum number of sessions per day and per week, then stick to it for a month to see the effect.
• Keep at least a few minutes between two patients. They are for taking notes, breathing and switching mental rooms.
• If you work with many traumatised people, spread these patients across the week rather than seeing them back to back.
• Block out patient-free days before going on leave, so you do not end up finishing files on holiday.

Administrative workload

It is not the main cause, but it weighs. McCormack's review lists administrative and non-clinical work among the workload-related risk factors. Van Hoy and Rzeszutek's review cites a study in which administrative paperwork predicts burnout. A growing backlog of notes adds a task to an already full day, and it often eats into rest time.

• Write your notes right after the session, in a few lines, rather than in a batch in the evening. A short template helps (see our session notes template).
• Group invoicing, emails and calls into a fixed slot in the week.
• For longer reports, our article on how to save time on clinical reports gives practical ideas.
• List what you still do by hand that could be simplified. Our article on the psychologist's administrative workload goes through these tasks.

Control over your work

Autonomy and a sense of control over one's work come out as protective in several reviews. In private practice, you control a good part of your organisation (hours, type of patients, length of sessions). It is worth reviewing these choices once a year, and not only when you set up. If you are setting up now, our guide to setting up in private practice as a psychologist covers how to organise the practice.

What happens outside work

The reviews cite social support, physical activity, sleep and a healthy lifestyle among the resources associated with less burnout. These links are modest and come from cross-sectional studies. They are no substitute for acting on workload.

When to call and who to call

The numbers in this section are French, Belgian and Swiss lines. They are meant for practitioners working in those countries.

If several signs persist, your first point of contact is your GP (in France, your « médecin traitant »). The HAS gives the GP the role of coordinating care, and states that sick leave is usually necessary when burnout is confirmed. If you are an employee, you can also ask to see the occupational physician at any time, including during sick leave.

In France

• SPS, l'institut pour la santé des soignants (the institute for carers' health, formerly the association Soins aux professionnels de santé). A free, anonymous helpline open 24 hours a day, 7 days a week, on 0 805 23 23 36. Psychologists answer the calls. It is for salaried and self-employed health professionals, students and their families. The association also offers an app and drop-in centres (« La Maison des Soignants »).
• 3114, the French national suicide prevention line. Free, 24 hours a day, staffed by trained nurses and psychologists. It also takes calls from family members and from professionals worried about someone.
• Association MOTS, for doctors and medical students, and therefore for psychiatrists. Support from one of the association's doctors on 06 08 28 25 89.

Think about continuity of care

Many practitioners delay taking time off for fear of "abandoning" their patients. The French psychologists' code of ethics covers this case. Its article 19 asks psychologists who must interrupt their work, for whatever reason, to seek to ensure continuity. In practice, this can mean a colleague who agrees to take over the most fragile patients. It is best to discuss this with a colleague before you need it.

How Delta works

Delta is an assistant for mental health professionals. During the session, it transcribes what is said and then prepares a session report that you review. You can also dictate your observations right after the session. It acts on only one of the factors described above, the note backlog, and replaces neither supervision nor medical advice.

Frequently asked questions

Sources

• WHO, Burn-out an "occupational phenomenon": International Classification of Diseases (28 May 2019)
• WHO, FAQ Burn-out an "occupational phenomenon"
• WHO, International Classification of Diseases (ICD-11 coming into force)
• ICD-11, code QD85 Burnout (code page)
• ICD-11, block QD80-QD8Z Problems associated with employment or unemployment
• HAS, Repérage et prise en charge cliniques du syndrome d'épuisement professionnel ou burnout (French guideline on identifying and managing burnout)
• O'Connor K., Muller Neff D., Pitman S. (2018), Burnout in mental health professionals: A systematic review and meta-analysis of prevalence and determinants, European Psychiatry
• McCormack H. M. et al. (2018), The prevalence and causes of burnout among applied psychologists: a systematic review, Frontiers in Psychology
• Van Hoy A., Rzeszutek M. (2022), Burnout and Psychological Wellbeing Among Psychotherapists: A Systematic Review, Frontiers in Psychology
• British Psychological Society, Research Digest on Simionato G. and Simpson S. (2018), Journal of Clinical Psychology
• Hensel J. M. et al. (2015), Meta-analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims, Journal of Traumatic Stress (summary sheet)
• McCann I. L., Pearlman L. A. (1990), Vicarious traumatization: A framework for understanding the psychological effects of working with victims, Journal of Traumatic Stress
• ProQOL, official website
• ProQOL 5, B. Hudnall Stamm (document with terms of use)
• Mind Garden, Maslach Burnout Inventory (MBI)
• Code de déontologie des psychologues (French psychologists' code of ethics), 2021 version
• Infirmiers.com, L'association SPS devient SPS, l'institut pour la santé des soignants (October 2025)
• Association SPS, press information (helpline)
• Santé Mentale, La plateforme d'appel SPS a reçu près de 5 700 appels en 2021
• Info.gouv.fr, 3114, le numéro national de prévention du suicide
• Association MOTS, leaflet (URML Normandie)
• Médecins en difficulté (Belgium)
• be.brussels, Aide psychologique (Centre de Prévention du Suicide, Télé-Accueil)
• ReMed, support network for doctors (FMH, Switzerland)
• La Main Tendue, 143
• Unisanté, list of resources (143 free of charge and 24/7)