Preventing burnout when you care too much

Burnout Prevention When You Care: Match Minus One

Help! I Think I Care More Than My Client

Josie Askin, guest expert contributor for Physiotherapy New Zealand, Physio Matters April 2024. While the intended audience for this article was physiotherapists, the lessons it offers are equally applicable to anyone in service and care roles and those prone to “over caring”.

Imagine this: John, a 52-year-old male, returns to the clinic with that lingering lower back injury from his weekend sports stint with mates. Despite the comprehensive rehabilitation programme tailored specifically for him, the pain persists, and progress seems slow. You’ve tried numerous approaches and even consulted with a colleague to ensure you haven’t missed anything, but nothing appears to be working. You have noticed he’s quick to divert the conversation when you ask how he’s going with his exercises at home. And then there’s the subtle hints that he hasn’t taken the advice around rest and recovery seriously after a throw away comment about the driving range last Sunday. If you’re honest you’re starting to question your competence and whether you care more about his recovery than he does. Either way, it’s left you feeling frustrated and burnout by it all.

Physiotherapy, like my role as a Professional Performance Coach, is a profession deeply rooted in the emotional service of supporting individuals toward improved performance and wellbeing. The nature of the roles attracts individuals who are motivated to help people in whatever way they can, whenever possible. While this motivation is admirable, and perhaps essential for the role it can backfire. While all working individuals may experience burnout in their life, the rates of burnout appear to be higher for those who regular perform emotional labour, including healthcare professional like physiotherapists, coaches and front-line staff. This is particularly the case for physiotherapists where the role takes a high emotional and physical load.

Care Currency

Through my coaching practice I learnt about the concept of “Care Points”.

Care Points are like currency representing how much time and energy you have for an activity. Like a bank account, you spend Care Points when you perform activities that require energy – the more energy the action requires the more points you use. Care Points are deposited when you perform activities that replenish and recharge, like a good night sleep or time with family and friends.

Clients also have a certain amount of Care Points in their account. They too are juggling multiple demands for their time and attention, with recovery from an injury or illness being one of many. It’s up to the client to prioritise their activities, and ultimately how many Care Points they can afford to spend on their recovery.

Balancing Care Accounts to Prevent Burnout

The goal for everyone is to keep the Care Account topped up, at least balanced and ideally in credit for optimal performance and wellbeing. However sometimes a physiotherapist Care Account can go into debt. If not topped up, exhaustion, decreased job satisfaction and burn out may follow.

This can occur for multiple reasons including:

  • not getting enough help or support;
  • not having enough recovery time;
  • ineffective boundaries; and
  • over-caring.

Over-caring can occur when a physiotherapist cares more about the client’s recovery than the client does. This is like overtraining for athletes, which we know lead to undesirable outcomes.

Clients Care Accounts

You can apply the concept of “Care Points”’ to a similar scale as the 10-point scale like the pain scale for yourself and your client.

Figure 1. 10-point Care Point Scale

In John’s case he appears to be invested in his recovery given he returns to your clinic regularly for check-ups. However, compliance with home exercises and recovery is limited suggesting he’s somewhere in the middle of the Care Point Scale for his own recovery.

How Much Should You Care to Prevent Burnout?

In physical therapy, as in coaching, it is the client that is ultimately responsible for the actions they take. While you may want John’s recovery to be as smooth and as fast as possible, you can’t do it for him, and you shouldn’t either. In coaching this concept of facilitating client autonomy and ownership is a core coaching competency.

Match how much they care, minus one point”.

With this in mind when balancing out Care Points the formula “Match your client’s level of care less one Care Point” offers two main benefits:

  • It protects your own recovery and wellbeing ensuring you can continue to provide effective care for your clients. As the saying goes on airplanes, “fit your own mask before helping others”.
  • It empowers your client to be in the lead, and take control of their own performance and wellbeing with your careful guidance. This ownership will enable your client to be more proactive and confident about their wellbeing in the future. As the saying goes, “If you give a man a fish, you feed him for a day. If you teach a man to fish, you feed him for a lifetime.”

While you may feel as though you’re not “giving your all” by not giving each and every client “all the care in the world” there is a fundamental paradox, where by if you really care about a person and want to see them change and grow, you must care less about the change than they do.

Empowering Care

In physiotherapy and professional coaching there may be a time where practitioners can find themselves so deeply invested in their clients’ progress, that they care more than their client does.

The concept of “Care Points” offers a framework for maintaining balance, safe-guarding recovery and wellbeing and fostering client autonomy and resilience. Ultimately, true care lies in guiding clients with empathy and expertise while empowering them to take ownership of their own performance and wellbeing.


About the author

Josie Askin, CEO of Spring Coaching, is a performance and productivity coach who works with driven leaders and entrepreneurs to improve their performance and productivity.

Josie has nearly 20 years working in government, in a range of advisory roles. She became interested in the gaps between workplace performance and wellbeing, gradually building analogies between sport and business performance while gaining several coaching qualifications. Now she deals with clients under pressure from all walks of life offering tailored leadership performance coaching, workplace wellbeing programmes, workshops, speaking and facilitation.