Dr. L. is a 48-year-old clinical psychologist working in a community mental health center. She has worked as a clinician for over 19 years and has been employed within this center over the past 8 years. Over the course of the past 8 years, she has experienced a decline in both professional and support staff, while at the same time an increase in both the number of clients seen and the level of severity of the issues being presented. The pressure from external funding sources as well as internal administration placed emphasis on a mandate to see more clients and produce results with fewer sessions. The increased workload resulted in her working late hours, often 10 hour days, and twice a month being required to work a sixth day, Saturday, to increase her “productivity” figures.
The physical exhaustion of the increased workload, the reduction of physical and emotional support, and a general dissatisfaction and discomfort with what she saw as her inability to provide “adequate” service began to take its toll. As one who considered her work more than a job, a true vocation, the situation left her feeling professionally inadequate.
While these changes developed slowly, it became obvious that Dr. L. was experiencing a deep sadness and a lack of interest in engaging in previously enjoyable activities (e.g., racquet ball, golf, etc.). She was finding it difficult to make decisions within her practice, even to the point of failing to develop meaningful treatment plans for her clients. Dr. L. reported a concern that her ability to attend to her clients seemed diminished and that she had on occasion experienced moments when her memory went “blank.” She reported entering sessions in which she brought the wrong case file and even had three occasions where she either could not remember the client’s name or referred to the client by using another client’s name.
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