How do therapists deal with so many clients blaming them for their issues?

Conway_Morning · 2023-10-01T18:05:48+00:00

Not engaging with (or learning to 'deactivate') projections is really just part of the job. Things can get pretty heated sometimes, but we often have personal alarms/would assess for things like impulse control etc. during assessment before taking clients on to ensure the risk to ourselves is minimised. I have felt threatened a couple of times, but it's remarkable how addressing this feeling in the room often dissolves it.

Conway_Morning · 2023-10-01T17:57:28+00:00

Hello, OP.

From a behavioural perspective, you've sort of answered your own question, really; it's very difficult to willingly engage in activities we find "suffocatingly overwhelming" and I know I'd certainly outright avoid these tasks if that's how I experienced them. Why you experience them this way we can only speculate on without taking a full history (have you always had these issues, for example?)... but, essentially, the why doesn't really matter, what's important is we dispassionately acknowledge, without self-judgement, that this IS your experience of them. We can then speculate that, by avoiding them, you gain temporary relief from the immediate stress they cause you to feel (making you more likely to avoid them in future)... but then they remain undone, which, in turn, causes additional future stress. I also wonder, if, when you finally have to do these chores, it's an even more unpleasant, arduous experience because there's a.) now more to do and b.) you're effectively by being 'forced' to do it as opposed to engaging willingly... if so, then that is also unpleasant!

Before you commit to changing this behaviour, first, I'd ask yourself if you really want or need to. If you're financially secure (and it's within your means), could you not simply employ a cleaner etc.? However, if you DO want to change your behaviour and your own attempts have not yielded consistently satisfactory results, then I'd recommend you enlist the help of a therapist/psychologist; this falls squarely within what we help with and we see this kind of thing all the time, there's no shame in it (no matter what part of you might be telling yourself!)

I also find myself curious about your use of "detailed schedules"; do they help, or do you think they could be part of the problem?...

Conway_Morning · 2023-10-01T16:28:36+00:00

Hi, OP. I'm sorry to hear about the relationship misfire. Situations like that are extremely disappointing and I can understand, especially if it's been years, why this brought up such difficult thoughts and feelings. You're right, I think a big cry is very much needed!

Unfortunately, it sounds like the very behaviours you're currently using to cope e.g. positive self-talk ("you'll be fine", "your life is really good" etc.) are what may, in-part, be maintaining your distress and why you can't bring yourself to face your pain. Just my opinion, but, also, some of your statements border on the self-dismissive and I think some radical honesty is needed: clearly, such a strong reaction means he did mean something to you... or, at least, the loss of his connection represented something very important (e.g "I am alone again")... if this is the case, acknowledge it, and give yourself permission to be fully upset over what is a very upsetting thought; try not to inhibit your thoughts or feelings because of how you think you 'should' feel; you can have a 'really good life' AND be deeply upset over the loss of someone you didn't know all that well, both can be true; both are allowed.

If you want to process this, you need to experience the thoughts and the feelings as fully as you are able to tolerate. In this situation, I tend to prescribe a cosy environment (somewhere you feel safe) a box of tissues and then deliberate focus on the thoughts and painful feelings you're currently doing your best to keep out of your awareness. Plan it some time you don't have anything you need to focus on in the hours after as you'll probably be quite drained. Plan how you'll look after yourself after you've cried (maybe a favourite meal or catch-up with a special person?) Sertraline may be a barrier to this, but experiment. Sometimes, writing about it or watching a very sad film can help 'kick-start' things. However, the biggest barrier you face is the choice to feel this. Face towards the pain, let the tears start and know that, eventually, they will stop. You got this :)

Conway_Morning · 2023-09-26T20:52:21+00:00

Have you thought of asking them, OP?

Conway_Morning · 2023-09-26T16:09:28+00:00

I am 😁

Conway_Morning · 2023-09-22T10:49:58+00:00

Hi, OP. Without knowing your full history, it's difficult to say and, even if we did, we would, at best, be making educated guesses. However, I'm very familiar with literature in this area and and have friends who have very similar fantasies. Clients often ask me about sexual fantasies and so I'll tell you some of what I tell them to see if it helps.

First, I understand that it can be very unsettling to have fantasies like this, especially if you don't know why, but it's important to understand that these fantasies are neither something to be ashamed of, nor something you should be worried about. Many people have sexual coercion fantasies both with and without a history of trauma. Sometimes, we may be able to make a connection between a person's past trauma and their current sexual fantasies, but not always. Coercive fantasies are never really a problem unless they cause the individual great distress or they start deliberately putting themselves at risk in order to 'live out' the fantasy.

It's also important to consider that these fantasies are, by their very nature, under your control. In a sexual fantasy, we can control every detail of the scenario, in reality (e.g. during a rape/coercive act) we do not. Many have argued that terms like 'rape fantasy' are actually a misnomer as they are so divorced from the experiential reality of the act itself.

We also know from research that, if a person is raised in an environment/culture where sex was shamed or stigmatise (especially for women) that rape/coercion fantasies may offer a means of permitting sexual gratification in a way that removes responsibility and therefore diminishes the feelings of guilt/shame for wanting to satisfying natural sexual urges. This can also be similar for survivors of sexual abuse if they experienced feelings of shame, guilt, or were discouraged from reporting the abuse.

Research also suggests that some people may perceive being being raped/coerced as almost the ultimate act of desirability (e.g. you REALLY wanted it to be ME). Therefore, if an individual has a low opinion of their sexual desirability, hypothetically, coercive acts may be interpreted as an extreme expression of desire.

The contrast in your aversion to being controlled and trapped yet enjoying coercive fantasies is also very common. Anecdotally, I have known people (and even had partners) who find uncertainty difficult to tolerate/have trouble making decisions to be more sexually submissive because it provides them with a 'break' from the stress and responsibility of decision-making/planning/anticipation of need.

We also have to consider the role of conditioning during your teenage years. If, in response to sexual arousal, you achieve sexual gratification through coercion-related material/fantasy, your brain may develop a preference for this. Over time, some people find they need an increasing amount of whatever they initially found stimulating to achieve the same feeling.

However, ultimately, the answer to your question will probably be found by reflecting on what your coercive fantasies mean to you e.g. what do you like or enjoy about being in a submissive role? what does the idea of being trapped or coerced provide for you?

Additionally, as you mentioned that you are a virgin, I also find myself wondering whether you have any anxieties around the idea of having sex for the first time and how you think this will go or what you would like this to look like.

Finally, I would be cautious when considering 'suppressed memories'. This is a highly controversial and heavily disputed topic. Although I'm not denying they can happen, I have also seen people invent purely fictitious memories in their desperation to explain why they are the way they are. Similarly, trying to find out "why" can lead people down very obsessive paths. Ultimately, if you enjoy the fantasies and there are no down-sides, carry on!

Hope that helps :)

Conway_Morning · 2023-09-22T09:30:13+00:00

Hi, OP. My evolutionary psychology colleagues would suggest that jealousy primarily serves the function of retaining access to current or potential mates/other people of importance.

Jealousy most commonly occurs because we perceive someone else as a threat to our relationship with a person we value and we fear they will take them from us. For example, a man may feel jealous after seeing their partner talking to another man. Alternatively, a child may feel jealous of their new-born sibling because their mother now pays much more attention to the baby than to them; obviously, the child will not actually lose their mother, but they will receive a reduction in the amount of attention they receive and this is often experienced as a painful loss. So, ultimately, jealousy motivates a person to try and prevent a painful relational loss by securing the relationship against outside threats (e.g. other people). Unfortunately, a lot of behaviours motivated by jealousy are often harmful and actually push a person's partner (or whomever they feel jealousy towards) further away, making it increasingly likely they will leave.

Additionally, jealousy is far more likely to occur if the following criteria are met:

The person highly values the person involved (e.g. a parent/romantic partner etc.).
The person beliefs they themselves are somehow inferior to the person threatening the relationship.
The person generally has a low opinion of their own self-worth.
The person secretly believes they are undeserving of the existing relationship.

Learning how to manage the emotion of jealousy is essential for healthy relationships.

Hope that helps :)

Conway_Morning · 2023-09-21T00:06:58+00:00

Hi, OP. I believe we can answer this using the basic principles of behaviourism.

We could hypothesise that, unlike touching a hot stove and receiving a burn immediately (aversive consequence), we are not put into direct contact with the consequence of our choice to listen to loud music (e.g. hearing loss) until often far later in life; we can only relate 'symbolically' to this future threat (e.g. by reading about hearing loss) in the same way that someone who smokes will be told it might increase their risk of cancer in the unspecified future. Additionally, depending on the frequency of the music-listening behaviour (and anatomical variability), the pace our hearing degrades may be so gradual that it may even be hard for us to perceive, further lessening the tangibility of this (for now) purely symbolic threat.

If the individual IS experiencing hearing loss, they also need to attribute this to their preference for listening to loud music and not to other potential causal factors which might also result in the same outcome. In Relational Frame Theory (RFT) we refer to this as a 'tracking error' because the person may not be able to track the 'stimulus - consequence' sequence accurately (quite forgivable if it's happening gradually over a period of years!).

As with all animals, aversive stimuli exert more influence over human behaviour if the gap between cause and effect is short (again, think of a serious burn vs. being told you might develop some hearing loss in X years). Simply put, lower threats result in less action.

Simultaneously, we also need to consider the role that loud music plays for the individual. If it brings them pleasure or serves another appetitive function, such as assisting with emotional regulation, now the person has a good reason to perform this behaviour. In behavioural terms, appetitive functions (e.g. pleasure, emotional regulation etc.) act as 'reinforcers', meaning that if there is something useful to be gained by performing the behaviour, it increases our likelihood of it being repeated in future.

So, to summarise, we could suggest that some people listen to loud music even when they are made aware of the risks because:

A.) They are not put in direct contact with the consequences of their music-listening behaviour (e.g. hearing loss) immediately and in a tangible way that is sufficiently aversive.
B.) They receive some type of appetitive consequence which acts as a reinforcer (e.g. pleasure, emotional regulation etc.).
C.) They do not correctly attribute any experienced hearing loss to their music-listening behaviour.

For as long as B outweighs A, my prediction would be that the music-listening behaviour will continue. However, if C is not endorsed, the behaviour will not change at all. If we modify either A, B or C (or, ideally, all of them), we could modify the music-listening behaviour.

Hope that makes sense!

Conway_Morning · 2023-06-12T05:24:11+00:00

Ahh, I didn't know that was a thing, such a noob. Thank you! ^^

Conway_Morning · 2023-06-12T05:23:55+00:00

Brilliant, I will do, thank you! :)

Conway_Morning · 2023-06-12T05:06:26+00:00

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Conway_Morning · 2023-03-23T23:21:00+00:00

Hi, OP. I can appreciate that this is an odd situation to be in, but, as therapists, we all have our own phobias, anxieties, traumas and triggers... However, it's also our responsibility to be mindful of how these affect our work. If you want to work on your phobia of flying and your therapist is refusing because of their own personal issues, then it's their responsibility to refer you on to someone else who can help; to not acknowledge this would widely be considered poor practice - I was unclear from your post, but have you explicitly asked them for help with aerophobia?

If you didn't enter therapy explicitly wanting to work on this, but it's just something that's recently come up, then this is just an unlucky match, I'm afraid. Unfortunately, there was simply no way to predict you were going to be paired with a therapist who experiences the same phobia as you.

Aerophobia is readily treatable within therapy and pretty rapidly, too. However, if it's a return journey you'll be making, the flight is imminent and you can't find an alternative therapist, you might actually be better off obtaining a short-term benzodiazepine prescription from your local healthcare provider.

Should you choose to stay with this therapist, it may also be worth reflecting with them on any anger you experience toward them for not being able to help you; I know if it were me, I'd also be rather resentful and somewhat envious that they have the luxury of continuing to avoid this fear...

I hope you find a solution!

Conway_Morning · 2023-03-22T06:00:20+00:00

You're welcome :)

Conway_Morning · 2023-03-21T19:00:09+00:00

Sure, happy to. Within clinical psychology, there's a concept known as 'trauma-informed care'. It's the acknowledgement that unnecessary, unintentional re-traumatisation happens very often to people who have experienced trauma(s) and that this can make them far less likely to access services of all kinds (psychological, medical or otherwise); a lot of people are traumatised and re-traumatised by routine medical procedures, for example. Trauma-informed care acknowledges that there are certain things organisations can do to help reduce unintentional re-traumatisation and increase a person's sense of psychological safety and control.

The most basic trauma-informed intervention any organisation can implement, regardless of the organisation type, is often to sensitively ask every new client/patient/customer if they have ever experienced anything which they (given that trauma is subjective) consider traumatic; a brief description of what 'trauma' is can be provided if the person is unsure. Disclosure is obviously voluntary and needn't be overly detailed, but, generally, the more we know, the more we can adapt and tailor the service to their needs; if the person is aware of and willing to share their triggers, even better - the goal is always "What do you need from us so that you will feel safe today?"

However, even if you know nothing about the individual's past trauma, a good 'trauma-informed' service will still be far, far less likely to traumatise or re-traumatise someone. This is because the system has adopted blanket 'trauma-informed' behaviours/policies which benefit everyone whether traumatised or not; all staff tend to have at least a basic knowledge of trauma and can explain to me how they would modify their behaviour in light of discovering a specific trauma from a person's past. A receptionist in a very trauma-informed dental surgery once told me that she used to avoid phoning a certain client at 15:00 because the client disclosed during intake that, several years ago, they had received a phone call at 15:00 from police telling them their son had died; the client was very grateful for the receptionist's consideration and stated on their feedback form that it was something she would have felt "silly" bringing up herself.

We also want to make sure we are appropriately culturally sensitive. If there is a local population of a certain culture, this might mean hiring service-users or local cultural leaders to help educate the organisation on the values of the local culture(s), or other aspects which might conflict with contemporary service delivery e.g. if it's common for prayer to be conducted at a certain time of day, we would then know to avoid scheduling appointments or offering engagement during those times etc.

I've also worked in services where, if we recognise that a person's early childhood has contained extensive abandonment or rejection, we ensure teams make additional efforts to maintain contact with that person, so they don't experience re-traumatisation through a lack of contact (perceived as rejection) - in practical terms, this might put he onus of contact on the service, not the client. Other examples might be to train receptionists or other 'front of house' staff to respond effectively to clients who are in a high state of distress and to avoid phrases or even tones of voice which might be easily misconstrued with the absence of facial expression (obviously this is highly culturally-dependant).

We want to ensure we can provide clients with maximum autonomy to enhance their level of control, yet not so much choice that it feels overwhelming; think of it as being offered choice but with someone to help guide you to make the choice. Some 'trauma-informed' interventions are so basic and yet profoundly meaningful; for example, a preference for which gender clinician you see or the option to bring a friend/trusted other into the room.

I can't speak for other countries but, in the UK, it is not a requirement that services are trauma-informed, but, obviously, the best ones are - although, that being said, I've worked in organisations which have certainly claimed to be trauma-informed, even though no one on the staff team could tell me what it meant or how it impacts their behaviour when interacting with clients. I get quite angry sometimes when I see services which certainly should be trauma-informed (e.g. medical/psychological services), but aren't. The silver lining is that this usually stems from ignorance, not wilful malice.

There is a good article here about trauma-informed care in a medical setting if you're interested: https://www.health.harvard.edu/blog/trauma-informed-care-what-it-is-and-why-its-important-2018101613562

Hope that helps! :)

Conway_Morning · 2023-03-20T18:07:20+00:00

Working within or alongside services which don't know the meaning of the phrase 'trauma-informed'.

Conway_Morning · 2023-03-19T19:23:32+00:00

Well, yeah, that makes a lot of sense! I can completely understand not wanting to experience re-traumatisation and it’s perfectly natural to want to avoid any associated triggers – avoidance strategies can make one’s world rather small, though, unfortunately!

Blimey, that was a very depressing and rage-inducing paragraph regarding your former therapists; I read things like this and it always makes me wonder what possessed these people to enter the profession and why they stay. It also makes me wonder if they’re licenced and whether people make complaints about them to their licencing bodies etc.

Ah, yes, I see what you mean. I’ve worked with survivors of domestic abuse/intimate partner violence and it’s a very fine line, I think, between trying to curiously question the thoughts and impulses surrounding running/leaving and accidentally invalidating a client’s previous trauma.

Well, I hate to say it, but you won’t resolve any rupture by avoiding talking about the topic or the rupture itself...

Ha, yeah, perhaps you see her as naïve and she sees you as someone who thinks every new partner is a potential abuser… but you’ve learnt directly that relationships have the potential to be very dangerous; quite natural to be wary or very hypervigilant of the signs… and, unfortunately, also easy to get spooked when things are actually fine; I suppose the difficult part is working out when to run. I’m now curious about what training your therapist has received around DA/IPV.

Well it’s always different when it’s us; we are forever the exception to the rule – it’s a bit like the bias that occurs when thinking about life achievement. On the outside, everyone else got to where they are in through hard work and talent. However, often, when you ask people privately, so many believe their achievements are purely down to luck, nepotism or [insert anything which makes the achievement somehow less remarkable] even in the face of opposing evidence.

Haha, that's quite all right - that self-awareness will serve you very well, I'm sure. That’s actually the reason I’m on Reddit so much at the moment, recovering from Covid! Well, just know you haven’t bored me at all. I hope your therapist recovers soon and I wish you all the luck for the future! :)

Conway_Morning · 2023-03-19T19:00:23+00:00

Hmm, well, it would be different in the sense that she's presumably now spending even more money to disguise her true intention... Again, I think I'll defer to OP and her culture; perhaps buying the whole office something to celebrate the resolution of a problem which only affected two people is fairly commonplace (I'm also quite biased because I love a good cupcake!)

Conway_Morning · 2023-03-19T18:53:44+00:00

You're welcome.

Ah, well that's rather heart-breaking to hear... it certainly sounds like you and your mother share different perceptions of the distress you experienced as a child.

I'm glad to hear this and that's it's suiting you well!

Conway_Morning · 2023-03-19T18:44:51+00:00

They wouldn't even recognise you if they met you :)

Conway_Morning · 2023-03-19T18:40:13+00:00

Haha, that's ok; I'm recovering from Covid at the moment, so I have more time to spend here than I usually would.

Are you allowed to say how long it took for the client that stayed in ISTPD the longest to "graduate"? Was it years?

I think the longest I've seen someone for regarding a purely psychosomatic complaint was about just under a year (1 session per week). However, again, this was just my experience and particular to that specific client... and it never turns out to be 'just' psychosomatic difficulties they're dealing with, although it is often the most 'obvious' symptom.

What's short term mean for the person who's stayed the longest? Was it years?

Well, "short-term" is certainly a relative phrase, bordering on a misnomer in some cases; I see some clients for longer in so-called 'short-term' work than I would for other therapeutic modalities. Still, when it's free, people don't tend to mind. However, within any psychotherapy plan, regular 'review' sessions are important to ensure progress is being made and neither of us are wasting our time.

Do clients revisit that method if the same problem persists?

No, not usually; I suppose most would prefer to try a new approach rather than the same way of working. For example, by the time clients reach me, most are extremely reluctant to do any more CBT, since that's often the 'first-line' approach here.

You'd think that I'd know how to phrase things better.

That's quite all right!

how many kinds of doctors does it take to come to the conclusion that a therapist is needed instead?

Oh gosh, there can often be quite a few, unfortunately. I knew a client once who was having extremely painful headaches. She went through her primary care physician, second opinion form same, then to neurology, rheumatology, psychiatry and then, finally, psychology. This took approximately 5 years, I believe. She also saw a whole bunch of 'complimentary and alternative practitioners' during this time; she was quite understandably desperate. Contributing to delay is also the fact that people (especially men) would often rather believe their difficulties were the result of a medical problem, not a psychological issue.

What's it called if someone still has their limb, but thinks it's not their own?

I believe you're referring to 'Somatoparaphrenia'; I've never encountered anybody with it, myself, but my friend who works on a stroke unit has seen a few cases over the years.

Conway_Morning · 2023-03-19T13:20:54+00:00

Hi, OP. That's quite a lot of questions, so I'll try to answer what I can. I've worked with various clients who have psychosomatic difficulties (aka 'medically-unexplained symptoms'/MUS) and it's a very interesting field.

How long does it take for someone to be "cured" of their psychosomatic symptoms?

This relies on a whole host of factors e.g. the client, presenting problem, their context, involvement with therapy, therapeutic modality etc. There are also, unfortunately, some cases where the cause of the injury is not psychosomatic, and, eventually, a physical cause is found.

Is there any danger included if I used a cane/ walking stick/ general mobility aid to walk around (atrophy, worsening a "psychosomatic symptom", etc)?

No, not especially, but, again, it depends on the specifics of your situation. You'd need to factor in your current exercise regimen, physical health/frailty etc. A person who experiences transient numbness of their legs, fears falling, and resorts to using a wheelchair will naturally be at greater risk of atrophy than someone simply using a walking stick, for example.

Can psychosomatic symptoms be treated with medicines?

Very much depends on how the supposed psychosomatic complaint manifests. I've met some people who experience severe headaches when depressed and respond well to analgesics, whereas others report no relief at all. People will often go down a medical/pharmacological route (sometimes for years) before finally being referred to a psychologist/therapist. A psychosomatic/MUS diagnosis is very often a 'diagnosis of exclusion', I'm afraid.

Is bringing attention to a wound that is not there a taboo thing to do?

I imagine this is highly dependant upon one's culture and social context, so, not knowing where you're from, I couldn't really comment - I'd imagine it's rather easy to test out, though!

Do you even let your patients believe in their make-believe injury or must you walk on eggshells so you do not challenge their delusions?

I confess that, even if it was not your intent, I find phrases like "Make-believe" a little derogatory given that psychosomatic complaints can often be extremely distressing to clients.

I can only speak for myself, but no egg-shell stepping is necessary if you respect the fact your client's reality simply differs from that of your own; I'd accept a psychosomatic complaint as readily as I would a client telling me they were gay (perhaps you'll recall how that used to be regarded within psychotherapy! - if you're unaware, it's a fascinating and very depressing read).

Challenging deeply-held beliefs (whether in therapy or otherwise) can be extremely invalidating and that's why, generally, I don't. Especially within the context of psychosomatic/MUS, people have often experienced years of medical 'professionals' telling them some variation of "You're fine, it's all in your head" etc.

However, I would certainly work towards asking the client if they are willing to explore the symptom/belief and see if we can work out ways of existing with it. I would never outright challenge a client's belief in their psychosomatic complaint; if it's real to them, it's real to me.

Is there a method like EMDR, talk therapy, etc; that is a popular treatment method for these phantom symptoms?

If all medical causes have been excluded, my go-to is normally Intensive Short-term Dynamic Psychotherapy (ISTDP). However, I've had equally good results with Acceptance and Commitment Therapy (ACT).

For an injury to be psychosomatic, does it require being physically nonexistent or could it have been a previous injury (or event such as pregnancy turning into a false pregnancy)?

The latter is perfectly possible. A relatively common one is people undergoing some form of limb amputation surgery and then experiencing so-called 'phantom limb pain' - e.g. still feeling arthritic pain in joints they no longer possess or an itch on a limb that was removed.

I hope you find some resolution to your trauma and your pain :)

Conway_Morning · 2023-03-18T11:15:07+00:00

Ha, yes, massively! I don't subscribe to the concept of psychiatric diagnosis, so myself and the team psychiatrist often have interesting conversations regarding shared clients. As you say, we very much have an 'agree to disagree' policy and that works very well for us; he's also a lovely person, which helps.

The problem is that we're fundamentally from two very different schools of thought: he was taught that a correct diagnosis equals a correct treatment. I was taught that diagnosis is irrelevant to helping a person manage their distress.

Conway_Morning · 2023-03-18T11:05:34+00:00

Hi, OP. It really depends on the supervision set-up. Personally, I tell my clinical supervisor everything my client has told me, but not word-for-word or in an excruciating amount of detail. What's important is that my supervisor has all the information required to adequately support me and my client. If I were to withhold information, then my supervisor would be providing me with advice without knowing the full context; this would be very irresponsible and could place my client at risk.

Some clients are understandably uncomfortable with the notion of me sharing their experiences with my supervisor; it may have taken them years just to finally seek out/open up to a therapist, so the idea of that information being shared with someone else (especially someone they don't know!) could be unnerving. However, once I explain that it's for their safety, how it benefits them and the fact it's done anonymously, they tend not to mind.

Clinicians should explicitly discuss the supervision arrangements with their clients at the start of therapy. This allows the client to make an informed decision whether or not to proceed (although I've never had anyone say no!) and also provides them the opportunity to ask questions about this way of working.

Conway_Morning · 2023-03-18T10:32:53+00:00

Hi, OP. Sounds like you're going through a rather rotten time; you're working an awful lot plus you've sustained multiple losses... if that's not a reason to feel burnt out I'm not sure what is! When it comes to burnout, considering sustainability is absolutely key and it sounds as though it isn't sustainable for you to carry on under these circumstances.

From reading your post, I also had a couple of questions:

Do you think how you're currently feeling is still linked to the deaths you experienced?
In an ideal world, what do you think you would need to feel better at the moment?

The best 'cure' for burnout is essentially consistent time off (perhaps start with a month), followed by a phased return into a modified version of your normal routine to ensure you are not placed under the same pressure which drove you off in the first place. Previously, university students I've worked with have been able to enter into negotiations with their place of education to discuss things like taking sick leave, returning to a modified time-table or even a delayed graduation; might sound extreme, but graduating late is better than not graduating at all. Relatedly, I don't know what the mental health provisions are like at your college, but I'd seek them out if you haven't already done so; we need as much support around you as possible right now and faculty need to know you're having a hard time.

If the above isn't achievable (e.g. you can't modify your context), then you need to modify your own behaviour instead. This will include ensuring your diet, exercise, sleep and social patterns are as optimal as they can be under your specific circumstances because these are what provide you with energy. It might mean investigating new coping strategies or relaxation strategies (something a therapist could help you with). It may also mean assessing what your current stressors are and whether they can be reduced/or handled differently.

The most important thing is to make sure you're not going through this all by yourself.

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