A Conversation with Marcia - Part 2

Growth Is an Act of Courage

Meet Marcia - Part 2

Burnout is something you specifically work with. How do you distinguish burnout from depression? And who in Missoula do you find tends to come to you burned out?

Depression and burnout can look very similar on the surface. Both can involve exhaustion, reduced motivation, irritability, difficulty concentrating, and a sense of feeling overwhelmed. The difference is that depression is a mental health condition influenced by a complex interaction of biological, psychological, and social factors, while burnout is not a mental health diagnosis. Burnout is often a response to chronic stress, particularly when the demands being placed on a person consistently exceed the resources they have to meet those demands.

One thing I pay attention to is context. With burnout, symptoms are often closely tied to a particular role, environment, or set of responsibilities. Symptoms of burnout often improve hen the workload changes, when support increases, or a person's relationship to the work shifts. Depression tends to be broader and may affect many areas of life, including things that would normally provide enjoyment, meaning, or rest. Of course, burnout and depression can overlap, and sometimes prolonged burnout contributes to depression.

Burnout can happen in both personal and professional areas of life. I often see burnout in people with caregiving responsibilities. I also see burnout in people whose work environments or workplace cultures are fundamentally misaligned with their own values and in situations where personal boundaries are repeatedly ignored or disrespected. Sometimes those boundaries are ignored or disrespected by others. Sometimes they are ignored or disrespected by the clients themselves.

Your bio mentions that therapy with you ‘can include moments of humor, joy, and relief.’ That’s not what most people expect from therapy. Why is that important to you?

Healing isn't just about suffering less. It's also about experiencing more joy, more connection, and more moments that remind us that being human can also be good. When humor, joy, and relief are present, trust, safety, and connection are often present too. We're going to do really hard things together, and we can delight in each other a little bit along the way.

For someone dealing with burnout or anxiety, what does it mean when ordinary things start to feel good again — when the flatness lifts and they can actually enjoy something? Is the restoration of that capacity itself a goal you work toward, or does it arrive as a byproduct?

I think it's both. Restoring our capacity for pleasure and connection is something we work toward, and it's also something that often arrives as a byproduct. The tricky part is that we can't force ourselves to enjoy things. We can strive for it, but often we experience it by relaxing into it. When ordinary things start to feel good again, it's a sign that people are beginning to feel safe. Their mind, body, and heart no longer have to devote quite so much energy to protection and survival, and there is more room to feel good.

CBT for Insomnia is a specialty within a specialty. How did you come to focus on it?

Well, as many people might imagine, I came to focus on insomnia because I have experienced insomnia. And it sucks! I'm fascinated by sleep and intrigued by the many ways it affects our mood, relationships, physical health, and quality of life. I'm hungry to learn all I can about it. I know how frustrating, exhausting, and helpless it can feel when something that “should” come naturally is hard. Helping people find sleep and rebuild trust in their ability to rest is very meaningful to me.

Most people with sleep problems assume they need medication. Why is CBT-I often a better first-line treatment? What does it actually do that medication doesn’t?

I think culturally we have this idea that sleep is something we should just be able to do naturally. In reality, sleep is also a behavior and a practice that we can influence. Often, insomnia is something we unintentionally train ourselves into. CBT-I is a way of training ourselves back out of it. It helps rebalance our biological sleep-wake cycle and retrain the brain to associate the bed with sleep. One of the things I appreciate most about CBT-I is its simplicity. If we can rebalance your sleep cycle and rebuild trust in your ability to sleep, let's start there. If that doesn't work, then we can gather more information and explore additional options. Medication can be incredibly helpful and absolutely has its place. But medication generally helps people sleep while they're taking it. CBT-I teaches skills and changes patterns that can continue supporting sleep long after treatment is over.

What are the most common sleep mistakes you see — things people do thinking they’re helping their sleep but that actually make insomnia worse?

Great question, thank you for asking! The two most common mistakes I see are increasing time in bed to create more opportunity for sleep and going all-in on sleep hygiene.

Both of these responses are instinctual and absolutely reinforced by our culture. It makes perfect sense that if you're not sleeping, you'd try to spend more time in bed. And who among us hasn't been lectured about screen time before bed or the temperature of our bedroom? The problem is that neither approach addresses the underlying mechanisms that maintain chronic insomnia. In fact, sometimes they can unintentionally make it worse. 

Working with sleep gives you a window into how physical states drive psychological ones that most therapists don’t get. What does CBT-I reveal about the body’s role in mood and mental health — and does that change how you approach anxiety or burnout even outside of sleep issues?

Historically, the mental health field often treated insomnia as a symptom of other mental health conditions. The thinking was that if we treated anxiety or depression, sleep would naturally improve. Increasingly, though, we're understanding insomnia as a co-occurring condition rather than simply a symptom. You don't necessarily have anxiety causing insomnia or depression causing insomnia. You may have anxiety and insomnia, or depression and insomnia, etc..

What's fascinating is that treating sleep often improves anxiety and depression more than treating anxiety and depression improves sleep. To me, that's a powerful reminder of just how deeply our physical and psychological experiences are connected.

You describe offering ‘compassionate, honest reflection’ — meaning you’ll tell a client something real, even if it’s uncomfortable. How do you know when to offer that? And how do you deliver it so it lands as care rather than criticism?

First, trust is really important. Honest reflection is most useful if there is enough safety and trust in the relationship to support it. Second, I want my reflections to be grounded in the client's experience and what they've shared, not just my own ideas about what's happening. I don't want to tell people who they are. I want to offer observations and perspectives that might help them understand themselves more clearly. Timing matters, and I want to have enough information about a person's experience for my reflections to be grounded in who they are. What that timing looks like depends a lot on the person I'm working with. Lastly, I do my best to offer those reflections with empathy, humility, and openness to being wrong.

Even when I do all of those things, sometimes what I say still lands as criticism. And sometimes that’s ok. If there is trust in our relationship and the client is willing, then we can work through that. That's part of the healing.

What do you hope a client feels after their very first session with you?

Seen, heard, and maybe a little hopeful.

Learn more about Marcia with Part 1!