Die meisten Patienten mit einem Burnout-Syndrom kommen erst zur Therapie, nachdem sie vorher oft jahrelang versucht haben, selber einen Weg aus der Krise zu finden. In der Regel erfolgen diese Selbstheilungsversuche unter zunehmender Abspaltung und Ignoranz eigener seelischer Bedürfnisse. In den Anfängen sind die Symptome eines Burnout-Syndroms milde und es reichen punktuelle Massnahmen und kleinere Veränderungen, um sie zunächst wieder zum Verschwinden zu bringen. Es gibt aber auch viele Menschen, die sich bereits in einem fortgeschrittenen Burnout-Prozess befinden, ohne den Ernst der Lage zu bemerken und Hilfe zu holen! Weil sich Burnout-Syndrome meist sehr langsam entwickeln, werden sie von den Betroffenen und auch von Mitarbeitern, Vorgesetzten und Angehörigen selten rechtzeitig als Krankheit erkannt und gelangen, wie oben erwähnt, erst sehr spät zur Therapie!
Therapeutisch zunächst im Vordergrund stehen soweit vorhanden die Begleit- und/oder Folge-Störungen des Burnout-Prozesses, z. B. ein depressives Syndrom, Ängste, eine Sozialphobie oderTraumatisierungszeichen. Als „umschriebene“ Symptomkomplexe sind diese der Therapie zugänglicher als die unspezifischen Symptome eines Burnout-Syndroms, nämlich die Antriebsstörung, die inneren Widerstände, die chronische Erschöpfung und Müdigkeit. Gerade diese unspezifischen Störungen wirken sich, weil sie so schlecht definierbar und behandelbar sind, oft besonders nachteilig auf die berufliche und soziale Rehabilitation und Arbeitsunfähigkeit aus und werden nicht selten zum invalidisierenden Dauerzustand.
Spezifische Medikamente für Burnout-Patienten existieren nicht. Die „Identitätskrise“ benötigt in der Regel eine inhaltliche Therapie. Es geht um die leidvolle therapeutische Verarbeitung von Desillusionierungen, auch um Trauerarbeit sowie darum, sich neu aufzustellen und aus dieser Position heraus das Vergangene neu zu bewerten und dadurch „aufzuarbeiten“. Viele Patienten erleben die Einnahme eines Antidepressivums als zusätzliche Schmach, nicht als Hilfe. Sie reagieren entsprechend besonders sensibel auf Nebenwirkungen und setzen die Substanzen besonders oft eigenmächtig ab. Stattdessen besteht ein erhöhtes Missbrauschspotential gegenüber Tranquilizern und „Schlafmitteln“, welches früh besprochen werden und welchem gegengesteuert werden muß! Je weniger Kränkungsaffekte und je mehr typische depressive Affekte und Ängste vorherrschen, umso aussichtsreicher ist eine Begleitbehandlung mit Antidepressiva.
Manche Patienten mit Burnout-Syndrom weisen wie oben angedeutet erhebliche Zeichen von Traumatisierungen auf, sodass auch trauma-spezifische Therapie-Verfahren (z. B. autosuggestive Verfahren, Imaginieren etc..) zur Anwendung kommen können. Bei Patienten mit schweren Kränkungsgefühlen stellt die Stärkung des Selbstwertgefühls und die behutsame korrigierende kognitive Aufarbeitung einen Therapie-Schwerpunkt dar. Nicht selten dauert es in solchen Fällen sehr lange, bis überhaupt konkret über das Vorgefallene gesprochen werden kann, weil die Patienten die Konfrontation gar nicht aushalten. Trotzdem muß sie irgendwann erfolgen, damit eine Ausheilung erfolgen kann.
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