Unveiling the Hidden Toll of Therapy: Nurturing the Healers Within

June 7, 2023
Person with a clipboard sitting and taking notes.

By Dr. Jen Blanchette

Imagine a serene room, softly lit, where individuals come seeking solace, guidance, and healing. Behind every compassionate therapist lies an incredible journey of resilience, dedication, and empathy. However, what remains unseen is the immense toll therapy can take on these very healers. Welcome to our exploration of the often-untold story, where we delve into the complexities of a therapist’s world, exposing the profound challenges they face and the strategies they employ to overcome them. In this article, we embark on a captivating journey through the shadows of therapy, shining a light on the elusive trio of burnout, compassion fatigue, and vicarious trauma. Burnout, a state of emotional, physical, and mental exhaustion, lurks at the end of the treacherous path marked by prolonged exposure to stressful work conditions. We unravel the layers of compassion fatigue, a unique form of burnout borne from the selfless art of caring for others. Moreover, we delve into the depths of vicarious trauma, a haunting phenomenon where therapists find themselves sharing the weight of their clients’ traumatic experiences.

But it doesn’t end there. We present a lifeline, a glimmer of hope amidst the challenges. The heart of our discourse lies in revealing vital strategies that can prevent and manage the toll therapy exacts. These invaluable techniques empower therapists to rejuvenate their spirits, protect their well-being, and bolster their ability to deliver exceptional care to those who depend on them.

What is Therapist Burnout?

Therapist burnout is a state of emotional, physical, and mental exhaustion that results from prolonged exposure to stressful and challenging work. Burnout can occur when therapists feel overwhelmed, unappreciated, and unsupported in their work. Symptoms of burnout include feelings of cynicism and detachment, emotional exhaustion, reduced productivity, and a sense of hopelessness.

Burnout is a common issue among mental health practitioners, with studies estimating that anywhere between 21% and 61% of practitioners experience symptoms of burnout (Morse et al., 2012). Workplace factors such as high caseload size and severity of client symptoms have been linked to burnout (Acker, 2011; Craig & Sprang, 2010; Thompson et al., 2014). In contrast, research has shown that smaller caseloads, less paperwork, and more workplace flexibility can help prevent burnout (Lent & Schwartz, 2012). The negative outcomes of burnout can affect both practitioners and their clients, with physical symptoms such as headaches and gastrointestinal problems also being reported (Kim et al., 2011).

What is Compassion Fatigue?

Compassion fatigue is a type of burnout that is specifically related to the work of caring for others. It occurs when therapists experience emotional exhaustion and a reduced ability to empathize with their clients. Compassion fatigue can lead to a loss of enthusiasm for work, a feeling of being emotionally drained, and a sense of being overwhelmed by the needs of clients.

What is Vicarious Trauma?

Vicarious trauma occurs when therapists are exposed to the traumatic experiences of their clients, and they begin to experience some of the same symptoms as their clients. Symptoms of vicarious trauma include intrusive thoughts, difficulty sleeping, a feeling of being overwhelmed, and a sense of despair or hopelessness.

Reasons why therapist burnout may be different

In a review of the literature  on burnout in clinical psychologists (McCormack et al., 2018)  identifies emotional exhaustion as the most common dimension of burnout, which results from high workload demands. The review also highlights the importance of social support for managing stress and burnout, with supervisors and peer-based support being recommended as resources to reduce burnout in clinical psychologists. The review finds a lack of theoretically driven research into burnout among psychologists. Studies have shown that burnout is prevalent across various professions and nationalities, with workload being a significant contributor. (Acker, 2012; Maslach, 2003; Hannigan et al., 2004; Rupert & Morgan, 2005; and Bearse et al., 2013).

  • High caseloads and long working hours: Therapists who work long hours and have high caseloads may feel overwhelmed and struggle to maintain work-life balance.
  • Compassion fatigue/emotional exhaustion: Working with clients who have experienced trauma or other challenging life experiences can be emotionally draining and may contribute to burnout.
  • Lack of support and supervision: Therapists who do not receive adequate support from colleagues, supervisors, or the organization they work for may feel isolated and unsupported.

Research has shown that ethical challenges and burnout are interconnected for therapists. When therapists experience ethical challenges in their work, it can take an emotional toll and increase the risk of burnout (Barnett, Baker, Elman, & Schoener, 2007). On the flip side, burnout can also impair therapists’ ability to make ethical decisions (Taylor, Bohart, & Elliott, 2014). This is why it’s important for therapists to prioritize self-care and maintain ethical standards to prevent burnout.

Self-care practices are essential for preventing burnout in therapists. Engaging in activities like exercise, mindfulness, and social support can help therapists manage stress, maintain emotional regulation, and improve job satisfaction (Barnett, 2008; Norcross & Guy, 2007). By prioritizing self-care, therapists are more likely to stay in the profession for the long term.

Therapists are not immune to mental health problems, and research shows that they may experience mental illness at similar rates as the general population (Bishop, 2005). However, therapists may be less likely to seek treatment for their mental health concerns due to stigma and fear of professional repercussions (Gabbard & Nadelson, 2016). This highlights the importance of prioritizing mental health and seeking support when needed. Overall, research suggests that therapists’ ethical practice, self-care, and mental health are interconnected and critical for maintaining a sustainable and fulfilling career in the mental health field.

What helps? 

Protective factors have been identified that can mitigate the risk of therapist burnout, in addition to the risk factors. One such protective factor is social support, which has been found to reduce feelings of isolation and provide validation (Maslach & Leiter, 2016). Self-care activities, such as exercise and mindfulness practices, have also been found to reduce stress and replenish emotional resources, thereby reducing the likelihood of burnout (Mealer et al., 2017). Job satisfaction is another protective factor, as therapists who feel satisfied with their work are less likely to experience burnout (Shanafelt et al., 2016). Finally, education and training can provide therapists with the skills and resources needed to manage the demands of the job and prevent burnout (Dyrbye et al., 2014).

Compassion satisfaction, defined as “the positive feelings that derive from helping others or making a positive difference in their lives” (Stamm, 2010, p. 6), is another important concept in the context of therapist well-being. It has been studied in various contexts, including among trauma treatment therapists and healthcare providers (Craig & Sprang, 2010; Boyle et al., 2017). Research has shown that compassion satisfaction is positively associated with job satisfaction, work engagement, and resilience (Bride et al., 2014; Jenkins & Baird, 2012; Sabo, 2011). Furthermore, mindfulness-based stress reduction interventions have been found to increase compassion satisfaction among healthcare providers (McClelland et al., 2017). However, more research is needed to better understand the factors that contribute to compassion satisfaction and how it can be promoted in different settings.

Preventing and Managing Therapist Burnout, Compassion Fatigue, and Vicarious Trauma

Therapists can take steps to prevent and manage burnout, compassion fatigue, and vicarious trauma. Here are some strategies that therapists can use:

  •  Self-Care: Therapists should prioritize self-care and engage in activities that promote their physical, mental, and emotional well-being. This can include exercise, meditation, spending time in nature, and engaging in hobbies and interests outside of work.
  • Boundaries: Therapists should establish clear boundaries with their clients, colleagues, and supervisors. This can include setting limits on the number of clients they see each day, taking breaks between sessions, and communicating their needs and expectations clearly.
  • Supervision: Therapists should seek out regular supervision and support from colleagues and supervisors. This can include discussing challenging cases, receiving feedback on their work, and seeking guidance on how to manage difficult situations.
  • Continuing Education: Therapists should continue to learn and grow in their profession by attending workshops, conferences, and training programs. This can help them stay current on the latest research and techniques, and provide new ideas and inspiration for their work.
  • In addition to the general strategies for managing and preventing burnout, therapists can also take specific steps to manage the neuropsychological symptoms that may arise. Some tips for managing brain fog and decreased work output may include:
  • Take breaks between sessions: It can be helpful to take a few minutes to rest and recharge between sessions. This can help reduce the cognitive load and prevent brain fog.
  • Prioritize sleep: Getting enough sleep is essential for cognitive functioning. Aim for seven to eight hours of sleep per night, and establish a consistent sleep routine to help improve the quality of your sleep.
  • Engage in physical activity: Exercise has been shown to improve cognitive functioning and reduce stress. Try to incorporate regular physical activity into your routine, such as walking, yoga, or running.
  • Practice mindfulness: Mindfulness practices such as meditation or deep breathing can help reduce stress and improve cognitive functioning.
  • Stay hydrated: Dehydration can impair cognitive functioning, so it’s important to stay hydrated throughout the day.
  • Seek support: If you are experiencing significant symptoms, such as brain fog or decreased work output, it may be helpful to seek support from colleagues or a mental health professional. They can provide guidance and support in managing these symptoms.
  • Prioritize self-compassion: Be kind and understanding with yourself. Burnout and its symptoms are not your fault. Prioritize self-care, rest, and recovery to help manage the symptoms and prevent burnout from escalating.


The article discusses the toll that therapy can take on therapists, including burnout, compassion fatigue, and vicarious trauma. Burnout is a state of emotional, physical, and mental exhaustion that can occur as a result of prolonged exposure to stressful work conditions. Compassion fatigue is a type of burnout that is specifically related to the work of caring for others, while vicarious trauma occurs when therapists experience the traumatic experiences of their clients.

The article provides strategies for preventing and managing these issues, including prioritizing self-care, establishing clear boundaries, seeking out regular supervision and support, continuing education, and managing the neuropsychological symptoms that may arise. By incorporating these strategies, therapists can manage the symptoms of burnout and improve their ability to provide quality care to their clients.


Acker, G. M. (2011). Burnout among mental health care providers. Journal of Social Work, 11(1), 33-46.

Craig, C. D., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety, Stress, & Coping, 23(3), 319-339.

Kim, H. J., Shin, K. H., & Swanger, N. (2011). Burnout and engagement: A comparative analysis using the big five personality dimensions. International Journal of Hospitality Management, 30(1), 96-104.

Lent, R. W., & Schwartz, R. C. (2012). The prevention of burnout in helping professions: Practice, research, and theory. Psychology Press.

McCormack, H. M., MacIntyre, T. E., O’Shea, D., Herring, M. P., & Campbell, M. J. (2018). The Prevalence and Cause(s) of Burnout Among Applied Psychologists: A Systematic Review. Frontiers in psychology, 9, 1897. https://doi.org/10.3389/fpsyg.2018.01897

Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341-352.

Thompson, B. M., Schoeder, B. T., & Sherman, R. (2014). Emotional burnout and perceived sources of stress among staff at a mental health hospital. Journal of Clinical Psychology in Medical Settings, 21(3), 310-319. 

Boyle, D. A., Plack, M. M., Collins, M., & Glass, D. J. (2017). Compassion fatigue and compassion satisfaction in hospice social work. Journal of Social Work in End-of-Life & Palliative Care, 13(1), 1-16. doi:10.1080/15524256.2016.1243325

Bride, B. E., Robinson, M. M., Yegidis, B., & Figley, C. R. (2014). Development and validation of the secondary traumatic stress scale. Research on Social Work Practice, 24(1), 27-35. doi:10.1177/1049731513489185

Craig, C. D., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety, Stress, & Coping, 23(3), 319-339. doi:10.1080/10615800903085818

Jenkins, B., & Baird, S. (2012). Secondary traumatic stress and oncology social work: Protecting compassion from fatigue and compromising the worker’s worldview. Journal of Psychosocial Oncology, 30(6), 671-683. doi:10.1080/07347332.2012.719838

McClelland, L. E., Vogus, T. J., & Compassion and Mindfulness in Medicine Study Team. (2017). Compassion practices, nurse well-being, and ambulatory patient experience ratings. Medical Care, 55(4), 391-398. doi:10.1097/MLR.0000000000000694

Sabo, B. M. (2011). Compassion fatigue and nursing work: Can we accurately capture the consequences of caring work? International Journal of Nursing Practice, 17(2), 135-142. doi:10.1111/j.1440-172X.2011.01922.x

Stamm, B. H. (2010). The concise ProQOL manual (2nd ed.). Pocatello, ID: ProQOL.org.

Boyle, D. A., Furey, W. M., O’Brien, K. E., & Wasson, K. (2017). Compassion satisfaction, burnout, and secondary traumatic stress among clinicians: Comparing psychiatry and palliative care. Journal of Palliative Medicine, 20(11), 1217-1223. doi: 10.1089/jpm.2017.0153

Craig, C. D., & Sprang, G. (2010). Compassion satisfaction, compassion fatigue, and burnout in a national sample of trauma treatment therapists. Anxiety, Stress & Coping: An International Journal, 23(3), 319-339. doi: 10.1080/10615800903085818

Dyrbye, L. N., Shanafelt, T. D., & Sinsky, C. A. (2014). Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. National Academy of Medicine Perspectives, 4(10), 1-8. doi: 10.1016/j.japh.2017.09.017

Jenkins, B., & Baird, S. (2012). Secondary traumatic stress and oncology social work: Protecting compassion from fatigue and compromising the worker’s worldview. Journal of Psychosocial Oncology, 30(1), 70-83. doi: 10.1080/07347332.2011.623861

Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15(2), 103-111. doi: 10.1002/wps.20311

McClelland, L. E., Vogus, T. J., & Compassion Practices, O. T. (2017). Compassion practices, nurse well-being, and ambulatory

Barnett, J. E. (2008). Self-care and the ethical imperative. Psychotherapy: Theory, Research, Practice, Training, 45(4), 583-590. doi: 10.1037/a0013744

Barnett, J. E., Baker, E. K., Elman, N. S., & Schoener, G. R. (2007). In pursuit of wellness: The self-care imperative. Professional Psychology: Research and Practice, 38(6), 603-612. doi: 10.1037/0735-7028.38.6.603

Bishop, J. E. (2005). The mental health of psychotherapists: A review. Clinical Psychology Review, 25(1), 91-116. doi: 10.1016/j.cpr.2004.09.002

Gabbard, G. O., & Nadelson, C. C. (2016). Professional boundaries in the era of the Internet. Academic Psychiatry, 40(5), 835-839. doi: 10.1007/s40596-016-0529-9

Norcross, J. C., & Guy, J. D. (2007). Leaving it at the office: A guide to psychotherapist self-care. Guilford Press.

Taylor, E., Bohart, A. C., & Elliott, R. (2014). Impact of therapist theoretical orientation on adherence to the therapeutic relationship. Journal of Counseling Psychology, 61(3), 356-364. doi: 10.1037/a0036289


Sign up with your email address to receive the latest on the podcast and my offerings