How to Avoid Compassion Fatigue with High-Intensity Therapy Clients
Dr. Lisa Marie Bobby is a licensed psychologist, licensed marriage and family therapist, board-certified coach, AAMFT clinical supervisor, host of the Love, Happiness, and Success Podcast and founder of Growing Self.
Ever feel like you’ve just completed an emotional marathon after a therapy session? Working with high-intensity clients can push us to our limits, and without the right tools, it’s easy to feel overwhelmed, drained, or even question if we’re in the right profession. But with the right strategies, we can prevent compassion fatigue, support our clients, create a fulfilling career, and avoid therapist burnout.
In my latest episode of Love, Happiness, and Success for Therapists, I dove into this exact topic — managing high-intensity clients while keeping our sanity and passion intact. Let’s break down a few powerful ways to manage the effects of therapy work on our wellbeing as therapists, even with the most emotionally charged cases.
The Unique Challenges of High-Intensity Clients
High-intensity clients are often deeply inspiring, pushing us to become better therapists. They challenge us with complex issues, high emotions, and sometimes intense crisis situations. But if you’re a highly empathic therapist (like many of us), you might find yourself absorbing these emotions to an exhausting degree. Research has shown that emotional exhaustion is a leading cause of burnout among therapists. As empathetic therapists, we can be especially vulnerable to burnout.
Essential Boundaries: A Therapist’s Best Friend
One of the biggest lessons I’ve learned? Setting boundaries as a therapist is everything when it comes to managing high-intensity clients. Without clear boundaries, it’s all too easy to get pulled into clients’ crises, especially with clients who struggle with emotional regulation.
Here’s how to protect your energy and professionalism:
1. Session Times and Structure
Ending therapy sessions on time is crucial. Some clients struggle with boundaries themselves, making it easy to get swept up in their needs. Clear time limits help them learn to self-regulate and respect your boundaries.
2. After-Hours Communication
High-intensity clients often have an “emergency” or crisis feel to their needs, and it’s common for them to reach out after hours. Having a clear policy on after-hours communication (such as offering resources for immediate support like crisis lines) helps ensure that your clients can still get the help they need without sacrificing your time.
3. Containing Emotional Impact
High-intensity cases can stay with you long after sessions end. Practices like visualizing boundaries or using mindfulness techniques can help you detach emotionally and stop thinking about your therapy clients when the day is over. Dr. Elisha Goldstein’s work on mindfulness for therapists is an excellent resource for grounding techniques that help you avoid burnout.
Balancing Your Caseload for Longevity
Having a balanced caseload is essential. Try not to fill your calendar with high-intensity clients alone. Mixing in lower-intensity or coaching clients can make a world of difference in maintaining your energy. Coaching, in particular, has a different focus — it’s often about goal-setting, growth, and future plans, which can bring fresh energy to your week.
Adding variety is a great strategy for both seasoned therapists and newer practitioners. If you’re interested in adding coaching skills to your practice, consider my free 2-part training, Therapists Guide to Coaching, as a next step.
Supervision and Support: Don’t Go It Alone
Many therapists — especially those in solo practice — can feel isolated. But working through high-intensity cases alone isn’t just challenging; it’s unsustainable. Support systems like clinical supervision, consultation groups, and professional mentors are essential. I encourage you to connect with colleagues, join peer groups, or even reach out to me on LinkedIn for professional support. It’s truly transformative to share the weight of your caseload with trusted peers and mentors.
This isn’t something we grow out of; we all need to process the emotional load we carry. Just as we encourage our clients to reach out for support, we need to be there for each other, too.
Defining Your Niche for Career Longevity
Sometimes, it’s a matter of finding the right niche. Not all therapists are meant to work with every type of client, and that’s okay! For example, while some clinicians thrive in trauma work, others find their calling in career or relationship coaching. Knowing your strengths — and limitations — is key to creating a sustainable career.
If you’re unsure about your niche, listen to my podcast episode Finding Your Niche as a Therapist. Understanding the work that energizes and fulfills you (versus what drains you) is a journey worth taking, and it can change the entire course of your career.
Take Charge of Your Career Path
Therapy is a deeply fulfilling but demanding career, especially when we work with high-intensity clients. But by setting strong boundaries, balancing your caseload, seeking support, and defining a sustainable niche, you can create a career that brings you joy, purpose, and longevity. Remember, we’re in this together, and with the right strategies, you’ll be able to thrive.
Ready to Take the Next Step?
If you’re curious about integrating coaching into your practice or need guidance on defining your career path, check out my Therapists Guide to Coaching Training. It’s packed with insights on career clarity and the benefits of coaching.
Connect with me on LinkedIn to share your thoughts or ask questions about managing high-intensity clients — I’d love to hear from you!
P.S. If this article resonates, think about a colleague who could benefit and share it with them. Supporting each other in this work is the best way to grow and thrive.
Xoxo,
Dr. Lisa Marie Bobby
Resources:
Linley, P. A., & Joseph, S. (2007). Therapy work and therapists’ positive and negative well–being. Journal of Social and clinical Psychology, 26(3), 385-403.
Rosenberg, T., & Pace, M. (2006). Burnout among mental health professionals: Special considerations for the marriage and family therapist. Journal of marital and family therapy, 32(1), 87-99.
Goldstein, E. (2016). Beyond mindfulness: The power of self-compassion, purpose, play, and confidence in the clinical treatment of the depressed client. In Mindfulness in positive psychology (pp. 308-320). Routledge.
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