How do therapists cope with patients’ pain without being overwhelmed?

Question

We often talk about people struggling with anxiety, depression, trauma, grief, and other mental health problems, but we don’t always think about the people sitting across from them and listening to these stories every day 🧠

Imagine hearing about someone’s abuse, loss, family problems, suicidal thoughts, or years of trauma, then going home and trying to live a completely normal life afterward...🤔😐 Therapists are trained to create professional boundaries, but they’re still human. Surely some stories must stay with them longer than others.

I wonder how they actually cope with that emotional weight. Do they eventually become emotionally numb to protect themselves, or do they learn how to care deeply without taking everything home with them? And what happens when a therapist is going through their own difficult period while still having to be emotionally present for their clients?

There’s also something strangely human about the idea that someone can spend all day helping other people understand themselves while quietly having their own struggles that nobody sees. ❤️

I’m genuinely curious about people who work in mental health: does the profession ever become emotionally overwhelming, and what do you do to keep other people’s pain from becoming your own?

Levin · Accepted Answer

I am a qualified therapist.

There's actually an interesting article on secondary post traumatic stress disorder that shows that we do inwardly take a lot of the client's emotional content, even if we are not aware of it. I'll dig it out over the weekend if you're interested.

I think this depends on various factors, for example, if you work in 'industry' or yourself. If your caseload is large and you're being thrown client after client, with little autonomy, then surely for your own survival you will have to find ways to cope with what is in front of you. It likely becomes less of a devotion.

I think it also depends on the modality you work in. If you have a 'scientific' structure such as in CBT, that surely presents something of a barrier between you and client. You can fall back on that structure and to some degree go into autopilot. Compared to Person Centred where you're just kind of on your own in a certain way, meeting your personality with there’s; it's a very challenging, but also rewarding way to work.

But yeah, there's a few factors to it.

Boundaries as you identify is definitely one. For example, some counsellors will become too involved in the client, they will allow loose boundaries such as over-running the time, communication outside of the session etc. Boundaries help protect you. But it's also more subtle than that. You can get some dangerous clients. For example, I had one that made up a malicious allegation against me when I was volunteering. Part of this comes with experience where you learn to deal with what they are projecting onto you, and also nip in the bud any awry behaviour.

Projection becomes ever more subtle in its forms, the deeper you go into your psyche. We are subtly interacting with people, having things projected on us and also projecting out our own ideas onto other people. People are merely what we project onto them. There are ways to help protect yourself, the more you get into meditation. Nothing is fail-safe but it helps.

You have to remember, that if you work for yourself you do also have autonomy. We can choose your clients. For example, counsellors I know will refer on clients who are going through bereavement when the counsellor is going through the same.

Also, and similarly related is I do find that what affects me most is what is sort of latent or lays dormant within me, or my own stuff I'm going through. So trying to integrate your problems as much as possible is really important.

One of the most important factors is resilience. Again, this is a bit of a learned skill. It's sort of not too dissimilar to health, in that, it's not disease that causes people to be sick, it's their susceptibility and immune system. So, touch wood, I seldom will get sick when they wittered on about covid for example. Resilience takes many forms but it also includes physical resilience (and the implication is we're holistic beings). Learning how to physically take care of yourself is really important. It includes, good food, sleeping well, lowering your stress levels, good social contacts, the right mix of physical exercise (strength training, mobility and flexibility). If you can make yourself physically resilient you will tend to find that it makes you more mentally resilient.

But yeah, just try not to get too involved in your client. I would also say, don't get attached to outcomes. Because some will not go too well and you can't fix your client's life. Again, you're getting too drawn into your client. Again, some will come with experience. It's also a practical thing for self-preservation. But worrying about your client afterwards doesn't actually do any good, anyway.

In terms of my experience hearing people's problems, often times, it will have no affect on me at all. These are the days when I am firing all all cylinders and am in a kind of flow. If I am stressed or run down, then obviously it takes its toll more. As you can imagine, the more you are struggling yourself, the less you can take on board.

Shiprex · Accepted Answer

I think they need to be very stoic and stable as well as have ways to remove themselves from the engagement with the feelings. This is one of the reasons , I think women especially, get stressed out because they think "venting" or sharing their emotional event with others makes it easier to deal with when it doesn't. All it does is spread and reinvent the issue

KBird · Accepted Answer

I’m not a therapist, but my best friend is. Because of confidentiality, she has never told me the details of any of her cases, but she has mentioned that some can be very dark, overwhelming, or even triggering for her.

She told me that her office has a “quiet room” where she’ll sometimes go afterward. She’ll cozy up on the couch with a blanket and a warm drink or snack, put on some music, and journal about how she’s feeling.

She says it helps ground her and bring her back into the present, basically reminding herself that she’s safe, that she can have empathy for what someone has experienced without taking that trauma on as her own, and giving herself a little time to process before moving forward.

I always thought that sounded like a really healthy way of handling such an emotionally heavy job.

bobalife · Accepted Answer

This is a very heartfelt and insightful question bc not many people consider what does the provider is going through. They’re just like another individual and not a pedestal that most people put them on bc of their job title. It’s a combination of processing and managing your own emotions, self-care, and the practice of not crossing countertransference.

Massageman · Answer

Per my wife, a counselor with 20 years of experience- "You listen, empathize (with the client), and then 'step back out' "  Keeping good boundaries.

Anonymous · Answer

I am not a therapist but I am sure that some cases stay with them for a LONG TIME.
I am very curious person and love to read about psychology and try to understand more and more, I am usually not really involving with people's stories but sometimes when I hear things that are very "hard to swallow", I end up thinking about it even after a few days or so... I once got so "obsessed" with one story that I read online, that it started hunting me long after I read about it and I even started being slightly paranoid, so I can imagine that psychologists sometimes need a psychologist as well, just like a dentist needs another dentist or a hairdresser another hairdresser...

Taranis_Thunor · Answer

Doctors, Police, Firemen and Soldier's get desensitised to seeing some seriously bad things & they get desensitised to it. There's only so much emotional baggage someone can carry.

It doesn't mean they don't care exactly it's just that they get used to it and I think if they do help people they'll even derive meaning from it.

FreyaRed · Answer

In my specialization nobody dies but oncologists need to have a thick skin. On the other hand they have do deal with death already while their internship and they can decide if they want go further this way or not. I guess they get a little bit jaded toward woe of their patients after a while

EzraIsShy76028 · Answer

Great question honestly! I myself don't quite know the answer but my guess would be they become desensitized to it. When you go into this line of work you kinda already know what you're getting into. Doctors in general as a whole for example probably have to deal with all sorts of disturbing shit and I've heard that the first few days is rough but they get used to it real fast.

exitseven · Answer

One day i got a phonecall telling me that my father had collapsed at work. I got in my car and drove to the hospital where he was taken. I met with a male nurse who told me that I should sit. I knew it was going to be bad news.

Eventually I asked him how he does it? How does he give people the worst news they could get on a daily basis. He told me about all the times he gets to tell people the best news that they can get.

I imagine it is like that.

gasman70 · Answer

so therapists talk to other therapists about patients, very interesting. so you're a patient then with a therapist that then talks about you to other therapists and so on, it never ends apparently. So, my therapist talks about me with other therapists, so everyone knows my business and yours.

AviatorTom · Answer

Several years of professional training. Therapists are trained to remain professional, stay aloof from their patients. Never get personally involved.

Anonymous · Answer

People are different. Just because you can't handle certain things, it's does not mean it's same for other people. I am a nurse, I see horrifying things on a daily basis from dead babies to abandoned children to amputated people, rotting legs, detached limbs, and it doesn't interfere with my daily life when I get home.

Paige2006 · Answer

I think they are use to being that situation

whosnumber_1 · Answer

I think it can be difficult but, a lot of people's problems and trauma are the same but in different circumstances. The healing process and stages are also similar. I think there's a great reward seeing people's progress and changing people's lives in a positive way

Chayce · Answer

Like others have said by having a therapist. But I think the answer people are avoiding is that... not having a strong conscience or compass or feeling emotions really makes navigating a lot of things in life easier.

ohsheeT · Answer

I hear you I just wrote out a two-page answer and I couldn't even send it for me I just want to feel love give love experience it with a smile on my face

Screenwriter · Answer

Therapists see other therapists to manage coping with heavy issues. It's a requirement of doing therapeutic work.

Nikki1989 · Answer

They need to rely on specific psychological frameworks, behavioral boundaries, and clinical training.

MrChinaski · Answer

Mostly, by not caring. Or rather by caring 100% in the moment, and then blocking it out completely. If something lingers, they debrief with other therapists. At least, that's what I did when I was on crisis lines.

jennifer_bloom · Answer

I like helping people with their emotional problems, just like I like nursing wounded dogs back to health, or cooking for needy people. You have to become a person who enjoys it.

_Jenny_ · Answer

@veronika_p  the therapist were trained for that kind of work

Alex-Snow · Answer

I'm sure it is a stressful job. I'm glad that they are able to help people through tough times.

Maybe_Maybe_not · Answer

I hope they don't perfectly cope with, otherwise they would look like chatgpt instead of therapists to me

jahaims · Answer

A therapist is supposed to be emotionally healthy enough to separate themselves from the situation

AngryCarl3 · Answer

By helping people. I can only assume their oxytocin is off the charts. Seriously though, these people are professionals. A plumber fixes your pipes, a therapist fixes your brain.

OneViewpoint · Answer

The $250/hr fees help a lot. You can listen to a lot of whining for $250/hr.

DishLady · Answer

They DO get overwhelmed. They're also only human. They have to take breaks just like everyone else.

Iron_Man · Answer

They don’t have feelings for the patient and they trained themselves to be tough. I don’t know how they deal with it

Jackblue · Answer

My mother quit Psychology for this exact reason.

NathanDavis · Answer

they have their own therapist...

Elizabeth113 · Answer

My cousin talks with his wife for an hour. They each have an hour so they can relax.

MainCharacter6 · Answer

My aunts are therapists; every few months, they take a break.

rgb008 · Answer

Memory erasure therapy

jamesgoldman · Answer

They have their own therapists

Agape93 · Answer

Yo @lordofthepines

In_Trance · Answer

They get paid

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