How Therapists Carry Work Into Life: Making Peace with a Career that Follows You Home

Early in my time working as a school-based therapist, I sat through a professional development seminar: "Normalizing Self-Care." The advice was predictable and echoed a lot of what I’d heard in graduate school: get enough sleep, exercise regularly, eat well, take breaks. I left with a checklist that sounded simple enough.

A few months later, one of my students had a very public mental health crisis that made the local news. I followed the checklist. I slept, I exercised, I ate decently. On paper, I was doing everything right. But I still felt raw.

When my friends are done with their workday, their checklist seems to work for them. They shut down the computer, turn off the office lights, and commute home. If they’re stressed, they hit the gym. Sometimes they’ll complain about a boss or an annoying coworker, but the stories are usually lighthearted. My days didn’t end that way. There was no switch to flip and there was no moment where the weight of what I’d seen and heard stayed behind in the office. My phone buzzed constantly with texts from friends (some were concerned, but some were just curious) and instead of feeling supported, I pulled away. Even the people I trusted most were hard to answer.

Even when therapists are doing everything "right," there is often still no way to leave the work behind at the end of the day. Checklists are convenient for systems, because they make it look like the responsibility ends with us. But if we’re going to talk about normalizing anything, we need to normalize the truth that therapy work is different, and that understanding how it actually impacts us is how we sustain both the therapy work and the human doing that work.

Reverse countertransference

Alongside self-care, one of the first concepts we’re taught in graduate school is transference, which is when our clients project their outside lives onto us. And we learn countertransference, which is one of the ways our outside life inevitably shows up in the therapy room. What we don’t often talk about is the reverse of countertransference: how the room follows us out. Therapists don’t leave one self at the office and step into another at home. The identities overlap, layered so tightly that the “session self” seeps into the rest of life as easily as "life self" seeps into sessions.

It’s been about five years since my last direct-care role, and I still notice the ways my experiences as a clinician shapes how I move through the world. My kids will never be allowed to do sleepovers. When I hear certain phrases people use to describe their marriages, I instinctively assume there are problems beneath the surface. Sometimes I catch myself scanning for risk in ordinary situations, like at the playground, in a classroom, or in casual conversations. And I certainly notice the (seemingly) small experiences my children have and wonder which ones will eventually end up as anecdotes for their therapists to unravel with them.

As Jeffrey Kottler, author of On Being a Therapist, once wrote: “What the client brings to us in a session is so overwhelming … we can’t hold it all. So we have to find ways to live with that — to live with all this uncertainty, all this mystery, all this ambiguity.”

What we’re learning about sustainability

If even the best checklist can’t erase the reality that therapy comes with us, the question becomes about how we can move away from thinking a checklist will magically let us leave work behind. Instead, we need to learn how we carry the weight of the work in ways that are healthy and sustainable for ourselves, for our families, and for our clients. And luckily, there are people who have been thinking about that for a long time.

Françoise Mathieu, PhD, who writes and teaches widely about compassion fatigue, reminds us that therapists can’t do this in isolation: "We are not meant to do this work alone, and when we try, we deplete ourselves far more quickly." According to Dr. Mathieu, peer support and reflective supervision are part of the structure that makes this work survivable.

Laura van Dernoot Lipsky puts it more bluntly in Trauma Stewardship: "The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet." According to Lipsky, noticing the impact is more helpful than fighting to stay ‘dry’. As she writes, "We can sustain our work with trauma only if we combine our capacity for empathy with a dedication to personal insight and mindfulness."

Dr. Patricia Fisher, an expert in trauma exposure in organizations, argues that what wears people down isn’t just the stories themselves but the silence in workplaces that act as if those stories leave no mark. Fisher calls for organizations to recognize and respond to the cumulative impact on clinicians, so that responsibility is shared instead of shifted entirely onto the individual.

These voices widen the conversation beyond self-care by pointing us toward something that sounds more honest: therapists are changed by the work, and the way forward is not to deny that, but to build the structures and communities that allow us to keep showing up whole.

Making room for humanity

Part of why the role of therapist feels so unbelievably heavy is because society has basically poured the weight of trauma onto therapists. A lot of what used to be held in families, neighborhoods, faith communities, or other forms of shared life now lands in our offices. That sucks, and it makes the job so much harder than it should be. It’s also why we need so much support that a checklist can’t supply.

But there’s another side too. Carrying all of this means therapists also get to experience a part of humanity that most people never do. They sit in the rooms where people are most honest, witness resilience and change that others miss, and engage with parts of themselves and others that rarely see the light of day.

Therapists can’t (and shouldn’t try to) pretend they can leave work at the office. The goal is to notice how it follows us, to understand the ways it shapes us, and to build the support that lets us keep showing up whole. This work costs something and it always has, and that cost is more than a checklist can cancel, but that doesn’t mean the cost is a failure or something to avoid. After all, as Viktor Frankl wrote, "What is to give light must endure burning."