For therapists & counselors: caring for the carers

A separate guide covers what to do after a hard session, grieving a client who died by suicide, supporting a colleague, and client aggression.

A separate guide summarizes what the APA, ACA and NASW codes say, how to work with countertransference, and the wounded healer.

A separate guide covers finding your own therapist, getting the most from supervision, private practice isolation, imposter feelings and identity stress.

Vicarious trauma builds up over time from repeated exposure to other people’s trauma. It can shift your core beliefs, such as feeling the world is less safe or people are less trustworthy.

The Office for Victims of Crime says some shift in worldview is to be expected in this work. It can move toward cynicism or fear, or toward greater appreciation.

In a 2026 survey of 255 UK psychologists exposed to clients’ trauma stories, higher vicarious trauma was linked with higher personal, work and client-related burnout.

It can sound like

• “I assume the worst about new people.”
• “I can’t watch the news without picturing my clients.”
• “I don’t let my kids out of my sight anymore.”

The National Child Traumatic Stress Network describes secondary traumatic stress as the emotional distress that comes from hearing about another person’s firsthand trauma. It calls it a common occupational hazard for therapists, case managers and others who work with traumatized children and families.

It can come on more quickly than vicarious trauma, sometimes after one very hard session. The When clients are in crisis or die guide has a plan for after a hard session.

Compassion fatigue is a draining of your ability to feel and offer empathy. You still care about your clients, but you feel flat, numb or irritable with them, and guilty about it.

It is closely tied to the emotional load of the work itself, which is why rest alone may not fix it. Support, supervision and things that refill you all matter.

Burnout grows from workload, time pressure, low control and unfairness at work. In mental health services, research links it to large caseloads, paperwork and productivity targets.

The Office for Victims of Crime describes compassion satisfaction, the sense of meaning gained from this work, and vicarious resilience, drawing strength from watching clients survive and heal.

A 2026 study of 278 mental health professionals found that vicarious trauma and vicarious post-traumatic growth can exist side by side, and that clinical supervision helped shape whether reflection led toward growth.

The Office for Victims of Crime lists

• Destructive coping, such as substance use or risky behaviour
• Feeling emotionally numb or shut down
• Irritability or withdrawing from relationships
• Losing interest in things you used to enjoy
• Physical complaints
• Sleep problems
• Trouble managing emotions

The Office for Victims of Crime names

• Avoidance as a way of coping
• Being newer or less experienced in the role
• No effective, supportive way to talk through the traumatic content of the work
• Prior trauma of your own
• Social isolation

None of these mean you will be harmed. They point to where extra support helps most.

Ideas

• Stand up, stretch and drink water
• Three slow breaths with longer out-breaths
• Open a window or step outside
• Jot one line in your notes, then close the file

Back-to-back sessions with no gap make this harder. If you can, protect even five minutes in your schedule.

Ideas

• Write tomorrow’s to-do list so it stops circling
• Imagine placing each client’s story in a box you leave at the office
• Change clothes or wash your hands and face when you get home
• A walk, a song or a drive with no news on

If you work from home, a physical cue helps even more: close the door, shut the laptop, turn off the lamp you only use for sessions.

Try

• Name it: “That session is still with me.”
• Write down what you’re worried about and one thing you can do tomorrow
• If safety is involved, follow your agency’s on-call or consultation route instead of carrying it alone
• Book a consultation or bring it to supervision

If you can, mix trauma-heavy cases with other kinds of work, such as groups, consultation, teaching or lower-intensity clients. Spread the hardest sessions across the week rather than stacking them.

Try

• Keep your feet on the floor while listening to hard material
• Slow your own breathing; it can help both of you
• Take brief notes to stay in “observer” mode when needed
• Keep water and a grounding object nearby

In a 2026 multistate study of opioid treatment program staff, counselors who had clinical supervision reported lower vicarious trauma and burnout. Simply having training available was not protective on its own.

Another 2026 study found that supervision helped turn reflection on hard material toward growth rather than getting stuck.

Ideas

• Choose lighter shows, books and podcasts in the evenings
• Limit graphic news, especially before bed
• Spend time with people who make you laugh
• Time in nature or with animals

A “30-client week” is never 30 hours. Add notes, calls, treatment planning, insurance work, emails and supervision. Seeing the real total helps you plan and helps you make the case for change.

Ideas

• Write notes right after each session or in a set block, not at midnight
• Use templates that meet your agency’s or payer’s needs
• Batch insurance calls into one time slot
• Ask what is truly required and what is habit

If you are considering AI note tools, read the AI & mental health guide first and check your code, state law and client consent requirements.

In a 2026 study of 141 community mental health clinicians, participants suggested many agency and supervisor changes to reduce burnout, grouped into areas such as client-related changes, structural support, teams, emotional support, supervisor support and self-care.

Things to ask for

• A caseload cap or a mix of high- and lower-intensity clients
• Protected time for notes
• Admin help with insurance
• Fair productivity targets that count non-billable work

The Office for Victims of Crime suggests supervisors discuss vicarious trauma in supervision, offer flexible schedules, protect downtime and provide space for reflection.

In a 2026 multistate study, counselors who had clinical supervision reported lower vicarious trauma and burnout. Simply having training available was not protective on its own.

Organizations can connect staff with peer support teams, employee assistance programs or chaplains, and refer people to professional help when it is needed.

In a 2026 study of 141 community mental health clinicians, suggestions to reduce burnout were grouped into client-related changes, structural support, teams, emotional support, supervisor support and self-care.

For example

• Caseload limits or a balanced mix of clients
• Emotional support and team connection
• Protected time for notes and reflection
• Supervisors who check in on wellbeing

Steps

• Talk with a supervisor or trusted colleague first
• Arrange coverage and crisis plans for clients
• Tell clients with enough notice, in a way that fits each one
• Plan what “rest” will actually look like

Some clinicians move into teaching, supervision, research, program work, advocacy or a different population. A change of setting can bring back meaning without leaving the field.

The APA code asks psychologists to offer pre-termination counseling and suggest other providers when appropriate. The ACA code asks counselors to have a plan for transferring clients and records.

Leaving can bring grief, guilt and relief all at once. Your worth was never only your job. The Career guide has more on identity and purpose.