Top challenges mental health practitioners face — and how to overcome them

Kristin Trick, MA, LPC-S, RPT is a therapist in private practice and specializes in the treatment of post-traumatic stress and anxiety disorders. She has worked in the psychiatric hospital, non-profit agency, and private practice settings over the past 10 years.

Having worked as a licensed professional counselor (LPC) for over a decade, I understand the challenges mental health practitioners face on an intimate level. I recognize the enormous toll this profession takes and the regularity of burnout. 

Reflecting on my career, it’s easy now to recognize professional vulnerabilities I previously overlooked. Caution signs were present all along the way; I just hadn’t known to identify them or what to do when they appeared. Now a clinical supervisor, I routinely share my experiences with aspiring counselors to help them navigate this field with awareness and discretion.

For mental health practitioners, challenges take 3 broad forms: mental, emotional, and physical.

Ironically, our psychological well-being can be less than desirable. As counselors and social workers, we expose ourselves to information overload. Instead of reading standardized questions and burying our heads to record notes in the moment, we often maintain a mental log of our clients’ answers to document later.

This ongoing mental effort is compounded by the need to present ourselves as fully attentive and engaged, hour after hour, regardless of what we’ve just heard or seen. We may listen to a bereaved adult client at a 2pm appointment who is grieving the loss of their child, while knowing we have a 3pm session with a child client and a 4pm slot with a client who is processing their recent abortion. The need to reset ourselves between sessions to greet each client with a fresh face and open heart is mentally taxing.

Clients also expect their providers to remember the deeply personal details they disclose across sessions: the names of their immediate family members, relationship statuses, ages of their children, individualized treatment goals, and more. The incessant retention of facts about individuals who aren’t our friends or family members can be wearisome, especially when we manage caseloads of 30 or 40 clients.

The chances of developing vicarious trauma, compassion fatigue, or burnout are high for practitioners due to our repeated exposure to humanity's troubles and pains. It can be soul-crushing to hear clients’ stories, such as their experiences of horrific childhood abuse, dangerous military combat, and attempts to end their own lives. In some cases, notably those of post-traumatic stress and depression, we can begin to experience our clients’ symptoms secondhand as we’re exposed to their intense emotions and behaviors.

Our workdays normally resemble a revolving door of one-sided relationships. We actively listen to clients and center our comments around them, yet we don’t experience this reciprocity. We learn our clients' secrets, insecurities, and aspirations — all the while limiting the details we share about our personal life in attempts to avoid dual relationships that could jeopardize our clinical judgment.

Unlike assembly line workers or restaurant servers, mental health practitioners spend most of our days sitting down. We may schedule 6 clients back-to-back, getting up only to usher one client out of our office and welcome in the next one. 

Most therapy offices are small, which results in limited square footage for movement. Our mediocre steps are restricted to the several paces between chair, desk, and door, making a daily step-count goal laughable. This strict confinement can lead us to become lethargic and sluggish.

Alternatively, it’s possible for providers to overuse certain body parts in our provision of specialized therapies. Consider the brisk, repetitive arm movements needed to provide eye movement desensitization and reprocessing (EMDR) therapy.

The motions appear small but can cause substantial fatigue and damage over time to the joints involved. One of my EMDR trainers underwent 2 different surgeries to treat their overextended rotator cuff.

The risks of becoming a mental health practitioner aren’t clearly communicated early on. Graduate programs, practicums, and internships often focus on quality care for clients, rather than for the providers-in-training.

An awareness of these lesser-known vulnerabilities can help you delay or even prevent their consequences. If you’ve already encountered them and are struggling to recover, think through these applications to help bring your career back into balance.

Give yourself time to scan clients’ charts before you meet with them. This habit helps you to remember pertinent information before starting your session. Set aside some time at the start of the day to review all your clients' charts. Or plan for a few minutes to review each client’s record prior to their appointment.

Initiate a personal “reset button.” Blow your nose into a tissue, even if you’re not congested. Eat a quick snack or drink several gulps of water. Sit in a different spot with your next client. Have physical movement in-between sessions, even if it's basic — such as walking 2 laps around your office, one clockwise and the other counter-clockwise. My personal reset at the end of each workday involves praying for my clients.

Limit your entertainment choices to topics unrelated to mental health. There’s no shortage of movies, television series, and books which center around this subject. If you choose to allow mental health themes to seep into your recreational time, though, you’ll inevitably think about your clients. Reserve your free time for enjoying lighthearted, optimistic, and refreshing input.

Balance your bookings. If you don’t have to meet 5 clients back-to-back who are dealing with posttraumatic stress, why would you? Owning a private practice gives you the freedom to set appointments at the times which work best for you. Arrange your sessions so you have emotional breaks throughout the day. Only offer bookings to clients with “heavy” presenting problems for the hours you’re best prepared to work with them.

Spend time with family and friends. Over the years, I’ve heard several adult women clients comment that they could picture us being friends if we weren’t in a counseling relationship. It’s easy for me to call up this image, as well, because I’ve found myself enjoying their company so much it seemed that we easily could meet for coffee or dinner if not for our existing link of client and therapist. On these occasions, I’ve affirmed my mutual satisfaction with our time together, reiterated professional boundaries, and then made time for close friends or family to appropriately refuel my emotional tank.

Celebrate the end of your workday or week. Give yourself something special to anticipate as you complete your sessions. At a former worksite, I initiated “Friday Teatime,” in which I brought a special mug and yummy teabag from home that I could enjoy uninterrupted as I finished that week’s chart reviews. For increased accountability and endorphins, meet your loved ones for a social event after work: visit a new restaurant, watch a live sports game, or hike a nearby trail.

Invest in hobbies where you share or assume the lead role. Therapists can adopt a passive role in their personal lives because they’re so used to listening to clients and matching their pace. Counter this by pursuing assertive activities — whether organizing soccer or basketball games, sharing your thoughts in a book club, or learning martial arts.

Practice an active lifestyle as opportunities arise. Use of your time between clients for movement. Walk up a flight of stairs or down the hallway, stand up to write your notes or make phone calls, take the longer route to the bathroom or breakroom, or walk around the block to exert some energy. 

Re-evaluate your office setup. I personally chose not to have a desk in my last office due to its small square footage. This decision gave me more space and motivation for movement. Evaluate whether or not you actually need this piece of furniture in your therapy office.

Schedule exercise around your workday. I also enjoy exercising, running in particular, and didn’t like feeling stuck to my chair all day. After recognizing this pattern, I started scheduling long runs and walks for the mornings of my fully booked workdays. My mood and endurance improved significantly with this change; I enjoyed getting to sit down for a couple hours after completing a 5-mile jog or 30-minute walk. 

Arrive to work in appropriate active wear. One outcome of the COVID-19 pandemic was a surge in work-from-home fashion from noteworthy brands. Nowadays, it’s common to encounter professionals dressed in stylish joggers, chic sneakers, and breezy tops. Give thought to how your workday outfit will allow you to be active. If you can’t break away from starched button-ups and ironed trousers, pack workout clothing to change into so you can log a walk around the office park or drive straight to the gym. 

Incorporate movement into your sessions. Lead your adult clients in several rounds of stretches, both seated and standing, as you model physical grounding skills. Challenge your child clients, particularly those with high energy and distractibility, in “workout sessions” to help them improve their focus and concentration. Include exercises like jumping jacks, push-ups, and jogging in place. These activities can fill your entire session or serve as warm-ups or icebreakers to begin your time together.

Schedule clients with their potential for movement in mind. Rather than booking 4 older adult clients in a row, all of whom have limited mobility and low energy, schedule an adult, an adolescent, another adult, and a child client in that order. This rotation breaks up the monotony that comes from sitting in a chair all day and presents chances for you to increase your activity. I’ve found myself winded at the end of children’s sessions, which could involve a dance party and jumping jacks challenge, and looking forward to settling into my chair to “just listen” for the next hour as my more reserved adult clients talked.

As mental health providers, we can become preoccupied with our clients’ needs and forget to apply the very same advice we give them to ourselves. You have a wealth of resources at your fingertips for stress management.

In fact, you’ve likely already developed a solid repertoire of coping skills from which you can draw. The following resources are some of my favorites to share with clients, as well as to practice myself:

The intensity, devotion, and endurance required of mental health practitioners is often minimized and overlooked. It’s naïve to assume that professionals in this arena have it easy because we’re “just listening” or “talking to people” all day.

Mental health is complex and its treatment requires the well-being of the providers involved. Amidst the heavy work of helping others, ensure that you regularly assess and care for yourself in order to surmount the hurdles on your path.