Therapists carry a lot for their patients. In this video, I talk about the peer support group that’s helped me carry it well — for almost 40 years running.”
Why Therapists Are at Risk for Emotional Exhaustion
Our profession asks us to do something unusual. We sit with other people’s pain, day after day, and we absorb it.
Researchers have studied the connection between the mind and the body for decades. Carrying other people’s trauma takes a physical toll, not just an emotional one.
There is a name for the specific kind of exhaustion therapists experience from hearing repeated stories of trauma. It is called compassion fatigue, sometimes also referred to as vicarious traumatization (taking on stress symptoms similar to the patient’s own trauma, simply from hearing about it).
I have heard a lot of trauma over four decades of practice. It does affect us. It has affected me.
That is not a weakness. It is the cost of doing meaningful work.
Next, let’s move to the concept that is central to understanding why we react to patients the way we do.
What Is Countertransference? (And Why It Matters for Self-Care)
You may have heard the word countertransference and wondered what it means. It is simpler than it sounds.
Countertransference is the set of feelings a therapist has toward a patient, based on the therapist’s own life experience (in plain terms: how your own history quietly shapes your reactions to the people you treat).
Sometimes a patient reminds us of someone from our own life. Maybe a parent, a sibling, or a painful relationship.
Their story stirs something in us. Their pain can echo a pain we carry too.
This is normal. Every therapist experiences it. The danger is not in having these reactions. The danger is in not knowing we are having them.
When we are unaware of our own countertransference, we risk making decisions in the therapy room that are about us, not about our patient. That is where peer support becomes essential, which I’ll explain next.
The Power of Peer Consultation Groups
One of the things I am a strong believer in is therapists having peer support groups. I have been part of one for about 40 years.
We call it a countertransference group. A small group of therapists meets regularly. We talk honestly about our patients, our reactions, and ourselves.
We discuss how a patient’s story affected us that week. We talk about who a patient reminds us of. We explore how their trauma may be touching our own.
This kind of peer consultation has been one of the most important parts of my career. It has helped me process some of the most painful stories I have heard over the years, without carrying that weight alone.
Confidentiality is the rule. What is shared in group stays in group. That safety is what allows real honesty.
I encourage every therapist reading this to find or form a group like it. It does not need to be large. Six to eight members meeting consistently is enough to make a real difference.
Beyond peer groups, there are other paths to self-care for therapists worth knowing about.
Other Tools for Self-Care for Therapists
Peer consultation is not the only answer. A well-rounded approach to therapist self-care includes several supports working together.
|
Self-Care Tool |
What It Helps With |
|
Personal psychotherapy |
Sorting out the therapist’s own unresolved issues |
|
Peer consultation groups |
Processing countertransference and isolation |
|
Regular exercise |
Releasing stress held in the body |
|
Setting caseload limits |
Preventing emotional overload |
|
Spiritual or reflective practice |
Restoring a sense of meaning and perspective |
|
Time fully away from work |
Allowing the mind and body to recover |
No single tool does the whole job. It is the combination, practiced consistently, that protects against burnout over the long run.
I am a big believer in therapists healing themselves as a necessary piece of healing others. We cannot give our patients what we do not have ourselves.
So what does this mean if you are the patient, not the therapist? Let’s close with that.
Why This Matters for You as a Patient
You might be wondering why any of this matters if you are not a therapist yourself.
Here is why it matters. A therapist who has done their own inner work is a better therapist.
A therapist who understands their own countertransference is less likely to bring their own unresolved pain into your sessions. A therapist with a strong support system has more patience, more presence, and more genuine empathy to offer you.
After more than 40 years in this field, I am still here. I still look forward to sitting with my patients.
That is not an accident. It is the result of decades of intentional self-care, peer support, and doing my own work alongside the work I do for others.
If you are looking for a therapist, ask how they care for themselves. The answer tells you a great deal about the care you will receive.
Martin E. Keller, Ed.D., ABPP
Diplomate in Clinical Psychology, Private Practice
Scottsdale, Arizona
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