Why is self-care essential for therapists?

Self-care is essential for therapists to maintain their own well-being, prevent burnout, and ensure they can provide the best support for their clients. It helps therapists manage stress and maintain healthy boundaries.

What is the autonomic nervous system and why does it matter for therapists?

The autonomic nervous system (ANS) controls involuntary bodily functions such as heart rate and digestion. For therapists, understanding the ANS is important because stress and emotional labor can impact their nervous system, affecting both their health and their work.

How can therapists support their autonomic nervous system?

Therapists can support their autonomic nervous system by practicing mindfulness, engaging in regular physical activity, ensuring adequate rest, seeking supervision, and maintaining a work-life balance.

What are signs of stress or dysregulation in the autonomic nervous system?

Signs of dysregulation may include fatigue, irritability, anxiety, difficulty concentrating, sleep disturbances, and physical symptoms like headaches or digestive issues.

Can self-care improve a therapist’s effectiveness?

Yes, therapists who prioritize self-care are better equipped to manage stress and emotional challenges, which enhances their effectiveness and resilience in clinical practice.

Therapists, Don’t Hold Your Autonomic Nervous System Hostage

By David Hennessy, Clinical Psychologist

Therapists, Don’t Hold Your Autonomic Nervous System Hostage

Being a busy therapist can sometimes feel like holding your own autonomic nervous system hostage. Our attention, emotional capacity, and physiological resources are routinely directed outward as we hold space for others. This work is meaningful and often deeply rewarding. However, it also carries a real biological and psychological cost.

Empathy is a gift we offer clients. Importantly, it is not a neutral act for the therapist. When we listen to distressing or traumatic material, our own autonomic nervous system responds, even when clinical skill and experience are high. Over time, particularly in high-demand or trauma-exposed settings, this cumulative activation increases the risk of burnout, compassion fatigue, and emotional exhaustion (1, 2).

For this reason, these responses do not reflect personal failure. Instead, they reflect normal nervous system functioning under sustained interpersonal load.

The Autonomic Nervous System and Therapeutic Work

The autonomic nervous system regulates arousal, threat response, rest, and recovery. It operates largely outside conscious awareness and responds rapidly to cues of safety and danger (3). As a result, it often reacts before conscious reasoning has time to intervene.

Therapists repeatedly encounter emotionally charged material, including trauma narratives, fear, grief, and despair. Research shows that this exposure contributes to secondary traumatic stress and vicarious trauma, even when clinicians have no direct personal trauma history (4, 5). In practice, trauma-informed therapy describes this pattern as cumulative nervous system load rather than individual weakness.

The Overlap With Our Clients

Interestingly, the physiological and emotional effects therapists experience under sustained load often mirror the symptoms clients describe. These commonly include fatigue, irritability, difficulty concentrating, disrupted sleep, and emotional numbing (2, 5).

However, these responses do not signal incompetence. Instead, they indicate prolonged autonomic activation. Therapists, like all people, remain biologically responsive to stress.

The Hidden Upside of Discomfort

There are real costs to this reality. At the same time, discomfort can prompt growth. When the nervous system is stretched, many therapists begin to reflect more carefully on workload, boundaries, and recovery.

Over time, this reflection often leads therapists to refine self-care practices that genuinely support regulation rather than those that sound virtuous. From a tradesman’s perspective, tools must work under load. Consequently, what supports regulation is kept, and what fails is replaced.

Practising the Same Evidence-Based Strategies We Teach

The strategies therapists teach clients are the same strategies research shows support therapist wellbeing. Behavioural activation, mindfulness-based practices, values-guided action, sleep regulation, and boundary management support emotional regulation and stress tolerance (6–8).

Nevertheless, therapists often sideline these strategies during periods of high demand. Revisiting core regulation skills, such as those outlined in managing strong emotions and emotional regulation, can therefore be both clinically grounding and personally protective.

Our own physical and psychological health is supported
We develop lived experience data that informs therapy
Our authenticity and credibility increase
Our therapeutic skills are sharpened through direct application
We model what regulated engagement looks like in practice
We are better situated to provide co-regulation in session through a more grounded, regulated, and emotionally available presence

At times, regulation is not about reducing distress. Instead, it involves staying present with distress safely. In these moments, distress tolerance skills become particularly relevant for both therapists and clients.

A Gentle Reminder

Not practising self-care sufficiently can feel like holding your own nervous system hostage. However, this pattern is rarely intentional. More often, it develops gradually through workload, responsibility, and care for others.

For this reason, even small steps toward tending to personal needs build capacity over time and support sustainable clinical practice.

Frequently Asked Questions

Is Therapist Burnout Common?

Yes. Large-scale studies consistently report high rates of burnout and emotional exhaustion among mental health professionals (1, 2).

Can Therapists Experience Trauma Responses Without Direct Trauma Exposure?

Yes. Research clearly documents secondary traumatic stress and vicarious trauma in clinicians exposed to trauma narratives (4, 5).

Does Self-Care Actually Change Nervous System Functioning?

Yes. Mindfulness-based and values-oriented interventions improve emotional regulation and stress tolerance over time (6, 7).

Why Is Co Regulation Important in Therapy?

Clients often regulate through the therapist’s presence before they can self-regulate. Consequently, a grounded and emotionally available therapist supports nervous system safety and engagement (3, 8).

References

Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience. World Psychiatry, 15(2), 103–111. https://doi.org/10.1002/wps.20311
Figley, C. R. (2002). Compassion fatigue. Journal of Psychosocial Nursing and Mental Health Services, 40(3), 14–20. https://doi.org/10.3928/0279-3695-20020301-09
Porges, S. W. (2011). The polyvagal theory. Norton.
McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization. Journal of Traumatic Stress, 3(1), 131–149. https://doi.org/10.1007/BF00975140
Bride, B. E., Radey, M., & Figley, C. R. (2007). Measuring compassion fatigue. Journal of Traumatic Stress, 20(2), 155–163. https://doi.org/10.1002/jts.20214
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy. Guilford Press.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context. Clinical Psychology: Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy.bpg016
Barlow, D. H., Sauer-Zavala, S., Carl, J. R., Bullis, J. R., & Ellard, K. K. (2014). The nature, diagnosis, and treatment of neuroticism. Clinical Psychological Science, 2(3), 344–365. https://doi.org/10.1177/2167702613505532

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