When Helping Hurts

Written by Danielle Hiestand, PsyD, LMFT, CEDS‑C

‍Danielle Hiestand, PsyD, LMFT  is a Certified EMDR Therapist, EMDRIA‑Approved Consultant, Assistant Director of Professional Credentialing at Precision EMDR, and an IAEDP Certified Eating Disorder Specialist Consultant. She specializes in treating Eating Disorders, PTSD, Complex Trauma, and supporting mental health professionals. With advanced training in trauma, dissociation, and traumatic-stress studies, she brings depth, compassion, and clinical rigor to her work. In addition to her clinical practice, Danielle has taught undergraduate, graduate, and continuing-education courses, authored the textbook "Understanding Eating Disorders: Risk Factors, Diagnosis, Treatment, and Recovery," and developed therapist-centered trainings that focus on self-care, emotional sustainability, and the self of the therapist in trauma work.

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Developing Resilience in the Face of Compassion Fatigue, Secondary Trauma, and Burnout

You became a trauma therapist because you care. But when helping begins to hurt, something needs to change.

As trauma therapists, we carry stories that don’t leave us. We hold suffering that isn't ours. We sit with grief that has no resolution. And while we may have training in boundaries and strategies for attunement, none of us are immune to the cost of prolonged exposure to trauma.

Whether it is secondary traumatic stress, compassion fatigue, or burnout—the impact is real. And if we don’t understand it, name it, and tend to it strategically, it can erode the very qualities that make us safe and effective.

What happens when helping starts to hurt?

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The Hidden Cost of Carrying Trauma

Burnout doesn’t arrive all at once. It seeps in slowly, dimming the light you once brought to the work.

Burnout rarely announces itself with drama. Instead, it whispers: subtle detachment, emotional exhaustion, dread before sessions, irritability where compassion used to live.

You might notice it in your body first—tight shoulders, shallow breathing, headaches that won’t go away.

Or in your work—phoning it in, struggling to track a client’s process, or resenting the work you once loved.

These are not signs of failure. They’re signs of depletion. Indicators that your system is sending up flares: I need support. I need space. I need care.

Therapist self-care has been reduced to bubble baths and boundaries. But what we need is something more robust—a self-care paradigm rooted in ethics, embodiment, and sustainability.

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Therapist Self-Care Is a Clinical Imperative

When our nervous systems are dysregulated, our clinical judgment and attunement degrade.

Working with trauma changes us. And if we’re not careful, it changes us in ways that make our work less safe.

When we are depleted, we can’t attune. We miss cues. We default to strategies instead of presence. We react instead of respond. We lose the nuance our clients need.

For therapists, self-care isn’t indulgent. It’s ethical. Because ethical care demands attunement—and attunement requires regulation.

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The Boundaries That Hold Us: Preventing Burnout, Compassion Fatigue, and Secondary Trauma

You can’t be a safe container if you’re always leaking.

Boundary work is often misunderstood. It’s not about being hard—it’s about being honest.

So many trauma therapists are drawn to this work because you’re attuned, responsive, and deeply relational. But those same qualities, when unprotected, make us especially vulnerable to secondary trauma, compassion fatigue and burnout.

We care. And that care has often been shaped by early roles of emotional caretaking, people-pleasing, and high-functioning vigilance.

Without noticing, those same survival strategies can shape our clinical boundaries—making it hard to say no, take breaks, or charge what we’re worth.

This isn’t just about saying “yes” too often. It’s about the quiet ways we absorb the message that to be valuable, we must be endlessly available.

That we should stretch ourselves thin because clients need us. That good therapists sacrifice.

But the truth? When we’re overextended, we’re under-resourced. And that compromises our care.

Clinical boundaries aren’t just personal—they’re professional. It means recognizing that over-giving is not a sustainable business model. Boundaries protect our energy and our livelihood.

It is critical to know what you can hold; to say no when a yes would come at too high a cost; and to honor the limits of your presence and your energy.

Boundaries preserve the sacredness of the work.

And they preserve you.

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Structured Therapist Self-Care: Reclaiming Sustainability as a Trauma Therapist

You can’t just “remember to take care of yourself” in a system that’s built for burnout.

This work is often underpaid, undervalued, and emotionally overloaded.

The therapy field often glorifies sacrifice. You’re taught to endure, to hold more, to be the safe place for everyone else—even when you’re unraveling inside.

But that isn’t resilience. That’s depletion.

How you show up matters. And you can’t do this work well if you’re eroding in the process.

If you want to do this work for the long haul, you need to get honest about what sustains you.

That includes emotional support—but also training that deepens your effectiveness, and a financial and logistical strategy that actually meets your needs.

It means questioning the systems that profit off your self-abandonment.

You need a new model of success—one that honors breathable spaciousness, ample provision, and clinical depth—over endless sacrificial hustle.

Your work is more effective when it’s sustainable. And sustainability is built, not wished for.

In practical terms, this might mean:

• Building a schedule that fits your own biorhythms
• Setting a limit on caseload size based on a realistic measure of stamina and sustainability
• Investing in robust clinical trainings that increase your effectiveness transforming trauma—rather than just holding space for pain
• Prioritizing your sense of fit—not just the clients’—when choosing which cases to take and which cases to refer to other clinicians
• Charging enough to afford a life with margin

Self-care lives in the shape and details of your schedule, your skills, your policies, and your pricing. It has to.

Which means self-care cannot just be aspirational—it has to be structured.

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The Therapist Body: Your Most Important Clinical Tool

Your nervous system is your first and most essential clinical instrument.

Polyvagal theory reminds us: safety is not conceptual—it’s embodied.

Which means your body needs care, too.

Notice when you’re bracing, rushing, or dissociating. Practice returning to yourself through grounding, movement, breathwork, or sensory regulation.

Our bodies absorb stories. Without metabolizing what we take in, those stories accumulate.

Consultation must be about listening to what is going on inside you as you do the work, as much as it is about the clients you treat.

Giving yourself rest, bodywork, somatic support, and even your own EMDR therapy—these are not luxuries. They’re maintenance. And you deserve to be maintained.

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Final Thoughts on Therapist Self-Care: When Helping Hurts, Don’t Go It Alone

Therapist self-care isn’t a side conversation. It’s foundational.

Ethical, effective trauma therapy begins with a grounded, well-resourced therapist—not a perfect one, but one who is actively tending to their own system with the same compassion they offer their clients.

Whether you’re an EMDR therapist or a trauma clinician feeling the weight of burnout and compassion fatigue, I created this training with you in mind: Improving Clinical Outcomes through Trauma-Informed Focus on Clinician and Client Self-Care.

Because you matter. Because this work matters. And because you can’t do one well without the other.

Resources

• To access the training Improving Clinical Outcomes through Trauma-Informed Focus on Clinician & Client Self Care (On-Demand - 6.5 EMDRIA + APA + NBCC CE Credit Hours Available): CLICK HERE

• To contact Danielle Hiestand, PsyD, LMFT for Therapy and Consultation focused on EMDR, Eating Disorders and/or the Self of the Therapist in Trauma Work: CLICK HERE

‍References:
Baker, C., & Gabriel, L. (2021). Exploring how therapists engage in self-care in times of personal distress. British Journal of Guidance & Counselling, 49(3), 435–444. https://doi.org/10.1080/03069885.2021.1885010

Duncan, S., & Pond, R. (2024). Effective burnout prevention strategies for counsellors and other therapists: a systematic review and meta-synthesis of qualitative studies. Counseling Psychology Quarterly, 1–30.
https://doi.org/10.1080/09515070.2024.2394767

‍Kumar, S. A., Brand, B. L., & Courtois, C. A. (2022). The need for trauma training: Clinicians’ reactions to training on complex trauma. Psychological Trauma: Theory, Research, Practice, and Policy, 14(8), 1387–1394.
https://doi.org/10.1037/tra0000515

‍Porges, S. W. (2022). Polyvagal theory: A science of safety. Frontiers in Integrative Neuroscience, 16, Article 871227. https://doi.org/10.3389/fnint.2022.871227

Steele, W. (2020). Reducing compassion fatigue, secondary traumatic stress, and burnout: A trauma-sensitive workbook. Routledge.

van Dernoot Lipsky, L., & Burk, C. (2009). Trauma stewardship: An everyday guide to caring for self while caring for others. Berrett-Koehler Publishers.

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