Seven Ways to Manage Caregiver Stress when Their Issues Are Also Your Own

We got this question from a weary California therapist, who is struggling with her own discouragement, distress and disorientation following the November election, and whose clients are presenting her with the same issue. 

Belleruth gives her some bullet points on preventing burnout and compassion fatigue under these circumstances.  They have wide applicability – this is an issue for parents, educators, journalists, friends and managers, too.


I have a question about self-care and coping with stress as a therapist. Now and then we might meet with a client whose issue mirrors something we’re dealing with ourselves. We offer our support while maintaining our professional distance… but it doesn’t usually happen two or three times a week. It has been lately, especially here in California where so many of us are still struggling with the outcome of the November election.

When we’re blindsided and distraught, how best to maintain our equilibrium when our clients are similarly upset? For them I offer a simple, “I’m still trying to understand it myself.”

That’s within my self-disclosure comfort zone, but in terms of self-care, we practitioners don’t get much of a break. Compassion fatigue is lurking in the wings when we’re regularly dosed with the source of our own anxieties.

I listen to your Heartbreak, Betrayal and Abandonment guided imagery and recommend it, and I’m wondering if other practitioners have expressed similar concerns and if you have any additional ideas for self-care.

Thanks for your good work.



Dear Marilyn,

Yes, many other practitioners have expressed similar concerns. 

Of course, you raise the Mother of All Issues for therapists (and, for that matter, parents, journalists, teachers and managers, too); how to manage the strain, distress, confusion, blurred boundaries, projections and biased thinking that occur when our clients’ miseries are our own. 

I always felt that one of the great side benefits of being a therapist was the way the work required my exquisite, all-in, attentional focus on someone else, and that became my daily single-pointed meditation, taking me away from my own worries and stresses.

Clearly, that benefit is lost under these circumstances.

Other than listening to the Abandonment imagery, what else might you do to cushion yourself against the stress and distress you describe? I’ve got some thoughts about that. No doubt most of these have occurred to you too, but sometimes it helps to hear it from someone else.

  • First of all, the obvious: back up and give extra attention to daily self-care. This is a time to very consciously make those little, minute-to-minute choices, to get enough rest, eat well, take a few moments between things to just sit, reflect, and breathe. 
  • This would be a perfect time to keep a gratitude journal. Assigning ourselves the task of writing down the good things, large and small, mechanically forces us to notice them. Simplistic, you bet – but ridiculously powerful and effective.
  • Take time between clients, even if you’re running late, to open the window, breathe in some fresh air, walk out of the room, clear your mind, get to the bathroom, have a glass of water… (but try, try, try not to run late – it’s a subtle but relentless source of underlying stress when you do – take it from a reformed late-nik.)
  • Remind yourself of your higher mission each time you place your bottom on that chair.
  • Also remind yourself that it’s not all on you.  This is where that central theme from the Abandonment imagery comes in handy. That imagery elicits the arrival of ancestors, whose values and banner you carry forward, as a powerful, steady, reliable source of support and validation.  Ask for help each time your session begins – and imagine the ancestors, helpers, guides, and teachers showing up in the room with you. Some people call this imagery; others call it prayer.  It doesn’t matter how you label it.  It's shockingly helpful.
  • Remind yourself of the obvious: This Is Not About You. It’s about that person sitting across from you. So focus there. As long as your focus stays true and your mind doesn’t wander, you’re fine. And if/when it does wander, you know where to steer it back.
  • Never let the session devolve into an ‘Ain’t It Awful” conversation – that’s non-productive and disempowering (with friends, too, by the way.  After the first 5 supportive minutes, that is a conversation to end.)  Instead, do your best to keep the focus on what positive steps can be taken in the face of feeling helpless and discouraged…. Which, after all, is what you always do with a client, right? 

I hope this helps. 

My very best to you,

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