If you’re a clinician providing therapy, how many times today have you used the word “boundaries”? Likely in the context of working with someone in their relationships or helping someone try to get more balance in their life.

Now, in your professional context, what comes up when you think of boundaries? Maybe your ethical code and standards of practice, your schedule, client contact (or if you’re like me, always working on ending sessions on time!). You've probably even read the articles. You might have even written one. "Ten Self-Care Strategies for Therapists." "How to Prevent Burnout in Clinical Practice." "The Importance of Boundaries for Helping Professionals."

You have likely done most of what they suggest too. You exercise, go to your own therapy, do the breathwork. You read the books, take the trainings, get supervision. You set boundaries, at least you do your best. You do what you’re supposed to do.

Then why are you exhausted?

I hear this question all the time from mid-career clinicians, the ones with seven, twelve, or eighteen years of experience. The ones who have enough clinical skill to do complex work, supervise others, and who have enough self-awareness to know something is wrong but internalize it as they are the ones doing it wrong.

What if the problem isn't your self-care?

This is the first episode in a multi-part series on clinician sustainability, building on earlier episodes exploring moral injury and the systemic forces shaping clinical work.

Reflection Prompts

1. When you say you're "burned out," what are you actually describing — exhaustion, shame, grief, or a values violation?
2. Which of the four constructs (burnout, secondary traumatic stress, vicarious traumatization, moral injury) most closely maps onto what you're carrying right now?
3. Is your current practice designed for sustainability or for output? Whose interests does that design serve?
4. Where do the Self-Sacrifice or Unrelenting Standards schemas show up in how you relate to your work?

Connect

You hold space for others but where do you go when you need it held for you?

Join me at the ReLit Reset Circle™

A no cost, monthly gathering for therapists who want to stay in this work without losing themselves, while navigating burnout, moral strain, and the emotional weight of practice inside demanding systems.

Next gathering is April 14th 7pm EST where our topic will be “Being Good Enough”.

Register here: https://www.relitpractice.com/circle

Registration gives you access to the replay, subscription to the ReLit Practice Newsletter where I share topics about therapist burnout recovery, moral injury, trauma informed care, and how to stay in this work without losing yourself!

When you register, you'll also get access to the free Reset Checklist, a practical starting point for noticing where your system is right now, and you'll be first in line when doors open for the ReLit Practice program.

If someone asked you to name the core tool of your clinical practice, what would you say? EMDR? CBT? Your favourite assessment measure?

Maybe it's none of the above. And maybe it’s you.

The caring self, who you are in the therapy space, is the primary therapeutic instrument. And like any instrument, it needs tending and tuning.

In this episode, I walk through the Cycle of Caring, a four-phase framework that maps the rhythm we move through with every client: empathic attachment, active involvement, felt separation, and re-creation.

I explore what happens in our nervous systems during each phase, where moral injury and schema patterns show up, and why the phases we skip most, felt separation and re-creation, are exactly the ones that make the rest of the cycle sustainable.

This episode is for you if you’ve ever closed a session, opened the door, and realized you’re still carrying the last client’s material into the next room. It’s for you if “self-care” has started to feel like another thing on the to-do list. And it’s for you if you’ve been wondering whether the weight you’re carrying is burnout, or something more structural.

You hold space for others but where do you go when you need it held for you?

Join me at the ReLit Reset Circle™

A no cost, monthly gathering for therapists who want to stay in this work without losing themselves, while navigating burnout, moral strain, and the emotional weight of practice inside demanding systems.

Next gathering is April 14th 7pm EST where our topic will be “Being Good Enough”.

Register here: https://www.relitpractice.com/circle

Registration gives you access to the replay, subscription to the ReLit Practice Newsletter where I share topics about therapist burnout recovery, moral injury, trauma informed care, and how to stay in this work without losing yourself!

When you register, you'll also get access to the free Reset Checklist, a practical starting point for noticing where your system is right now, and you'll be first in line when doors open for the ReLit Practice program.

References Mentioned

Skovholt, T. M. (2005). The cycle of caring: A model of expertise in the helping professions. Journal of Mental Health Counseling, 27(1), 82–93.

Skovholt, T. M., & Trotter-Mathison, M. (2016). The resilient practitioner: Burnout and compassion fatigue prevention and self-care strategies for the helping professions (3rd ed.). Routledge.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

Thank you for listening! Everything on this podcast is guided by five pillars, recognizing and releasing burnout, repairing and rewiring overfunctioning patterns, restoring rhythm and regulation, redesigning practice for long-term sustainability, and relighting passion so you can stay in the work without losing yourself.

Therapist burnout is often framed as having poor boundaries, inadequate self care, or exhaustion. For many mid-career clinicians, the deeper core of this is moral injury, the impact (psychological and physical) of being repeatedly placed in situations that compromise our ethics and values.

Questions for Reflection

1. Reframe: What changes for you when I reframe “I am broken” to “I’ve been hurt by a broken system”?
2. Connect: Who are the people you trust that get it? How can you connect with them?
3. Feel: What does your body feel like when this topic comes up? What practices soothe that feeling (if painful)?
4. Clarity: What values are most important to you in this work? How do you practice them in and out of session?

Join Me In The Reset Circle

You hold space for others but where do you go when you need it held for you?

Join me on the second Tuesday of every month for the ReLit Reset Circle™: A Monthly Reset for Therapists. https://www.relitpractice.com/circle

Research Cited

Čartolovni, A., Stolt, M., Scott, P.A., & Suhonen, R. (2021). Moral injury in healthcare professionals: A scoping review and discussion. Nursing Ethics.https://journals.sagepub.com/doi/10.1177/0969733020966776

Coimbra, B.M., Zylberstajn, C., van Zuiden, M., Hoeboer, C.M., Feijo Mello, A., Feijo Mello, M., & Olff, M. (2024). Moral injury and mental health among health-care workers during the COVID-19 pandemic: Meta-analysis. European Journal of Psychotraumatology, https://www.tandfonline.com/doi/full/10.1080/20008066.2023.2299659#d1e352

Dean, W., Morris, D., Manzur, M.K., & Talbot, S. (2024). Moral injury in health care: A unified definition and its relationship to burnout. Federal Practitioner https://www.tandfonline.com/doi/full/10.1080/20008066.2023.2299659#abstract

Litz, B.T., Stein, N., Delaney, E., et al. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review https://www.sciencedirect.com/science/article/abs/pii/S0272735809000920

Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0036090

Usset, T.J., Baker, L.D., Griffin, B.J., et al. (2024). Burnout and turnover risks for healthcare workers in the United States: Downstream effects from moral injury exposure. Scientific Reports https://www.nature.com/articles/s41598-024-74086-0