You've heard it. You've said it. "You just need better boundaries." But what if the boundary conversation has become part of the problem? In this episode, we explore how self-sacrifice and unrelenting standards schemas, two of the most common patterns in helping professionals , can turn well-meaning boundary advice into a shame spiral. Drawing on Jeffrey Young's schema therapy model and Skovholt and Trotter-Mathison's Clinician Paradox, we unpack why the same qualities that make you effective in clinical work are the ones that make saying no feel genuinely dangerous. This isn't an anti-boundary episode but acknowledges that burnout doesn't mean a boundary failure.

You spend your life holding space for others but where do you go when you're exhausted and need it held for you?

When the very nature of therapy is about giving and caring, it’s easy to forget about what we need! And when the structures we work in (even private practice) aren’t designed to hold space for us, burnout becomes real. I see this all of the time in my burnout recovery work with therapists and other helpers, they are excellent clinicians and even “do all of the things” for self care, but are still tired.

It's because we can't do this alone. That's why I created the Reset Circle, because the number one agent of burnout prevention and recovery is being with peers who get it. Not bubble baths, more CE's, or boundaries. But connection.

The ReLit Reset Circle™ is 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.

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

This month's Reset Circle explores the Unrelenting Standards schema and why the clinicians most committed to excellence can fall into the trap of the endless pursuit of excellence which can be another mask for burnout.

We will look at the impact of overfunctioning and what it looks like to practice “enough-ness”.

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

References & Links:

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner's Guide. Guilford Press. https://www.guilford.com/books/Schema-Therapy/Young-Klosko-Weishaar/9781593853723

https://www.routledge.com/The-Resilient-Practitioner/Skovholt-Trotter-Mathison/p/book/9781138830073

https://onlinelibrary.wiley.com/doi/10.1002/cpp.70115

https://www.ncbi.nlm.nih.gov/books/NBK614517/

https://www.guilford.com/books/DBT-Skills-Training-Manual/Marsha-Linehan/9781462516995

https://www.sciencedirect.com/science/article/pii/S2213058614200179

https://onlinelibrary.wiley.com/doi/10.1002/cpp.2328

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

Rest didn't fix it. That's because burnout in clinical practice is often driven by something different: grief. Grief requires a different kind of repair. In this episode, we go beneath the surface of therapist burnout to explore its intersection with moral injury: the wound that forms when clinicians are repeatedly asked to act against their own values. We talk about why rest alone doesn't heal this kind of harm, how ethical compromise accumulates in the nervous system, and what genuine recovery actually looks like, built on autonomy, values alignment, and honest reckoning with the systems shaping your practice.

If you've ever felt like you're mourning the work you trained to do, this conversation is where I'd start. In this episode:

• Why burnout and grief so often look the same — and why the distinction matters
• The difference between exhaustion, burnout, secondary traumatic stress, and moral injury
• How ethical compromise shows up in the body and the work
• Why "rest more" is not a treatment plan for moral injury
• What recovery actually requires

The Research Behind This Episode:

The WHO (2019) classifies burnout as an occupational phenomenon — not a personal one — defined by exhaustion, cynicism, and reduced professional efficacy. That framing matters. It locates the problem in conditions, not character. → https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-disease

Maslach & Leiter (2016) showed that burnout emerges at the intersection of individual experience and workplace environment. Emotional exhaustion is only one dimension — depersonalization and loss of professional efficacy are equally significant, and harder to recover from without structural change. → https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911781/

Golkar et al. (2019) documented the physiological signature of burnout: dysregulated stress response systems, altered HPA axis functioning, and measurable changes in how the nervous system processes threat. This is not metaphor. Burnout changes the body. → https://pmc.ncbi.nlm.nih.gov/articles/PMC6701350/

Čartolovni et al. (2021) clarified that moral injury is distinct from burnout — it arises specifically from perpetrating, witnessing, or failing to prevent acts that violate one's moral code, or from institutional betrayal. For clinicians, this often means the system, not the client, is the source of the wound. → https://pmc.ncbi.nlm.nih.gov/articles/PMC8366182/

Williamson, Murphy & Greenberg (2020) connected moral injury directly to frontline clinical work, establishing that the conditions of care delivery — not just the content — generate injury. → https://academic.oup.com/occmed/article/70/5/317/5842928

Purcell et al. (2024) found that moral injury in healthcare workers is significantly linked to organizational culture and modifiable workplace conditions — reinforcing that recovery isn't only an inside job. The conditions have to change too. → https://pmc.ncbi.nlm.nih.gov/articles/PMC11951272/

Burnout, Moral Injury, and Sustainable Recovery for Therapists

In this episode, we explore why burnout for therapists often reflects ethical strain, cumulative trauma exposure, and nervous system overload rather than simple fatigue.

Reflection & Journaling Exercises for Clinicians

If you want a deeper dive into moral injury and burnout, take some time and reflect on the following:

Values:

• Where in my work lately have I felt that something is off?

• Which value feels most challenged: dignity, safety, fairness, integrity, access to care?

Somatic Awareness

• When during my workday does my body feel most activated?

• What small reset could I realistically do between sessions?

Restoring Agency

• Where do I feel I have no choice right now?

• Where might I have one small choice I have not been using?

Overfunctioning Patterns

• What am I afraid will happen if I don’t keep pushing?

• What would sustainable care look like without self-sacrifice?

Redesigning Your Practice

• What part of my workload take the most energy?

• What part of my workload is the most energizing?

Stay Connected & Explore More

ReLit Practice™ Newsletter https://relitpractice.com/newsletter

Find me on Substack https://substack.com/@staceysteele

Follow on Instagram https://instagram.com/staceysteelepsychology

Podcast Feed https://media.rss.com/relitpractice/feed.xml

Stacey Steele Psychology https://steelepsychology.com

YouTube

https://www.youtube.com/@relitpractice

Research & Evidence Referenced

Burnout as a Systems Issue

Maslach, C., & Leiter, M. P. (2016).

Understanding the burnout experience: Recent research and its implications for psychiatry.

https://onlinelibrary.wiley.com/doi/10.1002/wps.20311

Meta-analysis on Moral Injury Severity

https://www.researchgate.net/publication/389000562

Secondary Traumatic Stress

Whittenbury et al. (2025).

https://doi.org/10.1177/15248380241309371

Power, Agency, and Burnout Inequities

Kirk et al. (2023).

https://doi.org/10.1177/26320770231189611

Norris & Primm (2022).

https://psychiatryonline.org/doi/full/10.1176/appi.ps.20220522

References are provided for educational purposes only and do not constitute therapy, supervision, or individualized clinical consultation.