One of the most important elements of a thriving practice is mindfully choosing your caseload. Done with self-awareness and intentionality, this can be a highly meaningful prevention strategy for burnout and compassion fatigue. How? This posts highlights 3 key elements – values, strengths, and stress hardiness – that when thoughtfully considered can help build a caseload that serves you and your clients quite well.
It may feel like we simply “get” our caseload because prospective clients call. Aren’t you supposed to be their therapist if they are interested in being your client?
Well, that’s totally up to you, in many ways, even if it doesn’t feel like it.
(I realize that if you work for an agency, clinic, or group practice, this is much less under your control. So this post is admittedly more for private practitioners).
Preview: In Part 2 I will highlight several more key elements, including: financial situation, paperwork, self-care, cultural expectations, and balancing work with personal life.
Values & Passion
Reflecting on what truly matters to you in life is one of THE best ways to bring clarity to the kind of clients (and how many of them) you ultimately want/need to see.
What types of work and clinical engagement do you truly find meaningful?
What are you most passionate about doing?
How meaningful to you are the following attributes and qualities?
Creativity Peacefulness Energetic interpersonal exchange Structured sessions
Diversity of people to help Honing your craft Learning new ways to help
Quiet Stillness Activity Deep Listening
Using your verbal talents Using your body to help others Teaching skills
The value you place on these (and many other) qualities and how they are expressed in your work matters.
The level of passion and energy you can bring to different types of clients matters.
When you have clarity on this, I believe that you get clear on who you allow into your practice and who (and how many) you can meaningfully serve week by week, month after month.
Burning out becomes less likely then because you are doing purpose- and passion-driven work from a consciously awake emotional and spiritual space.
Simply put, what are you good at?
What feedback to you get from others about your talents and skills?
They could be interpersonal or “method-based” strengths.
These talents could be “natural” or consciously cultivated.
In some ways, that distinction doesn’t matter.
In other ways, it does matter because innate talents can go under our radar and even dismissed. But when we work at something, we know it and maybe we’ve chosen quite purposefully to enhance that skill.
So, determining what assets you bring to your clinical work is essential for preventing burnout and general fatigue.
One of my former supervisees was brilliant at being spontaneously creative in the room with her child clients. She had a knack for it. It served her and them very well.
But if we work against the grain, we’re expending energy and resources in a strained manner. We simply won’t serve ourselves and our clients nearly as well if we are “mis-employing” our assets.
When our skill set is better aligned with the people with whom we choose to work, we become much better able to truly help, to feel more competence and confident, and to establish more collaborative relationships.
Note. Working from our strengths, however, doesn’t mean that we can’t develop an entirely new skill set. We just have to recognize limits and boundaries of our capacities at any given point in time.
Resilience & Stress Hardiness
Resilience and stress hardiness are all about your emotional, mental, physical, spiritual, and relational capacities, at any given phase of your life.
It’s all about how quickly and readily you can bounce back from challenge and adversity and move through vs. get knocked over by life’s stressors.
Ask yourself (and/or trusted others) about your own capacity to handle a particular caseload.
We can of course cultivate more stress hardiness. Self-care practices and attitudes are all about doing just that.
But in general, what is your capacity right now?
Could you imagine that X number of clients would burn you out in just a few short weeks?
Could you imagine that seeing 10 severely depressed clients week after week would be good for what you typically can handle?
Some therapists can do it. Some would have a much harder time. To know where you stand on this is the ultimate act of self-care and client care.
We actually are ethically motivated to know this for ourselves.
For example, I know that I would never have been able to handle inpatient work. I did a rotation on an inpatient psychiatric unit on internship, and although I learned a ton, I just don’t have the stress hardiness chops for that specific kind of work.
I have friends and colleagues who excel at that role. It just resonates better with their temperament, sensibilities, and skill set.
The Highly Sensitive Therapist
Speaking of temperament, if you have a highly sensitive temperament (see Elaine Aron’s ground-breaking work on this topic), it is absolutely crucial for you to be aware of your caseload – both number-wise and by type of client and presenting issues.
I, like many of other helpers out there, have a quintessential highly sensitive temperament.
That means that we:
1) think and process deeply,
2) can get overstimulated by our sensory world,
3) have a high level of empathy and deep emotional response to the world, and
4) pick up on subtleties and nuances in ourselves and environment when others might be quite oblivious.
That’s, in part, what makes us effective helpers. And that’s also what can strain and complicate our capacity for resilience.
So, aside from building our mindfulness muscle and doing harmonizing energy work (which will be the subject of a blog post in the near future), knowing your limits in this regard is one of your best allies.
Stay tuned for Part 2 in this mini-series on Mindfully Choosing Your Caseload. We will tackle your financial situation, paperwork, self-care, cultural expectations, and balancing work with personal life.
Please leave a comment below about how these elements operate in your caseload decisions. Our Thriving Therapist community will most definitely benefit from your experience.
Matt, I really enjoyed reading this-I was enthralled. As counsellors one thing we generally try to support people towards is genuineness and this blog reminds me that I need to also be genuine, which is sometimes difficult to do. I will be doing some journaling to examine those questions. Thanks so much for this!
Thank you so much, Heather! Apologies for the delay in responding. Glad to hear you enjoyed the post and found it useful to contemplate your own genuineness in therapy. Indeed a difficult endeavor at times. Journaling about these questions sounds incredibly beneficial. Thanks, and best of luck to you!
Many thanks, Sharon! I agree – burnout is often mis-conceptualized or mis-attributed. It’s like the fundamental attribution error in social psych. We far too often attribute negative behavior to someone’s personal characteristics vs. contextual factors. At the same time, we can empower ourselves with self-awareness, resources, and cultivation of resourcefulness.
Part 2 on its way soon. 🙂
This is so helpful, Matt. I think too often burn out is viewed a personal and/or professional failing. Thanks for your positive spin on it. Look forward to part 2!