Caring for Clients Without Abandoning Yourself

What happens when the impulse to care crosses into self-abandonment? For many therapists—especially those drawn to the work through their own histories of emotional caregiving, the boundary between compassion and over-functioning can be hard to find. We learn to equate endurance with effectiveness. Somewhere along the way, we start confusing sacrifice with service.

One early-career therapist I worked with—smart, deeply attuned—was being urged by her supervisor to “stretch and grow” by taking on more clients and retaining high-risk cases beyond her scope. She was already holding space for 25 people a week, and it was wearing her thin. The unspoken message was clear: growth means never saying no.

But what we often fail to recognize, especially those of us who identify as deeply empathetic, is that growth sometimes means saying no. Saying no to over-functioning. Saying no to reenacting survival strategies that once kept us safe but now keep us stuck.

That’s the therapist’s double bind: we’re expected to do two complex things at once, often without training or permission—to navigate both with care. First, we’re expected to hold boundaries: to be ethical, regulated, and structured. This includes managing caseloads realistically, honoring time limits, staying within scope, and making timely referrals. Second, we’re expected to be emotional containers: to make space for grief, rage, fear, trauma, and vulnerability—even when we ourselves feel taxed.

But how do we stay human in the process of holding that tension? We don’t have infinite capacity.

Years ago, a mentor told me I should be able to “adapt to all kinds of clients.” Something in me recoiled. I value authenticity, not performance. But I swallowed the advice, tucked away my instinct, and spent the next year trying to be endlessly accommodating. I took on clients I shouldn’t have—and learned some hard lessons that way.

Ironically, one of my mentor’s former clients later came to me and told me her previous therapy experience had left her feeling worse about her issues, not less. That moment stayed with me. I wasn’t surprised. A part of me already knew that much of what we call clinical commitment may be our own ego running the show. And beneath that ego? Unexamined shame that can leak into the therapy room, distort the work, and even harm the client.

Saying No as an Act of Integrity

When ego drives care, therapy becomes a stage for our own trauma. We overextend ourselves to feel useful, stay too long with clients we can’t help, and absorb pain that isn’t ours to hold—pain we carry home and transfer onto our partners, our children, ourselves. It can look noble. It can win quiet applause. And it can hollow us out.

Not long ago, I was working with another therapist whose needs exceeded what I could ethically offer. When I told her I didn’t think I was the right fit, she looked demoralized. “I feel like you’re rejecting me,” she said. Then she added, “I should be able to not trust you.” I understood where that came from. She’d likely heard from other clinicians that distrust in therapy is part of the process—that it can be worked through. And to a degree, that’s true. As an attachment-based therapist, I expect distrust; it’s part of the work. But in this case, the level of distrust made the work itself impossible. I had to trust my instinct—something I’d failed to do in the past.

She wanted me to use a specific modality, but every time I did, she would resist. I kept trying to find language that could bridge the gap, but the more I tried to name what was happening, the more hypervigilant she became. I was left choosing between being honest in a way that wasn’t cruel or softening the truth to preserve the connection. In the end, it didn’t matter—honesty itself seemed to be the threat. No matter how much compassion I brought, the truth was what she couldn’t bear.

I second-guessed myself, worried I was doing something wrong. But my limits weren’t about her worth; they were about my capacity. I explained that what she wanted wasn’t something I could offer within the time and insurance constraints she was facing. I knew trust would take time and pacing, which meant slowing down—or even halting—the modality. But she was insistent on it.

We processed her feelings around our transition, and I provided referrals and a termination letter. Still, I remember watching her face grow heavier as I explained. Because she, too, was a therapist shaped by the same cultural scripts around self-sacrifice, she likely believed I was abandoning her.

Honoring my own limits was hard. I carried the shame and sadness into my own therapy and unearthed something familiar: by continuing to work with her, I would’ve been reenacting my oldest wound—the one where I tried to rescue my mother from painful problems that were never mine to fix. That was an old story, and I didn’t want it running the work I did with clients. To choose integrity over ego, I had to disidentify from my shame and let go of the need to prove I was a good person—or a good therapist—by staying. Some therapists might think, “Well, you can’t just refer people out because they trigger your old wounds. You need to do your work.” But that’s not work—that’s habit. Work is doing the harder thing, and in this case, the harder thing was naming the pattern and stepping out of it before it repeated. My ego said, “Stay—prove you can handle it.” The part of me striving for greater integrity said, “Not this time.” I was able to stop confusing endurance with healing and remember, A good therapist knows when to stop.

Caring Wisely Within a System That Doesn’t

What I’m learning is that the antidote to burning out isn’t to care more, it’s to care more wisely, to care for two people in the room: the client, and myself. And to do it with honesty, humility, and reality checks.

My own ongoing therapy isn’t a luxury; it’s my compass. It’s where I meet the parts of me still trying to earn love through usefulness. It’s how I make sure my clients don’t become stand-ins for people in my past I couldn’t save. Many of us who became therapists were praised for being overly responsible as kids. We learned to care by over functioning. That trait gets rewarded in our field—until it doesn’t. Because when we chronically over-function, our clients don’t just learn to rely on us. They miss the opportunity to rely on themselves.

Boundaries aren’t the end of compassion. They’re how compassion stays clean. They make room for sustainable care, where both therapist and client are protected from the burden of unspoken needs. When we offer more than we have, we don’t just burn out, we make the care we give about us: our usefulness, our virtue, our image of who we think we should be.

We often talk about the mental health system being broken, the lack of wraparound care, the absence of ethical step-up options for clients who need more than a weekly session. It’s true: the step-up system is often unsafe and unsustainable. Inpatient facilities are overwhelmed, under-resourced, and too often retraumatizing. The gaps between levels of care leave individual clinicians holding what entire teams should be holding.

If ethical step-up care existed, I might have been able to keep the therapist-client I referred out. Imagine if she’d had access to a free trauma-informed yoga class, a nutritionist who understood the stress body, a psychiatrist available for meds, and a space for bodywork like myofascial release. That kind of network might’ve supported her nervous system enough to stay in the work. She didn’t just need therapy—she needed a community of regulation and care, and she needed healthcare without a designated time limit.

We can refer clients to resources, but the problem is coordination. There’s no integrated system ensuring follow-up, collaboration, or shared goals. Everyone works in silos—therapist here, psychiatrist there, bodyworker somewhere else—each doing their best, rarely communicating. True wraparound care systems would bridge those divides. Clients wouldn’t have to patch together their own healing. Clinicians wouldn’t have to be an entire system inside one relationship.

Those systemic fractures live inside us too: in the pressure to hold impossible caseloads, in the guilt we feel when we refer clients out, in the quiet belief that good therapists never say no. Every time we override our own limits to fill the gaps the system leaves, we reinforce the very structure we protest. That’s how the system lives in our bodies.

Change won’t begin with policy alone. It begins in the room. Each time a therapist chooses integrity over ego, honors a limit, ends a case beyond their scope, they refuse to collude with a culture that thrives on overextension. Those individual choices may not fix inpatient care or insurance overnight. But they expose what’s broken. And sometimes that visibility is the first step toward repair. Maybe what we need isn’t just personal humility but institutional ego death.

Yes, setting boundaries can make things look worse before they get better. When we stop over-functioning, the cracks become more visible. Clients may have nowhere to go. Agencies may hit capacity. Policies may shift only once the system can no longer hide behind our unpaid labor. Letting those cracks be seen is painful—and sometimes, clients get hurt in the exposure. That’s the part that breaks our hearts.

But it’s also where integrity lives: in knowing both our capacity and what is truly ours to hold. Every boundary becomes a quiet act of resistance—a collective whisper from therapists saying, no more. We can only carry so much. When we accept pain as part of the human condition, and limits as part of love, we can stop performing care and start truly offering it.

“Do not abandon” must include not abandoning ourselves.