Is Your Capacity to See Clients Shrinking Every Year?
When you have a client complete therapy with you, how often do you dream about not taking on a new client to fill that hour? Maybe you leave that hour free to have a longer lunch break, catch up on notes, go for a walk, or just do nothing! Then reality comes in to remind you that’s not financially feasible or your inner critic believes that would be lazy or irresponsible. This is the struggle for so many highly sensitive therapists - choosing financial or energetic sustainability, keeping up with the caseload size of other therapists or honoring your own needs.
Seeing Fewer and Fewer Clients
Recently I was with a group of fellow HSTs where everyone has experienced this correlation between caseload capacity and career length. The longer they’ve been a therapist, the fewer clients you can see each day, each week. I have observed the same pattern in my own practice. In the early years of internship and private practice, I regularly saw five clients per day which felt sustainable - at least for a few years. That number eventually felt very depleting and I needed to reduce how many clients I saw each day to four. Four, that was the magic daily caseload size for me and I’ve heard many other HSTs say the same. Recently though, I’ve been feeling much better working with three clients per day. Three feels much better than four, but it’s not as financially sustainable. I have to wonder if my capacity will continue to decrease. Have you noticed your capacity for seeing clients decreasing or increasing as you spend more time in this field?
This trend is counterintuitive, isn’t it? You probably would expect caseload capacity to increase over time as you had more experience, more options in your toolbox, and felt more comfortable in the work. Especially as an HSP who deeply processes, there would be less to contemplate about how to do the work and fewer surprises as your experience with different types of clients and issues grew. I would think more experience would free up quite a bit of energy.
The Cumulative Emotional Toll
Of course, we know being a therapist is unlike any other type of work and it requires a considerable amount of emotional and energetic resources. If you’re highly sensitive and/or an empath, the weight of doing therapy could take an emotional and nervous system toll from vicarious trauma and the mere stress of supporting others. This depletion would only intensify if you’re also dealing with stress in your personal life, being inundated by global or political uncertainty, or impacted by seasonal shifts in your mood.
When you’re feeling resistant to holding more clients because you’re tired and emotionally saturated, you then have to worry about financial limitations from a smaller caseload. With less financial freedom comes less time off and with less time off makes you more susceptible to burnout. It’s a vicious cycle. How can you escape to find balance again? That’s a complicated question and I’m still figuring this out myself, but here are a few ideas:
Are You Living Like a Therapist?
Therapists are expected to operate as if they had any other type of career. This is not sustainable. Check in with yourself - are you living like you did before becoming a therapist? What do you need in place to sustainably work as a therapist long-term? Prioritize your own healing and find ways to take more time off, even long weekends and staycations where you don’t have to spend money can help significantly.
Look at your level of fulfillment as a therapist. Are you fulfilled with your clinical work or do you need to be challenged or engaged in a different way? Most careers involve an evolution of responsibilities and roles over time, which offer purpose and exciting challenges. Is it time to make a shift? Maybe you’re ready to begin mentoring incoming therapists as a supervisor or educator? Perhaps there’s other services you would like to include in your practice such as consulting. You may want to do something completely different like supporting other therapists through admin help or website design. What would light you up?
Make sure your practice systems and policies are set up to support you. Get really clear on who you work best with and when you work. Especially when you have limited capacity as an HST, it’s important to be very intentional during your screening process to make sure clients are a great fit regarding presenting concerns, population, and treatment modality. Once you narrow down the best fit clients for you, make sure you are holding firm boundaries around when you work with those clients, how much you charge, and ending sessions on time.
Being highly sensitive as a therapist can be a really fulfilling experience, but it can also be an exhausting struggle to keep up with your peers and be present for your clients. You must take really good care of yourself, regardless if that looks completely different than what other therapists are doing.
