Why Therapist Self-Care is an Ethical Issue
As therapists, we know the importance of boundaries and self-care. We preach it to our clients all the time. But in reality, most of us are terrible at putting it into practice. To make matters worse, our workplaces and leaders are often also terrible at enforcing it. In fact, they sometimes enforce the opposite.
When I worked at an agency, I liked my bosses. We got along, I respected them, and they cared about us. But we did not see eye to eye about boundaries and self-care in the workplace. I had noticed that certain things made it harder to do my job well - how late I worked, how many people I saw in a row, etc. I thought it was reasonable to make some minor adjustments in order to do my job better. My boss felt that I should be able to do my job just fine the way things were. (Despite that I told them I couldn’t.) To them, the changes I asked for were optional luxuries - an unnecessary deviation from the default. To me, they were a necessity for self-preservation.
I wish my bosses understood that I didn’t just “want” these things - I needed them. It wasn’t that I didn’t care to work hard, or that I expected this job to be chill. The fact was that I required the things I was asking for, so that I could work hard. I knew the job wouldn’t be chill; therefore I needed these things to function in it. I wasn’t doing anything straight up unethical, but I knew that feeling like shit made the quality of my work suffer. I could technically do my job the way I was, but I wasn’t happy and it wasn’t what my clients deserved. And I wasn’t willing to settle for that.
Right now in this field, the status quo is painfully flawed. The default setting for most therapist jobs involves long hours, low pay, little to no vacation/sick time, and heavy caseloads. We put up with so much, and it’s totally normalized. And if you begin to question it, you may be written off as high maintenance, lazy, or unrealistic. You may be told that it’s actually you that needs to change - it couldn’t possibly be the system. You may even start to believe that.
But really - How is it ethical to work 10 hour days if you’re depressed at the end of it? How is it ethical to take on 40 clients in a week if you feel dissociated and apathetic by 3pm? How is it ethical to work while you’re sick, or never take a vacation, if it leads you to resent your clients? For me, it was simply not ethical to prioritize quantity over quality. It’s therapy, not a factory. Being a therapist takes so much more than just a pulse. You need empathy, patience, focus, quick thinking… all kinds of things that are very hard to do when you’re exhausted. I am the vessel that my therapy happens through - I need to treat that vessel with care, not like a machine.
When we set boundaries at work, it’s about more than personal preference. It’s about knowing what you can tolerate and still function. It’s about not doing your job in a way that leads to burnout, illness, compassion fatigue, trouble in your personal life, or unhelpful/unethical behavior with your clients. It’s about respecting your own limits. And those limits look different for everyone.
More people in leadership need to understand this. When your employees try to set a boundary, they’re not doing it because it would be “nice to have”. They’re most likely requesting it so they can do their job effectively. They’re doing it because they care about the quality of their work (which is something you should care about too). And they’re telling you that if they don’t set these limits, they aren’t going to be able to do good work.
How bosses respond to these requests is everything. Because therapists who feel ineffective, unheard, and burnt out tend to quit. And then surprise! - You’ve got turnover. Places that are structured to allow no flexibility for their employees are the ones with the highest turnover. They scratch their heads and claim to not know why this is, but if they look back at their conversations with their employees, they should know exactly why. They told you what they needed, and you told them that was too much.
Therapists, you are not too much. You are not being unreasonable by having limits. Do not let anyone to gaslight you into thinking otherwise. We’re not asking for ten thousand dollars an hour or eight months off every year. We just maybe don’t want to work until 7pm every day, or see six clients in a row. It’s really not a lot to ask.
Bottom line:
Self-care through setting boundaries at work is necessary to practice ethically. These are not extra things you do as damage control when things are already terrible. They aren’t luxuries or rewards that happen if someone else allows you. Asking your employer to respect your needs is not asking for a favor. So do yourself a favor, and remember this the next time you discover a limit. Stand up for yourself and the quality of your care (and your own life).