Therapy Burnout in Patients: Why Treatment Can Feel Exhausting

Why People Experience Burnout From Mental Health Treatment

Though it’s normal to feel some nervousness before a session or emotional fatigue from therapy in general, always feeling that way can be really tough.^[1] The reasons why therapy feels exhausting can vary, and each person usually has their own combination of factors. These may include:

High Pressure to Perform in Therapy

Some people simply find therapy more draining than others. The reasons are unique to each person, but those with people-pleasing tendencies may expend a great deal of energy being the “perfect” client. For example, they might:^[2]

• Worry about paying on time.
• Never miss an appointment, even when they’d like to.
• Never complain or disagree with their therapist.
• Adhere to every boundary in therapy without question.
• Always feel thrilled (or say that they are) at the end of sessions.

These behaviors around therapy may indicate that you want your therapist to like you or that you want to be an “easy” client who’s always improving. However, this could be getting in the way of you showing up authentically.^[2] 

It can actually be useful to show up in therapy in a bad mood, say when you disagree with your therapist, and tell them when you’re still experiencing poor mental health. This can help your therapist understand the causes of symptoms, so you can develop better coping strategies together.

Emotional Hangover

A “therapy hangover” is sometimes used to describe burnout from therapy. Confronting the stress in your life, recalling past memories, and experiencing the emotions that come with conversations can cause you to expend a significant amount of energy. This can understandably create an emotional hangover afterwards. 

Even the physical act of talking to someone for a 50-minute session can be exhausting. As discussed below, burnout due to emotional hangover can potentially be reduced by less frequent sessions. The important thing is that the right balance is struck between not burning yourself out and getting the full benefits from therapy.

Processing Trauma

Certain forms of therapy may require you to process painful memories, which can be incredibly draining. Revisiting traumatic experiences can invoke your fight or flight response, causing you to feel: 

• Anxious.
• Angry.
• Numb.
• Dissociated.  

Trauma-focused therapies are designed to help you work through difficult memories, but that work can deplete your emotional reserves. Your nervous system doesn’t distinguish between remembering a traumatic event and experiencing it in real time. This is why sessions focused on trauma can leave you feeling as though you’ve just lived through something difficult.

It’s also common for symptoms to temporarily intensify during trauma processing before they improve. This can be scary if you’re not prepared for it, and it’s one of the reasons why feeling worse after sessions is so common with trauma-focused therapy.

Navigating a Draining Relational Dynamic

As you don’t typically learn much about your therapist over the course of your work together, a common phenomenon is transference. This is when you unintentionally transfer past feelings and experiences onto your therapist.^[3] 

For example, many people see their therapist as a wise authority figure and transfer feelings about previous authority figures onto them. This can leave you feeling agitated or scared in their company, as if you were with the actual person who evokes those reactions.

Transference can actually be very useful. It can give clues about your early experiences, which may have informed how you relate to people and feel about yourself. Some therapists may use what you transfer onto them to make interpretations about your psychological landscape and how it has formed.^[3] 

However, this can be understandably draining. The therapeutic relationship is like no other, and it can feel strange, challenging, and triggering. Though difficult, these difficulties are common and expected. Instead of letting it affect your motivation for therapy, exploring the challenges can be valuable for deepening your self-understanding.

Changes to Your Personal Relationships

Therapy can also be draining if it’s affecting how you feel about and behave in your close relationships. Effective counseling and psychotherapy can help you: 

• Feel more confident.
• Find your voice. 
• Identify your preferences or boundaries in relationships. 

However, this can also cause disruption at the same time. For example:^[4] 

• Your friends and family may feel challenged by your new outlook.
• You may realize ways people have hurt you in the past.
• You and your therapist may speak about your parents or caregivers in a negative way.
• Your new insights may lead to more confrontations and boundary-setting with people in your life.
• You may become less interested in drugs and alcohol, while your friends and family continue to be.
• You may begin asking for more intimacy and honesty in your relationships.

While these changes can feel really positive for you, they can also cause your life and relationships to change in ways that create new challenges. Attending therapy may feel daunting if you associate it with these relational difficulties.

Mental Health Conditions and Related Difficulties

While therapy itself can cause you to be burned out, various other factors can contribute to your exhaustion. It can be difficult to identify which stressors exactly are making therapy more difficult, as some of them, like complex mental health conditions, may be reasons you started therapy in the first place. Talking about those issues can be draining, too, even if it also helps bring relief. 

The truth is that simply having a mental health condition can make you more susceptible to burning out. Stress, grief, and trauma can all weigh on your emotional bandwidth, making it harder to cope with the demands of therapy. Emotional bandwidth is how much energy you have to dedicate to emotional labor, but it can be depleted by:  

• Being too caring.
• Traumatic experiences, such as grief or abuse.
• Difficult conversations and relationships.
• Coping with daily stressors and chronic stress long-term.
• Experiencing strong emotions.
• Illness.
• Having to set and reinforce boundaries.
• Reflecting on yourself in therapy.

If therapy is too intense, recognizing these factors can help you and your therapist find the right balance and approach.