Dr. Matt Hersh, founder of The Thriving Therapist

Dr. Hersh is a psychotherapist, Certified Energy Psychologist, mindfulness teacher, & founder of The Thriving Therapist, a site devoted to helping the helpers. Learn more about us and check out our free resources, online courses, and workshops on self-care, work-life balance, burnout prevention, your thriving practice, & much more.

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.

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