We have all heard of the term burnout, and some of us may have been unfortunate enough to experience it. However, when we think of burnout, we usually associate it with work or even exercise, but probably not therapy. The reality is that we can burn out from any intensive activity, and therapy can be an incredibly intensive experience.
Therapy fatigue in depression and anxiety treatment is particularly common, but it doesn’t get the attention it should. This means that burnout in mental health treatment isn’t something people expect, and so they may miss the signs completely. To prevent this and help people get the support they need for emotional burnout, this page will cover:
If you’ve been in therapy for a while, you will know the difference between a session that was difficult and one that genuinely took something out of you. While the tough sessions may leave you thinking for a period of time afterwards, the depleting ones leave you feeling as though you’re zapped of energy for the rest of the day.
You may have noticed that the hours after therapy have started to feel immobilizing, whereas in the past, they were reflective. Perhaps you used to be able to go about your day after these types of sessions, but recently, you’ve noticed that you’re canceling plans or switching off from the world afterwards. Because of this, you may even be dreading the next session or looking for ways to get out of it or reschedule.
If any of these potential scenarios resonate with you, it’s certainly worth noting that you’re not the only one who feels this way.Â
A survey of psychotherapy patients found that 57.8% reported unpleasant memories resurfacing during treatment, with a further 30.5% reporting unpleasant feelings as a direct result of the process.[1]
What this data suggests is that difficult emotional reactions during therapy are relatively common, particularly when treatment involves discussing painful experiences.
For a majority of people in therapy, some degree of emotional difficulty is part of the process. But it’s worth paying attention to whether that difficulty is recoverable between sessions or not. Therapy overload and stress that doesn’t resolve between appointments is a sign that something may need to be addressed.
Emotional exhaustion from therapy can start allowing all sorts of self-doubts and negative thoughts to creep in. For example, you may wonder whether you’re doing something wrong or if you’re even strong enough to do therapy in the first place.Â
The truth is, it’s easier to think this way because it gives us an easy answer. In reality, the reasons why therapy feels this way are due to numerous factors, some of which can be difficult to explore.Â
When therapy feels too intense, the pace itself may be the problem rather than your reaction to what is coming up in the sessions. There is a concept in trauma therapy called the window of tolerance, which describes the zone where you can experience emotions without being flooded by them.[2] Difficult feelings are workable inside this zone, but outside it is a whole different story.
You may have had this window of tolerance tested in therapy before, and it’s quite common to experience it. However, if it feels as though your window is repeatedly being tested, it’s worth looking at why this is happening.
It may be that the pacing of therapy is not leaving you enough room to reflect and act on what’s been tested. If this is happening, it’s more of a mechanical issue with how the therapy is delivered, which is something that your therapist can adjust once they know what’s happening.Â
Some of what therapy asks you to deal with is genuinely demanding. For example, if you’re dealing with grief or trauma, these conditions may not come with a comfortable processing speed. The emotional toll of engaging with them can build over time, and even though therapy might be working well, burnout from therapy sessions may set in.
A study on trauma-focused therapy found that between 15% and 29% of patients experienced a temporary worsening of their symptoms during treatment, which shows us that the heaviness of the topic can weigh us down.[3]
One review of multiple trauma therapy studies found that emotional distress was reported in every study reviewed. Participants described the process as being much harder than they had initially expected.[4]Â
While the same research showed that symptoms did eventually improve as treatment went on, it would be fair to say that this period is genuinely exhausting for the person experiencing it.[4]Â
Mental health treatment fatigue is something the research has documented, and what it shows may resonate with your experience. Research on session frequency found that more frequent therapy sped up the pace of recovery but didn’t change the total amount of improvement.[5]
This suggests that the sessions themselves still expend the same emotional energy, but the returns can get smaller over time. That is a documented trajectory and one worth recognizing in yourself if it seems to reflect what you’ve been experiencing.Â
Long-term therapy exhaustion is one of the reasons why adjusting the frequency of your sessions, or perhaps even considering a planned break, deserves more thought than it usually gets.
This one is easy to overlook because it can feel completely separate from the therapy itself. But therapy draws from the same emotional reserves as everything else in your life.Â
For example, a demanding job, childcare duties, financial pressure, or a relationship that’s not in a great place can all take from the same pool of energy that your session is about to ask you to dip into.
Research on what clinicians call emergent life events found that acute stressors disclosed in therapy sessions are associated with reduced treatment progress.[6] This makes sense when you think about it, because expecting yourself to do deep therapeutic work at the same intensity during a period of external chaos is an unrealistic ask. It’s important to recognize that rather than blaming yourself for not having enough left to give.
Feeling worse after therapy is something many people experience, so the next natural question is how to tell the difference between normal therapeutic difficulty and therapy burnout.
Sometimes, undergoing a difficult period is inevitable in therapy, and the emotional toll that it can take can certainly look and feel like burnout. But it’s important to be able to tell the difference between them because the response to each is very different.Â
An analysis of therapeutic decline found that the rate of genuine worsening was around 4%. The study also found that patients in therapy were much less likely to decline than those who received no treatment at all. What this suggests is that if you’re statistically typical, what you’re experiencing may be productive discomfort rather than treatment not working for you at all.
The way to tell the difference in your own experience most likely comes down to how long a difficult session bothers you afterwards. If you’re dealing with it within a few days, it could be a productive difficulty. It’s acute and doesn’t last long.Â
In fact, research on trauma symptoms in therapy found that patients who went through a temporary worsening still achieved improvement by the end of their treatment, and these spikes in symptoms didn’t predict a dropout.[3]Â
But when the trajectory has been declining, or even just flat, for four weeks or more, the research suggests that’s the point where something needs to change.
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
In many cases, the most effective response to therapy exhaustion begins with the same step, which is telling your therapist. You’re not expected to deal with this on your own, and in fact, a quality therapist will be more than happy to assist you with your concerns.
Below, we look at some of the ways you can approach your therapist about this issue and what they may discuss with you.
Your therapist can see what happens during the hour you’re together, but the hours in between are invisible to them unless you share what’s been going on. Something as simple as “Sessions have been leaving me drained for days” or “I’ve started dreading coming in” gives them information they can actually work with.
The research is worth referring to here, with one study finding that when difficulties in therapy were addressed directly, it predicted much better outcomes for treatment.[7]
Bringing up your exhaustion works in the same way, as it turns a problem into a much-needed conversation. Managing therapy burnout effectively almost always requires this kind of direct communication with your treatment provider.
If you feel as though the issue lies in how often the sessions are taking place, it’s worth bringing that up with your therapist. Perhaps in the beginning, weekly sessions were needed to deal with the specific situation you were experiencing. Or maybe the frequency is right, but you need a break from the schedule. Whichever category you fall into, it’s worth raising the point.
Research shows that reducing session frequency affects the speed of recovery more than the total amount of improvement.[5] This could mean that slowing down when you feel like you’re running on empty is a more than reasonable request, and it shouldn’t be seen as a retreat from treatment.
Before we continue, we need to explicitly state that a decision to take a planned break from therapy is usually best discussed collaboratively with your therapist. Many therapists recommend agreeing on a review date before taking a break, along with a plan for what to do if things escalate while you’re away.
Research specifically on planned breaks in therapy is limited, meaning we can’t present data on whether it works or not, but it is something that can be considered in certain situations.
If each session has started to feel like something you’re dragging yourself through rather than actively participating in, a planned break is something worth discussing. But taking a break with a clear return plan and your therapist’s input is very different from simply dropping out of treatment.
Everything that we’ve covered so far assumes that the therapeutic setup is suitable and that the issue lies in the pacing or capacity. But there are situations where mental health recovery fatigue points to deeper problems than pacing alone.
For example, surveys found that 16.8% of therapy patients reported feeling violated by statements made by their therapist.[1] This goes far beyond productive discomfort, and if your therapist’s approach is leaving you feeling misunderstood or even dismissed, it’s a real reason to consider the possibility of changing therapists.Â
Worsening that continues over a decent period of time could also be a sign that the type of therapy needs to change. For example, you might be in a type of therapy that helped in the initial stages, but you’ve outgrown what it can offer you. Mental health conditions can be complex, and it’s normal for your needs to change over time.
The window of tolerance research we presented earlier is also worth touching on again. If you’re consistently being pushed past your limits, then the approach itself may need to change before the pacing does.
It’s also worth being clear that if distress between your sessions is creating new suicidal thoughts or self-harm urges, it’s a clear sign that a step up to a higher level of care is needed.Â
If you’ve experienced these thoughts or ideations, it’s crucial to reach out to your therapist or, if urgent, contact emergency services as soon as possible.
A higher level of care could come in the form of residential treatment or an intensive outpatient program, which exists for exactly these types of situations.Â
A Mission For Michael (AMFM) provides treatment for adults experiencing various conditions. Mental Health support is a phone call away – call 866-478-4383 to learn about our current treatment options.
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If emotional burnout from therapy has been raised with your therapist and nothing has improved, it could be a sign that re-evaluation of your care is needed. In some cases, a fresh look at your current setup could indicate that a more structured therapeutic environment is needed and could make a real difference.
For those who may benefit from the structure of a full-time therapeutic environment, AMFM Mental Health Treatment offers residential mental health treatment programs at our locations in California, Minnesota, and Virginia. We also offer intensive outpatient options for those who need flexible support that works around their daily life.
Our expert clinical team is experienced in providing support for those dealing with mental health conditions like:
We personalize your treatment plan so you can achieve lasting, life-changing outcomes. AMFM accepts insurance and is in-network with most major providers. To check your insurance coverage for mental health care, simply complete our confidential online verification form.
If you feel the pace of your care needs to slow down or a full reassessment is needed, call us today at 866-478-4383. A member of our admissions team will be on hand to walk you through your next steps and the options that are available to you.
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