I’ve learned this lesson the hard way. And to be completely honest, I still don’t have it mastered every single day.
Maybe that deep compassion is what makes me the kind of therapist who cares so fiercely. But it may also be the very thing that needs to shift a bit. Those two realities can both be true at once.
There were seasons early in my practice when I left far more sessions than I’d like to admit, feeling like I had taken my clients’ pain home with me. I found myself replaying their words while cooking dinner, or waking up at 3:00 AM turning over what else I could have said. Back then, I told myself that was just what empathy looked like.
Really, it was absorption.
That realization sits close to why I built My Wellness Wallet. Care has to be sustainable for everyone in the room. We can’t pour from an empty vessel, and we can’t faithfully show up for others if we are slowly divorcing ourselves from our own needs.
The Unseen Cost of Presence
In mental healthcare, we talk constantly about “holding space.” But what does that actually mean?
To me, holding space means being fully present with someone’s pain without trying to fix it, minimize it, or run from it. It’s important work. But what happens when that container starts to spill over? When the emotions we witness begin to echo in our own nervous systems? That’s the line between holding space and carrying the burden, and every therapist has to learn to navigate it.
Holding space sounds serene, but clinically, it’s intense emotional labor. Aseem Garg, LPCC-S, LMFT (2025), describes this as “metabolically and psychologically taxing.” He points directly to the unseen effort required to manage empathy, attunement, and professional composure while absorbing another human being’s distress.
Garg is right. The better we get at holding space, the less visible the toll becomes to the outside world. We’re expected to stay calm and grounded, but the exhaustion and grief that accompany that composure often go unnoticed.
It reminds me of a principle Brené Brown highlights in her work on human paradox: growth often lives inside tension between courage and fear, vulnerability and strength, giving and receiving.
That same paradox shows up in our profession every day. The more skillfully we hold space, the less visible the cost becomes. Yet it’s in that unseen space, and in the steady work of presence, where the heart of therapy truly lives. Sometimes it can feel like walking on a tightrope.
The Three Tiers of Clinical Labor
Jen Bennethum, LCSW, noted in her 2025 piece The Hidden Labor of Holding Space that clinicians often “carry the echoes of sessions long after the door closes.” That line hits home because it moves the issue out of the realm of self-doubt and into physiology. If you leave a session feeling heavy, restless, or haunted by a client’s story, that isn’t personal weakness; it’s your nervous system in activation mode. But over time, it can lead to burnout, and we need to recognize that.
Her research articulates our daily workload across three distinct demands:
- Emotional Labor: Deliberately managing our internal emotional state to cultivate unconditional safety and empathy for the client.
- Somatic Labor: Regulating our own physiological state while actively co-regulating with a dysregulated nervous system
- Cognitive Labor: Continuously tracking case formulation, ethical boundaries, risk assessments, and clinical nuances while staying attuned in real time.
Each one demands a different kind of energy. When any of these systems get overloaded without intentional release, our clinical discernment begins to blur.
When Dedication Becomes Depletion
For me, one of the most confusing parts is that carrying the burden often disguises itself as dedication.
Replaying case notes on the weekend, carrying persistent worry about a client between appointments, or feeling guilty for taking a scheduled sabbatical- we label these habits as devotion. In reality, they are early indicators of depletion. The American Counseling Association continues to identify compassion fatigue and vicarious trauma as occupational hazards. Intrusive imagery, persistent emotional fatigue, and irritability are not signs of poor dedication; they are signs that we have picked up a load we were never meant to carry.
The irony is that the very qualities that make us gifted healers, like attunement, emotional sensitivity, and genuine warmth, are the exact traits that leave us vulnerable to secondary exhaustion.
Our calling is to accompany people into the valley, not to claim ownership of their pain.
Practices for Sustainable Grounding
Holding space without carrying the burden isn’t about building detachment or emotional walls; it’s about establishing rhythms of restoration. Here are five micro-practices that help sustain that boundary:
- Somatic Grounding: Breathwork, posture resets, and sensory grounding help the body discharge emotional build-up and return to baseline. They’re small, but they keep the nervous system from accumulating stress hormones that fuel fatigue.
- Reflective Supervision and Consultation: Regular consultation gives us a safe container for our own emotional processing. Garg’s framework emphasizes “relational repair after ruptures”- not just with clients, but within ourselves. Supervision turns isolation into shared understanding.
- Intentional Rituals of Closure: Simple acts like jotting a reflection, washing your hands with cold water, or stepping outside signal to your body that the session has ended. These micro‑actions help separate professional empathy from personal absorption.
- Community and Peer Support: We need each other. Peer groups and consultation circles normalize the emotional labor of therapy.
- Self-Compassion and Permission: Giving ourselves permission to rest, to feel, to not fix everything (that isn’t ours to fix!) That’s sustainability.
Sustaining the Vessel
Culturally, we still revere the image of the self-sacrificing caregiver; the clinician, teacher, or nurse who burns down their own house to keep someone else warm. But that model is broken.
The objective of clinical practice is not to absorb every story into our own bones; it’s to keep the room clear and our spirits grounded so that healing can unfold again and again. That ethos is at the core of My Wellness Wallet: care that honors both the receiver and the giver of care.
We’re building a culture where therapists can thrive, not just survive. Where holding space is defined and self-care is normalized, things can change.
Every therapist recognizes that moment when a client walks out, and the room still hums with raw emotion. Holding space means honoring that hum with steadiness and grace. But to be clear, carrying the burden looks like letting it follow you home.
So, what is the nuanced difference? The difference lies in boundaries, awareness, and care. Holding space is the art of presence; carrying the burden takes away your ability to be fully present. I see it this way: holding space sustains the work; carrying the burden depletes it.
As I’ve learned over time, empathy matters, but it has to be sustainable.
To hold space with integrity for others, we must first learn to hold space for ourselves.
