The Middle Way for Burned-Out Therapists: Beyond Extremes
Like many therapists, I once oscillated between two familiar extremes. Some days, I would push myself beyond reasonable limits, taking on extra clients, skipping breaks, carrying their stories home - convinced that anything less meant I wasn't doing enough. Other days, exhausted and depleted, I'd feel waves of guilt for setting boundaries, taking time off, or simply admitting I couldn't hold it all.
I recognized this pattern for what it was - the very struggle the Buddha addressed in his teaching of the Middle Way. Just as he discovered that neither extreme asceticism nor indulgence led to liberation, I began to understand that neither burning myself out nor withdrawing in guilt would lead to sustainable therapeutic practice.
The Middle Way points to a profound truth about sustainable practice: presence without strain, commitment without attachment, care without depletion. This teaching feels particularly relevant for those of us in the helping professions, where the lines between dedication and self-sacrifice often blur.
Many of us internalize impossible standards early in our careers. We absorb messages about being endlessly available, infinitely compassionate, perpetually composed. These expectations lodge themselves deep in our nervous systems, creating patterns of hypervigilance and hyper-responsibility that feel normal until our bodies force us to stop.
The neurobiological cost is real. Research shows that chronic stress from professional caregiving can alter our cortisol patterns, affect immune function, and impact cognitive performance. Yet the solution isn't to withdraw or build walls around our hearts. Instead, the Middle Way invites us to find what Buddhist psychology calls "wise effort" - the sweet spot between striving and surrender.
I've found it helpful to develop what I call the "Check-in ritual" - a practice of checking in with our internal state before, during, and after client sessions. Like monitoring a gauge, we learn to recognize our sustainable range. In the nervous system language, what is our window of tolerance and how we can bring ourselves back into safety, moment to moment? We pause and notice when we're pushing into depletion or pulling back in fear. With practice, we develop a more refined awareness of where healthy engagement lies.
How do we know if we're operating at one of the extremes? Here are some signs:
Signs of over-effort/ tension/ hyper-arousal:
Regularly working beyond scheduled hours
Difficulty sleeping due to client concerns
Chronic tension or anxiety about work
Postponing personal needs repeatedly
Signs of withdrawal/ hypo-arousal:
Emotional numbness toward clients
Excessive self-criticism about boundaries
Guilt about taking breaks or time off
Fear of professional engagement
The Middle Way invites us to hold these experiences with compassion while cultivating sustainable alternatives. This might mean:
Setting clear session limits and honoring them
Creating transition rituals between clients
Maintaining regular supervision and peer support
Practicing self-compassion around limitations
For organizations and group practice, supporting the Middle Way could include:
Realistic caseload expectations
Regular opportunities for reflection and processing
Recognition of the importance of rest and renewal
Cultural shift from endurance to sustainability
The Buddha's insight about the Middle Way wasn't just philosophical - it was deeply practical. Cultivating pristine awareness of our thoughts, feelings and somatic sensations will allow us to track how we are doing and what to do instead to bring us back to the Middle way. For therapists, it offers a path beyond the exhausting cycle of burnout and guilt. It reminds us that sustainable practice isn't about finding perfect balance, but about cultivating wise relationship with our energy, our work, and ourselves.
