Why Therapists Overwork Themselves

Most therapists who overwork themselves don’t decide to. The week starts at eighteen clinical hours, which is the number they planned. By April it’s at twenty-two. By September it’s at twenty-six, with a Saturday morning slot added during the August slump and never removed. Each step up made sense in the moment. The cumulative drift didn’t.

Three forces tend to be running underneath the drift.

Income variability. Last year’s slow month was financially rough, and the body remembers. Saying yes to the new inquiry feels like insurance against another one. The insurance accumulates across the year and the schedule fills.

Helper identity. Saying no to a person in distress conflicts with the role of being someone who helps. The internal experience of refusing a referral feels worse than the external experience of taking the case. The case gets taken because the alternative is something the helper-identity can’t tolerate.

Quiet belief in your own indispensability. You think, partly correctly, that you’re the right therapist for this particular case. If you don’t take her, the question of where she’ll go has no clean answer. So you take her, and a month later your Friday afternoon was already at capacity before the new case got squeezed in.

What changes the pattern is setting your cap when you’re rested and holding it against the live pull when you’re not. Eighteen clinical hours, or twenty, or twenty-two, whatever your number is. The cap is decided in writing during your annual leave week, when you have perspective. When the new inquiry arrives in October and the helper-pull is loud, the decision was already made in August. You read what August-you wrote and you act on it.

The complementary structure is a waitlist for inquiries that arrive over the cap. A working waitlist gives the new person a queue with real movement. Three or four clients move out of the practice each quarter on standard treatment ends, and the people on the waitlist take those slots in order. When you tell the new inquiry “I don’t have a slot now, I expect to in eight to ten weeks, would you like to be on the list,” you’re not abandoning her. You’re being honest about the timeline.

In my-cbt, the booking widget shows your real availability and won’t book past the slots you’ve made available. The waitlist sits as case file records with status “waitlist.” When a slot opens, you contact the next matching person on the list. The structure does the holding that your in-the-moment judgment can’t reliably do.

The cap is a decision made once and held. The waitlist is the answer for the people who would otherwise push you past it. Set both up while you’re rested. The autumn version of you needs them.