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Ways to Successfully Balance a Full Caseload as a Therapist

By: Bridget Eickhoff, MA, Alison Dolan, Psy.D., LP, and Andrea Hutchinson, Psy.D., LP

Being a therapist can be a fulfilling and rewarding career. However, it can be hard to remember that therapists are humans who also experience anxiety, stress, and burnout. We took a survey of 30 clinicians at CARE Counseling asking what makes them feel successful and balanced at work. Here are the main points our amazing clinicians found that help them find balance when working with a full caseload.

  • Create Boundaries and Stick to Them
    • Let your clients know your boundaries for cancellations and follow through with the boundaries you’ve set or are set by your agency. Therapy should be a flexible time for the client to address topics that are important to them; however, aspects of structure are important in therapy to keep both your clients and yourself accountable. 
    • Start and end sessions on time so that you have time to complete documentation, grab something to eat or drink, use the restroom, consult with a colleague, and/or take a moment to regroup.
  • Manage your Schedule Proactively
      • Make your life easier by scheduling clients as recurring appointments and practice confirming the next appointment at the end of the session. 
      • You probably enjoy seeing clients and it can be heartbreaking to refer them out. However, back to that accountability point, close your clients who are not following the attendance policy (or use supervision and consultation if you need guidance) and give them referrals to help with barriers (e.g., closer to home, different hours, attending to a different piece of their difficulties, etc).
      • Proactively reach out and ask for more clients if you start to notice your caseload looking low or you have inconsistent clients. 
        • Keep in mind, being proactive will help keep the number of intakes in the same week lower and documentation will likely feel more manageable. 
      • Take advantage of cancellations and catch up on documentation or check-in with a co-worker. If you are finding yourself racing towards burnout remember:
        • You can use PTO and take a day or more to feel grounded again
        • Ask if you can have a temporary block off time in your schedule to help you gain some extra time to feel like things are more manageable again
        • Talk to management to see if there are ways to contribute to the team without as many client appointments. 
  • Try to NOT Take this Very Personal Job, Personally (easier said than done)
      • For both you and your clients, use your intuition for goodness of fit. As you know, a healthy therapeutic alliance is a key factor for the overall success of therapy. At times, especially as a new clinician, it can be difficult to decipher between your intuition and anxiety. Clinicians should utilize supervision and consultation to explore types of clients who are and are not a good fit. Supervision and consultation are also helpful when you feel stuck.
      • Sometimes, it can feel pretty personal when a client cancels often or ghosts us. Keep in mind, clients will cancel appointments for a multitude of reasons ranging from weather, illness, moving, and symptoms and this happens to the best of us. 
  • You’re Not Alone
    • Consult with your peers and use supervision to feel balanced and confident with your caseload.
    • While you are likely a compassionate person, remember you too may have times when you need to check-in on your own mental health. Remember everyone can benefit from therapy!