✨🫨 The Reality of Being A MH & SU Therapist 😪✨
📝 Note: MH = Mental Health and SU = Substance Use.
✨ When I entered the field of counseling, I imagined something completely different. I pictured breakthroughs in every session, gratitude from every client, and a sense of purpose that filled my cup daily. The truth? It’s so much heavier, and more human, than that.
~ This isn’t just a career. It’s carrying stories most people never have to hear. It’s being a silent witness to trauma, pain, resilience, and sometimes… endings. Real, heartbreaking endings. In the past two years, we’ve lost three people from our caseload. One due to domestic violence, the hold the man had on her couldn’t allow her to leave, no matter how many safety plans we created together, how much we emphasized needing to be there for her son, and the overall life goals she has for herself.
~ She was a very sweet woman, so it was very disheartening to read… YES, I saw the news article first and immediately called my boss with the hopes it wasn’t true. I still remember the way she spoke about her child and how ecstatic she would get when she would show me pictures, the brightest smile she had when showing me their photos, even as she tried to hid bruises on her sleeves and other areas of her body. Her case still sits heavy in my heart 💔
~ Two others passed from overdoses, one being on my caseload and the other on my boss’. We suspected ongoing substance use for one, and each time we gently offered Narcan, they’d laugh it off or say, “I don’t need that stuff” or “I’m not using anything”, despite a long history of battling with substance use. They were so deep in denial, and though we knew the risks and mentally prepped for it, nothing could prepare us for the call and one of my coworkers discovering them.
~ I still replay my male client’s last few sessions in my head… wondering if there was anything else more encouraging or, hell, even pressuring I could’ve said or done to get my client to take the dang Narcan and keep sight of his goals. But no, that is an autonomous choice that ended poorly for both.
✨ This job will test your hope. You’ll cry in your car after a session where a client curses you out, yelling that you “don’t want to help me”, despite all that you’re trying to do to better their situation. You’ll sit with clients who go right back to unsafe homes, unhealthy relationships, or addiction, knowing they’ll be back again in crisis, or worse, not at all if it goes to the bad… You’ll carry grief that isn’t yours, but still lives in your chest. And sometimes, you’ll realize you want their healing more than they do.
✨ Interestingly enough, there was a time where I didn’t know how to go about empathy as a teen, but as I grew up, it set in and I became more in touch with my emotions and how to display them when aiding others. There was also a time where I questioned if I was cut out for this. The emotional labor felt like it was eating away at me.
✨ But then, there are the quiet wins:
~ The client at my previous job who got her children back due to progress she showed while in treatment.
~ The teen who stopped self-harming after many months of safety planning.
~ The dad who finally accepted inpatient treatment to be there for himself and his children (by living).
~ The young mom at my previous job who called to say she had made it to three years alcohol free (omg I was elated! 🥹)
~ My client who, although we are still working to address his ongoing substance use, regurgitates the coping and treatment-related skills we’ve discussed and the passion he exudes when discussing his goals.
✨ These moments, and the many others I’ve had along with growth hoping to be seen in the future, remind me why I chose this field. But they don’t erase the weight of the losses 😩.
📝 To anyone considering counseling as a career: yes, it is rewarding, but it is also incredibly RAW. You’ll learn quickly and soon emphasize that healing isn’t linear, progress isn’t always visible, and saving someone? That was never your job to begin with, that’s a whole different title and weight to carry right there.
💬 Whew… now, let’s chat! Have you ever worked in a helping profession? How do you protect your own peace when your job drains you emotionally? Would you be able to stay in a career that constantly exposes you to grief and loss? Drop your thoughts below! 👇🏾 Especially if you’re in the mental health or human services field. Let’s support each other through the realness. 💛
Mental health and substance use (MH & SU) therapists have an indispensable role in supporting individuals facing some of life’s greatest challenges. These professionals often work with clients experiencing trauma, addiction, domestic violence, and other serious mental health issues. Their work involves not just counseling but also being a witness to deeply personal and sometimes heartbreaking stories. One of the most difficult aspects of this profession is managing the emotional toll that comes with witnessing loss and ongoing struggles. For example, therapists may encounter clients entangled in abusive relationships or battling substance dependency, where despite intervention efforts such as safety planning and offering life-saving tools like Narcan, some clients tragically succumb to overdose or violence. These experiences can challenge therapists' hope and resilience. Narcan (naloxone) is a critical medication used to counter opioid overdoses, and it is often offered to clients at risk of substance use relapse. However, denial and stigma about substance use may prevent clients from accepting this help, underscoring the complexities therapists face in encouraging recovery while respecting clients' autonomy. Safety is a paramount concern for MH & SU therapists, especially those engaged in community-based treatments such as Assertive Community Treatment (ACT). ACT teams focus on individuals with severe mental illness or substance use disorders, providing multidisciplinary support to improve outcomes. Safety protocols, scenario-based training, and effective team communication are essential components to protect both clients and therapists during community visits, especially when unpredictable behaviors or unsafe environments are involved. Despite the grim realities, therapists also experience meaningful victories—the return of children to recovering parents, cessation of self-harming behaviors, acceptance of inpatient treatment, and milestones in sobriety. These successes are critical reminders of the positive impact therapists can have even when healing is non-linear and progress is not always immediately visible. Therapists often utilize empathy—a skill refined over years—to connect with clients authentically. However, emotional labor can be consuming, prompting professionals to develop self-care strategies to maintain their own well-being. Support from colleagues, debriefing after tough encounters, and fostering open team cultures centered on safety and mental health are vital for sustaining therapists’ peace of mind. If you are considering a career in mental health or substance use counseling, it’s important to understand both the rewards and the raw challenges it entails. The path often involves grief, resilience, and an unwavering commitment to being present for clients in their darkest moments. At the same time, it’s a profession rich with profound human connection and growth. For those in mental health and human services fields, sharing experiences and strategies for emotional protection can build a supportive community. Recognizing that saving someone is not solely the therapist’s burden but a complex interplay of client autonomy, treatment, and support helps create a sustainable outlook on this demanding yet meaningful career.
See more comments