The Helper’s Paradox: Caring Deeply Without Disappearing

Disclaimer: Generative AI (ChatGPT, OpenAI) was used during the development of this manuscript to assist with structure, editing, literature searching and reference checking. The author developed the ideas, lived-experience reflections and substantive content, reviewed the source literature, and takes responsibility for the final manuscript.

A month or so after I stopped working because of burnout, my life partner, Ryan, said something that has stayed with me. “I’ve got the old Shanny back.” I asked him what made him say that. He told me I was laughing again, and that he hadn’t heard me laugh in a long time.

I hadn’t noticed. I hadn’t noticed that the laughter had gone, or how much of me had gone with it. That is perhaps one of the things that unsettles me most when I look back now. I didn’t know that I had lost myself. I didn’t know that I had gradually disappeared into the roles I occupied, including the role of psychologist and helper.

Burnout eventually forced me to confront this, but the story didn’t begin with burnout, or even with becoming a psychologist. Looking back now, I can see that I had been practising disappearing for a very long time. I had learned to orient myself towards what was needed, expected and required of me long before I learned to ask what I needed, wanted or even liked. I had become what I now call the “good girl”.

I didn’t know any of this then. What I knew was that I was deeply perplexed by humans, myself included. I didn’t get them. I wanted to understand why people did what they did, and psychology offered me a way of trying to make sense of people, relationships and, eventually, myself. In many ways, psychology has been one of the most important therapies of my life. It gave me knowledge, language and tools that helped me begin to understand who I was and how I had learned to move through the world.

In hindsight, I can see that I had always been sensitive to other people and to suffering. I noticed things. I felt things deeply. I could listen, empathise and sit with distress. I was often attuned to what other people needed, although I certainly wouldn’t have described myself that way at the time. These are qualities I have since come to recognise and value in myself, and they have served me well as a psychologist. But with hindsight I can also see that they existed alongside something else.

The good girl pleased. She achieved. She did what she should and must. She was useful. She noticed what other people needed and tried to provide it. Her own needs were either not considered or moved down the ladder when they competed with somebody else’s. Worth became entangled with achievement, usefulness and being enough for others. Becoming a psychologist didn’t create this pattern. It gave me another role in which it could flourish.

And flourish it did. Many of the ways I had already learned to be in the world could look remarkably like professional strengths in a helping profession. Being attuned to others, responsible, conscientious, accommodating and able to sit with distress are useful qualities when your work involves entering the emotional worlds of other human beings. They were strengths, and that distinction matters to me. I don’t want to become less empathic, less sensitive or less able to sit beside another person’s suffering. But I have had to learn that a strength can become costly when it is continually extended towards others without also being extended towards ourselves.

Perhaps this is part of the helper’s paradox: some of what allows us to care deeply for others can also make it easier to lose sight of ourselves while doing so.

When caring becomes carrying

I became very good at helping. I built a career around it, and that career brought meaning, purpose and the privilege of being trusted with parts of people’s lives that are often difficult to share. I loved psychology and I still do. This isn’t a story about helping being bad for us, or about caring less in order to survive the work. It is about what can happen when caring begins to travel overwhelmingly in one direction.

For me, being a good psychologist became tangled with responsibility in ways I didn’t fully recognise at the time. If someone was struggling, I wanted to help. If therapy wasn’t progressing in the way I hoped, I looked to myself. What else could I do? What had I missed? Was I good enough? The old equation between worth, usefulness and doing the right thing had found very sophisticated professional clothing.

One of the things I have had to understand since burnout is the difference between caring about someone and taking responsibility for them. I am responsible for how I show up. I am responsible for my actions, my attitude, my professional practice and what I bring into the therapeutic relationship. I am not responsible for controlling another person’s thoughts, feelings, choices or outcomes. That does not mean caring less. If anything, I think I care more freely now because caring no longer has to mean carrying responsibility for what I cannot control.

There was another kind of carrying happening too, one that I understood only after I stopped working. During my recovery, I was meditating one day when an image emerged that I have never forgotten. I saw waterways running throughout my body. They were filled with tears for my clients’ pain and suffering. It was as though all the sadness I had witnessed over the years had found somewhere inside me to live.

Therapeutic work asks us to sit alongside extraordinary amounts of human suffering. We hear about trauma, grief, cruelty and loss. We hear about inhumane acts perpetrated by one human being against another, sometimes by the very people who were supposed to love, nurture and protect them. We witness injustice. We sometimes work within systems designed to support people that instead cause further harm, and we may see what needs to change while having little power to change it.

Then there is helplessness. We enter this work wanting to help while repeatedly confronting the reality that there are things we cannot fix. We cannot undo what happened. We cannot guarantee that systems will respond fairly. We cannot control another person’s life. Sometimes we cannot offer the outcome we desperately wish were possible for the person sitting opposite us.

There are professional terms for some of what can arise from this work, including secondary traumatic stress, vicarious trauma and empathy (compassion) fatigue. These experiences are distinct from, although they may coexist with, burnout (Duncan & Pond, 2024). Therapeutic work itself can involve repeated encounters with suffering, conflict, loss and trauma, alongside the sustained use of practitioners’ emotional and cognitive resources (Duncan & Pond, 2024). Yet clinical terminology can sometimes make something profoundly human sound strangely tidy.

What I remember is the weight of it: anger, grief, sorrow, rage, sadness, disappointment, trauma, fear, hopelessness and helplessness. Where does the helper put all of that? Confidentiality necessarily places boundaries around what we can share. Time for genuine reflection can be scarce. Many of us work alone. We may not want to bring the people we love down with the emotional realities of our work. So sometimes we sit with it ourselves. We hold, and hold, and hold, until perhaps the question becomes: when did holding space for another person become carrying what I had witnessed away with me?

That question has become increasingly important to me because I now wonder whether we talk enough about the humanity of the person doing the helping. We become highly skilled at asking what the client needs, what will serve the therapeutic process and how we can remain present to another person. But what does sustained presence require from the human being providing it, and where does that person go to be held?

Who holds the helper?

Before burnout, it was not unusual for me to see six clients in a day, four or five days a week. That could mean sitting with six distressed human beings, one after another, while remaining emotionally present, cognitively alert, empathically engaged and therapeutically useful. Then I would come back and do it again.

At the time, I didn’t question this very much. It was simply what psychologists did. Now I do question it, but not because I believe six clients is inherently too many. For some practitioners that workload may be sustainable; for others it may not be. The number itself isn’t the point. The point is whether we are sufficiently curious about the capacity of the particular human being doing the work.

Research suggests that sustainable practice involves more than simply counting clients. Duncan and Pond's (2024) systematic review found that therapists described boundaries and balance, support and connection, awareness of their internal state, and knowing when to step back or seek support as important aspects of burnout prevention.

Our capacities are different, and they are not static. One practitioner may flourish in intensive one-to-one work while another needs greater variety. Some may thrive within teams and others in solo practice. Our capacity can also change as our lives change. Bodies change, families change, health changes, priorities change and we move through different personal and professional seasons. What was sustainable for us at one stage of our career may not remain so forever.

Today, I know that the way I once practised is not sustainable for me. I now see around ten clients spread across four days and combine clinical work with group work, writing, speaking, podcasting, community work and other creative and professional pursuits. That is not a formula I am suggesting anyone else follow. It is simply the shape of practice that fits me now. Sustainable practice, I have come to believe, requires an ongoing willingness to match our work to our capacity rather than continually requiring ourselves to fit the work.

Yet workload was only part of my story. I had supervision. I knew about self-care. I had studied the very psychological ideas that should have helped me recognise what was happening. I had also sought help at various times. On paper, I could have ticked quite a few of the boxes we associate with practitioner wellbeing. What I didn’t understand was that accessing help and allowing myself to be helped are not necessarily the same thing.

Learning to be the helpee

We spend years learning how to become helpers. We learn assessment, formulation, intervention, ethics, boundaries, communication and reflective practice. We learn how to sit with distress and how to help another person feel safe enough to bring us what hurts. We become skilled at noticing what another person may need and finding ways to offer it. I don’t remember being taught much about how to become the helpee.

Before burnout, I did seek help, but I can see now that I often went through the motions because that was what a good girl and a good psychologist did. Much of my help-seeking was private and transactional. I could see a professional, read another book or learn another therapeutic approach and remain remarkably self-contained while doing it. I rarely shared what was happening with peers, friends or family. I was receiving help technically, but I wasn’t always allowing myself to be cared for.

Being the helpee was difficult for me. Receiving nurturing and genuine care felt strange and alien because I had so little experience of allowing it in. There was fear there too: fear of rejection, judgement and abandonment, and fear that if I allowed myself to be truly seen in my need, someone might discover that I wasn’t enough. I yearned for and provided the kind of help to others that I needed myself but couldn’t allow in.

This is one place where my very personal experience meets something broader within our profession. In a systematic review of 14 studies involving 5,422 mental health professionals and trainees, Crisp and Bartels (2025) identified barriers to self-care and help-seeking including stigma, confidentiality concerns, possible career implications, time, competing professional demands and cost. Their review also makes a useful distinction between self-care, which is predominantly preventative, and help-seeking, which is more commonly a response to psychological distress.

Australian research also reveals an interesting gap between knowing help is important and actually seeking it. Edwards and Crisp (2017) found that while most of the Australian mental health professionals and trainees in their study said they would seek help if distressed, more than half acknowledged there had previously been a time when they would have benefited from seeking help but had not. Wanting to solve the problem themselves was also a common barrier.

Perhaps knowing how to help does not automatically make us good at being helped. I wonder now whether sustainable practice requires us to become competent in both roles: helper and helpee. Not waiting until we are depleted enough that receiving help becomes unavoidable, but learning to receive care proactively throughout our professional lives.

For me, this also changes the conversation about self-care. If sustainable practice is reduced to what the individual practitioner does to keep themselves well enough to continue working, we risk placing the responsibility for surviving the work back onto the same person who is already doing the carrying.

Care cannot travel in only one direction

Self-care matters enormously to me. It is part of how I live now, although my understanding of it has changed. It is not simply bubble baths, exercise, holidays or walks, valuable though those things can be. Some of my deepest self-care has been the inner work of recognising the patterns that once kept me outside my own care. It has meant developing compassion for myself, changing old beliefs and behaviours, respecting my limits, asking what I need and learning to show up for myself with something approaching the commitment with which I have always shown up for others.

The experiences of therapists reflected in the literature similarly suggest that burnout prevention is multifaceted. Time away from work, leisure, exercise, support and connection, boundaries and balance, awareness of one’s internal state, spirituality or meditation, and ongoing professional growth are among the strategies practitioners have described as helpful (Duncan & Pond, 2024).

But self-care cannot carry this alone. Burnout does not occur in a vacuum, and responsibility cannot sit solely with individual practitioners. Organisations, workplaces, professions and the wider systems in which we provide care shape our ability to practise sustainably. Duncan and Pond (2024) emphasise that organisations also have an active role in burnout prevention, including through policy, training and supporting practitioners in managing workplace pressures.

There are also times when the distress we experience is connected not simply to how much work we are doing, but to what we are being asked to witness or participate in. Moral distress offers one way of understanding this. Griffin et al. (2023) describe moral distress as psychological distress arising when people are constrained from acting on what they believe to be right, and situate these experiences within wider interpersonal, organisational and societal contexts.

This resonates with my own experiences of witnessing systems intended to help people instead cause harm, and of sometimes feeling helpless to change them. No amount of meditation can make an unjust system just. We can teach practitioners to breathe, rest, reflect and set boundaries, but we must also be willing to ask what they are being asked to tolerate and whether the environments around them are providing enough care in return. Individual care matters, organisational care matters and collective care matters. I have come to believe deeply that healing isn’t an individual job.

That includes the relational spaces we create within our professions. Supervision, mentorship, colleagues and professional communities can give us somewhere to take what the work evokes in us. In a study of 298 psychological therapists, Johnson et al. (2020) found that higher-quality supervisory relationships were associated with lower disengagement, while supervision frequency was not associated with either disengagement or exhaustion. As the study was cross-sectional, this does not establish that better supervision causes lower disengagement, but it does suggest that the quality of the supervisory relationship deserves attention.

Perhaps the question is not simply whether the helper is practising self-care. It is also: Who is caring for the helper? Where can they put what they carry? Where can they be uncertain, vulnerable or tired? Where can they receive rather than provide?

Returning ourselves to the circle of care

If you asked me now what sustainable practice looks like, I could give you a list: regular supervision and mentorship, work that fits my capacity, ongoing learning, values-aligned choices, rest, creativity, movement, mindfulness, compassion, boundaries, community and a willingness to reach for support. I have also had to learn to walk away from systems and people that cause harm, to let go of hyper-independence and to stop wearing busyness as a badge of worth.

But the list isn’t really the answer. For me, sustainable practice is about the relationship I have with myself underneath all of those things. Before burnout, I would have said that I treated myself as negotiable. Looking back, even that gives me too much credit. I wasn’t really in the circle of care at all. I could extend enormous amounts of attention, compassion and responsibility towards other people while somehow remaining outside that same field of concern myself.

Sustainable practice now means that I am a non-negotiable person within that circle. This does not mean I always come first or that another person’s needs never take priority in a particular moment. It means that I count too. My needs, body, capacity, values, creativity, relationships, joy and humanity have a place alongside the needs of those I care for.

It means noticing what is happening within me while I am attending to what is happening in another. It means respecting my limits rather than treating them as evidence that I should try harder. It means being willing to change the shape of my work as I change. It means having places where I do not have to be the expert, the strong one or the person holding everything together. Most of all, it means learning to receive.

This is why I no longer think of sustainable practice as something we achieve. There is no point at which we become perfectly boundaried, resilient and self-aware practitioners who have finally mastered being human while helping other humans. It is an ongoing relationship with ourselves, one that requires us to keep noticing, adjusting and returning. What am I carrying? What do I need? Does the way I am working still fit the person I am today? Am I still in the circle?

When Ryan told me he had the “old Shanny” back, he was right in one sense. My laughter was returning, but I don’t think recovery has simply been about returning to the person I used to be. In many ways, I had disappeared long before I ever became a psychologist. I was never really free to discover some parts of myself in the first place. Perhaps what Ryan was witnessing wasn’t only the old Shanny coming back. Perhaps I was finally beginning to meet her.

Psychology, unexpectedly, has been part of that process too. The profession that became another place for me to disappear also gave me knowledge, practices and ways of understanding myself that helped me find my way home. I know more now about what I like and dislike, what I value, what I need, what brings me joy and what lights me up. I know more about who I am when I am not being useful to someone else.

I still care deeply. I still feel suffering. I still want to help. None of this has required me to care less. What has changed is my understanding that care cannot sustainably travel in only one direction. Perhaps our task as helpers is not to become less human so that we can withstand the emotional demands of caring for other people. Perhaps it is to make room for our own humanity within that care.

So rather than ending with another prescription for practitioner wellbeing, I want to leave you with the questions I continue to ask myself: What are you carrying? Where are you in your own circle of care? And what might caring deeply without disappearing look like for you now?

Take gentle care of you

Shannon A Swales

Fellow Helper

Written by Shannon A. Swales, Clinical Psychologist | Updated 11 Sept 2026

References

Crisp, D., & Bartels, M. (2025). Barriers to self-care and seeking help among mental health professionals and trainees: A systematic review. Clinical Psychology: Science and Practice, 32(4), 375–387. https://doi.org/10.1037/cps0000285

Duncan, S., & Pond, R. (2024). Effective burnout prevention strategies for counsellors and other therapists: A systematic review and meta-synthesis of qualitative studies. Counselling Psychology Quarterly. Advance online publication. https://doi.org/10.1080/09515070.2024.2394767

Edwards, J. L., & Crisp, D. A. (2017). Seeking help for psychological distress: Barriers for mental health professionals. Australian Journal of Psychology, 69(3), 218–225. https://doi.org/10.1111/ajpy.12146

Griffin, B. J., Weber, M. C., Hinkson, K. D., Jendro, A. M., Pyne, J. M., Smith, A. J., Usset, T., Cucciare, M. A., Norman, S. B., Khan, A., Purcell, N., & Maguen, S. (2023). Toward a dimensional contextual model of moral injury: A scoping review on healthcare workers. Current Treatment Options in Psychiatry, 10, 199–216. https://doi.org/10.1007/s40501-023-00296-4

Johnson, J., Corker, C., & O’Connor, D. B. (2020). Burnout in psychological therapists: A cross-sectional study investigating the role of supervisory relationship quality. Clinical Psychologist, 24(3), 223–235. https://doi.org/10.1111/cp.12206