Why the work stays with you and why self-care isn’t the answer

It's not always loud and obvious.

Often, it’s unseen: the self-doubt behind the scenes; waking at 2 and 3am; moving from being an engaged, passionate practitioner to privately dreaming about running a flower farm.

But sometimes it is loud: seeing valued and respected clinicians falling apart, passing out in the office, collapsing in tears or leaving the work altogether.

At either end of this spectrum, the clinicians I’ve seen here were good at their work.

That's what can make it so baffling, and why it is so important to take this seriously.

When we work with human pain and suffering, we do carry it home.

The problem is that whilst we were told to watch out for vicarious trauma or burnout, we weren’t shown what to do with the day-to-day accumulation over time.

The pathway to either tends to accumulate in increments, rather than all at once.

You’re not the problem. And more self-care is not the answer

The standard response to a clinician who is struggling is familiar: clearer boundaries, some leave, exercise, EAP. All well-intentioned and helpful to some extent, but all missing the point.

It is not a matter of discipline or resilience.

The self-care framing locates the problem in the individual, and it implies that if you were doing it right, you wouldn't be struggling.

Why the work stays with you: three ways clinical impact accumulates

Sustained relational work in complex and challenging environments has an occupational impact. This is well-documented across the research on vicarious trauma, moral distress, empathic strain, and burnout in clinical and community settings.

What is far less developed, both in our training and in our workplaces, is an understanding of how these impacts accumulate day-to-day, and how to work with them in practice.

In my experience across 25 years of clinical work and supervision, the impact of this work tends to collect in three distinct places.

In the body - activation, tension, or a depletion that rest alone doesn't resolve.

In the mind - rumination and thought loops that won't settle.

In meaning - a gradual shift in how the work feels, sometimes as an erosion of purpose.

Most approaches to clinician wellbeing address one of these. But very few support you to work with all three, particularly in a way that is sustained, structured, and integrated into your practice.

Why understanding the problem isn't enough to resolve it

Most of the therapists and clinicians I work with don't need more information. They can talk about burnout, vicarious trauma and nervous system dysregulation. They have read the books and can list what is needed.

What is often missing is not insight. It is a practical structure that allows that insight to be used in practice.

Much of what we carry from this work sits outside of thinking, reflection and conscious awareness. It lives in the body and in the felt sense - in the subcortical realms that manage stress responses and emotional experience. And those parts of us don't respond to insight and thought the way they respond to sound, movement, images and colour.

You already know this if you think about the signals that your body gives you: a rumbling tummy, a sense of heaviness, butterflies in your stomach, goosebumps or your hair standing on end.

And when we learn to work with these signals practically, it changes what working with clinical impact actually needs to look like.

I’ll be speaking about this more practically in a live workshop next month, including a way of working with what the work leaves behind in us.

Minky van der Walt is a Registered Music Therapist, PACFA Clinical Member and Accredited Clinical Supervisor with 25 years of experience in clinical work and supervision. She is the founder of Tempo Therapy and Consulting and the creator of Flourish.