About two years ago, I was driving home after a day of seeing six clients, all carrying significant trauma histories. Somewhere on the highway, I felt an overwhelming wave of sleepiness wash over me. Not the kind that comes from a bad night of sleep. The kind that comes from a nervous system that has simply had enough.

It was like my body decided, without asking me, that we were done. That scary drive home, and the quiet unraveling that followed, taught me something I should have known sooner: I cannot pour from an empty vessel. And more specifically, I cannot co-regulate from a dysregulated state.

If you’ve ever searched “therapy for therapists” in a moment of quiet desperation, you already know something important about yourself. You know that what you do for a living is not emotionally neutral. You know that sitting with pain, day after day, costs something. And you may be starting to wonder whether the way you’ve been managing that cost is actually working.

This post is not a list of bubble baths and journaling prompts (and trust me, I love journaling… just not as a means to self-regulate during a busy workday). This is a practical, body-based framework rooted in nervous system science (specifically, Peter Levine’s work in Somatic Experiencing and Stephen Porges’ Polyvagal Theory).

Because your burnout isn’t a scheduling problem. It’s a physiological one. And it deserves a physiological response.

Why Therapists Are Uniquely Vulnerable to Dysregulation

Here’s something that doesn’t get said often enough: you are the therapeutic instrument. Your nervous system is the tool. And like any instrument, it requires regular tuning.

Co-regulation, which is the process of helping a dysregulated client return to a window of tolerance by offering them your own regulated nervous system, is physiologically costly. It requires you to stay in your ventral vagal state (calm, connected, socially engaged) while your client is cycling through fight/flight or freeze. You’re essentially holding two nervous systems at once. Over the course of a full day of sessions, that is an enormous ask of your body.

Add to this the cumulative exposure to vicarious trauma, the chronic low-grade activation of compassion fatigue, and the professional expectation to appear calm and present at all times… and you have a recipe for a nervous system that quietly runs itself into the ground.

There’s also what I call the “therapist persona” trap. Many of us are extraordinarily skilled at masking internal dysregulation with a composed exterior. We nod thoughtfully while our hearts are racing. We offer grounding interventions while our own feet have floated off the floor. We become so practiced at looking regulated that we stop noticing when we actually aren’t.

This is not a character flaw. It’s an occupational hazard. And it starts to heal the moment you decide to pay attention.

Understanding Your Own Nervous System First

What follows will not be new to those of you familiar with Polyvagal Theory. But I want to ask you something gently: how often do we learn something in theory and never actuallyapply it to ourselves? How often do we teach our clients about the nervous system and then ignore what our own is trying to say?

A quick refresher: Dr. Porges’ Polyvagal Theory describes how the vagus nerve connects with the autonomic nervous system to help us navigate safety and threat. There are three primary states:

Ventral vagal state: Our least protective state. This is where we feel safe, connected, and socially engaged. It’s where connection happens, for both of you.
Sympathetic state: Mobilized, activated energy. Anxiety, irritability, fight or flight. This is the state many therapists are quietly running on by Thursday afternoon.
Dorsal vagal state: The most protective state: shutdown, disconnection, collapse, dissociation. That sleepiness I felt on the drive home? That was dorsal vagal, my system’s last resort after being redlined all day.

There are also mixed states. Freeze is a combination of sympathetic and dorsal vagal: you’re activated but unable to move. Play is a combination of ventral vagal and sympathetic: energized and safe at the same time.

Here’s what’s important to understand about your workday: your neuroception, the body’s unconscious process of scanning for safety or threat, may be quietly flagging your client’s distress as dangerous, even when your thinking mind knows you’re safe.

Your body is doing its job. But your job requires you to override that signal and stay present anyway. Over time, this is exhausting in a way that no vacation can fully fix.

Start noticing your baseline. Pay attention to how you feel throughout the day, not just in session, but on the drive to work, during your lunch break, at the end of the week. If you notice your heart rate spiking before you’ve even walked through the office door, that’s information. Your body is telling you something worth listening to.

One more distinction worth making: being calm is not the same as being regulated. Calm is a temporary state with low activation in the moment. Regulation is a capacity. It means you can move through different emotional states, including anger, grief, and anxiety, without becoming overwhelmed or reactive. The goal isn’t to be a flatline. The goal is to be flexible.

Body-Based Regulation Strategies You Can Use During the Workday

Regulation works best before you hit capacity, not after. Think of it as charging your phone throughout the day rather than waiting until the battery dies. The following practices are designed to fit into the actual rhythms of your workday because you deserve tools that work in real life, not just in theory.

Between Sessions: The 5-Minute Reset

I know you barely have 10 minutes between sessions to use the bathroom, check your notes, grab water, and breathe. So, this sequence is intentionally short. Do it between every session, consistently, and you will feel the difference by the end of the week.

Stretching (2 minutes): Stand up. Reach your arms overhead and lengthen your spine. Bend side to side. Fold forward and let your upper body hang. Come back up slowly and rotate your torso left and right, letting your arms swing loosely like wet noodles. Open your chest wide and look up, stretching your neck. These movements help discharge the tension that accumulates when you’re holding yourself still and composed for 50 minutes at a time.
Physiological sigh (1 minute): Take one deep inhale through your nose, filling your belly. Without exhaling, take a second inhale to fill your chest. Then exhale slowly and steadily through your mouth. Do this 3 times. This double inhale fully inflates the alveoli in your lungs and is one of the fastest ways to activate the parasympathetic nervous system. It works. Use it.
Front-occipital hold (2 minutes): Place one hand gently on your forehead and the other on the back of your head, at the base of your skull. Apply light pressure with both hands. Breathe slowly. This hold targets the prefrontal cortex and the brainstem and is a simple but surprisingly powerful way to settle an activated nervous system. Hold for two minutes, or until you notice a softening.

During Sessions: Staying Grounded Without Losing Presence

I know, I know… you already have a lot to hold during a session. The last thing you need is another thing to monitor. That's exactly why I'm keeping these practices intentionally tiny. Smallenough to disappear into the background of your awareness, powerfulenough to actually change how you feel in the room.

Feet on the floor: Bring intentional awareness to the soles of your feet and their contact with the ground. Press gently into the floor and then release. Repeat as needed. It sounds small. It isn’t.

Nasal breathing: You may be surprised how often you breathe through your mouth when you start paying attention. Nasal breathing slows airflow, lowers heart rate, and helps regulate the nervous system. Research also suggests it supports better focus and emotional processing. If you want to maximize your presence in the room, nasal breathing is the way to do it.
Staying curious about your body: Your body is giving you information throughout every session: a tightening in your chest, a held breath, a sudden urge to look away. These aren't distractions. They're data. Cultivating a gentle, ongoing awareness of your own internal experience while you're with a client is one of the most underrated clinical skills there is. It keeps you honest, it keeps you present, and it helps you catch dysregulation early, before it starts quietly running the session.

After Difficult Sessions: Discharge and Transition Rituals

It’s tempting to head straight to your car after a hard day. Home has snacks and pets and everything soft. But if you skip the transition, you bring the session home with you in your body. Just ten minutes of intentional discharge can change the entire rest of your evening.

Shaking and dancing for upregulating (7 minutes): This is a technique developed by Dr. James S. Gordon, a Harvard-educated psychiatrist, designed to release trauma, stress, and activation stored in the body. Put on rhythmic music and shake your hands, your arms, and your whole body until you feel the sympathetic activation beginning to move through and out – about three to four minutes. Then switch to something fun and dance for a song or two. This is not silly. This is science.
Child’s pose or corpse pose for downregulating (3 minutes): Child’s pose (balasana) provides a full-body stretch, activates the parasympathetic nervous system, and (when practiced regularly) can lower resting heart rate and blood pressure. If you’re too depleted even for that, corpse pose (savasana) asks nothing of you except to lie on your back, close your eyes, and breathe. Set a timer. People do fall asleep.

Addressing the Deeper Patterns

Sometimes burnout isn’t a between-session problem. Sometimes it’s pointing at something larger: a caseload that has quietly become unsustainable, a workplace culture that doesn’t support your needs, or unprocessed material of your own that keeps getting activated by your clients’ stories.

There’s also something worth naming about the therapist’s resistance to receiving care. We are helpers. We are trained to sit in the holding role. And many of us carry a quiet belief that needing support means we’re somehow failing at this work. That belief is worth examining… gently, and probably with someone else in the room.

Your own therapy and supervision are not optional. They are clinical maintenance. Therapy for therapists is not a luxury or an indulgence, it’s a professional and ethical responsibility.

You cannot model what you haven’t lived. And the most regulated, present version of you is not a performance. It’s something that has to be built and maintained, from the inside out.

Beyond the workday practices, sustainable nervous system health looks like:

Regular movement: Not necessarily structured exercise, though that counts too. Running around with your dog, playing with kids, challenging your partner to a dance-off: all of it moves energy through the body. If you haven’t tried ecstatic dance, I encourage you to look it up (here’s one for Denver).
Breathwork: Apps like Othership offer free daily routines for both up- and down-regulating. YouTube is full of free breathwork videos. Find something that fits into your morning or your transition out of work.
Time in nature: Not as a productivity hack. Just as a nervous system reset. Trees don’t need anything from you.
Music and arts: Listening, making, moving to… these are all forms of right-brain nourishment that talk therapy doesn’t always reach.
Social connection and time with pets: Your nervous system co-regulates with others, including animals. Safe, warm, non-therapeutic relationships are not a break from the work. They are part of what sustains it.

Moving From Reactive Self-Care to Proactive Nervous System Hygiene

There’s a reframe I want to offer you before we close: sustainable practice is not selfish. It is ethical. When you regulate your own nervous system consistently, not just when you’re in crisis, but as an ongoing way of being, you become a more present, more effective, and more genuinely connected therapist. Your clients feelthe difference, even when they can’t name it.

You cannot co-regulate from a dysregulated state. That’s not a failure of will. It’s just physiology.

So, start small. Pick one practice from this post. Try it consistently for a week and notice what shifts. You don’t have to overhaul everything at once. You just have to start listening to your own body with the same quality of attention you offer your clients every single day.

If you’re finding that the patterns are deeper than daily practices can reach… if there’s unprocessed material getting activated, or if your system has been running on empty for a long time, therapy for therapists is a real and valuable thing. You deserve the same quality of care you provide. Please don’t wait until you’re on the highway, barely able to keep your eyes open, to decide that you matter too.

You’re a human being doing extraordinarily human work. And that deserves tending.

AUTHOR BIO

Anna Khandrueva, LCSW, is a trauma and relationship therapist based in Broomfield, CO. She has a soft spot for late-diagnosed neurodivergent women – those who spent years being told they were "too much" or "not enough" before finally getting answers – and for couples navigating the beautiful complexity of neurodivergent partnership. If you want to keep digging deeper into nervous system regulation, Anna has a whole podcast episode on polyvagal theory with your name on it.

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