I am what I would consider a high-volume clinician, and that is entirely my choice. I am the master of my own schedule and my own time, and I make choices about both based on what actually works for my nervous system and my body. And yet, whenever I tell fellow clinicians how many clients I see in a week, I am often met with some version of the same response. There is a widening of the eyes, a slight bracing, sometimes genuine concern. “I don’t understand how you do that.” “Are you sure this isn’t coming from a place of scarcity?” “I’m worried you’re going to burn out.”
I don’t necessarily experience these responses as malicious. Often, I think they’re coming from a place of care. But there is still something interesting about them, because underneath the concern is sometimes an assumption:
I could not sustainably do what you are doing, therefore I am not sure what you are doing can be sustainable.
And I think we do this to each other all the time.
We have become much better, particularly in mental health spaces, at talking about limits. We talk about burnout, overfunctioning, people-pleasing, fawning, nervous system dysregulation, boundaries, rest. I am glad that we do. These are important conversations, particularly in a culture that has historically glorified productivity at enormous human cost. But sometimes, in our effort to stop pathologizing people for having less capacity, we accidentally begin pathologizing people for having more of it. We replace one rigid standard with another.
The truth is that capacity is profoundly individual. It is also contextual, seasonal, relational, neurological, financial, physical, and constantly subject to change.
The Ecosystem Behind My Caseload
My current capacity makes sense within the context of my actual life. I don’t have children, and I cannot emphasize enough how significantly that informs what I am able to give to my work right now. My mornings are my own. I can sleep later when I need to. I can work out. I have two partners and am well supported in my life. I control my schedule. I work four days a week. These are not incidental details. They are part of the ecosystem that makes my current workload possible.
My neurodivergence matters too. I am autistic and believe I also have hyperactive ADHD, and there are aspects of the way my brain works that make the rhythm of my clinical days surprisingly compatible with me. I can hyperfocus intensely. Once I am in a cadence, I can stay there for a long time. In fact, breaks often don’t restore me in the way people assume they should. They interrupt my momentum.
The closest comparison I can think of is finding your pace during a long run. Once my body has settled into its rhythm, continuing at that rhythm often requires less effort than stopping and asking myself to start again. Transitions are difficult for me. A one-hour break in the middle of my clinical day means transitioning out of therapy, figuring out what to do with myself for an hour, probably doing administrative work or looking at my phone, activating an entirely different part of my brain, and then transitioning back into being a therapist. That isn’t necessarily restful for me. Sometimes it is considerably more taxing than simply remaining in the state my nervous system has already organized itself around.
This is one of the reasons generic prescriptions about what a “healthy” caseload should look like have never made much sense to me. They assume that the same activities cost all of us approximately the same amount of energy. They don’t.
Therapy Is Sometimes When I Feel Most Regulated
Before becoming a therapist, I spent roughly twenty years as an educator, teaching music, voice, and piano. And if I am being completely candid, I found that work substantially more exhausting than the clinical work I do now. Teaching required me to constantly shift pedagogical strategies depending on a student’s age, developmental needs, learning style, personality, and background. I was demonstrating physically and vocally while simultaneously trying to determine how to translate a concept so that this particular student could understand it. There was an enormous amount of switching involved. Therapy, while intellectually and emotionally complex, engages my brain differently. I find it deeply stimulating, and I am able to settle into a kind of sustained presence that feels remarkably natural to me.
I am also highly embodied in the therapy room. I am paying attention to my body throughout sessions. I notice when I subtly begin to pull back. I notice moments of activation, disconnection, or dissociation, and I become curious about what that information might be telling me about the relational field and my own countertransference. I regulate myself actively. As a trauma therapist, I take attunement and co-regulation very seriously, and somewhat paradoxically, being with my clients is often when I feel most regulated and embodied during my week.
My Oura Ring has actually offered an interesting external confirmation of something I already knew internally: physiologically, I am frequently in a highly restorative state while sitting with clients. The days when my body registers the most stress are often my days off, days filled with errands, transitions, social activities, hosting, and being on the go. Apparently my nervous system did not receive the memo about which activities are supposed to be exhausting.
But that is precisely the point.
None of this means that seeing a high number of clients is inherently healthy. It means that it currently works for me. There have absolutely been weeks when my caseload has felt heavier. Sometimes several clients are in crisis simultaneously. Sometimes there are more ruptures or relational complexities in the room. Sometimes something in my personal life is consuming more of my resources than usual. Capacity isn’t a fixed number that I discovered once and can now carve into stone. I have to keep listening.
Capacity isn’t a fixed number that I discovered once and can now carve into stone. I have to keep listening.
And my capacity will change. If I choose to have a child, for example, I fully expect my bandwidth to shift radically. My life would need to be recalibrated, and what I can sustainably offer my clients may look very different. There may be other seasons of my life when illness, grief, caregiving, hormones, aging, relationship changes, or circumstances I cannot currently predict alter the equation again. The fact that I can do something sustainably now does not mean I will always be able to do it. Nor would a future decrease in my capacity mean that something had gone wrong.
When Capacity Becomes Comparison
This is where I think our conversations about capacity sometimes become unexpectedly cruel. We are very quick to turn somebody else’s capacity into information about ourselves.
Someone sees that I can carry a large caseload and thinks, I should be doing more.
I see someone recoil when I describe my caseload and a part of my brain briefly wonders, Should I be doing less?
Neither conclusion necessarily has anything to do with reality.
I remember once describing my workload and the ways I show up in my relationships to a former friend, who responded, “Danielle, you must be a fawner.” I remember how reductive that felt. There are certainly parts of me that genuinely love to give, nurture, contribute, and show up for people. But generosity and self-abandonment are not synonyms. I can tolerate other people’s disappointment. I don’t particularly enjoy it, but I am capable of allowing someone to be disappointed in me without automatically sacrificing my body, needs, or boundaries to make that feeling disappear.
Sometimes a person doing a lot is overfunctioning. Sometimes a person doing a lot simply has the capacity to do a lot. Sometimes a person doing less is depleted or burned out. Sometimes a person doing less simply has a lower capacity for that particular kind of labor. Sometimes capacity itself changes from Tuesday to Thursday. We cannot know which story is true simply by looking at the quantity.
Generosity and self-abandonment are not synonyms.
What I Actually Want to Know
This is becoming particularly important to me as I begin hiring associates and building a broader group practice. I don’t want to create a culture in which clinicians are expected to approximate my nervous system. I cannot imagine telling another therapist that because I can comfortably see a certain number of clients, they should be able to do the same. A therapist who can sustainably and attentively see fifteen clients a week is not less committed than someone who can see thirty-five. At the same time, I don’t want to infantilize clinicians with high capacity by assuming they must be disconnected from themselves simply because their threshold is different from mine or someone else’s.
I want the clinicians who work with me to learn themselves.
Of course, sometimes we don’t know our capacity until we exceed it. Sometimes we discover a limit by running headfirst into it. Sometimes what we thought was sustainable turns out not to be, and there is humility required in recognizing that. But I think there is a difference between helping people develop awareness of their own limits and deciding those limits for them.
Perhaps the better questions are not, how much are you doing? or how much should you be able to do? Perhaps they are: what happens inside of you while you’re doing it? What happens afterward? Are you recovering? Are you present? Is there room for pleasure? Can you say no? Can you change course when your body asks you to? Does this pace allow you to remain connected to yourself and the people you care about?
Those questions tell me far more about sustainability than a number ever could.
I think we desperately need permission to have different capacities without turning those differences into hierarchies. Your lower capacity is not evidence of your inadequacy. My higher capacity is not evidence of my pathology. Your need for more rest does not mean you are lazy, and my need for less interruption does not mean I am secretly running from myself. None of us needs to make somebody else’s nervous system wrong in order to trust our own.
We have beautiful, different, complicated nervous systems that need beautifully different, complicated things. And perhaps part of becoming genuinely attuned to ourselves is resisting the urge to use somebody else’s capacity as the measuring stick for our own.
Your capacity is not a commentary on mine. And mine is not a commentary on yours.
