Why Therapists Leave Crisis Work

You walk out of the unit after a hard call. Your hands are still shaking a little. Someone asks if you're okay, and you say "fine" (out of habit). Then the next overhead page comes in, or you get called on the radio.

If you've done crisis work, you know this moment. You may also know the drive home, when the whole day finally catches up with you.

In this episode of The Art of Being a Therapist, hosts Ashley Charbonneau and Morgen Villegas talk with Jill Barker, LSW. Jill spent close to eight years in crisis settings, from a psychiatric hospital in New Jersey to psychiatric hospitals in Colorado. Her story raises a question many clinicians think about but rarely ask out loud: Why do so many therapists leave crisis work?

It's Not The Clients That Make Us Leave

Most therapists who leave high-acuity settings don't leave because of the clients. They leave because the conditions made quality work almost impossible. Picture a typical day: Back-to-back sessions with no time to eat, a grueling schedule someone else built for you, a caseload full of a population you were never trained to serve., insurance deciding if you can admit someone, a client who needs ten more minutes, and a system that says no. None of this shows up in a job posting; all of it adds up. When a system asks for more than any human can give, many therapists turn the blame inward. I should be able to handle this. Morgen shares that she once felt this way in community mental health. Over time, she saw the problem wasn't her skill. The setup itself clashed with her ethics. That isn't one social worker's weakness; that's our values coming up against realities of system work.

What Few People Talk About

The episode goes somewhere many conversations skip: physical restraint. In some hospitals and residential programs, the therapist is part of the team that steps in when a client is at imminent risk of hurting themselves or someone else. We - and our coworkers - are the safety and security. Restraint (often called physical management or "going hands on") is a last resort, after talking someone down hasn't worked. It's brutal, honestly, as most of us got into this field to help people feel safe. Putting hands on a client can collide with your whole sense of who you are as a helper. Your body holds those moments long after the shift ends. And if your supervisor treats it as "part of the job," you're left to carry it alone.

Why Some Therapists Stay

So what helps? Jill's answer is simple: The people around you, a supervisor who notices a heavy moment and tells you to step outside for a few minutes, coworkers who have your back, and a colleague who can say, "I've been there too." These things sound small. For Jill, they're a big part of why she lasted as long as she did. Burnout grows in isolation; in this way, community is one of the strongest protections we have.

When Gatekeeping Gets Personal

The conversation also turns to licensing. Jill talks openly about her experience with the LCSW exam, including how hard it was to get testing accommodations for ADHD. The hosts question why a test that rewards test-taking skill, rather than real-world judgment, holds so much power over who gets to practice. Their view is clear: an exam score doesn't decide whether you're a good therapist. For anyone who has felt small in front of a licensing board, this reminder may land hard.

Being Allowed to Choose a Different Path

Leaving crisis work isn't quitting. Moving to private practice, going remote, or stepping back for a while doesn't prove you couldn't hack it. Sometimes it's the most ethical choice you can make, for your clients and for yourself. Jill's path has had plenty of turns. She went from crisis care to private practice, then to a remote role, and now she's heading back toward client care and a practice of her own. Her message to listeners is simple: Everyone moves at their own pace, and you're not alone in this.

Hear the Full Conversation

There's much more in this conversation, including Jill's take on what makes a good therapist and what it took for her to start questioning a field she loves. Listen to the full episode of The Art of Being a Therapist to hear the whole story.

If parts of this story feel familiar, it might be time to let someone hold space for you. Therapists need therapy too. Nothing has to be wrong with you to deserve support. This work asks a lot, and you deserve a place to set it down. Visit our Therapy for Therapists page to learn more about support made for clinicians.