I am a disabled and chronically ill care worker, a neurodivergent human who is also a therapist. This is the story of what I have had to unlearn as a provider in order to show up fully in my humanity within my work. I share these words as an offering of vulnerability and self-reflection. I hope that in reading my story, others can re-locate parts of themselves lost to stigma, trauma, and self-judgment. May we all remember the value and wisdom contained within our wounds. May we continue to cultivate spaces that cherish our vulnerability, tend to our wounds, and allow us to connect through our grief.
Allowing my Wounds to Inform My Work
My relationship with being a therapist is complex, tender, and filled with mystery. I honor this profession I have chosen because of the therapists who supported me when I was at my lowest. Regardless of the length or content of our work, each of these mental health workers impacted me profoundly; some of them kept me alive. The dedication of therapists, social workers, and care providers helped me survive my late teens and early 20s. I carry immense gratitude for these humans who held space for my pain and allowed me to break down. It has required a lot of compassion for me to reconcile the competing truths that some of these relationships were life-saving, yet the system still failed me in significant ways. While I understand that the therapists I worked with did their best with the resources available to them, the pain of feeling misunderstood, misdiagnosed, and misattuned to still stings. I sensed that something was missing, and I believed something better was out there for my healing and the recovery of many people I loved dearly. Even at my lowest points, there was a quiet hum of rage driving me forward in search of holistic, sustainable care that would bring relief beyond symptom reduction.
My search for relief led me to becoming a social worker, and then a therapist. In my early therapy career and clinical training I was taught not to share my experience and to mask my affect in order to not interfere with the therapy process. I learned early in life how to abandon my body’s sensations and suppress my needs in service of attuning to the needs and distress in my environment. My decade as a social worker and years training and practicing therapy has only reinforced this lesson: Foreclose my individual needs and offer myself as a vessel to care for others.
As I was trained as a clinical social worker and grew into myself as a therapist, I worked in various treatment environments where I didn’t believe I could bring my full self to my work. I found little space in my educational and clinical training to process my own wounds or to discuss the impact of providing care work while also being a human experiencing the same grief, uncertainty, and longing for protection that my clients seek. As a master’s student and in my field experience, I was taught to be a blank slate, removing myself from the therapy room and allowing the client to project their needs, beliefs, and desires onto me. For years, I didn’t believe there was room for my complexity and brokenness, no space in my work for me to speak about my own lived experience with despair, hopelessness, and loss.
Starting my private practice in 2020 was an act of self preservation as a care worker who was deeply burnt out and traumatized by my own lived experience on top of years of holding space for individual, family and community suffering. I was an expert on masking my internal experience, obscuring my pain, and disconnecting from my body, mind and spirit. Obscuring our pain, or distancing ourselves from the most vulnerable parts of self, is a powerful survival strategy. Exiling the parts of myself that were not okay, and denying my own need for care made it possible for me to be a social worker, and to provide attuned support to those I worked with. The stressed environmental working conditions against the backdrop of multi-systemic issues within of the mental health and medical industry did little more than help providers like me to merely cope with the brokenness in our organizations, the pain of our clients and the emerging needs of our own bodyminds. These coping strategies keep care workers burnt out, job-hopping, and unable to make the impact they desire with their work. What might become possible if we focused less on 'getting by' and more on addressing the systemic roots of these individual and collective symptoms?
Systemic Care Worker Burnout
Care work is embedded in institutions of colonization, racism and ableism, to name a few. To see these systems of oppression as separate from the mental health industry is to miss the ways that we, as providers, have internalized and are reflections of these systems. Unlearning the perfectionism, individualism, control, and violence embedded in our history and training requires humility and diligence.
I am gaining a deeper understanding of the ways I have been conditioned as a mental health professional and therapist to deny my own needs and lived experience. I remember back to my first clinical job after graduating with my master’s degree; I was working as the only therapist for a small non-profit serving unhoused single mothers and their families. This was a part time job with no benefits and an hourly wage where I was expected to work less than 20 hours weekly and my caseload included 15 mothers and their children. The Christian background and the utter lack of community, inclusion and queer visibility in this space (and many jobs following), meant I was largely closeted from sharing my relationships, sexuality and gender identity at work, even with coworkers, for fear of repercussions and job loss.
Working day in and day out serving clients that were shielded from witnessing fundamental parts of my identity really wore on my nervous system. I would be fatigued from a day of performing okayness and hetero-cis-normativity and I easily burnt out. Unable to spend time outside of work on anything other than rest. Stuck in a cycle of overwork and collapse, and feeling desperately lonely. Compartmentalizing my queerness and my most wounded parts, I kept these lived experiences as far away from my clinical work as possible. This strategy numbed the pain of operating in a system made by and for neurotypicals and based on the pathology paradigm, but it only lasted so long before I found myself stretched beyond my means.
Without community, without seeing folks like me in the field and in training and continuing education spaces, I lacked support and opportunities for professional development. You can only handle the stress of providing trauma informed care while carrying your own trauma for so long. Some agency and community mental health environments are referred to by staff as “revolving doors’’ because therapists and staff can only tolerate working there for so long without needing to find another job — this is largely due to lack of funding, low wages and long hours, unrealistic caseloads, and poor environmental conditions for both clients and employees. Many of the job experiences I had prior to self-employment would follow a similar pattern: learning the ropes → realizing the workload was unrealistic → struggling with managing therapy sessions, crisis intervention and group facilitation, on top of hours of documentation → over-exerting myself to compensate for poor-treatment outcomes → feeling overly responsible to ‘fix’ the system/situation by advocating for client needs and engaging self-advocacy → efforting in vain until a breaking point where I would inevitably collapse from overwhelm, or a physical health crisis and need to find another job that would make doing this work possible, again.
'The Care Worker Burnout Cycle' creating revolving door employment
I am a licensed clinical social worker rapidly approaching 30. I am autistic and adhd, but did not have these key pieces of self-understanding until very recently. I have struggled with migraines, mood dysregulation, severe anxiety and chronic pain for over a decade. My mental health has been in various emergent states since early adolescence.
When I moved away from my home state of Florida for undergraduate studies at Loyola University Chicago, I joined a mindfulness group through the campus medical center and it was recommended I engage in individual therapy. I had my very first therapy session at 18 through the student health center, and have been in the client chair ever since. I have worked with 13 therapists over the last decade. I have been a therapy client for 5 years longer than I have been a therapist. My own mental and psychological distress, and the care and treatment I have received in response has informed me as a therapist more than any class or clinical training could. I was given a battery of diagnosis throughout this time including Major Depression, Bipolar Disorder, Obsessive Compulsive Disorder, Unspecified Neurocognitive Disorder, Complex-PTSD and multiple Anxiety Disorders. It wasn’t until I was a therapist in my own practice working with queer and neurodivergent clients that I was able to self-diagnose my AuDHD, and seek neurodivergent affirming therapeutic care for myself. For me, this process of self-identification was made possible due to the financial freedom and time-freedoms I have gained through self-employment and divesting from treatment environments that exploit therapist labor all while profiting off their marginalized identities. If you are a therapist or care worker who has been affected by systemic burnout, and you're willing to explore the impact it had on your work, please complete this survey.
Delayed understanding of neurodivergence is a common experience for many high-masking autistic women, trans and non-binary individuals who come to understand their neurotype late in life. Missed diagnosis among the BIPOC and LGBTQIA+ communities can be attributed to narrow, white-male-centered diagnostic criteria, intersecting experiences of oppression that impact access to therapeutic care and accommodations, and camouflaging behaviors and symptoms that may increase risk of violence and further marginalization. These realities and my lived experience have led me to be a fierce advocate for the validity of self-diagnosis within the neurodivergent community. A process involving thorough research, self assessment and introspection can equip a self-diagnosed person with finding coping skills, accessing community, and understanding themself. The Neurodiversity, Disability Justice, Mad Liberation and Autistic Self-Advocacy Movements view disability and neurodivergence as natural forms of human diversity that require acceptance and accommodation, not to be fixed or cured. To learn more about the liberatory nature of self-diagnosis, check out the work of Dr. Devon Price, Author of "Unmasking Autism".
There is a particular melancholy that I carry as a late-discovering autistic and ADHD person. I hold the relief of self-understanding in one hand — it comes with new language for my experiences and needs; and on the other hand I carry grief. Who would I have become if it was understood and accepted that I was multiply neurodivergent earlier in my life? I grieve for the younger parts of me that feel confused, denied, and alone. The parts of me that learned to shrink, shut down and go mute instead of letting my pain be known. I grieve the realization that my life could have been different, or at the very least easier, if my sensory processing, neurological and mental health differences were not dismissed as minor sensitivities or framed as moral failures.
Holding Duality as a Therapist & Client
My experience as a client interacting with the mental health industry and its providers was one of feeling misattuned to, othered, ashamed, wrong and disordered. I lost years to the belief “there is something deeply wrong with me”. My perception of myself as a broken and disordered individual was in part a result of the pathologization and stigmatization of my mental health symptoms, and the western individualistic approach to wellness.
The pathology model fails to identify the impact of the environment, minority stress, dominant cultural norms, identity based oppression and lived experience on any person’s emotional wellness. It views the symptoms of distress that would fall into “disordered” categories as solely the responsibility of the individual. Our western model pathologizes human behavior and categorizes it into DSM diagnostic labels, requiring treatment that individuals seek in private. One of the biggest myths perpetuated by this individualistic medical model is that mental and emotional anguish can be solved on our own.
Mental and emotional health is not an individual concern that needs to be addressed in private, it is a collective concern that must be healed in relationship with other humans and the community at large.
I am not and will not ever be a fully healed, fully integrated human. I am still in the thick of my own therapeutic work, and increasingly realizing that my “work” will never be quite done. I don’t fit into the // well provider — sick patient // paradigm. I am both a disabled, neurodivergent provider and a vulnerable patient in ongoing weekly therapy. I am not well, how could any of us be?
I am in pain. My body hurts and struggles with chronic pain, GI concerns, hyper mobility and a compromised immune system. Most of my physical symptoms are invisible. My mind is in deep pain as well. I frequently feel overcome with distress. I carry wounds in my heart, spiritual wounds that run deep. I grapple with grief, uncertainty, and existential dread. I carry wounds that won’t heal, symptoms I will live with for the remainder of my life, and conditions of living that I simply can’t change. This doesn’t make me sick, this makes me human.
None of the therapists I saw fixed me. None of them cured me from my human afflictions. That wasn’t their job. Their job was to be with me as I moved through my suffering; they offered their attention to me, in those hour long meetings. Sometimes we sat together in silence because there were no answers to the questions asked. Bearing witness to another’s suffering is healing. Attention is reparative, attention is love. I remind myself often that my work is not to fix or cure my clients, my work is to be in connection and to offer attention. Solution oriented work is not the end goal for myself and many of my clients, the work we value is more about finding ways to live authentic, whole lives and be with the realities of ourselves in our world.
Establishing my practice and working full time through self employment has allowed me to push back on and unlearn the ways I have been taught to “show up” as a therapist. I have made space for myself, in all my complexity, in my work with clients and in the therapeutic relationship. I am a human in the room with my clients. I feel with them, I cry with them. I no longer mask my affect or filter what I share about my experience with such control. I am reconciling my relationship with myself as a provider through this process of radical visibility. I am intentionally highlighting the parts of myself that society usually shuns or silences, I am allowing my wounds to impact my work. I am learning ways to remain embodied and in touch with my human experience, and these shifts are reinforced when I allow myself to connect vulnerably with community.
Communal Shadow Work
The more I allow myself to live with, shed light on, and inquire into my own wounds, the more free I become from my unconscious patterns to deny or control. I have found we can only shed so much light on our own. We need one another to feel and heal and build awareness of our wounds. I thank communities like The Kintsugi Therapist Collective for holding space for me and an abundantly diverse community of therapists and aligned care workers to support one another in building embodied and liberatory practices of care. Spaces like this help me remember I am not alone. Being a member of collectives like this has strengthened my ability to hold multidimensional, nuanced truths about myself and my work in the mental healthcare field.
Embracing the competing truths that reside in these liminal spaces has served as an invitation to look for and tend to the parts of the system that can grow to be more equitable, sustainable, and just.
Healing, to me, is about allowing all parts of myself to exist, without wanting to fix them, cure them, or change them. This is an integrative and intentional progress. No part of us can be left out or left behind. We need all of us. Healing is found in connection, remembering, and reclaiming space to be fully human.
Through this communal practice of shadow work, I have found the more human I allow myself to be as a provider, the deeper the healing goes, for both my clients and myself. I am learning that sharing my feelings and reflections, not hiding them, is a way I can remain embodied while providing care and therapeutic guidance to individuals, families and groups. I am learning that bringing my neuroqueer authentic self to this work actually makes me a better therapist, and keeps me working in ways that are not only sustainable but deeply generative.
Since beginning the Intentions Therapy private practice, and accessing queer and disabled community though spaces like Kintsugi Therapists Collective I have been able to fully step into my truth as a nonbinary gender fluid person, a mad, multiply neurodivergent therapist, someone healing from complex, embodied trauma, and someone with chronic, invisible illness and pain. I share these experiences with my clients and I watch many of them settle, become more comfortable with me, my truth, and the reality that I am also a human learning and going through it. Each time I allow my wounds to be seen and witnessed, I integrate the parts of myself that have been wounded by the pathologization of my mental health back into my life and therapy work.
As a licensed clinical social worker in Florida and Illinois, serving predominantly trans, nonbinary, and neurodivergent LGBTQIA+ clients, it is painful to witness the onslaught of anti-trans legislation and the direct impact it has on my clients (and my own) mental health, relational wellbeing and sense of safety in our world. I am struck with grief by the impact of the countless assaults on medical and educational freedom and bodily autonomy on our collective psyche. Now, more than ever, there is an urgent need for spaces to gather in community and be held in kindness.
I know the salve of being understood, and the hope derived from belonging within community. As someone with complex and intersecting identities and experiences, the simple antidotes of community care, collective unlearning and rediscovery have been the most potent medicine for me. It has become central to my work to build offerings of collective care where multiply marginalized individuals can explore their depths and shadows within inclusive and affirming spaces. There is no healing without belonging, and no belonging without community.
If you are looking for healing, and feel overcome with pain, find a community that will hold you in your truth, and allow you to explore your wounds.
About the writer: Dani Sullivan, LCSW is a neuroqueer non-binary therapist and the founder of Intentions Therapy, a private practice based in Chicago and serving therapy clients throughout Florida and Illinois. Dani co-facilitates support groups for neurodivergent queer, trans and gender non conforming adults. Dani provides a range of virtual services including relationship coaching, individual therapy and coaching, professional consultation, and training with a focus on serving the LGBTQIA+ community, and adults healing from complex trauma. If you are interested in joining a Neuroqueer Connections group, or learning more about their work, you can visit intentionstherapy.com