When You're the Therapist Going Through Perimenopause: Holding Space While Losing Yours

The Irony Is Not Lost on You

You spend your professional life helping other people understand their emotions, regulate their nervous systems, and sit with discomfort. And then perimenopause arrives, and suddenly you are the one who cannot regulate, cannot concentrate, and cannot find the word you need in the middle of a session.

The irony is thick. You know the theory. You understand the window of tolerance, the polyvagal ladder, the importance of self-compassion. And yet at 3 a.m., drenched and wide awake, or at 2 p.m., staring blankly at a client's face as the thread of their narrative slips away from you, theory offers limited comfort.

This is a real clinical challenge, and it is not one that professional training prepares you for. The following is an honest look at what perimenopause does to therapists and what actually helps.

Brain Fog in the Therapy Room: What Is Actually Happening

The cognitive changes of perimenopause have a neurological basis. Estrogen supports glucose metabolism in the brain, and as levels fluctuate and decline, the brain undergoes a measurable transition in how it uses energy. Researchers including Dr. Lisa Mosconi at Weill Cornell have documented this shift using PET and MRI imaging.

For most women, this is a temporary transitional state. The cognitive changes tend to be most pronounced during the perimenopausal years and often improve after the menopause transition completes. But that does not help you today, in a session with a client who is in crisis, when your working memory is not working.

What you are experiencing is not incompetence. It is not burnout in the traditional sense, though burnout can compound it. It is a real neurological phenomenon with a biological cause. Naming it that way, privately and clearly, is the first step toward managing it rather than being managed by it.

Countertransference Risk When Your Reserves Are Low

Emotional regulation is the substrate of good clinical work. When your own nervous system is dysregulated by sleep deprivation, mood instability, and unpredictable anxiety, your countertransference management becomes genuinely harder.

You may notice irritability with clients who are stuck in patterns you have seen a hundred times. You may find yourself less able to stay curious when your energy is depleted. You may have more emotional reactivity to clients whose material activates your own current struggles, particularly if those struggles involve identity, aging, or loss.

None of this makes you a bad therapist. It makes you a human therapist experiencing a demanding physiological transition. But it does mean the monitoring and management that was previously somewhat automatic now requires more conscious attention. Your supervision and personal therapy become more important, not less.

Boundary Fatigue Is Real

One of the less-discussed aspects of perimenopausal emotional depletion is what happens to professional boundaries. Not clinical boundaries, necessarily, though those can slip when you are exhausted, but the internal regulation of how much of yourself you give in a session.

Some therapists describe a permeability that increases during this period. The membrane between you and the client's material feels thinner. The containment that usually feels natural starts to feel effortful. You walk out of back-to-back sessions feeling not just tired but hollowed.

This is worth taking seriously. Reducing caseload during the acute phase of perimenopause is not weakness. It is clinical wisdom. Protecting enough recovery time between demanding sessions is not indulgence. It is what allows you to continue doing the work well rather than doing it poorly for longer.

If your practice structure does not currently allow you to protect yourself this way, that is worth examining. What would need to change? What might it cost, and what does continuing the current pattern cost?

Supervision, Consultation, and Disclosure Decisions

Your supervisor or consultation group may not have had this conversation with you yet. That does not mean it does not belong there. Bringing your perimenopause into supervision, not as a personal complaint but as a clinical variable, is appropriate and often useful.

The relevant clinical questions are: how is your current physiological state affecting the quality of your presence with clients? Are there patterns in your countertransference that are influenced by this transition? Are there client presentations you are less equipped to handle well right now? These are clinical questions, and supervision is the right place for them.

Disclosure to clients is a separate and more nuanced question. For most clients, in most cases, direct disclosure is not clinically indicated. But some clients, particularly those who notice changes in you, or whose therapeutic relationship is deep enough that not naming something real feels like a rupture waiting to happen, may benefit from a carefully framed, minimal disclosure. This is a judgment call that your supervision and your own clinical experience should inform.

Using Your Own Therapist Differently Now

If you are in your own therapy, and if you are a therapist reading this, you probably should be, this is a time to use it fully. Not as professional development or a check-box. As actual treatment.

Bring the brain fog. Bring the identity disruption that comes from feeling like you have lost the sharpness you have always relied on. Bring the fear that you may not be giving your clients what they need. Bring the complexity of being the expert in a room when you are privately struggling with something you cannot yet fully make sense of.

Your own therapist can also be a resource for concrete recommendations: who else is navigating this, what has helped clinically and personally, and how to think about the practice changes that may need to happen. You do not have to figure this out alone, and your professional training does not mean you should.

The Identity Shift: Being a Healer Who Needs Healing

The professional identity of a therapist is often deeply wound up with being the steady, present, regulated person in the room. Perimenopause disrupts that identity in ways that go beyond clinical concerns.

You may find yourself grieving the version of you that found this work easier. The version that could hold difficult material without as much effort, that reliably had the right words, that left sessions feeling depleted but not erased. That grief is legitimate.

But there is something else available here too. Therapists who have navigated serious personal challenge and come out the other side often describe a quality of presence that deepens. Not because suffering is inherently instructive, but because you know from the inside what it costs to keep showing up when your body is not cooperating, and that knowing can translate to something genuine in the room.

You are not going to be in this acute phase forever. Most women describe significant improvement in cognitive and emotional symptoms after the menopause transition completes. What you are in is a transition, not a destination.

What Actually Helps: Practical Adjustments for Clinical Work

Here are concrete things therapists have reported as helpful during this transition.

Reduce back-to-back sessions where possible. Cognitive fatigue accumulates across sessions, and having even ten minutes between appointments to reset makes a difference.

Keep brief notes between sessions rather than relying on memory. A two-sentence summary after each session protects you against the memory gaps that perimenopause can create.

Be honest with yourself about caseload limits. The hardest clinical work, high-risk presentations, acute trauma processing, severe personality pathology, requires the most of you. It is not a permanent reduction to protect your capacity for that work right now.

Prioritize sleep aggressively. The cognitive symptoms of perimenopause are significantly worsened by sleep deprivation, and as a therapist your cognitive functioning is literally your instrument. Treating sleep as a clinical priority rather than a lifestyle preference is justified.

Track your patterns. Knowing where you are in your cycle, when symptoms are typically worse, and which days your concentration is sharper lets you schedule your most demanding work strategically. Daily tracking with something like PeriPlan can give you that pattern data over time.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.