How Do You Deal With So Much Suffering?

Recently, a young psychologist in supervision asked me a question that landed somewhere between the clinical and the existential.

“How do you do it? How do you deal with suffering?”

She had come into the supervision today already exhausted from work and burnt out. She wondered if she should be a therapist at all. Before we spoke about anything analytically, I invited her to slow down for a moment. We did a short Gendlin-like focusing exercise together: simply breathing, sensing the body, and noticing what image might arise from that felt sense.

At first she described an anchor holding her boat down. It gave stability: her work gave her purpose, but it was also exhausting her.

Then another image appeared.

A small boat on the ocean. “I’ve always loved the water,” she said. That image stayed with me. Because the question she asked next is one that many therapists eventually ask themselves, whether out loud or quietly inside.

How do you deal with so much suffering?

I had to be honest with her.

"Well, I'm still learning." I started. I used to struggle with this a lot and in some ways I still do. I do not feel I have “solved” it. But her question stayed with me because it pointed to something important, something strangely under-discussed in our profession.

As therapists, psychologists, psychotherapists, we deal with an unnatural amount of suffering. Nurses do. Doctors do. Firefighters do. Police officers do. Many caring professionals do. But so do we. Day after day, people place the heaviest parts of their lives on the table between us.

Loneliness. Trauma. Shame. Grief. Fear. Panic. Illness. Rage. Betrayal. Meaninglessness.

And if you are at all sensitive, if you are not made of marble and billing codes, this stuff affects you. Interestingly, this question is not only relevant for therapists. Today, anyone scrolling through the news or social media is confronted with an endless stream of suffering: wars, disasters, violence, ecological crises. One way people cope is by turning away, numbing out, or becoming desensitized. Another is becoming overwhelmed by the sheer scale of what we see.

Frontline professions such as nurses, firefighters, or doctors do not really have the option of “turning off the TV.” The suffering is right in front of them, as part of their work. And if they become too detached or too numb, it does not make them better in their job. It makes them worse. The same is true for therapists.

Some people cope by avoiding suffering, numbing themselves, or becoming desensitized. Others remain overly shocked by it, over-identified with it, or quietly flooded by the sheer amount of pain they witness. Neither response is ideal. One loses heart. The other loses footing.

The question, then, is not whether suffering exists. Of course it does.

The question is: how do we stay close to it without drowning in it?

One thing that struck me when I tried to answer my supervisee is that in my first five years of psychology training, there was not a single lecture, and not even a single article I can remember, that directly taught me how to deal with suffering. We learned about statistics, biology, diagnosis, classification, treatment modalities, and neuroscience. We learned how to assess, conceptualize, categorize, and intervene.

But how to deal with the amount of emotional pain one encounters in this work, both one’s own and that of others? That was hardly addressed directly. You better look into the philosophy or self-help aisle.

Even later, in 4 years of postgraduate psychotherapy training, there was still nothing very explicit on this. There were secondary ingredients that helped: supervision, intervision, personal therapy, and the slow ripening that comes from being around good clinicians. Carl Rogers' "as if" condition was mentioned too: understanding the client’s world as if it were your own, but not "that it is" your own. I found that elegant and true, but also a bit too intellectual to simply embody this approach on command.

Something was missing.

Over time I found a handful of perspectives and practices that slowly changed how I relate to suffering. Not one grand answer, but something more subtle and soft.

The image that emerged in the supervision session that day helps me explain it.

Suffering is like a beautiful ocean.

If you have a boat, and the boat has no holes in it, you can be in the ocean. You can even learn to ride the waves. You can be rocked by them, drenched by them, surprised by them. You may need to go back to a safe harbour, repair the boat, tend to it, strengthen it. But you do not have to drown.

Therapeutic work, at least in part, is about learning how to remain in the ocean without fully becoming the ocean.

Without that, we either sink into everything we witness, or we pull so far back from feeling that we become less alive, less present, less human.

A video that helped me hold this tension better is one by Ram Dass, a Stanford-trained psychologist turned hippie-guru, though that shorthand hardly captures the man. In this animation "How to Keep Your Heart Open in Hell" he points to two perspectives that seem opposite at first, but which actually need one another.

https://www.youtube.com/watch?v=Ym4Rpd72tq8

One perspective is vast, relative, and cosmic. We are, after all, a tiny speck on a tiny planet floating through a vast universe. Everything is impermanent. Everything changes. Entire lifetimes, with all their joys and tragedies, are but fleeting flashes in the larger unfolding of existence. Seen from there, suffering becomes at once infinitely small and somehow less solid. Not meaningless, but less absolute.

This perspective can bring equanimity. And humor.

Not cynical humor. Cosmic humor. The kind that loosens the grip a little.

And yet, if we stay only there, something human gets lost.

Because there is another perspective, the ordinary, intimate, compassionate one. The suffering of the person in front of you, just like your own pain, is not small to them. It matters immensely. If someone is grieving, panicking, dissociating, living on the street, dying of AIDS, haunted by trauma, abandoned by love, then universal perspective alone does not hold them. Any child in a war zone. They need us to care. They need us to remain human with them.

Both views matter.

The more universal, spacious view helps us not to drown.

The more human, empathic, compassionate view keeps us from becoming cold.

To me, these two go hand in hand.

Without some form of equanimity, we can get swallowed by the pain we encounter, not just in clients, but in the people around us and in the world more broadly. Margaret Cullen’s ongoing work on equanimity and her latest, just published book Quiet Strength, deserves much more attention in the helping professions. She presents equanimity not as detachment, but as a trainable steadiness that lets us remain present in the face of difficulty:

"Equanimity is characterized by non-reactivity and clear seeing and has the power to help us navigate the biggest dramas in our lives—not by ignoring them (or reacting in more fiery ways) but by being present with, and open to, all the very real struggles of being human without being hijacked by them. Equanimity is a profound and powerful force that can transform our responses to the events of our lives and in the world at large—and effect change inside our hearts and in all our interactions."

At the same time, equanimity without compassion might become emotional distance dressed up as wisdom. Wisdom and compassion need another.

One of my psychotherapy supervisors once told me something I have never forgotten: the day I lose my curiosity and empathy for people is the day I should stop being a therapist.

I believe she was right. Because if we lose our genuine interest in people; their stories, their struggles, their contradictions, something essential in the work disappears. If we become overly rational and robotic then something essential in the work dies. That finesse, that human touch, that living responsiveness, is not a decorative extra. It is part of what heals.

It is also a quiet privilege to be invited into the deepest layers of people’s lives.

Still, empathy on its own can be rough on the system.

This is where the distinction between empathy and compassion became important for me. Research by Tania Singer and Olga Klimecki has shown that empathic resonance with others’ pain can increase our negative emotions, whereas compassion training can shift the same experience toward warmth, affiliation, positive affect, and resilience. In one study, empathy training increased negative affect in response to others’ suffering, while subsequent compassion training helped reverse that effect; in another, compassion training was associated with increased positive inner states when witnessing distress.

That rang very true to my own experience with cultivating compassion.

If we stay only in empathy, especially emotional empathy, our neural pain systems can light up and we can end up overwhelmed, helpless, or exhausted. We feel with, but do not always know how to help, making us feel powerless. Compassion includes thinking and feeling with, yes, but it also includes a wish, a motivation, an orientation toward alleviating suffering. And that changes the whole inner posture.

Barbara Fredrickson’s broaden-and-build theory helped me think about this more broadly. Her work shows how positive emotional states can widen our cognitive and behavioral repertoire and, over time, help build enduring psychological and social resources. I do not mean that therapists should slap positivity over tragedy like cheap wallpaper. I mean that states such as warmth, care, appreciation, calm, and connection can expand us rather than contract us, and that matters when we sit with pain for a living.

What helped me most practically, though, was something more subtle.

Tonglen. And more broadly, Compassion Cultivation Training.

Tonglen is a Buddhist psychological practice often described as “taking and sending.” There are different ways of understanding it, and I am not suggesting all therapists should do this, nor that everyone needs Buddhist practices to survive clinical life. I am simply saying this practice has helped me.

Sometimes in sessions I have felt completely hopeless. Not dramatically hopeless perhaps, but quietly, painfully aware that I could not ease the other person’s pain in any major way. No practical support would change the facts. No brilliant interpretation would magically undo the wound (or at least not one within my skillset). No analytical question would meaningfully touch the depth of what was happening. No clever experiential intervention would disolve the pain.

And then, sometimes, all I could do was breathe and wish that person well.

That sounds very small. Like, perhaps too ridiculously small.

But for me, it has been a game changer.

Because something subtle shifts in me when I do this. I become more present. A bit more attuned. Warmer. Less flooded. Less helpless. Less preoccupied with my own inadequacy. My state changes. And because my state changes, my way of being with the person changes too.

That matters.

Compassion can of course take many forms. Sometimes it is practical support. Someone falls and you give them a bandaid. Sometimes it is advice or structure. Or a suggestion. Or emotional support. Sometimes it is simply listening, fully, without rushing to fix. And in therapy, it can be more subtle still. Wishing someone relief (without necessarily sharing that directly with your client). Imagining their life opening again. Holding the possibility that they may yet heal, love, laugh, or become more free.

You can interpret this spiritually if you want. Some people might relate to prayer, or to offering this wish into some larger field of meaning. Others won’t. Either way, what seems most important to me is that intention reshapes our inner state. And that inner state is not irrelevant. It enters the room with us.

If someone falls by the side of the road and is crying in pain, and I collapse next to them in tears and despair, I am no longer of much help. But if I can feel their pain, remain human, and still offer grounded support, then something useful can happen.

This, in some ways, also reminds me of psychoanalyst Bion's idea of alpha and beta elements. The notion that patients can bring something raw, unprocessed, almost unthinkable (alpha elements). We receive it, digest it, and offer it back in a more metabolized (beta) form. To do that, we cannot be endlessly porous. We need a mind that can transform what it receives, not merely echo it (I'm talking to you AI).

Perhaps that is one of the quiet tasks of this profession: to become a place where unbearable experiences can be held, digested, and gradually transformed. Or at least returned in a form that can be lived with. And perhaps this matters too: levity is not betrayal. Joy is not naivety. A little humor, rightly timed and rightly held, can keep the heart supple. Ram Dass understood this well. The world seems tragic, yes. It is also occasionally absurd. A therapist who can smile without mocking, who can remain light without becoming superficial, may sometimes be better able to keep their heart open in hell. And there is one more thing I have come to value.

The pause.

Just before the next session, sometimes I take a few seconds and breathe. A brief moment of self-regulation in between a hectic day. Some doctors say the same before entering a room or even before operating: I know I could rush in immediately, but those few seconds change the quality of my presence. They remind me I am not a machine. They let me arrive.

Sometimes that is all I have.

A breath. Maybe two.

A wish.

And a willingness not to turn away.

But there is more to the ocean than suffering. If that young psychologist asked me again today, I think I would say something like this:

Look, I’m still learning. These are simply some of the ideas and practices that have helped me so far.

You do not have to become invulnerable. You do not have to stop feeling.

You do not have to drown to prove that you care.

Sometimes all you can do is breathe and silently wish the person in front of you well.

And yes, that may sound painfully subtle. But subtle does not mean trivial.

Something in you shifts when you do this. You become more present, more attuned, warmer, steadier. And from there, you are often more able to help.

And if you dare to live, to courageously and deeply look at the ocean, you will see not only suffering.

You will see beauty in the reflections of the waves.

Rich joys in the ocean's depths. Impermanence and interconnectedness. The absurdity and tenderness of being human. The freshness of the present moment. We sit front row to to the strange theatre of human life. Endlessly fascinating stories, from the mundane to the mythic.

Boy, what a ride.

I would not want to miss it.

References and further reading

Cullen, M. Quiet Strength. Find Peace, Feel Alive, and Love Boundlessly Through the Power of Equanimity. (2026). Harper One.

Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist.

Klimecki, O. M., Leiberg, S., Ricard, M., & Singer, T. (2014). Differential pattern of functional brain plasticity after compassion and empathy training. Social Cognitive and Affective Neuroscience.

Klimecki, O. M., Leiberg, S., Lamm, C., & Singer, T. (2013). Functional neural plasticity and associated changes in positive affect after compassion training. Cerebral Cortex.

Pema Chödrön, especially When Things Fall Apart and Start Where You Are, for accessible writing on compassion, suffering, and Tonglen.

Bion, W. R. (1962). Learning from Experience.

Compassion Cultivation Training, (Compassion Institute / Stanford University's CCARE).