In 21st century America, the adage that “all work and no play” makes a person dull should probably be amended to say that it makes a person stressed out.

Every job involves a certain amount of stress, and it’s normal for work demands and pressures to ebb and flow. When the tension rises above a normal level for a sustained period of time or becomes an ongoing reality, however, work-related stress can dramatically affect the individual’s personal life and mental, emotional and physical health. Trying to handle friction with a co-worker or supervisor, taking on an unwanted change in role or responsibilities, or being forced to navigate a toxic work environment, possibly including bullying or harassment from co-workers, can all result in stress setting up shop in a person’s life and remaining there, even after the workday (or workweek) is done. Today’s technology tools — wonderful as they can be — are another common contributor to ongoing work stress because they tend to encourage overwork and expectations of around-the-clock connectivity. Work emails don’t typically abide by a 9-to-5 schedule, and neither do smartphones, laptops and WiFi connections.

Professional clinical counselors, no matter their setting or specialty, may notice work stress manifesting in clients’ lives in a variety of ways. Some clients might complain about having trouble sleeping or experiencing physical aches and pains. Others might mention ruminating on work issues when they are off the clock, associating their self-worth with career achievements, feeling guilty when they take time off, fearing losing a job, or even feeling mentally or emotionally exhausted just thinking about their job responsibilities or work environment.

Work-related stress “can take away some of our joy,” says Michele Kielty, a licensed professional counselor (LPC) and licensed school counselor in Virginia. “We can be so overrun with responsibilities that we experience a lack of joy in things we have previously found joy in. … It’s carrying an ever-present, low-grade, oppressive stress with you all the time. It can take over your life more than you’d like for it to.”

Simply put, work stress keeps us from being the person we want to be, says Kielty, a professor of counseling and director of the school counseling program at James Madison University (JMU) in Harrisonburg, Virginia.

Complicating the issue further is that some clients who realize that work is the main cause of their stress feel embarrassed that a job can have that effect and level of control over them.

“The painful thing about this is that there can be a lot of regret, guilt and, occasionally, shame over loss of presence — not being able to be fully present when you’re home or around your children,” says A. Renée Staton, an LPC and professor in JMU’s counseling program. “Parents may report [in counseling] that their work stress might not feel like it’s on the forefront of their mind, but they’re finding they’re more reactive and impatient with their children. It might be harder to keep things in perspective, in context, when they’re responding to their children.”

A major source of stress

A majority of American adults (64%) cited work as a significant source of personal stress last year in the American Psychological Association’s annual Stress in America survey, which collected data from more than 3,000 adults between August and September 2019. Among Gen Xers, money and work were tied as the most frequently cited sources of stress (at 65% apiece). Among millennials, money (72%) barely edged out work (71%) as the most frequently cited stressor. Work was the second-most cited source of stress for baby boomers (preceded by health concerns), whereas Generation Z, or the post-millennial generation, reported work as its third-largest source of stress (behind money and health concerns).

The American Institute of Stress, a Texas-based nonprofit organization, notes that work and career are major sources of stress for Americans and can be linked to hypertension, increased risk of heart attack, and other medical concerns.

“Although the Institute is often asked to construct lists of the ‘most’ and ‘least’ stressful occupations, such rankings have little importance for several reasons,” the organization says on its website ( “It is not the job but the person-environment fit that matters. … Stress is a highly personalized phenomenon and can vary widely even in identical situations for different reasons. One survey showed that having to complete paperwork was more stressful for many police officers than the dangers associated with pursuing criminals. The severity of job stress depends on the magnitude of the demands that are being made and the individual’s sense of control or decision-making latitude he or she has in dealing with them. Scientific studies based on this model confirm that workers who perceive they are subjected to high demands but have little control are at increased risk for cardiovascular disease.”

Dissatisfied, disconnected, underappreciated

The term “work stress” can mean different things to each individual client, and a counselor’s response should be tailored to each client’s distinct situation. However, Sharon Givens, an LPC in private practice who specializes in career development and mental health, has found some common themes in her work with clients. She says that levels of dissatisfaction and stress can surge for individuals when they:

  • Are in a job or role that they find unfulfilling or don’t enjoy
  • Have issues with leadership (e.g., think that they have a bad boss, don’t feel respected or valued, have a personality or values conflict with a supervisor or company leadership)
  • Believe they are not being compensated properly financially
  • Are doing work that doesn’t meet their needs, such as personality style, passion or interests

This last bullet point can make all the difference, asserts Givens, president-elect-elect of the National Career Development Association, a division of the American Counseling Association. At the end of the day, a job will be a good fit only if what it offers matches what the individual needs. For example, a person who values teamwork and struggles to work independently will never thrive in a position in which they work alone from home full time, says Givens, whose practice has offices in Columbia, South Carolina, and Charlotte, North Carolina.

Research indicates that many workers leave jobs on the basis of whether they connect with their co-workers. Stress and unhappiness will naturally swell if an employee doesn’t enjoy the work or the people with whom they work — even if the employee is well-compensated, Givens adds.

Jennifer Linnekaste, an LPC with a practice in Oslo, Norway, specializes in career counseling and helping clients with work-related trauma. She says counselor practitioners should probe with further questions when clients, regardless of their presenting issue, spend a majority of sessions discussing or complaining about negative issues at work. Practitioners can get a fuller picture by asking clients when they began feeling overly stressed and whether that coincided with a change in leadership or supervision at work, a new job role or new work responsibilities, a traumatic incident in the workplace, or some other work-related circumstance.

Work stress occurs on a continuum, and “whether or not someone can handle that stress is totally within the perception of the client,” adds Linnekaste, who is writing a book on work trauma to be published by ACA.

Possible indicators

When work stress bubbles over, personal relationships commonly suffer the effects. That’s because work stress often robs individuals of their ability to engage with and be fully available to the people they love, Kielty says.

Givens, an ACA member, has seen work stress put so much strain on clients’ marital relationships that they end up on the verge of divorce. Carrying around constant feelings of stress can make the person become less patient, more irritable, and more likely to be snappy with or lash out at their significant other and other loved ones, generating relationship conflict as a result. Or, a couple can become distant if one person, feeling overwhelmed by work, shuts down and doesn’t want to communicate their needs and stressors to a partner, Givens points out.

In addition to staying alert to possible red flags in clients’ personal relationships, counselors should listen for other clues that work stress may be manifesting in clients’ lives, Givens says, including:

  • Displaying anxious behavior, including feeling paranoid that they are going to be fired
  • Spending a large amount of time talking about financial worries
  • Expressing a lack of commitment to their work, desiring to take excessive amounts of time off, or doing the bare minimum to get by
  • Expressing a lack of fulfillment or using language that indicates they simply tolerate their work
  • Expressing that they feel stuck, are too old or too entrenched to try something new, or are thinking about premature retirement
  • Saying that they do not enjoy, engage with or trust their co-workers
  • Feeling a lack of control or power over their work situation, feeling like a victim or feeling overlooked in company decision-making

Work stress may also be to blame if clients talk about physical symptoms such as headaches, high blood pressure, gaining or losing a significant amount of weight, or having trouble sleeping.

Fatigue can be another indicator that work pressures are overwhelming a client, says Quentin Hunter, an LPC associate in Kentucky who co-authored the September 2019 Journal of Counseling & Development (JCD) article “Assessing Life Balance and Work Addiction in High‐Pressure, High-Demand Careers.” When clients talk about chronic tiredness, feeling totally spent once they get home, not being able to turn off their “work brain,” or ruminating about work tasks when watching television or eating dinner with their family, counselors should probe with questions to learn more. “People often come in knowing that they’re exhausted by their job and that it’s affecting them, but not that it’s inappropriate,” notes Hunter, who works in a group private practice in a rural setting.

Amanda M. Evans, an LPC and co-author of a 2013 JCD article titled “Work-life Balance for Men: Counseling Implications,” notes that work stress can manifest in ways that chip away at clients’ overall wellness, including decreases in marital satisfaction and sexual activity or an inability to fully relax and engage in activities and hobbies that they previously enjoyed.

“For me, it would be concerning if a client says things like, ‘I just need to push through’ or ‘If I put my head down [and work hard], it will get better,’” says Evans, an assistant professor in JMU’s graduate psychology department and director of the university’s clinical mental health counseling program. “A counselor can be a reminder that it’s not a requirement [to be unhappy at work], and that’s not how we have to live our lives.”

Evans, Kielty and Staton have discovered that work stress often emerges as an issue that connects to other mental health topics that they collaborate on as colleagues at JMU, including most recently in their research on bicultural identity, which the trio presented at the Let the Voices Be Heard! conference in Belfast, Northern Ireland, this past October. (The conference, billed as “an international conversation on counselling, psychotherapy and social justice,” was jointly planned by ACA, the British Association for Counselling and Psychotherapy, and the Irish Association for Counselling and Psychotherapy.) Evans and Staton will also discuss work stress as part of a poster session on institutional discrimination at the ACA 2020 Conference & Expo in San Diego in April.

Recognizing counseling’s roots

Counselors may see clients who name work stress as their presenting issue. This is often the case for Givens, who receives many of her clients through referrals from employee assistance programs. But other clients may show up to counseling for help with a troubled marriage or help dealing with depression without realizing that work stress is inextricably linked to their presenting issue, Givens says.

“Work is such a large domain of our life, and it plays such an integral part in impacting our mental health,” Givens explains. “You can’t address one without the other.”

In other situations, Kielty points out, clients may come to counseling for work stress because it feels like a “safer,” less stigmatized or less embarrassing issue than what may be lying underneath, such as marriage trouble or intimate partner violence. In other words, for certain clients, work stress may represent a more acceptable way of entering the counseling relationship.

Givens says career counselors and mental health counselors shouldn’t hesitate to refer clients to one another or to co-treat clients who need to focus on both realms of life.

Many of the counselors interviewed for this article pointed out that the counseling profession’s foundations are in career counseling and say that professional clinical counselors shouldn’t hesitate to lean into the profession’s vocational roots.

“Remember that work and career are a key part of almost everyone’s life, so we need to spend some time exploring them,” says Hunter, an ACA member and assistant professor at Lindsey Wilson College in Columbia, Kentucky. “If you ask, ‘How’s your job?’ and they answer, ‘Great,’ don’t just accept that and move on. … A client might not necessarily say, ‘I know that work is stressing me out’ or ‘I hate my job,’ but it’s still sucking up a lot of their energy, and they’re not feeling effective in the domain they came to you for.”

Spurring self-reflection

Discovering to what degree work stress is affecting a client’s mental health can be eye-opening for both counselor and client. Hunter says he often begins by asking clients to reflect on where a majority of their energy is going. “We only have so much personal energy each day,” he explains to clients. “How much of it is going into your work domain, family domain and individual domain, and where are the deficits? Where have you seen this affect you? … Work can impact all of the domains of wellness, [including] sleep disturbances, spirituality, intimacy with a partner, energy levels. How much of your life is wrapped up in work?”

Hunter often directs clients to think of their day as a pie, with each slice indicating a domain where they invest their energy. He then asks them to consider how this looks and feels. Is work the biggest slice? The entire pie? Are they OK with the way their pie is divvied up? Is it causing them stress?

Another exercise Hunter finds helpful is to have clients create a prioritized list of their values and the things they find important in life. Most clients place family and relationships at or near the top of their list and relegate work to further down. From there, Hunter spends time talking with clients about the priority they assign to different aspects of their life and where things may be out of alignment related to where they spend most of their energy. For instance, if work is No. 5 on their list of things they value, does that correspond with how much energy they are dedicating to it? If their marriage or their relationship with their children is the first thing on their list, is that part of their life truly receiving the most of their attention and energy?

Staton agrees that values exploration can be an important part of counseling with clients who are struggling with work stress. Counselors can help clients realize when their work does not align with their personal values, determine what is essential for them to “feel fulfilled without overdoing,” and learn when to say no and make changes when their situation doesn’t match with “what they truly want in their heart,” Staton says.

Kielty, a past president of the Association for Spiritual, Ethical and Religious Values in Counseling, a division of ACA, suggests that counselors guide clients in making a list of values and creating goals based on the top values they identify. For example, for clients who value autonomy, an appropriate goal might be to uninstall work email apps from their smartphones so that they can’t be contacted — and aren’t tempted to engage with work — when they’re supposed to be off the clock. Clients who value flexibility might consider requesting a change in their work schedule to do four 10-hour shifts per week so that one weekday is left free to go on field trips with their child’s school, grocery shop or focus on self-care, Kielty suggests.

These counseling exercises are all done with an eye toward building self-evaluation and self-reflection skills in clients, Hunter notes. One of the most important things counselors can help clients do when their work stress spikes is to take a step back to assess what they want their life to look like versus what it looks like in reality, he says.

Any type of contemplative practice — such as journaling or mindfulness — can help clients reflect, hone self-awareness and be honest with themselves, Hunter says. These skills are also important to instill in clients so that they can fall back on them outside of counseling sessions, he adds.

“[Creating] that space to listen to yourself and have self-evaluation is a hard habit to build but so powerful,” Hunter says. “Eventually, they will leave therapy and have to self-prescribe their own goals. They need to be able to assess their energy levels and where [in which domains of life] they are placing importance.”

Supporting clients if and when they decide to leave a job and transition to a new role is important, but a counselor’s guidance shouldn’t end there, Givens says. “In many cases, work stress can be the symptom of something greater, and it’s our responsibility to research and make sure we understand the root cause to help the person holistically, instead of just from a career or mental health perspective,” she explains.

Givens recalls a client who initially came to her for career guidance. He expressed feeling unhappy and “maxed out” in his role as an executive vice president. As Givens’ work with the client progressed, he also disclosed that he had become distant from his wife. The couple wasn’t communicating well, and their sex life was “nonexistent,” according to the client.

Further assessment and exploration revealed that the client wasn’t clicking with a new boss who had recently started working at the client’s company, leaving the client feeling undervalued. On top of everything else, Givens found that the client had never processed his parents’ deaths (his mother had been dead for eight years and his father for 26) and was beginning to show signs of depression.

At that point, “the work stuff became secondary,” Givens remembers. She introduced grief work and self-esteem techniques into their sessions, as well as cognitive behavior therapy. She worked with the client for roughly a year and a half, and during that time his self-esteem and marital relationship began to strengthen and rebound.

Roughly a year into their therapy relationship, the client made the decision to leave his company and find a new position. He received three desirable offers and ultimately accepted a position as a CEO — a life goal he had always wanted to achieve, Givens recalls.

Guiding influences

When considering changes to a work situation or pursuing work-life balance, it is often clients who have the answers themselves, Givens says. A counselor’s role is to guide and support clients as they take a step back, tap into the answers they already have within, and make decisions.

Givens had a client who came to her for career counseling. The client was well-paid, but she was also responsible for three different roles at her company: payroll, accounting and human resources. “When we talked it through, she realized it wasn’t fair to get one salary for three jobs,” Givens says. “She didn’t see it until she took a step back [in counseling] and realized, ‘I could get paid the same amount for doing just one of these jobs!’ Eventually, she made the choice to leave.”

Givens has a number of worksheets, questionnaires and other tools she uses in sessions with clients who are struggling with work stress to spark self-reflection and engage in goal setting. One of these tools is a puzzle with blank pieces that can be written on with a special marker and wiped clean for reuse. Clients label the puzzle pieces with various aspects of their lives, including work, and then fit the pieces together in two different ways: as their “ideal” life puzzle and as what their life looks like in actuality. After talking things through with her clients, Givens asks them what they would need to change — which puzzle pieces they would need to shift or remove altogether — to make the two puzzles be in better alignment.

In a similar vein, Givens uses a “life wheel” illustration (below) with clients so they can rate different areas of their lives (finances, career, relationships, relaxation, etc.) on a scale from 1 to 10. This exercise provides both the counselor and clients a better understanding of how clients see themselves and where they are — and aren’t — finding fulfillment.

Image courtesy of Sharon Givens

Givens also created and uses a flowchart-type document that she refers to as a “gap analysis.” The chart has two boxes with a gap in the middle. She asks clients to write a description of what their life looks like now in the first box and ideas about the life they would like to have in the second box. Clients’ challenges and missing pieces are written in the gap between the two boxes. These challenges and missing pieces might include getting a professional certification, partaking in additional training, or pursuing additional education to get into a desired career, she notes. In each session, Givens works with the client to set goals, address the challenges listed in the gap on the flowchart, and check in about progress.

“It could be that [a client] wants to be a plumber, but they need the proper training. I would help them connect to that,” Givens says. “Ultimately, that’s what we’re trying to do: get the client to where they want to be and get over what’s getting in the way.”

When clients are feeling overwhelmed by work stress, counselors can help them break up what seems like an insurmountable challenge into smaller pieces, says Evans, a member of ACA. She suggests that practitioners equip clients with coping mechanisms, including psychoeducation on self-care, boundary setting and thought-stopping techniques, to navigate the here and now before tackling bigger decisions such as whether to leave a job or change career paths entirely.

Kielty notes that lessons on mindfulness and body scanning can provide clients with helpful tools for managing their emotions at work when stress begins to overwhelm them. “Identify what sets you off and how you can create healthy spaces for yourself. Create some healthy space between you and your work,” she advises.

Kielty, a member of ACA, often introduces the concept of “mindfulness moments” when she does workplace trainings. Taking time to reset, even if it’s just for a minute or two, can be a tremendous coping mechanism for handling work stress, she says. Resetting might include closing the door to one’s office and taking deep breaths, going for a brisk walk, doing a quick body scan or taking inventory of one’s senses of sight, smell, hearing, taste and touch. Mindfulness helps regulate stress hormones and heart rate, improves concentration and increases self-compassion, says Kielty, who adds that mindfulness is an evidence-based way to “help build inner resources.”

Being able to pause, even for just a moment, gives a person choice, agency and some options for dealing with stress rather than allowing it to control them, adds Staton, an ACA member.

Hunter sometimes equips individuals who are having trouble separating their work and home lives with a mantra they can repeat to themselves each day as they’re leaving work: “I’m finished with work today. I’m leaving work here in the parking lot. Anything that needs to be done at work can be done tomorrow (or the next time I return).” This simple exercise can help clients reinforce the idea that they are not their jobs and that work is only part of who they are, he says.

Counselors should be aware that some clients who struggle with work stress may also have a work addiction, Hunter points out. As is the case with any process or behavioral addiction (e.g., gambling, gaming, shopping), work can become an activity that provides a person with a temporary “high” and serves as an escape to avoid other issues. Professional clinical counselors should listen closely for hints that clients are practicing avoidance behaviors — such as throwing themselves into work to avoid dealing with relationship problems or mental health issues — or using language that may indicate work addiction, such as “I only feel good when I’m at work,” Hunter advises.

Although goal setting can be a helpful part of supporting clients through work stress, Hunter cautions that counselors must be sensitive to the individual client’s needs and personality before using the approach because it may not be a good fit for everyone. Setting benchmarks — such as leaving work by 5:30 each day, having dinner with the family every evening and making time to read a book for pleasure — can be helpful for clients who are interested in order and objective tasks, he says, but it can feed into anxiety for other clients.

“Goal setting can be a good place to start, until [finding work-life balance] becomes more natural,” Hunter says. “But when we set expectations, we have to realize that they can be anxiety-provoking. A client can throw themselves more into work because they don’t feel like they’ll meet their goals or have anxiety over meeting goals. The bigger goal should be knowing when work-life balance is off-kilter and needs to be shifted.”

Flipping perspective

One major factor that can contribute to clients’ hesitancy to push back against unrealistic workloads or to experience guilt over taking time off is cultural messaging, Hunter says. Clients may struggle to equate work stress with its harmful effects (physical and mental) because American culture emphasizes that working and supporting yourself is a highly valued quality.

“When I grew up, being a workaholic was a compliment,” Hunter says. “Counselors can be advocates [for the idea] that work is not the be-all, end-all, and there can be rewards in other domains of life. We can be the ones to push and question that as a culture. … While it’s good for people to have direction in a career and feel valued, it’s important to balance that with family and life outside of work.”

Counselors can be agents of change in this regard, Hunter insists, and help clients make a cognitive shift: Work is not intrinsically bad, but it can become a problem when it negatively affects an individual’s mental health and spills over into their personal life. This is especially true, Hunter says, when working with clients who struggle with work addiction, who express feeling like everything rests on their shoulders, or who voice sentiments such as “If I don’t do this work, who will?”

“When it comes to work-life balance, it’s such a challenge in 2020 America to think of work as a problem. It’s hard to argue that working hard and supporting your family is wrong,” Hunter observes. “A client may say, ‘I’m doing everything right. I’m doing what I should to build a career and support myself and my family.’ When in actuality, overwork is the issue, and feeling obligated to a career and sacrificing other aspects of life.”

“Oftentimes, a career will take as much as you will give,” Hunter continues. “We live in a capitalist society, and even a well-meaning organization will accept all the work you will put into it, and it’s up to the individual to say when it’s enough. The organization never will.”



Contact the counselors interviewed for this article:


Want to learn more?

Sharon Givens will present the session “Career development and mental health strategies” at the ACA 2020 Conference & Expo in San Diego in April. Find out more about Givens’ presentation and numerous other sessions on career-related topics at


Additional resources

Take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (

Books (

  • Coping Skills for a Stressful World by Michelle Muratori and Robert Haynes
  • Postmodern Career Counseling: A Handbook of Culture, Context and Cases, edited by Louis A. Busacca and Mark C. Rehfuss
  • Career Counseling: Holism, Diversity and Strengths, fourth edition, by Norman C. Gysbers, Mary J. Heppner and Joseph A. Johnston

ACA divisions



Should I stay or should I go now?

What should a counselor’s role be when a client who is overwhelmed by work stress wants to throw in the towel and leave a job? Explore this issue in an online exclusive article at CT Online:



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