To the Clinicians Who Missed Supervision (again).

The Overlooked Child’s Burden

“It happened again,” you wrote.

Another crisis—urgent, unavoidable.

“There was no one else. I’m sorry for wasting your time.”

I pictured you: 9 p.m., shift long over, still on your phone, fielding emails, still working.

A team in crisis, and you didn’t say no. The impact still taking its toll. Your loyalty heavy. Others’ needs putting your own in shadow.

Last time you’d said:

“It’s about responsibility. If not me, who?”

I had shrugged. Your face tightened. A flicker of anger hid quickly. You smiled.

“Someone’s got to do it.”

Sacrifice is a necessary part of your work—crises demand it, patients need it, teams lean on it. Yet when it drains you to nothing, what remains? Like a bath without a plug. Without sufficient frame to hold it, sacrifice pours straight into the chaos.

I feel it again: a pull to agree.

I know you fear you’ve let me down—another person disappointed. Another person you need to take care of.

But also I wonder if there is a hope I won’t collude, won’t be another clinician who sees only your usefulness, not your need to live. Maybe I can rescue you from this. If I will just fight hard enough for you.

But this is not a dance I want to begin. No matter how tempting.

It’s not about being rescued.

It’s about the mess, the hopelessness. The determination. The hate. The wish to succeed where others might fail. The refusal to be a disappointment. The inevitably. The collapse.

There is no getting this right. No secret trick.

This is more disturbing than being right or wrong. It is about limits.

Your absence then isn’t just a gap—it’s a communication. It speaks of how hard it is to say no, even when you know saying yes doesn't really help.

Next session, you apologise again.

I’m torn. Frustrated you won’t prioritise yourself, yet wary of stealing your anger.

Beneath each sorry is a rage you can’t reach, a fury at the injustice—then and now.

Jessica Benjamin writes, “There is no love without aggression, just as there is no aggression that is not an effort to make contact with an other and be loved.”

Your care masks this aggression—a yearning to be seen—but it’s buried under responsibility and shame. If we can’t name the anger, we can’t reach the grief. Without grief, we stay stuck in sacrifice. None of this is fair—not for you, not for them.

Should supervision be this deep?

But what other way is open?

The Overlooked Child in the Matrix

In group analysis, the matrix is the shared field of stories, fears, and silences. Your missed session, your apologetic email—these echo a figure in that web: the Overlooked Child.

This child learned early that to matter, he must give everything—his time, his care, his body. His needs feel shameful, even dangerous. Saying no risks being seen as selfish, undependable—someone life is easier without.

As Jonathan Schedler notes, some repeat pain to ease guilt, as if self-care were a betrayal. You've said, going home feels like abandoning duty. I suspect a lesson born in childhood and reinforced by stiff upper lip culture.

Heroes despise their own vulnerability. Others return to suffering because it’s home, like horses running back to a burning stable. The system, like a neglectful parent, intertwines care with pain, making depletion feel safe. And there’s a hidden gain—being the one who “holds the line” earns trust, purpose, even praise, making rest a threat to identity. These aren’t conscious choices but echoes of a child who learned worth lies in giving everything.

In the NHS, this pattern is embedded. The more you give, the more you're asked to give. Sacrifice becomes the cost of competence, the currency of care. But the price stays hidden.

Beneath your relentless yes, I see him—the child who fears that if he stops, others will suffer. That if he rests, something terrible will happen. That he alone must hold the line.

Sacrifice may be necessary in an under-resourced system, but when it’s unrelenting, it corrodes care itself. As Marcus Aurelius said, “What injures the hive injures the bee.” A clinician drained to nothing doesn’t protect the system—they become a symptom of its collapse. Stoicism isn’t unthinking endurance—it’s intentional perseverance: knowing when to give, and when to step back.

Still, the Death Mother whispers: If you stop, they suffer. This is your task.

This isn’t just burnout. It’s moral injury—shaped by personal history, institutional neglect, and a terror of failure. It’s the ache: Does anyone else even care?

As Marion Woodman wrote, “Children not loved for who they are do not learn how to love themselves.” They grow by pleasing, not by living. The NHS echoes this dynamic—demanding clinicians pour out care without pause, while punishing those who try to live fully.

The myth of the selfless healer is potent—and dangerous. It says that the more life you claim, the more you take from others. That healing comes only through self-erasure. But this is a lie. A lie that leaves us invisible, exhausted, and unable to care in any meaningful way.

The Guardian of the Threshold: Janus

In unbearable indecision, I turn to myth and find Janus, the two-faced Roman god of doorways. When thinking of our work I think of him — guarding the threshold between past and future. Janus faces both directions, holding time and change.

Each team crisis is a doorway you open. Each call, email, forces a choice: Keep going, or step back? The past—where you learned to give without asking—pulls you back. The future—where you hope to protect yourself—feels distant. Janus sees the unspoken drives: a need to master old wounds by controlling crises, a flicker of anger at those who don’t step up, a quiet pride in suffering more.

These, too, are the Overlooked Child’s attempts to matter.

Janus guards the threshold—a place of transformation.

Saying no feels like betrayal, but as Donald Kalsched writes, "reality breaks our hearts" and that grieving limits keeps you alive in the real world, unlike the slow drain of denial and endless giving.

Janus reminds us: to move forward, we close doors to the past and open new ones to reclaim ourselves.

Janus asks you to choose—not between abandoning your team or patients, but between sacrificing yourself and protecting the space to care from strength. The fear of stopping meets the hope that stepping away is stepping into sustainability.

Space as a Boundary

In therapy, space is a container. The session’s frame—its time, boundaries—is care. It’s meaning.

When you miss supervision or skip rest, that frame lets me know something needs attention. Something unnamed or unseen is trying to get noticed. That’s why I wrote in this. To name what’s overlooked.

Please know, if anything I’m hopeful. I see your not coming as a cry of distress. It is the quiet baby that has given up hope. Naming the anger—at the system, the past—opens a door to grief. Grief is where connection and healing begins. You don’t have to be alone with this. Even if you can’t change it.

Protecting space to digest and think isn’t abandonment. It’s the condition for sustainable care.

Individual boundaries alone can’t hold the frame. The NHS is not a machine—it’s a group of people, and the group is the system. Without their collective commitment to structure—adequate staffing, mental health support, time for supervision—sacrifice breeds chaos, depleting clinicians and faltering care. The group must choose to sustain, not exhaust, its own.

Saying no to one task might mean yes to clarity and presence.

Crossing the Threshold

Another call will come. Another patient in need. A team with insufficient resource . Your loyalty will stir. “Just one more.”

But I picture you with Janus, at the threshold. Saying no will feel like failure. The Overlooked Child’s fear will grip you: If I stop, I vanish. Your email, your apologies, asked me to witness this. To hold it with you.

Benjamin reminds us: anger, even hidden, reaches for love. For contact. For truth.

The Death Mother says your taking space harms others.

But myth offers another truth: care is a crossing. It includes grief, boundaries, courage to choose. Grief keeps you human.

Start small. See what happens when you attend here. A call goes unanswered. An email waits. A team meeting has an empty chair. Care doesn’t demand your disappearance. It asks you to choose wisely. These aren’t betrayals. They’re the foundations of sustainable care—for patients, teams, you.