So, Now What?

13- How Therapists Can Meet High Achievers Without Losing Themselves

• angela tam

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Pain that’s been ignored for years doesn’t whisper—it barges in with a stopwatch. We sit down to talk about what happens when high-achieving, Type A clients arrive in therapy with urgency, burnout, and a fierce demand for quick relief. If you’ve ever felt your confidence wobble under “this isn’t working,” this conversation maps a steadier way forward.

We start by naming the reality: many high performers show up late in their pain cycle, armed with competence and an inner critic that wants results yesterday. From an Internal Family Systems lens, we unpack the protectors that drive perfectionism, speed, and self-reliance, and how those same parts can view slowing down as threatening rather than healing. You’ll hear practical language for validating urgency without buying into it, scripts to surface expectations early, and a clear first-four-sessions roadmap that sets treatment timelines, defines success, and reduces dropout risk.

We also dig into parts-informed goal setting so you don’t accidentally collude with perfectionism. Instead of “tolerate more workload,” we co-create measurable, sustainable targets that lower urgency, build capacity, and protect relationships. On the therapist side, we address what to do when feedback stings—how to notice your fixer, defender, or pleaser, invite them to step back, and stay curious. When pacing becomes the pain point, we share ways to match energy with brief, stabilizing moves, then pivot into insight without flooding the system. The throughline is simple and hard: healing happens at the speed of trust, not urgency.

If you work with ambitious clients—or you are one—you’ll leave with concrete steps to strengthen the alliance, protect your frame, and turn criticism into collaboration. Subscribe for more therapist-first strategies, share this with a colleague who needs the reminder, and leave a review to tell us what landed and what you want next.

Come follow me on instagram @heyangelatam and subscribe to my newsletter here. Looking forward to adventuring with you!

SPEAKER_00:

Hey, welcome back to the Sew Now Wood podcast. I'm Angela Tam, and I'm here to share another episode with you about how to work with some of your most difficult clients. Some things that I'm getting feedback-wise from both clients and supervisees that I'm seeing is that there's this thing that comes up around working with type A clients, clients who are really high achieving in their workplace, clients who are hyper competitive and very driven and work well under a lot of pressure, take themselves very seriously, and are very career focused, are that they are coming in with a lot of burnout. And so a lot of clinicians that I work with don't have a problem working with burnout in particular. Burnout is something that is very treatable, it's very workable, and stress-related relationship pain, work-related pains are extremely pretty straightforward to work with as a clinician. And that is actually not something that is the problem. A lot of the clinicians that come to me have worries about working with people who find particularly who are high achieving, that implicitly or indirectly share that, and sometimes directly share with their client, with the therapist, that they are extremely not competent, they're not doing a good enough job, they are not helpful. And if anything, any of the interventions they're using are not only not helpful, but they are extremely ineffective. And some of the things that I've heard clinicians do are that they're slowing folks down, they're creating space to help them connect with their feelings, and they are helping them cope by connecting their bodies and creating more mind-body connection and working with helping them to bring awareness to their in our landscape. All those things, from what I'm hearing, are very, very understandable and if anything, very effective and very good. However, what I hear is that it's not working out with the client. There's a disconnect with what the client thinks it's effective and what the therapist is doing intervention-wise. And one of the biggest confidence killers with therapists is that we are told that we are ineffective at what we do, unhelpful, and everything that we're doing is not working. And I have a lot of compassion because I have definitely, in my 12 and a half years of working as a clinician, had my share of complaints from my clients, especially my type A clients who are highly driven, perfectionistic, competitive, prone to burnout, high intellectualizers, impatient with themselves and others, highly self-critical, and somewhat externally critical of others. These are clients that are one of my favorites to work with because I love the challenge, but also had I have had my share of complaints from. I want to share some of that with you. Some things that I like to focus on as an internal family therapist is the content of what is happening, meaning addressing the burnout, talking about what it's like to live a high, highly stressful life, to have a lot of pressures and criticisms on put on yourself, from yourself and from others, the pressure to keep things moving, to not slow down, to really just be very productive. These type of clients they are not going to be shy to share when they are not liking therapy and they're very honest, and some of them want immediate solutions. They're filled with a sense of urgency. And they sometimes might challenge us as therapists, and they might say, I don't like that intervention, or they might micromanage the process, criticize you as a therapist. I've gotten that before, too, where I've been told, man, I am not doing a very good job. And they themselves are very self-critical. Like they have the internal dialogue of saying that they should be better already, or they should, they should be able to do more without complaining, they should tolerate more and more without being so stressed. And a lot of their goals are around increasing their tolerance to their increased workload and their increased pressures. And some of them that come in are sharing about their anxiety, their insomnia, their gut-related issues, their cardiovascular issues. And a lot of folks that come in that are type A sometimes see sessions as a performance evaluation rather than an exploratory safe space, a playground to explore. And some of the things that I want to encourage you to do is I want you to notice what's going on. I want you to notice the urgency that clients bring in. I want you to notice how their intense desire to be relieved of their stress informs their urgency and how their goal-related tendencies are brought in session where they really want us to be very goal-driven with them and really want almost have this ambitiousness about healing. Like they treat healing as if it's something to conquer, to overcome, to work through and succeed at. So this is not a they thing, they versus us thing. This is a me thing. I have these tendencies where I subscribe to perfectionism, where I have a competitive drive, and I have tendencies to compare myself with others. I have impatience with my slow progress. I have difficulty disconnecting sometimes. I'm very plugged in to my phone and email at times. And I am pretty resilient under pressure. But one of the challenges that I personally face as a type A person is I'm very prone to burnout. I have chronic stress, and I have difficulty collaborating with others and delegating. And like so many of my beloved clients, I really love working with them, and I find a sense of joy and solidarity with a lot of my type A clients. And I really appreciate them, some of the ways that their protectors show up. What do I mean by that? Some of their protectors, and this is coming from an internal family systems lens. So if any of you know about internal family systems, some of the whole way that I look at individuals have changed. And systems has changed because of my training with internal family systems. It's been a whole new paradigm of how I operate. And I'm gonna explain what it is in a little bit, and then I'll go into how that looks like as a way to facilitate smoother sessions for us. For me, and how I look at how a person is made up is that they are made up of a multiplicity of parts. What does that mean? It means that we wear multiple hats at different moments, and it could switch moment to moment. You could be driving in your car totally calm, and all of a sudden someone cuts you off, and all of a sudden you get angry. That's an angry part that comes up. That doesn't define you, it's not you, but it's a part of you that shows up in response to something else that's happening. In the same way, all of our tendencies, our patterns, our personality types, our feelings are parts of us that make up who we are. We are not defined by one part, like the type A part, but we are the sum of our parts. And we are also made up of our authentic self, which is the core self. It's our higher self who is untouched by trauma, untouched by any bad thing that's happened, that's the truly us. A lot of us have not been able to have an opportunity to see the true us, the true us that's curious, connected, compassionate, open, joyful, free, playful, but also serious when we need to be serious and very connected with not only others but humanity. A lot of us have never been parented by our parents who showed up as their authentic self. A lot of us were parented by our parents who showed up as their immature selves, the younger parts of themselves. How does this relate to working with type A people as a therapist? Well, what I noticed is that people that have type A personalities, me included, come in with a sense of urgency. First of all, we have come in way too late past the mark where we have needed to. We are coming in seven years too late for our issues. How is that possible? How do type A people come in too late? What do I mean by that? Type A people have such a high pain tolerance that they will, and they're super hyper-independent. So they come up with the mentality of I will work really hard on my own to figure this out. I'll read all the books, I'll listen to all the podcasts, I will consult with all my friends, I will do this self-healing work that they said I could do with coaches, with some, with whatever on my own before I will ask for help. That's one aspect. Number two is ironically, type A people are super great planners with everything else except their own personal pain. They are we are really good. I'm gonna stop saying they because I'm a type A person. I'm just gonna own it. We are so good with anticipating problems in our lives and getting ahead of them that we are unable to get ahead and take care of our own personal problems. And we deprioritize our own care so that we can get shit done. And we get a lot of shit done. We are really good at getting shit done, but we're not good at taking care of our relationships, of ourselves, of our capacities, of the basic things like sleeping, eating, recreational activities, hobbies, and friendships. So when people come into our office who are type A high achievers, they have been suffering for a really long time and they have waited way too long to get care, and they finally are basically pulling themselves in through the threshold of our doors, knocking on our doors, and in a lot of pain. And so when you can imagine someone's in a lot of pain, there's gonna be a high sense of urgency, and they're gonna be under a lot of distress. We who are type A might not seem like we're under a lot of stress when we come in to the therapy door, but we are. And when people are under high distress, different people do different things. Maybe a depressed person will not speak much and they'll not have access to a lot of their feelings, they'll be numbed out, they'll feel hopeless, they'll be in a dark place. But when us type A people are in a lot of pain, we take it out on other people and we criticize ourselves and others for not working fast enough. There's a big sense of urgency and there's big complaining. I just want to say that because I want to normalize that. I want to normalize that people who are gonna come into your door who are high achievers or type 8 will have a huge sense of time urgency and a huge sense of pain and will put a lot of pressure on you to work on making sure that pain goes away. And so the mentality is if by the end of our session I'm not feeling 1% better, it's gonna be on you as a therapist to take that responsibility, take that ownership. And you're gonna feel that implicit pressure to take ownership. You're gonna feel that implicit pressure to fix the other person who is in pain because they are the fixer. High achievers, type A people are usually the fixers in everyone else's life. They are the Carrie Washingtons of everyone else's life. They are like the people that make all the problems go away for their family, their companies, their teams. They are highly capable people who make everything go away. And they will expect you to make things go away for them in the form of relief, in the form of interventions, in the form of giving them tools, giving them insight into what things they need to change. And the expectation is that you do it pretty quickly. And so I want to invite you to notice how that feels on your system as I'm saying this. Just normalizing that people who come in who are like me, high achievers, will have a really big expectation that you work pretty quickly to fix them. And one of the things that I like to uh share with folks is to name that pretty quickly with folks. To name that right off the bat. To name you might have a part of you that might be expecting me to fix you, to fix you pretty quickly because you're in a ton of pain. And you have a part of you that might be really frustrated if you're leaving my meetings and we're exploring family history or things that don't really have anything to do seeming seemingly so with your pain. And it feels so irrelevant to ask me about my history when I really need help with my marriage right now. And I don't know what my marriage has anything to do with my family history. And they might question, they might challenge, they might say, What you're asking irrelevant questions. You're working through some irrelevant things when I just need help on this specific problem. And this is your chance to get ahead of it to just start naming. Wow, I notice some strong sense of urgency here. And whenever there's urgency, there's always a big pain underneath. Whenever there's a sense of urgency, there's a huge sense of pain underneath. And this is a great time to notice when someone is urgently coming to you in distress. What parts of you come up? What parts of you are brought up? Maybe there's a part that wants to fix it. Maybe there's a part that feels uh bought into the urgency and wants to engage with it and wants to bring it relief. Maybe there's a part that really wants to believe that they can be the fixer. Maybe there's a part that wants to buy into the fact that they can be the hero. Maybe there's a part that's really scared that if you don't show up for this person the way that they want you to show up, they might leave you. So maybe there's an abandonment part that, oh my gosh, if you're not gonna be happy with what I have said I could deliver, you might leave me. So I want to invite you to explore this just to notice what is coming up with you. What feels really at the top of mind when someone comes to you with a huge drive to heal, a huge drive to get relief, and they expect you to tell them how to do it. You and I both know that we're not magicians, we're not mechanics, people can't just bring in their metaphorical cars and we just pop the hood and we do some tinkering and then close the hood and then send them on their way. We both know that that's not how it works. And part of how I think marketing can help is when you share what it means to work with you before they even get in the door, that would be a huge way that clients can notice: okay, this is what the timeline is like, and this is what I can expect and not expect. And I'm gonna share what I would share with my clients with you. Before clients come in through the door, I hope that they would know that I'm not a magic worker. And I know clients intellectually know this. But there's a part underneath that drives them and can drive them out the door pretty quickly when they realize, oh my gosh, you're not working fast enough. And so before they even get in the door during your consultation call, there might be some opportunities for psychoeducation where you lay out the process for when you will share your treatment plan with folks, when you will share your when you contract with them with your goals. That's why I feel like contracting goals are so, so important. There's whole art to contracting goals, art and science to contracting goals, because the goals need to be measurable and they need to be done with parts in mind. Some folks want to come in and they want you to help them build their capacity to do status quo. They want to keep the status quo, even though status quo is killing them. And they want to do the very thing that will kill them, which is to have a bigger pain tolerance, to bear more workload and more stress and not bend under that stress. So a lot of my high-achieving people will not say, I want to divest from being high achieving, I want to relax my perfectionism. They want to, they usually tell me, I want to get better at being a perfectionist. And so recognizing while we're contracting with them in their goals, that they might have not bought into what might actually be healing. And they might be operating and creating their goals with a part leading the process of them creating their goals. In other words, a perfectionistic part of them might be the part that's contracting with you on creating those goals. And when you collude with that part, which is what I've done before, I've been like, yeah, sure, we could work on that without realizing that that's what I was doing. I unknowingly set myself up for failure because they it's not actually helpful for them to become more of a perfectionist, it's not actually helpful for them to be more steeped into their over-functioning, overworking, overcompensating for people who are under-functioning in their team or their family or in their families. What I realized is that I was unknowingly not aware of the parts at play that were really concerned with being informed about the treatment plan too. I didn't realize that a lot of type A folks, myself included, really need a roadmap for how healing looks like and a timeline for that roadmap. And sometimes I as a therapist need more than one or two or even three sessions to formulate that treatment plan. And sometimes clients are not going to hang in there long enough to want to wait around for that. And so sometimes people are in so much pain that they're like, if you can't help me on the second session, and if we're still doing exploratory stuff, I need to leave. I need to find someone else that could work with me faster. That is something to create some awareness around, right? To share with them about your timeline of what to expect in the first four sessions, what exactly you're going to cover, how the contracting of the goals will go, and what the treatment plan actually is. And then sharing with them that treatment plan and seeing if they consent to it. So the first four sessions is what I like to share with people about how it is a trial and error experience. It will be an experimentation on if we are a good fit for each other. And during that time, I gather information, I contract the goals with them, I share with them a general treatment plan as to what I could see would be really helpful in the trajectory of our work together. And I really focus on the process of that. One month, which is equal to four sessions over a span of four weeks, might be too much for them to wait. They might want more immediate results. And helping them see beforehand that we can't just dive in that quickly because actually we need to slowly go in is something that they might be surprised about. They might be surprised to find out slow is fast. And a lot of people can't tolerate that. A lot of people don't like to slow down who are type A. Slowing down is the one thing that they find most threatening because moving fast helps people to not get into their feelings for very long. But slowing down and explaining to people, helping my type A folks out there, to work in the slowness, and that slowness does again show up in how the first four sessions of therapy is, can be intolerable for some people. And some people might end up running because they might find that the first four sessions might be too slow for them, and that's okay. But the point is that there needs to be some transparency. So on your website, you could lay out the plan. This is how this is what happens when you schedule a consult with me. In that consult, we make an appointment for the first meeting. In that first meeting, your intake should be completed. In the first four meetings, what we will do is we contract goals. I will draft up a treatment plan. I'll ask you about your family history. We'll go through some assessments, perhaps, that I will send you. And I will in that treatment plan include how I see us working together. And you can consider whether or not you want to opt in or opt out, depending on if you like my style, if you like my practice, or if you don't. And this is the way I practice. And I explain my modality very clearly as to how it contributes or positively will contribute to changes in their life. Now, with type A clients, I really like to work on clarity and transparency so that they get a lot of information up front. And it might be information overload for some people, but some people really need that. Another thing that I notice is that for high-achieving clients, for the therapists to have really good relationships with their inner critics. And so some things that I see, with me in particular, I'm just gonna speak for me, is that I notice that when I work with some high-achieving folks, they can be really easily, they're they're very honest about how terrible I might be doing. They could show it with their eye rolls or with facial language or explicitly verbally. And what I have learned because I'm a parent to three kids and they're very honest kids, is that I really need to take their feedback to heart. And I also want to practice some curiosity around their complaints. I don't I want to work with my protectors around my defensiveness, and so I have defensive protectors that will be really quick to help me to speak up for my own self-righteousness, my own reasons for why I do what I do. And they really don't want me to be misunderstood. But these parts of me, which I explained before about the internal family systems framework, these parts are the very parts that will actually break trust. And these parts are parts that at the bottom of it prevent me from feeling the shame that I probably already felt before meeting my clients around my own inadequacies. So really working with building relationships with your own shame and insecurities was working. Working with type A clients will be so so key. I know this because I have kids who are very quick and honest to share about how they are completely unhappy with who I am and how I parent. And I have learned that if I take it to heart and I believe it, then I will be certainly crushed in my parenting. But I've learned to really take it in and to really notice what areas I could grow in and take it as it is, but not really believe it. Like I'm not gonna really internalize it, is what I'm saying, that I'm a bad person or I'm a bad therapist. And the way we don't internalize it, but we really could take it in, soak it in for what it is, and really extrapolate your areas of growth. If they're complaining about how you're not moving fast enough or how you're not helpful enough, or how your interventions are too threatening and too slow and so ineffective, really take that to heart to notice, okay, how can I examine myself? And this person's really just saying what you're doing isn't helpful. How can you take that in and practice curiosity without internalizing it? And the way we can do that is to build a relationship with our own inner critics, to build that relationship with our own inner rescuers that really want to just apologize and please and accommodate. But we're not, that's not really helpful either, right? If we just apologize and say, you know what, you're right. I should listen to you and just follow your lead. That's not really going to feel good to the client either, because they don't want to be in charge. They want it to be at the heart of it, they want us to collaborate and they want us to facilitate the process for them. Not for them to be in charge or even for us to fully be in charge either. But part of that work comes with really working with your inner critics, inner rescuers, inner caretakers, inner accommodators, inner people pleasers to really sit down with them and not let them take over the session and hijack the session so that you over-apologize or over-accommodate. If you really allow their complaints to sink in and work with those defensive parts that come up with you, ask them to give you space so that you can be curious and really notice what is going on. There might be a part of them that feels an incredible amount of pain that they're vulnerably sharing. There's a pain of invisibility in that, or a pain that we might be missing and might be unknowingly reenacting, and a part of the trigger that we might not be seen. There might be unobvious things here that we might be missing because we might be taking it so personally that they're complaining to us. And so I wanted to invite you to be in that space of curiosity. Notice those clients who you're working with that have a deep sense of urgency, that are coming in with a lot of pain, that are asking for you for support. And when you're helping them and they're complaining about how you're not helpful, noticing your responses and noticing how you can create more relationships with those different parts of you that come up, that come to defend you, and ask them to give you some space so that you could really decode what is actually happening. And when, and if you are fortunate enough to still work with this person, you might be surprised to find out what is actually happening. Sometimes clients might feel like your interventions are too scary. They're not actually unhelpful, but they're too threatening to their protectors. Some of the clients that I have seen before that are type A find it too threatening for me to slow down. Maybe I'm slowing down too much. I'm not matching their energy. I'm not slowing them down too much, and they're finding it really unhelpful because that's not inherently unhelpful, but actually more so threatening to be so slow and to be so sensitive to your feelings. And maybe it's bringing up too much pain for them to be flooded with their feelings that they've compartmentalized for so long. And so your work is to not continue to slow them down, but match their energy and name the fact that you're slowing down too much has caused them to be triggered. And maybe they're not ready to really soak that in and agree with you, but you naming it can be part of something that's really healing to them and could be a mirror to their experience. I hope this episode was helpful. And if you have any other thoughts on how you've worked with high-achieving clients who are type A, please let me know. I'd love to hear more about how your most difficult clients have totally deflated your confidence as a clinician. But please send me a message in the show notes, and there's a link to send me a DM, and I read all my DMs. I'll see you for the next episode. Bye bye.