Therapy for carers: carer burnout, when to get help and how to choose

It is eleven at night and you have finally got your father to bed. You have sorted out tomorrow's pills, put a wash on and answered the family group chat, where nobody has offered to help on Saturday. You sit down on the sofa and could not say when you last had an afternoon to yourself. You love him and you would do it all again. But you cannot go on like this, and even thinking it makes you feel guilty.

Looking after a relative who depends on you is one of the most demanding jobs there is, and the toll it takes has a name: carer burnout, also called caregiver burnout. It is not a diagnosis in the manuals, but it does real damage to health. If you are thinking about therapy for carers, this guide explains when it is worth asking for help, which treatment works, what therapy is like from the inside, how long it takes, whether it works online when you cannot leave the house, what other support exists and how to choose a professional.

Carer burnout: when to see a psychologist

NICE's guideline on supporting adult carers defines a carer as an adult who provides unpaid care and support to a family member, partner or friend because of a disability, a health condition, frailty, a mental health problem or an addiction. In Spain, according to the survey on disability, personal autonomy and dependency by the National Statistics Institute (INE), almost half of people with a disability aged six or over receive care or personal assistance. Women make up 63.7% of those providing care, the most common profile is a woman aged 45 to 64, and almost half of the people cared for receive care for eight hours a day or more.

That effort takes its toll. A meta-analysis by Pinquart and Sörensen of 84 studies compared people caring for a frail older person with people who were not: the biggest differences were in depression and stress, well ahead of physical health, and they were larger when the person being cared for had dementia. Another meta-analysis, by Sallim and colleagues, covering more than 10,800 carers of people with Alzheimer's disease, found depression in 34% and anxiety in 43.6%, with a higher risk of depression among women and among those caring for their partner.

According to the Cleveland Clinic, the signs of carer burnout are similar to those of stress and depression:

• Physical and emotional exhaustion.
• Withdrawing from friends, family and other loved ones.
• Losing interest in things you used to enjoy.
• Feeling hopeless and helpless.
• Changes in appetite or weight.
• Changes in sleep.
• Trouble concentrating.
• Getting ill more often.
• Irritability, frustration or anger towards others.

If you recognise several of these over a number of weeks, it is time to ask for help. The same goes if you notice resentment towards the person you care for or fear that you might hurt them: in that case, the Cleveland Clinic advises reaching out for help straight away. To get your bearings, the Burnout Test also works for carers: its page explains that carer burnout has the same features as work burnout and that you can answer it with your caring role in mind. If what weighs most is sadness, lack of drive or hopelessness, the Depression Test can help you see whether there is something more. We explain the difference between normal tiredness, emotional exhaustion and burnout in Emotional exhaustion: symptoms, causes and how to tell if it is burnout.

And if thoughts of harming yourself, or that it would be better not to carry on, appear, call the 024 line in Spain (free, confidential, around the clock), 112, or your local emergency number.

Which treatment works for carer burnout

NICE's guideline suggests offering carers psychosocial and psychoeducational support: personalised strategies and caring skills, advice on looking after their own physical and mental health, and information about the psychological therapies available. It also asks for group options, for timing that suits the carer's life and for thought to be given to whether someone needs to stay with the person being cared for in the meantime. And if the carer already has a mental health problem, such as depression, it recommends psychotherapy in line with the guidance for that problem or referral to a GP or mental health professional.

Research backs this up. A meta-analysis by Cheng, Losada and colleagues, covering 131 trials with carers of people with dementia, found that, taken together, the interventions improved every outcome measured. Educational programmes with psychotherapeutic components, counselling and psychotherapy, and mindfulness had the strongest effects on depressive symptoms; programmes combining several components did most to ease burden and stress. The authors point out that many of the psychotherapy and mindfulness studies were small.

In Spain, the teams led by Andrés Losada at Rey Juan Carlos University and María Márquez-González at the Autonomous University of Madrid have spent years studying cognitive behavioural therapy for carers. In a trial with carers of people with dementia, a twelve-session group programme that worked on unhelpful thoughts about caring and increased pleasant activities reduced depression, and the change was partly explained by those two ingredients. In a pilot trial with 42 carers with high levels of guilt, an intervention focused on guilt reduced guilt, depression and anxiety.

What therapy for carers is like from the inside

Every process is different, but it usually covers these points:

1. Looking at how you are, as well as at how the person you care for is doing: your sleep, your health, your mood, the support you have and whether there are thoughts of harming yourself.
2. Making the load visible. What you do, for how many hours, what someone else or a service could do and what you are putting aside.
3. Working on guilt: for resting, for getting angry or for wishing now and then that it would all end. Feeling it does not mean you love them any less.
4. Questioning the thoughts that tie you down, such as "nobody will look after him like I do" or "asking for help means abandoning her", which is exactly what the programmes of Losada's and Márquez-González's teams work on.
5. Getting something of your own back, however small: a walk, a hobby, seeing a friend. In their studies, increasing pleasant activities was part of what lifted mood.
6. Setting limits and asking for help from family, friends or work, without feeling you are failing.
7. Preparing for changes. A move into a care home, a decline or the end of life change the carer's role, and NICE asks for support through those stages too.

Many people caring for someone with a progressive illness also go through anticipatory grief: they start saying goodbye before the loss. We look at grief when it comes in Stages of grief: what the evidence says about the five-stage model.

What if it is already depression?

Sometimes exhaustion has turned into depression or an anxiety disorder. NICE then asks for it to be treated as such, with the psychotherapy its guidelines recommend or a referral to a GP or mental health services. If medication is needed, a doctor decides. The key is not to mistake depression for "the normal tiredness of caring".

How long therapy for carers takes

It depends on how heavy the caring is, whether there is depression or anxiety and the stage you are at. The programmes studied tend to be short: the one by Losada's team had twelve group sessions. But caring changes over time, and NICE points out that support may be needed at different points and asks for carers to be asked regularly whether they need it. That is why it makes sense to go back to therapy when things change, for example after a decline or a hospital admission.

Does online therapy for carers work?

Yes, and for carers it may be the most realistic way to attend. A meta-analysis by Sherifali and colleagues of 13 studies found that internet-based interventions reduced carers' stress and anxiety, and that when they combined information with professional psychological support they also improved depression. The authors note that many studies were of low quality. And in a trial by Au and colleagues with 96 carers of people with Alzheimer's disease, a telephone-based behavioural activation intervention reduced depressive symptoms and burden.

With online therapy there is no need to find someone to stay with your relative, arrange travel or leave the house. You can join while they nap, while they are at a day centre or when someone else takes over, which is exactly what NICE asks to be taken into account: the place, the timing and whether someone needs to provide care in the meantime. If you have never had therapy by video call, Online psychologist: how to choose well and what to expect from video-call therapy may help.

Getting help beyond therapy

Therapy works better if you are not holding everything up on your own. Some options:

• Respite. NICE describes carers' breaks as short-term care for the person with care needs, at home or in a residential setting, for a few hours, overnight or longer, so that the carer can rest.
• Carer's assessment and the Dependency Act. In England, unpaid carers have the right to discuss their own needs with their local council under the Care Act 2014. In Spain, the Dependency Act provides, among other things, a cash benefit for care in the family setting and temporary stays in residential care during carers' rest periods; your local council's social services can tell you more.
• Groups and associations. NICE asks for group options to be part of the support on offer, and peer support lets you share experiences and practical advice with people going through the same thing.
• Accepting help at home. The same guideline recognises that many carers find this hard and experience it as an intrusion, especially at the end of life. That is normal, and it can be worked on in therapy too.

How to choose a psychologist for carers

These checks help you get it right:

• Registration as a health professional. This comes first.
• Experience with carers and with grief, and with your relative's condition if it is something specific, such as dementia.
• An evidence-based approach, such as cognitive behavioural therapy.
• Flexibility: online sessions and appointment times that fit around caring, without having to find cover for every session.
• Attention to the wider family, because sharing the caring and setting limits usually involves talking to other people.
• A space without judgement, where you can say that you cannot go on or that sometimes you wish it would all end without feeling like a bad person.
• Coordination with your GP if there is depression, insomnia or medication.

A psychologist for carers

At MyPsicoTest we recommend Xènia Capel Salcedo, a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy. She sees clients in Igualada and Sant Sadurní d'Anoia and also through online therapy, and on her blog she has written an article about caregiver burnout. In it she explains that in therapy she works both on the exhaustion and on what lies beneath it (the guilt, the pressure to do everything alone, the difficulty setting limits and the grief that has already begun) so that you can keep caring without disappearing in the process, and that she does this online with flexible hours. She also sets it apart from work burnout: caring has no schedule, no weekends off and no salary, and often nobody recognises it as a job. She works from an integrative, evidence-based approach: on her website she explains that she uses tools from cognitive behavioural therapy, EMDR, systemic therapy and person-centred therapy. Sessions are available in English, Spanish or Catalan, and the first contact is a free, no-commitment information consultation. She herself points out that in a serious crisis or psychiatric emergency, immediate in-person care is what is needed.

If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.

MyPsicoTest team · Updated: 17 October 2026