Over the past few years, I have seen a marked increase in clients coming to therapy not because they “can’t cope with work,” but because work itself has become harmful. They describe workplaces that are chronically stressful, hostile, and dismissive of their wellbeing. What begins as a demanding job slowly shifts into something more insidious: a toxic environment where burnout is normalised, bullying is minimised, and gaslighting is used to silence concerns and rewrite reality. From a psychological perspective, the impact on mental health and self-esteem can be profound and long-lasting.
A toxic workplace is more than just a stressful job or a difficult colleague. It is a system in which unhealthy patterns are embedded in the culture: persistent incivility, scapegoating, public shaming, impossible workloads, and leadership that responds to distress with defensiveness or denial. Research on job stress consistently shows that chronic exposure to high demands, low control, and low social support is strongly associated with anxiety, depression and burnout (Karasek & Theorell, 1990; Harvey et al., 2017). When those pressures are combined with relational harm – such as bullying and gaslighting – the workplace becomes not just stressful but psychologically unsafe.
Many clients sit in therapy and say things like, “Everyone else seems to manage; maybe I’m just too sensitive,” or “I feel crazy, like I’m overreacting.” As we unpack what is actually happening, it becomes clear that the environment is eroding their sense of reality and self-worth. They are not simply “struggling with work”; they are being reshaped by a culture that rewards endurance and punishes vulnerability.
Burnout: When Exhaustion Becomes an Identity
Burnout is one of the clearest outcomes of a toxic workplace. The World Health Organisation defines burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed, characterised by emotional exhaustion, mental distance or cynicism, and reduced professional efficacy (World Health Organisation, 2019). Although technically an “occupational phenomenon,” in practice burnout touches every area of a person’s life.
Clients rarely present saying, “I think I have burnout.” Instead, they describe dragging themselves through each day, crying before work, feeling constantly on edge and guilty for not doing more. They report lying awake at night replaying conversations with managers, worrying about performance reviews, and feeling increasingly numb with patients, clients or students they once felt deeply committed to. This matches long-standing research showing that burnout involves emotional exhaustion, depersonalisation and a reduced sense of personal accomplishment (Maslach & Leiter, 2016).
In toxic workplaces, burnout is not only about workload but also about values. People are asked to cut corners, hit unrealistic targets, or treat others in ways that conflict with their ethics. This kind of “moral distress” is strongly linked to psychological strain and intention to leave (Litz et al., 2009; West et al., 2018). When clients talk about feeling “like a shell of myself,” they are often describing not just fatigue, but the pain of repeatedly acting against their own values in order to survive at work.
Over time, the person begins to internalise the problem. Instead of recognising that the demands are unsustainable, they conclude, “I’m not good enough,” “I’m lazy,” or “I’ve lost my edge.” Self-esteem gradually shifts from a stable sense of worth to a fragile structure entirely dependent on external evaluation. From a clinical point of view, this self-blame is part of the injury: the system fails, and the individual carries the shame.
Bullying at Work: Erosion by a Thousand Cuts
Workplace bullying is another common feature of toxic environments. It is typically defined as repeated, health-harming mistreatment where there is a power imbalance and the target finds it difficult to defend themselves (Einarsen, Hoel, Zapf, & Cooper, 2020). Bullying behaviours can be overt, such as shouting, threats, or public humiliation, but they are often subtle: exclusion from key meetings, persistent criticism framed as “feedback,” spreading rumours, undermining decisions, or constantly moving the goalposts, with schedules which continually change, or different workloads expectations.
Clients who are being bullied often minimise what is happening: “It all seems very subtle – it’s not like they have called me out in public” “Maybe I’m just not resilient enough.” However, meta-analytic research shows that workplace bullying is strongly associated with depression, anxiety, post-traumatic stress symptoms, and lowered self-esteem (Nielsen & Einarsen, 2012; Verkuil, Atasayi, & Molendijk, 2015). Many of the people I see describe classic trauma symptoms: hypervigilance, difficulty relaxing, intrusive memories of confrontations, and a heightened startle response when they hear their manager’s voice or email notification sound.
Bullying gradually reshapes the internal world of the target. When you are repeatedly criticised, sidelined or ridiculed, you naturally begin to question yourself. A once confident professional can start to feel incompetent and needy. The bullying message – “You are the problem” – is absorbed as truth. Shame becomes a central emotion; people feel embarrassed even talking about what is happening, as though seeking help confirms they are weak. This is particularly powerful when the wider workplace culture suggests that enduring harsh treatment is a sign of strength or “professionalism.”
From a therapeutic perspective, a key task is to help the person name what is happening. Giving it language – “This is bullying” – repositions the problem in the system rather than in the individual. It can also evoke grief and anger, emotions that often sit just beneath the surface of shame and self-blame.
Gaslighting: When Reality Is Rewritten
A more subtle, but increasingly reported, dynamic is workplace gaslighting. Gaslighting involves manipulating someone into doubting their own perceptions, memory, or judgement (Sarkis, 2018; Sweet, 2019). In organisational settings, it can look like managers denying previous agreements, reframing concerns as “paranoia” or “overreacting,” rewriting the narrative about events, or systematically questioning a person’s competence in ways that make them feel unstable and unsure of themselves.
Clients might describe situations where a manager explicitly agreed to an arrangement, later denied ever doing so, and then framed the employee as disorganised or unreliable. Or they may raise a concern about workload or a colleague’s behaviour only to be told they are “too emotional,” “imagining things,” or “creating drama.” Painting the employee as difficult to other members of the team, and very often re-organising workloads, to imply the employee has been incompetent in some way. Over time, this leads to confusion, self-doubt and a kind of cognitive fog. People say, “I don’t trust myself anymore,” or “I keep wondering if I’m the problem.”
Gaslighting is particularly corrosive to self-esteem because it strikes at the core of our sense of reality. If I can’t rely on my own perceptions, how can I stand up for myself? Employees may become increasingly compliant, anxious and dependent on the very people who are undermining them. For clients who have a history of relational trauma or invalidating environments, workplace gaslighting can re-activate older patterns of doubting themselves and over-accommodating others. The current workplace then functions as both a stressor in its own right and a trigger for earlier wounds.
Therapeutically, one of the most powerful interventions is simple validation. Reflecting back, “Given what you’ve described, your reactions make sense,” is not just a comforting statement; it is an act of reality restoration. We work together to reconstruct timelines, check email trails, and tease apart the difference between feedback (which can be uncomfortable but grounded in facts and respect) and manipulation.
The Impact on Self-Esteem and Identity
Across burnout, bullying and gaslighting, a common thread is the erosion of self-esteem and professional identity. Self-esteem is not just about “feeling good about yourself”; it is about having a relatively stable sense of worth even when things go wrong (Orth & Robins, 2014). In toxic workplaces, this stability is undermined. Praise and criticism may be inconsistent, expectations unclear, and standards applied unfairly. Employees find themselves constantly scanning for signs they are “in trouble,” adjusting who they are to fit whatever version of “good” the organisation appears to want that week.
People who enter the workplace with a strong sense of purpose and competence often describe feeling “hollowed out” after prolonged exposure to toxicity. They may begin to question not just their skills, but their character: “Maybe I am difficult,” “Maybe I am too sensitive,” “Maybe I’m not cut out for this profession.” Research suggests that persistent job stress and bullying experiences are associated with decreased self-esteem and self-efficacy over time (Randle, 2003; Nielsen & Einarsen, 2012). The workplace, which should be a context for growth and mastery, becomes a place of humiliation and self-doubt.
Part of the work in therapy is helping clients disentangle their core self from the narratives imposed by a toxic system. We explore what they were like before things deteriorated – their values, strengths, and sense of meaning. This is not about romanticising the past, but about remembering that the identity constructed under chronic threat is not the whole truth of who they are.
Why People Stay – and Why That Matters Clinically
From the outside, it can be tempting to ask, “Why don’t they just leave?” But this question oversimplifies complex realities. Financial obligations, caring responsibilities, limited job opportunities, visa status, loyalty to colleagues or service users, and fear of retaliation all play a role, and even institutionalisation if the person has been working there for a long time – initially without issue. There can also be a form of trauma bonding: the more a person invests in trying to prove themselves or “win over” the organisation, the harder it becomes to walk away.
Clinically, it is important not to collude with a narrative that equates staying with weakness. Instead, we acknowledge the constraints while gently exploring options and building internal resources. Sometimes the first step is not resignation, but small acts of resistance: setting firmer boundaries around working hours, documenting incidents, seeking support from trusted colleagues, or engaging in activities outside work that restore a sense of competence and joy.
Healing and Moving Forward
Recovery from a toxic workplace involves both symptom reduction and meaning-making. On a practical level, clients often need help managing anxiety, sleep difficulties, and the physiological effects of chronic stress. Evidence-based approaches such as cognitive behavioural therapy, compassion-focused therapy, and trauma-informed work can support people in noticing and challenging harsh self-talk, processing experiences of humiliation or betrayal, and reconnecting with their values (Gilbert, 2010; Beck, 2011).
Equally important is the relational context of therapy. Having a space where the person’s experiences are taken seriously, where they are believed, and where their boundaries are respected can be a powerful corrective to the invalidation they have experienced at work. Over time, we look not only at what happened, but at what story the person wants to carry forward about themselves. Instead of “I failed at my job,” it might become “I did my best in a system that was failing me,” or “I recognised that this environment was harming me and took steps to protect myself.”
Many clients, once they have moved on from a toxic workplace, describe a period of emotional “decompression.” They realise how chronically activated their nervous system was and how small they had made themselves to survive. With support, this can evolve into a renewed, sometimes more grounded, sense of self. They may become clearer about red flags in future workplaces, more confident in setting boundaries, and more compassionate toward their own limits.
The Wider Responsibility
While psychological support can be transformative, it is vital to emphasise that individual therapy is not the solution to systemic toxicity. Addressing burnout, bullying and gaslighting requires organisational responsibility: ethical leadership, psychologically safe cultures, robust policies that are actually implemented, and a genuine commitment to staff wellbeing rather than superficial wellbeing initiatives (Edmondson, 2019; West et al., 2018). Blaming individuals for not being resilient enough only deepens the harm.
From a psychological perspective, naming these dynamics – burnout, bullying, gaslighting – is an act of resistance. It shifts the narrative from “there is something wrong with me” to “something harmful is happening here.” For many of the people I work with, that shift is the beginning of reclaiming their mental wellbeing and rebuilding a more solid, compassionate sense of self.
References
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Edmondson, A. (2019). The fearless organisation: Creating psychological safety in the workplace for learning, innovation, and growth. Wiley.
Einarsen, S. V., Hoel, H., Zapf, D., & Cooper, C. L. (Eds.). (2020). Bullying and harassment in the workplace: Theory, research, and practice (3rd ed.). CRC Press.
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Randle, J. (2003). Bullying in the nursing profession. Journal of Advanced Nursing, 43(4), 395–401.
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Sweet, P. L. (2019). The sociology of gaslighting. American Sociological Review, 84(5), 851–875.
Verkuil, B., Atasayi, S., & Molendijk, M. L. (2015). Workplace bullying and mental health: A meta-analysis on cross-sectional and longitudinal data. PLOS ONE, 10(8), e0135225.
West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: Contributors, consequences and solutions. Journal of Internal Medicine, 283(6), 516–529.
World Health Organization. (2019). Burn-out an “occupational phenomenon”: International Classification of Diseases.
Dr M’s thoughts 