Sarah Buino, LCSW, RDDP, CADC, CDWF
Sarah Buino is a licensed clinical social worker, therapist, educator, consultant, speaker, and organizational leader whose work brings together developmental trauma, addiction treatment, shame resilience, therapist wellness, ethical leadership, and systems-level change. She is the founder of Head/Heart Therapy and Head/Heart Business Therapy, where she supports individuals, helping professionals, practice owners, and healthcare organizations seeking more relationally skillful and ethically grounded ways to work.
Her professional work is grounded in the understanding that therapists and other helping professionals do not operate outside the systems affecting their clients. Clinicians bring their own histories, attachment patterns, emotional responses, values, social identities, and experiences of power into their workplaces and therapeutic relationships. Sarah helps professionals recognize these influences without turning ordinary human vulnerability into evidence that they are unfit to help others.
Professional Background of Sarah Buino
Sarah Buino earned her master’s degree from Loyola University Chicago and her undergraduate degree from Miami University in Oxford, Ohio. Her professional credentials identify her as a Licensed Clinical Social Worker, Registered Dual Diagnosis Professional, Certified Alcohol and Other Drug Counselor, and NARM Master Therapist. She founded Head/Heart Therapy in 2014 and continues to maintain a small clinical caseload while focusing much of her work on education, consultation, leadership, and organizational development.
For more than a decade, Sarah has worked with individuals, groups, clinicians, and organizations on concerns including developmental trauma, addiction, shame, perfectionism, professional wellness, leadership, power, and anti-oppressive healthcare practice. Her perspective reflects experience in direct therapy, group-practice development, professional training, podcasting, organizational consultation, and addiction education.
Developmental Trauma and NARM
Developmental and complex trauma are central to the clinical work of Sarah Buino. She is a NARM Master Therapist and previously helped launch the NARM Training Institute’s Transforming Trauma podcast, serving as its host during its first two years and interviewing clinicians and researchers working in trauma treatment.
The NeuroAffective Relational Model is an approach developed for the effects of complex and developmental trauma. Rather than focusing exclusively on retelling past events, NARM examines survival patterns that developed in response to early relational environments, including ways people learned to disconnect from their bodies, emotions, needs, relationships, or sense of personal agency.
This framework complements Sarah’s interest in the relationship between connection and self-protection. A client may long for closeness while simultaneously fearing dependence, rejection, criticism, exposure, or loss of control. Treatment can help the client approach these patterns with curiosity instead of shame while developing greater flexibility in how they relate to themselves and others.
Sarah’s trauma-informed perspective also extends beyond individual symptoms. The principles of safety, trust, collaboration, empowerment, cultural awareness, and meaningful choice should be reflected in organizational policies and treatment systems—not limited to language used during therapy sessions. SAMHSA similarly identifies these elements as guiding principles of trauma-informed care.
Shame Resilience and the Therapeutic Relationship
Shame resilience is another defining area within the teaching of Sarah Buino. Shame may communicate that a person is defective, unworthy, unacceptable, or fundamentally different from others. It can appear through withdrawal, perfectionism, defensiveness, overachievement, emotional collapse, self-criticism, people-pleasing, addiction, or difficulty receiving care.
When clinicians respond to shame with excessive reassurance, confrontation, or pressure, clients may feel more exposed rather than understood. Sarah’s work emphasizes relational safety, compassionate curiosity, appropriate vulnerability, and the gradual development of a therapeutic relationship in which difficult experiences can be acknowledged without humiliation.
The Clinical Events article Healing Shame in the Therapy Room explores how shame may influence posture, speech, bodily responses, self-silencing, trauma reactions, and relationship patterns. It also explains why consistent experiences of attunement and respect can help clients develop a different relationship with the parts of themselves they learned to hide.
Shame resilience does not mean convincing clients that every behavior is harmless. Compassion and accountability can coexist. Therapy can help people acknowledge the impact of their actions without reducing their entire identity to a mistake, coping pattern, diagnosis, or traumatic history.
Addiction and Dual-Diagnosis Treatment
As a Registered Dual Diagnosis Professional and Certified Alcohol and Other Drug Counselor, Sarah Buino brings specialized experience in substance-use disorders and co-occurring mental health concerns.
Substance use may interact with trauma, shame, anxiety, depression, relationship difficulties, chronic stress, identity, physical pain, and social conditions. A substance or compulsive behavior may provide temporary relief from emotional activation, numbness, isolation, traumatic memories, or an unbearable sense of self-criticism.
Understanding the function of substance use does not minimize its consequences. It helps clinicians develop treatment that addresses the need the behavior has been meeting rather than relying only on confrontation or instruction. The National Institute on Drug Abuse describes addiction as a medical disorder that affects brain functioning and behavior, supporting treatment grounded in science rather than moral judgment.
Sarah has also collaborated on education addressing racism and inequity within addiction treatment. This work asks professionals to examine how cultural stereotypes, institutional power, unequal access to care, criminalization, and clinician bias influence assessment and recovery services. Her educational materials encourage addiction professionals to move beyond vague declarations of inclusion and examine how everyday practices may reproduce harm.
The Wounded Healer and Therapist Wellness
Sarah Buino is widely associated with the concept of the wounded healer: the recognition that therapists and other care providers may be engaged in their own healing while supporting clients.
This concept should not be used to romanticize untreated impairment or excuse unethical conduct. It instead acknowledges that clinicians remain human. They may experience grief, trauma, illness, relationship changes, financial pressure, fear, burnout, or uncertainty while holding professional responsibilities.
Sarah encourages clinicians to examine how their own experiences influence urgency, rescue fantasies, avoidance, perfectionism, countertransference, and the wish to appear endlessly capable. Personal therapy, consultation, supervision, rest, boundaries, community, and honest self-reflection can help professionals remain connected to their humanity without making the client responsible for caring for them.
The NASW Code of Ethics explicitly recognizes the importance of professional self-care and identifies practitioner impairment as an ethical concern when personal distress interferes with competent service. It also encourages organizations and educational institutions to support conditions that promote social-worker health and integrity.
Beyond Burnout: Systemic Strain in Mental Healthcare
Sarah’s current organizational work challenges the tendency to describe every form of professional exhaustion as an individual failure of self-care. Head/Heart Business Therapy frames many clinician difficulties as systemic strain created when high emotional demands collide with limited authority, inadequate resources, productivity pressure, organizational power, and business structures that prioritize scale over relationship.
Personal wellness practices can be helpful, but they cannot independently repair understaffing, exploitative compensation, unclear leadership, discrimination, poor supervision, or systems that repeatedly ask clinicians to work beyond their capacity.
Through consultation, Sarah Buino helps therapists and group-practice leaders examine how attachment patterns, power, money, authority, conflict, and organizational culture influence workplace decisions. Her approach encourages leaders to create structures where clinicians can work with integrity rather than merely endure increasingly unsustainable expectations.
Power, Leadership, and Organizational Relationships
A major focus of Sarah’s recent work is the ethical use of power. Therapists may feel uncomfortable acknowledging power because their professional identity is connected with empathy and service. Yet power is present in clinical roles, supervision, hiring, compensation, policy development, performance reviews, and decisions about access to care.
Avoiding the subject does not eliminate the power difference. It can make its effects harder to examine.
Sarah Buino helps leaders understand organizations as relational systems shaped by psychology, history, culture, authority, and unspoken expectations. The same dynamics that appear in therapy—avoidance, conflict, overfunctioning, withdrawal, idealization, resentment, and fear of rupture—can also appear in teams and businesses.
Ethical leadership requires more than good intentions. It involves transparent communication, meaningful accountability, clear roles, fair compensation practices, thoughtful use of authority, openness to feedback, and the capacity to repair harm without becoming defensive or abandoning responsibility.
Anti-Oppressive and Culturally Responsive Practice
Sarah Buino also teaches about anti-racism and anti-oppressive practice within mental health and addiction services. Alongside Sarah Suzuki, she has developed workshops and consultation intended to help professionals and organizations examine how racism, privilege, culture, and structural power influence healthcare.
Anti-oppressive practice is not achieved through a single training or statement. It requires continued attention to hiring, leadership, compensation, treatment access, diagnostic assumptions, communication, referral patterns, client feedback, and the perspectives that receive authority within an organization.
This work also asks clinicians to distinguish between shame and responsibility. Becoming immobilized by shame may keep attention focused on the professional’s distress. Responsibility directs attention toward listening, learning, repair, changed behavior, and the redistribution of power where appropriate.
Conversations With a Wounded Healer
Sarah is the creator, host, and producer of Conversations With a Wounded Healer, a podcast exploring personal healing, professional identity, trauma, organizational systems, leadership, spirituality, power, money, ethics, and social change. The show brings together intimate personal stories and wider questions about how mental healthcare systems can become more humane and relationally responsible.
Recent episodes have examined politics in the therapy room, dissociative identity disorder, practicing therapy during social instability, the emotional cost of leadership, artificial intelligence, power in group practice, therapist community, employment law, psychedelics, and alternatives to narrowly medicalized models of care.
Through the podcast, Sarah invites helping professionals to consider how caring for themselves, supporting clients, leading organizations, and participating in social systems are interconnected rather than separate responsibilities.
Upcoming Clinical Event With Sarah Buino
On September 19, 2026, Sarah Buino and Livia Budrys will present When Outpatient Care Isn’t Enough: Ethical Decision-Making Across the Continuum of Care. The live virtual workshop runs from 10:00 a.m. to 1:15 p.m. ET and offers three ethics CE credits.
The training addresses the difficult threshold at which ordinary outpatient treatment may no longer provide enough safety, structure, stabilization, or multidisciplinary support. Participants will examine clinical acuity, IOP, PHP, residential and inpatient treatment, scope of practice, consultation, documentation, countertransference, rescue dynamics, and the risks of both delayed and premature referral.
The program also provides practical language for discussing a higher level of care without framing referral as rejection or therapeutic failure. The goal is to help clinicians protect client welfare while maintaining transparency, collaboration, appropriate boundaries, and respect for the therapeutic alliance.
Professionals can explore additional education through the Clinical Events continuing education calendar, including workshops on trauma, professional boundaries, addiction, ethics, clinician wellness, dissociation, cultural humility, and complex clinical decision-making.
Learn With Sarah Buino
The professional work of Sarah Buino, LCSW, RDDP, CADC, CDWF, NMT, connects developmental trauma, addiction recovery, shame resilience, therapist wellness, leadership, organizational culture, ethical power, and anti-oppressive practice.
Her approach encourages clinicians to examine both the client’s internal experience and the systems surrounding care. It also recognizes that therapists’ personal histories, workplace conditions, leadership structures, and access to meaningful support can affect professional judgment and therapeutic presence.
Through psychotherapy, education, consultation, speaking, and podcasting, Sarah Buino helps helping professionals remain human, relational, accountable, and ethically engaged while working inside a rapidly changing mental health field.