In this raw and deeply human conversation, therapist, consultant, and founder Sarah Buino pulls back the curtain on what it really cost her to build — and ultimately let go of — a thriving group therapy practice. Sarah shares how rapid growth, unhealed trauma, and a crushing sense of responsibility left her completely burnt out, pushed her into residential treatment, and forced her to confront her relationship with work at the deepest level.
This episode explores the emotional toll of being “the boss,” the hidden loneliness of being the person everyone depends on, and the courage required to tell the truth when your success is slowly destroying your wellbeing. Sarah’s story is a powerful reminder that leadership doesn’t require martyrdom, and that sometimes the bravest move is to walk away.
Trigger Warning: discussion of suicidal ideation
Episode Highlights
- The breaking point: Sarah describes the moment she realized she was “literally failing at everything” after tripling her staff and workload — and how burnout overtook her completely.
- The emotional cost of leadership: Why being “the boss” created expectations, pressure, and isolation she never could have prepared for.
- Trauma rising to the surface: How unresolved childhood trauma collided with the demands of running a business, ultimately pushing her into residential treatment.
- Radical honesty: The moment she looked her future executive director in the eye during the interview and said, “I don’t want to do this anymore.”
- Letting go without shame: Why selling her practice wasn’t a failure but an act of profound self-trust.
- A different way to lead: How Sarah now works with therapists on aligning their inner healing with the way they run their businesses — so no one else has to crash the way she did.
- A message to leaders: If your success is costing you your health, your joy, or your sanity… it’s okay to choose yourself.
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What is Lonely at the Top?
The podcast for high-level leaders carrying the invisible weight of the world.
If you’re a founder, executive, or high-ranking leader, you already know this truth: the higher you rise, the fewer people you can safely talk to.
Lonely at the Top is a sanctuary in the storm—a space where the emotional cost of leadership is named, and where relief, clarity, and grounded support are always on the table.
Hosted by Soul Medic and former psychotherapist Rachel Alexandria, this podcast dives into the unspoken realities of high-level decision-making: the pressure, the isolation, the doubt, and the fatigue. Each episode offers insight, emotional tools, and conversations with seasoned leaders who’ve learned to navigate the weight of responsibility without losing themselves.