(p. 148) As a Professional, I Don’t Need to Worry About Self-Care: It Is Just Some Meaningless New Age Concept That Is Being Hyped by the Media
It seems like everyone is talking about self-care these days. Of course, you understand that it is important for graduate students and some practicing professionals, but clearly it is not relevant for you. It’s not like you have a problem with handling the day-to-day challenges and stresses of being in private practice. You very likely agree that practitioners at risk of burnout should practice self-care, but you are a competent professional with good coping skills. Perhaps the excessive focus on self-care these days is part of that whole New Age movement. Next thing you know, they’ll be telling everyone to burn incense in the office, have crystals with healing powers under each client’s chair, and practice yoga every morning. All this seems more than just a bit excessive. Although self-care may help those with poor coping skills and major life challenges, clearly it is not for you.
Understanding the Myth
As a licensed mental health professional, you are in the business of assisting others who are in distress. Clients regularly seek you out for your expertise in helping them better manage the stressors in their lives. You are an expert in stress management and effective coping. From your years of education and training you understand mental health issues and how to effectively assess, treat, manage, and prevent stressors and their effects. You are the expert in these issues. How could you be at risk of suffering from any of them or being vulnerable to stress-related difficulties or ineffective coping?
Based on all your experience and expertise in focusing on others’ difficulties, it may be natural for you not to focus on yourself as potentially needing assistance in (p. 149) this area. Yet, not only do we each experience the same challenges, stressors, and issues as our clients do, we are at additional risk because of the nature of the work we do as mental health professionals and because of key features and vulnerabilities many of us bring with us into our work. As O’Connor (2001) highlights, many mental health professionals have histories of abuse, neglect, and trauma, and frequently have played a caregiving role or peacemaker role in our families of origin. Many of us have unresolved issues from earlier in our lives that lead us to seek out the careers we have chosen.
Private practice work for mental health clinicians can be very isolating work, in which hours are spent each day hearing about clients’ difficulties, stresses, and trauma. You may have clients with chronic mental health issues who suffer from relapse and who may not improve. You also may work with clients who are aggressive, violent, or suicidal. Being physically or emotionally assaulted by a client, or having a client commit or attempt suicide can be especially emotionally distressing for you, regardless of your innate coping abilities (Pope, Sonne, & Greene, 2006). Although it may be very rewarding and gratifying overall, work as a mental health clinician may be stressful, demanding, emotionally taxing, and at times, exhausting.
If you provide treatment to victims of abuse and trauma, as you listen to clients graphically recount all they have been through, you may find yourself experiencing many of the same symptoms your clients are experiencing. When treating victims of trauma and abuse you are at increased risk of experiencing what Figley (1995) described as Secondary Traumatic Stress Disorder and what Perlman and Saakvitne (1995) have called Vicarious Traumatization or Secondary Victimization. By being emotionally engaged with your clients and conveying genuine empathy for them as they describe all they have been through and are presently experiencing, you may be traumatized, experiencing symptoms such as physiologic arousal, intrusive thoughts, sleep difficulties, and emotional distress. Even the strongest individual may experience these reactions.
As a mental health clinician, you also live with the day-to-day risk of having licensure board and ethics committee complaints and malpractice lawsuits filed against you at any time. Some areas of clinical practice hold a higher risk of these events occurring than others (e.g., child custody evaluations), but any client may be dissatisfied with how their treatment went and may file a complaint or lawsuit. Even in the case of a frivolous lawsuit where you know you did nothing wrong and you are confident that you will be exonerated, the process of having a complaint filed against you, having to defend yourself, and the potential impact on your professional reputation, can be time consuming, costly, and very stressful (Baerger, 2001).
Even when things are going well, it can be stressful to be a mental health clinician. You may worry about your caseload and whether additional referrals will be coming in and the potential impact of this on your finances. You have bills to pay and if you have employees, payroll to meet. You may need to deal with (p. 150) insurance and managed care requirements, provide administrative supervision to employees, and be available for clients during evenings and weekends in case they experience crises or emergencies. The very nature of providing effective psychotherapy may be emotionally demanding and even draining, as you work with clients with a wide range of mental health difficulties. Some clients may experience symptoms that fall outside of your clinical competence, and others may be overly demanding or challenge boundaries.
In addition to the many work-related issues you must cope with and manage as a mental health clinician, you also are a person with a life of your own and all the usual challenges, issues, and stressors that all people experience over time. You may have financial stressors, relationship challenges, family conflict, and family caregiver obligations to address. Even if everything is going well in your personal life, you still need to be there for others in your life to support and assist them with the difficulties they may be experiencing. You also have the same risks as members of the public in general of experiencing medical, mental health, and substance abuse difficulties, further adding to what you may need to deal with personally while focusing and attending to all your clients’ needs and issues.
Your work-related challenges and stressors will be impacting you and your functioning, as will the challenges and stressors in your personal life; these two aspects of your life will interact, and each will impact the other. It is not possible to “leave it at the office” or to “leave it at home.” You will regularly experience emotional distress, what Prochaska and Norcross (1983) describe as the subjective emotional response to stressors in your life (both professional and personal). Although distress is a common experience, by itself not something to be concerned about, distress that is not attended to adequately will over time typically result in a reduction in your professional competence. You are also at a significant risk of developing burnout if you do not proactively and effectively respond to the stressors and resulting distress in your life. Working long hours, being on call, having clients not make progress, dealing with bureaucratic demands such as those from managed care, and all the other stressors already described, can over time result in you suffering from burnout.
Symptoms of burnout include emotional exhaustion, depersonalization (loss of caring and compassion), and loss of feelings of professional achievement and accomplishment, what Baker (2003) describes as “the terminal phase of distress” (p. 21). We each may experience some of the symptoms of burnout to varying degrees at different times throughout our careers and lives, but when allowed to progress unchecked, it can have a number of negative effects. Burnout will decrease your quality of life and emotional satisfaction, and it also will have a negative impact on the quality of care you can provide to your clients, and perhaps on your personal relationships. It can also impact your ethical judgment, leaving you vulnerable to “mistakes,” which could lead to greater exposure of malpractice and other claims against your license.
(p. 151) Additionally, the ethics codes of the mental health professions make it clear that to be ethical, you must monitor and attend to your ongoing wellness. The Ethical Principles of Psychologists and Code of Conduct (APA, 2017) guides psychologists to “strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work” (p. 3). Further, psychologists are required to monitor their ongoing effectiveness and take needed actions when personal problems threaten to impact their professional effectiveness (Standard 2.06, Personal Problems and Conflicts). Similar standards are found in the other mental health professions’ codes of ethics.
Moving Beyond the Myth
The practice of engaging in healthy and stress-reducing coping behaviors is termed self-care. You are ethically mandated to monitor your ongoing effectiveness, attend to the effect of the various stressors on your functioning, and participate in ongoing self-care activities. As with all other mental health clinicians, however, you have blind spots that make you even more vulnerable to the development of burnout. Health professionals are notoriously poor at self-assessment and the more isolated you are professionally, the more at risk you are for developing burnout (Dunning, Heath, & Suls, 2004). Although ongoing self-assessment is important, it is of great importance that you not rely solely on your own self-assessments, but rather, participate in ongoing support and assessment activities with groups of colleagues, such as through peer support and consultation groups (see Chapter 13).
It is also important that you participate in ongoing self-care activities to better manage the many stressors in your professional and personal lives, and to help prevent burnout and vicarious traumatization from developing. Self-care may include positive actions such as getting enough sleep each night, maintaining a healthy diet, ensuring time to participate in hobbies and other enjoyable activities, and giving adequate attention to the relationships in your life. In your professional life, self-care may involve setting limits on the number of hours you work each day and each week; scheduling regular breaks in your day such as to complete documentation, return e-mails and telephone calls, and to eat lunch; regulating the types of clients you accept and the type of work you do in order to have a balance between different types of professional activities; and setting reasonable limits on how accessible you are to clients after work hours. You also will want to schedule time to interact with colleagues, such as through attending professional conferences and continuing education events. Further, you should consider personal psychotherapy to assist you with life’s challenges just as you expect your clients to do so.
It is essential that you not engage in self-care activities that reduce your wellness and functioning even more. For example, you may enjoy an alcoholic beverage (p. 152) or fine meal as a means of coping and relaxing after a particularly challenging or stressful day. But, too much of a good thing is still too much. Excessive self-medication, whether with substances or food, can compound your difficulties and prove not to be helpful. It is important to schedule time off from work to relax and regenerate, such as to take a vacation, but taking too much time off will likely add to your stress by leading you to not make enough money to pay your bills and by having clients’ needs go unattended.
One of the key ingredients of self-care is balance. This is an aspirational goal that you can never fully achieve, but it is important to strive to achieve a balance in your professional life, in your personal life, and in the interaction between the two. Promoting balance within your life helps to prevent burnout and adds to your quality of life. Instead of providing 30–40 hours of individual psychotherapy to clients each week, you might achieve better balance in your professional life by engaging in a variety of practice activities. These could include providing some psychotherapy, some assessment, some consultation or supervision, and some teaching, as well as giving workshops and doing professional writing. You also may have to work to achieve better balance between your professional and personal lives. You will need to schedule time off from work, time to be with loved ones and to nurture relationships in your life, and time for your own wellness. All this will involve setting reasonable limits in your life, being able to say “no” when needed, and not continually taking on more and more.
It is true that some mental health clinicians engage in the practice of yoga, meditation, and other relaxing activities; these are just some of the self-care activities that many clinicians find helpful for managing the stressors in their lives (Wise & Barnett, 2016). The activities you choose may change over time. They may be done independently or with others. There may even be a “menu” of actions you choose from to maintain your own emotional well-being, including some you use when you are particularly stressed or challenged. Find what works for you and over time be willing to swap out some items on the menu for others. It is important for you to see the ongoing practice of self-care as a required activity and not some extra “nice to do if you have the time or interest” type of activity. Your clients deserve your best self, just as you do.
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010 and January 1, 2017). Retrieved from http://www.apa.org/ethics/code/index.aspx
Baerger, D. R. (2001). Risk management with the suicidal patient: Lessons from case law. Professional Psychology: Research and Practice, 32(4), 359–366.Find this resource:
Baker, E. K. (2003). Caring for ourselves: A therapist’s guide to personal and professional well-being. Washington, DC: American Psychological Association.Find this resource:
(p. 153) Dunning, D., Heath, C., & Suls, J. M. (2004). Flawed self-assessment: Implications for health, education, and the workplace. Psychological Science in the Public Interest, 5, 69–106.Find this resource:
Figley, C. R. (1995). Compassion fatigue: Secondary traumatic stress from treating the traumatized. New York, NY: Bruner/Mazel.Find this resource:
O’Connor, M. F. (2001). On the etiology and effective management of professional distress and impairment among psychologists. Professional Psychology: Research and Practice, 32(4), 345–350.Find this resource:
Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the therapist—Counter- transference and vicarious traumatization in psychotherapy with incest survivors. New York, NY: W.W. Norton.Find this resource:
Pope, K. S., Sonne, J. L., & Greene, B. (2006). What therapists don’t talk about and why: Understanding taboos that hurt us and our clients. Washington, DC: American Psychological Association.Find this resource:
Prochaska, J. O., & Norcross, J. C. (1983). Psychotherapists’ perspectives on treating themselves and their clients for psychic distress. Professional Psychology: Research and Practice, 14(5), 642–655.Find this resource:
Wise, E. H., & Barnett, J. E. (2016). Self-care for psychologists. In J. C. Norcross, G. R. VandenBos & D. K. Freedheim (Eds.), APA handbook of clinical psychology: Vol. 5. Education and profession (pp. 209–222). Washington, DC: American Psychological Association.Find this resource: