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For the most part, the people who come to see therapists are in pain. Some are in great anguish. While the tendency at both a societal and individual level is to turn away from the suffering of others, therapists turn toward the pain of others. To establish a healing relationship, we must make contact with what others instinctually turn away from.
When we open ourselves up to the struggles of others, we are changed in the process. We must acknowledge and tend to the cumulative impact of our work. We must remain mindful of how the self-of-the-therapist is altered (at the micro-level with particular clients; and at the macro-level, across clients). Denying this leaves us vulnerable to compassion fatigue (Figley, 1995; Mathieu, 2012) and vicarious traumatization (Pearlman & Saakvitne, 1995; Saakvitne & Pearlman, 1996).
Therapist self-care involves the same understanding and compassion we attempt to give to others (other-directed) and turning it toward the self (self-directed). Here we are highlighting the quality of the therapist’s relationship to her/himself.
Taking care of others really does start with yourself
You already know you can’t be a meaningful resource for others if you aren’t a resource for yourself, but many therapists give that wisdom lip service, or they defer it for a later time when their practices are fuller or when they’ve earned a certain credential or when some other important criterion has been achieved (and you can see how the finish-line is perpetually pushed forward and therefore can never be reached).
But think about this: Can you truly say you’re throwing yourself into your work out of an altruistic goal when you know you can’t give your clients your best if you’re not at your best? No one has ever said, “You know, I think I have the best therapist ever. She’s exhausted and beleaguered, and that works for me.”
(I don’t need to tell you that exhausted and beleaguered can’t lead to present and attentive.)
But how to put a practical spin on this advice? How to take it from productive head-talk to doable daily behaviors?
As you might tell your clients when they’re on the verge of voluntary life-revision, start small so that you don’t scare the skittish change off. Incorporate one new thing before adding another. And give yourself time to stretch into whatever change you implement. There’s plenty of time, no matter what your crammed calendar might say to the contrary.
Some self-care tips for therapists (or anyone employed in caring for others)
1) Supervision isn’t just for newbies
It often seems that there aren’t enough hours in the day to accommodate all that needs to get done. And many days, that’s the truth and not just a perception. So it’s not surprising that when mental health workers have completed the required number of hours with a supervising professional, they often leave supervision behind entirely.
However, even when it’s not mandated for your license, it’s an excellent idea to connect with other therapists or counselors in a meaningful way and on a regular basis. I’m not talking about “networking,” which is necessary in setting up and growing a practice, but which is a business endeavor, not a self-care measure. I’m talking about clinical supervision or something like it, where you have the opportunity to lean on someone else—and can reciprocally be a resource for a peer—and where you can count on a safe place to work through some of your own questions or stumbling blocks in your counseling work.
Counseling is a necessarily isolative practice—supervision is a way for you to honor your need to walk the path with someone who understands and who has the same needs.
2) Build breaks in to your work day
This means knowing yourself. Some counselors I know say they can see three clients before needing an hour break to recharge; others four or five. It might take some time, and some honest assessment, before you discover what an ideal day looks like for you.
Maybe you can see a total of seven clients in one day and still feel you can be of use to even the last one. Maybe five is your number. Or eight. The point isn’t to compare with what your colleagues are doing—the point is to learn what’s best for you (and, by extension, what’s best for your clients, since your goal of course is to give your clients your best self).
And once you have an idea of what a truly sane working day looks like for you, stick to it. Resist the temptation to over-schedule just because you “can.” Block out your break in your calendar and don’t put a last-minute client there (barring emergencies, of course).
Your recharge-time is just as important as client-time. I know the temptation is to think it’s throwaway time because you’re not getting paid, but resist that temptation. Remember the Emily Dickinson line: “I took my power in my hand and went against the world.”
3) Be mindful of mindfulness
More and more—and maybe this comes with age—I’m thinking about how to slow down and be more mindful. And when I say slow down, I am referring to the redirection of our attention to the now; aligning self with presence.
Meditation is perhaps the most popular path to mindfulness—which is merely the state of being fully present in the moment, without any fretting about the future or ruminating about the past—but it’s not the only one. You might start a mindfulness practice by building in ten minutes of your break devoted to whatever being in the now looks like for you. It might involve noticing your body after a particularly challenging therapy session or slowing down and being more deliberate while you eat your lunch (how many of us are guilty of rushing through lunch between a packed day of clients?).
With practice, you’ll be able to bring that mindfulness to your sessions with clients, too. And that will be good for both of you.
4) Regularly do something just because you want to
I do realize that this is easier said than done, especially for those of us who have families as well as therapy practices. But it really is vital for self-care.
It may feel indulgent to book a massage or a rhumba class or a quiet coffee and scone with a novel at your favorite local hangout, but even if you can commit to just one small-but-lovely experience each week, you will be giving yourself a gift that will ultimately do your clients good, too, since you’ll be rejuvenating yourself in subtle ways that will allow you to be more focused on them when you’re in session.
These don’t have to be big, expensive things—a walk by the river, attending a poetry reading, seeing a movie by yourself—but the key here, as with all of these tips, is not to let opportunities slip through your fingers. You might have that novel on your desk and be ready to leave the office for a latte and a few chapters before your next obligation, but if you talk yourself out of “bothering” with something that isn’t a “should,” you’ll be setting the precedent that self-care is worth dismissing, not pursuing.
Though it sounds counterintuitive to say that relaxation takes effort, for people in the caring industry especially, it can.
5) Build self-care into your business model
Come back and reassess your practice—and how it impacts your emotional wellbeing—on a regular basis. We tend to set our sights on a certain quantitative marker (i.e., number of sessions we need to have each week to make a living) and tend to lose sight of qualitative markers (i.e., am I sleeping well and enough? Do I feel peaceful more often than not, or do I feel stressed?).
Contrary to conventional “wisdom,” the person who is working the most hours or exclusively focused on work is not the most effective worker, nor the most dedicated to his/her profession. Caring for others, especially when it comes to mental health, is a complex, dynamic art that requires you give of yourself; and that giving can leave you depleted if you don’t make self-care a priority and build in opportunities for recharging into your business plan (not around it or outside of it, where it’s likely to get lost or dismissed).
For instance, when you’re sitting down at the beginning of the year and setting up goals for the months ahead, you might start by booking a mindfulness retreat or a seminar devoted to self-care for mental health professionals. In short, build regularly scheduled self-care into the practice of running your business.
Rich Nicastro, Ph.D.
Finley, C. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized.
Mathieu, F. (2012). The Compassion Fatigue Workbook.
Perlman, L.A., & Saakvitne, K. (1995). Trauma and the Therapist: Countertransference and Vicarious Traumatization in Psychotherapy with Incest Survivors.
Saakvitne, K., & Perlman, L.A. (1996). Transforming the Pain: A Workbook on Vicarious Traumatization.