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One CE Credit/Hour

Caring for Ourselves as Psychologists  by Ellen K. Baker, Ph.D.

Learning Objectives

  • Learn the attributes of self care and its importance across the life span.
  • Learn how to assess your own needs and to balance and modulate personal and professional needs.

For ourselves as psychologists, as for our patients, 9-11 changed our lives. For those of us who have been asked to tend to those directly and indirectly affected, most of us are honored to respond to such a calling.

Michael O'Connor, chair of the APA's Advisory Committee on Colleague Assistance (ACCA) has advised psychologists, in whatever capacity they serve, in the best of times, or in the most painful, to not consider themselves invulnerable (Clay, 2001). O'Connor reminds us that in order to help others we also need to take good care of ourselves.

Therapist self-care appears to be reaching a "critical mass" in terms of literature, advocates, and visibility. Credit is due to those psychologists who have been speaking out over time about this imperative (Freudenberger, 1974; Goldberg, 1991; Guy, 1987; Kilburg, Nathan, & Thoreson, 1986; Pope, Keith-Spiegel, & Tabachnick, 1986; Mahoney, 1997; Norcross, 2000; Saakvitne & Pearlman, 1996; Schwebel, Skorina, & Schoener, 1988; Sussman, 1995.)

As psychologists, we apply our training, whatever our theoretical or clinical perspective, and our commitment to assist our patients in becoming more self-understanding and self-caring. We are specialists, and some of us are truly masterful, at helping others learn about and practice self-care. Offering ourselves the same consideration and concern may be quite another matter. Self-care remains a challenge for many of us, personally and professionally. It is one thing to know, it is another to implement. The reality is that many of us struggle with conflicts and deterrents to our own self-care.

Self-care is different from selfishness, self-absorption, or self-indulgence. Self-preoccupation is more likely to occur as a result of inadequate self-care over time. Fitting self-consideration is a manifestation of a healthy respect for one's self and one's clients. Given the fine line between the therapist's personal and professional self, self-denial or self-abnegation is neglectful not only of real self needs, but ultimately of patient care. Appropriate therapist self-care is an important component in the prevention of Iatrogenic effects, i.e., harm to patients caused by the therapist or therapy, are always unfortunate, particularly to the degree that they are avoidable.

THE PROCESS OF SELF CARE

Like other skills, self-care is an ongoing process involving trial and error. There are also many different ways to practice self-care. Self-care needs vary as a function of differences between individuals, in terms of personal history, gender, and personality, as well as within individual differences affected by developmental stage or other life changes.

For purposes of discussion, self-care is considered in terms of self-awareness and self-regulation in the service of balancing these factors: our psychological, physical, and spiritual needs; connection between our self and others; and our personal and professional lives. In reality, these categories are somewhat arbitrary. Our mind, body, and spirit; our connection with self and with others; and our personal and professional selves, interact in infinitely complex ways.

As we know, and remind our patients, "(A)wareness is a prelude to regulating our way of life, modifying behavior as needed" (Coster & Schwebel, 1997, p. 10). Ideally, the process involves benignly observing our own inner self experience - our needs, abilities, proclivities, fears, antipathies, conflicts, limits, defenses, and regressive vulnerabilities under stress - as well as our conduct.

Becoming more self-aware is not necessarily easy or pleasant, for us or our patients. The process may be elusive and conflictual. It involves becoming conscious of, and grappling with, confusing and painful internal conflicts and tensions existing between different kinds and levels of needs and desires. Acknowledging unmet hungers may be anxiety-provoking. Observing raw and primitive impulses or reactions may be threatening to our sense of self. Yet, as we counsel, awareness is crucial in the process of managing emotions in a manner acceptable to the self. Without awareness, unprocessed feelings are at risk of being acted out, potentially in very costly ways for ourselves as psychologists, our patients, and our families.

Self-regulation, a term used in both behavioral and dynamic psychology, refers to both conscious and less conscious management of physical and emotional impulses, drives, and anxieties. Regulating affect, stimulation, and energy in the course of our professional and personal lives, as well as relationships with self and others, is a continuous, complex process, impacted by many variables, including personality, developmental stage, and environmental factors. Self-regulation is key in the service of balance, "the essential concept of self care" (Jaffee & Scott, 1984, p. 146).

The goal of balance is commonsensical, frequently cited advice. Nonetheless, it's an ongoing process to learn, find, practice, maintain, and regain our balance. Balance is actually a high-level function involving modulation and experientially searching for the figurative center on the continuum between the extremes. It necessitates dealing with tradeoffs, costs and benefits, pros and cons. Fortunately, the payoffs of balance and modulation are potentially high, including a sense of mastery, esteem, and self-trust in the capacity to tend to one's various needs and desires.

SELF-CARE ACROSS THE LIFESPAN

Self-care is a life span issue. Self-care needs change over time. The young professional struggles to feel competent enough. The mid-stage psychotherapist may be stretched juggling a young family and the demands of a career. The seasoned psychologist experiences the personal and professional benefits - and costs - of maturity, including limits of time and energy.

The process of becoming more attuned to and responsible for one's self is developmental. It involves a gradual transition from functioning in a dependent, unconscious, childlike state to a more autonomous, conscious, adult mode. As noted above, with accruing benefits and gratifications of self-care, the practice becomes more rewarding. The increase in esteem that usually accompanies self-mastery and self-regulation is a potent reinforcement.

BALANCING MIND, BODY, AND SOUL

To take adequate care of ourselves, we must continue learning throughout life about what facilitates, deepens, and strengthens our sense of personal well-being. Only we can decide what is essential to our own peace of mind. We benefit immeasurably in observing our interior experience, our emotional responses, ideas, dreams, and fantasies. "Each person contains a vast inner world of thoughts, feelings, values, aspirations, potentials, and needs that he or she is capable of knowing and exploring. Distress, ill health, and burnout can result from neglecting this inner world" (Jaffee & Scott, 1984, p. 129-130).

Some of us may need to learn how to better tolerate what we observe, particularly some of the primary process material, which may seem outrageous, disturbing, or unacceptable to our self, as known and preferred. Any and all of the material observed offers valuable information about our deep self-needs. Better understanding these sensations and impulses grants us more choice in how we respond or take action. Fortunately, with time and experience, a deeper connection with self is usually enriching and integrative.

We rationally know that taking care of our body, as the physical residence of our self, is important. But most of us have a complicated relationship with our own physical being, with a gamut of ambivalent feelings and responses. Caring for our self physically requires regular, and regulated, eating, drinking, sleeping, and exercise. For some of us, a casual approach to physical self-care suffices. For others, a proactive regimen of physical health care is necessary to preserve or restore health. Genetic factors influence physical functioning, but our own behavior maximizes or minimizes our genetic blueprint.

Although the field of psychology recognizes the importance of the spirit, as well as of the mind and body, only recently has spirituality been considered in any depth in academic and clinical psychology (Miller, 1999). Principles or elements associated with spirituality include uncertainty, the impossibility of fully knowing or understanding everything in life, faith, mystery, meaningfulness, connectedness, higher consciousness, gratitude, compassion, forgiveness, universality, surrender, suffering, and redemption (Starr & Weiner, 2000, pp. 7-10). The process involves a sense of connection, sought and/or found, with a force transcendent of one's self, such as nature, the universe, and/or God. Sometimes, this level of experience is described as transformative. Obviously, it is very personal, and potentially profound.

BALANCING CONNECTION WITH SELF AND WITH OTHERS

Many of us who have become therapists have a capacity, whether inborn, developed, or both, to be open and attuned to others. The challenge, as persons and as professionals, is to balance our interest in and ability to relate to others with the need to maintain connection with our own separate, individual self. For most of us, it's an ongoing process to find and re-find our balance, our fulcrum, our center of gravity that enables us to reach out and share with others while remaining connected with our own self.

Satisfying relationships with others is an important part of self care for most of us, including connection with an intimate other, children, family of origin, friends, colleagues, the greater society - civically, professionally, and beyond. The quality of our relationships, more than the quantity, is key. Our best relationships, personally and professionally, are those in which we can be as close to our true self as possible. In such relationships, we can move beyond our listening role as a good therapist, and feel able to speak out and be heard as we express our thoughts, feelings, and concerns; we can feel valued and appreciated for our real self rather than idealized or judged; and we can feel safe in lowering our defenses but still be separate and differentiated from the other. Such relationships help us tend our needs in ways that relationships with clients can not, and should not (Guy, 2000).

BALANCING OUR PERSONAL AND PROFESSIONAL LIVES

The rewards of our profession are potentially rich and plentiful on many levels in terms of personal growth, status, and material comforts. Nonetheless, in the best of circumstances, the reality is that the gratifications of the work involve significant responsibilities and stresses, along with "complex demands, human costs, constant risks, and often limited resources" (Pope & Vasquez, 1998, p. 1).

The profession of psychology has its own constellation of inherent demands, as well as contemporary pressures. Advisory Committee on Colleague Assistance member Karen Saakvitne reminds us that, "(I)t is important that psychologists and all mental health professionals recognize that the work we do creates a unique set of occupational stresses" (Rabasca, 1999, p. 23).

Our work intrinsically demands that we use our self, intellectually and emotionally. At the same time, our self is impacted by early life experience, personality, gender, and ongoing life events. We share the same pain and joys of human existence as do our patients. Most of us, when we're honest or pressed, feel very human indeed. In truth, it is a very fine, but critical line, between our personal and professional selves. Responsibly taking care of ourselves, as well as our patients, may be the most important thing that we do, not just for ourselves, but ultimately for our clients, and for our own families. The reality is that, in fact, self-care is essential in order to have enough to give and share with others, a value held deeply among most of us as psychologists.

SELF-CARE EDUCATION AND TRAINING

Therapists in training need "to explore the balance in their lives and to establish routines of self-care" (Mahoney, 1998, p. 56). Well-planned, coherent, self-care training modules, available during both graduate school and through continuing education, are necessary for the ongoing discussion and practice of personal and professional self-care concerns across the lifespan as well as for prevention of burnout and impairment.

PROFESSIONAL ASSOCIATION SUPPORT OF THERAPIST SELF-CARE

The imprimatur of major organizations like the APA and the National Register regarding the importance and practice of therapist self-care is requisite, pressing, and invaluable. Fortunately, the benefits of that support are mutually enrichening. Well-functioning psychologists make for heartier, more vibrant professional associations - and the reverse is likely true as well.

THERAPIST SELF-CARE QUESTIONNAIRE

In the preparation and development of the book, Caring for Ourselves: A Therapist's Guide to Personal and Professional Well-Being, interviews were done with a select, nonrandom sample of more than 30 practitioners representing a diverse group of psychologists in terms of clinical orientation, age, career stage, gender, race, geography, sexual orientation, and self or agency employed.

The questionnaire is shared here for readers' use. Some parts may be more engaging or apropos than others. There are no right or wrong responses. The purpose is to support psychologists, of all ages and stages, in the process of self-awareness and self-management in the service of personal and professional self care.

I Professional Demographics

  1. Date of Birth
  2. Work setting (solo or group private practice, hospital, agency, academic, etc.)
  3. Length of time in private practice
  4. Theoretical, clinical orientation
  5. Average # clinical hours in private practice per week

II Professional Self

  1. What do you like most regarding working as a psychotherapist?
  2. What do you like least?
  3. What is your understanding of your motivations to become a psychotherapist?
  4. What are the factors leading to your choice of profession, e.g. your response to family of origin dynamics?
  5. What other relevant life history experiences that have impacted, or continue to influence, your work as a psychotherapist?
  6. Is your work as a psychotherapist different than anticipated? If so, how?
  7. What real life experiences have impacted your practice?
  8. How have life-stage developmental factors impacted your work?
  9. What is your view of the role of your gender as it affects your working as a psychotherapist?
  10. How would you describe the fit between your personality and your work?
  11. How does your work as a clinician impact your emotional style and personal vulnerabilities?
  12. Likewise, how do your emotional make-up and personal limits effect your clinical work?
  13. How do you feel in terms of personal limits in your work as a psychotherapist? How do you deal with these limits?
  14. Have there been unexpected challenges?
  15. Have you experienced significant periods in your career related to professional or personal stresses? If so, how did
    you cope?
  16. What did you learn from the situation?
  17. What are your current professional concerns?
  18. Has your work situation changed in the past 5 years? If so, how?
  19. What are your concerns about the future of psychotherapy as a profession?
  20. Have you ever considered leaving the field? If so, why?

III Therapist Self-Experience

A. Emotional demands, stresses

  1. Range, kinds of such?
  2. How demanding for you is the emotional impact of working as therapist?
  3. How does your stress manifest, e.g. emotionally, behaviorally, physically?
  4. Perceived effect of your stress upon others?
  5. Impact of clinical work on other relationships?
  6. Most stressful experience? What? When?
  7. "Worst fear," regarding stress. In terms of self? In terms of others?

B. Self-care

  1. How do you define self-care? What is the meaning of the term for you?
  2. What are your attitudes about therapist self-care, i.e. how you think and feel about it?
  3. Are you conscious of any conflictual feelings about therapist self-care?
  4. Do you see therapist self-care as different from the self-care of any other professional?
  5. What have you learned with respect to your own needs regarding self-care:
    a) physically b) intra-personally (psychologically-emotionally) c) interpersonally
    d) spiritually e) psychotherapeutically (personal therapy-professionally, private or peer supervision)
  6. What do you do to take care of yourself as a therapist? Be specific and give examples.
  7. What, of you, has been most helpful in terms of self-care, e.g., what, when, how?
  8. Does self-care, for you, entail more time with others professionally and/or socially, and/or more time for yourself?
  9. How important is it to you to balance your life between home and work?
  10. How do you think/feel you're doing at managing yourself?
  11. What do you consider your greatest challenge in self-care?
  12. How have your attitudes and behaviors regarding therapist self-care changed over time?
  13. What factors impact and/or restrict your self-care?

IV Related Questions

  1. How do you view yourself, in terms of self-knowledge, self-understanding, self-acceptance?
  2. Is that something you value, have worked at over time?
  3. Have there been particular motivations to do such?
  4. Do you feel well-suited to your work?
  5. Do you feel competent, able, talented?
  6. Do you feel like you are growing in terms of self-knowledge, skills?
  7. Given what you know now about yourself and the field, would you chose the same profession over again?

V Closing Thoughts and Feelings

Questionnaire written by Ellen K. Baker, Ph.D. © 2003 by the American Psychological Association. Reprinted and adapted with permission. The above set of questions have been developed from my own thoughts and the following set of reference materials: Cantor, D. & Bernay, T., Women in Power (Houghton Mifflin, 1992); Goldberg, C., The Seasoned Psychotherapist (Norton, 1992); Guy, J., The Personal Life of the Psychotherapist (Wiley, 1987); Mahoney, M., "Psychotherapists' Personal problems & Self-care patterns" (Professional Psychology: Research and Practice, Vol. 28, 1997); Saakvitne, Pealrman & Staff, Transforming the Pain (Norton, 1996).

Article © 2003 by the American Psychological Association. Reprinted and adapted with permission.

AUTHOR

Ellen Baker, Ph.D., is a psychologist in private practice in Washington, DC. She has served in the governance of the District of Columbia Psychological Association, the Division (42) of Independent Practice of the APA, and the National Register Appeal Board. She has nearly 20 years experience writing, consulting, and leading experiential workshops on therapist well-being.

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