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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
-
Date of Birth
-
Work setting (solo
or group private practice, hospital, agency, academic, etc.)
-
Length of time in
private practice
-
Theoretical, clinical
orientation
-
Average # clinical
hours in private practice per week
II Professional Self
-
What do you like most
regarding working as a psychotherapist?
-
What do you like least?
-
What is your understanding
of your motivations to become a psychotherapist?
-
What are the factors
leading to your choice of profession, e.g. your response to family
of origin dynamics?
-
What other relevant
life history experiences that have impacted, or continue to influence,
your work as a psychotherapist?
-
Is your work as a
psychotherapist different than anticipated? If so, how?
-
What real life experiences
have impacted your practice?
-
How have life-stage
developmental factors impacted your work?
-
What is your view
of the role of your gender as it affects your working as a psychotherapist?
-
How would you describe
the fit between your personality and your work?
-
How does your work
as a clinician impact your emotional style and personal vulnerabilities?
-
Likewise, how do your
emotional make-up and personal limits effect your clinical work?
-
How do you feel in
terms of personal limits in your work as a psychotherapist? How
do you deal with these limits?
-
Have there been unexpected
challenges?
-
Have you experienced
significant periods in your career related to professional or personal
stresses? If so, how did
you cope?
-
What did you learn
from the situation?
-
What are your current
professional concerns?
-
Has your work situation
changed in the past 5 years? If so, how?
-
What are your concerns
about the future of psychotherapy as a profession?
-
Have you ever considered
leaving the field? If so, why?
III Therapist Self-Experience
A. Emotional demands, stresses
-
Range, kinds of such?
-
How demanding for
you is the emotional impact of working as therapist?
-
How does your stress
manifest, e.g. emotionally, behaviorally, physically?
-
Perceived effect of
your stress upon others?
-
Impact of clinical
work on other relationships?
-
Most stressful experience?
What? When?
-
"Worst fear," regarding
stress. In terms of self? In terms of others?
B. Self-care
-
How do you define
self-care? What is the meaning of the term for you?
-
What are your attitudes
about therapist self-care, i.e. how you think and feel about it?
-
Are you conscious
of any conflictual feelings about therapist self-care?
-
Do you see therapist
self-care as different from the self-care of any other professional?
-
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)
-
What do you do to
take care of yourself as a therapist? Be specific and give examples.
-
What, of you, has
been most helpful in terms of self-care, e.g., what, when, how?
-
Does self-care, for
you, entail more time with others professionally and/or socially,
and/or more time for yourself?
-
How important is it
to you to balance your life between home and work?
-
How do you think/feel
you're doing at managing yourself?
-
What do you consider
your greatest challenge in self-care?
-
How have your attitudes
and behaviors regarding therapist self-care changed over time?
-
What factors impact
and/or restrict your self-care?
IV Related Questions
-
How do you view yourself,
in terms of self-knowledge, self-understanding, self-acceptance?
-
Is that something
you value, have worked at over time?
-
Have there been particular
motivations to do such?
-
Do you feel well-suited
to your work?
-
Do you feel competent,
able, talented?
-
Do you feel like you
are growing in terms of self-knowledge, skills?
-
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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