Download Therapist Self-Care - HBFT Self-Care

THERAPIST SELF-CARE
Sandra Stith, Ph.D.
Fall 2007
Adapted from presentations by
Diane A. McKay, Psy.D., P.A.
And Eric McCollum, Ph.D., Virginia Tech
Paradox Of Providing Therapy?
 We are rewarded for our choice of profession
in many ways.

Examples
 There are also challenges associated with
our choice of profession

Examples
 We often experience the same struggles that
our clients experience.
 We are human
Paradox Of Providing Therapy?
(cont’d)
 Masterful at helping others learn about and practice
self-care, many of us struggle with conflicts and
deterrents to our own self-care.
 Each of us brings our own personal and professional
history to the practice of self-care. This history can
both help and complicate the process.
The Irony Of It All?




As therapists, we use our education, training, and
skills to help our patients to live more rewarding and
healthy lifestyles, independently.
Ironically, many of us are reluctant to offer
ourselves the same kind of understanding and care.
Yet, in reality, it is this self-care, personal and
professional, that ultimately is the most important
not just for us, but for our clients.
It is possible that we are one of the few, if not the
only profession, that does not purchase or utilize its
own product?
What causes therapist stress?
 Individual issues
 Stress from work


Mismatch between expectations and reality
Organizational


Too much to do in too little time
Organizational climate




Value conflicts
Gender/age/racial bias
Theoretical conflicts
Little positive feedback for performance
Work Related Distress
 (National Survey by Pope & Tabachnick, 1993)
80% reported feelings of fear, anger, and sexual
arousal at various times in their work
 97% feared that a client would commit suicide
 Almost 90% felt anger at a client at some point
 Over half admitted to having been so concerned
about a patient that their eating, sleeping, or
concentration was affected.
 Like their patients with a corresponding diagnosis,
therapists exposed to a patient’s trauma can develop
 emotional distancing or insensitivity
 loss of trust in others
 increased alcohol use
 and/or ultimately burnout.

What causes therapist stress?
 Client generated stress

Difficult clients



What types of clients are most stressful to you?
High expectations
Lack of success
 Special factors for family therapists

Wetchler and Piercy article


Table 104 –Potential stressors
Table 105 Enhancers
Special issues
 Women or people involved in parenting
 Men
Special issues
 Stressors and enhancers of life as a therapist
for single people
 Stressors and enhancers of life as graduate
student
 Exercise (discuss in small groups how
learning to do and doing this work has
affected you)
Why is it so hard to attend to our own needs for
nurturance, balance, and renewal?
Not Me!!!
 Many factors influence the effects of stressors on
individual therapists. Our personal history,
developmental state, and personality as well as the
potency of the individual or cumulative stressors,
affect our susceptibility to stress.
 “An accumulation of stressors … together in some
critical mass” (Kottler & Hazler, 1997, p. 194) can
conceivably happen to any psychotherapist in the
course of a personal and professional lifetime and
can knock even the physically and mentally healthiest
of therapists off balance.
Emotional Overload/Depletion
 We witness and vicariously experience a cumulative
barrage of raw emotion.
 Emotional overload or depletion is not disabling.
 Can include many symptoms such as
 disrupted sleep
 depleted physical and mental energy
 emotional withdrawal from family
 less interest in socializing with friends
 fantasies about mental health days or paid
vacation
 fantasies about being taken care of.
Therapist Distress
 Therapist distress describes conscious discomfort of






suffering
Distress “per se does not necessarily imply
impairment” (O’Connor, 2001)
It might be seen or used as a warning signal
Has the potential to affect the quality of patient care
Many personal and professional sources
Over 60% of therapists reported having been
seriously depressed at some point during their career
Others experience marital/relationship difficulties,
inadequate self-esteem, anxiety, and career
concerns (Pope & Tabachnick, 1994)
STAGES OF BURNOUT
 The honeymoon


Boundless energy
Believe job will satisfy all your needs and
desires and solve all your problems
 Awakening


Disillusionment and disappointment grow
Often work harder and become increasingly
tired, bored, frustrated. Question your
competence and start losing self-confidence
BROWNOUT
 Early enthusiasm gives way to chronic fatigue
and irritability
 Eating and sleeping patterns change
 Productivity drops
Burnout
 Terminal Phase of Therapist Distress
 Freudenberger (1984) defined the term as “a
depletion or exhaustion of a person’s mental
and physical resources attributed to his/her
prolonged, yet unsuccessful striving toward
unrealistic expectations, internally or
externally derived.”
 Symptoms include: fatigue, frustration,
disengagement, stress, depletion,
helplessness, hopelessness, emotional drain,
emotional exhaustion, and cynicism.
Other symptoms of Burnout
 Despair
 Overwhelming sense of failure
 Devastating loss of self-esteem and
confidence
 Depression
 Suicide, stroke, heart attack
 Physical or mental breakdown
SELF-CARE AS A CONCEPT



Self-care is being widely discussed these days as a
healthy and valuable process. The myriad of books
available on the general market address the
benefits of self-care, self-nurturance, and selfnourishment.
Self-care is a responsible practice – for all human
beings – and in disputably for those employed in the
service and care of others, like psychology.
Self-care is a lifespan issue, personally and
professionally, whatever your theoretical or clinical
worldview.
Therapist Self-Care


Therapist Self-Care is a comprehensive and broad
subject that benefits from a Broad-Based
Theoretical Orientation which considers character
development, symptom reduction, and coping
strategies.
*Responsible self-care is a complex, lifelong, trial
and error process.*
3 Key Components of Self-Care
 Self-Awareness (uncovering)
 Self-Regulation (coping)
 Balance (centering)
SELF-AWARENESS



“Awareness is a prelude to regulating our way of life,
modifying behavior as needed.”
It involves benign self-observation of our own
physical and psychological experience to the degree
possible without distortion or avoidance.
Only if we are aware of our needs and limitations can
we consciously weigh our options in tending to those
concerns, whether external or internal and whether
related to personality, life state, or circumstance.
SELF-AWARENESS (cont’d)
 Without it, we risk acting out repressed (and thereby
unprocessed and unmanaged) emotions and needs,
in indirect, irresponsible, and potentially harmful ways
that are costly to our self, personally and
professionally, and to our patients, family, and others.
 If unaware of our self needs and self dynamics, we
may unconsciously and unintentionally neglect our
patients or exploit them to meet our own needs for
intimacy, esteem, or dominance.
SELF-REGULATION
 Refers to the conscious and less conscious
management of our physical and emotional impulses,
drives, and anxieties.
 Regulatory processes, such [as] relaxation, exercise,
and diversion, help us maintain and restore our
physiological and psychological equilibrium.
 Our sense of well-being and esteem is closely related
to the level of mastery of our self-regulation and
impulse control skills. Difficulties in self-regulation
often cause frustration of shame.
SELF-REGULATION (cont’d)
 To regulate mood and affect:
we must learn how to both proactively and
constructively manage dysphoric affect (such as
anxiety and depression)
AND
 adaptively defuse or “metabolize” intense, charged
emotional experience to lessen the risk of
becoming emotionally flooded and overwhelmed
 A fine line may exist between stimulation that is
nourishing and enriching AND stimulation that is
overwhelming and stultifying.

SELF-REGULATION (continued)
 Our goal is to learn what we need to do to
keep our self [selves] on course – to develop
our own internal gyroscope.
 Our ability to self-regulate increases when we
are self-aware of our feelings, needs, and
limits and when we practice managing
dysphoria and intense emotions.
BALANCE
 A positive connection and relationship with our self,
others, and the universe which serves as an antidote
to the anxieties of the human condition.
 Balance is essential in enabling us to tend our core
needs and concerns, including those of the body,
mind and spirit; of the self in relation to others; and in
our personal and professional lives. Balancing can
involve many factors, such as time, energy, and
money.
 The goal of balance is commonsensical, frequently
cited advice. It’s an ongoing process to learn, find,
practice, maintain, and regain our balance.
PREVENTING BURNOUT
 Increase your sense of control
 Create realistic expectations for yourself
 Monitor the impact of stress on your life
 Find things outside of work that give you meaning in




life
Arrange your schedule to not concentrate stressors
Set limits
Get support – TALK
Look for first signs of burnout, especially the state of
non-feeling
CONCLUSION
 We know that self-care is a healthy, self-respecting,
mature process.
 Appropriate self-consideration is a manifestation of a
healthy respect for one’s self and one’s clients. It is,
in turn, in the service of a robust, autonomous self.
 We need to replenish if we are to share with others.
We require both physical and psychological
nourishment and rest to restore our well-being and to
give what we want to give – to our patients, as well
as to the significant others in our lives.
 Self-care thus is different from selfishness, selfabsorption, or self-indulgence.
CONCLUSION
 Self-preoccupation is, in fact, more likely to occur as
a result of inadequate self-care over time.
 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.
 The reality is that therapists, as professionals and as
human beings, have the right, and deserve, to share
with ourselves the same time, care, and tenderness
we extend to clients, family, and friends.
Activity
 Develop self-care plan
 Post it on your refrigerator