Tag Archives: Self-care

4 steps to refresh, recharge and reconnect

By Autumn Gonzalez December 22, 2022

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tiles spelling self-care on table with two pink and white flowers

Image by Tiny Tribes from Pixabay

If you are anything like me, you find being a counselor very enjoyable and fulfilling. We regularly make positive impacts on the lives of people we serve, and we’re committed to help them heal and grow.

However, this endeavor can be emotionally demanding and challenging. We hold space for successes, but we also come face to face with various sufferings and human misery. Even an ordinary day can at times be exhausting.

Add in the personal responsibilities of everyday life, living amid a pandemic, daily acts of violence and inflation, and the potential implications can be prevalent and persistent for counselors. These implications include increased depression, anxiety, psychosocial isolation, loneliness, disrupted personal relationships, compassion fatigue, vicarious trauma, burnout and professional impairment, all of which can impact the quality of services for effective and ethical counseling and overall functioning.

While most of us have substantial knowledge about self-care and convey its importance to clients, there is a disconnect between knowing about and doing self-care. For many counselors, self-care is front and center yet so far away.

Defining self-care

What exactly is self-care? Simply put, self-care is intentional actions and experiences to enhance or maintain physical, emotional, mental and social well-being and balance in life.

Self-care has many benefits. It boosts well-being, builds resilience, increases self-awareness and self-esteem, prevents burnout and compassion fatigue, and helps us perform at our best. It is a form of prevention, an ethical responsibility and an imperative for counselors personally and professionally.

Most important, self-care is about choice and understanding what it means for you. Everyone has a unique definition of self-care. For some, it may be a spa day, a massage or weeks of vacation. For others, it may be curling up with a good book, taking a moment to breathe, establishing boundaries, being intentional or assertive, or holding oneself accountable. Self-care is what maintains and restores your sense of self and what nourishes you.

Making self-care routine

It can be challenging to integrate self-care into a daily routine, which is why I created a four-step guide and a few practical self-care tips and strategies for counselors that can be built into everyday life in a manageable and sustainable way.

Step 1: Complete a self-care assessment

The first step is completing a self-care assessment to help you learn about and become aware of where you are at with your needs. There are various assessments readily available on the internet, in books, etc. A common one is the Self-Care Assessment created by Therapist Aid, which helps people reflect on current self-care practices, explore areas of improvement and identify new practices.

Step 2: Create a self-care plan

The second step is to create a self-care plan. Create an inventory of personalized self-care strategies that cater to the whole self and include physically, mentally, emotionally and spiritually nourishing activities. This could be a list of the top five things you can do, or not do. Be specific. Don’t just write down “do a breathing exercise” — describe which exercises you foresee yourself doing and enjoy doing. Focus specifically on those you can do when you wake up or before you go to sleep, when you start and finish your day, and when you are between sessions.

Here are some possible self-care tips and strategies:

  • Set daily intention. Setting a positive daily intention can help you lead a purposeful and meaningful life. At the end of each day, think about how you lived your daily intention and how it impacted your way of being.
  • Live in the moment. Give yourself permission to just be and to be present in the moment. Scheduling short breaks throughout the day, doing one-minute meditations, breathing, noticing your surroundings, practicing gratitude, accepting things as they are, being mindful, taking a break from social media and technology, doing physical and mental grounding exercises, and focusing on one thing at a time can help you be in the moment and reset.
  • Fuel yourself. Truth is, you are what you eat. Eat balanced meals and drink plenty of water.
  • Move and exercise. A body in motion stays in motion. Engage in regular movement and exercise. Stretch to give your muscles a break to relieve tension and anxiety and pay attention to your posture. Take a brief walk between sessions, in the morning or after work.
  • Get enough sleep. Sleep hygiene impacts energy, concentration, learning and memory.
  • Set boundaries. Boundaries promote safety and security of self and others. Create and maintain professional and personal boundaries. At the workplace, this may mean saying “no,” delegating tasks, stopping a session on time, not answering emails from your family, not overloading your caseload with too many clients, asking for help, working within your competence, minimizing and avoiding dual relationships, and refraining from overidentification. At home, it may be taking breaks, being consistent in asserting yourself, not answering emails from work, not doing the “thing” that was planned or adjusting your schedule.
  • Connect with others. Spend time with family, friends or someone who brings you joy. Regularly meet with peers or colleagues for support, engage in clinical or reflective supervision, participate in personal therapy, or attend a mutual support group.
  • Practice self-reflection. Make time for self-reflection to gain an understanding of yourself, your motivations and your behaviors. Increase your self-awareness and examine your self-talk, window of tolerance, inner critic, strengths and weaknesses. This can help you better understand yourself and possibly others, assist in better decision-making, increase self-confidence, reduce assumptions and biases, build better relationships, increase emotional regulation, decrease stress, and reduce transference and countertransference issues. It can also help you pursue your purpose and live authentically. Reflective practices can include clarifying values, journaling, practicing mindful meditation, turning off autopilot, seeking supervision and completing a strengths assessment.
  • Use positive affirmations. Praise yourself for what you do. Positive affirmations promote positive well-being and lower stress. Try writing yourself a Post-it note or setting a daily reminder.
  • Have self-compassion. Honor and respect your feelings when you suffer, fail, feel inadequate or succeed. Allow yourself to cry and express your feelings. This can be one minute to one hour but take the time to release your emotions and all you hold on to.
  • Engage in enjoyable activities. Participate in activities you enjoy, such as group exercise, spending time in nature, listening to music, playing a recreational sport, reading for leisure or another hobby.
  • Practice relaxation. Relaxation is the lowering of tension in the mind and body. Relaxation improves coping abilities; decreases anxiety, depression and insomnia; lowers blood pressure and increases blood flow; decreases heart rate and respiration rate; provides a sense of calmness and confidence; relaxes muscles; promotes healing; and can reduce pain. Types of relaxation techniques include yoga, massage therapy, mindfulness meditation, progressive muscle relaxation, body scan, visualization/guided imagery, deep breathing and breath focus.
  • Use humor. Laughing feels good, can reduce stress, stimulates circulation, aids in relaxation and sustains resilience. Look up a joke, reframe or find humor in a situation, or watch something funny.
  • Treat yourself. Indulge in the things you enjoy, such as ice cream, a new book, etc.
  • Learn. Try learning something new. This can mean learning a new skill, building your strengths, gathering information or seeking out intellectual challenges personally and professionally.
  • Breathe. Just breathe.
  • Focus. You have the ability to intentionally choose what you focus your energy on.
  • Reduce stress. Aim to reduce stressors in your life.

Step 3: Commit to the plan

Commit yourself to intentionally use your self-care plan. You can share your plan with an accountability partner or someone encouraging. Just as you would ask a client to create a safety plan or relapse prevention plan, it is helpful to do the same for your self-care plan. This can be done in many ways, whether it is using your daily calendar, writing Post-it notes, or writing your plan on an index card to keep in your purse or wallet. Remember to start small and start where you are. Be realistic with your plan and implement activities that work for your life.

Step 4: Check in and monitor the plan

Check in with yourself regularly to review your plan and hold yourself accountable. The Professional Quality of Life (ProQOL) is a useful self-care tool developed by Beth Hudnall Stamm to help you monitor your self-care by seeing how you score on compassion satisfaction, burnout and secondary traumatic stress. Don’t forget to take the time to celebrate your success and evaluate where things did not go as planned.

Moving forward

The most selfless act we as counselors can do is to take care of ourselves actively, regularly and purposefully. Maintaining and enhancing our emotional, mental and physical well-being is a form of prevention as well as an ethical responsibility and a personal and professional imperative. It prevents burnout, assists in staying present with clients and enables us to provide the highest quality of care to clients while maintaining our well-being.

When we take time to care of and invest in ourselves, we are preparing ourselves to take care of others.

 

Autumn Gonzalez (she/her) is a licensed clinical professional counselor in Illinois and Iowa, a national certified clinical mental health counselor, and an advanced alcohol and other drug counselor certified by the International Certification & Reciprocity Consortium. She is a licensed mental health clinician and site supervisor for master’s-level practicum and internship counselors-in-training at The Project of the Quad Cities and residential and inpatient counselor at UnityPoint Health Robert Young Center. Contact her at agonzalez@tpqc.org.

This research was inspired by Gonzalez’s participation in the Refresh, Recharge, and Reconnect Retreat for Therapists funded by the Merlin W. Schultz Foundation Grant.

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Tips to navigate workload and prevent burnout  

Celine Cluff  December 9, 2022

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The COVID-19 pandemic has left few sectors untouched when it comes to burnout. With an ever-increasing need for sector-specific crisis measures to mitigate some of the stressors faced by workers globally, society finds itself in midst of a burnout epidemic. The biggest issue we face collectively is that burning out in one’s professional life also leaves one struggling in one’s personal life. This carry-over effect is what many counselors and psychologists are seeing in their practice today.  

As we prepare to enter another holiday season — a time that can add stress to a routine that is already hectic — people need to check in with themselves and consider how they are feeling during this busy time of the year. This simple step can make all the difference, and it might even improve their relationships with loved ones.  

The need for interpersonal connection 

Virtual therapy and telehealth platforms are continuing to emerge as a by-product of the pandemic. These resources can provide some of the emotional support people need to get through the day. For example, the company Spring Health offers virtual therapy to the employees of organizations that have added the platform to their health benefits package. It is hopeful that these telehealth platforms will also become available and affordable for everyone — regardless of employment status — especially older people and those living in rural areas.  

These virtual counseling platforms, however, do not replace some of the vital interpersonal relationships humans need to thrive and build resilience. This includes their relationship with their counselor. The connections people have with each other are important ingredients in helping them feel there is meaning in life beyond what they achieve as part of a task or job.  

Much like a forest where trees are interconnected with each other via their root systems, people are also connected to their community on a deeper level. This connection, however, can be compromised if other environmental factors have a negative impact on people. Recent research on pandemic-specific stressors has revealed that professionals working in health care might benefit from coping strategies that are geared toward nourishing interpersonal connections.

Although meeting and socializing with others in person used to be a common occurrence, now it is often overshadowed by all the ways in which people connect virtually, from one bandwidth to another.

Preventing work-related burnout 

Dr. Maria Gualano, who was recently listed as one of the top 2% of scientists in the world according to Stanford University, conducted a systemic review in 2021 and found that three factors appear to have played a prevalent role in causing health care professionals to burn out during the COVID-19 pandemic. These factors are emotional exhaustion, high levels of depersonalization and the lack of personal accomplishments.  

Focusing on the prevention of these three factors may help people develop new norms that promote their well-being in midst of a global health crisis.  

Here are six tips on how employees can target and counteract feelings of emotional exhaustion and high stress related to work:  

  • Take breaks throughout the workday. Research from Microsoft’s Human Factors Lab shows that breaks allow the brain to reset, which can help reduce the cumulative buildup of stress. Even taking breaks in small seven-minute increments throughout the workday can make a difference if done regularly. One way to ensure you are taking a break from work is to turn off work notifications in the evenings. But if your job requires you to be on call for an extended period, then you could carve out a few minutes for yourself throughout the day (e.g., taking mental breaks for seven minutes several times a day). Although evidence on shorter workweek benefits is limited, the emerging literature shows that employees report feeling happier at work when working a shorter workweek. In addition, when people feel connected to the work they do, their well-being increases. So weaving more leisure time (even minutes) into one’s workweek can help increase feelings of well-being and lead to better work engagement, which in turn results in better work outcomes. 
  • Develop a point system for unwinding. Typically, I like to count one point for every 10 minutes of doing something that is not work-related (or better yet: look out a window). Find a point system that is suitable for your lifestyle, and then aim to accumulate a certain number of points over the course of a workweek. Achieving your goal for the week helps you feel accomplished, and this can lead to a cumulative effect.  
  • Adopt a growth mindset. In a Tedx talk on the power of belief, growth mindset expert Eduardo Briceno said we can cultivate a growth mindset by accepting that we are not chained to our capabilities. This uplifting and inspirational message is one we must all internalize in times of stress and uncertainty. I invite you to think deeply about what it means to be successful and at what cost. Only through personal reflection can we maximize outcomes at work and in our personal lives. It helps us learn about ourselves and why we do what we do.  
  • Shift the perspective. An inspiring way to ground yourself is to take an imaginary field trip to the moon and look back at Earth. There are no deadlines, no objectives. The beauty of this exercise lies in reflecting on the miracle of life itself, not what is accomplished throughout it. It invites you to take a step back from all the noise you encounter as part of daily life, and instead focus only on what is necessary. If practiced regularly, this activity can work to alleviate some of the chronic stress people associate with work deadlines.  
  • Spend time doing something for yourself regularly. When it comes to meeting work demands, people are quick to prioritize deadlines over themselves, which can lead to people feeling disconnected from their work and associating it with stress. In general, burnout rates increase when people feel they have no control over their workload and stress levels. In a society that celebrates being busy, putting oneself first should be at the top of the to-do list. Self-care is crucial in maintaining a pace that is sustainable and healthy. This rings especially true during the holidays. We often feel pressure to participate in all the festivities, bake sales, cheer, and so on. But sometimes it’s OK to not spread yourself so thin. Choose one contribution and be proud of it — your time is valuable.  
  • Seek out a qualified counselor. This is inarguably the most important tip for those wanting to combat burnout. Seeking out a registered counselor is pivotal in the prevention of a burnout episode because they understand the underlying challenges faced by those who struggle with managing a heavy workload and are trained to provide the tools necessary to prevent escalation. Whether someone works in health care or another industry, identifying the root causes that resulted in a burnout episode with a counselor can be the first step in implementing a solution.  

 

 

Profile picture of Celine Cluff, the authorCeline Cluff is a registered clinical counselor and researcher in Kelowna, British Columbia, Canada. She holds a master’s degree in psychoanalytic studies from Middlesex University in London and recently completed her doctorate in psychology at Adler University in Chicago. Her private practice focuses on family therapy, couples therapy and parenting challenges. Contact her at celine.cluff@yahoo.com. 

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association. 

Opening keynote underscores a holistic approach to self-care

By Lindsey Phillips April 5, 2021

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ACA’s 2021 Virtual Conference Experience started off strong with a keynote panel on self-care.

We all know self-care is important, but it can be difficult to define because there is no “correct” way to engage in self-care.

Gerald Corey, one of the four keynote panelists, stressed the importance of reflecting every day — even if it’s just for a couple of minutes — on how your day is going and what changes you want to make.

“Think of self-care holistically, and not just [as] physical exercise. Think of it in terms of relationships, meaning in life, having fun, recreating our existence, engaging in life rather than pulling back and disengaging,” says Corey, professor emeritus of human services and counseling at California State University at Fullerton.

Michelle Muratori, a senior counselor at the Center for Talented Youth at Johns Hopkins University, finds when she is tending to her self-care needs, her own internal boundaries are stronger, which allows her to be emotionally present with clients in session and let them have their own pain.

Gerald Corey, Michelle Muratori, Jude T. Austin II and Julius A. Austin, co-authors of the ACA-published book Counselor Self-Care, presented the opening keynote of the American Counseling Association’s 2021 Virtual Conference Experience on April 5. The theme for the first week of the monthlong conference is self-care.

Create a self-care plan that works for you  

Counselors can have insight and awareness, but if they don’t have their own self-care plan — one that’s simple and realistic — then change won’t happen, asserts Corey, an American Counseling Association Fellow. This plan provides counselors with an opportunity to reflect on ways they can change what they’re doing to function better personally and professionally, he notes.

“It does help to have [the self-care plan] in writing and [to] talk to somebody about it and be accountable. Think of a way to get support to carry out your plan when it becomes difficult,” Corey adds. One useful exercise may be to think about what change you want to see six months or a year into the future, he suggests. Maybe you want to make more time for a hobby or write in your journal more often.

Jude T. Austin II, an assistant professor and coordinator of the clinical mental health counseling track in the professional counseling program at the University of Mary Hardin-Baylor, advises writing this action plan in pencil because obstacles will arise that force you to readjust your plan. He loves to work out in his garage, but when it’s cold outside, he has to find another way.

Counselors can also incorporate their self-care plan into their current routines, notes Julius A. Austin, a clinical therapist and the coordinator for the Office of Substance Abuse and Recovery at Tulane University. For example, they can check in with family or listen to an audiobook during their hour-long commute to work.

Muratori, co-author of Coping Skills for a Stressful World: A Workbook for Counselors and Clients, reminds counselors that they don’t have to do self-care perfectly. Often, doing their best is good enough, she says.

Get to know your stress

Jude Austin shares advice he received from a supervisor: “Make … stress [and] anxiety your best friend. Sit them next to you and get to know them. Understand what stress does to you [and] how it influences you. What are your triggers? How do you deal with it? Who are the people around you that it affects?”

Considering these questions allows people to be intentional about how they approach self-care because they better understand their unique kind of stressors, he explains.

This reflection should also extend to one’s relationship with other people. Carefully consider who you want to be around professionally and personally, advises Jude Austin, a licensed professional counselor (LPC) and licensed marriage and family therapist associate in private practice in Temple, Texas. It’s OK to fire a supervisor or not to be friends with every colleague if the relationship isn’t working for you or makes you feel bad.

Finding ways to cope with stress can be challenging. The keynote speakers, co-authors of Counselor Self-Care, share some activities that help them better manage their stress:

  • Find some type of physical activity that you enjoy doing and that fits within your lifestyle and do it relatively consistently, Corey says. And it doesn’t have to be time consuming, he adds. You can take the stairs rather than the elevator, for example.
  • Learn something new. When graduate school became overwhelming, Jude Austin started growing bonsai trees to help him cope with the stress of having things outside his control. He still finds learning something new every year helps him manage his stress and fosters his curiosity.
  • Connect with others. Julius Austin, an LPC and adjunct professor at Southeastern Louisiana University, takes time to check in with his family, friends and colleagues. Even just a five-minute phone call with his family gives him a sense of warmth and calm after a stressful day.
  • Muratori watches late-night comedy as a way to decompress.
  • Enjoy nature. Corey advises counselors to step away from their desks and spend at least 30 minutes outside in nature every day. Jude Austin sometimes finds it challenging to leave his office, so he brought nature inside by adding a few plants to his workspace.
  • Find meaning and purpose in your life. Think about what makes you want to wake up in the morning, Corey says. He notes that spiritual involvement and service to others can often be a source of meaning for many people.
  • Go to counseling. All the speakers stressed the importance of counselors seeking their own counseling throughout their lives.

Revising self-care plans

Each new career stage presents new stressors that require counselors to constantly adjust and revise their self-care plans.

Julius and Jude Austin, co-authors of Surviving and Thriving in Your Counseling Program, are in the early stages of their professional careers, and they’ve noticed new professionals often quickly say “yes” to every professional opportunity because they are building their careers and gaining self-confidence. But this behavior can lead to burnout, so they caution new professionals to be more intentional with the job responsibilities they assume.

Corey suggests counselors say, “Let me think about it,” when approached for a professional opportunity. And then they really have to consider if that opportunity is a good one for them in that moment.

Jude Austin also finds it challenging to balance all of his daily responsibilities between his work and personal life. “Your career and family are sometimes growing in parallel,” he says. And juggling these roles is often when he feels the most out of balance.

Mid-career is often a time when people assume more work-related responsibilities, Muratori says. And they may need someone to hold them accountable and ensure they aren’t taking on too much. She also points out it’s a time when counselors may experience new family stressors such as a child going off to college or caring for older parents.

Corey credits his long, productive counseling career with two things: 1) He took the time to create a self-care plan that worked for him and encompassed all facets of wellness, including physical, emotional, relational and spiritual health. 2) He took the time to reach out and connect with colleagues. “This can be a lonely profession,” he notes. “Don’t wait for somebody else to … reach out. … It’s important for us to reach out to those friends and colleagues and take the initiative.”

Counselors shouldn’t feel guilty for taking time to care for themselves. “Pay attention to yourself; listen to yourself; allow yourself to guide you through this [self-care process],” Jude Austin says. “If something doesn’t feel right, doesn’t feel comfortable, then reevaluate. … Self-care is flexible. It’s not selfish. It’s responsible. So, just be kind to yourself.”

 

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This keynote panel kicked off a month of virtual events, including hundreds of educational sessions and three additional keynotes, that lasts through April 30.

Find out more about the American Counseling Association’s 2021 Virtual Conference Experience at counseling.org/conference/conference-2021

Registration is open until April 30; participants will have access to all conference content until May 31.

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Spokes of a wheel: A lesson in physics

By Gregory K. Moffatt March 29, 2021

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I can’t count the number of calls and emails I’ve gotten over the past year, in addition to the many times I’ve been asked to speak (virtually, of course), on the same topic: How can we help people cope during the pandemic? In fact, I recently spoke on this topic to one group for the second time in the past year.

Who could have known this pandemic would go on for so long and how our lives would be disrupted? We are all fatigued. Not only do I have to help my clients manage their fatigue, but I am also focused on the needs of my clinicians and supervisees. No one is immune.

There is no single answer to the best way to cope. As is the case with almost any issue in mental health, we encourage our clients to eat right, sleep right and exercise. This is what I call Moffatt’s Mantra. The treatments for depression, anxiety, grief and a host of other common diagnoses must include these three common components.

But beyond that, coping is idiosyncratic. Things that bring me peace might bring you stress, and vice versa. For example, I just finished a five-day business trip to the Gulf Coast. I stayed in a luxury estate, had a private chef for suppers and ate catered meals otherwise. All of the refrigerators were stocked with just about anything you could imagine. I was paid very well, my workload was light, and I had plenty of time for sailing, deep-sea fishing and the beach.

But I don’t like the beach. I’d rather be in the mountains. I also find it very hard to relax when I’m working, even in luxury accommodations like the ones I experienced. I’m happiest sleeping in my own bed. I may be the only person who wouldn’t find this consulting trip relaxing, but I am intensely introverted. Social events leave me feeling drained, and I’m always “on” when I’m in environments like that.

As odd as I am, I’m not alone in my idiosyncrasies. Some of you reading this might list coping strategies that perhaps nobody else would find helpful. In other words, we shouldn’t assume what would be a healthy coping strategy or stress relief technique for our clients. Our clients need to teach us those facts.

So, here is the physics lesson. The individual spokes on a bicycle are quite weak. Even a child could easily bend one. A bike with only one spoke wouldn’t go very far. In fact, the weight of the bicycle alone would crush that single spoke. But when you put multiple spokes around the rim — with several dozen of them sharing the load — the bicycle sustains its own weight and that of the rider. And the pliability of those spokes — the ones a child could bend — helps the repair person true the rim so that it doesn’t wobble.

This brief foray into physics teaches us something about coping. If you were to ask the bicycle specialist which spoke was most important, they would laugh. All of the spokes are important, and they all have to work together. Our ability to cope with stress, frustrations, anger, relationship problems and grief — all magnified by the pandemic — is based on multiple strategies working together. The more the load is shared, the better.

Even though one strategy — exercise, let’s say — may usually work, it might not always work. Healthy coping involves many skills from which one can draw.

A minimum of three clear strategies, tailored to the individual, is a starting point. We might think of these strategies as legs of a stool. With at least three legs in place, a stool will remain standing, and the more legs on the stool — like the spokes of a bicycle — the harder it will be for something to break it.

So, my response to all those media questions about how we can help people cope during the pandemic is the same. Examine your own life. What tools, skills and strategies have you found helpful in the past? The longer your list, the more spokes you have to sustain you when you feel you are reaching the point of fatigue.

I exercise religiously — almost every day, rain or shine — because I know it helps me avoid fatigue and depression. I nurture relationships — especially my family relationships. I know they are important spokes in my wheel. I need solitude, quiet, predictability and routine. These are some of my spokes, and I might even add my own pillow and my own bed as two others. So, even though a lucrative consulting gig on the Gulf might sound good, I limit them because limiting that kind of work is a spoke for me too.

Know your own spokes and help your clients brainstorm their personal lists. We can’t do that for them. With overt tools to lean on, we will see our way through these very challenging days.

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Primum cura te ipsum: First, heal thyself

By Samuel Kohlenberg August 17, 2020

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During this bizarre and painful epoch beset by pandemic, racial trauma and social injustice, there is a growing emphasis on clinician well-being and self-care, and rightfully so.

Countless articles and blogs have been written about self-care for counselor clinicians, and here is one more. Why write another one? Because as a counselor educator and supervisor, I want to sell you on a goal other than being OK enough to work. Because avoiding burnout is not enough. We need to set the bar higher to competently render care. Make no mistake, this is an ethical issue.

Like many, perhaps, I have always found Latin venerating in a way that underscores the importance of a phrase or idea. Whether carved into cornerstones or encircling university seals, the tradition has gravitas. One idea I find worthy of such reverence, as it pertains to psychotherapy and behavioral health, is that clinicians need to “do their own work.” Therapists need to heal.

Whether it is through traditional talk therapy or other means, therapists need to attend to their own trauma, developmental journeys and growth. While the oft-cited phrase attributed to Hippocrates, “primum non nocere” (first, do no harm), is a vitally important doctrine in mental health, I am suggesting that there is an overlooked and more sequentially vital step in terms of primacy required to avoid doing harm: that therapists confront and deal with their own issues.

Although therapists are often told that they need to take care of themselves and “do their own work,” I do not believe there is enough understanding regarding why this is so crucially important. Yes, it benefits the therapists, it may mitigate burnout, and it may increase professionals’ longevity in the field. But from my perspective, not enough emphasis has been placed on the idea that people who are not OK do not make competent therapists.

This is not to say that people who have endured trauma or have previously met criteria for a behavioral health diagnosis should not pursue jobs as therapists. Far from it. Many of the best therapists I know are as good as they are in large part because of the difficult roads they have had to walk.

There are many ways to describe how therapists doing their own work might affect them professionally, but I am going to focus on three ideas:

1) Your nervous system is an instrument for attachment work and relationship, and it is shaped by how much work you have done.

2) Doing your work helps you project less and become more aware of your projections.

3) Having done the work means being able to genuinely relate to what your patients are going through instead of just understanding. (Note: Although I say “patient,” please feel free to substitute “client.” The reason I prefer patient is that I feel it better emphasizes the connection between the physical and psychological realms, and given the field’s current understanding of the interconnection between the two, I intentionally use language that fits in both lexicons.)

The nervous system

In a typical stress response, a perceived threat can activate the amygdala, leading to the release of epinephrine and coordinating a sympathetic response to the stressor. Typically, this sort of sympathetic activation means that you are no longer using the circuits associated with optimal social engagement (consider, is it harder to tell how other people feel when you are angry?).

The social engagement system is characterized by the feeling of social connection, the ability to read social cues, eye contact, voice modulation and comfort. All of these things shut down when we go into sympathetic activation as part of a stress response.

Imagine a therapist who has yet to “do their own work” sitting in their office listening to their patient describe a traumatic event. Even if an activated therapist gives no obvious facial expression or gesture, how do you think the person sitting across from them will be affected by the therapist’s nervous system switching gears from social engagement to fight-or-flight?

Imagine for a moment a scared child running to a parent or caregiver and being met with warm eyes, a soft smile and a soothing voice. Now imagine the same child being met with scared eyes, decreased facial muscle tone and a flat voice. In which situation is the child going to be more OK?

Similar dynamics play out in therapy. This means that therapists’ ability to stay in their social engagement system affects patients’ likelihood of being OK while doing things such as trauma work. Part of a therapist’s work is using their nervous system to help resource a patient’s nervous system. For some, it will take significant and ongoing work to be able to do this well. 

Awareness

Awareness and projection share a simple relationship: The more aware you are of your projections, the less likely you are to inadvertently allow those projections to affect your relationships with others.

Regardless of theoretical underpinning, modality or clinical philosophy, virtually all types of psychotherapeutic work regard the relationship between therapist and patient as instrumental. Thus, if the therapeutic relationship itself is one of the primary means by which therapists ply their trade, and a lack of awareness can lead to one’s projections interfering with relationships with others, there is an argument to be made that therapists are on ethically dubious ground if they practice without having cultivated enough awareness and done enough work to overcome this potential pitfall.

You are missing your patient if all you can see is your projection. You are not going to realize that it is a projection if you have yet to cultivate enough awareness. 

Relating

There is a difference between understanding what someone is going through and being able to truly relate to it. While psychotherapists are undoubtedly an empathetic bunch, helping someone engage in the process of developmental therapeutic growth beyond where you yourself have grown is no easy task.

Imagine for a moment a 40-year-old in the midst of an existential crisis. Now imagine an empathetic and well-meaning 14-year-old attempting to help that 40-year-old. Unfortunately, a developmental stage is not always as clear as chronological age, and this can lead to blind spots for clinicians that may negatively affect quality of care. Being able to genuinely relate to what your patients are going through is important, and the 14-year-old is going to have a heck of a time helping the 40-year-old.

Keep doing your work

The thing that all of the above ideas boil down to is relationship. It is your job to ensure a helpful clinical relationship, and the relationship itself is the greatest clinical tool that you have. Ensuring that this primary tool is going to be functional, let alone optimal, can require time, effort and a willingness to endure the discomfort necessary for growth.

Of course, more basic day-to-day self-care is still important for fighting burnout and for resourcing one’s self, especially when you are tasked with taking care of others and especially during times in which nobody seems to be OK. The invitation, the challenge, the mandate, is to not stop at “resourced.”

Aim higher. Embrace catalysts for growth and development. Get comfortable with discomfort when it means a potential breakthrough. Do it for you. Do it for them. Do it like it’s your job.

 

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Samuel Kohlenberg is a clinical psychophysiologist, licensed professional counselor and behavioral health educator specializing in the treatment of stress. He is a master of education in the health professions fellow at Johns Hopkins University and a postdoctoral fellow at Saybrook University and works in private practice in Denver. Contact him through his Facebook page or through his website at denverstressclinic.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.