By: Veronica H Visger, MA, LLPC, NCC
A common error in judgment can be found within the helping professions. It has been found that too often we forget about, or are lackadaisical about, self-care even though we ask our clients’ to entertain this same ideal. The American Counseling Association (ACA) challenges us ethically to do no harm, benefit others, and pursue excellence in the profession. As helping professionals we then should embrace self-care behaviors for continued personal and professional development.
Freud stated (1905) that “No one who, like me, conjures up the most evil of those half-tamed demons that inhabit the human breast, and seeks to wrestle with them, can expect to come through the struggle unscathed” (p. 184). Clearly, the need for self-care has been spoken about since the start of psychoanalysis.
As a counselor we face various challenges that include burnout, vicarious traumatization, compassion fatigue, and elevated risks of stress (Tan & Castillo, 2014). Professional burnout has been described as a state of psychological, spiritual, physical, and emotional exhaustion as result from chronic involvement or exposure in human service work (Newell & Nelson-Gardell, 2014). Newell & Nelson-Gardell (2014) further describe burning out as a progressive state “conceptualized as a multi-dimensional construct with three distinct domains – emotional exhaustion, depersonalization, and reduced personal accomplishment”. Secondary traumatic stress (STS), or vicarious traumatization, is the result of empathically engaging in relationships with clients suffering from traumatic experiences and bearing witness to their intense and horrific traumatic experiences. Symptoms of STS, or vicarious traumatization can mirror those of post-traumatic stress disorder (PTSD) in the helping professional (Newell & Nelson-Gardell, 2014). Compassion fatigue is the overall experience of both emotional and psychological fatigue that can be experienced by helping professionals due to the chronic use of empathy (Newell & Nelson-Gardell, 2014). Lastly, common with other professions, an occupational hazard also experienced in the helping professions is elevated risks of stress. As we are all aware, stress is deadly. Research has shown that self-care and planning is paramount in helping to prevent these challenges from affecting our professional ability to help others clinically in a therapeutic relationship. Burnout, STS, compassion fatigue, and stress are a reality if self-care isn’t a priority for those in the helping professions.
Goncher, Sherman, Barnett, & Haskins (2013) endorse both graduate psychology students and psychologists engaging in ongoing self-care as both a foundational professional competency and an ethically imperative practice. Furthermore, Tan & Castillo (2014) found that self-care strategies for the professional self and personal self are rather intimately related. Their research found that self-care should include ongoing self-awareness, using helpful self-care strategies, and active self-assessment. Goncher, et al. (2013) endorse the ongoing use of 12 self-care strategies by psychology trainees and psychologists in order to manage inherent professional challenges and stressors, these include: “valuing the person of the psychotherapist, refocusing on the rewards of the practice of psychology, recognizing occupational hazards, minding the body, cultivating and nurturing supportive relationships, setting boundaries, cognitive restructuring, sustaining healthy escapes, creating a flourishing environment, personal psychotherapy, cultivating spirituality and mission, and fostering creativity and growth” (p. 57) (Tan & Castillo, 2014). While Goncher, et al (2013) and many other researchers have given us lists of strategies to engage in self-care it is best to also operationally define the physical, psychological, spiritual, and support components of self-care.
The physical component of self-care entails the incorporation of physical activity into your daily activities. This can be achieved through exercise, activities of daily living, or sports. Recommendations are usually made to engage in physical activity, under the supervision of a physician, for at least 30 minutes a day. While there are specific advantages of engaging in physical activity it has also been shown to benefit general wellness, decrease symptoms of anxiety and depression, increase the health component of quality of life, and also increase women’s satisfaction with body functions and ability to cope with daily stresses (Campenni, C.E, Muse-Burke, J.L., & Richard, K.C., 2010).
The psychological component of self-care entails seeking personal counseling to share in the same benefits of counseling that we offer our clients. In the practice of implementing self-care strategies it is of importance to remember that we need not be so self-sufficient, prideful and independent to think that we can care for others and ourselves with our own strength alone. We need others, both personally and professionally, so must remain mindful of the suggestion of personal psychotherapy (Goncher, et al, 2013; Tan & Castillo, 2014). Mackey & Mackey (1994) found that personal counseling supports professional development for counselors as it allows for better understanding of self-care and development of an awareness of one’s limitations and boundaries. Research by Mahoney (1997) that included psychotherapy practitioners (N=155) found the most frequently reported personal problems clustered around emotional exhaustion and fatigue although they were concerns among less than half the sample. On a positive note, Mahoney (1997) found that of the 155 practitioners in this study 90% of them were active in personal counseling with very positive ratings of their experience. Counselors’ empathic skills and self-awareness are both enhanced in personal counseling and are significant advantages in professional development (Mackey & Mackey, 1994). The study by Mahoney (1997) speaks volumes about the need for the helping profession to engage in self-care. If we were to generalize this sample of psychotherapists to the norm it appears as if most psychotherapists understand the importance of the component of self-care about personal counseling. However, even with personal counseling half of the psychotherapists still self-reported experiencing emotional exhaustion and fatigue – symptoms of burnout. Caring for ourselves personally and professionally thus isn’t an option it is a necessity. Cleary, engaging in personal counseling as a self-care activity is very beneficial personally and professionally as Mackey & Mackey (1994) found.
The spiritual component of self-care is described as how a counselor connects and makes an understanding with both their sense of purpose and their meaning of life (Campenni, et al., 2010). Spirituality has been found to not only promote quality of life but also a sense of self-awareness (Campenni, et al., 2010). Spiritual/religious beliefs and quality of life are positively correlated. Furthermore, Hamilton & Jackson (1998) suggest that spirituality is important for the continued progression and development of self-awareness. Included in spirituality is the practice of meditation for counselors. I have personally incorporated meditation time into my daily routine and have found this very beneficial to help to stay centered and more fully present with each client.
The support component of self-care includes interactions and relationships that are developed from both personal and professional support systems. Professional support entails supervision and consultation from peers, supervisors and colleagues. Professional support also is defined as continuation of professional education through personal research, seminars, and education. (Campenni, et al., 2010). Personal support is defined as our relationships with a spouse, friends, companion, and other family members (Campenni, et al, 2010). A suggestion that was made in my graduate education was to create support groups amongst ourselves that get together monthly for both professional and personal support and growth after graduation. This suggestion rang true and aligns with the self-care principles found within the current research as described here within. I enjoy the benefits of this and am grateful this suggestion was made. As we learn in the educational and clinical process both supervision and consultation help us to recognize and overcome ethical and clinical difficulties and can help us in our case conceptualization. Per Campenni, et al. (2010) mental health professionals should routinely participate in professional communication with colleagues in order to prevent burnout as well as for the benefit of further professional development and thus greater continued self-awareness. As demonstrated here within thus far self-care influences our self-awareness (Hamilton & Jackson, 1998).
Research conducted by Campenni, et al. (2010) of N=148 mental health professionals holding a bachelors degree or higher and practicing as fully licensed or graduate students in the northeastern United States found some interesting correlations as described here within. Utilizing the definitions of self-awareness as “knowledge of one’s thoughts, emotions and behaviors” and mindfulness as “maintaining awareness of and attention to oneself and one’s surroundings” results showed a significant positive correlation between the two. Specifically, when self-awareness increases so does mindfulness, and vice versa (Campenni, et al., 2010). Of note, this research found a significant positive correlation also between self-care frequency and well-being indicative of increased participation in self-care activities associated with an increased general well-being (Campenni, et al., 2010). While mindfulness and self-awareness are positively correlated neither were found to be significant mediators in the relationship between self-care activities and well-being in the research. Furthermore, “mindfulness was found to indirectly influence the relationship between self-care importance and well-being but not the relationship between self-care frequency and well-being” (Campenni, et al., 2010). The research by Campenni, et al. (2010) did find a positive correlation between self-awareness and well-being independent of self-care suggesting that an increase in self-awareness increases well-being and vice versa. Lastly, the research by Campenni, et al. (2010) also showed a significantly positive correlation between self-care frequency and self-care importance. This correlation is also then indicative of frequency of participation in self-care activities bringing about a rise in perceived importance of them and vice versa (Campenni, et al., 2010). To best summarize and understand the correlations in this research this researcher has noted the correlations as found below:
|CAMPENNI, ET AL., (2010) CORRELATIONS|
|Increased Self-Awareness = Increased Mindfulness|
|Increased Mindfulness = Increased Self-Awareness|
|Increased Self-Awareness = Increased General Well-Being.|
|Increased General Well-Being = Increased Self-Awareness.|
|Mindfulness is NOT a significant mediator in relationship between self-care frequency and well-being. Mindfulness influences self-care importance and well-being indirectly.|
|Self-awareness is NOT a significant mediator in the relationship between self-care and well-being. Self-awareness influences self-care importance and well-being.|
|Increased self-care frequency = Increased General Well-Being|
|Increased General Well-Being = Increased Self-Care Frequency|
|Increased frequency of participation in self-care activities = increased perceived importance in them.|
|Increased perceived importance in self-care activities = increased frequency of participation in them.|
How can we practically implement the results of this research? First we must be mindful that ultimately we are responsible for our own wellness and this includes both personal self-care and professional self-care. To improve personal wellness and professional effectiveness mental health professionals should regularly adhere to practices that enhance their overall well-being. Research by Goncher, et al. (2013) found that disconnect in self-care use clearly highlights the importance of appropriate self-care strategies being taught to graduate students. Furthermore, they found that the importance of stressing self-care strategies at the beginning of graduate training is paramount in helping professionals learn to utilize these strategies throughout their professional career (Goncher, et al., 2013). The importance of participating in self-care activities regularly, seeking greater self-awareness and mindfulness, and striving to foster a sense of general well-being should be something that is spoken of in graduate programs and among licensed professionals frequently. A starting point for self-care strategies for current graduate students and the seasoned helping professional are found below again for quick reference (Goncher, et al., 2013):
- Value the person of the psychotherapist
- Refocus on the rewards of the practice of psychology
- Recognize occupational hazards
- Mind the body
- Cultivate and nurture supportive relationships
- Set and maintain boundaries
- Utilize cognitive restructuring
- Sustain healthy escapes
- Create a flourishing environment
- Engage in personal psychotherapy
- Cultivate spirituality and mission
- Foster creativity and growth
Campenni, C. E., Muse-Burke, J. L., & Richards, K. C. (2010, July). Self-care and well-being in mental health professionals: the mediating effects of self-awareness and mindfulness. Journal of Mental Health Counseling, 32(3), 247+. Retrieved from click here for reference link
Freud, S. (1905) Fragment of an Analysis of a Case of Hysteria. S. E. 7. London: Hogarth Press
Goncher, I.D., Sherman, M.F., Barnett, J.E., & Haskins, D. (2013). Progammatic perceptions of self-care emphasis and quality of life among graduate trainees in clinical psychology: The meditational role of self-care utilization. Training and Education in Professional Psychology, 7, 53-60. doi:10.1037/a0031501
Hamilton, D.M., & Jackson, M.H. (1998). Spiritual development: Paths and processes. Journal of Instructional Psychology, 25, 262-270.
Mackey, R.A., & Mackey, E.F. (1994). Personal psychotherapy and the development of a professional self. Families in Society, 75, 490-498.
Mahoney, M. J. (1997). Psychotherapists’ personal problems and self-care patterns. Professional Psychology: Research and Practice, 28(1), 14-16. doi:http://dx.doi.org/10.1037/0735-7028.28.1.14
Newell, J.M., & Nelson-Gardell, D. (2014). A competency-based approach to teaching professional self-care: An ethical consideration for social work educators. Journal Of Social Work Education, 50(3), 427-439.
Newsome, S., Chambers-Christopher, J., Dahlen, P. & Christopher, S. (2006). Teaching counselors self-care through mindfulness practices. Teachers College Record (Columbia University), 108(9), 1881-1900
Tan, S.-Y., & Castillo, M. (2014). Self-care and beyond: a brief literature review from a Christian perspective. Journal of Psychology and Christianity, 33(1), 90+. Retrieved from click here for reference link