The Need for Self-Care How working with clients can affect you and the importance of coping mechanisms and self-care strategies Roger Higgins 2011
The Cost Of Caring • “There is a cost to caring. Professionals who listen to clients’ stories of fear, pain, and suffering may feel similar fear, pain, and suffering because they care. Sometimes we feel we are losing our sense of self to the clients we serve...ironically, as will be noted later, the most effective therapists are most vulnerable to this mirroring or contagion effect.” (Figley, 1995: 1)
The Cost Of Caring • “Therapists cannot do this work without experiencing assaults to their usual ways of viewing themselves, the world, and other people...we do not believe anyone, however psychologically healthy, can do this work and remain unchanged.” (Pearlman and Saakvitne, 1995b: 295)
How We Can Be Affected • Feelings of helplessness • Questioning of competence • Triggering of own issues • Physical feelings • Unwanted and intrusive thoughts • Changes in beliefs / worldview, often in a negative way
Coping Mechanisms and Self-Care Strategies • All therapists should establish and maintain a balance between their professional and personal lives...(Cerney, 1995: 140) • The success of both the psychotherapy of clients and the self-care of psychotherapists is greatly enhanced by the liberal application of common sense (Rothschild, 2006: xi).
Achieving Balance Between 5 Key Areas • Physical: exercise, activity • Psychological: time for self-reflection • Emotional: comforting activities • Spiritual: experiences of awe • Professional: supervision, peer support
PHYSICAL • In terms of getting back some equilibrium, walking and gardening are very much for me the times when I’m physically on my own. They’re very much grounding experiences for me, making sense of stuff and getting things back into perspective, getting peace again. (Louise)
“Everyone needs an outlet for pent-up emotions of anger, frustration, hostility, and discouragement. Toward that end, physical exertion can help divert aggressive energy; it is a safe way to express powerful emotions.” (Menninger, 1999: 6) • Pearlman (1999: 54) recommends “being physically active through exercise, dance, or hard physical work; reconnecting with one’s body through massage, dance, yoga”.
Select those which apply to you and include anything else you do • Exercise - walking, going to the gym • Activity - gardening, dancing • Eating regularly • Eating healthily • Sleep patterns • Taking time off when sick • Time to be sexual with yourself / partner
Assessment of Self-Care Worksheet • Write down each of the items you have chosen as a statement, e.g. • I go to the gym twice a week and work out for about an hour. • Try and include as many items as possible (a minimum of 5).
PSYCHOLOGICAL • This area covers time for self-reflection and processing, which is an essential component of effective self-care. • Sometimes we may use negative coping strategies like avoidance. • One counselor used a cognitive approach to establish a clear boundary -
After a while I disciplined myself, to some extent, not to carry him around with me. I gave myself some processing time after each session and I gave him longer than I normally do. Then I quite firmly put it out of my mind and said, “Now, you don’t deal with it again ‘til next week,” which sometimes is quite hard, but I think actually, I needed to do that to get that distance and to get that impartiality, that balance back again, before the next session.” (Louise)
Select those which apply to you and include anything else you do • Creating time for self-reflection • Keeping a journal • Being mindful - yoga, meditation • Reading books for pleasure • Learning something new • Doing something different • Saying no occasionally • Listening to your intuition
Assessment of Self-Care Worksheet • Write down each of the items you have chosen as a statement, e.g. • I keep a weekly journal. • Try and include as many items as possible (a minimum of 5).
EMOTIONAL • This area includes comforting activities, such as spending time with family and friends, listening to music and having fun! • I love listening to music. I can wind down listening to music...I can get lost in that and pretend I’m dancing... (Bill) • I do keep a journal when something’s bothering me, but sometimes a hug is all you need...just the touch, that’s all ...(Bill)
One counselor was aware that her method of relaxation could be viewed as a negative coping strategy. • A glass of wine can work wonders too. If nothing else reaches those places, I’ll have a nice glass of wine and a hot bath, although in some ways it’s a negative coping strategy.I think if you’reusing an aid, something like that to get you there, it’s a shortcut...(Daphne)
Several counselors underlined the importance of a support network, where “you just access different bits on different days for different purposes, but they all feed each into other” (Filomena). • Friends, who may or not be therapists, can provide invaluable support and reassurance in times of crisis. • Yassen (1995: 188) believes “connections with other people are restorative” and that “social supports are a central component of the prevention of personal and professional Secondary Traumatic Stress Disorder”.
Select those which apply to you and include anything else you do • Time to relax • Time with loved ones • Having a support network • Accepting small breakthroughs and victories • Laughing • Crying • Being playful • Engaging in social action, campaigning
Assessment of Self-Care Worksheet • Now write down each of the items you have chosen as a statement, e.g. • I arrive home at 6pm each day so that I can spend time with my kids. • Try and include as many items as possible (a minimum of 5).
SPIRITUAL • This area covers beliefs, worldview, finding meaning, cherishing hope, experiences of awe, creativity, and activities which replenish or feed the counselor. • Beliefs, ranging from religious faith to humanistic philosophy, play a crucial role in motivating therapists and in helping them to find meaning in their lives as they listen to stories of unbearable pain, suffering and cruelty.
Pearlman and Saakvitne (1995a) believe therapists suffer spiritual damage as a result of vicarious traumatization and that, as a consequence of this, “it is essential to develop and nurture spiritual lives outside of our work”. • Each counselor values experiences of awe, which can be a simple appreciation of the beauty of nature, but which help the counselor to feel more grounded and balanced.
Counselors also find that there are positive aspects to this difficult work, where “those who voluntarily engage empathically with survivors to help them resolve the aftermath of psychological trauma open themselves to a deep personal transformation. This transformation includes personal growth, a deeper connection with both individuals and the human experience, and a greater awareness of all aspects of life” (Pearlman 1999: 51).
Select those which apply to you and include anything else you do • Having experiences of awe • Being creative - writing, drawing, gardening • Cherishing hope • Having beliefs which give meaning • Being inspired • Going for walks in the countryside • Sharing your spirituality with others • Praying / meditating
Assessment of Self-Care Worksheet • Write down each of the items you have chosen as a statement, e.g. • I go for walks in the countryside every other day. • Try and include as many items as possible (a minimum of 5).
PROFESSIONAL • This area includes supervision, peer support and training. • All the counselors interviewed found supervision, either individual, group, or both, essential, but it has made some counsellors more selective in their choice of supervisor. • Some also believe it is more beneficial if the supervisor for this type of work is of a similar theoretical orientation.
It’s made me think about the different types of support I need while I work, and this is one of the reasons why I’ve got more than one type of supervision, but it’s made me think about who I want supervision with, and it’s made me put another layer in place, as well as the stuff that ticks boxes, that we have to do. • I now look for more experience in the people I work with, and a different level of experience, wider experience, more experience of very difficult situations, rather than just the norm. (Filomena)
Etherington (2000: 146) raises the problem of denial amongst colleagues, where “there is a wish to deny the centrality of the harm caused by abuse”. • This may be why Louise felt her supervisor gave mixed messages, because, although she offered support, “running through that, somehow, there was this (and I don’t know whether that was just me or whether it was her), “Not this one again? Can’t you find something else to bring?”
Peer Support • Peer support is also valued and according to Catherall (1999: 81), “one of the primary sources of support for therapists is the professional peer group. • The therapist’s professional peer group has the power to dilute the impact of STS, to normalize the disturbing reactions, and to help the therapist maintain the therapeutic connection with clients despite his or her personal upheaval”.
Training • No counselors felt that their training had prepared them for the negative effects of STS or had introduced them to effective coping strategies and mechanisms for managing it. • However, all believe that training courses have an important role to play in this area. • “We have a duty to educate those entering the field to anticipate how the work will affect them and to prepare them to address these effects.” Zimering, Munroe, & Gulliver (2003: 3)
Select those which apply to you and include anything else you do • Having adequate and regular supervision • Peer support where you can be open and honest • Peer support which will challenge you • Setting adequate boundaries • Feeling comfortable in your workplace • Having time for lunch • Setting achievable goals
Assessment of Self-Care Worksheet • Write down each of the items you have chosen as a statement, e.g. • I attend a peer support group every two weeks, which challenges me when necessary. • Try and include as many items as possible (a minimum of 5).
BALANCE • But I don’t think the theme of self-care is pushed enough on courses and supervision alone isn’t the answer. You have to have the other things in place to create a balance. (Louise) • Achieving a balance is paramount. Absolutely paramount. (Filomena)
Yassen (1995: 186) refers to the concept of ‘life balance’, which “emphasizes the value of striving for an overall balance of work, outside interests, social contacts, personal time, and recreation. Life balance includes a commitment to life and life-enhancing activities”. • It appears to be the key component in managing the secondary stress which inevitably accompanies work with people who have been traumatized.
Select those which apply to you and include anything else you do • Finding a balance between the 5 areas: physical; psychological; emotional; spiritual; professional. • Finding a balance between work and play • Identifying areas which are out of balance in your life, either professionally or personally. • Developing plans to re-balance those areas.
Assessment of Self-Care Worksheet • Write down each of the items you have chosen as a statement, e.g. • I recognize that I need to spend more time with my children and am going to re-arrange my work schedule to make this happen. • Try and include as many items as possible (a minimum of 3).
CONCLUSION • Self-care needs to be a continual, evolving process for any counsellor / psychotherapist. • Therapists need to discover the combination of elements from each of the self-care areas, which can meet their individual needs, and which may differ considerably from therapist to therapist, in terms of specific activities, beliefs, or interests.
When each of these area is represented in a balance way, “while we will certainly not eliminate trauma nor likely eliminate the hatred, evil, or violence that feeds it, we may learn to transform our encounters with these things into opportunities for growth for ourselves and for those whom we seek to heal” (Stamm, 1999: xviii).