Online continuing education provider for mental health professionals by real professionals with real clinical experience.

2020 – 05 – Self-Care

Trauma informed care is not only about the way that we treat our clients. It is also about how we treat ourselves.

Self-care is an important aspect of any mental health professional’s work. Due to the type of work that we do, it is even more important that we are able to monitor and manage our own stress as a result of our work. Self-care is the idea that we take time to ensure that we are emotionally, mentally, and physically healthy; in other words, that we care for ourselves. While this might sound like an important factor to consider in any job, it is especially important in the mental health field due to the intense stories and experiences that our clients often disclose to us in session.  

As mental health professionals, one thing that we have to always keep in mind is the fact that we are all humans…not superhumans. We have our own personal lives, families, significant others, pets, children, community obligations, hobbies, etc that we must also adhere to. However, the perception is often that we are superhuman as a mental health professional. Maybe you have already experienced this from clients where they might have made comments to you that implied that you do not struggle with the same things that they do. Or maybe you have had friends or family members insinuate that you are better at managing your emotions or stressful situations than they are because of your line of work. While there may (or may not!) be truth to these ideas, even the idea can cause pressure on mental health professionals to somehow make sure that they are doing better than everyone else. Sometimes we might even feel pressure from our own clients to enact this role when working with them as a way to be a firm support for them. This becomes especially true when we have clients that are actively in crisis or domestic violence situations.

One of the main reasons why it is so important for mental health professionals to engage in self-care is because it can help us to avoid negative effects of burnout, vicarious trauma, and compassion fatigue. Research has supported the idea that self-care is directly related to a therapist’s ability to fight off the negative effects of work related stress in the behavioral health field (Meyer & Ponton, 2006; Grafanki et al., 2005).

Self-care is not always about taking a vacation, spending time with family, or picking up a new hobby. It can also be attending a professional training, networking with other colleagues in the field, or working with a different client population. Professional engagement and seeking out regular supervision can be a health way for professionals to ensure that they are growing professionally and have an appropriate mechanism for letting out steam. While this might be more easily achievable in a community mental health clinic or in agency work, it can be more challenging for those in a small or private practice setting. In fact, solo private practice settings are some of the most dangerous for ethical compromising situations to occur (Celenza, 2007; Pope & Bouhoutsos, 1986). If you practice in setting like this, you might want to consider one of the following activities to help protect your work:

  1. Regular Supervision
  2. Consultation with Peers

Self-care is such an important part of mental health professionals’ work that the American Counseling Association has dedicated an entire Task Force to outlining some helpful ways that we can incorporate this into our work (ACA, 2003):

  1. Rethinking Your Shoulds

One of the struggles in making the case for a wellness effort among counselors is that often counselors do not practice what they preach (O’Halloran & Linton, 2000). The task force is sensitive to the fact that counselors have unique challenges to their own wellness when regularly and intimately involved in the painful experiences of other people’s’ lives. Cognitive restructuring-namely taking time to track negative cognitions that interfere with self-care-can be an effective tool for clinicians who clearly know successful strategies to promote their wellness yet have difficulty implementing them. What are the “should” statements that prevent you from leaving the office earlier, saying “no” to requests from colleagues, or taking lunch? Giving yourself permission to set limits and say “yes” to your own needs is a critical first step.

  1. Begin Where You Are Now

In assessing your wellness strategies generally, ask yourself the following two questions:

  1. When I examine my wellness needs, what area do I want to begin with Today?
  2. What area is being most taxed Today?
  3. Develop a Self-Care Program for Your Whole Self

A self-care program should take a holistic approach toward preserving and maintaining our own wellness across domains. Pearlman and MacIan (1995) note the ten most helpful activities that trauma therapists use to promote wellness. They include:

  1. Discussing cases with colleagues
  2. Attending workshops
  3. Spending time with family or friends
  4. Travel, vacations, hobbies, and movies
  5. Talking with colleagues between sessions
  6. Socializing
  7. Exercise
  8. Limiting case load
  9. Developing spiritual life, and
  10. Receiving supervision.

Peer Support

The support of peers and other social supports are often overlooked, and yet consistently appear as an asset in maintaining wellness. An active supportive relationship with supervisors and peers is an especially important component of self-care for counselors (Catherall, 1995; Munroe, Shay, Fisher, Makary, Rapperport, & Zimering, 1995).

When a mental health professional is struggling, their ability to accurately monitor their own wellness may also become impaired. At those times the support of peers and supervisors can be especially helpful. More important than simply identifying whether we are stressed, distressed, or impaired, supervisors and peers play a role on the assets side of the ledger. Too often supervision is provided only for counselors who are new to the field or seeking licensure. Supervision can help, even veteran counselors, maintain an appropriate perspective on the counselor’s role, mitigating the harmful secondary exposure to trauma by helping counselors to process their counseling work. It is especially important for supervisors in this role to understand that counselors experiencing impairment, or the prelude to impairment, require support towards ameliorating the problem and promoting resiliency. Ultimately, the care that counselors provide others will be only as good as the care they provide themselves.

What Agencies Can Do to Support Wellness:

  1. Educate your staff and supervisors on the concepts of impairment, vicarious traumatization, compassion fatigue and wellness.
  2. Develop or sponsor wellness programs (such as in-service trainings and day-long staff retreats)
  3. Provide clinical supervision (not just task supervision)
  4. Encourage peer supervision
  5. Maintain manageable caseloads
  6. Encourage/require vacations
  7. Do not reward “workaholism”
  8. Encourage diversity of tasks and new areas of interest/practice
  9. Establish and encourage EAPs

Have you ever been in a situation with a client where they have said something that triggered a reaction in you? I remember a colleague telling me about when he was doing an intake with a male client who was bragging to him about his womanizing behaviors and all my colleague wanted to do was punch him in the face. He didn’t of course. But his initial reaction to him sharing this information was not good. Maybe you’ve had a similar situation happen to you with a client. We all have emotional triggers and reactions. These are normal and what make us human. We are not exempt from having these initial reactions simply because we are mental health professionals. However, we do have a responsibility to control these reactions and engage in self-monitoring behaviors to help us re-focus on what is happening in the therapeutic session.

While self-monitoring behaviors are always important for therapists regardless of the situation, they are especially important during crisis situations. It is imperative for mental health professionals to always be able to monitor their own reactions and ensure that they can appropriately respond to the crisis at hand. When we are unable to monitor our own reactions to crisis situations, we put ourselves at risk as well as those we are trying to help by not being able to properly assist those in need.  

One of the reasons why it is so vital for mental health professionals to be able to remain in control in crisis situations is because these circumstances usually evoke strong emotions and anxiety in clients. If a mental health professional is not skilled and prepared for handling these types of situations, they cannot appropriately respond to the crisis situation and ultimately be of any help for the client in distress.  

Another aspect of remaining in control is that as mental health professionals, we will encounter many different people who hold different values and beliefs than our own. I am sure that you have experienced something similar. I am also sure that you have heard about the importance of “checking your own biases at the door” when working with a client. In a similar way to handling crisis situations, we also have to ensure that we are appropriately reacting to others’ views, beliefs, and values when they differ from our own. Not only is it ineffective when we are working with clients to react negatively to their differing views but it is also considered unethical.

Countertransference is a term that dates back to the early psychoanalytic days. In its most basic definition, it is the emotional reaction of the analyst to the subject’s contribution. In other words, it is the emotional reactions that we as mental health professional may have toward our clients when we are trying to remain objective in our client’s treatment. When specifically working with clients, it is likely that we will experience a wide range of reactions, including stereotypes, projections, and reactions from finding similarities (or differences of opinions or values!) with the client.

In example, suppose a mental health professional finds themselves working with client who reminds them of their ex-spouse. The client might make comments that are similar to something that their ex-spouse might have said and the clothes that they wear might remind the professional of the same style as their ex-spouse. For the sake of the example, let’s also pretend that the mental health professional ex-spouse had a long-term affair and that is what, ultimately lead to the ending of the marriage. As treatment begins, the client discloses that they are having an affair on their spouse. When the professional is working with this client who reminds them of their ex-spouse it could become very difficult for the professional to remain truly objective when they might begin to ascribe specific traits and conclusions about the client that may or may not be true.

If you were the mental health professional in this scenario, what would you do?

With this scenario, should the mental health professional always refer the client out to someone else who will not experience the same kind of countertransference issues with the client? Is it ever possible for a mental health professional to be effective even when struggling with countertransference issues with a client? The answer is: it depends.

This is where self-awareness is important and comes into play in our work.

  • First, we, as mental health professionals, must have the ability to recognize and acknowledge that we are experiencing these feelings and thoughts about the client. There might be those of us who incorrectly believe that we are invincible and no client could ever create countertransference issues for us. In reality, every mental health professional is at risk for being susceptible to these types of issues. Having the ability to recognize your own susceptibility and risk is imperative.
  • Second, we need to consult with other professionals about the situation. Having a third-party, outsider to consult with about the situation can be helpful as they can offer guidance and can let you know if you are remaining truly objective or not.
  • Third, if we cannot remain objective we must refer the client to another professional who can offer that objectivity. If we can remain objective, we need to continuously seek out supervision or consultation from other professionals throughout the treatment, document their feedback, and document everything that we are doing with the client to ensure objectivity is being properly maintained.