pi3: Good Self-Care for Therapists

Many who take up careers in clinical psychotherapy have a deep personal commitment — some might say calling — to help others on their journey toward better mental health. Some, like post traumatic stress expert Dr. Bessel van der Kolk (whose father was a Nazi concentration camp survivor), found powerful motivation to improve mental illness treatment, after bearing witness to the deep impact of trauma on a loved one.

By nature, the work of a clinical psychotherapist can carry a high risk of burnout because so much of the therapist’s job is to listen deeply to toxic effects of trauma every day.

Helping people recover mental health can be very rewarding. Yet, client success alone is not enough to keep us safe from the risk of burnout – or to keep us as effective with all patients as we can be.

As practicing clinicians, we need self-care strategies of our own to sustain our energies, develop our skills, and maintain our best work as therapists. Good self-care, specific to our therapeutic work, is essential to remaining effective and healthy as clinicians.

What is Good Self Care for Therapists?

Self-care is not a haphazard set of distractions in between office hours.

It means having a personal answer to the question: What are you going to do to ensure that you are present with your patients and at peace within yourself? How are you informed with new knowledge that can make you most effective?

Professional self-care shows in the habits and routines you use to keep a healthy separation between your personal life and your work. Here are some examples:

Being able to set and honor clear boundaries with your time – “These are the hours I work. These are the hours I’m available.”
Having restorative activities in your life other than work – You can take the time you need at day’s end to transition from work to home life. You can enjoy your personal time and close relationships without feeling intrusions from work.
Giving yourself access to consultation with colleagues – You have other clinicians to collaborate with; you can reach out to someone about professional challenges.
Making sure that you are well educated – You remain updated with approaches and skills to respond effectively during client interactions. You can rely on a full range of therapeutic tools and techniques that come to you naturally during sessions with clients, and you are nurturing your strengths.

Creating Self-Caring Rituals and Restorative Separation Time

Higher education programs for clinical psychotherapy have progressed to help therapists promote their own mental health. However, many therapists never truly learn in the classroom how to go from being present 100 percent for patients, to resting from that work when they go home.

Having rituals and separation time are important self-care routines I needed, and which I developed for myself. These are vital to prevent having one area of life spill over into the other. For example:

I make sure I eat breakfast.
I get to the office at least a half an hour or 45 minutes before my first client.
I do whatever I need to do to get myself organized.
I make sure I take a lunch break during the day.

In the morning I have the time I need, so that the angst that I might have over terrible traffic does not spill into my time with patients. I can get settled into my space to really be present with them. My lunch break is the time to take care of myself and make sure that I eat and nourish myself.

And then at the end of the day, because I have a commute, that’s my separation time. My car ride home is when I make the shift between my work life and my home life. These are the 30 or so minutes I have when I am actively leaving work behind before I walk in the door at home.

Good Self Care Is Essential, Not a Luxury

I believe self-care is something we all need to protect with healthy boundaries as therapists. A lot of therapists tend to work through lunch. It’s important to nourish yourself and tend to what you need. You may tell yourself you’re fine with the extra work. But if the quality of client care (or your personal care) is impacted, these work habits may not be in your best interest.

Sometimes you may find that between work life and home life, one is intruding into the other. This may indicate it’s time to re-think self-care. Specific examples:

You’re spending time working (returning client calls, for example), when you were planning to be at home in your personal life
You’ve spent your evening thinking about client X
You dwell on less-than-optimal interactions, thinking “I wish I had done A instead of B”
When you get to work you’re still thinking about that guy who cut you off in traffic
You are in session and your stomach is growling

Hitting “Reset”

Enjoying weekends and time out isn’t just a matter of personal preference. It’s important to rest, connect, and recreate to restore our own emotional balance and effectiveness.

I know for me, that I have to laugh over the weekend because, at work, the energy and emotions we face as therapists can be so heavy. I need to focus in on some of the lighter and enjoyable sides of life with family, friends, and my choice of activities. Laughing is so re-energizing!

What if your life outside of work is not so fulfilling? One of our professional challenges is to be able to be fully present in the present, feel enjoyment, and ensure we get that relaxation we need.

This is why some form of support from colleagues and consultation with colleagues is very important. All therapists are required to have done their own therapeutic work on their own issues. I believe that to be effective, each of us has to sit in that client chair to know what it feels like — and to know we can keep getting the support we need.

Provide for Your Education and Professional Support

Beyond our formal education, it is important to have resources that support you professionally and personally, and enable you to address key issues for you.

Making sure you feel well educated and well supported is part of good self-care. This (feeling) gives you confidence with new ideas to bring to treatment.

Clinical consultation is so important because every professional (I can think of no exceptions) needs this support on a regular basis:

To run ideas past another professional
To learn something new
To have a safe place to work on issues triggered for the therapist (countertransference)

Good clinical consultation (discussed in its own article) is a combination of suggestions (“Here are some approaches to think about with your clients”), and access to support around countertransference issues.

The Outcome of Good Self-Care Strategies for Clinicians

When it comes to strategies for self-care, each clinician will find a balance of activities that works for them. Some activities will be part of each day’s routine. Some will be weekly, some monthly. For example, now in my 20+ year of clinical work, I still gift myself clinical consultations a few times a month, or just when I need it!

I believe that every therapist needs a deliberate program of self-care. Not only does it guard against burnout, it enables us to work at our best, to continue to improve our skills and see better patient outcomes, and ultimately enjoy this challenging and deeply rewarding work to the fullest.

More Resources

Bessel Van der Kolk speaks about his career and book The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (video):https://youtu.be/53RX2ESIqsM?t=10m47s: