1. THERAPIST SELF-CARE Sandra Stith, Ph.D. Fall 2007 Adapted from presentations by Diane A. McKay, Psy.D., P.A. And Eric McCollum, Ph.D., Virginia Tech

2. Paradox Of Providing Therapy? We are rewarded for our choice of profession in many ways. Examples There are also challenges associated with our choice of profession Examples We often experience the same struggles that our clients experience. We are human

3. Paradox Of Providing Therapy? (cont’d) Masterful at helping others learn about and practice self-care, many of us struggle with conflicts and deterrents to our own self-care. Each of us brings our own personal and professional history to the practice of self-care. This history can both help and complicate the process.

4. The Irony Of It All? As therapists, we use our education, training, and skills to help our patients to live more rewarding and healthy lifestyles, independently. Ironically, many of us are reluctant to offer ourselves the same kind of understanding and care. Yet, in reality, it is this self-care, personal and professional, that ultimately is the most important not just for us, but for our clients. It is possible that we are one of the few, if not the only profession, that does not purchase or utilize its own product?

5. What causes therapist stress? Individual issues Stress from work Mismatch between expectations and reality Organizational Too much to do in too little time Organizational climate  Value conflicts  Gender/age/racial bias  Theoretical conflicts  Little positive feedback for performance

6. Work Related Distress (National Survey by Pope & Tabachnick, 1993) 80% reported feelings of fear, anger, and sexual arousal at various times in their work 97% feared that a client would commit suicide Almost 90% felt anger at a client at some point Over half admitted to having been so concerned about a patient that their eating, sleeping, or concentration was affected. Like their patients with a corresponding diagnosis, therapists exposed to a patient’s trauma can develop emotional distancing or insensitivity loss of trust in others increased alcohol use and/or ultimately burnout.

7. What causes therapist stress? Client generated stress Difficult clients What types of clients are most stressful to you? High expectations Lack of success Special factors for family therapists Wetchler and Piercy article Table 104 –Potential stressors Table 105 Enhancers

8. Special issues Women or people involved in parenting Men

9. Special issues Stressors and enhancers of life as a therapist for single people Stressors and enhancers of life as graduate student Exercise (discuss in small groups how learning to do and doing this work has affected you)

10. Why is it so hard to attend to our own needs for nurturance, balance, and renewal?

11. Not Me!!! Many factors influence the effects of stressors on individual therapists. Our personal history, developmental state, and personality as well as the potency of the individual or cumulative stressors, affect our susceptibility to stress. “An accumulation of stressors … together in some critical mass” (Kottler & Hazler, 1997, p. 194) can conceivably happen to any psychotherapist in the course of a personal and professional lifetime and can knock even the physically and mentally healthiest of therapists off balance.

12. Emotional Overload/Depletion We witness and vicariously experience a cumulative barrage of raw emotion. Emotional overload or depletion is not disabling. Can include many symptoms such as disrupted sleep depleted physical and mental energy emotional withdrawal from family less interest in socializing with friends fantasies about mental health days or paid vacation fantasies about being taken care of.

13. Therapist Distress Therapist distress describes conscious discomfort of suffering Distress “per se does not necessarily imply impairment” (O’Connor, 2001) It might be seen or used as a warning signal Has the potential to affect the quality of patient care Many personal and professional sources Over 60% of therapists reported having been seriously depressed at some point during their career Others experience marital/relationship difficulties, inadequate self-esteem, anxiety, and career concerns (Pope & Tabachnick, 1994)

14. STAGES OF BURNOUT The honeymoon Boundless energy Believe job will satisfy all your needs and desires and solve all your problems Awakening Disillusionment and disappointment grow Often work harder and become increasingly tired, bored, frustrated. Question your competence and start losing self-confidence

15. BROWNOUT Early enthusiasm gives way to chronic fatigue and irritability Eating and sleeping patterns change Productivity drops

16. Burnout Terminal Phase of Therapist Distress Freudenberger (1984) defined the term as “a depletion or exhaustion of a person’s mental and physical resources attributed to his/her prolonged, yet unsuccessful striving toward unrealistic expectations, internally or externally derived.” Symptoms include: fatigue, frustration, disengagement, stress, depletion, helplessness, hopelessness, emotional drain, emotional exhaustion, and cynicism.

17. Other symptoms of Burnout Despair Overwhelming sense of failure Devastating loss of self-esteem and confidence Depression Suicide, stroke, heart attack Physical or mental breakdown

18. SELF-CARE AS A CONCEPT Self-care is being widely discussed these days as a healthy and valuable process. The myriad of books available on the general market address the benefits of self-care, self-nurturance, and self- nourishment. Self-care is a responsible practice – for all human beings – and in disputably for those employed in the service and care of others, like psychology. Self-care is a lifespan issue, personally and professionally, whatever your theoretical or clinical worldview.

19. Therapist Self-Care Therapist Self-Care is a comprehensive and broad subject that benefits from a Broad-Based Theoretical Orientation which considers character development, symptom reduction, and coping strategies. *Responsible self-care is a complex, lifelong, trial and error process.*

20. 3 Key Components of Self-Care Self-Awareness (uncovering) Self-Regulation (coping) Balance (centering)

21. SELF-AWARENESS “Awareness is a prelude to regulating our way of life, modifying behavior as needed.” It involves benign self-observation of our own physical and psychological experience to the degree possible without distortion or avoidance. Only if we are aware of our needs and limitations can we consciously weigh our options in tending to those concerns, whether external or internal and whether related to personality, life state, or circumstance.

22. SELF-AWARENESS (cont’d) Without it, we risk acting out repressed (and thereby unprocessed and unmanaged) emotions and needs, in indirect, irresponsible, and potentially harmful ways that are costly to our self, personally and professionally, and to our patients, family, and others. If unaware of our self needs and self dynamics, we may unconsciously and unintentionally neglect our patients or exploit them to meet our own needs for intimacy, esteem, or dominance.

23. SELF-REGULATION Refers to the conscious and less conscious management of our physical and emotional impulses, drives, and anxieties. Regulatory processes, such [as] relaxation, exercise, and diversion, help us maintain and restore our physiological and psychological equilibrium. Our sense of well-being and esteem is closely related to the level of mastery of our self-regulation and impulse control skills. Difficulties in self-regulation often cause frustration of shame.

24. SELF-REGULATION (cont’d) To regulate mood and affect: we must learn how to both proactively and constructively manage dysphoric affect (such as anxiety and depression) AND adaptively defuse or “metabolize” intense, charged emotional experience to lessen the risk of becoming emotionally flooded and overwhelmed A fine line may exist between stimulation that is nourishing and enriching AND stimulation that is overwhelming and stultifying.

25. SELF-REGULATION (continued) Our goal is to learn what we need to do to keep our self [selves] on course – to develop our own internal gyroscope. Our ability to self-regulate increases when we are self-aware of our feelings, needs, and limits and when we practice managing dysphoria and intense emotions.

26. BALANCE A positive connection and relationship with our self, others, and the universe which serves as an antidote to the anxieties of the human condition. Balance is essential in enabling us to tend our core needs and concerns, including those of the body, mind and spirit; of the self in relation to others; and in our personal and professional lives. Balancing can involve many factors, such as time, energy, and money. The goal of balance is commonsensical, frequently cited advice. It’s an ongoing process to learn, find, practice, maintain, and regain our balance.

27. PREVENTING BURNOUT Increase your sense of control Create realistic expectations for yourself Monitor the impact of stress on your life Find things outside of work that give you meaning in life Arrange your schedule to not concentrate stressors Set limits Get support – TALK Look for first signs of burnout, especially the state of non-feeling

28. CONCLUSION We know that self-care is a healthy, self-respecting, mature process. Appropriate self-consideration is a manifestation of a healthy respect for one’s self and one’s clients. It is, in turn, in the service of a robust, autonomous self. We need to replenish if we are to share with others. We require both physical and psychological nourishment and rest to restore our well-being and to give what we want to give – to our patients, as well as to the significant others in our lives. Self-care thus is different from selfishness, self- absorption, or self-indulgence.

29. CONCLUSION Self-preoccupation is, in fact, more likely to occur as a result of inadequate self-care over time. Given the fine line between the therapist’s personal and professional self, self-denial or self-abnegation is neglectful not only of real self needs, but ultimately of patient care. The reality is that therapists, as professionals and as human beings, have the right, and deserve, to share with ourselves the same time, care, and tenderness we extend to clients, family, and friends.

30. Activity Develop self-care plan Post it on your refrigerator