I have chosen a grueling and demanding calling: I am a licensed professional counselor. This calling is both one of the most emotionally challenging of professions and one of the most uplifting human endeavors. I serve as a holding container, a cradler of secrets, a re-enactor of Bowlby’s secure attachment, and a key change agent in facilitating another’s personal growth. Along with my colleagues in the mental health professions, I bear witness to human suffering. I see human depravities that often unfold in therapy, but also the most glorious and profound self-growth imaginable.Self-Care in the Face of Vulnerability to Burnout
People in my profession frequently experience strong emotions brought about by the intimacy of the counseling relationship. Our work is particularly challenging in that it requires deep and sustained engagement with clients. Because of the psychologically, emotionally, and spiritually demanding nature of this work, compassion fatigue and burnout are hazards of the profession, which in turn significantly impact our ability to be effective counselors.
Moreover, traditional self-care is primarily solitary. This is the paradox of the therapist’s working environment: working alone despite the intimacy of many therapeutic relationships. Indeed, the counseling profession can be both isolating and overwhelming.
Thus, attending to our personal selves is critical for us to be able to serve our clients. In fact, self-care activities that promote well-being are mandated by professional counseling associations and state laws in order to maintain professional competencies.
Despite the theoretical foundation underpinning the professional necessity of self-care for therapists, there is no widespread agreement about how to actually do it. Self-care is a topic more conceptualized than applied, and ironically, one that is more requested of our clients than expected of ourselves.
Moving away from a Deficit Model
The traditional self-care strategies that do exist follow a pathology-oriented model, focusing on reducing and mitigating stress-related outcomes, counteracting burnout and compassion fatigue, avoiding stress-related adverse effects, reducing professional impairment, and limiting legal liability.Therapists are left with no clear direction for proactively meeting the demands of a demanding profession, nor are they encouraged to draw on a community of support. Thus, there is a very real unmet need for nurturing a culture of self-care that integrates psychological, emotional, spiritual, and relational wellness into our professional identities, a foundation from which therapists can sustain not only their professional functioning, but their very selves.
The science of positive psychology offers a radical shift in both the theory underlying self-care and the self-care practices. A positive-psychology-based model changes the focus from deficit-based to one oriented to well-being, while shifting the goal from mitigation and remediation to self-renewal and optimal functioning, both personally and professionally. When I picture a flourishing therapist, I see someone who engages in self-care practices that promote personal self-growth, spiritual fulfillment, emotional support, psychological replenishment, and relationship connection. The contrast with traditional self-care is illustrated in the table below.
|TRADITIONAL SELF-CARE||POSITIVE PSYCHOLOGY|
|Pathology-oriented model||Model oriented to wellbeing, thriving, and flourishing|
|Reduce and mitigate stress-related outcomes||Cultivate the conditions for self-renewal|
|Remediate burnout, compassion fatigue, and professional impairment||Promote self-growth, improvement, and transformation|
|Focus on self-protection, reducing risk, and limiting exposure and legal liability||Focus on optimal personal and professional functioning|
|Constrictive and restrictive||Expansive|
|Practiced in isolation||Engages community and connectedness|
Practices Drawn from Positive Psychology
Using positive psychology’s pillars of well-being, I developed a formal self-care program for therapists that cultivates enhanced well-being by offering psychological, emotional, and spiritual support through peer connection and community.The acronym, PSYCH, succinctly describes the motivation for this set of practices: Positive Self-care Yields Caring Healers.
The program consists of seven evidence-based interventions, each of which has been demonstrated to contribute to therapists’ well-being as well as to translate into tangible benefits in the maintenance of the therapeutic relationship and the effectiveness of therapy. Importantly, PSYCH is practiced within a group setting, providing opportunities for therapists to come together for social connectedness, which capitalizes on the demonstrated benefits of relationships and social support.
Component activities include:
- Positive Introductions, in which individuals describe a time when they were their very best selves
- Strengths Spotting, in which partners acknowledge and describe the use of a specific strength by the other
- Active Constructive Responding, in which partners practice the principles of supportive responses to positive events
- Positivity Portfolios, in which participants cultivate positive emotions and foster emotional perspective through creation of a collection of mementos focused on a selected positive emotion
- Savoring by seeking bittersweet experiences, in which participants focus attention on an experience in three dimensions of time (past, present, future)
- Reciprocity Ring, in which high-quality connections are fostered as participants both make requests and help to fulfill requests
- Group meditation, prayer, and/or reflection, in which participants are mindful and/or spend time in the presence of God, Spirit, Nature, a Higher Power
The table below shows how these activities contribute to pillars of well-being.
|Pillar of Well-being||Impact on Therapists||Contributing Activity|
|Self-worth||Enhances compassion, cushions against stress, fosters psychological flexibility, cultivates curiosity and listening skills||Positive Introductions|
|Meaning||Improves wellbeing, sense of meaning, coherence, purpose & relatedness, limits over-identification||Signature Strengths|
|Relationships||Improves empathy, relationship quality||Active Constructive Responding|
|Positive emotions & perspective||Increase positivity & wellbeing, enhances inter-connectedness||Positivity Portfolios|
|Engagement & attention||Improves skills for engaging and separating||Savor the Bittersweet|
|Connectedness & community||Cultivates understanding, empathy, & trust||Reciprocity Ring|
|Spirituality, transcendence, & religion||Improves attention & self-monitoring, welcoming & witnessing practices||Meditation / Prayer / Reflection|
Therapist self-care represents a unique application of the principles of positive psychology. Self-care that supports and sustains clinicians’ well-being through positive evidence-based strategies has immense potential not only for the therapists’ wellness, but also for the benefit of those they serve.
Schiavone, L. M. (2017). Positive Self-Care Yields Caring Healers (PSYCH): A Positive-Psychology-Based, Peer-Supported Self-Care Series for Therapist Wellbeing. MAPP Capstone, University of Pennsylvania.
Bowlby, J. (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. Basic Books.
Best Self Introductions: Peterson, C., (2006). A Primer in Positive Psychology New York, NY: Oxford University Press.
Strengths-spotting: Niemiec, R. (2013). Mindfulness and Character Strengths. Hogrefe.
Active-Constructive Responding: Gable, S. L., Gonzaga, G. C., & Strachman, A. (2006). Will you be there for me when things go right? Supportive responses to positive event disclosures. Journal of Personality and Social Psychology, 91, 004-917.
Positivity Portfolio: Fredrickson, B. L. (2009). Positivity: Groundbreaking Research Reveals How to Embrace the Hidden Strength of Positive Emotions, Overcome Negativity, and Thrive. New York: Crown.
Savoring: Bryant, F. & Veroff, J. (2007) Savoring: A new model of positive experience.. Mahwah, New Jersey: Lawrence Erlbaum Associates.
Reciprocity Ring: Grant, Adam. (2013). Give and Take: A Revolutionary Approach to Success. Viking Press.
Group meditation or religion: Lyubomirsky, S. (2008). The How of Happiness: A Scientific Approach to Getting the Life You Want. New York: Penguin Books.
Photo Credit: Flickr via Compfight with Creative Commons licenses
Holder of secrets courtesy of Gwendal_
Minister to loneliness courtesy of marcoverch
We don’t have to walk alone courtesy of Baha’i Views / Flitzy Phoebie
Hi, Linda, This is EXACTLY what I needed to remind myself today! Thanks for helping me upward spiral a downward spiraling morning! Well done!
Thanks Judy – an upward spiral is exactly what therapist self-care is about, except with exponential impact as our clients upward spiral in response. I am glad this topic was personally helpful to you. Linda
So, does such a peer-support group exist? Sign me up!
Eva, the therapist self-care program, PSYCH, is still conceptual, however I have been incorporating its tenets into peer-to-peer supervision opportunities that I have been participating in. I am seeing that by investing in peer support and helping one another without the intentional focus on case consultation or therapeutic problem solving, and instead highlighting therapist strengths, taking a few minutes at beginning and end of consultations for reflection, or having each therapist take a turn at positive introductions before meetings. subtle but important shifts are occurring within the group. I would encourage anyone to start with pieces of the program and observe what happens. I hope to continue to experiment myself and hopefully build a more structured activity over time.
Thank you for writing Eva.
Yes! I have been writing about how self-care is imperative for resilience in motherhood and using the motto that surfaced through the MAPP community, “Drink while you pour.” This is a powerful article that highlights how crucial it is for those of us who nurture (in various domains) to prioritize our own wellbeing. Thank you!
Thank you, Alicia, for your linking the importance of self-care in the many roles that we each play as nurturer, caregiver, and keeper of souls. A fellow MAPP12ster, Rosie Jaye, and I facilitated a workshop together at 2017 FETE. She highlighted tending to those who cared for the dying, while I talked about therapist care. To your point, though, I introduced myself as a veteran caregiver who worked in the oldest profession of humanity, motherhood. I think your writings, Alicia, are so very valuable. I appreciate your connecting with mine.