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Dr Mish Seabrook
In my experience, self-care can create a conflict in those who need it the most. It sounds so simple; a purposeful act of replenishment through prioritising ourselves, and yet those working within the helping professions often find self-care very difficult.
Unfortunately, self-care in one of its’ recent forms has become a buzz word, something that is ‘on-trend’, a popular subject that has produced many books, celebrity endorsement and an increased social media presence.
There is an alarming tendency to place any time not at work, such as a ‘normal’ pastime, as self-care. So, rather than it being a purposeful, meaningful activity, there is a risk of it becoming diluted and meaningless. Practitioner self-care is more than a ‘buzz-word’. It should involve a deliberate intention that transcends the ‘normal’ and is, in fact, a professional and ethical must.
As a Psychotherapist, I am ethically bound (1) to commit to addressing my self-care needs, but my own self-care journey has had its’ peaks and troughs. I learnt my hardest lessons about the necessity of looking after myself in my previous role, as a Probation Officer, where the levels of trauma and an unhealthy workplace began to take its toll.
At times, I have fallen foul of reducing my own well-being to yet another item too far down on the ‘to-do’ list.
I have learned that I need to make a conscious and deliberate effort to prioritise my own wellbeing, yet I remain curious as to what hinders this, and I suspect it is the justifications we give. Here, I will draw together some of the distortions that impact on a practitioners’ ability to address their self-care needs. These issues can often link back to our own vulnerabilities or professional myths and in turn evolve into unwritten rules that justify impaired self-care.
These ‘rules’ have emerged from drawing on my own ideas, those from other writers and researchers, and through witnessing both myself and other professionals grapple with a number of ingrained beliefs that we uphold as a pseudo-professional standard, to the detriment of our well-being.
The Unwritten ‘Rules’
1) “I give 100%” aka high expectations of ourselves
“I’m determined not to let this client down as others have done, so I’m here, tired, rundown and frankly I could do with a duvet day, but I can’t have one, because they need me and I’m far too busy.”
Often, we approach our professional roles with the best of intentions; we wish to help people, to make a difference and to be there for them where others have failed. Unfortunately, this can create an unrealistic and grandiose expectation of our professional selves; wanting to be the ‘best’ therapist/social worker/helper that client has worked with and to always be 100% present or available for our clients(2). We use this as an excuse for rarely take breaks or sick-days, because the warped belief to be ever present and available overrides reason. So, whilst we will spout advice to clients about the importance of looking after themselves, practicing what we preach can be a challenge.
Additionally, practitioners will work above and beyond their normal working hours or client capacity, sometimes because of a misplaced loyalty to an organisation. Or, in order to maintain their unrealistic view of what a professional ‘should’ do, which perpetuates a version of themselves that they believe their colleagues or employers expect. The concept of being a “good enough practitioner” (2) seems alien. However, this precept is not sustainable and those that subscribe to the “I give 100%” ‘rule’ can undoubtably expect to fail.
2) “Been there, done that” aka Historical hurt
“I can connect with my client because I know what they have gone through, I’ve been there too, so I know how they feel and that makes me a better at doing my job.”
Many of us that enter into a helping profession do so with some form of historical personal story that connects us emotionally to the role we are in, and one that drives the motivation to work within this field. The theory of being a ‘wounded healer’ has been familiar to the psychotherapy world for some time (3). The term suggests that we have an unconsciously met need to process our own ‘wounds’ via another, thereby vicariously address our own issues through the process of helping others with theirs (4). Sound familiar?
In my experience it is not unusual for Psychotherapists to choose to specialise in an area of work that reflects their own difficulties, and this can be true across many helping professions. I have seen many practitioners talk about “been there, done that” and it ends up being worn like badge of honour. It can mean that we develop an uneasy expertise in an area overly close to our own issues. In relation to self-care this may raise ethical questions; should we work with issues that are so close to our own? There is a risk that we are more susceptible to the potential detrimental impact of the work, or perhaps do we believe that we are somehow ‘more qualified’ to work with that issue, having experienced it? It potentially leaves our ability to objectively look at our self-care needs somewhat skewed, as there may be an assumption that experience equates an automatic immunity from being affected by it. We have a responsibility to recognise when the work is too closely aligned to our own vulnerabilities in order to fully attend to our own self-care needs, and a duty to ask ourselves whether the clients’ issues are to too close for comfort.
3) “I feel what they feel” aka toxic empathy
“The expectation that we can be immersed in suffering and loss daily – and not be touched by it – is as unrealistic as expecting to be able to walk through water without getting wet. This sort of denial is no small matter” (p:52) (5)
Practitioners are likely to have heard of the terms ‘burnout’(6), ‘compassion fatigue’ (7) and ‘vicarious trauma’ (8). It is well known that engaging empathically with our clients comes at a price and bearing witness to their trauma can erode, alter and skew our own view of life. Empathy is a skill that applies across all of the helping professions, many practitioners pride themselves on being able to connect with and help those with levels of trauma that would render most people speechless. However, by connecting and ‘feeling what they feel’ we leave ourselves open to the potential of our own vulnerabilities being triggered.
Working with trauma always affects us, we cannot unknow what we know. The images and stories we experience create a ‘drip effect’ that erodes us; the over exposure to others trauma can have lasting effects on our view of the world and our relationships. Our own mental health can become impaired by our ability to maintain a safe enough, yet permeable, professional boundary between the clients’ issues and our personal reaction to their trauma (9). All too often, in my experience, I have seen practitioners ignore the early signs of the impact of ‘feeling’ because it’s upheld as a professional skill, a benchmark to aim for. Then, when the toxic levels get too much to bear, practitioners find that they can no longer ignore the effects of working empathetically, but equally find it difficult to ask for help, because of the belief that “I can handle it”, and I’ll revisit this later on in this article. Unfortunately, I have seen very experienced colleagues leave the profession because of the toxic effects of the work. Often, early career practitioners leap into the depths of empathy without being forewarned of the potential invasive impact of ‘feeling’. So, let’s be clear, our greatest skill comes at a price.
4) “Membership of the ‘I can’t tell you’ club” aka professional isolation
“How was my day? Fine, tricky at points, but I’m fine thanks”
There is an inherent contradiction in the helping profession world, an expectation and invitation that clients will disclose their lives, their closely guarded secrets, distress, fears and traumas and yet, there are few that we share our work with. Because of the nature of the work we do, practitioners in many helping professions become members of the exclusive, secret club that can inspire awe and fear in equal amounts. When telling people of my professional role, I often get a ‘taken aback’ look with a swiftly followed “I don’t know how you do it”.
In my psychotherapy role, client trust and confidentiality limitations prohibit sharing. For many in the helping professions, we are unable to disclose the full details of our work with those closest to us. Both the successes and challenges of the work are often kept locked away, so that the normal question from a family member of “what did you do today?” can never be fully answered. Yet, bearing witness to another’s suffering takes its toll and as seen with “I feel what they feel” rule, it can fundamentally alter a practitioners’ view of the world. This then, has a ripple effect for the level of interaction for family and friends, who realise that they can’t really ask you in depth about the work, and often colleagues may be so busy and immersed in their own practice that they can only quickly ask in brief spurts in between appointments.
In addition to this, many assumptions can be made of the lives of those that work in the helping professions, clients can believe we live in ivory towers, friends and family can assume that we have no problems of our own, colleagues may think that we are coping well with the demands of the work. This, of course, is a myth! But at times we perpetuate this assumption by not having our self-care needs met in our personal relationships and appearing ‘capable’ in our professional relationships. This can potentially leave us in a very difficult position of feeling as though we have limited options of who we go to when we have our own difficulties, especially when the message we give is “I’m fine thanks”. Furthermore, there can be caution around seeking professional help; in my role, the world of therapy is a small one, many therapists have professional links so the potential threat of ‘six degrees of separation’ with wider colleagues can instil a fear of our personal difficulties and vulnerabilities being exposed to the professional world we belong to. It can be a challenge to ask for help, but it’s very worth it.
5) “I can handle it” aka a lack of support
“Clinical supervision? Don’t need it.”
I hope that all helping professions have clinical supervision as a means of processing the difficult work we engage with, but I know from experience that this isn’t always the case. I have heard of clinical supervision focussing only on organisational targets, being shunted down the priority list, or at worst, not happening at all. Similarly, there are practitioners that undermine the value of clinical supervision stating they don’t need to attend and implying that it is a weakness of colleagues that chose to go. Practitioners may believe that their life experience both personally and professionally means that they are above needing professional support, despite there being numerous warning signs that their well-being is impaired. I wonder if there is a kudos with being seen to be able to ‘handle’ the most traumatic or difficult issues that a client brings, or working extra hours to manage an overly high caseload and not taking time off to compensate. As a clinical supervisor, I am at my most concerned when a practitioner justifies an unmaintainable pace of work or is no longer affected by the work they do, especially when they see it as having reached a level where they are ‘un-shockable’.
Social aspects of self-care are an important factor; peers, friends, family and supervision are all protective factors (10). However, all too often, practitioners will withdraw from their social network of support when the stressors of the role are eroding their well-being. Furthermore, this can also extend to a denial of needing support for personal issues and not attending to this perpetuates the myth that practitioners are immune to having distress of their own (11). We are only human!
So fellow practitioners, for your own well-being I invite you to take a long look at the ‘rules’ you and your colleagues follow, please beware of the distorted thinking that upholds the practitioners’ unwritten ‘rules’; they only serve to justify or collude with poor self-care.
If we can’t help ourselves, can we really help other people?
References
1. BACP. Ethical Framework for the Counselling Professions. Lutterworth: BACP; 2018.
2. Skovholt TM, Trotter-Mathison M. The Resilient Practitioner: Burnout and Compassion Fatigue Prevention and Self-Care Strategies for the Helping Professions: Taylor & Francis; 2016.
3. Jung CG. Fundamental Questions of Psychotherapy. In: Read H, Fordham M, Adler G, McGuire W, editors. The Collected Works of C G Jung. 16. Princeton, NJ: Princeton University Press; 1951. p. 116-25.
4. Sussman MB. A curious calling: Unconscious motivations for practicing psychotherapy. USA: Aronson; 2007.
5. Remen RN, Wisdom KT. Stories That Heal. New York: River-head Books. 1996:35-6.
6. Maslach C, Jackson S. Burnout: The cost of caring. 1982. Englewood Cliffs, NJ, PrenticeHall. 1982.
7. Figley CR, editor. Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. Brunner-Routledge; New York: 1995.
8. McCann L, Pearlman L. Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131-149. 1990.
9. Gartner RB. Trauma and Countertrauma, Resilience and Counterresilience: Insights from Psychoanalysts and Trauma Experts: Routledge; 2016.
10. Malinowski AJ. Self-Care for the Mental health Practitioner. London: Jessica Kingsley; 2014.
11. Adams M. The myth of the untroubled therapist. London: Routledge; 2014.
Michelle is a psychotherapist and doctoral researcher, based in Leicestershire. She has been working within the helping professions since 1999. Michelle assists individuals and organisations address their mental health needs through offering a bespoke range of clinical services via counselling, psychotherapy, clinical supervision and consultancy.
Website: www.mscp.co.uk Twitter: @mrs_seabrook
