Therapists self care isn't something that's just nice to have
No, it's vital for both you and your clients and I'll tell you why.
I love being a therapist.
I've been a counsellor since January 2005 and it's been amazing. When the world leaves people feeling broken and confused, therapy helps to make sense of it all again.
Job satisfaction - off the scale!
But did you know being a therapist has a detrimental impact on you physically and emotionally, and change relationships in a way you may not have considered?
This is why robust self care is vital for counsellor - it's an ethical consideration.
Take a look and see what I mean.
I used to have a self care blog and offered coaching and courses all about self care for people pleasers - you can check it out on JaneTravis.com. I gave a talk at the BACP student conference about how counsellor self care is an ethical consideration in February 2017, and I've talked about therapist self care at Onlinevents.
So I've learned a thing or two about self care!
And a monthly massage, lovely though it is, just doesn't cut it.
There is a big difference between relaxation and self care.
Self care isn't easy: maintaining firm boundaries is self care, saying no is self care, eating properly, exercising, getting enough sleep, honest communication - this is proper self care.
And as a therapist, it's imperative that you take very good care of yourself because of the work you do.
You have 5 clients in a day, and each one has an expectation of you that can ‘make them better’. That’s a heavy weight to bear.
This takes a heavy toll on us, and has an impact on how we view the world, on our relationships and our own mental health.
Let's take a closer look.
Why you need robust self care
We give endlessly while expecting nothing in return, except the fee - and if you're working on a voluntary basis, not even that!
As therapists, we pride ourselves on what we give our clients - unconditional positive regard, empathy, congruence along with acceptance, understanding, being non judgmental.
Constantly giving without taking is obviously an unbalanced way to be. Not surprisingly, this results in practitioners' emotional depletion, the therapists' sense that there is nothing more they can give to themselves or to anyone else. They feel ‘spent’.
So when a friend calls and wants to talk about their bastard of a boss, it can feel like someone taking more of you (and if you want to know how to deal with that, take a look at 'How To Tell If You're Being Used (and what to do about it)).
You want to ignore the phone, lock the doors and hide away from anyone or anything that wants something from you.
See how emotional depletion leads to isolation?
One of the first things that happens with depression is a tenancy to isolation, to close down and to hide. So if you recognise this in yourself it's important to take a good look at what's happening for you and get more balance into your life.
As a therapist in private practice, it’s important to be realistic about how much you can handle. If you're working full time and seeing 17-20 clients, your self care should be a priority, possibly extra supervision or personal counselling and time in your diary to recharge batteries.
Myself, I’ve never wanted to be a therapist full time, it's too intense. I balance my counselling with helping other therapists to grow their practices, which I love.
Are there any jobs you can do next to your therapy work that make use of your counselling skills but aren't as intense? And if you need some help with this, take a look at the 90 Minute Intensive Business for Therapists.
‘A problem shared is a problem halved’ might be true, but if you take half the problem of each client and you see 15 a week, that’s a lot of problems to hold on to!
Yes you can unload in supervision, but supervision is more than just unloading stuff and usually you’ll only get to really unpack one or 2 cases per session. So with 15 clients, you're holding 60 hours worth of issues!
Confidentiality is a basic and underpins the therapeutic relationship, but confidentiality can have an impact on the therapist and their relationships.
The traditional way to debrief the day AKA ‘how was your day, dear’ can only ever go so far.
You can't share things to do with your client work - maybe something has impacted you, or something was funny, or something made you angry, because our confidentiality rules are so complete. Even sharing something that may seem trivial can identify a client, so it's best to say nothing.
This not only leads to you feeling isolated, it can leave partners feeling distanced from you, excluded. ('I wouldn't say anything, don't you trust me?')
Confidentiality can be a heavy weight to bear.
It's karaoke night in the local pub, and as you're working up to the key change in 'my heart will go on' across the bar you see your new client. <gulp>
If you live in a village or small town, how do you feel about bumping into clients and potential clients? What if you're having a drink at the local pub - maybe getting squiffy, or being seen sweaty at the gym, or being on dating sites?
You are a human first, counsellor second so choosing to become a counsellor shouldn't have a detrimental effect on your personal and social life.
But sometimes it does.
Sometimes it makes you feel self conscious, like you have to be on your best behaviour, never swear, never snap at the kids, otherwise you'll be letting the side down. After all, a 'real' counsellor doesn't do those things (spoiler alert - they do!)
Take some time to reflect on this, and discuss it with your supervisor or other therapists.
Knowing where you stand in advance means you can mention this to new clients and they will know about your boundaries. There is no right and wrong, just what's right for you.
Because not only do you not have to hide away, if you're building your practice, you need to be visible.
THE EFFECTS OF EMPATHY
Do you ever hear this from clients? 'I felt like I was carrying around a heavy rucksack, weighted down with all my worries and pain. After each session, it felt lighter'.
Empathy is a biggie in counselling: It's one of the core conditions.
Empathy means 'The ability to understand and share the feelings of another'
Working constantly with people in pain, who feel suicidal, are grieving over the loss of loved ones or are severely traumatised can take a heavy toll on practitioners.
It has an impact on us emotionally, and can tap into our own fears and issues.
We can be 'infected' with a patient's sadness; a condition Jung called "psychic poisoning."
Listening all day to people in pain depletes the therapist and at the end of the day the they are exhausted.
So the client empties their rucksack of worries and feels unburdened and lighter, but the therapist can feel weighed down.
Take a read of 'Valuing ourselves as counsellors'.
VICARIOUS TRAUMATIZATION (VT)
VT is the result of empathetic engagement with patients who were traumatized.
An example of this would be my counselling friend Kate (names changed to protect the innocent!)
When still in training she was with a client who gave her such a vivid description of a traumatic event that afterwards she had a panic attack.
Due to confidentiality she wasn’t able to discuss the details of this event with her partner or friends.
Yes, it was discussed at supervision but she had to hold on to and contain this trauma until her next appointment which was a week away.
As a therapist you hear difficult and sometimes shocking stories. You are there for the client, but who is there for you?
NB When picking a supervisor, always check if it's okay to contact between sessions in urgent situations like this to either have a quick chat or bring your appointment forward.
NEGATIVE WORLD VIEW
Do you remember the terrorist attack in Nice? The one where a truck was deliberately driven into a crowded street.
This event effected me deeply.
Sadly there are many horrific events in this world, but something about this one hit me in my solar plexus. I cried, felt sick and was dazed for several days. It actually spurred me to write this blog - Managing Emotions When the Unthinkable Happens
As a therapist, you hear about the pain and suffering people have endured and are enduring - and it can be truly shocking!
Listening to stories of rejection, cruelty, bullying, abuse, and betrayal can influence our own ability to trust, to be optimistic and see the good in people.
For example, if a client talks about how they trusted their partner only to find out they'd been having an affair with their sister for years, it tells you that this kind of betrayal can and does happen, it makes the possibility real.
Over time it colours your world and can lead to a negative view of it, a mistrust of people and a feeling of being unsafe.
Feeling this way leads to feeling defeated by the world, and being highly attuned to the negative, and life loses it's colour, stripping the world of it's vivid spectrum and dialling everything down to grey.
Therefore, it's VITAL to get some balance, be social, avoid the Debbie downer friends that only moan about life and find people you can enjoy the company of and laugh with.
How does this affect the therapist?
Burnout is defined as a feeling of emotional and physical exhaustion coupled with a sense of frustration and failure. Burnout is the leading cause of psychotherapists' high rate of depression, drug and alcohol abuse, and suicide.
Feeling isolated and disconnected leads to loneliness, and being emotionally exhausted prevents us from seeking out others - a vicious circle. This can lead to stress, anxiety and depression.
Research has shown that psychotherapists are more prone to becoming depressed, substance abusing, or suicidal than any other comparable profession, such as doctors, lawyers, accountants, and dentists.
That's really shocking, isn't it?
But it's more than protecting yourself, it's also an ethical consideration:
Burnout manifests primarily as the therapists' emotional exhaustion and depersonalisation of both their patients and themselves. It has also been called "emotional fatigue" or "emotional overload," when the therapist feels drained, depleted, all used up, with nothing else to give out.
This can lead to a general dislike, and a detached and callous attitude towards clients, who are perceived as energy drains or stressors.
The burned-out therapist experiences low energy, reduced interest and satisfaction, and often dreads work.
Clearly, no therapist can be effective under these conditions.
So if you’re feeling emotionally depleted, if you’re feeling affected by Vicarious Trauma, if you’re view of the world has become very negative, if you’re feeling disconnected, if you’re feeling the pressure to be perfect - can you be fully present for your client?
Can you tolerate the uncertainty?
Can you allow your client to share their story fully?
Because if you can’t, this will leak out and your clients will pick up on it and censor themselves.
So you see why robust self care is vital for therapists, and a monthly massage won't cut it?
I invite you to consider:
So what can you do to protect yourself? What IS good self care for a therapist?
Well, check out part 2, which shares 22 practical ways to increase your self care, both professional and personal.
And if you feel isolated, come join us in the Grow Your Private Practice Club, where we have a wonderful supportive members Facebook community.