OK so today we had a very interesting lecture for our unit “Preparation for professional practice”. The lecture was called “Self-care for therapists“, and was presented by Dr. John Manners, a clinical psychologist who has been practicing for an amazing 38 years, and doesn’t intend on retiring. He apparently loves what he’s doing, although he almost seemed to try very hard, during his 3-hour seminar, to dissuade us from pursuing this career path…
Basically, he started his presentation by telling us that any good clinical psychologist will be negatively impacted by their work, because the therapeutic nature of our services depends on our ability to empathise with our clients. This means that we must feel what they are feeling. The problem is that many of our clients are feeling truly horrible things, and some of these things are even deeply traumatic. If we want to help them, we must literally experience what they are experiencing. How do we do that without getting permanently injured in the process? John had a number of great tips for us.
The first category of advice was about managing the work.
- Titrate the processing of trauma: since most therapeutic approaches involve some sort of exposure to a feared object or situation, we must be careful not to cause our client to be re-traumatised. Instead, we must help them to re-live the trauma in small, manageable steps. This also means that we, as therapists, can deal with it in small steps.
- Remain emotionally connected: successful therapy will never be administered by computers or by therapists who behave like robots. It is essential to be emotionally present.
- Maintain a separation between self and other: even though we must feel what the clients feel, we must not identify or merge with them. We must not take their load on our shoulders. This is their therapeutic space, their story, not ours.
- Have clear boundaries: we’re a team, but we’re not friends. I’m the therapist and you’re the client, I facilitate your healing using compassion and empathy, but this is still a professional relationship.
- Timing and spacing of difficult clients: some clinical psychologists see up to 8 clients a day, for nearly an hour each. It’s essential to spread out those that are particularly challenging and emotionally draining. If you’re a morning person, have your tough clients in the morning.
- Have a symbolic way to “finish” each session: takes notes, put the files away etc. Don’t take any work home, and find something “normal” to do when you get home, so you can get back in touch with the good old mundane.
- Debrief before going home: after some particularly challenging sessions, it’s essential to debrief with a colleague. You discuss the case, exchange ideas, share your feelings, and engage in a bit of therapeutic exchange. Don’t leave anything undigested to ruminate overnight!
- Keep responsibilities where they belong: as a therapist, I’m not responsible for my clients’ healing or safety, they are. I’m just a facilitator, helping and inviting my clients to change. If they don’t change, I’m not responsible.
The second category was about managing ourselves:
- Challenge your idealism: Your view of the world should be somewhere half-way between utter cynicism and naive idealism. Either extreme is unhealthy and not conducive to therapy
- Have realistic expectations of yourself and others
- Monitor your internal pace: if you tend to be a sprinter, convert to a marathon runner, be aware of compassion fatigue.
- Enliven your personal life: do intrinsically fun things in your own time (play with children, exercise, listen or play music, express yourself artistically etc.)
- Maintain intimate relationships and close friendships: don’t let the austerity of your work contaminate your relationships.
- Obtain frequent supervision, no matter your current expertise and experience. It’s a requirement of the profession, but do it because it’s the right thing to do, not because it’s required
- Obtain personal psychotherapy: to increase insight, resolve childhood issues, identify barriers to self-care etc.
- Have a healthy sense of self: “I’m OK”, not “I’m better|worse than such and such”. Ask yourself the questions: “What am I? What defines me? What am I not?”. Find three things that represent who you are as a person. Know yourself, otherwise you can’t help others discover who they are and be satisfied with it.
- Talk Therapy’s Demise Isn’t Such a Bad Thing for Depressed Patients (blisstree.com)
- How conducting trauma therapy changes the therapist (scientificamerican.com)