Self-care for psychologists

06 May

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…

Empathy can be harmful

Empathy can be harmful

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.
Although I didn’t agree with all of John’s opinions (I think I could have a great discussion with him about positive psychology), he really impressed me as a person. I think I have a lot in common with him, and probably just as much not in common šŸ™‚ I learned a lot from that lecture, that’s for sure!

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3 responses to “Self-care for psychologists

  1. morningstarrambles

    May 9, 2011 at 12:20 pm

    This is fascinating to me! I take an interest in psychology and at times wondered if I would make a good therapist, but I wonder if I could handle it after many years. Would I care too much? Would I eventually become indifferent because I feel the need to emotional distance myself?

    I think I could handle a specialized area, but as far as serious disorders go, that would be very hard. I would be more likely to go into marriage counseling or something like that.

    • nicolasconnault

      May 10, 2011 at 7:42 am

      Hi MorningStar šŸ™‚ You’re quite correct that clinical psychology deals with the more “heavy” stuff, people with profound mental disorders or horrific trauma, and it can be quite difficult to cope with that as a therapist. Counselling psychology is a bit easier I suppose, but you’re still very likely to come across abuse and trauma, as these are incredibly prevalent, and often lead to or perpetuate relationship problems.

      It’s always wise, whichever way you go, to stick to those things you’re good at, and humbly decline to work on issues you don’t feel competent do deal with.

  2. morningstarrambles

    May 11, 2011 at 11:10 am

    It would be a long way off if I ever decided to go down that path. When friends come to me, I am pretty good about listening and offering some helpful suggestions without getting totally sucked in, but when it comes to mentally ill people in my ward that I have had to deal with …… Ugh. It just gets too stressful. With one sister, I can never say the right thing because she wants to be served in every way humanly possible. If I explain why that can’t happen and offer some alternatives, she gets mad and says, “Now I feel like you’re telling me I’m asking for too much.”

    Hmmm …… Let’s see. After a year plus of her medical crisis, she wants someone to take her four kids during the day, take her youngest son in the evenings, bring dinner in, and do the family’s laundry. She was furious that she had to get a nanny, but seriously, what was the ward supposed to do? We can’t juggle her four children for well over a year and we can’t get her to understand that. Very frustrating. If I had to handle such patients all day, every day for years, I know that would be beyond my capability because I would start to lose sympathy.


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