Who Has Time for
Self Care?
I started
graduate school for Social Work in 2007. I did not know how isolated I was (this
was my first time moving away from my home town), or how little I knew about the
profession I was diving into. I learned about evidence-based
practice, which was a certification I gained, and about cognitive behavioral
therapy, and what I needed to learn to really listen and pay attention to people’s stories and validate their experiences. I even got to attend a
prestigious training at Northwestern University during my eight-month block
internship.
One thing I did
not learn about was self-care.
I was unprepared
for the impact of listening to traumatic events from the children I work with, day in and day out. I was also surprised by the rigorous amounts of
paperwork Medicaid demanded, and the sometimes dysfunctional agency settings
where I have worked. Our profession is a landmine of potential stressors. Working with trauma makes us vulnerable
to secondary traumatic stress. We often do not have time to quickly return phone calls,
check emails, complete paperwork and follow up with other demands of our job. Vicarious
trauma, compassion fatigue and secondary traumatic stress can be waiting around
every corner, so what can we do?
There
has been a surge of conversation about self-care in the therapy world in the
last few years. With mountains of documentation and long work hours, how do we
really find time for self-care? The increase of clients who are able to obtain
Medicaid in the United States and shortages of mental health practitioners can result in larger caseloads. What can our workplaces do to truly promote self-care?
While I regularly hear the message that it is my responsibility to practice self-care, it is also the responsibility of the agencies where we work to provide the means to practice, and to create an environment that promotes taking care of yourself.
I am a social worker, therefore systems are vitally important to the work I do with clients and their families, why isn't the same perspective important for us as part of the mental health system? While we all have a personal responsibility to take care of ourselves, we must also work together to promote health in all areas. Taking personal responsibility for self-care in a whirlwind of long hours and minimal pay is nearly impossible if there is not support to back it up.
Not only is it
good for us to practice self-care, it is also our ethical responsibility
because we need to be able to be at our best for our clients. Agencies are also responsible to increase access to healthy workplaces that promote self-care, and maintain their ethical responsibility.
The National Institute
of Mental Health defines burnout as, “emotional
exhaustion, depersonalization, and reduced personal accomplishment.” 21-67% of
mental health workers may be experiencing high levels of burnout according to
NIMH. (Morse, Salyers, Rollins, Monroe-DeVita & Pfahler 2012)
Based on a standardized clinical
interview, individuals with mild burnout were at 3.3 times more risk of having
major depressive disorder, and those with severe burnout were 15 times more
likely to have major depressive disorder. The risk of having a major depressive
disorder with severe burnout was greater for men than for women, with the risk
of a major depressive disorder 10.2 fold for women and 29.5 fold for men.
In addition, agency interventions as
opposed to individual interventions to prevent burnout are more needed and
effective according to NIMH (Morse, et. Al, 2012), “Research on the correlates and antecedents of burnout
suggest that a number of organizational-environmental variables are related to
burnout, including an excessive workload, time pressure, role conflict, role
ambiguity, an absence of job resources (especially supervisory and coworker
social support), limited job feedback, limited participation in decision-making
in matters affecting the employee, a lack of autonomy, unfairness or inequity in
the workplace, and insufficient rewards (including social recognition).”
Effective ways to decrease the rates of
burnout on the agency level include:
Increasing social support for employees
Teaching communication and social
skills to supervisors
Increasing individual autonomy and
involvement in decision making
Decreasing role ambiguity and conflicts
for employees
Providing regular supervision,
including peer supervision
Decreasing workloads and promoting
self-care as a value within the organizational culture (Morse, et. Al, 2012),
So how is your agency doing? Is it time
for your agency to take an inventory of how many of these resiliency factors it
incorporates into the workplace?
In the March
issue of the Journal of Counseling Psychology Dorociak, Rupert, Bryand and
Zahnister developed a self care scale for therapy practitioners that is divided
into two categories, personal and professional. The categories that were found to be meaningful included professional peer support, such as relationships with colleagues, professional development such as connecting to community organizations, life balance such as seeking out comforting activities, cognitive strategies such as knowing your feelings, needs and triggers and daily balance like taking breaks throughout the workday and not being overloaded with work commitments.
Some
activities such as taking a break between sessions, physical activity and
spending time with family and friends have been labeled “career sustaining
behaviors” (CSBs; Stevanovic & Rupert, 2004).
Mirella Di Benedetto and Michael Swadling
discuss in their study on self-care that personal burnout occurs before and
more often than professional burnout. People who have sustained a long career
in one work setting had lower levels of burnout overall as well. Mindfulness
has been shown to have a significant preventative factor to burnout.
Maintaining a sense of humor and engaging in physical activities have also been
shown to prevent burnout. Exercise can provide resilience in many areas, not
just professionally for therapists.
Preventing burnout means using
resiliency activities, assessing the agency where you work
and implementing proactive strategies to decrease and prevent compassion fatigue and related ills and
getting the help you need as a professional – especially from peers and
friends.
Take a quiz about your own and
your agency’s level of burnout. How are you and your agency doing to prevent
this damaging and costly epidemic of compassion fatigue, secondary traumatic
stress and burnout?
Di
Benedetto, M. (2014). Burnout in Australian psychologists: Correlations with
work-setting, mindfulness and self-care behaviours. Psychology Health and
Medicine, 19(6), 705-715.
Burnout in Mental
Health Services: A Review of the Problem and Its Remediation
Gary Morse-Michelle
Salyers-Angela Rollins-Maria Monroe-DeVita-Corey Pfahler -
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156844/
Dorociak, K. E., Reupert, P. A., Bryant, F. B., &
Zahnister, E. (2017). Development of the Professional Self-Care Scale. Journal of Counseling Psychology, 64(3),
325-334. Doi:10.1037/cou0000206
