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?

Click on this link to take a survey on your and your agency's level of 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?

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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