Self-care can be defined as an activity to “refill and refuel oneself in healthy ways” (Gentry, 2002, p. 48). Self-care is vital if we are to remain effective in our role and avoid burnout; however, many psychotherapists, me included, do not regularly implement the techniques they recommend to clients in their own lives (O’Halloran & Linton, 2000; Skovholt et al., 2001). We often ask our clients about their health and self-care, but we need to take care while giving care. We need to nurture ourselves while nurturing others; however, we tend to often put our own care last on the list.

I find it quite reassuring that even Carl Rogers struggled with this too. At the age of 75, Rogers stated: “I have always been better at caring for and looking after others than I have been at caring for myself. But in these later years, I have made progress.” (Rogers, 1995, p.80).
Anyone who has flown on an airplane and listened to the flight attendant before take-off, has been cautioned what to do in the event the oxygen masks fall from the ceiling, which is to put on your own mask first before trying to help someone else. Although most psychotherapists are familiar with self-care, even preaching the concept religiously to clients, many of us find it a challenge to put the concept into practice in our own lives.

I started my professional life in nursing. I loved it, but a few years after being promoted to managerial level, I burnt-out because I couldn’t say ‘no’, and tried to please everyone. I then realised that something had to change, but why wait until, like me, you reach burnout to change? We all want to prevent burnout but don’t always fully accept and commit to this goal. However, there is an increased awareness of the risks associated with doing too much. Take, for example, Jacinda Ardern: On January 19th, 2023, she announced that she is resigning as New Zealand prime minister saying she no longer has "enough in the tank" to lead.
Given the potential downsides of our work e.g., compassion fatigue, vicarious trauma, burnout, knowing the warning signs allows us to give the best of ourselves to our work instead of what’s left of us. In her book, “The Myth of the Untroubled Therapist,” Marie Adams (2014) talks about the privilege of working as a therapist, and the profound responsibility to know ourselves: she adds that although we are therapists, we are human too. While recognising this responsibility, we have a code of Ethics and Practice in relation to our clients and the public at large. The IACP spells out our ethical obligation to take care of ourselves and I quote:
“4.1.1. Engage in self-care activities which help to avoid conditions (for example, burnout, and addictions) which could result in impaired judgment and interfere with their ability to benefit their clients. 4.1.2. Monitor their own personal functioning and seek help when their personal resources are sufficiently depleted to require such action……”

Being a therapist is an incredibly important, invigorating, fulfilling career, yet the complexity of the work and the immersion in painful stories can often create difficult demands on our mental health. At the end of a long day of clients, I can sometimes find myself tired, overwhelmed, or dysregulated.
In their book, ‘Leaving it at the Office’, Norcross & Guy assert that self-care is an ethical imperative and it is not a ‘narcissistic luxury’ to be filled as time allows. I fully concur with this, and I am going to briefly mention some areas that I have found to be most important for my self-care.

Work versus life, or life versus work
I must admit that this has changed several times and for me it is a work in progress. Currently I work three and a half days a week. A typical working day involves a mixture of client sessions, both in person and on zoom, returning phone calls and liaising with other health care professionals, as needed, and catching up on administration.
Some mornings I start work at 8am. I try to have long gaps in between sessions and will have my last appointment at 6pm. I tend to go for a few walks during the day and sometimes I go to the gym. The maximum number of clients I see each day is five. Another important factor for me is the mix of clients I have; how many are high risk or otherwise very challenging clients.

Personal Therapy
My experience of personal therapy had and continues to have an important impact on my practice as a therapist. In fact, I believe that I have learnt much about being a good therapist just by sitting in the client chair. It has helped me to discover and explore my inner world, resulting in greater self-knowledge.
In my client work, there are times when I am triggered; as there can be parallel processes, transference and/or countertransference. For me, being able to bring these to my personal therapy and work through my experiences, is a vital part of my self-care.

Supervision

Supervision is a very important part of taking care of myself. Sometimes I think that my supervisor knows me better than I know myself and that he knows my work better than anyone, apart from myself or my clients. I feel safe to bring my disasters and dilemmas, my questions and satisfactions to my supervisor and he has come to know me as an individual, as well as a professional.
As well as using supervision as a way of monitoring our competence, stress levels and job satisfaction, in my view therapists would benefit from peer supervision. I attend peer supervision once a month with two colleagues where we offer and receive supervision from each other.

Knowing my role as a therapist
Knowing my role is something I have explored at length with my supervisor. My role is to help my clients free themselves from disabling assumptions so they can live fuller lives and reach their full potential. My belief is that each of my clients have the capacity for self-awareness and choice. As a therapist my emphasis is on growth and self-actualisation rather than on curing disorders. In other words, my role is not to fix. Always try to create a therapeutic relationship that is warm and accepting and that trust in the client’s ability to self-actualise. I use a nondirective approach and I don’t lead the process. I don’t suggest goals or decide how long the client should work with me for. I’m not an expert in the client’s life and therefore I do not give advice, answers and/or solutions.
At the heart of my work as a therapist is my ability to get centred, stay focused and listen. Cozolino (2004) says that through this we need to access all our intellectual and emotional capacities. Thinking and feeling are both vital and staying centred and gently guiding the direction of therapy. Therapy is not something I do to a client; it is how I am with the person. It’s about the relationship, and my feelings are a big part of the work.

Boundaries

A huge part of self-care is being aware of and respecting my boundaries and looking upon them with compassion and zero judgement. Maintaining boundaries is a crucial element of self-care; although we may be full of wellness tips for others, knowledge doesn’t always translate into action for ourselves.
In her book, ‘Help for the helper’, Rothschild (2006, P 1-2) asserts that the better we take care of ourselves and maintain a professional separation from our clients, the more we will be able to be truly empathetic and compassionate with them. Working on my boundaries is not something I just do when contracting with the client, I feel that it is something that requires ongoing work for me.

As you can see, therapist self-care is multi-factorial and no ‘one size fits all’. In this article I have shared some of my experiences and learnings. I believed I was pretty good at self-care after my experience of burnout and I am more aware of my little ‘tell-tale signs’, the messages my body tends to give me. However, I realized last year that I really needed to take it up a notch. The impact of the pandemic began to take its toll on me, so I began to make self-care more of a priority, to schedule it in my diary and make it happen. because our work is a bit like pouring water from a jug. We can keep pouring, but if we don’t stop to fill the jug, eventually it will run dry. With the dangers of burnout, compassion fatigue, and vicarious trauma, we can drain our jug very quickly and that’s why self-care practices are truly the only way to keep ourselves vital and healthy.

I will conclude with some kind words from Bush (2015) and this is my wish for each of you reading this article:

“May you be moved by passion and enthusiasm for your work, may you deeply believe that you deserve self-care, may you replenish yourself daily, may inspiration be a guiding compass to your days, may you know you are a bright light in a world that needs your presence, may you be an instrument of help and healing and may your cup overflow so that there is plenty to share”(p.254).

(1573 words)

References
Adams, M. (2014). The myth of the untroubled therapist: Private life, professional practice. Routledge, Taylor & Francis Group.

Bush, A. D. (2015). Simple self-care for therapists: Restorative practices to weave through your workday. W.W. Norton & Company.

Gentry, J. E. (2002). Compassion fatigue: A crucible of transformation. Compassion Fatigue: A Crucible of Transformation | Office of Justice Programs. Retrieved January 28, 2023, from: https://www.ojp.gov/ncjrs/virtual-library/abstracts/compassion-fatigue-crucible-transformation
Norcross, J. O. H. N. C. (2018). Leaving it at the Office: A Guide to psychotherapist self-care. Guilford.

O’Halloran, T. M., & Linton, J. M. (2000). Stress on the job: Self-care resources for counselors. Journal of Mental Health Counseling, 22, 354–364.

Rogers C. (1995). A way of being. Boston, MA: Houghton-Mifflin

Rothschild, B. (2006). Help for the helper. WW Northon & company.

Skovholt, T. M., Grier, T. L., & Hanson, M. R. (2001). Career counseling for longevity: Self-care and burnout prevention strategies for counselor resilience. Journal of Career Development, 27, 167–176. doi:10.1023/A:1007830908587

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