Self-care-An Ethical Imperative for Helping Professionals

Jamie Stacks and I have been internet friends for what feels like a long time. Jamie has been a staunch advocate for self care, not just through her awesome Facebook Group REAL Self-Care for Therapists,  but also through the way she interacts with people, the example she sets, and the passion she has for making sure we’re taking care of ourselves so we can do great work. She’s someone to follow if you, like me, have flirted with burnout or questioned if you can keep doing what you’re doing. I love Jamie’s bottom line: Self-care isn’t a luxury; it’s an ethical mandate. Let’s hear more about it:

Self-Care - An Ethical Imperative for Helping Professionals

Why are we, as helping professionals, not taught to handle burnout.  The concept of self-care has not been engrained in therapists, counselors and social workers, psychologists and other helping professionals as a rule.  We have not traditionally identified ourselves, with the concept of ethics as it relates to self-care.  We are expected to be professionally fit and available.  We are supposed to be able to handle the day in and day outs of holding space for others.  It’s as if having knowledge of compassion fatigue and burnout should be enough to keep it away.

We are led to think that the occasional CEU workshop is sufficient to fulfill our professional responsibility to ourselves and our clients.  We know that most people do not seek the services of helping professionals until or unless they are in crisis.  We do ourselves and our profession a great disservice if we think we are immune to our own humanity.  At the same time, we also provide daily care for our own family members, those in our organizations, those we work with and others. We do not have super powers and if by some chance we do then this is our kryptonite.

Psychologists who fail to take care of themselves are less likely to be competent providers, said Erica H. Wise, PhD, a presenter at an "Ethics and Self-Care" continuing-education workshop at APA's 2006 Annual Convention. In addition, when psychologists' mental or physical health affects their work, it can create an ethical problem because their ability to help clients is compromised, said Wise, a psychology professor at the University of North Carolina at Chapel Hill.

Impairment doesn't always take an obvious form like substance abuse, said Wise during the APA Continuing Education Committee-sponsored session. Snowballing personal stressors-such as health problems, marital problems or even day-to-day stressors-can foster mental distress that can impair a psychologist's effectiveness or even cause improper behavior, such as inability to set appropriate boundaries, breach of confidentiality, fraud or negligence.

We can teach the importance of avoiding such problems through preventive self-care.

Applying the Code of Ethics to the Concept of Self-Care

The following sections have been copied from the ACA Code of Ethics (eff. 1995). How do they apply to the issue of self-care as discussed in the module? Do you comply with additional professional codes? What do they say about the importance of counselor self-care?

C.2. Professional Competence

1. 7. Impairment. Counselors refrain from offering or accepting professional services when their physical, mental, or emotional problems are likely to harm a client or others. They are alert to the signs of impairment, seek assistance for problems, and, if necessary, limit, suspend, or terminate their professional responsibilities. (See A.11.c.)

Definition:

Burnout

An emotional condition marked by tiredness, loss of interest, or frustration that interferes with job performance. Burnout is usually regarded as the result of prolonged stress.

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

Burnout

Emotional and physical exhaustion resulting from a combination of exposure to environmental and internal stressors and inadequate coping and adaptive skills. In addition to signs of exhaustion, the person with burnout exhibits an increasingly negative attitude toward his or her job, low self-esteem, and personal devaluation.

Strategies for preventing and managing burnout include utilizing assertiveness techniques, improving problem-solving and decision-making skills, clarifying personal values and setting realistic personal goals, learning and using coping mechanisms to deal with emotions, ensuring oneself adequate relaxation and recreation, maintaining a healthy lifestyle, and minimizing stressors at work and at home.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

Definition:

Compassion Fatigue: Also called “vicarious traumatization” or secondary traumatization (Figley, 1995). The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burn-out, but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.

Mother Teresa Understood Compassion Fatigue

She wrote in her plan to her superiors that it was MANDATORY for her nuns to take an entire year off from their duties every 4-5 years to allow them to heal from the effects of their care-giving work.

Medical Definition of compassion fatigue

1. :  the physical and mental exhaustion and emotional withdrawal experienced by those that care for sick or traumatized people over an extended period of time <Some researchers consider compassion fatigue to be similar to posttraumatic stress disorder (PTSD), except that it applies to those emotionally affected by the trauma of another (eg, client or family member) rather than by one's own trauma.—Michael K. Kearney et al., The Journal of the American Medical Association, 18 Mar. 2009> <Clinicians should be aware of how their emotional withdrawal or lability and “compassion fatigue” can jeopardize the care of dying patients and their families.—Deborah Cook and Graeme Rocker, The New England Journal of Medicine, 26 June 2014>

Definition:

Vicarious Traumatization  

This is a term coined by McCann and Pearlman (1990). It refers to the transmission of traumatic stress through observation and/or hearing others’ stories of traumatic events. This results in a shift / distortion to the caregiver’s perceptual and meaning systems.

“Vicarious traumatization is the transformation of the therapists’ or helpers’ inner experience as a result of empathic engagement with survivor clients and their trauma material. It refers to the cumulative transformative effect on the helper working with the survivors of traumatic life event.”    (Saakvitne & Perlman, 1996)

How does self-care relate to ethics?   

It has been researched and shown that the single biggest factor in determining outcome of therapy is the relationship between the therapist and the client.  This makes a more significant difference than the type of technique used or any other factor in the relationship.

Can you be effective if you are not healthy?  If you are negative, exhausted and overworked can you be fully present for your clients?  I would argue you cannot and research shows the same thing.  The big question is can you be a danger if you are burned out or not taking the time to take care of yourself?  Who has not snapped at a family member or co-worker every now and then?  This does not happen intentionally but it happens.  What if this is bleeding over into the treatment of the most vulnerable of the clients who come to see us.  I venture to say we have all gone to work when we didn’t have enough sleep, didn’t have any down time for ourselves, we push on and push through and at times this works for us.  What makes me argue that self-care is an ethical imperative is the times that the pushing through does not work for us.  

Self-Care is vital – not a luxury- a look at helping professionals and self-care

You signed on as a helping professional to serve and to heal.  You may be a psychotherapist, a doctor, a teacher, a nurse or a mother, a caretaker or a combination of several of these.  You are anyone who serves others. Many of you are helping professionals and that is just where it starts.  You have sick kids, your aunt is in the hospital and your husband wants to host his work retreat all while you have a cold and are working full time.  You help, you serve and you provide the utmost care….for other people.  What about you?  You need to navigate your own self-care because “as simple as self-care sounds you are finding it's not”.   The serious and super scary aspect that is often overlooked is the “dark side” shown in research that we don’t always read.   The following paragraph gives some somber stats on what can happen if we are not proactive.

This Medscape article  shows how physician drug abuse is not a new problem -- William Stewart Halsted, the father of American surgery, was addicted to cocaine -- but it's a persistent one.[1] A number of surveys, conducted by Guy and others, reveal some very real and somber statistics about therapists' lives and well-being. At least three out of four therapists have experienced major distress within the past three years, the principal cause being relationship problems. More than 60 percent may have suffered a clinically significant depression at some point in their lives.  Read the entire article here.  Even more sobering and making an even stronger case for the need for helping professionals to have an active self-care plan is this statistic found in the same article.  One out of every four psychologists has suicidal feelings at times, according to one survey, and as many as one in 16 may have attempted suicide.  A study initiated by that task force, published in 1980, concluded that "psychiatrists commit suicide at rates about twice those expected [of physicians]" and that "the occurrence of suicides by psychiatrists is quite constant year-to-year, indicating a relatively stable over-supply of depressed psychiatrists." No other medical specialty yielded such a high suicide rate.  Self-care and finding support are necessary and not a luxury for “other people”.

First find yourself?

Before we really start to dig into all the aspects that self-care encompass’ let’s see where you are now.  To get a baseline of how much self-love you are giving yourself click here to take my self-care quiz if you have not taken it yet.  Check out number ten - people often laugh at it but they also have to admit that they can’t answer yes either.  Come back and let up know how YOU answer number ten.  Please remember we are letting this serve as a starting point and not an excuse to say “I can’t even pass a self-care quiz, I give up”.  

If you are one who would say “I don’t have time to take care of myself”.  My response is that you need it even more than someone who does have time.  You are the keeper of yourself, your body, your mind, spirit and most importantly your soul.  If you need more convincing go back to the first paragraph and read through the statistics again. This is important.  Self-care is a term which I define as any action intentionally done to improve your physical, emotional and/or spiritual wellbeing.  When you can integrate those aspects of self then you fully move into who you are and only then can you truly help others.  

Stay tuned for more on the ethical imperative of self-care for helping professionals.

Jamie Stacks is a psychotherapist, a self-care coach, a presenter.  She is a mother, a wife, a daughter, a sister and an aunt.  She is a friend and so many other things.  She loves what she does and is honored to get to help people navigate life and the things it throws at us.