Self-care for Psychologists

[Music] For more than 10 years, APA has reported on American stress levels. In 2018, APA's yearly stress and America survey found that Americans belonging to Generation Z, ages 15 to 22, reported a stress level that is slightly higher than the average for adults overall. And millennials who are between ages 22 and 37 reported the highest average stress level out of all the generations, including baby boomers and older adults. The survey found that teenagers and young adults are feeling the effects of stress from several areas, work, money, social media, and even politics. Only 50% of Jen's years feel like they are doing enough to manage their stress levels and take care of their mental health and emotional well-being. For all adults, one in five believe that they are not doing enough. Considering these results, I wasn't surprised to find that Google searches for the term "self-care" have been trending upward since 2014, hitting peak search popularity in 2016 and in fall of 2018, around the last major US election cycles. I'm Joule Edwards-Ashman. And in this episode of Progress Notes, a podcast keeping tabs on the practice of psychology, you'll hear from a psychologist who has spent the past few years working on ways to help other psychologists integrate self-care practices into their lives. So what do you find when you type "self-care" into the Google search bar? You get nearly 2 billion results. One of them being an article on Good Housekeeping's website featuring Dr. Helen Coons, clinical health psychologist, and former APA board member. Dr. Coons advises that self-care is one's action around our physical, emotional, and relational, perhaps professional, educational, and for some people spiritual well-being that reflects the way that we take care of ourselves on the most fundamental levels. Self-care is something that psychologists are experts on teaching and helping their clients and patients navigate. But how often do psychologists actually practice what they preach when it comes to self-care? There are still messages, at least that as psychologists we can perceive that we should have it all together already. And in fact, there has been studies showing that psychologists are not at all immune to the challenges of the rest of humankind. These are studies that are not absolute, but at least that suggests that psychologists may be drawn to practice because of their own histories of someone either affected by the past. Either a family member or a loved one or someone they themselves have struggled with emotional or mental illness or addictions or other kinds of significant stressors. So many people see these not just as vulnerabilities, but also of strengths in terms of our compassion. It also does mean that the idea that we're immune from the same experiences of everyone else is just not true. That's Dr. Erica Wise. She's a clinical psychologist and a professor at the University of North Carolina, Chapel Hill. Early in her career, Dr. Wise served on APA's Ethics Committee and the North Carolina Psychology Board, where she focused on addressing ethical and legal issues that psychologists face and practice. That experience of seeing some of the challenging issues that practitioners deal with led to Dr. Wise's involvement with the somewhat difficult and heart-to-visualized project, developing a new self-care training for psychologists to help them manage personal and occupational stress. So in 2005, I was asked by the North Carolina Psychological Association to work with our committee on colleague assistance to develop a program on ethics and self-care. And I truly was stymied. I had no idea what that would look like. I really thought of self-care as more so embedded in kind of the 12-step recovery programs. It really had not rolled itself out very much yet at that point into any aspect of kind of professionalism. Either for psychology or for other healthcare professionals, it's now a huge issue in medical school training and practice and dentistry and pharmacy and other areas, but at that point it really wasn't. Like paramedics and social workers, psychologists are frequently exposed to different traumas that their patients and clients experience, which is why practicing self-care is important for healthcare providers. Practicing psychologists are more at risk for overworking, professional isolation, or over-envolvement in their patients' lives. Also stigma within the profession can keep psychologists from acknowledging any moments of distress or seeking help to manage their workload and stressful situations. I think that self-care, at least for psychologists, is primarily in quotes personal, but where it intersects is where it affects our competence to practice or teach or do research, whatever it is that we're doing. I also was aware in doing a lot of ethical consultations that when psychologists were facing difficult practice situations, like a complaint to the psychology board or very frustrated or dissatisfied patient or even a personality conflict with another psychologist that those were very distressing. Many of the stories I heard on the psychology board were the end result of improper or unprofessional behavior really started with personal traumas or difficulties. It just seemed those areas were much more related than I had realized. I think where self-care can kind of get a little bit less respect is when it is presented in a one-size-fits-all kind of way. And I think of that maybe as the approach sometimes taken by magazines or kind of shallow news articles saying, "Every day you take a bubble bath and go and get a manicure." Those can be excellent parts of self-care, but I think for self-care to be effective it really does take the more foundational ability to be aware of the kinds of stressors that the work is sort of imposing on you and how to be aware of what you need to do to stay feeling at least competent if not better. APA's Advisory Committee on Colleague Assistance, also known as ACCA, developed the stress-distress continuum, showing how a variety of stressors can eventually lead to improper behavior in the workplace. Dr. Wise said this model served as a starting point for developing the self-care workshop. When we looked at what APA at that point was promulgating as a vision of self-care, it started at stress and then distress, then improper behavior, and then sort of actual impairment. And so it was kind of a downward spiral. And we gave some thought to that and realized that it was not a very optimistic view for our profession. The best we could do is to try to cling to being minimally competent and try not to spiral down into distress and inappropriate behavior. And we realized that when self-care is presented as something that you have to add on to everything else you're doing, it almost just becomes something else on your checklist. And we really wanted to focus on flourishing, not just surviving. We wanted it to be very intentional to make this a routine part of our lives that if every day you're deciding whether or not to do things to take care of yourself, that you probably are not going to, you know, that over time that tends to not be very successful. So things like being aware of the different elements of your life, physical health, emotional health, spiritual wellness, interrelatedness with others really need to be kind of built into the fabric of your life. Aka recommends that psychologists add these elements to their self-care practices, talking to colleagues about work stressors, educating yourself on burnout and how to recognize it, setting realistic expectations about work-life balance, and pursuing a hobby or other intellectual stimulation outside of work. When developing or training, the practice of reciprocity, care for the self and others, was another component that wise wanted to weave into a more integrated approach to self-care. If we're going to treat people in a clinical practice, we needed to be aware of the benefits that we couldn't receive from those connections with others, and also maybe in a more practical sense, applying some of the skills that we are teaching our clients to ourselves. So, we're experiencing CBT and mindfulness and making that part of our own practices means that we're in a much more reciprocal relationship with our patients. It's not that us and them, but it's a we and the human experience. Of course, we're in a professional role, but it's a much more, sort of, I think, respectful of clients and respectful of our own limitations. own humanity. Another important element of self-care, self-compassion, an ideal promulgated by psychologists, Christian, Neff, and others, which includes ideas like self-kindness, mindfulness, and a shared sense of humanity. And so the goal is to kind of reduce our self-judgment, our isolation, and our rumination that these are very, very common human experiences and that as psychologists we maybe especially need to be aware of managing those. In particular that when we experience painful thoughts and feelings we can have, keep them in a sort of balanced awareness with our other experiences rather than over-identifying with them that often in our work particularly if we're seeing patients who have had significant trauma experiences or are in any way dealing with lots of difficult life events, there's these notions of secondary or vicarious trauma that we may kind of hold that and we really do need to have some ways to buffer that so that we don't become detached or numb to the emotions of others. My hope, and this is something I've been writing about recently, is that we can leverage some of these ideas into continuing education programs so that when psychologists do their mandatory training they're also you know sort of learning to talk with other psychologists and hear what they're doing, they're getting to you know check out their ideas with other people, they're encouraged to be in peer supervision groups so I think that idea of making this really part of you know much more inherent part of how we train and how we practice would be a really good thing. Taking care of your emotional and mental well-being should be much more than another item on your daily or weekly to-do list. Why say it shouldn't be something that's in the back of psychologist's minds but at the forefront since neglecting self-care could lead to negative effects on the job. Developing good self-care practices may be one of the best ways to protect your investment in your education and your job. Many other professionals are aware that there's a high cost of burnout and that we've all invested a lot in our education and training and so this is I think a kind of co-investment that can help ensure that people stay excited and passionate about what they're doing. I think we're just beginning to kind of think through some of what these this approach would look like in graduate training. The dialectic here is that self-care I think is fundamentally different than what we might call self indulgence. You know that doesn't mean there's not a role for the bubble bath or the facial or even you know binge-watching Netflix but that we can balance it with being effective in our work and I think learning how to inculcate this undergraduate program so that we develop a sense of community so the graduate students learn how to take care of themselves as well as as well as others that we really articulate that and I think it is not just it's not just skills-based which I think is maybe where the earlier approach of just do a list of ABCD. It's not what we do it's also how we do it that we pursue it in a way that's that's mindful and attentive to what the stressors are, how they're affecting us and so that the types of activities we engage in for self-care are meaningfully connected to that and also our part of our lives that we don't see it as something that once we're out of graduate school we can stop doing this but that we really need to buffer buffer the stressors. For information on self-care practices for psychologists visit APA's self-care resource center at www.apa.org/helpcenter/selfcare Thanks so much for listening to another episode of progress notes produced by me Jewel Edwards-Ashman and Luana Bocelo. Subscribe to this podcast on iTunes or Google Play to make sure you catch next month's episode.