Self-Care: Where does the Onus Fall?  (Part 1)

A week or so ago I posted an article that suggested the idea that self-care is an ethical imperative for those in helping professions.  This idea of self-care as an ethical imperative has grabbed the attention of many and everyone wants to weigh in with their thoughts about it.  This is beautiful!  It is vital that we get this notion out in the world.  It is a conversation that the profession cannot afford not to have.

Self-Care as an Ethical Imperative is here.

The response to the article, the number of shares and the conversations it sparked just reinforced to me the idea of exploring and writing more about this.  It seems that it is also imperative to discuss this in more depth and from different angles.  There are so many ways to view this in regards to with whom would the ultimate responsibility lie?   When we have a profession that by its very existence exposes its front line workers to real life stories of trauma, abuse, death, depression and other significantly distressing events, who is responsible ultimately for ensuring those same front line staff take care of themselves?

There is this question of what is more important in therapy, the technique or the relationship.  The client-therapist relationship is important both as a primary element of therapy (an effective element of therapy in and of itself) and as a supportive or secondary element of therapy (an effective element of therapy through secondary effects) according to a study that you can read about here.  The question of “Which is the more important, the technique or the relationship?” in psychotherapy has been answered to some extent, because empirical data supports that both contribute to the effectiveness of psychotherapy.

With this support that the relationship is at least as important as the technique it is an easy leap for me to make that the personality of the clinician or therapist is important in the outcome of services for the client.  What types of people decide to go into helping professions?  What is the personality of one who decides to voluntarily expose themselves to other people’s worst stories and experiences daily?  This is a subject of study for a group of experts doing work for the APA community.    The therapist effect

A group of psychotherapy experts is working to delineate the characteristics that make some psychologists more effective than others.  The group seeks to identify the characteristics associated with successful therapists, establish what therapists are doing, thinking and feeling when they are conducting effective sessions.  This is discussed more in this article.   It verifies the need for ongoing studies of factors in effectiveness of psychotherapy.  The article does show that there appears to be a need for a therapist to innately be warm, welcoming, non-judgmental and empathetic among other characteristics traits.  Helping professionals must create an environment in which the client feels safe and is able to openly share with the professional and trust that they will be held in a safe container. If is it the job of the helping professional to “hold space’ for the client and their trauma then who ensures the safety of the professional?  Those who feel a great deal of empathy for others pain can take this on themselves as you will see below.

We have all heard the expression “I feel your pain” but this takes on new meaning when you consider the impact that vicarious trauma can have on helping professionals.  Scientists were first able to visualize how the brain processes someone else’s suffering. In a landmark paper in Science in 2004, Tania Singer and colleagues showed that some pain-sensitive parts of the brain are activated when we empathize with others who are in pain.  In recent years, she has been particularly interested in the differences between empathy and compassion, and, specifically, whether it is possible to transform people’s empathetic reactions into compassionate action. As she explains, empathy recruits negative emotions in people, while compassion elicits positive feelings.  You can read more about her work here.

In regards to self-care and clinicians; the very fact that they are quite likely by nature empathic (and we have research that shows us that this can literally mean that they feel others pain) then the idea of self-care as an ethical obligation becomes even more front and center.  Whose obligation is it?  I think that most of us agree that if clinicians take on others pain and never recharge themselves they won’t be able to safely continue the work that they do.  However, the onus is currently being put on the helping professional to make the time to do their own work.   I am in agreement with that onus in part and that is one of the many reasons I have made it a mission to bring self-care to helpers and healers.

However, one of the topics that comes up again and again is the idea that the profession itself and the agencies that employee clinicians hold a portion of the responsibility of the self-care for the helper.  This is expressed by many and often those who are working in the field.  “This is just one more demand for burned out workers”.  “Why does the industry that demands too much paperwork and increasingly large caseloads not take on some of this responsibility of supporting and educating and providing opportunities for self-care”?

Where do we draw the line and stop the madness that is making us sick and has the potential to be harmful to clients?  I think it takes a great deal of courage to stand up to the industry standard of high billing requirements and paperwork demands.  Licensed counselors, social workers and other therapists often do not get compensated for their hard work in appropriate ways.  According to this article on the 10 worst-paying jobs that require a masters degree it was very disconcerting to read 5 out of the 10 were rehab counselors, mental health counselors, marriage and family therapists, healthcare social workers and school and career counselors.   It is equally as disturbing to read things such as this article that shows that social work is rated as one of the most stressful, low paying jobs.

It will take volumes to even scratch the surface of these issues but with the well-being of so many at stake it is a topic worth re-visiting over and over.  I want to give you time to digest this information and we will pick this back up next week.  I would love to hear your thoughts on self-care for helping professionals and who do you hold as the responsible party?

Take gentle care of yourself.


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