Transcript Roger Higgins - Leeds Beckett University

The Need for Self-Care
How working with clients can
affect you and the importance
of coping mechanisms and
self-care strategies
Roger Higgins 2011
The Cost Of Caring
• “There is a cost to caring. Professionals who
listen to clients’ stories of fear, pain, and
suffering may feel similar fear, pain, and
suffering because they care. Sometimes we
feel we are losing our sense of self to the
clients we serve...ironically, as will be noted
later, the most effective therapists are most
vulnerable to this mirroring or contagion
effect.” (Figley, 1995: 1)
The Cost Of Caring
• “Therapists cannot do this work without
experiencing assaults to their usual
ways of viewing themselves, the world,
and other people...we do not believe
anyone, however psychologically
healthy, can do this work and remain
unchanged.” (Pearlman and
Saakvitne, 1995b: 295)
How We Can Be Affected
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Feelings of helplessness
Questioning of competence
Triggering of own issues
Physical feelings
Unwanted and intrusive thoughts
Changes in beliefs / worldview, often in
a negative way
Feelings of
helplessness
Changes in
beliefs
Questioning of
competence
Secondary
Traumatic Stress
Intrusive
thoughts
Triggering of
own issues
Strong physical
feelings
Coping Mechanisms and
Self-Care Strategies
• All therapists should establish and maintain
a balance between their professional and
personal lives...(Cerney, 1995: 140)
• The success of both the psychotherapy of
clients and the self-care of psychotherapists
is greatly enhanced by the liberal application
of common sense (Rothschild, 2006: xi).
Achieving Balance
Between 5 Key Areas
• Physical: exercise, activity
• Psychological: time for selfreflection
• Emotional: comforting activities
• Spiritual: experiences of awe
• Professional: supervision, peer
support
Achieving A Balance
Physical
Professional
Psychological
Balance is
the Key
Spiritual
Emotional
PHYSICAL
• In terms of getting back some
equilibrium, walking and gardening
are very much for me the times when
I’m physically on my own. They’re
very much grounding experiences for
me, making sense of stuff and getting
things back into perspective, getting
peace again. (Louise)
• “Everyone needs an outlet for pent-up
emotions of anger, frustration, hostility,
and discouragement. Toward that end,
physical exertion can help divert
aggressive energy; it is a safe way to
express powerful emotions.” (Menninger,
1999: 6)
• Pearlman (1999: 54) recommends “being
physically active through exercise, dance,
or hard physical work; reconnecting with
one’s body through massage, dance,
yoga”.
Select those which apply to you
and include anything else you do
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Exercise - walking, going to the gym
Activity - gardening, dancing
Eating regularly
Eating healthily
Sleep patterns
Taking time off when sick
Time to be sexual with yourself / partner
Assessment of Self-Care
Worksheet
• Write down each of the items you have
chosen as a statement, e.g.
• I go to the gym twice a week and work
out for about an hour.
–Try and include as many items as
possible (a minimum of 5).
PSYCHOLOGICAL
• This area covers time for self-reflection
and processing, which is an essential
component of effective self-care.
• Sometimes we may use negative coping
strategies like avoidance.
• One counselor used a cognitive
approach to establish a clear boundary -
• After a while I disciplined myself, to some
extent, not to carry him around with me. I
gave myself some processing time after
each session and I gave him longer than I
normally do. Then I quite firmly put it out of
my mind and said, “Now, you don’t deal with
it again ‘til next week,” which sometimes is
quite hard, but I think actually, I needed to
do that to get that distance and to get that
impartiality, that balance back again, before
the next session.” (Louise)
Select those which apply to you
and include anything else you do
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Creating time for self-reflection
Keeping a journal
Being mindful - yoga, meditation
Reading books for pleasure
Learning something new
Doing something different
Saying no occasionally
Listening to your intuition
Assessment of Self-Care
Worksheet
• Write down each of the items you have
chosen as a statement, e.g.
• I keep a weekly journal.
–Try and include as many items as
possible (a minimum of 5).
EMOTIONAL
• This area includes comforting activities, such
as spending time with family and friends,
listening to music and having fun!
• I love listening to music. I can wind down
listening to music...I can get lost in that and
pretend I’m dancing... (Bill)
• I do keep a journal when something’s
bothering me, but sometimes a hug is all you
need...just the touch, that’s all ...(Bill)
• One counselor was aware that her method
of relaxation could be viewed as a negative
coping strategy.
– A glass of wine can work wonders too. If
nothing else reaches those places, I’ll
have a nice glass of wine and a hot bath,
although in some ways it’s a negative
coping strategy. I think if you’re using an
aid, something like that to get you there,
it’s a shortcut...(Daphne)
• Several counselors underlined the
importance of a support network, where “you
just access different bits on different days for
different purposes, but they all feed each
into other” (Filomena).
• Friends, who may or not be therapists, can
provide invaluable support and reassurance
in times of crisis.
• Yassen (1995: 188) believes “connections
with other people are restorative” and that
“social supports are a central component of
the prevention of personal and professional
Secondary Traumatic Stress Disorder”.
Select those which apply to you
and include anything else you do
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Time to relax
Time with loved ones
Having a support network
Accepting small breakthroughs and victories
Laughing
Crying
Being playful
Engaging in social action, campaigning
Assessment of Self-Care
Worksheet
• Now write down each of the items you
have chosen as a statement, e.g.
• I arrive home at 6pm each day so that I
can spend time with my kids.
–Try and include as many items as
possible (a minimum of 5).
SPIRITUAL
• This area covers beliefs, worldview, finding
meaning, cherishing hope, experiences of
awe, creativity, and activities which replenish
or feed the counselor.
• Beliefs, ranging from religious faith to
humanistic philosophy, play a crucial role in
motivating therapists and in helping them to
find meaning in their lives as they listen to
stories of unbearable pain, suffering and
cruelty.
• Pearlman and Saakvitne (1995a) believe
therapists suffer spiritual damage as a
result of vicarious traumatization and that,
as a consequence of this, “it is essential to
develop and nurture spiritual lives outside of
our work”.
• Each counselor values experiences of awe,
which can be a simple appreciation of the
beauty of nature, but which help the
counselor to feel more grounded and
balanced.
• Counselors also find that there are positive
aspects to this difficult work, where “those
who voluntarily engage empathically with
survivors to help them resolve the aftermath
of psychological trauma open themselves to
a deep personal transformation. This
transformation includes personal growth, a
deeper connection with both individuals and
the human experience, and a greater
awareness of all aspects of life” (Pearlman
1999: 51).
Select those which apply to you
and include anything else you do
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Having experiences of awe
Being creative - writing, drawing, gardening
Cherishing hope
Having beliefs which give meaning
Being inspired
Going for walks in the countryside
Sharing your spirituality with others
Praying / meditating
Assessment of Self-Care
Worksheet
• Write down each of the items you have
chosen as a statement, e.g.
• I go for walks in the countryside every
other day.
–Try and include as many items as
possible (a minimum of 5).
PROFESSIONAL
• This area includes supervision, peer support
and training.
• All the counselors interviewed found
supervision, either individual, group, or both,
essential, but it has made some counsellors
more selective in their choice of supervisor.
• Some also believe it is more beneficial if the
supervisor for this type of work is of a similar
theoretical orientation.
• It’s made me think about the different types
of support I need while I work, and this is
one of the reasons why I’ve got more than
one type of supervision, but it’s made me
think about who I want supervision with, and
it’s made me put another layer in place, as
well as the stuff that ticks boxes, that we
have to do.
• I now look for more experience in the people
I work with, and a different level of
experience, wider experience, more
experience of very difficult situations, rather
than just the norm. (Filomena)
• Etherington (2000: 146) raises the problem
of denial amongst colleagues, where “there
is a wish to deny the centrality of the harm
caused by abuse”.
• This may be why Louise felt her supervisor
gave mixed messages, because, although
she offered support, “running through that,
somehow, there was this (and I don’t know
whether that was just me or whether it was
her), “Not this one again? Can’t you find
something else to bring?”
Peer Support
• Peer support is also valued and according to
Catherall (1999: 81), “one of the primary
sources of support for therapists is the
professional peer group.
• The therapist’s professional peer group has
the power to dilute the impact of STS, to
normalize the disturbing reactions, and to
help the therapist maintain the therapeutic
connection with clients despite his or her
personal upheaval”.
Training
• No counselors felt that their training had
prepared them for the negative effects of
STS or had introduced them to effective
coping strategies and mechanisms for
managing it.
• However, all believe that training courses
have an important role to play in this area.
• “We have a duty to educate those entering
the field to anticipate how the work will affect
them and to prepare them to address these
effects.” Zimering, Munroe, & Gulliver (2003: 3)
Select those which apply to you
and include anything else you do
• Having adequate and regular supervision
• Peer support where you can be open and
honest
• Peer support which will challenge you
• Setting adequate boundaries
• Feeling comfortable in your workplace
• Having time for lunch
• Setting achievable goals
Assessment of Self-Care
Worksheet
• Write down each of the items you have
chosen as a statement, e.g.
• I attend a peer support group every
two weeks, which challenges me when
necessary.
–Try and include as many items as
possible (a minimum of 5).
BALANCE
• But I don’t think the theme of self-care is
pushed enough on courses and
supervision alone isn’t the answer. You
have to have the other things in place to
create a balance. (Louise)
• Achieving a balance is paramount.
Absolutely paramount. (Filomena)
• Yassen (1995: 186) refers to the concept of
‘life balance’, which “emphasizes the value of
striving for an overall balance of work,
outside interests, social contacts, personal
time, and recreation. Life balance includes a
commitment to life and life-enhancing
activities”.
• It appears to be the key component in
managing the secondary stress which
inevitably accompanies work with people
who have been traumatized.
Select those which apply to you
and include anything else you do
• Finding a balance between the 5 areas:
physical; psychological; emotional; spiritual;
professional.
• Finding a balance between work and play
• Identifying areas which are out of balance in
your life, either professionally or personally.
• Developing plans to re-balance those areas.
Assessment of Self-Care
Worksheet
• Write down each of the items you have
chosen as a statement, e.g.
• I recognize that I need to spend more
time with my children and am going to
re-arrange my work schedule to make
this happen.
–Try and include as many items as
possible (a minimum of 3).
CONCLUSION
• Self-care needs to be a continual, evolving
process for any counsellor / psychotherapist.
• Therapists need to discover the combination
of elements from each of the self-care areas,
which can meet their individual needs, and
which may differ considerably from therapist
to therapist, in terms of specific activities,
beliefs, or interests.
• When each of these area is
represented in a balance way, “while
we will certainly not eliminate trauma
nor likely eliminate the hatred, evil, or
violence that feeds it, we may learn to
transform our encounters with these
things into opportunities for growth for
ourselves and for those whom we seek
to heal” (Stamm, 1999: xviii).