Leaving it at the office: Psychotherapist self-care
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Transcript Leaving it at the office: Psychotherapist self-care
Leaving It at the
Office:
Psychotherapist
Self-Care
John C. Norcross, Ph.D.
Description
Conducting psychotherapy places
additional and special burdens on
the person of the therapist. This
workshop puts the Socratic dicta
of “know thyself” and “heal
thyself”into practice. We shall
focus on 12 self-care strategies
that are clinician recommended,
research based, and practitioner
tested.
Learning Objectives
Participants will be able to:
Generate at least 6 self-care
strategies supported by the
empirical research
Conduct periodic selfassessments of their own
self-care.
Leave with an individualized
action plan.
What We Will NOT Do
Light
candles
Inflate balloons
Burn paper regrets
Meditate together
What We WILL Do
Traverse
the accumulating
research on self-care
Emphasize self-care
principles or strategies
Think with the mind of a
scientist, feel with the heart of
a humanist
Embrace multiple strategies
associated with diverse
theoretical orientations
Individualize your self-care to
your own vulnerabilities
The Paradox, Irony, &
Ethics of Self-Care
The Paradox: No time to
sharpen the saw
The Irony: Not availing
ourselves of what we
provide/recommend to clients
The Ethics: Personally
essential and professionally
ethical
Theoretical Orientation
and Patient Care
In treating patients, change
processes vary reliably with
the therapist's theory
E.g., CBT therapists use
counterconditioning,
contingency management,
and stimulus control
significantly more
E.g., Psychodynamic
therapists rely more on the
therapy relationship and
catharsis
Theoretical Orientation
and Self-Care
No differences in self-care
processes due to therapist’s
theory
Not even a few statistically
significant differences
expected by chance alone.
Results strongly argue for
considerable similarity
among psychotherapists in
their own self-care
Why No Differences?
1. In psychotherapist role,
people rely heavily on
theories. But in selfchange role, people are
not as influenced by
theory.
2. Possible duplicity
between public careers
and personal lives.
3. Therapists become more
pragmatic, eclectic, and
secular in their own selfcare.
12 Self-Care Strategies
Principles or strategies, not
techniques. Dozens of
techniques under each
strategy.
Probably more effective to
use multiple strategies than
to extensively use a single
strategy.
Must tailor to your own
resources and vulnerabilities
to insure long-term success.
1. Valuing the Person of
the Psychotherapist
Easier
to be wise and
available for others than for
ourselves.
Self-care begins with the
premise of valuing the person
of the therapist.
Alas, this runs against the tide
of managed care and
interchangeable “providers.”
Self-Awareness and
Commitment
Top-ranked
contributor in
studies to optimal functioning
Assess your self-care &
satisfaction as you would a
patient’s
Writing, journaling, logging,
self-monitoring, tracking
Honest feedback from loved
ones and coworkers
Making self-care a priority
Quis custodiet ipsos custodies
(Who will guard the guards?)
2. Refocusing on the
Rewards
Re-experience
Notice
Feel
the privileges
the life rewards
the career satisfaction
Practice
the mental set
3. Recognizing the
Hazards
The
classic stressors of
“impossible profession”
The
new & evolving distress
Acceptance
Begin
with self-awareness
and self-liberation
4. Minding the Body
Don’t
overlook the
biobehavioral basics
Sleep
Bodily
rest
Nutrition
and hydration
Exercise
Human
contact
5. Nurturing
Relationships
Emphasize
the human
element
At
the Office
Clinical colleagues
Peer support
Supervision groups
Clinical teams
Staff
Professionals in community
Mentors
Clients
5. Nurturing
Relationships (cont)
Outside
the Office
Spouse/partner
Family members
Friends
Colleague Assistance
Programs
Personal mentors
Personal therapist
6. Setting Boundaries
Delegate
Boundary
Balancing
set
client desires and
self-preservation
7. Restructuring
Cognitions
Avoid
wishful thinking & self-
blame
Monitor your internal dialogue
Watch for selective abstraction,
overwhelming tasks, and
assuming causality (Judy Beck)
Manage countertransference:
self-insight, self-integration,
empathy, anxiety management,
& conceptualizing ability
(Charles Gelso)
Five Therapist
Musterbations (Ellis)
I must be successful with my
patients, practically all of the
time.
I must be one of the world's most
outstanding therapists.
I should have no problems. After
all, I am a therapist!
I must be liked and respected by
all my clients.
Since I am a hard-working
therapist, my clients should be
equally persevering.
8. Sustaining Healthy
Escapes
True happiness, we are told,
consists in getting out of one’s
self. But the point is not only to
get out – you’ve got to stay out;
and to stay out you must have
some absorbing errand (Henry
James).
Beware the prevalent unhealthy
escapes: substance abuse,
isolation, sexual acting out
Variety in and outside of the
office
Some Absorbing Errands
Vital breaks
Relaxation
Humor
Hobbies
Days off
Vacations
Restorative solitude
Personal retreats
Play: How do you play?
9. Creating a Flourishing
Environment
Use
stimulus control - the most
neglected strategy
Avoid the fundamental
attribution error (FAE)
Take an environmental audit
Work safety
Business support
Behavioral boundaries
Institutional practices (high
demands plus high constraints
are toxic)
A self-care village in a
workaholic world
10. Undergoing Personal
Therapy
Commence personal tx at
beginning (90% plus benefit)
Pursue couples & family tx as well
Confront your resistance not to
pursue personal tx
Supplement psychotherapy with
personal analysis
Return to tx periodically without
shame (52% to 65% reinitiate)
Obtain annual satisfaction checkup
Only one form of self-development
(e.g., creative arts, meditation,
yoga)
11. Cultivating
Spirituality & Mission
Spirituality at the Office
Remember your calling
Reclaim your “mission” in
life (Maslow)
Care for others
Commitment to growth
Spirituality in clinical work
11. Cultivating
Spirituality & Mission
Spirituality Outside Office
Pursuing ultimate questions
Becoming a citizen-therapist
(Tikkun )
Integrating religion/
spirituality into your
personal life
Letting your life speak
12. Fostering Creativity
& Growth
Passionately
committed
therapists: adaptive & open
Everything comes together
in the creative process
Diversify: your therapy day,
your clients, your prof
activities
Growth (e.g., CE, videotape
yourself, prof organizations,
interdisciplinary research)
And, in the end, do more
than survive: Thrive
In Closing:
A Curious Blend
1. How to
2. You should
3. Chill out
Ave Atque Vale
(Hail & Farewell)
Please
♥ be gentle with yourself (selfempathy)
♥ remember that your life is a
work in progress (temper
corrosive expectations)
♥ recall that you cannot master
or profit from all self-care
possibilities (individualize)
♥ practice self-care as a skillful
attitude and lifelong
commitment
Hail & Farewell