Self-care for psychologists

Erica Wise, PhD, is a clinical professor and director of the Psychology Training Clinic in the clinical psychology doctoral program at UNC Chapel Hill. She is a former member and chair of the APA Ethics Committee and the North Carolina Psychology Board. She is a member of the APA Board Educational Affairs (BEA), past-president of NCPA and co-chair of the NCPA Ethics Committee. Her professional interests include professional education and training and the integration of ethics, diversity, and self-care into academic and professional practice settings. She was the recipient of the 2013 Fifth Annual APA Ethics Committee Award for Outstanding Contributions to Ethics Education, and in 2014 she received an APA Presidential Citation for her work in social justice advocacy and self-care for psychologists. 

Jewel Edwards-Ashman: For more than 10 years, APA has reported on Americans' stress levels. In 2018, APA's yearly Stress in 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 percent of Gen Zer's feel like they're doing enough to manage their stress levels and take care of their mental health and emotional wellbeing. 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 2018 around the last major U.S. election cycles.

I'm Jewel 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 psychologists integrate self-care practices into their lives.

Jewel Edwards-Ashman: So, what do you find when you type “self-care” into the Google search bar? When I did it about two billion results popped up, and I came across 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, 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?

Erica Wise: There are still messages at least that as psychologists we can perceive that we should have it all together already. And in fact, there have 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 suggest that psychologists may be drawn to practice because of their own histories of someone, either a family member or a loved one or someone else who's 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.

Jewel Edwards-Ashman: 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 the addressing ethical and legal issues that psychologists face in practice. That experience of seeing some of the challenging issues that practitioners deal with led to Dr. Wise's involvement with a somewhat difficult and hard to visualize project: developing a new self-care training for psychologists to help them manage personal and occupational stress.

Erica Wise: 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 a 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 in practice, in dentistry, in pharmacy and other areas. But at that point it really wasn't.

Jewel Edwards-Ashman: 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 health care providers. Practicing psychologists are more at risk for overworking, professional isolation or over-involvement in their patients' lives. Also, s tigma within the profession can keep psychologists from acknowledging any moments of distress or seeking help to manage their workload and stressful situations.

Erica Wise: I think that self-care for psychologists is primarily, in quotes, “personal”, but where it intersects professionally is where it affects our competence to practice or teach or do research, whatever it is that we are 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 a very frustrated or dissatisfied patient or even a personality conflict with another psychologist that those are very distressing.

Many of the stories I heard on the psychology board where the end result of improper or unprofessional behavior really started with personal traumas or difficulties, so it just seemed those areas were much more related than I realized.

I think 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, you know, every day you take a bubble bath or 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.

Jewel Edwards-Ashman: APAs 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.

Erica Wise: When we looked at what APA at that point was promulgating as a vision of self-care...it started at stress and distress then improper behavior and then actual impairment. And we gave some thought to that and we realize that that was not a very optimistic view for our profession, that the best we could do was try to cling to being minimally competent and try not to spiral down into distress and inappropriate behavior.

We realized that when self-care is presented as something that you have to add on to everything else you're doing it almost became something else on your checklist. So we really wanted to emphasize the idea of flourishing not just surviving.

We wanted it to be very intentional to make this a very routine part of our lives. That if everyday you're deciding whether or not to do things to take care of yourself, that over time that tends to not be very successful. So things like being aware of the different elements in your life: physical health, spiritual awareness, interrelatedness with others really need to be built into the fabric of your life.

Jewel Edwards-Ashman: ACCA 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 her 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.

Erica Wise: If we're going to treat people in a clinical practice we needed to be aware of the benefits that we can 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, using CBT and mindfulness and making that part of our own practices means that we're in a reciprocal relationship with our patients. It's not us and them. It's a we in the human experience. Of course, we're in a much more professional role. But it's much more respectful of clients and respectful of our own limitations and our own humanity

Jewel Edwards-Ashman: Another important element of self-care: Self-compassion, an idea promulgated by psychologist Kristen Kneff and others, which includes ideas like self-kindness, mindfulness and a sense of shared humanity.

Erica Wise:

So, the goal is kind of to reduce our self judgement our isolation and our rumination, that these are very common experiences and that as psychologists we especially need to be aware of managing those.

In particular that when we experience painful thoughts and feelings, we can keep them sort of in a balanced awareness with our other experiences rather than over identifying with them. So, the goal is kind of to reduce our self judgement our isolation and our rumination, that these are very common experiences and that as psychologists we especially need to be aware of managing those. 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. We really do need have some ways to buffer that so that we don't become numb or too detached from to emotions of others.

My hope, and this is something that 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 also are learning to talk with other psychologists and hear what they are doing. They're getting to check out their ideas with other people. They are encouraged to be in peer supervision groups. I think that idea of making this a much more inherent part of how we train and how we practice would be a really good thing.

Jewel Edwards-Ashman: Taking care of yourself emotional and mental well-being should be much more than another item on your daily or weekly to-do list. And Wise said it shouldn't be something that's in the back of psychologists' 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.

Erica Wise: Many other professionals are aware that there is a high cost of burn out and that we've all invested a lot in our education and training, So this is kind of a co-investment that can help ensure that people stay excited and passionate about what they're doing. My hope, and this is something that 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 also are learning to talk with other psychologists and hear what they are doing. They're getting to check out their ideas with other people. They are encouraged to be in peer supervision groups. I think that idea of making this a much more inherent part of how we train and how we practice would be a really good thing.

I think we're just kind of beginning to think through some of what 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 binge-watching Netflix, but that we can balance it with being effective in our work.

I think learning how to inculcate this into graduate programs so that we develop a sense of community so that graduate students learn how to take care of themselves as well as others, that we really articulate that. And I think it is not just skills-based, which I think is where the earlier approach of just do a list of A, B, C, D. It's not what we do, it's also how do we do it. Do we pursue it in a way that's mindful and attentive to what the stressors are, how they're affecting us, so that the types of activities we engage in for self-care are meaningful connected to that and also 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 the stressors

Jewel Edwards-Ashman: For more information self-care practices for psychologists, visit APA's self-care resource center.

Thanks so much for listening to another episode of Progress Notes, produced by me Jewel EdwardsAshman and Luana Bossolo. Subscribe to this podcast on iTunes or Google Play to make sure catch next month's episode.