No time for Self-Care?

Having it all; doing it all; struggling to keep up; just barely hanging on. All convey the pressures and stresses many psychologists may feel at various times as our lives get busier and we struggle to keep our lives in balance. Psychologists, like all other mental health professionals, are trained to be care providers. We typically pride ourselves in the quality of care we provide to others. Yet, we may at times do so at the expense of our own self-care, a pattern that has implications both for ourselves and our patients. Inadequate attention to the virtue of self-care in an oftentimes stressful and demanding profession may lead to distress and possibly impairment.

Independent practitioners must cope with numerous forms of stress that may contribute to feelings of distress. These include environmental factors such as professional isolation, the monotonous nature of our work, the demands of managed care to include increased paperwork requirements and reduced reimbursement rates, and work with difficult patients; and personal stress such as relationship problems, mental health difficulties, illness, and family stresses. While distress does not necessarily lead to professional impairment, studies have indicated that a significant level of distress is experienced by many psychologists and for some this does in fact lead to impairment of professional competence.

In one survey of mental health clinicians Deutsch (1985) found that nearly all respondents reported providing treatment services while experiencing personal stress. Examples include relationship problems (82%), depression (57%), and substance abuse (11%). Further 2% of this sample reported having attempted suicide, a sign of significant distress. In another survey Guy, Poelstra, & Stark (1989) found that 74.3% of responding psychologists reported distress and that for 36.7% of them it negatively affected "the quality of the patient care provided" (p. 49). Additionally, 4.6% reported that "the distress was serious enough to result in inadequate patient care" (p. 49). Further, in another survey (Pope, Tabachnick, & Keith-Spiegel, 1988) 62% of psychologists acknowledged working when too distressed to be effective and that 85.1% of these psychologists reported that treating patients under these conditions should be considered unethical.

Interestingly, in these studies a number of practitioners acknowledged not seeking assistance for their reported difficulties. Reasons given include concerns about confidentiality and the stigma of receiving treatment, a perceived lack of available resources, feeling they could manage the difficulties themselves, and fear of professional censure.

While distress is not guaranteed to lead to impaired competence the risks seem clear and our profession’s ethics code (APA, 1992) places a strong emphasis on taking preventive steps so such harm does not occur. The General Principles of Professional and Scientific Responsibility and Concern for Others’ Welfare as well as the specific Ethical Standards of Avoiding Harm and Personal Problems and Conflicts require us to be sensitive to issues of distress and to take preventive and corrective action so that impairment and the resultant harm that may occur will be avoided.

Psychologists take a variety of steps to address distress and avoid impairment. Guy et al. (1989) found that 70% of the clinicians acknowledging distress took some form of corrective action in response. Interventions reported include: seeking individual psychotherapy, seeking marital or family psychotherapy, reducing one’s case load, taking a leave of absence from work as a mental health practitioner, attending self-help groups, use of medication, and hospitalization. Additional strategies independent practitioners may wish to consider include:

Make adequate time for yourself. It’s easy to be consumed by all the various demands in our lives. Regularly scheduling time for yourself can make a big difference. Even something as simple as scheduling a lunch hour and really taking it can help.

Do something you enjoy. We get so caught up in being productive and meeting deadlines and others’ demands, it is easy to overlook ourselves. Do something just for you. This can range from pleasure reading (not journals), to taking a class unrelated to our profession just because you have an interest in that area, to athletics and the arts.

Take care of yourself physically and spiritually. Take the time to undergo regular physical exams and dental care, exercise regularly (even a little is better than none), get adequate rest, maintain a healthy diet (keeping fast food to a minimum if possible), get a massage, take a yoga class, or meditate, attend your church or synagogue regularly or attend to your spiritual needs in some other more personal way.

Say NO! Setting reasonable limits and having realistic expectations for ourselves is of great importance. Have firm and consistent boundaries and limit the number of difficult patients you treat at any one time. Remember that patient care is just one part of your life.

Don’t isolate. We can avoid professional isolation in a variety of rewarding ways. Suggestions include use of peer supervision or support groups, the liberal use of consultation with colleagues, involvement in state and national psychological association activities (Division 42 has lots of rewarding volunteer positions available), and involvement in civic or religious organizations.

Keep in mind that self-care is a good thing. Self-care is not selfishness. The better job we do in taking care of ourselves, the better job we can do to take care of our patients.

Watch out for warning signs. These include: violating boundaries, self-medicating, wishing patients would not show up, finding it difficult to focus on patient needs, and being preoccupied with our own needs and issues. Sherman (1996) also includes missing appointments, frequent cancellations, lateness for appointments, failure to return telephone calls, emotional outbursts in sessions, boredom, and fatigue.

Be you brothers’ and sisters’ keeper. Watch out for warning signs of distress, burnout, and impairment in colleagues. Don’t overlook them or think it will all work out on its own. Remember our obligation both to the public and to our profession.

Conduct periodic distress and impairment self-assessments and seek help when needed. It is important that we be aware of our caregiver blind spot. We can see others’ needs but often overlook our own. Attention to this is important. If assistance is needed consult with a trusted colleague or your state psychological association’s colleague assistance program.

Focus on prevention. By attending to the issues raised and by using the strategies outlined above, we can live a healthier lifestyle that helps to prevent distress and impairment. Stress is a part of our lives. Accept it, respond to it, and avoid the costly consequences of practicing while impaired.

Make time for self-care! Integrate it into your lifestyle and regular routine. You’ll be glad you did.

References

American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. American Psychologist,47, 1597-1611.

Deutsch, C.J. (1985). A survey of therapists’ personal problems and treatment. Professional Psychology: Research and Practice, 16 (2), 305-315.

Guy, J.D., Poelstra, P.L., & Stark, M.J. (1989). Personal distress and therapeutic effectiveness: National survey of psychologists practicing psychotherapy. Professional Psychology: Research and Practice, 20 (1), 48-50.

Pope, K.S., Tabachnick, B.G., & Keith-Spiegel, P. (1988). Good and poor practices in psychotherapy: National survey of beliefs of psychologists. Professional Psychology: Research and Practice, 19 (5), 547-552.

Sherman, M.D. (1996). Distress and professional impairment due to mental health problems among psychotherapists. Clinical Psychology Review, 16, 299-315.


	News and Views Ethics Issues		No time for Self-Care?
	Ethics Table of Contents		by Jeffrey Barnett, Psy.D. & Deborah Sarnel, M.S.

			Having it all; doing it all; struggling to keep up; just barely hanging on. All convey the pressures and stresses many psychologists may feel at various times as our lives get busier and we struggle to keep our lives in balance. Psychologists, like all other mental health professionals, are trained to be care providers. We typically pride ourselves in the quality of care we provide to others. Yet, we may at times do so at the expense of our own self-care, a pattern that has implications both for ourselves and our patients. Inadequate attention to the virtue of self-care in an oftentimes stressful and demanding profession may lead to distress and possibly impairment. Independent practitioners must cope with numerous forms of stress that may contribute to feelings of distress. These include environmental factors such as professional isolation, the monotonous nature of our work, the demands of managed care to include increased paperwork requirements and reduced reimbursement rates, and work with difficult patients; and personal stress such as relationship problems, mental health difficulties, illness, and family stresses. While distress does not necessarily lead to professional impairment, studies have indicated that a significant level of distress is experienced by many psychologists and for some this does in fact lead to impairment of professional competence. In one survey of mental health clinicians Deutsch (1985) found that nearly all respondents reported providing treatment services while experiencing personal stress. Examples include relationship problems (82%), depression (57%), and substance abuse (11%). Further 2% of this sample reported having attempted suicide, a sign of significant distress. In another survey Guy, Poelstra, & Stark (1989) found that 74.3% of responding psychologists reported distress and that for 36.7% of them it negatively affected "the quality of the patient care provided" (p. 49). Additionally, 4.6% reported that "the distress was serious enough to result in inadequate patient care" (p. 49). Further, in another survey (Pope, Tabachnick, & Keith-Spiegel, 1988) 62% of psychologists acknowledged working when too distressed to be effective and that 85.1% of these psychologists reported that treating patients under these conditions should be considered unethical. Interestingly, in these studies a number of practitioners acknowledged not seeking assistance for their reported difficulties. Reasons given include concerns about confidentiality and the stigma of receiving treatment, a perceived lack of available resources, feeling they could manage the difficulties themselves, and fear of professional censure. While distress is not guaranteed to lead to impaired competence the risks seem clear and our profession’s ethics code (APA, 1992) places a strong emphasis on taking preventive steps so such harm does not occur. The General Principles of Professional and Scientific Responsibility and Concern for Others’ Welfare as well as the specific Ethical Standards of Avoiding Harm and Personal Problems and Conflicts require us to be sensitive to issues of distress and to take preventive and corrective action so that impairment and the resultant harm that may occur will be avoided. Psychologists take a variety of steps to address distress and avoid impairment. Guy et al. (1989) found that 70% of the clinicians acknowledging distress took some form of corrective action in response. Interventions reported include: seeking individual psychotherapy, seeking marital or family psychotherapy, reducing one’s case load, taking a leave of absence from work as a mental health practitioner, attending self-help groups, use of medication, and hospitalization. Additional strategies independent practitioners may wish to consider include: Make adequate time for yourself. It’s easy to be consumed by all the various demands in our lives. Regularly scheduling time for yourself can make a big difference. Even something as simple as scheduling a lunch hour and really taking it can help. Do something you enjoy. We get so caught up in being productive and meeting deadlines and others’ demands, it is easy to overlook ourselves. Do something just for you. This can range from pleasure reading (not journals), to taking a class unrelated to our profession just because you have an interest in that area, to athletics and the arts. Take care of yourself physically and spiritually. Take the time to undergo regular physical exams and dental care, exercise regularly (even a little is better than none), get adequate rest, maintain a healthy diet (keeping fast food to a minimum if possible), get a massage, take a yoga class, or meditate, attend your church or synagogue regularly or attend to your spiritual needs in some other more personal way. Say NO! Setting reasonable limits and having realistic expectations for ourselves is of great importance. Have firm and consistent boundaries and limit the number of difficult patients you treat at any one time. Remember that patient care is just one part of your life. Don’t isolate. We can avoid professional isolation in a variety of rewarding ways. Suggestions include use of peer supervision or support groups, the liberal use of consultation with colleagues, involvement in state and national psychological association activities (Division 42 has lots of rewarding volunteer positions available), and involvement in civic or religious organizations. Keep in mind that self-care is a good thing. Self-care is not selfishness. The better job we do in taking care of ourselves, the better job we can do to take care of our patients. Watch out for warning signs. These include: violating boundaries, self-medicating, wishing patients would not show up, finding it difficult to focus on patient needs, and being preoccupied with our own needs and issues. Sherman (1996) also includes missing appointments, frequent cancellations, lateness for appointments, failure to return telephone calls, emotional outbursts in sessions, boredom, and fatigue. Be you brothers’ and sisters’ keeper. Watch out for warning signs of distress, burnout, and impairment in colleagues. Don’t overlook them or think it will all work out on its own. Remember our obligation both to the public and to our profession. Conduct periodic distress and impairment self-assessments and seek help when needed. It is important that we be aware of our caregiver blind spot. We can see others’ needs but often overlook our own. Attention to this is important. If assistance is needed consult with a trusted colleague or your state psychological association’s colleague assistance program. Focus on prevention. By attending to the issues raised and by using the strategies outlined above, we can live a healthier lifestyle that helps to prevent distress and impairment. Stress is a part of our lives. Accept it, respond to it, and avoid the costly consequences of practicing while impaired. Make time for self-care! Integrate it into your lifestyle and regular routine. You’ll be glad you did. References American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. American Psychologist,47, 1597-1611. Deutsch, C.J. (1985). A survey of therapists’ personal problems and treatment. Professional Psychology: Research and Practice, 16 (2), 305-315. Guy, J.D., Poelstra, P.L., & Stark, M.J. (1989). Personal distress and therapeutic effectiveness: National survey of psychologists practicing psychotherapy. Professional Psychology: Research and Practice, 20 (1), 48-50. Pope, K.S., Tabachnick, B.G., & Keith-Spiegel, P. (1988). Good and poor practices in psychotherapy: National survey of beliefs of psychologists. Professional Psychology: Research and Practice, 19 (5), 547-552. Sherman, M.D. (1996). Distress and professional impairment due to mental health problems among psychotherapists. Clinical Psychology Review, 16, 299-315.

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