Leaving It at the Office:

Psychotherapist Self-Care

John C. Norcross, Ph.D.

DescriptionConducting 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 self-assessments 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 self-change 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 self-care.

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 the privileges

Notice the life rewards

Feel 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

SleepBodily restNutrition and hydrationExerciseHuman contact

5. Nurturing RelationshipsEmphasize the human

elementAt the Office

Clinical colleaguesPeer supportSupervision groupsClinical teamsStaffProfessionals in community MentorsClients

5. Nurturing Relationships (cont)Outside the Office

Spouse/partnerFamily membersFriendsColleague Assistance ProgramsPersonal mentorsPersonal therapist

6. Setting Boundaries

Delegate

Boundary set

Balancing 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 EscapesTrue 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 OfficeRemember your callingReclaim your “mission” in

life (Maslow) Care for othersCommitment to growthSpirituality in clinical work

11. Cultivating Spirituality & Mission

Spirituality Outside OfficePursuing ultimate questionsBecoming a citizen-therapist

(Tikkun ) Integrating religion/

spirituality into your personal life

Letting your life speak

12. Fostering Creativity & GrowthPassionately committed

therapists: adaptive & open Everything comes together

in the creative processDiversify: 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 (self-

empathy)

♥ 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