Therapist's Guide to Self-Care

Lillie Weiss

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135935771
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Psychotherapy is an increasingly stressful profession. Yet therapists spend most of their time helping clients deal with their stress, not caring for their own. This book is designed as a tool for the experienced counselor, junior therapist, and graduate student, as the issues confronted and discussed herein are relevant to anyone in the field, regardless of experience or expertise. Dr. Weiss has written a book in an easy, conversational tone, filled with concrete examples and blending research findings, clinical experience and theoretical approaches into practical suggestions and sound advice. The book is divided into three parts, discussing therapist concerns and questions that are continually raised, and providing practical tools based on clinical experience and research findings. It will be useful to all mental health professionals who have felt the strain of their practice.

Part I
Designing and Creating the
Life You Want

CHAPTER 1
Visualize the Life You Want and DO IT!

The first step to getting the things you want out of life is this:

Decide what you want.

—Ben Stein

“I don’t know if I can even say it out loud,” said Lisa,* a psychologist who usually has no difficulty expressing her feelings. It took several sessions and lots of prodding before she could even verbalize the unthinkable: “I don’t know if I want to be a psychologist any longer. I don’t think I can do this the rest of my life.” Lisa’s reluctance to even voice the problem was understandable. After all, she had spent many, many years training to become a psychologist. The time, money, and energy she had invested toward her goal had been tremendous. No wonder she couldn’t even allow herself to admit that she couldn’t stand her job: It was her very identity.

Lisa might have been relieved to know that her feelings were not unique and are shared by many of her colleagues. In a large national survey of clinical psychologists, 4 out of 10 said they would choose a different career if they had their lives to live over (Norcross & Prochaska, 1982). Over the years, I have heard therapists express Lisa’s concerns in one form or another, whether these are done in a joking manner or in earnest. “I think I’ll close up shop and open a catering business,” a therapist will say. Being a tour guide, making flower arrangements, working in a bookstore—fantasies of these and other less stressful jobs are common in casual conversation among clinicians.

In fact, some of my colleagues have done just that—left the mental health field entirely. However, short of taking such a drastic step, are there other alternatives to cope with the thoughts that occupy most clinicians from time to time—that they just want to escape and can’t do this any longer?

*Names and details have been changed to protect identities.

If you are feeling like Lisa did or have at times felt “I just can’t see myself doing this for the rest of my life,” I would ask you, as I did Lisa, not to throw out the baby with the bath water and leave the mental health arena altogether—at least, not just yet—before exploring how many of the emotions you are experiencing are symptoms of burnout and how many have to do with the psychotherapy field itself.

I first asked Lisa to describe her work. Lisa had a fairly established practice and had contracts with several agencies to provide services for patients and their families. Because many of her clients were disabled, she often had to drive long distances to their settings to see them. She regularly got called on emergencies, and, in addition, she had the unpleasant task of informing relatives about the poor prognosis of their loved ones. Naturally, much of the families’ anger and frustration was directed at her. Lisa felt an enormous amount of responsibility, even though she knew that she had no control over her clients’ long-standing chronic conditions.

Lisa’s work pervaded her home life as well, as she would frequently get phone calls and faxes at all hours of the day. In fact, there seemed to be no separation between her home and her work life. Because she was so busy during the week, she couldn’t attend to her paperwork. She frequently ended up spending much of her weekend writing reports and letters and tending to other administrative details. Not surprisingly, this had started to cause problems in her marital relationship. Lisa had very little time for her husband or for herself and felt little control over what free moments she had because she thought that she had to be available and had to respond to any messages that came through. Most of the situations she got called on were quite depressing, and sometimes the intensity of the conditions would overwhelm her.

Lisa did not allow herself to say no to referrals; after all, she was in private practice and had to make a living. What if she didn’t get any more clients? She had no steady paycheck and got anxious if there were any empty spaces in her schedule. Lisa was feeling increasingly burned out and frustrated; there seemed to be so many demands on her time and energy. She hated the emotions that she, a very empathetic and caring person, was beginning to develop toward her clients. Everyone seemed to want something from her, including her husband. She saw his wanting her time and attention as “one more demand.” Unfortunately, he was the one person she most often said no to. She also had no energy for her friends and started feeling increasingly isolated.

Lisa’s work situation had all the elements necessary to produce fullblown burnout: time pressures, lack of control over her work schedule, a tremendous sense of responsibility, financial insecurities, and social isolation, with few apparent rewards (Maslach & Leiter, 1997). Lisa, who had always loved psychology, was beginning to dread going to work. In fact, she was beginning to dread her life.

“If you could design your life any way you could, how would you do it?” I asked her. “If time and money were no object, how would you create the life you want?” Until this point, Lisa had no idea that she could in fact fashion her existence and make it exactly the way she wanted. She was, after all, her own boss, and it was entirely up to her to decide her hours, her schedule, the types of clients she saw, and how she chose to fill up her days. What aspects of her current job would she keep? What would she throw out? What nonwork activities would she make time for?

Lisa said that if she could design her life any way she wanted, she would exercise and do meditation every morning before she set out for work, and she would come home from work earlier and have her evenings and weekends free to do whatever she wanted. In addition, she would structure her work so that she would see clients 2 days a week, do paperwork and reports the other 2 days, and take 1 day off for herself to pursue other interests, such as computer classes. She would eliminate all of the cases that involved a lot of driving to appointments (and consequently were not cost-effective, generating very little income), as well as those she found emotionally draining.

“DO IT!” Lisa almost immediately implemented those changes once she recognized that she was, in f fact, in charge of her life and could tailor it any way she wanted. She scheduled patients only on Mondays and Wednesdays and left Tuesdays and Thursdays for reports, phone calls, and other administrative chores. Because she had control over when to start her day, she began every morning with exercise and meditation before heading off for work, and when she came home, she turned off the faxes and the computer, leaving the paperwork for Tuesdays and Thursdays. She signed up for a computer class on her free day. She also informed her referral sources that she was only driving to settings close to her home and, in addition, outlined what types of cases she would see in the future. When she got “emergency” calls, she scheduled to see those patients on Mondays or Wednesdays, instead of disrupting her day completely and attending to the emergencies immediately.

Besides making changes in her outer environment, Lisa also made some inner changes in her behavior and attitudes. She said no to new referrals that she found to be too emotionally draining. She also learned to cope with her feelings of financial insecurity, recognizing that if she filled up her schedule with cases that drained her, there would be no room for those that exhilarated her. To her relief, she suffered no financial setbacks and managed to fill up her schedule with activities she liked. She also learned to cope with her feelings of overresponsibility for her patients by telling herself, “I didn’t make them disabled, and I cannot fix their situation.” Consequently, she was able to deal with the anger expressed by their relatives and not take it so personally. Within a few weeks, Lisa was feeling enthusiastic about her work and her life again. “I feel excited about what I’m doing,” she said, a far cry from the dread she described when she first came to see me. Not only did she feel good about her job, but her relationship with her spouse improved as well because she was able to give more to her marriage.

Lisa’s story comes in many different shapes and forms. Although Lisa’s level of burnout was quite pronounced, you may have felt like her at different times in your career. It is a rare therapist who has not experienced some of those emotions to some degree at some point or another. Whether you feel as stressed as Lisa was or only minimally burned out, or you merely want to make an already satisfying career even better, the first step is to visualize the kind of life you want. The next step is to DO IT! In the following chapters, I will provide tools to help you make those changes.

When you can see in your mind’s eye exactly how you would like your life to be, then you can make it a reality. Visualization is one of the most powerful tools for putting your ideas into action. Research has shown that people have used it successfully to help them realize their goals, whether those are to improve a golf score, overcome a phobia, lose weight, or even shrink malignant tumors (Samuels & Samuels, 1992). When you can see yourself doing what you love, it serves as a mental practice or a rehearsal for you, because you have already done it in your mind. That makes it easier for you to do the “real” thing.

The next two chapters are brief and consist mainly of self-assessments to help you visualize and fine-tune this process of making your dream a reality. At the end of every chapter in the book, there will be questions you can ask yourself to help you summarize the suggestions and apply them to your own life.

CHAPTER 2
Ask Yourself: “If Money Were No Object…”

It’s only money.

—Jackie Bradley, retired social worker

If you were guaranteed a steady, comfortable income for life, how would you structure your days? Would you still work? How many hours a week would you work? How would you fill up your time? What activities would you include in your schedule?

What would you make more time for? What would you eliminate? Would you remain in your profession or change careers? What kind of environment would you work in? Close your eyes for a few minutes and think about what would be an ideal situation for you. For the moment, don’t let reality and financial concerns get in the way. Just allow your mind to wander and think of how you would like your dream job to be.

I have often been surprised by how close people’s ideal job is to what they are already doing. Most therapists to whom I’ve put the question usually respond, as Lisa did, that they would put in less hours, start later or end earlier, not work with certain populations, make time for other interesting activities, or any number of changes that would be fairly easy to implement if they gave themselves permission to do so.

Irene is a case in point. Irene loved her work very much. She had recently set up a private practice in her home and enjoyed the variety and the stimulation it offered her. She took good care of herself and seldom felt burned out. On the contrary, her work exhilarated her. However, her career came at some personal sacrifice. Irene and her husband owned a small vacation home several thousand miles away, where she used to spend her summers before she went into private practice. It was a quiet hideaway in the woods where she went to recharge her batteries and which was very important to her emotional and spiritual well-being. Irene didn’t feel that she could leave every summer now that she had a full-time practice. “Why not?” I asked her. “I don’t know,” she said. “I just assumed it wasn’t possible.” Like Lisa, Irene had set her own road-blocks to fulfilling her fantasies and creating her dream job. What, in fact, was keeping Irene from leaving every summer? In her case, it wasn’t the income, because she lived very frugally. She also didn’t have any clients who would not be able to manage without a few weeks of therapy. Instead of worrying about why she couldn’t make her dream come true, Irene now focused on how she could, which, surprisingly, just as in Lisa’s case, only involved some planning and taking action. Irene developed a strategy to implement her plan of going away in the summer. She prepared all of her clients in advance and told them that she would be gone during the m...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Acknowledgments
• Introduction
• Part I: Designing and Creating the Life You Want
• Part II: Tips for Managing Your Outer Environment
• Part III: Tips for Managing Your Inner Environment
• References