One of the silver linings of the pandemic has been the plethora of informative and often free continuing education produced by a number of sources including this offering by The Trust. As we all scrambled to find resources to reassure ourselves that we were practicing safely and ethically during this unprecedented time these educational webinars offered in palatable formats were a welcome gift. I was especially excited to see Dr. Leisl Bryant’s presentation on self-care: Bryant, L (Producer) 2020 Turning Toward Ourselves and Each Other: The Pivotal Nature of Clinician Self-Care. Leisl is a NH colleague and friend whom I know to be authentically striving to integrate self-care into her practice and to support others in doing the same. I am offering my top ten take-aways from her presentation with some added thoughts and references.

One

“What do I need right now?”

Dr. Bryant started her presentation with a moment of mindful attention and check in prompting the audience to ask ourselves “what do I need right now?” This simple but powerful mindfulness practice can help us shift from our well-established neural pathway of turning toward other to take a moment to turn toward ourselves. Dan Siegel identifies time-in as one of the seven daily essential mental activities to optimize brain matter and create wellbeing.[1] So take a moment at the start of your day, after a challenging session, at any moment and ask, “what do I need right now?” with attention to physical, emotional, mental, and social needs.

[1] Siegel, Daniel. J (2010). Mindsight: The new science of personal transformation. Bantam Books

TWO

You are not alone

1.     Bryant references the APA stress in America survey that shows ever increasing levels of stress including a January snapshot that indicated 84% of Americans endorsed experiencing at least one significant stress in the last two weeks[1]. As psychologists we are not immune contrary to some of the misconceptions and myths around psychologist invulnerability. Informal polling during the presentation confirmed that participants were all experiencing stress related to current events as well as to the tsunami of need generated by COVID-19 and the highlighting of racial injustice. Self-compassion psychology developed by Kristin Neff[2] identifies common humanity as a key component of self-compassion alongside mindfulness and kindness. Knowing your experience is a human experience and a common experience among competent psychologists can help reduce negative cognitions about self that can further burn-out and restrict self-care.

[1] APA 2021 January Stress in America Snapshot [press release] https://www.apa.org/news/press/releases/stress

Three

Flourish

Don’t just avoid improper behavior arising out of distress and burn-out. Cultivate practices that will amplify the other end of the continuum that Bryant suggests could include flourishing. Her broader continuum concept (in process) identifies flourishing-surviving-stress-distress-impairment-improper behavior as an alternative to the classic stress-distress continuum that did not focus on the positive end. She emphasizes the importance of taking an active role in one’s wellbeing and happiness. Can you visualize what flourishing would look like?

four

Embed yourself in a caring community

We are social beings and the burden of self-care can’t just fall on our shoulders. Bryant discusses the idea of a competence constellation from the work of Johnson et al[1]. The competence constellation is defined as “a psychologist’s network or consortium of individual colleagues, consultation groups, supervisors, and other relationships that, combined, help to ensure ongoing enhancement and assessment of competence from multiple sources”. This group can be an early warning detection that you are shifting away from flourishing and into stress, distress, or even burn-out. It may be a lunch date, a walk, a formal consultation group meeting, or a curbside consult or even better all of the above. If COVID has taught us anything it is the risk of isolation, so reach out. One factor in my decision to relocate my practice during the pandemic was to join a group of other providers to have support embedded in my work day. It hasn’t worked out that way with most of us working from home but we connect by email, leave notes for each other when we are utilizing the offices for video sessions, and now with full vaccination we are meeting monthly again for a social hang-out. Who are your people?

[1] Johnson et al (2013). The Competence Constellation Model: A communitarian approach to support professional competence. Professional Psychology: Research and Practice, vol 44, No. 5, 343-354.

[2] Neff, Kristin (2015). Self-Compassion: The proven power of being kind to yourself. William Morrow.

five

Assess your professional quality of life

As scientist practitioners we should always be looking at some form of data. Bryant recommends assessing your level of burn-out or quality of professional life. A free resource she recommends is the Professional quality of Life Measure[1]. https://proqol.org/uploads/ProQOL_5_English.pdf . The Proqol website also offers a number of great resources including a “Pocket card for the COVID-19 Crisis”, a handy card you can print and carry with you full of great reminders for tending to self.

[1] B. Hudnall Stamm, 2009. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL)

six

Self-care needs change

Just as we develop as clinicians over the course of our careers our self-care needs may shift and evolve as well. At times we may really rely on a physical practice such as exercise in the morning while at other times meditation or journaling practice may be more replenishing. COVID-19 restrictions challenged many of us to have to adjust our self-care routines as we did not have access to the gym, the theater, social engagement, even a regularly scheduled massage or acupuncture session. Bryant discusses the need to check-in again around what the self-care need of the moment may be rather than just turning to the default. Getting creative can be a wonderful way to diversify your self-care and is recommended itself as a strategy for resetting the nervous system in Emily and Amelia Nagoski’s book Burnout: The secret to unlocking the stress cycle[1]. So don’t be rigid. Allow yourself to change self-care depending on circumstance or need. Self-care isn’t a to do it is a want to do.

[1] Nagoski, Amelia & Nagoski, Emily (2019) Burnout: The secret to unlocking the stress cycle. Ballantine Books.

SEven

Deep well

Related to shifting self-care needs is the importance of multiple broad strategies for self-care. We can’t just have one go to. You may love running but what if you twist your ankle? We need a deep and diverse reservoir of strategies for self-care. Think about strategies you can access quickly during your work day as well as those deeper dives that really allow you to restore. Think of solitary self-care and social self-care-sometimes we need a walk in the woods alone and sometimes we need to be amongst friends and in connection. Think of identifying strategies that tend to your physical body, your emotional self, your mind, and your connections. The more the merrier!

Eight

Lived self-care

Bryant’s presentation does a wonderful job of emphasizing that self-care can’t only be as needed but functions best when it is integrated into your way of living. It is a habit that needs to be actively practiced and developed and can be a “daily moment by moment choice”. Thinking of self-care as lived means that it is your morning meditation and the realization that you need a check in with a friend mid-day at lunch and that you need to pick up dinner to keep things simple vs. make one more decision. It is preventative in terms of physical activity, good nutrition, and enough sleep AND it is also checking in with yourself in the moment and making adjustments for what you need vs. what you thought you might need.

Nine

Joy

Focus on positive outcomes and special moments vs. the difficult client or challenging part of your day. Bryant’s presentation draws on the wonderful work of Norcross and VandenBos, Leaving it at the office: A guide to psychotherapist self-care.[1] They discuss the importance of revisiting the positive, joyful, and connected moments in the day rather than ruminating on that challenging interaction as a way of increased work satisfaction and staving off burn-out. There can be so much joy in the therapy relationship and video therapy has offered some new twists on the types of things that we laugh over with our clients. An added plus one of the other ways of completing the stress cycle discussed in the Nagoski’s book is laughter! When did you laugh from the belly last either with a client or with a good colleague or friend? Revising those moments of joy can be a step toward flourishing and away from stress and distress.

[1] Norcross, J & VandenBos, G (2018). Leaving it at the Office: A guide to psychotherapist self-care, Second Edition. The Guilford Press.

Ten

Ethical Imperative

Tending to self is an ethical imperative. Bryant does a great job (not a surprise as one of the Trust Risk Management advisors) delineating the relevant APA Ethic’s Code reasons for practicing self-care and for understanding that caring for self is imperative if we are to safely and ethically care for others. The relevant parts of the code include: Principle A: Beneficence and nonmaleficence, Standard 2.01 Boundaries of Competence, Standard 2.03 Maintaining Competence, and Standard 2.06 Personal Problems and Conflicts.[1] If self-care feels selfish to you then maybe you can start to approach it from a place of caring for others.

[1] American Psychological Association (2017). Ethical Principals of Psychologists and Code of Conduct. . Retrieved May 16, 2021 https://www.apa.org/ethics/code/

Self-care is a process. It evolves. It isn’t really self-care it is collective care. We are going to be in demand to hold the needs of others in our professional and personal lives for some time to come so finding ways to do so that are fulfilling and keep us in the equation is imperative.