Psychotherapist: Resource Thyself! Pearls of Wisdom on Self-Care

If you are like me, you likely find it easier to take care of others than to take care of yourself.  Many of us who practice as psychotherapists learned early in life to put the proverbial oxygen mask on others first. After almost 30 years of practicing this way, I am beginning to grow wiser. Many years ago an older female friend shared a pearl of wisdom with me.  She let me in on the secret gifts of mid-life: women stop wanting to take care of everyone else and they stop caring what people think about them.  As I find myself now at this juncture, with a “revolving door” nest, I recognize the truth of her words.  Not that I have stopped wanting to take care of others—the freedom actually has led to much generativity–but I have stopped wanting to do so in the way I used to—without sufficient boundaries, resources or reciprocity.

So, I am here to pay it forward, to first delineate the problem, and then to share some self-care pearls of wisdom that have been handed down to me.

Too many therapists work in relative isolation even as they encourage clients to seek social support.  Even when working in a clinic or sharing office space with colleagues, they tend to co-exist as ships passing in the night. Therapists working alone makes about as much sense as the isolation of the contemporary nuclear family. We can’t do it alone. It takes a village.  To sustain the work we do, we need each other.  We may offer our clients a “circle of support,” but do we do the same for ourselves?  Do we make time for peer supervision, lunch with a friend or colleague, consultation from a trusted mentor, a day at a nurturing workshop or conference rather than listening to a webinar while multi-tasking dinner preparation or clean-up?

Similarly, therapists too frequently work long days without a lunch (or dinner) hour or even regular bathroom breaks, all the while teaching clients about self-care and pacing. If you are like me (at least historically), you cram in as many clients as you can before you rush home to pick up the kids, take the dog for a walk, get dinner on the table, or maybe squeak in the door with just enough time for a bedtime story and kiss goodnight before you doze off yourself.  If by chance you are still awake, you likely spend two hours returning emails and phone calls you didn’t get to during the day because most of your sessions ran over a couple of minutes.

Most therapists I know not only work part or full-time without breaks, but work on and off the job. Many of us volunteer as the impromptu therapist for our family members, friends, friends’ friends, and sometimes even to strangers at cocktail parties or on long airplane flights if we dare to honestly reveal our profession.

Furthermore, many of us, despite child labor laws, began our training sometime before the age of majority.  For me, it was eavesdropping on what my Jewish family called bubbemintzes—the stories grandmas tell, the family gossip, listening for the precious nuggets of what makes people tick, of what keeps families together or tears them apart.  The latter was a hot topic for me as I grew up in a family rife with intergenerational trauma and in which all my relatives divorced.  I desperately took notes over dinner, when my mom had coffee with her friends, when my many aunts came to visit from out of town, or when my colorful grandmother engaged in her favorite defense of splitting.  It was essential to figure out what kept people in and out of good graces and compelling to try to take care of all of these hurting souls whom I love.  I sometimes joke that I was raised in the Jewish equivalent of the “Ya-Ya Sisterhood.”

So we learn early to take care of others, to rescue those in need, to be good listeners, while simultaneously pushing our needs to the back burner.  We develop lovely skills of compassion, empathy and insight while overlooking self-care and boundary setting.

To remedy this challenge, I’d like to offer some pearls of wisdom on doing it differently. Fortunately, I have never stopped listening to the pearls of wisdom contained in the bubbemintzes told by my colleagues and mentors, many of whom also just happen to be Jewish mothers and grandmothers. You may be glad to know that Janina Fisher’s choice words caution me against encouraging exhausted therapists to go to the gym. So, I have tried to think a bit outside of the box, focusing on strategies that take little extra time, money or energy.

  1. Stay “Calm” and carry on. Okay, this sounds more like Queen Elizabeth than a Jewish mother. By “Calm,” I mean the meditation app by that name on your smart phone. Give yourself a 2 to 10 minute break before your day begins, between sessions, at lunch…whenever.  Being in the moment without judgment will refresh you, like a palette cleanser for the soul.  Also, research shows clients are more satisfied when therapists do some form of meditation before sessions.  The first seven 10-minute sessions are free. You might not have the time or the money for a trip to Costa Rica, but you can access the image and sounds of a rainforest any time.
  2. Care less. Advice from the ever-insightful psychologist Janina Fisher. Not about your clients. Love your clients, but care less about feeling personally responsible for seeing each one through to the same stage of growth or recovery. So many of us went into this field, in part, out of a wish to rescue or be rescued.  Managed care companies that want us to document steady progress in ten or fewer sessions also pressure us to perform and “fix.”  When social worker Lisa Ferentz came to present in Michigan last year she shared with us the following metaphor: with some clients we will get to plant seeds, with others we will see the whole glorious garden bloom, and with many others we will witness something in between.  Focus on celebrating the seeds you can plant and nurture with each client.
  3. Don’t work harder than your clients. This is advice from social worker, Elie Rosenberg, one of my mentors at the University of Michigan, first in Child Psychiatry, then at the University Center for the Child and the Family. Don’t accept more than your fair share of responsibility for making the treatment work.  Sometimes, we overwhelm ourselves or become resentful if we take on too much.  Sometimes, we disempower clients by doing for them what they can learn to manage themselves. When you feel yourself on the edge of your seat, feeling a sense of urgency, frustration or impatience, sit back.  Take a breath.  Set a schedule that works for you.  Set a fee that works for you. Take time off.  Model the self-care you preach.
  4. Remember that it takes a village. Find your own “partners in healing.”  You need to feel the support that someone else has your back. You can’t do it all on your own.  Accept help—at home: ask partners, kids, other family members to step up. We are often more comfortable in giving help than asking for it.  Accept support from colleagues, from mentors.  Pay people to do tasks you can give away (advice from my own Jewish mother). Collaborate with neighbors to share babysitting or meal co-ops. Focus on what is most important and can only be done by you.  Either let go of, or give away, the non-essential tasks.
  5. Observe the Sabbath—advice, delivered to you admittedly, by a cultural, humanist Jew. But modelled for me by a wise and observant Jew, Lisa Ferentz.  Protect some sacred patch of down time—even if it’s just a couple of hours a week—the more, the better.  Do what you need to do in order to re-charge, re-connect and to focus on what matters most.
  6. Just say “no”.  Great advice—not from Nancy Reagan–but again from Lisa Ferentz.  Give yourself permission to say “yes” to what you really want and “no” to what you don’t.  By doing so, you can live a rich, fulfilling and busy—but not overwhelming—life. So simple, yet profound.  We are used to saying yes to meet other people’s needs and cultural expectations while saying “no” to the needs and desires tugging at our own sleeve.

In conclusion, you matter.  You are your own most precious instrument in this noble field in which we practice.  Take care of yourself.  You deserve it; you need it; others depend on you to resource yourself and for us to resource each other.