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Incorporating Self-Care into Early Career Practice

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Garson, J. K. (2017). Incorporating self-care into early career practice. Psychotherapy Bulletin, 52(3), 33-36.

Julie K. Garson, PsyD

I remember sitting in an ethics course during my fourth year of my doctoral program and listening to the professor reminding us that the self-care practices we establish in graduate school are the ones we maintain for our careers. I wondered how on earth I was supposed to live a healthy and balanced lifestyle while taking classes, teaching classes, working at two practicum sites, and working in someone’s private practice. Oh, and dissertation. Being a graduate student and now an early career psychologist has taught me to check my privilege and helped me become more aware of the socioeconomic privilege I had in my family of origin and how that influences my world view. I’ve also learned how to better incorporate self-care activities into my work day.

The Importance of Self-Care

Self-care is an ethical mandate according to the American Psychological Association (APA; 2016). Our ethics code notes the importance of maintaining our physical and mental well-being so as not to interfere with our work. However, self-care is a term that can refer to any number of behaviors. Godfrey et al. (2011) sought to synthesize a working definition of self-care through looking at ways the term has been used in the literature. They concluded that self-care has two primary components: “activities of daily living” and “therapeutic self-care” (Godfrey et al., 2011, p. 7). Godfrey et al. (2011) further described the behaviors of self-care as “engaging in activities to address health issues,” with “behaviours relating to promotion, lifestyle, risk and prevention” being “foremost” (p. 10). The authors also noted that “self-care may be performed independently, in collaboration with, or guided and directed by healthcare professionals” (p. 10).

In addition to the ethical mandate, research suggests that self-care is essential both for our personal and professional wellbeing. Professionals who engage in regular self-care are less likely to experience burnout (Stevanovic & Rupert, 2004). Smith and Moss (2009) argue that by engaging in self-care strategies therapists can help prevent themselves from reaching a state of professional impairment. Additionally, I am a firm believer in practicing what I preach, and if I am going to encourage clients to practice self-care, then I want to be mindful of my own. Experiencing firsthand in graduate school what it felt like to not have adequate time, energy, or money to take care of myself greatly increased my empathy for clients’ experience and continues to shape the way I talk about self-care with my clients and supervisees.

Socioeconomic Privilege and Self-Care

During graduate school, I worked in a department clinic that served a diverse urban community for a sliding scale fee. Graduate school was also the first time that I personally experienced financial challenges. What I learned from those experiences was to consider context in talking about self-care. I vividly remember my first client. She was an African American woman in her mid-thirties who was born and raised by a single mother in a lower middle class urban neighborhood. I’m White, was born to two parents who both have PhDs, and grew up in an upper middle class suburban neighborhood. My client presented with significant anxiety about multiple areas of her life and her symptoms met criteria for generalized anxiety disorder. My doctoral program had an emphasis on manualized treatment and I selected a mindfulness-based behavior therapy model to use with her. Each session had a mindfulness exercise and the use of metaphors was a part of explaining the theory to clients. I dutifully introduced the two mountains metaphor (Varra, Drossel, & Hayes, 2009) during session and watched as my client seemed to withdraw and looked at me with doubt on her face. I asked her if she was confused and she said that she had never seen a mountain.

I traveled frequently with my family of origin and those experiences of seeing diverse geographic regions and encountering cultures different from my own helped me be curious about other people, yet until I started to work with clients, I had little contact with people who grew up under such challenging economic circumstances. Not knowing what else to do in the moment with my client, my humanity took over and for the remainder of that session I put down the manual and asked her to tell me about her life.

What I realized was that the mindfulness exercises I had come to love as I started my own practice often utilized images of nature to which my urban clients had little exposure except on television. I looked to my supervisor and my peers for suggestions. I looked for resources on using mindfulness that had less emphasis on nature images and metaphors. Urban Mindfulness by Jonathan Kaplan (2010) became an indispensable resource for me in my clinical work, but also in my personal self-care practice. Kaplan outlines ways of practicing mindfulness in more accessible ways such as while making a cup of coffee at work or while riding a crowded subway.

I currently work in a university counseling center at a university that serves students who come from diverse socioeconomic backgrounds. Through supervision, training, and experience, I’ve learned to talk about financial difficulties with clients and to be more aware of the impact the difficulties have on clients’ ability to participate in therapy or in specific therapeutic tasks. Johnson (2014) makes an important point that socioeconomic status has rarely been considered in the area of leisure research. Additionally, socioeconomic privilege is not consistently included in research on oppression (Black & Stone, 2005). Knowing and appreciating our clients’ socioeconomic statuses can help us understand challenges they face in self-care that are unrelated to personal limitations. For example, joining a sorority or fraternity is an important part of the college experience for many of the students I serve. However, it can be incredibly expensive, often with dues of at least $500 a semester. I’ve worked with students who struggle to participate in numerous campus activities because of cost. Additionally, many students are balancing being a student and maintaining a job, and are not able to focus on their friends and hobbies the way their wealthier peers may.

Today as I write this, I am in my third year at my job and my lifestyle is radically different than it was in graduate school. I certainly have more time for self-care; I am only working one job, and that makes a difference. However, what stands out to me in terms of what feels most different are the intentional choices around self-care that I started to make as an intern and have further developed as a staff member. I needed to learn to be realistic about what self-care could look like in my life, with my budget.

According to research conducted in 2010, the level at which additional income no longer increased a sense of wellbeing was approximately $75,000 (Kahneman & Deaton, 2010). Interestingly, the median starting salary for psychologists is about $60,000—a figure that has not changed significantly in the past 10 years (Lu, 2016). I believe that this is an important factor to consider in thinking about potential for burnout for early career psychologists. Research suggests that younger psychologists are more likely to report experiencing burnout (Rupert & Morgan, 2005). I found this information validating as I considered some of my challenges in engaging in self-care during my first few years as a professional. Inspired by a yoga class I took about incorporating yoga throughout the day at work, I decided to be intentional about how I could engage in self-care activities as part of my job. I chose to primarily focus on mindfulness because I believe it can be realistic to practice at work and because research suggests that regular mindfulness practice can be beneficial in preventing burnout (Shapiro, Brown, & Biegel, 2007).

Implications for Early Career Professionals

I hope in sharing some of my personal experiences will help others consider how they can adapt to include more self-care into their daily schedules. Additionally, having more control over one’s work day has been shown to be related to job satisfaction for psychologists (Stevanovic & Rupert, 2004). Although I do face challenges, I believe that it is important to acknowledge the enormous privilege inherent in having the kind of access to opportunities I enjoy. Because of the nature of my work, I have several roles. I primarily work as a therapist, but I am also a supervisor and instructor. Part of what I like about my job is the variety of activities I have throughout each day. However, at the busier times of year I have little transition time between roles, which can be stressful. I try to practice mindfulness or breathing exercises as a way of marking the space between and giving myself a moment to check in, see how I am in the moment, and approach the next role with intention.

Another way that I regularly practice self-care at work is by selecting to facilitate groups and provide outreach services that involve teaching mindfulness. This gives me the opportunity to have practice built into my work schedule. When I facilitate groups, I am typically working with a co-facilitator, and we take turns leading mindfulness exercises, thus giving the other person the chance to participate.

I work in a setting that offers staff members a generous budget for professional development. In selecting the kind of professional development training I want to attend I consider what will be helpful in my work with clients as well as what could potentially feel rejuvenating and give me time for personal reflection. For example, this past year I attended a mindfulness and yoga retreat for mental health professionals where I was able to obtain 20 continuing education credits.

Practicing self-care is an ongoing commitment for me. I continue to look at ways I can engage in self-care activities during the course of the work day so that I am at my best for the people I serve. Additionally, I ask myself when sitting with a client or a trainee to consider how their socioeconomic status may impact their self-care activities.

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References

American Psychological Association. (2016). Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics/code/

Black, L. L., & Stone, D. (2005). Expanding the definition of privilege: The concept of social privilege. Journal of Multicultural Counseling and Development, 33(4), 243-255. doi:  10.1002/j.2161-1912.2005.tb00020.x

Godfrey, C. M., Harrison, M. B., Lysaght, R., Lamb, M., Graham, I. D., & Oakley, P. (2011). Care of self—care by other—care of other: The meaning of self-care from research, practice, policy and industry perspectives. International Journal of Evidence-Based Healthcare, 9(1), 3-24. doi:10.1111/j.1744-1609.2010.00196.x

Johnson, C. W. (2014). “All you need is love”: Considerations for a social justice inquiry in leisure studies. Leisure Sciences, 36(4), 388-399. doi:10.1080/01490400.2014.917006

Kahneman, D., & Deaton, A. (2010). High income improves evaluation of life but not emotional well-being. Proceedings of the National Academy of Sciences of the United States of America, 107(38), 16489–16493. doi: 10.1073/pnas.1011492107

Kaplan, J. S. (2010). Urban mindfulness: Cultivating peace, presence, & purpose in the middle of it all. Oakland, CA: New Harbinger Publications, Inc.

Lu, S. (2016, April). Median salaries for new psychologists are static. gradPSYCH, 14(2), Retrieved from http://www.apa.org/gradpsych/2016/04/salaries.aspx

Rupert, P. A., & Morgan, D. J. (2005). Work setting and burnout among professional psychologists. Professional Psychology: Research and Practice, 36(5), 544–550. doi: 10.1037/0735-7028.36.5.544

Shapiro, S. L., Brown, K. W., & Biegel, G. M. (2007). Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training. Training and Education in Professional Psychology, 1(2), 105-115. doi: 10.1037/1931-3918.1.2.105

Smith, P. L., & Moss, S. B. (2009). Psychologist impairment: What is it, how can it be prevented, and what can be done to address it? Clinical Psychology: Science and Practice, 16(1), 1-15. doi:10.1111/j.1468-2850.2009.01137.x

Stevanovic, P., & Rupert, P. A. (2004). Career-sustaining behaviors, satisfactions, and stresses of professional psychologists. Psychotherapy: Theory, Research, Practice, Training, 41(3), 301-309. doi: 10.1037/0033-3204.41.3.301

Varra A. A., Drossel C., & Hayes S. C. (2009). The use of metaphor to establish acceptance and mindfulness. In F. Didonna (Ed.), Clinical handbook of mindfulness (pp. 111-123). New York, NY: Springer.

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