Psychotherapy Articles

Psychotherapy Articles

Personal Psychotherapy as an Essential Self-Care Strategy

Numerous authors have emphasized the importance of the ongoing practice of self-care for psychotherapists (e.g. Baker, 2003; Barnett et al., 2007; Norcross & VandenBos, 2018; Wise & Reuman, 2019). Support for this focus on self-care by all psychotherapists is found in the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (Ethics Code, APA, 2017), first in the aspirational General Principle A: Beneficence and Nonmaleficence which guides psychologists to “be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work” and then in the enforceable Ethical Standard 2: Competence. Standard 2.06: Personal Problems and Conflicts requires psychologists to monitor their functioning and effectiveness, and to “refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.” Additionally, “When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.” The goal of Standard 2.06 is to ensure that limitations in one’s professional functioning that result from personal problems and conflicts do not lead to harm to one’s clients.

Self-Care, Ethics, and Psychotherapist Competence

While the practice and profession of psychotherapy can be greatly rewarding, it may also be stressful, demanding, and both physically and emotionally exhausting for the psychotherapist. As Barnett and Homany (2022) describe, work-related issues, demands, and challenges as well as stressors in the psychotherapist’s personal life, and personality characteristics and blind spots for the psychotherapist can each contribute to the development of problems with professional competence. Work as a psychotherapist may lead to the development of burnout and vicarious traumatization, and psychotherapists can experience mental health disorders just as all individuals may. While the graduate education and training each psychotherapist receives provide an important foundation for their clinical competence through the acquisition and development of essential knowledge and skills, it in no way immunizes psychotherapists against the ill effects of any of these stressors, demands, challenges, and difficulties. In fact, the challenges and stressors associated with being a psychotherapist along with predispositions psychotherapists bring to this role may actually increase the likelihood of these difficulties developing (O’Connor, 2001).

A direct connection between self-care and the maintenance of one’s clinical competence and effectiveness has been widely acknowledged (e.g., Wise et al., 2012). The effects of burnout and vicarious traumatization can negatively impact the psychotherapist’s ability to access and effectively apply their knowledge, skills, judgment, and decision-making for the benefit of their clients (Barnett et al., 2007). Further, how one responds to and copes with these difficulties has a direct impact on one’s functioning and clinical effectiveness as well. Some psychotherapists eschew helpful self-care activities, instead engaging in avoidance or denial, perhaps due to what Wise and Reuman (2019) identify as a “myth of invincibility” in which psychotherapists “believe they are immune from the issues that their clients face” (p. 131). Others may rely on maladaptive coping strategies such as self-medication with various substances or by attempting to address difficulties by working more hours, not scheduling breaks in their day, sleeping less, and by skipping meals. Consequently, this impacts competence and ethics, infringing on the ability to flourish.

Ways to Improve Ethics through Self-Care

Effective self-care should address the physical, emotional/psychological, relational, and spiritual/religious aspects of the psychotherapist’s life (Ziede & Norcross, 2020). Further, it should acknowledge personal histories and dispositions of each psychotherapist, the unique challenges and stressors in their personal life, the ongoing demands and effects of being a psychotherapist, and the interaction of each of these (Pipes et al., 2005). The effective practice of self-care involves the ongoing integration of what Coster and Schwebel (1997) and Stevanovic and Rupert (2004) term positive career sustaining behaviors. Commonly employed career sustaining behaviors these authors identified include self-awareness and the use of positive self-talk, working to maintain a balance between one’s professional and personal lives, a focus on the relationships in one’s personal life, taking breaks from work to include vacations, engaging in enjoyable leisure time activities, consulting with colleagues, engaging in relaxation, and participating in personal psychotherapy.

While many psychotherapists may engage in solitary or independent self-care activities, it is widely accepted that there are multiple limitations to this approach. A tendency to isolate oneself and not include others in the development and implementation of one’s self-care plan can be both of limited effectiveness and a risk factor for the development of problems with professional competence (Barnett & Homany, 2022). Due to limitations in accurate self-assessment along with personal biases and blind spots, to engage in effective self-care and wellness promotion activities psychotherapists must include others in these efforts (Johnson et al., 2012). Wise and Reuman (2019) emphasize the essential role reflective practice plays in each psychotherapist’s competence, to include “understanding one’s own history, needs and motivations, strengths and weaknesses, worldview, and life purpose” (p. 131). Each of the above are important reasons for including others in these efforts, to include participating in one’s own psychotherapy.

Personal Psychotherapy as a Self-Care Strategy

Psychotherapy for the psychotherapist may be an important self-care activity, assisting the clinician to better cope with ongoing challenges, demands, stressors, and conflicts in their personal and professional lives, to include their own and clients’ mental health issues (Consoli et al., 2021). As Pearlman and Saakvitne (1995) state, it is “a place in which to process the impact and effect of our therapeutic work on ourselves, to take all of our needs, our wishes, our fears, all of our feelings and thoughts” (p. 394). They also describe how personal psychotherapy provides benefits far beyond oneself, impacting relationships with others in one’s life to include those with clients.

Personal psychotherapy for psychotherapists provides support and assistance when the psychotherapist experiences loss, confronts life transitions and challenges, and ethical concerns, like when grappling with mental health struggles. It also assists the psychotherapist to work through their own issues, blind spots, and unresolved conflicts that may impact their effectiveness as a psychotherapist (and as a person). Norcross and Guy (2013) cite strong evidence that personal psychotherapy “is an emotionally vital and professionally nourishing experience central to self-care” (p. 752).

It is found that approximately 80% of psychotherapists across professions have participated in personal psychotherapy (Rønnestad et al., 2016). A recent survey of members of the Society for the Advancement of Psychotherapy found 82% of respondents reported having participated in personal psychotherapy at least once (Norcross et al., 2023). Yet, some psychotherapists do not participate in personal psychotherapy. Potential reasons for not participating in personal psychotherapy may include shame, preconceived notions about one’s identity as a care giver and not being one who seeks care for themselves, denial or minimization of difficulties and not believing psychotherapy to be needed, perceived lack of time and financial resources, and concerns about confidentiality and potential multiple relationships with other psychotherapists in one’s community (Baker, 2003; Hersh, 2022; Norcross & Guy, 2013).

For those who do participate in personal psychotherapy, Ziede and Norcross (2022) found psychotherapists report motivations to include the pursuit of personal growth and to address personal problems. These authors also elucidate the many potential benefits of personal psychotherapy for psychotherapists. These include:

  • Improved emotional and mental functioning and increased potential to flourish.
  • A better understanding of personal issues and dynamics.
  • Enhanced coping skills and better management of the challenges associated with being a psychotherapist.
  • Helping the clinician to better understand the role of being a client, thus assisting them in their work with their clients.
  • Benefiting from the modeling of psychotherapist expertise by their psychotherapist.

Interestingly, the views of psychotherapy clients are very positive about psychotherapists participating in personal psychotherapy. Most current and former psychotherapy clients surveyed by Ivey and Phillips (2016) viewed psychotherapists’ participation in their own psychotherapy to be very positive, with 75% of those surveyed desiring their psychotherapist to have done so. Respondents reported that psychotherapists who participated in personal psychotherapy were “more empathic, trustworthy and self-aware psychotherapists” (p. 101). They also viewed personal psychotherapy to be an important self-care activity and an important form of experiential learning for psychotherapists.

How to Flourish through Self-Care

It is hoped that all psychotherapists will engage in the ongoing practice of self-care to fulfill their ethics responsibilities of maintaining competence and providing effective treatment. This is essential for addressing the effects of being a psychotherapist as well as with the many stressors and challenges in each psychotherapist’s personal life. Further, it is hoped that psychotherapists will not limit themselves by focusing on minimal standards and expectations, but also to aspire to achieve the most effective functioning possible, what Wise and Reuman (2019) describe as thriving and flourishing. In addition to basic self-care strategies such as a healthy diet, adequate rest, regular exercise, managing one’s workload and client mix, attending to the relationships in one’s life; engaging in relaxing, enjoyable, and rejuvenating activities; among other positive career sustaining behaviors, it is hoped that all psychotherapists will value the role of personal psychotherapy at different points in their careers and lives, engaging in it to achieve the many personal and professional benefits it offers. Psychotherapists will hopefully see this as an essential aspect of their ongoing efforts to maintain their clinical competence, ethics, and effectiveness and to support their efforts to provide the best treatment possible to their clients and to thrive and flourish both professionally and personally.

Jeffrey E. Barnett, Psy.D., ABPP is a Professor in the Department of Psychology at Loyola University Maryland and a licensed psychologist who is board certified by the American Board of Professional Psychology in Clinical Psychology and in Clinical Child and Adolescent Psychology. Additionally, he is a Distinguished Practitioner in Psychology of the National Academies of Practice. Among his many professional activities, Dr. Barnett is a past chair of the ethics committees of the American Psychological Association, the American Board of Professional Psychology, and the Maryland Psychological Association. He previously served on the Maryland Board of Examiners of Psychologists and has been a consultant to licensing boards across a range of health professions. His numerous publications and presentations focus on ethics, legal, and professional practice issues in psychology. Dr. Barnett is a recipient of the APA’s outstanding ethics educator award.

Cite This Article

Barnett, J.E. & Levine, A. N. (2024, January). Personal Psychotherapy as an Essential Self-Care Strategy. Psychotherapy Bulletin, 59(1), 34-38.

References

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