My first lessons in self-care as a core professional competency were unwanted and unexpected. After a “normal” pregnancy, I went into labor five days past my due date and navigated to the hospital in the middle of the night under blizzard conditions. I made it to the hospital, but by the time I got there, my labor pains have changed. Pain is such a subjective experience that I cannot really describe clearly how the pain changed, but I can describe my changing cognitions about the pain. I remember repetitively thinking “hurry up” in an almost mantra-like cadence en route to the hospital because the pain was not coming in rhythmic waves anymore; it was frightening and unremitting. Unintentionally narrowing my focus on that simple, though silent plea was all I could muster as my body felt beyond my control. As my labor progressed, my daughter went into distress and she died before I could deliver her. Her loss was…and is…devastating. I was not useful to anyone, including myself, for a long time.
Although my experience is personal, I find myself reflecting on it because the meta-issues are timely and globally salient. At the time of my writing this column, the number of confirmed COVID-19 cases within the United States has passed the one million mark. Unwanted. Unexpected. Inherently transformative. Devastating. To address the mental health needs of our population, we first need to embrace self-care as a foundational professional competency. If we are to be useful to others, we must prioritize our self-care.
On behalf of your clients, and in a spirit of genuine concern, I am asking you to take a moment to engage the reality that you may not be engaging in self-care sufficiently. For many members of our Society, entire practices have been transformed to telepsychotherapy in recent weeks, treatment with current clients has intensified under the weight of new stressors, income and expenditures have shifted, and/or relationships professionally and personally have distanced. The average age of our Society membership suggests most members fall in a COVID-19 high risk category. While Santana and Fouad (2017) assert competent self-care to be an ethical imperative, the collective press created by these immediate realities is significant. Attending to self-care may feel somehow self-ish when so many are depending upon us.
In fact, self-care is not easy, even under more typical conditions. Self-care competency is more difficult to attain than many of the psychotherapy competencies we spend years of formal training developing. In an empirical study of professional competencies, item difficulty levels placed self-care firmly in the middle of a broad range of foundational and functional professional competencies (Price et al., 2017). Further, self-care deficits are a leading contributor to impaired professional functioning (El-Ghoroury et al., 2012). Sleep hygiene, social support, emotional regulation, acceptance; all are predictive of subjective stress (Myers et al., 2012).
Being truly competent necessitates taking enough time to evaluate our own self-care as a multidimensional construct, spanning cognitive, emotional, relational, physical, and, in some cases, spiritual domains (Ayala et al., 2017; Santana & Fouad, 2017). Taking a moment to focus self-evaluative attention to each self-care domain may reveal unevenness. While we may be doing well in some aspects of self-care, others may be neglected. Taking a moment to fearlessly inventory our self-care in each area is time well spent. For those who feel selfish taking that time away from others, I remind you: this is not about you. While I obviously want you to be well, in this column I am taking the role of advocating on behalf of your clients. In a randomized trial, clients who were blind to condition perceived their psychotherapist as significantly more effective in session (d = .52) when the psychotherapist took just a few minutes of self-care to center themselves before starting the session (Dunn et al., 2013). You want to take good care of your clients? Take good care of you.
Needless to say, the entire world has changed since I wrote my presidential candidate statement two years ago. At that time, I shared with you my hopes of getting needed resources into the hands of professionally isolated providers working with underserved populations. It saddens me to come the realization that those words have come to accurately describe nearly all of our Society membership. Although unwanted and unexpected, I am embracing the inherently transformative aspect of this new reality while aiming to keeping my former vision intact. I want to close this column by updating you briefly on those efforts and how they may be of benefit to you.
In the early pandemic weeks, I worked on developing a clinic manual and disseminating resources to you, via our Society listserv, that were (1) psychotherapy specific or (2) appropriate for those trying to run a practice while also having children at home. Parents, please do not be insulted, but I view you as under-served/under-resourced professionals if you have child(ren) who are too young to reasonably self-direct themselves long enough for you to run a telepsychotherapy session with a client. As the pandemic persists and possible vaccines and/or treatments remain fairly distal hopes, I have been cross-tapering crisis resource and dissemination efforts with longer term efforts.
In particular, I have been ramping up resources to facilitate high quality care across what is increasingly likely to become a protracted period of reliance on telepsychotherapy. Critical to those efforts, I want to alert you that the forthcoming June issue of Journal of Psychotherapy Integration (JPI) will be a special issue on “Telepsychotherapy in the Age of COVID-19.” As some of you may know, I am the current Editor for JPI, which is an APA publication that is sponsored by the Society for the Exploration of Psychotherapy Integration (SEPI). If you are not already aware, our Society has enjoyed a close working relationship with SEPI for a long time. Our Society reviews and provides CE credit for programming at the SEPI annual meeting and each Society sponsors an award in the other.
Over the past 6 weeks, I have been cross-pollinating my resource development and dissemination vision as President of our Society with my role as Editor of JPI to develop the special issue on “Telepsychotherapy in the Age of COVID-19.” When it became clear that we had more good papers than space to publish, I reached out to former Society President Jeff Zimmerman, who is Editor for another APA journal: Practice Innovations (PI). Jeff, per usual, was fantastic to work with and committed PI to rapidly publishing a companion section in the June issue of PI. I am committed to continuing to work across the remainder of this year to realize the vision I promised as a presidential candidate, while being firmly grounded in the challenges facing us today.
In closing, I am going to recycle the final paragraph from my last presidential column. It seems even more apropos now than it did then: “The relationships we nurture with one another, as psychotherapists, facilitate our expertise by providing conditions for safe exploration, identification of growth edges, and constructive feedback. Let’s be generous with credit for the sources of influence past and present and endeavor to meaningfully share our multigenerational expertise with one another into the future. Our Society can offset risk of professional isolation by providing a salve that brings psychotherapists at every career stage together in meaningful connections with one another” (Callahan, 2020, p. 3). Until next time, take good care of yourself.
Author’s Note: Have thoughts to share? Feel free to email me at [email protected] and keep the dialogue going.
Cite This Article
Callahan, J. L. (2020). President’s column. Psychotherapy Bulletin, 55(2), 2-4
Ayala, E. E., Ellis, M. V., Grudev, N., & Cole, J. (2017). Women in health service psychology programs: Stress, self-care, and quality of life. Training and Education in Professional Psychology, 11(1), 18-25. http://dx.doi.org/10.1037/tep0000141
Callahan, J. L. (2020). President’s Column. Psychotherapy Bulletin, 55(1), 2-4.
Dunn, R., Callahan, J. L., Swift, J. K., & Ivanovic, M. (2013). Effects of pre-session centering for clinicians on session presence and effectiveness. Psychotherapy Research, 23(1), 78-85. https://doi.org/10.1080/10503307.2012.731713
El-Ghoroury, N. H., Galper, D. I., Sawaqdeh, A., & Bufka, L. F. (2012). Stress, coping, and barriers to wellness among psychology graduate students. Training and Education in Professional Psychology, 6(2), 122-134. http://dx.doi.org/10.1037/a0028768
Myers, S. B., Sweeney, A. C., Popick, V., Wesley, K., Bordfeld, A., & Fingerhut, R. (2012). Self-care practices and perceived stress levels among psychology graduate students. Training and Education in Professional Psychology, 6(1), 55-66. http://dx.doi.org/10.1037/a0026534
Price, S. D., Callahan, J. L., Cox. R. J. (2017). Psychometric investigation of competency benchmarks. Training and Education in Professional Psychology, 11(3), 128-139. http://dx.doi.org/10.1037/tep0000133
Santana, M. C., & Fouad, N. A. (2017). Development and validation of a self-care behavior inventory. Training and Education in Professional Psychology, 11(3), 140-145. http://dx.doi.org/10.1037/tep0000142