Internet Editor’s Note: Dr. Jennie David and Stephanie Callan recently published an article in the Bulletin on “Trainee Perspectives on the Importance of Self-Care and Research in Clinical Supervision.” You can find a free copy of the article: here.
As a newly minted post-doctoral fellow, I have repeatedly encouraged junior trainees to eat lunch, talk about their pets, get candy from my candy bowl, or offer to get them coffee if I am already headed out to get my own. At its core, I am trying to model and foster self-care amongst trainees in a pediatric medical academic center, where every email notification and pager beep can be essential to attend to. The unstated but seemingly agreed upon culture is that you are always available, you can always do more, you can always work harder. But, put simply, that is impossible.
Recently, a junior trainee stopped by my office as I was reviewing a chart and asked if I had a moment. “Yes, of course, come sit down,” I told the trainee as I turned away from my computer to use my body language to echo what I had said verbally. The trainee sat down and paused, recounting all of the wonderful and exciting parts of the new training year, while also leaving breadcrumbs of challenges and exhaustion. “What am I supposed to do in supervision,” the trainee asked, “when all I’m doing is shadowing? Does my supervisor think I’m not smart and that I need that extra time?” The trainee detailed how every moment of the day was scheduled, including meetings over lunch, where the trainee relayed that eating alone would be a simple luxury. Meetings began at 8 AM daily, though the trainee described some meetings seemed unrelated and then that was yet another day where going to the gym before work was crossed off the schedule. The things that fueled this trainee – exercise, good sleep, eating well – were running dry. The trainee appeared exhausted, while also eager to learn and contribute.
Unfortunately, little of what the trainee described surprised me. While we, as a field, know how vital self-care is for providing quality, sustainable care (Barnett & Cooper, 2009; Elman & Forrest, 2007), we often find our trainees are poorly equipped in this domain (Munsey, 2006). But it is not the trainees, it is the very system in which we have clinical supervision and learn that affords trainees limited opportunities to meaningful learn and develop self-care competencies. As felt by the trainee in my office, many other graduate students described concerns that faculty and peers would negatively perceive self-care activities as counterproductive to ‘productive’ activities, like documentation (ACCA, 2009; Norcross & Guy, 2007). This idea that self-care and productivity are mutually exclusive is concerning, as it may encourage trainees to disregard self-care for the objective productivity of other tasks.
The understandable question becomes: what does this look like? In reality, this likely looks different depending on the setting. But what this must look like, regardless of setting, are faculty members valuing, modeling, and fostering self-care competencies in trainees. Perhaps this looks like a faculty member reviewing her schedule, noting aloud to a trainee that it will be a busy clinic day and verbally problem-solving and modeling how she will incorporate self-care into her day. Or maybe this is a department offering snacks during a mid-morning didactic for trainees. Maybe this is a training director encouraging and incentivizing trainees to leave the clinic by 5 PM.
For the trainee sitting in my office, I listened. When I offered normalization and validation that this specific training year is overwhelming for every trainee, the trainee seemed to stare at me as if that were novel news. This, it seems, may be another risk to poor integration of self-care into clinical supervision and clinical competencies – that we present an image that all trainees can gracefully manage multiple supervisors, clinical tasks, and expectations, when that is most likely the exception and not the rule. In turn, this may make it more difficult for trainees to describe feeling overwhelmed and ask for help.
Self-care does not come at the cost of productivity, if anything it may be the source of our productivity. And to many, self-care may only takes a few minutes – mindfully eating a favorite piece of candy, doing a deep breathing exercise for 2 minutes, drinking a cup of tea, checking your favorite pet Instagram page, or texting a friend to make dinner plans. So when you are getting your lunch, ask trainees if they have eaten their lunches. Talk about your pets and ask them about theirs. Get candy and offer candy to them. Get coffee and offer to pick up a cup for a trainee. The more that trainees routinely see faculty engage and model these self-care behaviors, the more we can foster this self-care competency development in our trainees.
Cite This Article
David, J., & Callan, S. (2020, February). Self-care as a clinical competency. [Web article]. Retrieved from https://societyforpsychotherapy.org/self-care-as-a-clinical-competency/
Advisory Committee on Colleague Assistance. (2006, February 10). Advancing colleague assistance in professional psychology. Retrieved from http://www.apa.org/practice/resources/assistance/monograph.pdf
Advisory Committee on Colleague Assistance. (2009). Who cares? Barriers, benefits and resources in colleague assistance and self-care. PowerPoint presentation presented at the 117th Annual Convention of the American Psychological Association, Toronto, Canada.
Barnett, J. E., & Cooper, N. (2009). Creating a culture of self-care. Clinical Psychology: Science and Practice, 16, 16-20. https://doi.org/10.1111/j.1468-2850.2009.01138.x
Elman, N. S., & Forrest, L. (2007). From trainee impairment to professional competence problems: Seeking new terminology that facilitates effective action. Professional Psychology: Research and Practice, 38(5), 501-509. doi:10.1037/0735-7028.38.5.501
Munsey, C. (2006, November). Questions of balance: An APA survey finds a lack of attention to self-care among training programs. gradPSYCH, 4(4). Retrieved from http://www.apa.org/gradpsych/2006/11/cover-balance.aspx
Norcross, J. C., & Guy, J. D. (2007). Leaving it at the office: A guide to psychotherapist self-care. New York, NY: The Guilford Press.