Leaving It at the Office: Psychotherapis t Self-Care John C. Norcross, Ph.D.
Dec 17, 2015
Leaving It at the Office:
Psychotherapist Self-Care
John C. Norcross, Ph.D.
DescriptionConducting psychotherapy places
additional and special burdens on
the person of the therapist. This
workshop puts the Socratic dicta
of “know thyself” and “heal
thyself”into practice. We shall
focus on 12 self-care strategies
that are clinician recommended,
research based, and practitioner
tested.
Learning Objectives
Participants will be able to: Generate at least 6 self-care
strategies supported by the empirical research
Conduct periodic self-assessments of their own self-care.
Leave with an individualized action plan.
What We Will NOT Do
Light candles Inflate balloons Burn paper regrets Meditate together
What We WILL Do
Traverse the accumulating research on self-care
Emphasize self-care principles or strategies
Think with the mind of a scientist, feel with the heart of a humanist
Embrace multiple strategies associated with diverse theoretical orientations
Individualize your self-care to your own vulnerabilities
The Paradox, Irony, & Ethics of Self-Care
The Paradox: No time to sharpen the saw
The Irony: Not availing ourselves of what we provide/recommend to clients
The Ethics: Personally essential and professionally ethical
Theoretical Orientation and Patient Care
In treating patients, change processes vary reliably with the therapist's theory
E.g., CBT therapists use counterconditioning, contingency management, and stimulus control significantly more
E.g., Psychodynamic therapists rely more on the therapy relationship and catharsis
Theoretical Orientation and Self-Care
No differences in self-care processes due to therapist’s theory
Not even a few statistically significant differences expected by chance alone.
Results strongly argue for considerable similarity among psychotherapists in their own self-care
Why No Differences?
1. In psychotherapist role, people rely heavily on theories. But in self-change role, people are not as influenced by theory.
2. Possible duplicity between public careers and personal lives.
3. Therapists become more pragmatic, eclectic, and secular in their own self-care.
12 Self-Care Strategies Principles or strategies, not
techniques. Dozens of techniques under each strategy.
Probably more effective to use multiple strategies than to extensively use a single strategy.
Must tailor to your own resources and vulnerabilities to insure long-term success.
1. Valuing the Person of the Psychotherapist Easier to be wise and
available for others than for ourselves.
Self-care begins with the premise of valuing the person of the therapist.
Alas, this runs against the tide of managed care and interchangeable “providers.”
Self-Awareness and Commitment Top-ranked contributor in
studies to optimal functioning Assess your self-care &
satisfaction as you would a patient’s
Writing, journaling, logging, self-monitoring, tracking
Honest feedback from loved ones and coworkers
Making self-care a priority Quis custodiet ipsos custodies
(Who will guard the guards?)
2. Refocusing on the Rewards
Re-experience the privileges
Notice the life rewards
Feel the career satisfaction
Practice the mental set
3. Recognizing the Hazards
The classic stressors of “impossible profession”
The new & evolving distress
Acceptance
Begin with self-awareness
and self-liberation
4. Minding the Body
Don’t overlook the biobehavioral basics
SleepBodily restNutrition and hydrationExerciseHuman contact
5. Nurturing RelationshipsEmphasize the human
elementAt the Office
Clinical colleaguesPeer supportSupervision groupsClinical teamsStaffProfessionals in community MentorsClients
5. Nurturing Relationships (cont)Outside the Office
Spouse/partnerFamily membersFriendsColleague Assistance ProgramsPersonal mentorsPersonal therapist
6. Setting Boundaries
Delegate
Boundary set
Balancing client desires and
self-preservation
7. Restructuring Cognitions
Avoid wishful thinking & self-blame
Monitor your internal dialogue Watch for selective abstraction,
overwhelming tasks, and assuming causality (Judy Beck)
Manage countertransference: self-insight, self-integration, empathy, anxiety management, & conceptualizing ability (Charles Gelso)
Five Therapist Musterbations (Ellis)
I must be successful with my patients, practically all of the time.
I must be one of the world's most outstanding therapists.
I should have no problems. After all, I am a therapist!
I must be liked and respected by all my clients.
Since I am a hard-working therapist, my clients should be equally persevering.
8. Sustaining Healthy EscapesTrue happiness, we are told,
consists in getting out of one’s self. But the point is not only to get out – you’ve got to stay out; and to stay out you must have some absorbing errand (Henry James).
Beware the prevalent unhealthy escapes: substance abuse, isolation, sexual acting out
Variety in and outside of the office
Some Absorbing Errands
Vital breaks
Relaxation
Humor
Hobbies
Days off
Vacations
Restorative solitude
Personal retreats
Play: How do you play?
9. Creating a Flourishing Environment
Use stimulus control - the most neglected strategy
Avoid the fundamental attribution error (FAE)
Take an environmental audit Work safety Business support Behavioral boundaries Institutional practices (high demands plus
high constraints are toxic) A self-care village in a workaholic world
10. Undergoing Personal Therapy
Commence personal tx at beginning (90% plus benefit)
Pursue couples & family tx as well Confront your resistance not to
pursue personal tx Supplement psychotherapy with
personal analysis Return to tx periodically without
shame (52% to 65% reinitiate) Obtain annual satisfaction checkup Only one form of self-development
(e.g., creative arts, meditation, yoga)
11. Cultivating Spirituality & Mission
Spirituality at the OfficeRemember your callingReclaim your “mission” in
life (Maslow) Care for othersCommitment to growthSpirituality in clinical work
11. Cultivating Spirituality & Mission
Spirituality Outside OfficePursuing ultimate questionsBecoming a citizen-therapist
(Tikkun ) Integrating religion/
spirituality into your personal life
Letting your life speak
12. Fostering Creativity & GrowthPassionately committed
therapists: adaptive & open Everything comes together
in the creative processDiversify: your therapy day,
your clients, your prof activities
Growth (e.g., CE, videotape yourself, prof organizations, interdisciplinary research)
And, in the end, do more than survive: Thrive
In Closing: A Curious Blend
1. How to
2. You should
3. Chill out
Ave Atque Vale(Hail & Farewell)
Please♥ be gentle with yourself (self-
empathy)
♥ remember that your life is a work in progress (temper corrosive expectations)
♥ recall that you cannot master or profit from all self-care possibilities (individualize)
♥ practice self-care as a skillful attitude and lifelong commitment
Hail & Farewell