Beyond Self-Care for Helping Professionals

The Expressive Therapies Continuum and the Life Enrichment Model

Lisa D. Hinz

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781315316420
• Edition: 1
• Topic: Education
• Subtopic: Professional Development

Beyond Self-Care for Helping Professionals is an innovative guide to professional self-care focused not just on avoiding the consequences of failing to take care of oneself, but on optimal health and positive psychology. This new volume builds upon the Expressive Therapies Continuum to introduce the Life Enrichment Model, a strengths-based model that encourages mindful participation in a broad array of enriching experiences. By enabling therapists and other Helping Professionals to develop a rich emotional, intellectual, and creative foundation to their lives and clinical practices, this guide sets a new standard for self-care in the helping professions.

1 Perils of the Helping Professions

Good people are like candles;
they burn themselves up to give others light.

Turkish Proverb

I believe that everyone has the capacity to live an enriched and optimally healthy life. However, it has been my observation that in our society, people are more likely to do the opposite of living an enriched life. They have a tendency to work too hard and to sacrifice their physical, mental, and spiritual health. Helping Professionals are especially at risk, due to a focus on assisting others and a pervasive belief that focusing on the self and one’s own needs contradicts professional values to care for others. I have encountered this attitude of self-denial among therapists of all kinds, as well as physicians, nurses, and clergy members. However, if Helping Professionals do not take good care of themselves, it is likely that over the long term they will end up ill or disabled with someone else caring for them.

Good self-care efforts can help prevent the development of stress, burnout, and other negative conditions (Kavoor, Mitra, Mahintamani, & Chatterjee, 2015; Malinowski, 2014; Norcross & Guy, 2007). The focus of this book goes beyond self-care; it is not about merely preventing a negative condition or achieving a safe neutral state. The goal of this book it is to bring attention to the topic of life enrichment and to increase understanding of how an enriched life can endow the clinician with a pervasive sense of well-being. Living an enriched life helps people achieve robust physical health, supportive social relationships, meaningful professional work, and an active spiritual life. This type of holistic health increases vitality and encourages creativity; it imbues the practitioner with the ability to be fully alive and uniquely fulfilled by their professional work.

Working as a psychologist and art therapist in a residential lifestyle medicine program, I have encountered many practitioners of the healing arts who personify the negative effects of constantly focusing outwardly and giving to others; believing that it is selfish to say no, set limits, or take care of themselves. Program participants often lack energy and vitality, and complain of experiencing stress and fatigue. Frequently they state that they eat haphazardly, exercise infrequently, and sleep poorly. Many find themselves in the vicious cycle of drinking caffeine to help them “function” during the day and depending on alcohol to relax in the evening. Often these people tell me that they would consider themselves selfish or self-serving if they thought about their own needs, and especially if they put their own needs above those of their patients or their family members.

A few years ago, I gave a presentation on self-care to a group of art therapists and received a scathing evaluation from an audience member that demonstrates this point. The participant wrote in the comment section, “All this focus on making art for self-care is sickening. Just do the work you signed up for!” I was flabbergasted. I do not know whether this is a common perception among art therapists, but I know that it is a harmful one. People who believe that they should just “get on with the work that they signed up for” likely ignore warning signs in themselves: They work through hunger or physical pain, tension, or depression. In doing so, they may become less effective as healers and their lifespan as a healer may be abbreviated.

Furthermore, someone who identifies as a “helper” may feel uncomfortable with asking for what they need for themselves. In our individualistic society, many people value being good at everything and consider it a weakness to ask for help. However, human beings are social creatures. We function best in groups (couples, families, organizations, and communities) because it is impossible for one person to be good at everything. In a group, people’s strengths can be complementary to the strengths of others, and compensate for their weaknesses as well. In reality, it is important for everyone, even those who identify as professional “helpers,” to know when to ask for support.

From my perspective, there are three essential pieces to living an enriched life, which will be defined and developed throughout the book: a deep well, wide margins, and firm boundaries. The relationships between these elements and the Life Enrichment Model will be explored and its application in a dynamic balance explained. Living in dynamic balance means that people who live enriched lives know that balance ebbs and flows; it is not static and should not be. Sometimes attention and energy are necessary in one area at other times another area of the LEM is the focus. A deep well of enrichment comes from various aspects of the LEM, but especially from increasing positive emotions like hope, optimism, resiliency, and self-efficacy. To have wide margins is to have time built into the day for a pause. Sometimes this pause is for rest or relaxation and sometimes it is for self-reflection, but it is always necessary to carve out time between activities to live mindfully. In order to embrace firm boundaries, one must realize that it is not selfish to focus on one’s own life and heath, but actually a form of necessary self-preservation. When you live an enriched life, you can preserve your health and have more energy to give to others.

Please do not read this book as a list of commandments or things that you “should” be doing or that you have to get right. You are already doing many things right. I would rather that you read the book as an affirmation of what you are already doing to ensure your optimal health. Notice what you are doing already, appreciate it, and perhaps continue doing it with more intention and gratitude. You many also read this book as a list of suggested opportunities to enrich your life in simple but influential ways. Furthermore, I am not seeking to promote a moral imperative that if you feel good you are a good person and vice versa (Cederström & Spicer, 2015). In writing this book, I only want to encourage you to be curious about yourself and the various ways that you can promote the utmost well-being in your life and practice.

There certainly will be times when you feel down or lack motivation; you would not be human if there were not. However, when you live a rich life, it is possible for those dark times to make the light more beautiful. For me, dark times accompanied by dark thoughts occasionally made writing this book extremely difficult. During the dark times, I thought that I could not have anything worthwhile to say to people about wellness if my life were not in perfect balance at all times. A revelation came when I realized that perfectionism was getting in my way. The writing came more easily again when I could tell myself that I do not have to be perfect in order to give advice from my life and my practice. I just have to be honestly striving towards optimal health – and that is how I am living my life.

There has been a great deal of research on the unintended harmful side effects of working in fields where helping others is the primary focus. Many books on self-care discuss the fact that as therapists listen to their clients describe physically or psychologically painful events, they can experience a condition that erodes their physical and mental well-being and interferes with their ability to carry out their work (Kottler, 2017; Malinowski, 2014; Norcross & Guy, 2007; Wicks, 2007). These syndromes, which have been called professional burnout, compassion fatigue, vicarious traumatization, and secondary traumatic stress are characterized by subtle differences but share a great deal of conceptual overlap (Canfield, 2005; Figley & Ludick, 2017; Malinowski, 2014). In fact, the use of various terms to describe these similar conditions may have slowed the progress of research aimed at defining the syndromes. Therefore, the helping professions are delayed in understanding these syndromes, realising their deleterious effects, and describing prevention and treatment efforts (Newell, Nelson-Gardell, & MacNeil, 2016). Readers of this book can remember it is possible to become traumatized by the suffering we encounter as therapists, and that this secondary trauma can cause emotional and physical exhaustion. However, with good self-care practices in place, the enriched life that results offers significant protection against this unintended harm.

Definitions and Distinctions

Professional burnout has been conceptualized as a multidimensional condition resulting from factors related to the helping professional, the populations where the work takes place, and the agency (Newell, et al., 2016). It is the only syndrome that takes organizational factors such as lack of agency resources and support into account (Figley & Ludick, 2017). Interestingly, professional burnout is a term more frequently used in the literature on nurses, physicians, and dentists than other helping professions. Further distinction comes from the fact that burnout is a condition that is a consequence of another syndrome: compassion fatigue, vicarious traumatization, or secondary traumatic stress. Vicarious traumatization and secondary traumatic stress are similar in that they are syndromes that develop due to continuous exposure to client trauma. The definitional difference seems to be that persons suffering from secondary traumatic stress display psychological and physical symptoms in line with Post Traumatic Stress Disorder (PTSD).

According to Malinowski (2014), the symptoms of secondary traumatic stress are very similar to those of PTSD with the exception that whereas the client suffering from PTSD actually has faced a life-threatening event or undergone a serious injury, the clinician suffering from secondary traumatic stress has experienced the trauma secondhand, through attending to client stories of traumatic events and empathizing with their clients’ emotions. Vicarious traumatization has been defined as being more highly associated with cognitive changes and beliefs about the world and one’s ability to affect change in the world (Newell, et al., 2016).

In the past, compassion fatigue was viewed as a condition with characteristics of both professional burnout and vicarious traumatization (Figley & Ludick, 2017; Newell, et al., 2016) but more recently has been defined as the overall experience of emotional and physical fatigue that can develop in Helping Professionals as a consequence of the chronic use of empathy with those who are suffering (Newell, et al., 2016). In this way, compassion fatigue can be viewed as a consequence of secondary traumatic stress (Figley & Ludick, 2017). The word compassion comes from the Latin roots pati and cum which together mean “to suffer with” (McNeill, Morrison, & Nouwen, 2006). Compassion is a demanding state of being that requires not only empathy for another’s suffering, but also a sense of responsibility for doing something about it. As McNeill, et al. (2016, p. 4) eloquently state:

Let us not underestimate how hard it is to be compassionate. Compassion is hard because it requires the inner disposition to go with others to places where they are weak, vulnerable, lonely, and broken. But this is not our spontaneous response to suffering. What we desire most is to do away with suffering by fleeing from it or finding a quick cure for it.

This passage fully describes the difficulties of undergoing constant demands on compassion and what the authors state is the most understandable response to suffering: We want to run away from it or quickly patch it up. When it is not possible to flee or fix the ongoing deluge of trauma that Helping Professionals encounter, secondary traumatic stress and compassion fatigue can develop.

Development of Secondary Traumatic Stress and Compassion Fatigue

According to two recent reviews, secondary traumatic stress and compassion fatigue are more likely to develop in Helping Professionals who demonstrate high levels of empathy, prolonged exposure to suffering and high caseloads, low levels of work satisfaction, traumatic memories, and other unexpected life demands (Figley & Ludick, 2017; Turgoose & Maddox, 2017). Although a high level of empathy is a personal characteristic that contributes to a person becoming an effective therapist, it is also one of the factors that leaves counselors vulnerable to developing compassion fatigue or secondary traumatic stress syndrome (Figley & Ludick, 2017; Malinowski, 2014; Turgoose & Maddox, 2017). Empathy and altruism can become depleted as Helping Professionals are continuously confronted with their clients’ traumatic experiences, especially if therapists have their own personal history of unresolved trauma. The greater the similarity between the client and therapist trauma, the more likely it is that the therapist will experience secondary traumatic stress and develop compassion fatigue (Figley & Ludick, 2017; Malinowski, 2014).

Other elements contributing to the development of secondary traumatic stress and compassion fatigue are countertransference issues, low levels of work satisfaction, and other life demands (Figley & Ludick, 2017; Malinowski, 2014). Countertransference issues are brought about by unconscious past influences or current life stressors in the therapist that are played out in the therapeutic relationship. For example, a therapist whose father committed suicide might react towards an older, suicidal male client with fear and sadness which interfere with his ability to render successful treatment. When therapists bring internal factors, such as their past or present lives, into their work with clients, countertransference issues become a challenge for both parties.

External factors also can cause Helping Professionals to become dissatisfied at work and contribute to burnout or exacerbate compassion fatigue. Unmanageable caseloads, a lack of respect, job demands that are perceived as out of the person’s control and/or a toxic work environment characterized by isolation and a lack of support are work-related external factors that can compound the challenges a therapist may experience in his or her work with clients (Figley & Ludick, 2017; Malinowski, 2014). Personal life stressors such as financial difficulties or changes in personal roles such as care-taking responsibilities can place greater demands on empathic reserves and also contribute to compassion fatigue (Figley & Ludick, 2017).

Prevention and Treatment of Secondary Traumatic Stress and Compassion Fatigue

Despite these challenges to professional well-being and longevity, recent research demonstrates that the development of secondary traumatic stress or compassion fatigue is not inevitable (Figley & Ludick, 2017; Malinowski, 2014; Newell, et al., 2016; Turgoose & Maddox, 2017). It is possible to remain resilient as a Helping Professional and even to develop Post Traumatic Growth (PTG) in response to trauma work. As the name implies, Post Traumatic Growth is a positive condition associated with finding new meaning in life after hardship, viewing the self as resilient and capable, developing a sense of hope for the future, and valuing relationships differently (Bartoskova, 2015; Forgeard, Mecklenburg, Lacasse, & Jayawickreme, 2014; McCormack & Adams, 2016; Želeskov-Dorić, Hedrih, & Dorić, 2012). Factors that contribute to the development of growth rather than professional burnout include maintaining good self-care practices, developing a sense of detachment from professional stressors, having a positive sense of job satisfaction, and acknow ledging a strong network of social support. These factors will be fully developed throughout the course of this book to provide you with a comprehensive foundation in life enrichment that can serve to prevent and/or ameliorate secondary traumatic stress and compassion fatigue.

Many Helping Professionals have identified support from compassionate and caring personal relationships as a primary factor in helping them develop resilience in the face of the ongoing stressors of their work (Želeskov-Dorić, et al., 2012). Each of the chapters in this book will emphasize the importance of sharing life enrichment with others as one way to strengthen reserves of positive emotions, empathy, and optimism. In survey research, expert practitioners have described specific professional factors that promoted resilience and prevented burnout in their careers, including having consistent, positive mentor and peer support relationships in the early career phases, having ongoing peer support throughout their career, having multiple professional roles (e.g., teacher, clinician, researcher), and experiencing a health-promoting work environment. Other positive and preventive factors include: dealing directly and openly with professional dilemmas that elicit personal problems, engaging in high quality continuing education, maintaining a balance of solitude and social interactions, investing in a broad array of restorative activities, art making (Salzano, Lindemann, & Tronsky, 2013), and making time for self-reflection (Mullenbach & Skovholt, 2001). Finally, mindfulness strategies have significant preventive effects (Luken & Sammons, 2016; Turgoose & Maddox, 2017). Mindful “micro-self-care practices” can be woven throughout the day to improve mood, decrease emotional reactivity, and increase mind-body awareness (Bush, 2015, p. 5).

Summary and Conclusions

Prolonged exposure to other people’s suffering, high levels of empathy, and concern for the welfare and success of their clients can lead Helping Professionals to develop conditions like vicarious traumatization, secondary traumatic stress, professional burnout, and compassion fatigue. Low work satisfaction, heavy caseloads, lack of support and a personal history of trauma will compound these factors and put certain professionals at higher risk of developing harmful work-related syndromes. However, these factors do not have to inevitably lead to a negative condition. There are many things that therapists can do to prevent or treat debilitating syndromes such as engaging in exceptional self-care practices, fostering supportive social systems, developing routines that encourage detachment from stressful situations, and cultivating a sense of satisfaction in their work. All of these themes and many more will be explored in the next chapters, and their relationships to life enrichment expounded upon.

It was not my wish to begin this book with a chapter on the perils of practicing the helping professions. However, I changed my mind as I was writing the book. I felt that it was necessary to present this cautionary framework so that life-enrichment could be viewed as empowering and not frivolous or superfluous. Self-care is a necessary ethical mandate for those in the helping professions – couching it in the context of life enrichment will hopefully make self-care feel less like another burden competing for your already limited time, and more like a series of consummate supportive practices that can enhance all areas of your life and well-being.

Art Exploration

1. Divide a paper in half and create a two-sided collage that shows the perils and pitfalls of the helping professions on one side and the rewards and potential for growth on the other.
2. Draw or paint a series of three self-portraits that explore the person you were and the factors that influenced your becoming a helping professional, who you are today, and how you would like to look in your optimally healthy future.

Questions for Self-Reflection

1. How do you feel about the level of satisfaction that you achieve from helping others in your current employment situation(s)? Is ther...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of Figures
• List of Plates
• About the Author
• Preface
• 1 Perils of the Helping Professions
• 2 Beyond Self-Care to Life Enrichment
• 3 The Life Enrichment Model
• 4 Life Enrichment through Sensation
• 5 Life Enrichment through Movement
• 6 Life Enrichment through Pattern and Routine
• 7 Life Enrichment through Emotion
• 8 Life Enrichment through Intellect
• 9 Life Enrichment through Symbolism
• 10 Life Enrichment through Creativity
• 11 Living Optimally: A Deep Well, Wide Margins, and Firm Boundaries
• References
• Index