Since the 1980’s, the field of psychology has taken a serious interest in the well-being of mental health practitioners (Deutsch, 1985; Emery, Wade, & McLean, 2009; Farber & Heifetz, 1982; Rupert, Miller, & Dorociak, 2015). Researchers have investigated the unique challenges that mental health professionals face: work-related stressors, fatigue, and emotional exhaustion. In more recent years, the focus has shifted from issues of burnout and occupational hazards to the self-care practices of mental health professionals (Bettney, 2017; Carroll, Gilroy, & Murra, 2002). Many researchers, organizations, and clinicians are now arguing that self-care among practitioners is an ethical obligation. I myself make this same argument and stand by it: mental health professionals are ethically obligated to practice self-care.
Psychological Challenges Faced by Mental Health Practitioners
It is no secret that clinians’ jobs can often be difficult and draining. A large number of mental health professionals suffer from compassion fatigue, secondary trauma, chronic stress, and a host of other work-related hazards (Johnson et al., 2014; Ray et al., 2013; Rupert, Miller & Dorociak, 2015). Moreover, studies have found that mental health professionals are at high risk for psychological issues (Gilroy, Carroll, & Murra, 2001). Researchers have reported that as many as 62% of licensed clinicians experience depression, with a higher number of female therapists struggling with depression (60%) than male therapists (40%); about a third of these individuals are also prescribed antidepressants. Even more disconcerting is that 42% of therapists have reported some type of suicidal ideation or behavior. (Gilroy et al., 2002).
While other researchers have found slightly lower prevalence rates, these findings are in stark contrast to prevalence rates of depression and suicidal ideation in the general population - about 7% and 4% respectively (Piscopo, Lipari, Cooney, & Glasheen, 2016). Although little is known about the causes of such high rates of psychological issues among mental health practitioners, professional stressors and burnout seem to be at least partially responsible (Bearse, McMinn, Seegobin, & Free, 2013). Other research suggests that many mental health clinicians are motivated to enter the field of psychology by their own experiences with mental health issues, which may also explain the high rates of depression and suicidal ideation in this particular population (Conchar & Repper, 2014).
The Negative Impacts of Unaddressed Mental Health Concerns
Regardless of the specific causes of such high rates of psychological issues among mental health practitioners, there is an indisputable need to address the unique challenges that clinicians face. Occupational hazards and depression have been shown to negatively impact professional work as well as client outcomes (APA Practice Organization, 2017). They can lead to job dissatisfaction, unprofessional behaviors, ethical and boundary violations, malpractice, loss of credibility, and lawsuits. Moreover, clients may experience symptom exacerbation and/or lose trust in the therapeutic process (Barnett, Baker, Elman, & Schoener, 2007). Leaving such issues unaddressed is extremely dangerous and can negatively affect both professionals’ and clients’ well-being. In order to prevent harming oneself and one’s clients, mental health practitioners must practice consistent and purposeful self-care.
What Exactly is Self-Care?
Self-care is defined as the act of properly and effectively addressing one’s own well-being (Conchar & Repper, 2014). In other words, self-care is “occupational hygiene.” There are six distinct categories of self-care: emotional (e.g., seeing a therapist, journaling, creating art), physical (e.g., adequate sleep and nutrition, exercise, hydration), social (e.g., tending to relationships, connecting with others), practical (e.g., creating a budget, organizing and cleaning one’s living space), mental (e.g., reading a book, solving a puzzle), and spiritual (e.g., meditation, mindfulness, prayer, engaging in worship, practicing self-reflection; Planned Parenthood, 2020; Richards et al, 2010).
Research has shown that mental health professionals who engage in meaningful self-care are able to deal with burnout and occupational stressors, provide effective care, avoid harming clients, and perform professional duties in a competent manner (Bearse et al., 2013; Rupert et al., 2015). Moreover, clinicians who practice consistent and purposeful self-care are more skilled, more reliable, and more empathetic than those who do not (Bike, Norcross, & Schatz, 2009). Self-care, therefore, is crucial to serving clients (Carroll et al., 1999).
More Than Just “Important:” An Ethical Imperative
Several professionals argue that self-care is much more than just an important aspect of good therapy; it is an ethical imperative (Barnett et al., 2007; Wise, Hersh, & Gibson, 2012). This idea is backed by Principle A, Beneficence and Nonmaleficence, of the American Psychological Association “Ethical Principles of Psychologists and Code of Conduct” (APA ethics code; APA, 2017). This principle states:
Psychologists strive to benefit those with whom they work and take care to do no harm….Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work (APA, 2017, p. 3).
Standard 2.06, Personal Problems and Conflicts, of the APA ethics code adds to Principle A by stating the following:
(a) Psychologists 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. (b) 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 (APA, 2017, p. 5).
Although the APA ethics code does not explicitly identify self-care as an ethical obligation, it does place great importance on self-awareness and on seeking assistance in the face of personal problems. Moreover, the ethics code addresses competence, which draws a strong link between ethics and self-care. Standard 2.03, Maintaining Competence, states:
Psychologists undertake ongoing efforts to develop and maintain their competence” (APA, 2017, p. 5). One could argue that self-care is critical to maintaining competence. In fact, Wise et al. (2012) do just that: they stress that self-care is paramount to maintaining competence, and that self-care is therefore an indirect ethical obligation of Standard 2.03.
Likewise, Barnett et al. (2007) also expand on the ethics code by arguing that MHPs should not wait until a conflict arises, but should be proactive at all times; they maintain that MHPs should be “aware of the possible impact of their own physical and mental health on their ability to help those with whom they work, and...engage in ongoing efforts to minimize the impact of these factors on their clinical competence and professional functioning” (Barnett et al., 2007, p. 604). In other words, therapists should be practicing positive, purposeful, and consistent self-care in order to prevent and address issues that could intervene with professional duties. It stands to reason, then, that failing to take care of oneself is an ethical violation.
To be clear, the problem is not that therapists experience distress or struggle with their own mental health issues. The problem arises when therapists do not address their own struggles through personal therapy or through other means. Clients have a right to quality care that is effective; if practitioners are not at their best, they cannot provide the best care to their clients.
So...How Exactly Should One Practice Self-Care?
Several researchers have made various proposals to encourage self-care among mental health clinicians. First and foremost, clinicians should make an effort to increase self-awareness. In order to better oneself and practice positive self-care, one must have a good understanding of one’s own specific wants and needs. Practitioners should make an effort to understand their own thoughts, emotions, triggers, coping mechanisms, reactions, and motivations (Richards et al., 2010). Mental health professionals may increase self-awareness by engaging in personal therapy, journaling, meditating, practicing religion, seeking feedback and advice, or engaging in any number of other activities that they feel would be helpful in gaining a better understanding of the self.
Secondly, practitioners should make sure to identify and avoid any unhelpful coping strategies which they may be employing on a regular basis. For example, using alcohol and drugs to cope with stressors is maladaptive and may lead to larger personal and professional problems over time (Barnett et al., 2007). Clinicians are encouraged to replace unhelpful coping strategies with more helpful ones (e.g., engaging in exercise, gardening, starting a new hobby, talking to a trusted friend). For a list of coping skills ideas, click here.
Lastly, self care must be purposeful and consistent (Richards et al., 2010; Wise et al., 2012). Mental health clinicians are encouraged to schedule self-care into their calendars and make self-care a part of their every day routine. While spontaneous or sporadic self-care activities can be beneficial, consistency and routine are crucial to feeling recharged and replenished long-term. For tips on how to make time for daily self-care, click here.
The Bottom Line
The topic of self-care in the mental health field has clearly gained attention and importance in recent years. Researchers have identified the positive impacts of self-care on practitioners and clients alike, as well as the dangers therapists face when they do not take care of themselves. Overall, self-care has been found to increase therapists’ skills and empathy, while the absence of self-care has been correlated with clinician burnout and unfavorable treatment outcomes for clients. Many researchers now view occupational hygiene as an ethical mandate, even though the APA ethics code does not explicitly address self-care. Some argue that mental health practitioners are ethically obligated to practice positive, purposeful, and consistent self-care in order to avoid doing harm, increase self-awareness, and maintain competence.
The bottom line is that professionals cannot provide quality services if they do not take care of themselves. Eleanor Brownn, author and motivational speaker, once eloquently stated, “You cannot pour from an empty vessel.” Few other statements ring as true for professionals in the field of mental health.
-Laura
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