More Than Just Self-care

When I was in graduate school, I remember being told that in order to work in a helping profession I needed to make taking care of myself a priority. Doing so would give me the emotional energy to help others. My professors called this “self-care” and defined it as exercise, taking vacations, doing relaxing activities, and enjoying hobbies.

“Cool,” I thought. “I can blame all the relaxing and fun I need to have on my work. What other profession can do that?” It also seemed really easy to do. I soon learned it wasn’t so easy. The demands of my job were never-ending and the guilt around leaving early to take care of myself was notable. I did the best I could and took measures to take time off to take care of myself when the stress seemed overwhelming.

I noticed that while self-care activities WERE relaxing and well-deserved, they didn’t seem to replenish my emotional energy when I was already fatigued. They only added to the guilt and stress because when I got back to work, there was still mounds of work to do that gathered dust while I was out doing things that felt like playing- leaving me more stressed out then I was when I left work! In addition, while engaging in self-care activities, I often found it hard to focus on the relaxing activity and my thoughts would wander to work worries. It isn’t surprising that I soon gave them up and became one of the many of us who struggle with compassion fatigue related to my work. I’d go to the conferences about compassion fatigue, but all I was told was reminder about having healthy hobbies and the need to work in the “right environment” as a way to combat my fatigue- until I met Dr. J. Eric Gentry.

Dr. Gentry is an international expert on compassion fatigue. I decided to contact him and ask the question that had been plaguing me for years “Once someone is fatigued, how do they heal?” Dr. Gentry responded quickly and said not many people ask that question but he had the answer for me. Years ago, while he was a student of Charles Figley (known as the father of compassion fatigue), he and the other students developed a treatment model called the Accelerated Recovery Program for those who are experiencing compassion fatigue and symptoms of vicarious trauma related to their work. He offered to fly to Utah to meet me and teach me the program personally. How could I pass up an opportunity like that?

Dr. Gentry in person is as kind and generous as he was over e-mail! He spent two days teaching me what I had always instinctual known. While self-care is an aspect of compassion fatigue recovery, it is only one of 5 steps, and the last one at that.

Treating compassion fatigue involves being aware of and controlling your physiological responses to perceived threat that comes from your jobs. I started to see how and where I felt threatened at work- like times when I felt inadequate as a therapist, when I worried about a reaction a client was going to have, or when some of my perceptions stemming from childhood trauma about work and how work should be done surfaced.

I learned that breeches of integrity triggered compassion fatigue. It came on when I wasn’t acting the way I felt I should according to my perception of what it meant to be a social worker. I often wasn’t even aware of what those perceptions were! Dr. Gentry encouraged me to explore them, display them openly, and refer to them often.

I learned that decreasing compassion fatigue had very little to do with the environment I worked in or my escape from it and more with my perceptions about the demands placed on me. I learned these perceptions mature naturally over time.

Once I was able to understand and apply these aspects of compassion fatigue, I was finally able to do self-care activities and feel like they were relaxing and replenishing instead of just another demand on my time.

Compassion fatigue happens to all of us in our careers. I’m so glad I discovered the other aspects of compassion fatigue treatment that make it possible for me to help others without hurting myself- and I can enjoy that vacation now too!

How do I chose the right counselor?

When people find out what I do for a living, it’s not uncommon for them to admit they are having difficulties in their personal life. When I suggest they go see a professional, they often express frustration and confusion with the process of finding a therapist and they want one that will help them produce the change they are looking for. To all those people I have met at airports, restaurants, charity events, and churches: here’s how I recommend you find the right counselor for you.

Research shows the most effective counseling works because of four things*:

1. The relationship with your therapist accounts for 30% of the effectiveness of counseling.
2. The method of treatment or techniques used account for 15% of the effectiveness of counseling.
3. Positive expectancy, which is your belief that you can get better, account for 15% of the effectiveness of counseling.
4. Extratherapeutic change accounts for 40% of the effectiveness of counseling. As a client, you come to therapy with a specific motivation, strength of character, psychological mindedness, ability to be insightful about your problem and events going on in your life, certain social support networks, and a diverse history. These are called extratherapeutic variables. The nature of some of these variables lead to effective therapy.

So if you want to find a counselor that works for you, focus on those four things. Do some thinking and introspection about what you need in each of those areas. What kind of therapist would be the easiest for me to build a relationship with? Some clients prefer someone with similar background or religious beliefs. Some feel as long as they feel unconditional acceptance from their therapist then demographics don’t matter.

There are some counseling techniques that are proven by research to be very effective, such as CBT, DBT, and EMDR. Find someone who is trained or certified in the therapeutic techniques you need. If you don’t know what you need, don’t be afraid to ask the counselor which techniques they use the most. Many counselors are trained in a technique, which means they have usually attended a class or two about the technique. Someone who is certified in a technique has not only taken classroom training, but has participated in intensive supervision while using the technique over the course of several years. Those who are certified are generally more versed and competent than those who are not.

Ask the counselor if they believe you can get better and have them explain why. A counselor who does not feel like you can recover may not be the best fit or may not have enough experience working with cases like yours.

Last, consider your own motivation and attitudes toward therapy. Are there things in your personality or environment that you can and do want to change? Make those known to the counselor you chose. Carefully consider what can be realistically influenced in those areas and what things you have no control over. If you have no control over them, neither does your therapist, but the two of you can learn to cope with them in positive ways.

* Research from the book The Heart and Soul of Change: What works in Therapy by Hubble, Duncan, & Miller.