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InPsych 2015 | Vol 37

February | Issue 1

Cover feature : Psychologist self-care

Self-care for psychologists: Lifeline’s learnings

Working as a psychologist often entails exposure to potentially traumatic and distressing material, including clients’ stories. Regular exposure means that there is a significant risk of vicarious trauma and burnout. There is often an assumption that our training as psychologists inoculates us against these ill effects, however, over time, the cumulative effect of being exposed to traumatic or distressing material can take its toll, making helpers such as psychologists more at risk than the general population. The large amount of literature on compassion fatigue for various helpers also supports this notion (Figley, 1995).

Recognising this and taking personal responsibility for self-care is essential for every psychologist. This is important not just for psychologists’ own wellbeing but also so that they are able to perform well in their role (Taylor & Furlonger, 2011; Figley, 1995). Evidence indicates that those who have been experiencing symptoms of secondary traumatisation or psychological distress, even if these are mild, will have difficulty in utilising their skills as well as those who are not distressed (Beaton & Murphy, 1995; Dunkley & Whelan, 2006).

Due to the crisis nature of Lifeline’s work, Lifeline’s staff and volunteers are regularly exposed to distressing material. Exposure may occur by listening to callers’ stories, providing supervision, or in conducting quality assurance activities. Thus, self-care is an area that has received significant attention, with various strategies being implemented to improve the support provided to Lifeline’s staff and volunteers. Many of these strategies are equally relevant to our work as psychologists.

Supervision

First and foremost, it is important to have regular, good-quality supervision. Supervision has the very real potential to improve and maintain wellbeing, increase skills and enhance reflection (Taylor & Furlonger, 2011, Senediak, 2013). Although supervision may entail additional financial costs, there are significant and potentially more costly (both in human and financial terms) implications of not prioritising supervision and putting in place good processes and practices. Supervision is not just important in the initial stages of one’s career, but as an ongoing practice for all psychologists.

The most effective supervision requires an open, transparent relationship where any limits to confidentiality are understood by the supervisee (Saxby, Wilson & Newcombe, 2013). This could mean ensuring that the supervisor is not a manager within the organisation, so that there is freedom to be open and disclose issues and struggles, and therefore develop clinical skills and self‑awareness. This is a challenge in a tight economic environment and has been particularly difficult in not‑for‑profit organisations such as Lifeline. There can also be issues when supervision is provided completely external to the organisation, as there are benefits in understanding the specific work that the supervisee is undertaking.

Additionally, the quality of the relationship between supervisor and supervisee has been demonstrated to be a key factor in the success of supervision (Senediak, 2014; Taylor & Furlonger, 2011). This would indicate that there needs to be some element of choice in supervisors, another key resource issue for smaller organisations.

Finally, whatever model the supervisor uses, it is important that supervision encourages the psychologist to reflect on his or her practice and wellbeing, as a way to grow and develop (Senediak, 2013).

Reflective practice

Reflective practice need not be contained to supervision, but is something that can be done oneself, by asking some key questions after a session (Senediak, 2014). A reflective practice journal can be kept in which any thoughts or reactions about a session can be noted down. This should only be done for sessions that have touched you in some way, e.g. left you with unresolved feelings of anxiety, sadness or frustration, or left you feeling that the session could have been better.

Write down what affected you and ask yourself some reflective questions, e.g., Why do I think I reacted this way? How did the client respond in the session? What would I do differently next time? How does this relate to the rest of my work? This journal can be taken to supervision sessions, and those sessions that stand out can be presented and further processed in order to aid your reflection, self-awareness and skills development.

Self-care in personal lives

As psychologists, we often talk to clients about the importance of a healthy lifestyle for overall wellbeing, such as getting enough sleep, exercising, eating well, drinking water, making time for the things you enjoy and practising relaxation and mindfulness. These factors are often neglected in the psychologist’s own life. Listen to your own emotional and physical needs and consider any changes you might need to make to allow room for these.

Another essential part of self-care is being willing to seek help ourselves when in crisis, affected by personal life events, feeling overwhelmed, or experiencing suicidal thoughts. It is also important to look out for other practitioners who might be struggling and to encourage them to seek help when needed. As psychologists we are not immune to life’s problems, to mental illness or to crisis. However, those working in the helping professions who experience psychological distress are often unwilling to seek help (Dunkley & Whelen, 2006; Darongkamas, Burton & Cushway, 1994). Would you seek help under these circumstances, or attempt to cope on your own?

This may be controversial, but Lifeline asserts that both paid and volunteer Crisis Supporters should not feel obliged to come to work if they are not feeling emotionally resilient enough – shouldn’t the same go for psychologists? It is better for your clients to have their appointment rescheduled than for you to not be sufficiently present to provide the psychological services they need. After all, Lifeline is available 24/7 to support people in crisis.

The author can be contacted at ann.evans@lifeline.org.au

Self-care tips and tools using reflective practice and mindfulness techniques (Lifeline, 2014)

Before sessions

  • Ensure you are in a good emotional place. If something is going on for you at present, are you able to leave it behind and focus on the client?
  • Ensure you allow time between clients or before your first client to get yourself settled without rushing. This will help you to be present for the session.
  • Practice a small relaxation or mindfulness technique (such as breathing from your diaphragm, or a mindfulness technique that works for you) before each session.

During a challenging session or when hearing traumatic material

  • Notice your reaction.
  • Practise a simple breathing or mindfulness technique to stay calm.
  • Focus on the client, here and now.

After a challenging session

  • Take time to ask yourself what made this session difficult. If you have an emotional reaction to a session (frustration, distress, anxiety, anger etc.), do not ignore it.
  • Sit with the reaction for a few minutes. You may want to practise a formal mindfulness technique to become more aware of where you are feeling it in your body.
  • Arrange to have a trusted professional (preferably more than one to ensure availability) who can provide timely, confidential support and debriefing whenever you need to access it, even if this is not often. This person may be your supervisor. Confidential material need not be shared; the important thing is to have someone to discuss your reaction to a session with, if and when needed. Contact your supervisor or another peer if:
    • The session has triggered a strong reaction in you
    • You are concerned about the wellbeing of the client
    • You are feeling very frustrated or emotional about the session.
  • If you find yourself thinking about the session afterwards, that’s OK. Notice your reaction, don’t ignore it. Use a reflective practice journal to assist. However, if you find yourself dwelling on it a lot, contact your supervisor for some additional debriefing or supervision.

Other self-care tips when seeing clients

  • Take a few minutes’ break between clients (when and if you need to) – if you feel that you need to take more than a few minutes, listen to yourself. You can always let your next client know you will be a little late. This is a better option than not being fully present for your clients.
  • Drink plenty of water and eat healthy snacks.
  • Try to leave your life pressures at the door when you come in and pressures of your work in the room on leaving. You may develop some rituals to help with this, such as making a list of things to follow up the next day before leaving the office.
  • When you finish for the day, take the time to reflect on (and write down if necessary) any sessions that you had a reaction to, even if you think you are OK. Talk to a peer or supervisor as soon as you’re able to if your reactions were strong.
  • Check yourself for any resentment, judgment or generalisations towards clients and make sure you discuss this openly with your supervisor at the next opportunity. These reactions are quite normal, but need to be examined honestly in order to learn and grow, and to maintain your non-judgmental attitude. If left unchecked they can result in burnout as well as ineffective service provision.
  • Recognise and acknowledge your strengths, where you did well, where you feel you may have made a difference in a client’s life or feel uplifted after a session.
  • Make time to talk to other psychologists – ensure you attend peer consultation sessions, APS events etc.

References

  • Beaton, R. & Murphy, S. (1995). Working with people in crisis: research implications. In C. R Figley (Ed), Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in those who treat the traumatized. New York: Routledge.
  • Darongkamas, J., Burton, M. V., & Cushway, D. (1994). The use of personal therapy by clinical psychologists working in the NHS in the United Kingdom. Clinical Psychology and Psychotherapy, 1(3), 165-173. doi: 10.1002/cpp.5640010304
  • Dunkley, J. & Whelan, T. (2006). Vicarious traumatisation in telephone counsellors: internal and external influences. British Journal of Guidance and Counselling, 34(4), 451-469.
  • Figley, C. R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in those who treat the traumatized. New York: Routledge.
  • Lifeline Australia. (2014). Self Care for Crisis Supporters and In-shift Support Supervisors: Practice Guidelines. Internal document developed by Lifeline.
  • Senediak, C. (2013). A reflective practice model of clinical supervision. Presentation at Advances in Clinical Supervision Conference, Sydney Australia, 4-6 June 2013.
  • Taylor, W. & Furlonger, B. (2011). A Review of Vicarious Traumatisation and Supervision Among Australian Telephone and Online Counsellors. Australian Journal of Guidance and Counselling, 21(2), 225-235.

Disclaimer: Published in InPsych on February 2015. The APS aims to ensure that information published in InPsych is current and accurate at the time of publication. Changes after publication may affect the accuracy of this information. Readers are responsible for ascertaining the currency and completeness of information they rely on, which is particularly important for government initiatives, legislation or best-practice principles which are open to amendment. The information provided in InPsych does not replace obtaining appropriate professional and/or legal advice.