The Secret Lives of Therapists: How They Practice Self-Care
These days there is only one thing that is certain…uncertainty. Keeping your social distance, dealing with isolation, worries about job security, health and so much more, has created painful uncertainty and enormous stress for most of us who aren’t used to managing this unpredictability. In this post, Divorceify pro and therapist, Kristin Davin, rounds up advice from her fellow therapists on how they practice self-care to help bring certainty and consistency to these unprecedented times. This post originally appeared on Kristin Davin’s blog.
Although therapists are not on the front line, every day we are working behind the scenes helping our patients cope with every day stressors and as of late, the current state of the world. A world that has been turned upside down. We are helping them through difficult and challenging times, filled with ups and downs, coupled with significant anxiety, depression and uncertainty.
These are unchartered territories for all of us.
Personally, my patients exhibit elevated levels of stress due to isolation from family, friends, and colleagues. The certainty of life has been decimated as they learn to live with uncertainty about their jobs, life, and the foreseeable future. It is a very difficult and challenging time for everyone.
In many ways, I have found that people (patients and others) feel immobilized and unable to do things in life that were once easy. Or maybe taken for granted. Going to the store, out to dinner, running errands, traveling, and making plans for the near future have been put on hold. That’s hard to take in.
However, there are things all of us can do right now to provide certainty and consistency in our lives so that we feel more hopeful and in control when everything feels simply out of control. The role of purpose and intention is helpful during this time as we have more time to think about our life, direction, and choices. Each day we have choices.
As I traverse this new path, I wanted to know how other therapists were helping their patients navigate the stressors inherent with Coronavirus as well as in life, managing their own mental and emotional health, and trends they were seeing in their practice. And now that we are all knee deep in our new normal, we are unable to go to practice in our ‘brick and mortal’ and all now provide teletherapy, which is a change for many therapists After all, it’s imperative that we take good care of ourselves. That is our number one responsibility to ourselves. As therapists it’s equally important so we can help our patients get to a healthier place, not just now, but in life.
So, I reached out to a few colleagues and asked them three questions:
- What are some of the main themes that people are addressing in therapy?
- What are you doing personally to manage your feelings/status during this time?
- What are some of the things you are suggesting to your clients to help them?
For me, a few themes have risen to the top with my patients. One is isolation, the loss of interaction at work with friends and family, and feeling cut off from humanity. Another theme I see is the significant stress being home with school age children, which is more difficult when they are younger (elementary school age etc). Patients have to work from home and manage the school day for their child.
For example, I have a patient who is working from home and her 8 year old has Attention Deficit Hyperactivity Disorder (ADHD). She is not only helping with schoolwork from the academic end but also managing his symptoms by helping him with structure, focus and coping skills while at the time being on conference calls throughout the day. A third theme is job uncertainty. A couple of my patients have lost work because they are employed in restaurant and health club industry. They are experiencing worsening mental health. For those who are heavy worriers and anxious (Generalized Anxiety Disorder, GAD) the added stress of COVID-9 has elevated those symptoms.
There are several things that I am doing personally. I am running more and using mindfulness or meditation every day for 15 minutes. I also joined Weight Watchers (WW) to ensure the choices I make around food are healthy. I am also putting in more phone calls and FaceTime with friends and family. I keep a positive attitude and recognize that although I am not exactly on the front exactly like health care workers are (nurses, doctors, etc), as a therapist, we are the next line of defense so we are very vital right now. It’s important therapists to stay strong during this.
What am I suggesting to clients with symptoms of anxiety and depression, is that I am teaching Cognitive Behavior Therapy (CBT) and Dialectical Behavior Therapy (DBT) skills. When warranted, I meet with patients twice a week who are struggling and having more difficulty managing. Also, we might consider them having them discuss their medication with their primary doctor for a possible increase or referring them for a psychiatric consult when necessary. I also suggest Mindfulness Meditation – even starting small for example 5-10 minutes a day is extremely helpful. We work on Behavioral Activation as a way to keep their mood elevated and positive.
What I find critical at this time is to make a schedule every day. What patients need now is an IMAGINATION to get through this because the structure of our lives has disappeared. Thus, no one will create your day for you so in essence you have to create one and ‘be the conductor of your orchestra.’ Be your own executive. For example, from 6:30-7 healthy breakfast, 7-7:30 meditation to start the day. And then maybe from 8-4 is work. But, at 10:30 get off the computer and take a 5 minute walk and listen to your favorite music and then maybe take a break and do the same thing at 2:30. And then, between 4 and bedtime, there could be some fitness, reading, time with kids (if you have them) board games etc. Provide enough structure but with some flexibility to help manage the ups and downs.
Overall, I’ve been encouraging people to seek out a hobby, or an online class that could provide a good distraction. Predictability is what I’m helping my patients believe in because right now, it is gone. I feel this helps when you are able to create a calendar of activities and connections, which in turn reinforces the purpose of an imagination.
Most of my patients are concerned about being isolated from their loved ones, and contracting the virus, and questioning if they have symptoms or not. We also continue to address their current concerns regarding relationships, sex, and addiction.
Personally, I am allowing myself to feel my feelings about the state of the world. If I am sad, I will cry. It is not healthy to keep a lid on my current feeling state. I share this with my patients because I want to model a healthy state of feelings. I am also working out daily via Live Stream online workouts, 1-2 walks a day when it is weather permitted and staying connected to friends and family. I am balancing the amount of online time I have because I do not want to virtually burnout. Additionally, I am working on small personal projects.
One of the things I recommend to all of my patients is to EXERCISE! We need a healthy mindset during this time and endorphins will help elevate and balance our mood. We need to keep our bodies moving and active. Eat well and staying hydrated. I think we are all craving the fridge, but we need to keep our bodies nourished for a healthy immune system. Check in on loved one, but set healthy boundaries. It’s also important to read articles and books unrelated to COVID-19 in order to keep ourselves challenged and pump our neurons. Meditation for 5-15 minutes a day. What I can share is that over all, I am trying to help my patients with balance, structure and routine so they still find purpose and meaning amongst the current state of the world!
For the most part, I am continuing to address the presenting issues that brought patients to seeking treatment initially. The COVID-19 crisis itself and/or what is being discussed in the news seems to be less central to sessions, though adjustment to the social isolation is a part of the conversation.
One trend I have seen is the underlying issues for which patients initially sought treatment are becoming exacerbated under these new circumstances. Much of this can be attributed to the many ways their coping strategies have become limited due to “social distancing” or “sheltering in place.” Some patients are experiencing increased distress because of a resurgence of past feelings or issues.
Couples are interesting because those that were less distressed before the quarantine seem to be better equipped in making it a positive experience and seeing it as an opportunity to learn from one another and deepen the bonds of the relationship. For couples who were more distressed prior to the quarantine, though, it seems that the close contact without reprieve is only exacerbating the distress. The issues that brought them to treatment are being put under a microscope. They do not have the means of escaping the issues or utilizing coping strategies if they included something social outside of the home.
The importance of self-care and avoiding burn out is always part of the conversation with other professionals and with our patients, though how often are we guilty of not taking our own advice? This is a time when “healer heal thyself” has never been more important. As someone who is living alone (and therefore quarantining alone) while self-employed, responsible for therapy patients as well as the therapists who work at my practice, and still dealing with all of the personal struggles I had before this pandemic, I have realized that I have to schedule self-care time for myself daily. For me, recharge includes time for connection with loved ones, physical activity, and practicing self-compassion.
An unintended positive consequence of the quarantine has been that I have made allocating time for my closest friends a weekly priority. These are the people who, in Brene Brown’s terms, are my “marble jar friends” (See her books Daring Greatly, Braving the Wilderness, and Dare to Lead ). My “marble jar friends” are the ones who make me feel recharged, not drained. They are the ones who know how to offer support through being able to respect boundaries, appropriately give kind but honest feedback, and offer compassion and empathy.
As therapists we give ourselves to so many, care taking is what we do and while it is so rewarding, it is also draining. In the grind of daily life it became too easy to forget that as therapists, we are just as deeply human as anyone else and have a personal need to feel cared about; not just caring for the people on our caseloads.
I have to be cognizant of which personal relationships are too one-sided and mimic a treatment relationship, in which I am only the caretaker and they the receiver, and intentionally limit time with them and give more time to relationships that recharge me. Also, I have been able to reconnect with my oldest and dearest friend in a way that we have not been able to since we were eight years old, and that has been incredibly healing in a number of ways.
As New Yorkers we are all used to being able to walk and use even our commutes and getting up to get the next client between sessions as a short “break” and much needed physical movement. I know I did not, as I’m sure is true for the rest of us, realize how important that was before the quarantine. I have been practicing yoga at least 4-5 times a week has been an essential time to disconnect and give myself space to breathe.
I am also trying (emphasis on the trying) to practice self-compassion and to be mindful of when old patterns of self-criticism only exacerbate negative feelings. Taking time to breathe, practice gratitude, rest, do something for fun and not because it’s a task, or do nothing at all is part of recharging. Self-criticism is an enormous personal struggle, and awareness of how I speak to myself on days when I am tired, irritable, anxious, sad, or just numb is something I have to make concerted efforts to pay attention to. One way in which I am practicing gratitude is writing “just because” notes/cards to my “marble jar friends” to let them know how much I appreciate the space they make for me.
One of the most important things I try to remind all of my patients, is that we are all experiencing a trauma, we are all grieving, and most importantly we are all doing the best we can. None of us are being an “ideal” version of ourselves right now, and what may look like a partner being unnecessarily critical or irritable, or someone in line at the pharmacy having an overreaction to a delayed prescription may actually be a grief response. We are able to act in ways that make us feel better about us when we are not in grief or in the middle of a trauma. We can be better when we are rested, have had time to recharge, and when we feel like we are accomplishing goals.
We have to give ourselves and each other more grace and forgiveness to make mistakes. This includes giving ourselves permission to feel, and forgiveness when we act out our feelings in a negative way toward someone we love.
Developing a practice for mindfulness of self-criticism and a practice for self-compassion can greatly improve how patients feel individually, as well as how they are able to show up for their loved ones. For couples and families, this can be an excellent opportunity to reframe their views of conflict as an opportunity for learning and growth, and to practice repair.
One of the common things we have heard others suggest is to make a schedule and maintain a routine. This is certainly very helpful in taking back some agency in a time when we feel like much of what we could control is lost; though with the caveat that it is more than okay to not get everything done at once. I often remind patients to create and maintain a schedule, but one that is flexible and sets manageable goals and expectations with options to add or take things off of the to-do list as needed depending on the day.
I have also noticed some clients feeling pressured or becoming self-critical for not “living their best life” as they see on social media. “I have all of this time now, why can’t I seem to get [fill in the blank] accomplished?” If clients do not finish all of the books in their apartments, become fluent in another language, or reorganize everything in their homes it does not mean that they have failed or wasted time.
For couples and families, scheduling should include boundaries and expectations for schoolwork and household chores; though it should also include time for each individual to be able to have space apart from the rest of the family. In families in which two parents reside in the home, this should also include time for the couple to reconnect apart from their children. I often suggest adding in something to break up the monotony of routine by having one person plan a surprise for the other(s), such as a new game or activity. The important factor is to add levity wherever possible.
We are all in pain, and we all need time and space to grieve and adjust; opportunities for a reprieve from the negative feelings help us prevent burn out.
There have been a range of emotional responses to our current situation, but some main themes that have come up in my work with both individuals and couples through this time has been managing fears of both the unknown as well as fears surrounding the information that each day brings, making adjustments for new expectations for ourselves and for our partner, and lastly, for some, continuing to stick with original treatment goals to bring about a sense of normalcy.
What I’ve found to be helpful personally is to check in with myself at the top of each day to take inventory of my needs and emotions. I have found that my needs have shifted from day to day depending on what the day(s) before have brought on, and so I’ve felt the need to check in with myself to see what needs take priority for each day. Some questions I’ve asked myself to do so have been: Do I need more connection or alone time today? Do I want to spend more time making meals for creative purposes or do I need quick meals due to my schedule? Does my body need rest or movement today? I know for many folks, a routine can be helpful in creating structure among the chaos, but I also think that a check in to allow for some flexibility with our needs can be helpful as well!
The most consistent suggestion that I’ve made to clients throughout this time is self-compassion. There is so much content out there right now that can put pressure on what we “should” be doing with this time, and sometimes we need to take a breath and come back home to ourselves to remember that we are allowed to have needs and wants that are different than others/others’ expectations. For those that have transitioned to working from home, self-compassion can come from the reminder that we aren’t working from home because of a personal choice, but rather from the impact of a global crisis. If you would like to connect with
In closing, as Shirey put it so eloquently, ‘mental health professionals are more vulnerable to burn out and exhaustion due to these circumstances and prioritize self-care as an essential part of our daily routines, like showering and brushing your teeth. We are experiencing not only the same stressors as everyone else in terms of anxiety about the unknown, significant financial strain (especially considering that most of us are self-employed), frustration, and social isolation, and concerns about the health of ourselves and loved ones, but we are also in the unique position of being required to hold emotional space for others, including our therapy clients as well as our personal relationships, who need to process their own fears and anxieties.’
This is why it remains important and vital that therapists continue to practice self-care and self-compassion allowing us to lead by example, helping our patients get to a healthier place in their lives.