Do I push harder or pull back? Is it time to be directive or let the client lead? Should I stick with the treatment plan or refer to a higher level of care? Is my client going to be safe if I send them home? Therapists make these decisions knowing that what they say and do (or don’t do) has the potential to impact someone’s life for better or worse. Anyone who has worked in the mental health field knows the role of a therapist is both rewarding and demanding. Guiding clients through treatment requires empathy, skill, and an unwavering commitment to the client’s well-being. Clinicians make difficult judgment calls on a daily basis. It’s a lot. 

I am a therapist and some of my favorite clients are also clinicians. Some come to therapy to work on their own stuff and others come because they are experiencing work related problems like secondary trauma stress, burnout or a loss of compassion satisfaction. When I work with other clinicians, I love the instant camaraderie I feel; without saying a word, we have a shared understanding about the joys and pains of the job.

I absolutely love watching people heal, grow, and change. It is one of the most satisfying, inspiring, heartwarming things in my life. It is also intense and filled with ups and downs and can trigger my own countertransference. And at various stages throughout my career, my work – or more accurately – how I’m engaging with my work, has had definite repercussions on my wellness.

The Self-Care Solution

All therapists know how important it is to prioritize their own well-being in theory. We know about the oxygen mask on the airplane and how you must put on your own mask first before you help others. We know we are less effective at work when we are not taking care of ourselves. And sometimes we even know that our wellbeing doesn’t just matter in the context of being a better helper to others but that our wellbeing matters because, well, we matter. After a lot of my own personal therapy, I actually reached a point of understanding that self-care is valuable in itself; that it’s not just about keeping the machine going at top speed. I realized I am a human with needs and wants and desires and that my quality of life matters just as much as my clients’. My work with other therapists often involves helping them understand this point. But the job doesn’t end there.

When working with burned-out clinicians, I rarely start off by recommending improved self-care. This is not because I think therapists are doing an excellent job of taking care of themselves.

One of my favorite memes starts out “my therapist: you need to engage in better self-care” the next line reads “also my therapist:” and has a scary picture of a decrepit looking person with red circles around their eyes and saggy, wrinkled skin. This meme always makes me laugh, then cringe because it hits a little too close to home. While we may know intellectually that we need to take care of ourselves, most therapists struggle to know how to do this in meaningful ways. But maybe the problem is not that we are failing with self-care, maybe the problem is how we’ve been conditioned to conceptualize self-care in the first place.

Does any of the following sound familiar?

If all goes well, after reading this article, you can expect to have perfect clarity and insight as to how to maintain a perfect work-life balance. The information I’m about to share will unlock the key to making sure that every important thing in your life will fit into a tidy schedule and you will have a to-do list that matches your energy level and is easily achievable on a daily basis. You will finally figure out how to exercise regularly, sleep well, eat nutritiously, make time for romance, keep a clean and inspiring environment, budget your money, have healthy relationships, and keep up on all your notes.

I know those types of promises sound so enticing but they carry an underlying message: if you are struggling it’s because you’re doing it wrong. The truth is, if you’re struggling it’s because you are a human being living in a messy world that is made even more messy because of your chosen profession. You are not the only clinician who is struggling to meet all the demands of working in a helping profession.

Believe me when I say:

You are not alone if you feel overwhelmed by your work.

You are not alone if you have been deeply affected by the stories of the people you work with.

You are not alone if your own mental health issues show up at work and you sometimes don’t know where to turn because even if you know you need to see a therapist, you have professional relationships with all the therapists you know which makes it really difficult to find someone you trust.

You are not alone if you wonder if anything you are doing makes a difference or if you sometimes feel at a loss as to how to help the people who are paying to see you.

And most importantly, you are also not alone if you struggle with feeling that you are alone.

Pain is Painful

I was at a recent ACT training where the trainer led an exercise around creative hopelessness. First, she had us list something that we are currently struggling with. Then we listed the thoughts and feelings that show up when we’re in the struggle. Next, she had us list all the ways we have tried to deal with the struggle. Most of us had some ‘healthy coping’ and ‘unhealthy coping’ items on the list. She then asked a very annoying question: has any of this worked? Meaning: has the struggle disappeared? Are you free and clear of the pain? I don’t think there was anyone in the room who said yes.

She then made a room full of therapists (who are highly trained to hold space for pain and who have high tolerance for discomfort) feel very uncomfortable. As we expressed our resistance to the idea that pain still exists in our lives despite our best (and worst) efforts to eradicate it, she kept asking things like “And is that going to get rid of the pain?” 

Us: I’ve learned a lot of helpful things in coping with pain. I have hobbies, 
I go out with friends, I take hot baths and I do my own therapy.
Her: And is the pain still there?
Us: Well, yea. BUT I’ve learned to embrace my pain.
Her: And did that get rid of it?
Us: Well, no. BUT….(realizing she’s right) Damn it! What the hell? What are you saying? That nothing matters? If nothing works, then what is the point of our jobs?
Her: And when we respond to pain with anger and frustration and tell ourselves that nothing matters and our efforts are pointless, does that get rid of the pain?
Us: Well, shit. No. BUT…

This went on for a while before she helped us process how much we struggle to accept the idea that pain is a part of life and that pain hurts.

One of the reasons talking about self-care can be so problematic is that we try to use self-care as a way to avoid struggle. We buy into the idea that if we do it right or do it well enough then our jobs will be easy and we will achieve a perfect work-life balance and live in a balanced state of regulated bliss for the rest of our careers. This way of thinking gives us an out because if we’re struggling it’s just because we’re not doing good enough self-care and as soon as we start doing self-care all will be well. After all, us therapists are very good at mental manipulation reframing; we practice it on a daily basis.

Having a conversation about self-care without recognizing that it will not save us from pain actually increases our levels of exhaustion and burnout. It turns into yet another item on a very long to-do list which we feel guilty for not completing. And when we make efforts to care for ourselves, we get frustrated when it’s not working meaning “I’m doing my self-care but I still feel pain? How can this be?”

As we work on accepting the reality that if we choose to work in the mental health field, we choose to let ourselves be affected by the pain of others as well as our own pain, we are in a better place to take care of ourselves. In this context, self-care stops becoming about running from pain and turns into something we do because it helps us face pain with an open heart. As we practice facing pain with an open heart, we fear it less and we can then practice facing it rather than running from it (and yes, pain is still painful even when we respond to it in this way).

I have done and continue to do a lot of work on myself to help me live this way. I often hear the voice of Steve Hayes in my head reminding me “Your pain is not your enemy.” At many times throughout the journey, I’ve needed to access professional help in order to face pain I was avoiding. I like to think this has made me a better clinician and human being. I also think it has helped me have empathy and utmost respect for my therapist-clients.

If you’re feeling the call to do a deep dive on yourself and figure out some ways to reduce your struggle against pain, I hope you’ll take the plunge. Whether that looks like doing some work on your own, with your coworkers, in supervision, with a self-help book or with another professional,I hope you will take good care of yourself in the process.