When I first heard the phrase "self-care," it was during my MFT graduate program. Hearing this phrase, I remember wanting to roll my eyes because it just sounded so indulgent to me. I grew up in a family that strongly values being productive. My mom and dad were always buzzing around doing things-- working, cleaning, fixing, running errands, etc.-- and I rarely saw them sitting and relaxing or wanting to take walks outside. Don't get me wrong-- I'm thankful to have parents who have done so much for me. But the whole concept of tuning in to your body, being mindful, taking time for yourself to relax-- these things just weren't practiced in my home growing up. Wondering if it was just my family or if it was a generational trend, I looked into the history of "self-care," and I learned this is fairly new as a mainstream concept. In fact, it didn't really have a name until the 1970s, and that was limited to the nursing community.
As I went through graduate school and my MFT traineeship (3.5 years), and subsequent internship (3 more years), I hate to say that I made very little time for self-care. The sad thing is, that's probably when I needed it the most! Not practicing self-care made everything so much harder on my mood, my high stress level, my relationships, and my health in general while trying to develop the skills to be a therapist. I didn't really start to take self-care seriously until I started the exam process last year because I heard so many people say they owed passing their exams mostly to practicing self-care.
Here is what I've learned about self-care over the past several months, so hopefully you can start earlier than I did!
1. It's important to see your own therapist
This is the one thing I did soon after I became an intern. I've talked about this in a previous entry, but I can't emphasize enough how important this is when you're starting out as a therapist. Supervision was not enough, I needed support to process my feelings of anxiety, fear of failure, and develop my own coping skills for when I felt overwhelmed, triggered by clients, or frustrated with supervisors. The great thing is, many therapists do take health insurance (if you have it), and you can count your therapy hours toward your MFT hours (not sure about SW hours).
2. You have to listen to your body
This one has been extremely difficult for me to do, and I still struggle with it, I have learned that when I'm feeling anxious and overwhelmed, my shoulders and neck get very tense and sore, and because I have Crohn's Disease (an autoimmune digestive chronic illness), stress increases inflammation for me. There were times I saw clients and tried to ignore or suffer through my symptoms during a flare-up, and this was not beneficial to them because I was taking all of my energy and resources to pretend I was okay and was just not fully present with them. Clients can tell when something is up, and I'm sure some of them did not return because they could sense I couldn't be fully there for them. I've gotten a lot better at staying on top of my healthcare (whereas I used to move my appointments around to accommodate clients sometimes), and I will reschedule sessions when I know I'm too sick to be present for clients. Turns out they are usually very understanding if I'm just honest with them about it.
3. It's important to get exercise or at least move around
Depending on what kind of therapist you are, you may be spending a lot of time sitting. There are many studies that say how too much sitting can be detrimental to your health. It's important to balance all the sitting with some movement. Many therapists have told me that yoga really helps them, as well as hiking, running, swimming, biking, etc. In the very least, I try to get outside for a walk in the evening or take my dog to the dog park and run around with him. Just being out in nature can be very healing and grounding.
4. As hard as it may be, you have to learn to leave work at work
I can't even tell you how many times I've laid awake at night worrying about clients. These are people struggling and in pain, and it can lead to feeling helpless and anxious for them. Over the years, I have had to remind myself that these clients do not depend on me solely for their survival,* and they will continue to survive (but hopefully thrive) when they're done seeing me. (*if they are currently in an unsafe situation, that's a different matter and there are obviously safety measures we have to take, I'm referring to my outpatient clients who are not in crisis). One specific thing that has helped me is I drive home from work in complete silence and let my brain process everything that happened during my sessions. My brain needs to do this every day, and I'd rather it happen when I'm wide awake than when I'm laying in bed at night trying to sleep. Once I feel like my brain has had enough time to process, I get home and then I allow myself to use distractions to relax-- playing or reading on my phone, watching a show I like, playing with my dog, talking to my husband or calling a friend or family member.
5. Learn to treat yourself and not feel guilty about it
My favorite way to relax is getting a massage, but I never used to get them because they can be expensive and it was hard for me to justify making time for it and spending the money on myself. Since I've been making a more conscious effort to notice the tension in my body and address it now, I found a way to reconcile my guilt: There are many massage schools where you can get massaged at a very low rate by a student/intern. If there's anyone who can empathize with being student or intern, it's me! I'm not very particular about massages, I'm just happy to have somebody working through the big knots on my shoulders, neck, and back every couple weeks so I can function better in the long-term.
6. It's important to be able to set boundaries, personally and professionally
Oh, man-- this is still another very difficult one for me. After practicing for about 5 years so far, I still have trouble ending sessions on time. Even though I know it's important because it provides containment for the client, if I'm having a connecting moment where they're being very vulnerable, I have such a hard time interrupting them! I used to have a lot of trouble saying no and agreeing to take on responsibilities for which I didn't have time or energy. My need to be liked and to be seen as reliable overshadowed my need to honor my own time and personal needs. I also used to struggle with setting my fee at the rate I felt I was worth. Or I would agree to come in on a Saturday to see a client, and if they didn't show up, I'd be very upset. I have not mastered this skill, but I have learned to pause before agreeing to things and consider whether I'd end up resentful about it later. After trying this out a few times and it going well, I've gotten more comfortable doing it.
7. Don't underestimate the importance of SLEEP!
This one is a no-brainer for most people, but I have always had difficulty sleeping. I like to stay up late and used to have little regard for how tired I'd feel the next day. It's funny to remember how in college, I'd brag about pulling an all-nighter studying for an exam, like it was some kind of brave accomplishment rather than a terrible consequence of procrastinating! As I get older, my body lets me know when I'm not getting enough sleep and it's not pretty! Thankfully, my husband and I have finally been able to invest in a really good, quality mattress, and it makes a huge difference for my quality of sleep. A good pillow is important too, as well as reducing light in the room as much as possible, maintaining a comfortable temperature, and for some of us light sleeers, white noise or earplugs. To help me fall asleep, I found a couple of hypnosis podcasts I like that help me relax and fall asleep. Listening to someone's soothing voice telling me to let things go and relax and picture a beautiful lake or whatever helps keep me out of brain-processing mode, which I talked about earlier. I'm not going to lie, sometimes I still lay in bed reading things on my phone, but this is a habit I'm trying to break because the light stimulates your brain and keeps you awake.
8. Lastly, get support from your peers and colleagues!
Being a therapist is very difficult sometimes, but especially if you're a trainee or intern. It can feel overwhelming, and I know there were many times I felt disappointed in myself for not knowing what to do with a client until after the fact and a supervisor (or the client themselves) pointed out my mistakes or what I could have done better. What helped me probably the most was getting to know other trainees or interns who felt the same way. We would vent to each other, cry to each other, and build each other back up. If you're looking for peer support, there are groups online on Facebook, MeetUp.com, etc. If you're in Ventura County, California, check out our Thriving Therapist group at The New Beginnings Center in Camarillo! We meet on Mondays from 1-2pm. Email me at britt.fishman@gmail.com for more information or if you want to join!
