6 March 2020
Being a hypnotherapist or talking therapist can be a highly rewarding and satisfying occupation. You are in a position to help clients make significant and positive changes, enhancing their quality of life. However, this work can also be highly challenging and emotionally demanding and can, without care, lead to feeling depleted, distressed or burned-out, and, as a result, a less-effective and less compassionate therapist. This may be experienced as a growing sense of emotional exhaustion, a lack of care or loss of ability to be empathetic, or even a reduction in any sense of achievement. Depending on client caseload, there may also be aspects of vicarious traumatisation, which is sometimes considered as secondary traumatic stress. This can result in compassion fatigue, intrusive thoughts and images relating to the client’s issues, even physical symptoms.
Common factors that can contribute to the above issues include; isolation (lack of peer contact or professional debriefing; lack of feedback (clients not giving positive feedback, so missing out on a sense of achievement or of feelings of being appreciated); narrow range of client issues (e.g. all depressed or all trauma clients); poor boundaries (putting others needs before your own); poor fee management (e.g. charging too little, late-paying clients); time pressures (too much work, too little time); weak administration systems (lack of skill in managing paperwork, records and running a business).
In addition, regardless of the best intentions of a therapist to keep personal issues away from their work life, in reality there is no real line drawn in the sand that keeps professional and personal lives completely separate. Each will have an influence and impact on the other. As a result, clinical effectiveness and therapist emotional well-being can be influenced by a pressured personal life, whether family, relationships, health, hobbies, even troublesome neighbours.
Whether professional or personal in origin, pressures can build and, for a while, you may not even notice them or might be subconsciously ignoring them. Being self-aware in a therapy session can enhance your therapeutic work in many ways and can help you notice early warning signs before they escalate into something potentially more damaging. Behaviours to notice in the therapy room can include; accepting high workloads to keep too busy to think on other issues; avoiding taking scheduled breaks; being bored, distracted, disinterested or irritated by clients; clock watching, waiting for the session to end; feeling emotionally drained or exhausted during or after certain client sessions; feelings of fatigue, even during the start of a work day; finding yourself staring into space and unable to focus on work; the inability to feel rewarded or gratified by work; isolating yourself from other professional colleagues; lack of enjoyment at the end of a session; low motivation to promote positive client changes; reduced feeling of enjoyment of life; seeking emotional support and nurturing from clients; violating or ignoring your own professional boundaries.
In addition, you may also have emotional or physical symptoms that indicate an issue, such as; disordered eating; disturbed sleep; general aches and pains; poor concentration; poor symptom management of chronic conditions; headaches; self-medicating (e.g. alcohol).
Engaging in self-care will help you develop your physical, mental and emotional well-being. This, in turn, enables you to fulfil your professional responsibilities more capably. When you consider your level of self-care at present, does it help you act in a confident and professional manner? Behave in a warm, caring manner with unconditional positive regard? Conduct yourself in accordance with your professional code, and legal and ethical standards? Engage in professional development? Have a range of leisure activities to engage with and relax away from work? Have a system of leaving client work at work? Keep your sense of humour? Maintain a strong support network of friends and family? Regard clients’ issues as interesting and enjoy working with them? Regularly feel energised and positive about your work with clients? Regularly notice new or varied interest in your professional work? Regularly undertake therapy supervision? Think objectively about your clients’ challenges and problems? Use your own therapy skills to benefit yourself?
Therapists will often have their own self-care strategies. Some helpful and resourceful, others less helpful. Building a range of supportive and positive self-care approaches can help a therapist develop a healthier sense of professional and personal balance. Some useful self-care strategies include:
Strategy #1 – Spend time checking in with yourself
Schedule a ‘professional review’ with yourself on a regular basis e.g. once a month or once a quarter. Become familiar with your own warning signs (e.g. self-medicating, fatigue or irritation). Notice how you ‘do’ distress, what your early burnout symptoms are, or what the first indicator is of a reduction in empathy or compassion. Ask yourself the questions you may have been ignoring, such as, “Am I working too much?”, “Do I feel I have enough personal time?”, “Am I been affected by my clients?”, even, “What do I need?”.
Strategy #2 – Get regular exercise and have a nutritious diet
You might wonder quite how fit you need to be to sit down all day and talk to clients. It might surprise you to know that physical fitness has a strong connection with mental health and resilience. A healthy diet will give you the nutrients to enable you to think and work effectively, whilst boosting your immune system and helping you work and sleep better! Food affects us not just on a physical level, but also on an emotional and psychological level. The more challenging or demanding your present schedule, the greater care your mind and body will require in order to maintain a strong level of performance. Consider yourself as a therapy athlete.
Strategy #3 – Work smarter not harder or longer to make time for yourself
What routine tasks do you do that you could automate, delegate or contract-out? For example, do you manually email a consultation form to new clients? Could you have a form on your website instead? Do you input your accounts manually onto a spreadsheet? Could you use an online accounting programme instead?
Strategy #4 – Allocate personal hours and put them in your calendar
Work can have an interesting way of expanding to fill available time, particularly if you are self-employed. It is natural to want to build and develop your business. Yet, if you spend all your energy on work, over time this can deplete your personal reserves and you will have less and less to give. It can be helpful to manage your own personal time and actually schedule your personal time. This helps you better balance your work and life obligations.
Strategy #5 – Make time for healthy relationships
As a therapist you are likely to be in contact with clients who have issues, challenges and problems. This can be draining over the course of a week. Make time to meet up with friends and loved ones and engage with people who are positive, supportive and encouraging. Consider people who you have relationships with. Are they mutual relationships? Are they reciprocal? Is there a healthy give and take? Or are you the friend or relative who is the fixer? That everyone goes to when they want something done or a problem solved, but never expect you to need or want support or help. Rather than taking whatever hours are left over from work commitments for personal time and relationship time, schedule time in for these things (and not just that final half-hour before falling into bed in exhaustion).
Strategy #6 – Create and maintain healthy boundaries
Do you find it difficult to say no? When a client asks for a last-minute session to be fitted in at the end of an already long day? When people ask you to work for less (or free)? Professional boundaries support a healthy and fulfilling work life. Furthermore, personal boundaries help you live a more balanced and stable life. However, setting and maintaining those boundaries can be a real skill and something that can be learned and developed. The first step in having healthy boundaries is to have an idea of what your limits are. Think about what you find acceptable or tolerable and also what you feel is not acceptable, uncomfortable, or unbearable. For example, think about a recent situation where you were ‘persuaded’ to do something you initially did not want to do. When you then did it, how did you feel afterwards? Glad you had gone beyond your comfort zone? Or uncomfortable that you did it? Even resentful for being ‘persuaded’? Did you feel taken advantage of?
The next time someone is pushing you to, or beyond your initial limit and you notice feeling uncomfortable, that can be a sign your boundary may benefit from strengthening. Working on your assertiveness can help you to respect your own boundaries and convey them to others. This can start with simply giving yourself permission to say ‘no’. To put your needs first. To even think about what is making you feel uncomfortable and address it, perhaps by negotiating an outcome that works well for both parties.
Effective therapist self-care helps you live a healthy and rewarding life which will benefit your clients and enhance your work with them, as they will receive care from a healthy and resilient therapist. We hope that this blog about self-care for therapists has been helpful. If you have any questions about this topic or anything else for that matter, do please get in touch, because we’re always happy to help!
– written by Dr Kate Beaven-Marks