Leaving It at the Office: A Guide to Psychotherapist Self-Care

This small book (206 pages without references) is a gem, full of wisdom and depth but presented in a highly accessible and practical format. The concept of self-care is important and often neglected in training and practice. Both authors are experienced clinicians and teachers as well as accomplished researchers, who have studied over many years the personal development of psychotherapists. They have contributed dozens of papers and several books between them. They offer a broad perspective abstracted from the research literature, interviews with senior clinicians, and their own experience. Papers and books on self-care typically focus on the prevention of burnout or "compassion fatigue," and recommendations are often facile or obvious. As the authors note, "The failure to consider the individual motives, needs, and vulnerabilities of psychotherapists renders much of the well-intended practical advice on self-care hollow and general.… One-size-fits-all treatments never accommodate many people, be it our clients or ourselves."

The authors emphasize self-care as an "ethical imperative" for psychotherapists (and I would add for all caregivers). The authors specifically cite the ethical codes for psychologists and mental health counselors, both of which require the practitioner to be aware of any personal problems or restrictions that could impair his or her capacity to render care and to seek consultation or assistance if these exist. Similar ethical guidelines exist, of course, for psychiatrists and social workers. I was, however, struck by the additional ethical guideline for mental health counselors that explicitly enjoins counselors to "engage in self-care activities to maintain and promote their emotional, physical, mental, and spiritual well-being to best meet their professional responsibilities." Given the centrality of the therapist, one would wish that such an appreciation of self-care be codified in the ethical standards of all mental health fields.

This book sets out to consider a wide range of strategies that can be tailored to the individual clinician and integrated into his or her practice and personal life. Although the recommendations are appropriate for therapists of any theoretical stripe, the authors clearly have an appreciation for psychodynamic perspectives and they draw on these understandings to enrich their recommendations.

With candor, compassion, and humility, the authors consider the special predispositions and vulnerabilities of those of us who choose to become psychotherapists. In chapter 2 the authors identify the many considerable rewards of being a psychotherapist, such as the satisfaction of helping others, daily variety and challenge, and personal growth. More revealing, however, is their sophisticated discussion in chapter 3 of the potential hazards of being a psychotherapist, including the commonly acknowledged ones (emotional depletion; work isolation; working with difficult, unmotivated, or hostile patients; and managed care intrusions) and those less easily acknowledged (grandiosity, unrealistic self-imposed expectations for success, and exploitation of patients for vicarious gratification of the therapist needs). Throughout the book, the authors are sensitive to the importance of the human relationship between two unique individuals, therapist and patient, and the potentially dehumanizing impact of managed care intrusions.

Subsequent chapters then address various aspects of self-care—attention to physical health, building supportive relationships, defining boundaries, confronting cognitive distortions, developing nonprofessional interests, creating a sustaining work environment, using personal therapy for psychological growth, enhancing spiritual growth, and fostering creativity. Each chapter integrates research data with the authors' thoughts and experiences and ends with a summary and self-care checklist. Readers needn't be put off by the notion of a checklist; the items include subtle and imaginative ideas that stimulate one to consider ways to self-assess and creatively integrate strategies that will enhance personal well-being. Here are a few examples: "Beware of avarice. Are you working long hours out of financial necessity or because you are getting greedy?" "Compare your clinical and scholarly performance to same-aged peers in similar circumstances, not to authorities." "Conduct an environmental audit of your workplace for comfort and appeal." "Cultivate awe and wonder at the human spirit; it will enable you to pull hope from hell."

My single quibble is that the book's title, verging as it does on "Just say no," understates the complexity of the issues and solutions addressed by the authors. In summary, I highly recommend this book for all mental health trainees, practicing clinicians, and indeed all professionals who struggle to provide care to persons in need.