The Internalized Mentor Part ii

If an ounce of prevention is worth a pound of cure, then the best way to beat burnout is to keep it from happening in the first place. -Maslach, 2015, p. 216

Self-Care and Clinical Supervision Summary Points: 

  • Self-care acts as an antidote to burnout, compassion fatigue, professional impairment and malpractice.
  • The restorative function of clinical supervision provides an important means of addressing self-care needs of clinicians, while ensuring an ethical and safe practice.
Self-Care and Clinical Supervision 

Work as a mental health practitioner necessitates a deep psychological, emotional, and relational commitment to client care, all while maintaining appropriate therapeutic boundaries. This type of care is often unidirectional (Guy, 2000). It requires a sense of empathy, compassion, and unconditional positive regard from clinician to clients (Skovholt et al. 2001). It is also particularly challenging, leaving counsellors at a higher risk for burnout, professional impairment, and/or feelings of self-doubt (Wityk, 2003). In fact, in a recent study polling over 8,000 therapists, nearly 55% reported having above moderate risk of work related burnout (Simionato & Simpson, 2018). It is quite clear that professionals in this field care deeply for their clients and also feel deeply in return.

Supervision plays a critical role in supporting counsellor professional development and wellness maintenance. The restorative function of supervision is key to burnout prevention (Bernard & Goodyear, 2019). In this function, the supervisor acts as a safeguard to counsellor depletion by ensuring practitioners are working within manageable expectations and also following best practices of self-care. Most importantly, many strategies for wellness can be integrated into a supervision practice, thus supporting the integrity of the tool with which we work -- our being.

When we think of self-care, it is essential to recognize the intricacies of the concept. Much like a reflective practice, self-care is an active and ongoing assessment of your wholistic state and overall needs (see Figure 1). It is an activity that promotes wellness in it's entirety and is a mindset that encourages this care to also be directed inward to the self (Polsuns & Gall, 2020). In this sense, it is an ethical responsibility to maintain a self-care practice that ensures you are cared for, rested, and able to provide quality care to your clients (Norcross & Guy, 2007)

By engaging in a reflective self-care practice, it is anticipated that the clinician develops a greater sense of understanding of their self and their needs (Skovholt et al. 2001). This practice can improve clinical judgement, while reducing burnout and potential malpractice. As a result, clinicians who engage in adequate and consistent self-care practices reduce their risk of client complaints greatly (Polsuns & Gall, 2020).
So why is it so hard to make time for ourselves and our own care needs?

Working in a human services field, I have encountered incredibly selfless, compassionate, and committed clinicians. This is by far one of the most caring and dedicated groups of people to work with. However, I have also witnessed this level of care for others overshadow personal needs and deplete energy levels. I have witnessed therapists and supervisors skip lunch breaks, remain on-call, genuinely worry when going on holidays, and somehow always find space to fit just one more client in for the day. This level of care makes service so great ... but for only so long.  Engaging in clinical supervision and prioritizing time for self-care truly is an antidote to burnout and as such, is a necessary and ethical component of practice.

Clinical supervision with a focus on self-care strategies can support clinicians resulting in improved client care. Furthermore, integrating self-care into supervision allows for a well-rounded supervisory practice taking into account the person of the therapist.

As you continue on this journey of developing a self-care practice, it would be helpful to consider some questions: How do you monitor and assess your individual self-care needs and overall practice? How do you work with your supervisees to do the same?
Click here for a self-care inventory and check-in.
A Self-Care Strategy

The Self-Care Battery* is intended to be a gentle check-in with yourself. It asks you to truly reflect upon where your energy is being both depleted and rejuvenated. By the end of this reflective exercise, you should have a deeper understanding of where you stand overall with wellness, what activities are adding value in your life, what activities are depleting energy, and what you need to "recharge".

Imagine a battery.  Consider: 

  • When is the last time you have taken a moment to check-in with yourself?
  • Have you considered sleep quality? Are you eating meals and exercising?
  • Do you have time to "unplug" and be still?
  • If you had to fill in a battery percentage, what is your energy level at currently?
  • Think of the wellness diagram (Figure 1): Where are you spending your levels of energy? Is there an area that needs more focus/balance?
  • As you work through this exercise and reflect on your "battery", consider the different areas of life and where you may need to focus attention either physically, mentally, emotionally, or spiritually.
  • What are some activities you may engage in to charge your battery?

*activity adapted from: https://emduk.org/wp-content/uploads/2022/09/Self-care-battery.pdf
The role of the clinical supervisor is fundamental to this profession for so many reasons. In my experience, the restorative function of supervision has not been emphasized as much as its potential positive impact on counsellor development. The clinical supervisor provides a vital point of intervention to assure counsellor self-care, yet it begs the question: how might we appropriately integrate self-care discussions in our supervision sessions to promote wellness and growth?

References
Bernard J. M. & Goodyear R. K. (2019). Fundamentals of clinical supervision (Sixth). Pearson.
Guy JD. (2000). Self-care corner: Holding the holding environment together: Self-psychology and psychotherapist care. Professional Psychology: Research and Practice. 31(3):351–352.
Maslach, C. (2015). Burnout : the cost of caring. Malor Books. 
Neff, K. (2004). Self-compassion and psychological well-being. Constructivism in the human sciences, 9(2), 27-37.
Norcross, J. C., & Guy, J. D. J. (2007). Leaving it at the office: A guide to psychotherapist self-care [Adobe Digital Editions version]. 
Posluns, K., & Gall, T.L. (2019). Dear Mental Health Practitioners, Take Care of Yourselves: a Literature Review on Self-Care. International Journal for the Advancement of Counseling, 42, 1 - 20.
Simionato, G. K., & Simpson, S. (2018). Personal risk factors associated with burnout among psychotherapists: A systematic review of the literature. Journal of Clinical Psychology, 74, 1431–1456.
Skovholt TM, Grier TL, Hanson MR. (2001). Career counselling for longevity: Self-care and burnout prevention strategies for counsellor resilience. Journal of Career Development. 2001;27(3):167–176. 
Wityk TL. (2003). Burnout and the ethics of self-care for therapists. Alberta Counsellor. 28(1):4–11.