I confess. The bag of Lindt peppermint chocolates I bought last night is nearly gone already (it's 3pm). I did take a walk at lunch – my first workday walk in nearly a month. I then ate my lunch while working, obviously a no-no in the self care world. And yet – it's been a stellar self-care day for me.
Why?
Because in-session self care is the most effective, important self care we can do as therapists.
It would, of course, be beautiful if I also fit in a trip to the gym, ate that box of greens slowly going bad in my fridge, and went to bed when I said I would. Sometimes I do. Mostly, though, my self care as a counselor follows this protocol:
- Have favorites
- Refuse to engage
- Nurse a drink
- Maximize the hall pass
This seems to work pretty well. I still feel slightly sick to my stomach every day before I start seeing clients (I'm not naturally a people person, which I assume is why I chose the socially unnatural position of "counselor"). But I get started anyway, and follow my in-session self care plan. By the end of the day, I'm usually walking on air and trying not to be such a dork as to ask for a fist bump from my partner cause I have such an AMAZING job and my clients are blowing me away with their progress ...
Would you like more details on this particular self care plan?
You got it.
1) Have Favorites
I assume I'm not the only one with favorite clients. Having a few favorite clients is a secret self care weapon.
I don't play favorites. Every client I see receives the same attentiveness and skill set, and I deeply care about every one of them.
Very often the clients I originally felt most worried about working with the first few weeks become my favorites!!
I don't stress about the differences in my feelings or wonder if it’s unethical.
Instead, I allow myself to feel that twinge of relief when those favorites come in. I allow myself to feel that little bit extra happy to see them. I allow myself to feel comfortable challenging them within the bounds of our therapeutic relationship, trusting in the goodwill we have got. That trust makes the whole process feel more natural and rewarding—for both of us It's ok to have favorites. You're a human therapist, not a machine therapist. You get to embrace that it's more exciting and interpersonal some times, less so other times. That's normal.
What stops me from crossing the line from "favorite" to "friend?"
That's number 2.
2) Refuse to engage.
This one may seem ironic after the above. It's one of my most important self care tools.
One day I was exploring sensation with a client (i.e. what their body was doing/feeling in response to a thought/external cue.*) I asked them if they could pop that sensation out of their body and drop it in my hands, what would I feel? They did a great job describing it. Me, being the empathetic counselor I truly wanted to be, allowed myself to sense exactly what they described, as though it really was in my hands.
It was dreadful.
I still get a shiver when I think about it, even though I can't remember the words they used.
And I realized--I've been doing that with my clients all the time. That's why I'm so exhausted after even just a few sessions.
It was a first with a client's sensations, but not with their thoughts, not with their descriptions of their external worlds. I would so very often think the thoughts they shared with me; in my mind see, hear, and feel the external realities they described.
I believed this was necessary. I'd assumed common therapeutic practices taught that you needed to accurately capture in detail what's going on with the client or you risk failing as a professional. This had inadvertently led to me receiving too intensely, and wearing myself out. I have enough thoughts, sensations, and external cues of my own! It's ok to operate with a strong insulatory boundary between me and their thoughts, sensations, and external world, and rely on other skills and theoretical constructs to support the therapeutic relationship. They don't need me to experience their thoughts, sensations, and external cues with them. Maintaining this boundary doesn’t diminish my empathy—it strengthens it by keeping me clear-headed and fully present for my clients
Which leads me to
3) Nurse a drink.
Ok, it's just water. Maybe peach tea or hot chocolate on cold days. And, I definitely nurse it. I pour myself water and sip it during the session rather than gulping it down in between, waiting till a longer break, or forgetting to drink water all together.
You can see Steven Hayes doing something similar in his Acceptance and Commitment Therapy training videos on Psychotherapy.net, with a cup of coffee.
I offer to you that this is strategic. It lets my base nervous system know "We're just here in this room. We're not out there, with the client, in their heartbreaking world. We have time to take a drink. There's no rush. There's no major agenda. I can relax. I can let the client know I'm relaxed."
On days I forget to fill my water pitcher before I launch into a pack of clients, I finish the day worn out.
On days I remind my nervous system all day that a drink right now is totally doable, I finish feeling fine. But, Emily, doesn't that mean you ... need to use the restroom a lot?
Yep. Which is why #4 is
4) Maximize the hall pass.
I have the pleasure of working part time for an agency that has an 80% direct hour policy. As an intern, not subject to said policy, I was soooooo stressed about this upcoming change. How on earth would I ever do all my notes and meetings and other things within that expectation?
Well, the clients are only promised 45-50 minutes. I get to bill the agency 60.
So that gives me 10-15 minutes. 10-15 minutes to do whatever I need to do. And I'll tell you, you can't hardly ever write a note and stretch your legs/use the bathroom in less than 15 minutes.
So what do my clients get? 45 minutes.
Not always. Maybe one or two clients a week I push it up to 60 minutes cause we're in the middle of something special, especially if I've been able to write the note up as we go along.
Most days though, those 15 minutes are mine.
Insurance demanding that you do 50 minutes or get paid peanuts? Guess what. None of my clients are bothered when I take a pause to write up their note as we go. I just tell them what I'm doing: "That seems important; I'm writing it down so we don't forget it." They understand. If you know/practice your theoretical approach well, you can throw in a few key phrases (preferably pre-templated) to de-cryptify your observations and, bam, you're done. I don't bring people in early if I finish my restroom break quickly. Sometimes I start wrapping up at 35 after, depending on the client's tendency to veer into a new topic. They do not notice as long as they know in advance and I'm consistent that the session is only 45 min. I promise you, it's fine. I'm a recovering push-it-to-the absolute-60-min-mark client, myself. I knew exactly what I was doing. You don't need to let them take advantage of you like that. Ha!
So there you have it. The four part in-session self care plan that gets me to feeling like I'm the luckiest therapist on the planet. Again, in-session self care is the key to more doable therapy – for you, and for your clients. I'd invite you to try it out, too, and let us know how it goes!
