APA’s Advisory Committee on Colleague Assistance (ACCA): Promoting Prevention, Wellness, and Coping with Challenges

Keeping Psychologists Healthy: Is Self-Care Important?

The need for self-care seems obvious yet is often ignored. Balance drives a healthy self-care regime. Balancing a healthy mind and body enhances our personal and professional lives. Psychologists are not immune to the effects of a busy career and life’s demands. If we follow our own advice, everyone benefits. Maintaining a sense of balance also assists in honoring our professional guild and Principle A of APA’s Code of Ethics*.

In the interest of self-care, it is important to remember that BALANCE:

• is especially important given our unique occupational vulnerabilities,
• promotes being more present and effective with our clients, and
• encourages more rewards in all aspects of our lives.

 
Listening to what we offer our clients:

• Maintain awareness of stressors.
• Use self-assessment and plan coping strategies.
• Maintain participation in consultation, therapy, or treatment when needed.
• Take care of yourself—get an adequate amount of sleep, exercise regularly, maintain a healthy diet, nurture meaningful relationships, and allow for leisure time.

Give priority to your own mental and physical needs by developing and working toward goals unique to you.

• One of the most important things we can do is maintain connections with our colleagues. Connecting with colleagues on a regular basis can lessen the isolation often experienced in independent practice. Peer mentoring provides reciprocal support and time to discuss and share vulnerabilities and successes. Many possibilities can be created to increase peer contact.
• Suggestions:
• Consider a formal consultation group to review ethical dilemmas, for collegial support and to explore current developments in the field.
• Attend workshops to stay current in professional knowledge and to increase competence in areas of interest.
• Strengthen relationships with colleagues. Appreciate that not unlike those we serve, we will experience professional and personal issues at all stages of our lives, from graduate school or early career through retirement. It is normal and understandable to have such challenges. We should not let stigma keep us from support. Our field is evolving and colleague support can keep us healthy and adaptive.

Tips for Balance in the Workplace:

• Assess and readjust your caseload.
• Set healthy boundaries for yourself and the clients you serve.
• Vary professional activities to prevent isolation and burnout.
• Consider occasional self-assessments.

Diane Bridgeman, Ph.D.

State and local colleague assistance programs (CAPs) can provide support. Visit their websites for valuable resources on self-assessments, self-care, and effective coping strategies. For further information and resources visit the APA website (www.apa.org).

* “Be aware of the possible affect of [our] physical and mental health on [our] ability to help those with whom [we] work.” APA 2002, page 3.

By the Advisory Committee on Colleague Assistance (ACCA), July 2010

Bibliography

Barnett, J.E., Baker, E.K., Elman, N.S., & Schoener, G.R. (2007). In pursuit of wellness: The self-care imperative. Professional Psychology: Research and practice, 38, 603-612.

Bridgeman, D.L. (2010) Colleague Assistance Toolkit: Tools of Engagement for Psychologists for APA’s Advisory Committee on Colleague Assistance (ACCA), a 21 page resource for developing a colleague assistance program and articles relevant to all psychologists personally & professional from graduate school phase through retirement. www.apa.org or www.cpaclasp.org

Bridgeman, D.L. (2009) Balance, Boundaries & Benevolence: The Complexities of Psychologists’ Self-Care, Coping & Wellness, an informal self-assessment. www.cpaclasp.org

Coster, J.S., & Schwebel, M. (1997). Well-functioning in professional psychologists. Professional Psychology: Research and practice, 28, 5-13.

Elman, N.S., Illfelder-Kaye, J., & Robiner, W.N. (2005). Professional development: Training for professionalism as a foundation for competent practice in psychology. Professional Psychology: Research and practice, 36, 367-375.

Kaslow, N.J., Rubin, N.J., Forrest, L., et al. (2007). Recognizing, assessing, and intervening with problems of professional competence. Professional Psychology: Research and practice, 38, 479-492.

Kramen-Kahn, B., & Hansen, N.D. (1998). Rafting the rapids: Occupational hazards, rewards, and coping strategies of psychotherapists. Professional Psychology: Research and practice, 29, 130-134.

Leigh, I.W., Smith, I.L., Bebeau, M.J., et al. (2007). Competence assessment models. Professional Psychology: Research and practice, 38, 463-473.

Skovholt, T. (2001) The Resilient Practitioner: Burnout prevention & self-care strategies for counselors, therapist, teachers, & health care professionals. Allyn & Bacon.

Smith, P. L., & Moss, S.B. (2009). Psychological Impairment: What is it, how can it be prevented, & what can be done to address it? Clinical Psychology: Science & Practice, 16 (1), 1-15.

Stvanovic, P., & Rupert, P.A. (2004). Career-sustaining behaviors: Satisfactions, and stresses of professional psychologists. Psychotherapy: Theory, Research, Practice, Training, 41, 301-309.

Stevanovic, P. & Ripert, P. (2009) Work-Family Spillover & Life Satisfaction Among Professional Psychologists. Professional Pspychology: Research and practice, 40, 1, 62-68.

by Diane Bridgeman, Ph.D.

Updated, 2008

There is wisdom in embracing a strength-based approach to mental health work in general, and in disaster mental health work specifically. Such a framework can offer a more positive, hopeful, thoughtful context in which to provide support and insight. One
such approach is to employ concepts such as those associated with variants of resilience. Typically resilience is defined as the ability to adapt to, and cope with, or in some cases, I propose, to lessen or even prevent the negative impact of challenging experiences.

Whether as a psychotherapist or disaster mental health professional, we can better hold, support and process our own feelings and those of our clients when acknowledgement of their challenge is coupled with exploration of relational connectedness, trust, empathy, and their areas of strength.

As is inherent in any paradigm, it is important to be mindful to not unwittingly minimize difficult experiences, or reinforce negative challenges when integrating a more optimistic approach. These tendencies can be avoided with thoughtfulness and the use of our clinical lens with respect to relevant factors such as:

• Awareness of the person’s prior difficult experiences and the similarities to this
  specific incident.
• Knowledge of their strengths, insights & abilities in coping with previousdifficulties.
• Length of time from your interaction with them and the incident.
• Strength & intactness of their current support system & resources.
• Their mental and physical health status prior to incident & currently.
• Their age and gender.
• Their closeness to the traumatic experience in actual time & space.

With the above variables in mind the mental health professional can then support the person to:

• Borrow from their previous experience when they were able to cope with challenging experiences and view those past accomplishments as evidence of their ability to deal with life’s serious confrontations.
• Maintain close relational connections, or re-connect with those who are supportive & trusting.
• Frame the challenge into a larger perspective of experiences.
• Value the lessons learned as part of personal development & growth.
• Practice healthy self-care now and on an ongoing basis.
• Set times for joyful & centering activities, help others, & give back.

These and other examples of positive strategies described below can be helpful when approached and tailored appropriately for each individual and not in a rote fashion. Most importantly, resilience is an asset not only for minimizing serious consequences but if embraced on a sustained basis it can be a preventive strategy to facilitate better coping when challenges arise, or perhaps in some cases, even mitigate negative impacts as a
result. Striving for wellness and employing preventive strategies are important for those we serve but also for us as mental health professionals, and especially if dealing with serious traumas on an ongoing basis.

To assist us in truly doing diligence please take the following “Professional Quality of Life Scale” to maintain your wellness so that you can better serve your clients and enhance your own quality of life.

ProQOL R-IV

PROFESSIONAL QUALITY OF LIFE SCALE

Compassion Satisfaction and Fatigue Subscales—Revision IV

[Helping] people puts you indirect contact with their lives. As you probably have
experienced, your compassion for those you [help]has both positive and negative aspects.
We would like to ask you questions about your experiences, both positive and negative,
as a [helper]. Consider each of the following questions about you and your current
situation. Select the number that honestly reflects how frequently you experienced these
characteristics in the last 30days.

0=Never 1=Rarely 2=A Few Times 3=Somewhat Often 4=Often 5=Very Often

____ 1. I am happy.
____ 2. I am preoccupied with more than one person I [help].
____ 3. I get satisfaction from being able to [help] people.
____ 4. I feel connected to others.
____ 5. I jump or am startled by unexpected sounds.
____ 6. I feel invigorated after working with those I [help].
____ 7. I find it difficult to separate my personal life from my life as a [helper].
____ 8. I am losing sleep over traumatic experiences of a person I [help].
____ 9. I think that I might have been “infected” by the traumatic stress of those I
[help].
____ 10. I feel trapped by my work as a [helper].
____ 11. Because of my [helping], I have felt “on edge” about various things.
____ 12. I like my work as a [helper].
____ 13. I feel depressed as a result of my work as a [helper].
____ 14. I feel as though I am experiencing the trauma of someone I have [helped].
____ 15. I have beliefs that sustain me.
____ 16. I am pleased with how I am able to keep up with [helping] techniques and
protocols.
____ 17. I am the person I always wanted to be.
____ 18. My work makes me feel satisfied.
____ 19. Because of my work as a [helper], I feel exhausted.
____ 20. I have happy thoughts and feelings about those I [help] and how I could
help them.
____ 21. I feel overwhelmed by the amount of work or the size of my case[work]load
I have to deal with.
____ 22. I believe I can make a difference through my work.
____ 23. I avoid certain activities or situations because they remind me of frightening
experiences of the people I [help].
____ 24. I am proud of what I can do to [help].
____ 25. As a result of my [helping], I have intrusive, frightening thoughts.
____ 26. I feel “bogged down” by the system.
____ 27. I have thoughts that I am a “success” as a [helper].
____ 28. I can’t recall important parts of my work with trauma victims.
____ 29. I am a very sensitive person.
____ 30. I am happy that I chose to do this work.

Copyright Information

© B. Hudnall Stamm, 1997-2005. Professional Quality of Life: Compassion Satisfaction
and Fatigue Subscales, R-IV (ProQOL). http://www.isu.edu/~bhstamm. This test may be
freely copied as long as (a) author is credited, (b) no changes are made other than those
authorized below, and (c) it is not sold. You may substitute the appropriate target group
for [helper] if that is not the best term. For example, if you are working with teachers,
replace [helper] with teacher. Word changes may be made to any word in italicized
square brackets to make the measure read more smoothly for a particular target group.

Disclaimer

This information is presented for educational purposes only. It is not a substitute for
informed medical advice or training. Do not use this information to diagnose or treat a
health problem without consulting a qualified health or mental health care provider. If
you have concerns, contact your health care provider, mental health professional, or your
community health center.

Self-scoring directions, if used as self-test

1. Be certain you respond to all items.
2. On some items the scores need to be reversed. Next to your response write the
reverse of that score (i.e. 0=0, 1=5, 2=4, 3=3). Reverse the scores on these 5
items: 1, 4, 15, 17 and 29. Please note that the value 0 is not reversed, as its value
is always null.
3. Mark the items for scoring:
a. Put an X by the 10 items that form the Compassion Satisfaction Scale: 3,
6, 12, 16, 18, 20,22, 24, 27, 30.
b. Put a check by the 10 items on the Burnout Scale: 1, 4, 8, 10, 15, 17, 19,
21, 26, 29.
c. Circle the 10 items on the Trauma/Compassion Fatigue Scale: 2, 5, 7, 9,
11, 13, 14, 23,25, 28.
4. Add the numbers you wrote next to the items for each set of items and compare
with the theoretical scores.

The following two sets of guidelines are also meant to embrace and sustain wellness and
resilience. From my perspective, the quality of ones relational connectedness with a few
trusted people in a mutually respected, reciprocal and empathic interaction is the heart of
what contributes to the effectiveness of resilience.

Appreciating the importance of this primary connectedness in your efforts with your
clients and in your own personal life will support the cultivation and sustainment of true
resilience.

Bridgeman’s Relational Concepts for Cultivating Resilience

R = RECIPROCITY – The importance of give & take, sharing, and the considering
of other perspectives.

E = EMPATHY – Identify with the feelings of others, which leads to tolerance &
compassion.

S = SELF-EFFICACY – The ability to work toward & appreciate a sense of
mastery & accomplishment.

I = INSIGHT – Explore patterns, meaningful connections, think critically, question,
be resourceful, & put matters into a larger perspective.

L = LETTING GO – Discard less healthy habits, such as staying stuck or
victimized, & develop realistic strategies. Set goals & incentives for staying
focused on a proactive approach.

I = IMAGINATION – Consider creative ways to move forward & put balance in
your life. Experiment with new hobbies, educational goals and novel interests
such as music, dance, meditation, volunteering, journaling, healthy diet and
regular exercise.

E = EXPECTATION – Expect that sadness & disappointment are part of
everyone’s life from time to time. Learning from challenges to cope better next
time is key.

N = NURTURANCE – Learn to accept, affirm, validate and nurture yourself. The
result is less need for external approval & more to share with others.

C = COMMUNICATION – Express feelings, ask for assistance, delegate, engage
in proactive problem solving, get out negative thoughts in constructive ways,
find confidantes to share experiences & learn to be a good listener. Such
factors contribute to taking responsibility for a healthy life & enhanced self worth.

E = EDUCATION – Academic, social, & civic education elicits more choices,
richness, & life satisfaction.

D. Bridgeman, Ph.D.

Resilience Approach to Self Care Guidelines for Health Care Professionals

• Accept support from others.
• Adjust work schedule for a healthy balance of challenging clients with less demanding ones.
• Develop creative outlets, activities unrelated to work, &/ or volunteer time.
• Take pride in your craft as a professional, as well as in your personal development.
• Acknowledge your limits & strive for flexibility.
• Put balance & nurturing into your ongoing schedule. Consider variants of mindfulness meditation, relaxation strategies, yoga, and healthy self-soothing methods to achieve harmony.
• Value the importance of empathy and going beyond yourself, and appreciate that these concepts can co-exist with good self-care.
• Accept appropriateness of boundary setting as none of us can, nor should, be present for others at all times.

* Review Bridgeman’s relational concepts for cultivating resilience..

Diane Bridgeman, Ph.D.,

For Volunteer Responders

1. The intensity of a critical incident (i.e. disaster volunteering), and the challenges faced by each person may vary with respect to prior experiences, degree of exposure to the incident or those impacted by it, preparedness, training, support, and physical and psychological levels of health.
2. Returning home and transitioning from the disaster experience can take a while.For example, loved ones and friends may not be able to fully relate to what you have experienced.
3. Most people will be very proud of you for your volunteer efforts – a few might be envious or even a little upset that you left and they didn’t get to share the experience with you.
4. You may find yourself ruminating about your experiences for quite some time after you return. One way to prevent thoughts and feelings from consuming your day is to set a specific time to reflect on the experience, and perhaps even write about it. It helps to include both rewards and challenges in your reflections, and to think about what you have learned during your most recent volunteer experience or critical incident.
5. Give yourself a few days before you have to resume your job and other everyday tasks if you can. Try using the first day or two after your return to nurture yourself and to re-connect with family and close friends. Meaningful personal connectedness to those close to you can provide a bridge for transitioning to your usual life patterns. Such closeness and trust can contribute to and sustain ones sense of self and level of resilience.
6. Attempting to put your recent, intense experience into a larger perspective (perhaps with support from a close friend or therapist, depending on issues), can help to make sense of, learn from, and accept the challenges you experienced.
7. Other than a brief call to check-in with your chapter or organization, allow yourself a few days (or more) before seeking further, even local, volunteer chapter/organization assignments.
8. Try to get regular exercise – it can help you cope with the mixture of feelings normally experienced by those working on an intense disaster.
9. Be proactive and try to follow good self-care guidelines: Get adequate sleep – when you first return you may need more sleep than usual, as your body may need to recuperate from the sleep deprivation common in volunteering; eat healthy foods; spend some time in nature and with close friends; check in with other volunteers to see how they are doing; spend time on a favorite hobby or activity that gives you satisfaction; and consider yoga, meditation, or some calming activity that helps you experience balance and harmony.
10. The ease of your return may be dependent on the level and quality of support during your volunteer work and upon your return; the presence of recent challenges or losses in your life (which ideally were taken into consideration during screening); and the level of hardship presented by your volunteer assignment.
11. Finally, it is helpful to recall when you have worked through other challenges and view your patterns of strength, some such skills that you may well take for granted, as a type of resilience that can move your forward while still learning from this experience.

Diane Bridgeman, Ph.D. (831) 420-1109, dianebridgeman@mac.com Also, see or give out a copy of ARC document # 4473, 12/91 “Returning Home From a National Disaster Assignment”

Diane Bridgeman, Ph.D. 4/17

• First, acknowledge the work you are doing in helping others
• Adjust your work schedule for a balance of problematic demands with those less challenging
• Acknowledge your limits and strive for flexibility
• Accept support from others
• Take pride in your professionalism, as well as in your personal development & put balance & nurturing into ongoing schedule
• Use self-care strategies such as; self-soothing methods for example; meditation, mindfulness, yoga, journal your thoughts, take time to reflect, be with liked minded friends/family, spend time in nature, etc.
• There is not one specific way for self-care, you need to tailor it for your needs/interests, and not add guilt for times you can’t fit in these nurturing strategies
• Value the importance of empathy & going beyond yourself, & appreciate that these concepts can co-exist with good self-care
• Accept appropriateness of boundary setting as none of us can, nor should, be “present” for others at all times

Even experts need support and reminders. As psychologists, and experts in the field of human behavior, we show wisdom not weakness by integrating healthy self-care strategies into our regular schedules by periodically assessing our level of wellness, and by accessing assistance when needed.

This brief, informal assessment will assist in assessing your needs throughout the various phases of your personal and professional development, so you can due diligence with respect to your self & family, your clients and the ethics of our profession.

Self-care is complex, and to be effective it needs to reflect your unique values, and be meaningful for you. By inquiring as to what contributes to your feelings of rewarding engagement with your career, and with your personal life you can better construct a path of balance, and connection so you can be vital and flourish. Experimentation may be needed.

Remember to date your responses so you can compare your replies over time.

1. Please list 3 of your professional strengths – (& do you tend to acknowledge your wisdom in having cultivated these strengths (yes or no)?
2. List 3 areas where you could improve professionally.
3. What seems to get in the way of making these improvements?
4. Outline how you can work toward these improvements (and suggest supportive ways to help you do so).
5. Give an example of a helpful nurturing experience you have had and what you can do to have more such experiences.
6. What are unique warning signs that you need to be mindful of, and to integrate into your schedule to achieve more balance for yourself personally?
7. What are unique warning signs that you need to be mindful of, and to integrate into your schedule to achieve more balance for yourself professionally?
8. Do you acknowledge yourself for being aware of early warning signs, and how can you   be mindful of other ways to prompt ongoing self-care?
9. What are a few of your personal concerns and what are a few ways to address these concerns and/or assistance you can get in working through such concerns?
10. What are a few of your professional concerns, and what are a few ways to address these concerns and/or assistance you can get in working through such concerns?

How well do you do the following (1= not at all, to 5 = very well, and give an example)?

1. Accept being good enough at your craft while still wanting to do your best?
2. Set healthy boundaries with clients in general and with respect to accessibility?
3. Accept support from peers/colleagues, &/or use consultation on an ongoing basis?
4. Say no to unreasonable requests, and in general develop healthy protective factors?
5. Allow yourself to experiment with various projects and varied ways to stay professionally  vital and engaged?
6. How easy is it to show the same tolerance you give to your clients and family, to yourself?
7. If you are a graduate student or early career psychologists do you allow for the fact that      you aren’t expected to have all the answers? What is a primary professional concern and what can best help you work though that concern? How can you share your expertise with more experienced psychologists?
8. As an experienced psychologist can you accept that you might still need support and can give yourself permission to get it? What is a primary professional concern you have and what will best help you work through that concern? Do you share your expertise (mentor/coach), and are you open to still learn from others?
9. As a seasoned psychologist do you add varied types of professional projects to your work for enriching purposes? Do similar professional concerns get repeated, and what novel ways now might help you better resolve or lessen these issues from reoccurring?  What are  ways you can share & learn from other psychologists?
10. As a retired psychologist do you still share & learn from and with others?  What types of new challenges have retirement prompted and how can you work through them? What can make your retirement years even more fulfilling and meaningful?
11. Do you genuinely get in time for yourself, on a regular basis, and how can you further develop this time into a more ongoing, rewarding manner?
12. How well do you regularly get; exercise, outdoor activity, healthy eating, sufficient sleep,  quality time with close friends & family, moments of joy and/ or spiritual peacefulness, time for community efforts,  time to nurture your primary relationship, to put matters into a larger perspective, to ask for assistance when needed, etc.? What can you practically do to enhance the time and quality of these strategies?
13. Have you considered a professional executor, developed a professional will, considered long term personal and professional planning with respect to finances, fulfillment and joy?
14. What are the most effective ways for you to cope with ongoing client demands, exposure to vicarious trauma, violence, loss and grief? What can you do to remind yourself to use these coping strategies?

Make a commitment to connect with a colleague where you can provide for each other a supportive mentoring, coaching type of interaction on an ongoing basis whether by telephone, walks, over tea, etc. You can periodically use this assessment to review where you are and want to be with respect to ongoing healthy self-care.

Congratulations on taking steps to due diligence with respect to your self, family, clients and profession, and in honoring the importance of wise self-care!

Please recall that most local Psychological Associations and State Psychological Associations have “Colleague Assistance Programs”, as does the American Psychological Association with its “Advisory Committee On Colleague Assistance” (ACCA). You can contact these programs for resources, materials, trainings, and in many cases for confidential assistance for maintaining wellness and for coping with challenges.