Challenges to Therapist Self-Care with In-Home Work

Module Sections:

Continuum of Therapist Self-Care

To explore personal levels of stress we suggest using the framework from the Multidimensional Model of Cultural Competence (Sue & Sue, 2003). Developed to examine levels of counselor cultural competence, this model provides a useful framework involving the awareness, knowledge and skills that are necessary for continued improvement of clinical competence. The areas of this framework provide guidance for thinking about areas of our professional and personal lives that may be easily forgotten or ignored.

The following continuum illustrates the correlation between a therapist's level of stress and the types of efforts that are used to address that stress. Moving toward the right along the continuum reflects a therapist's experiences of stress as increasingly unmanageable. HBFT therapists face additional stressors related to safety concerns and feelings of isolation experienced with doing therapy in the home. Separation from the ongoing collegial and supervisory support, more readily available in an office-based setting, requires additional self-care efforts that address these deficits. Consequently, the efforts to relieve the stress increasingly reflects the use of reactive and, eventually, remedial strategies. Conversely, moving toward the left along the continuum suggests that a therapist is using a self-care program that incorporates more preventative measures for handling stress and more likely perceives the unique home-based stressors as manageable.

Figure 1. (Sue & Sue, 2003) Managed Stress - Unmanaged StressFigure 1. (Sue & Sue, 2003)

Unmanaged stress in the absence of a self-care plan or program, often leads to reactive efforts that may or may not moderate or resolve the stress. Increasing unmanaged stress eventually results in burnout. Somewhere between reactive and remedial efforts reflects a theoretical point where unethical behaviors compromise professional integrity and inhibit therapy progress. Increasing unmanaged stress reaches a point where the clinician's judgment and resulting actions are severely compromised. Approaching beyond this point there is an increasing impact on client safety and quality of care. Clinicians who have developed a dual relationship, engaged in sexual relationships, or neglected a client would be identified at this end of the continuum. If a clinician engages in unethical behaviors, remedial measures would be required to reestablish ethical practice.

Movement toward the left of the continuum requires an enhanced self-care program. Consider the following concepts as a guide to reviewing your level of stress and your attempts to address that stress:

Improving awareness

  • Examine your own level of stress and its possible impact on your ability to provide effective therapeutic care.

Building knowledge

  • Your involvement with this module, access to the available literature, and consultations with your supervisor and colleagues can help to build your knowledge of the factors that impact your levels of stress. Additional knowledge can also improve awareness of the available strategies for appropriately handling stress.

Developing skills

  • Establish specific ways to include self-care into your daily schedule. Use your collegial and supervisory supports to improve the accountability for making self-care a priority and determining its effectiveness.

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