Challenges to Therapist Self-Care with In-Home Work

Module Sections:

Scope of the Issue

The multidisciplinary, behavioral sciences literature often suggests that psychotherapist self- care is an essential element for providing effective clinical services to those with mental health needs (Baker, 2003; Lonergan et al., 2004). If behavioral science practitioners want to continue providing effective clinical services, an emphasis on self-care is necessary for preventing or minimizing therapist burnout.

Depression is the most prevalent symptom of clinicians experiencing professional distress. Approximately two-thirds of therapists have experienced at least one episode of depression (Gilroy, Carroll, & Murra, 2002). A former study by the same authors (Gilroy, Carroll, & Murra, 2001) discovered that 76% of the female therapists in their sample were experiencing dysthymia. Gilroy, Carroll, and Murra (2002) note that previous studies have determined that depressive symptoms significantly impact a clinician's professional functioning. The "detrimental consequences include: inability to maintain a focus with clients, memory problems, fatigue, lack of energy and motivation for therapeutic work… and can potentially lead to more serious signs of impairment, including boundary and other ethical violations." (p.402) Furthermore, clients notice when a clinician experiences the progressive effects of burnout. McCarthy and Frieze (1999) studied clients who reported perceiving their therapist as experiencing "burnout". The clients generally report receiving sub-par services and may experience negative outcomes from therapy. They discovered that "participants' perceptions of their therapists' effectiveness, their satisfaction with the therapeutic relationship, and their overall impression of the successfulness (sic) of therapy were related in predicted ways to their reports of therapist… burnout." (pp. 46-47)

While a therapist's burnout impacts the therapy process, Bakker & Schaufeli (2001) noted that the therapist's burnout also has an impact on colleagues with whom he/she works. They discovered that burnout has a contagious effect on others in an organization. They describe the effect as a "staff infection" where "human service professionals may 'catch' the negative feelings, the cynical attitudes, or impaired job behaviors of their colleagues." (p. 92) Given this result, there are many ethical implications for a therapist's use of self-care for maintaining or improving personal as well as professional functioning and collegial relationships.

Ironically, many graduate programs tout the importance of preventative measures and exercises against therapist burnout (Lonergan et al., 2004). However, contrary to recommendations to prioritize therapist self-care, the literature states that there is a paucity of research and focus on self-care in the behavioral sciences across the many disciplines. This module addresses this important issue and will provide you with a framework for understanding the importance of developing and utilizing a self-care program. Specific suggestions will help you to develop a program that encompasses several activities that have been purposefully chosen, prioritized, and integrated in your daily schedule. Furthermore, suggestions will be offered for developing collegial relationships mutually supportive of therapist self-care.

Audio Companion: Challenges to Therapist Self-Care