Confidential Peer Support Committee Reports/Updates

July 2021

My Top Ten Take-Aways from The Trust’s "Turning Toward Ourselves and Each Other:
The Pivotal Nature of Clinician Self-Care" Presented by Leisl M. Bryant, PhD, ABPP

Submitted by: Maura D. Sullivan, PsyD on behalf of the OPA Confidential Peer Support Committee

One of the positive aspects of the pandemic has been the plethora of informative and often free continuing education produced by a number of sources, including this offering by The Trust. As we all scrambled to find resources to reassure ourselves that we were practicing safely and ethically during these challenging times, these educational webinars offered in palatable formats were a welcome gift. I was especially excited to see Dr. Leisl Bryant’s presentation on self-care. Dr. Bryant is a New Hampshire colleague and friend whom I know to be authentically striving to integrate self-care into her practice and to support others in doing the same. I am offering my top 10 take-aways from her presentation with some added thoughts and references. 

  1. Ask yourself, “What do I need right now?” Dr. Bryant started her presentation with a moment of mindful attention and check in prompting each of us in the audience to ask ourselves this question. This simple but powerful mindfulness practice can help us shift from our well-established neural pathway of turning toward others to take a moment to turn toward ourselves. Siegel (2010) identified time-in as one of the seven daily essential mental activities to optimize brain matter and create wellbeing. So take a moment at the start of your day, after a challenging session, or at any moment and ask “what do I need right now?” with attention to physical, emotional, mental, and social needs.
  2. You are not alone. Bryant referenced the American Psychological Association Stress in America survey that shows ever increasing levels of stress, including a January snapshot that indicated 84% of Americans endorsed experiencing at least one significant stress in the last 2 weeks (APA, 2021). As psychologists, we are not immune, contrary to some of the misconceptions and myths around psychologist invulnerability. Informal polling during the presentation confirmed that participants were all experiencing stress related to current events as well as to the tsunami of need generated by COVID-19 and the highlighting of racial injustice. Neff (2015) developed self-compassion psychology, which identifies common humanity as a key component of self-compassion alongside mindfulness and kindness. Knowing your experience is a human experience and a common experience among competent psychologists can help reduce negative cognitions about self that further burn-out and restrict self-care.
  3. Flourish. Don’t just avoid improper behavior arising out of distress and burn-out. Cultivate practices that will amplify the other end of the continuum (i.e., flourishing).  Bryant’s broader continuum concept (in process) identifies flourishing-surviving-stress-distress-impairment-improper behavior as an alternative to the classic stress-distress continuum that does not focus on the positive end. She emphasizes the importance of taking an active role in one’s wellbeing and happiness. Can you visualize what flourishing would look like?
  4. Embed yourself in a caring community. We are social beings and the burden of self-care can’t just fall on our shoulders. Bryant discussed the idea of a competence constellation, as identified by Johnson et al. (2013). The competence constellation is defined as “a psychologist’s network or consortium of individual colleagues, consultation groups, supervisors, and other relationships that, combined, help to ensure ongoing enhancement and assessment of competence from multiple sources”(Johnson et al., 2013, p. 344). This group can be an early warning detection that you are shifting away from flourishing and into stress, distress, or even burn-out. It may be a lunch date, a walk, a formal consultation group meeting, a curbside consult, or, even better, all of the above. If COVID has taught us anything, it is the risk of isolation, so reach out. One factor in my decision to relocate my practice during the pandemic was to join a group of other providers to have support embedded in my work day. It hasn’t worked out that way with most of us working from home but we connect by email, leave notes for each other when we are utilizing the offices for video sessions, and now with full vaccination we are meeting monthly again for a social hang-out. Who are your people?
  5. Assess your professional quality of life. As scientist-practitioners or practitioner-scholars, we should always be looking at some form of data. Bryant recommended assessing your level of burn-out or quality of professional life. A free resource she recommended is the Professional Quality of Life Measure (ProQOL; Stamm, 2009). The ProQOL website offers a number of great resources including a “Pocket Card for the COVID-19 Crisis,” a handy card you can print and carry with you full of great reminders for tending to self.
  6. Self-care needs change. Just as we develop as clinicians over the course of our careers, our self-care needs may shift and evolve as well. At times, we may really rely on a physical practice such as exercise in the morning, whereas at other times meditation or journaling practice may be more replenishing. COVID-19 restrictions challenged many of us to have to adjust our self-care routines, as we did not have access to the gym, the theater, social engagement, or a regularly scheduled massage or acupuncture session. Bryant discussed the need to check-in again around what the self-care need of the moment may be rather than just turning to the default. Getting creative can be a wonderful way to diversify your self-care and is recommended itself as a strategy for resetting the nervous system in the book Burnout: The Secret to Unlocking the Stress Cycle (Nagoski & Nagoski, 2019). So don’t be rigid. Allow yourself to change self-care depending on circumstance or need. Self-care isn’t a ‘to do;’ it is a ‘want to do.’
  7. Deep well. Related to shifting self-care needs is the importance of multiple broad strategies for self-care. We can’t just have one go-to strategy. You may love running but what if you twist your ankle? We need a deep and diverse reservoir of strategies for self-care. Think about strategies you can access quickly during your work day as well as those deeper dives that really allow you to restore. Think of solitary self-care and social self-care:  sometimes we need a walk in the woods alone, and sometimes we need to be amongst friends and in connection. Think of identifying strategies that tend to your physical body, your emotional self, your mind, and your connections. The more the merrier!
  8. Lived self-care. Bryant’s presentation did a wonderful job emphasizing that self-care can’t only be as needed but instead functions best when it is integrated into your way of living. It is a habit that needs to be actively practiced and developed and can be a daily moment-by-moment choice. Self-care can be your morning meditation, the realization that you need a check-in with a friend mid-day at lunch, and the recognition that you need to pick up dinner to keep things simple versus making one more decision. It is preventative in terms of physical activity, good nutrition, and enough sleep AND it is also checking in with yourself in the moment and making adjustments for what you need versus what you thought you might need.
  9. Joy. Focus on positive outcomes and special moments versus the difficult client or challenging parts of your day. Bryant’s presentation drew on the wonderful work of Norcross and VandenBos (2018).  In their book Leaving it at the office: A guide to psychotherapist self-care, they discussed the importance of revisiting the positive, joyful, and connected moments in the day rather than ruminating on a challenging interaction as a way of increasing work satisfaction and staving off burn-out. There can be so much joy in the therapy relationship, and video therapy has offered some new twists on the types of things that we laugh over with our clients. One of the other ways of completing the stress cycle discussed in the Nagoski and Nagoski’s book (2019) is laughter! When did you last laugh from the belly, either with a client or with a good colleague or friend? Revising those moments of joy can be a step toward flourishing and away from stress and distress.
  10. Ethical imperative. Tending to self is an ethical imperative. Bryant did a great job (not a surprise as one of the Trust Risk Management advisors) delineating the ethical codes (APA, 2017) relevant to self-care.  She indicated that we must understand that caring for self is imperative if we are to safely and ethically care for others. The relevant parts of the code include: Principle A (Beneficence and Nonmaleficence), Standard 2.01 (Boundaries of Competence), Standard 2.03 (Maintaining Competence), and Standard 2.06 (Personal Problems and Conflicts; APA, 2017). If self-care feels selfish to you, then maybe you can start to approach it from a place of caring for others. 

Self-care is a process; it evolves. It is not really self-care; it is collective care. We are going to be in demand to hold the needs of others in our professional and personal lives for some time to come, so finding ways to do so that are fulfilling and keep us in the equation is imperative. 

References 

American Psychological Association. (2021). January stress in America snapshot [press release]. https://www.apa.org/news/press/releases/stress 

American Psychological Association (2017). Ethical principles of psychologists and code of conduct.  https://www.apa.org/ethics/code/ 

Bryant, L. (2020). Turning toward ourselves and each other: The pivotal nature of clinician self-care [Webinar]. https://parma.trustinsurance.com/Workshops-Webinars/Virtual-Webinar-Series/clinician-self-care 

Johnson, W. B., Barnett, J. E., Elman, N. E., Forrest, L., & Kaslow, N. J. (2013). The competence constellation model: A communitarian approach to support professional competence. Professional Psychology: Research and Practice, 44 (5), 343-354. https://psycnet.apa.org/doi/10.1037/a0033131 

Nagoski, A., & Nagoski, E. (2019). Burnout: The secret to unlocking the stress cycle. Ballantine Books. 

Neff, K. (2015). Self-compassion: The proven power of being kind to yourself. William Morrow. 

Norcross, J., & VandenBos, G. (2018). Leaving it at the office: A guide to psychotherapist self-care (2nd ed.). The Guilford Press.

Siegel, D. J. (2010). Mindsight: The new science of personal transformation. Bantam Books. 

Stamm, B. H. (2009). Professional Quality of Life: Compassion Satisfaction and Fatigue (Version 5; ProQOL). https://proqol.org/


 

September 2020

Do you feel like you signed up for a 5K and you reached what you thought was the last leg only to learn that you actually signed up for a marathon, a marathon that could turn into an ironman? There is no doubt that we are in it for the long haul. We have shifted our practices to digital platforms. We are navigating the new challenges of a therapy frame without the traditional boundaries of our office walls, and, for many of us, the added difficulty of our personal and professional space overlapping. We are not getting the restorative time we need, as we are restricted by the constraints of a global pandemic. We are all aware that the mental health repercussions of this time will extend out into the future.

Many of us are working to support others, including front line workers, with processing the rapid changes we are confronted with on a daily basis. We are also processing grief, grief for the losses we have sustained and grief of our clients for the loss of activities, community, future planning, and a sense of ease and contentment.

The APA article titled “As COVID-19 cases increase, so does trauma among health providers” addresses strategies for assisting frontline workers with their own trauma. I wanted to highlight the importance of two parts of this article.

  1. Enhancing support: We are not in this situation alone. We need support to manage the work we are doing every day.
  2. Collective trauma: We need to consider what we are going through as a collective trauma and how trauma happening on a collective scale presents unique challenges and may require different strategies for coping and healing. As mentioned in the article, Nadine Kaslow’s work on making meaning of trauma offers some guidance for how we may proceed in our own personal work and the work we offer to others in regards to our collective trauma.

The Confidential Peer Support Committee is here for you. If you want to reach out to reduce isolation or feel supported, please contact us. If you are questioning how to navigate any of these challenges, we are here to offer confidential support and guidance. If you want to have a conversation about how to make meaning during this challenging time, don’t hesitate to call any of us.

We may be running a marathon but we don’t have to do it alone and we can find support along the route.

Confidential Peer Support Committee Members

Marcia Wood, PhD - Chair
503-248-4511

Jennifer Huwe, PsyD
503-538-6045

Rebecca Martin-Gerhards, EdD
503-243-2900

Colleen Parker, PhD
503-466-2846

Maura Sullivan, PsyD
503-616-8488