Does Self-Care Really Work?

Working with complex trauma clients for many years and being given a foundation when I was at University of the importance of self-care, I have always given self-care a priority in my work life. So how come I still burnt out? That’s the question that I often reflect upon. Did I miss something? Is burn out and vicarious trauma inevitable when you’re working in the trauma field? Was moving into private practice the answer? Did I burn out because I wasn’t doing enough self-care? I was called the ‘Self-Care Queen’ at work, so was I doing something wrong? The Self-Care Movement/Industry has made a fortune out of burnt out folks and the focus is on "SELF" and individual responsibility.

Firstly, it’s probably a good idea to define burnout, compassion fatigue, and vicarious trauma. If you do an internet search on burnout, vicarious trauma, or compassion fatigue, you’ll come up with thousands of articles and books on these subjects, but I’ll just give you a basic definition of each.

Burnout can be defined as emotional exhaustion often stemming from chronic job stress that hasn’t been managed well.

Compassion Fatigue is defined as an apathy or reduced capacity to be empathetic when trying to care for others’ emotional pain.

Vicarious Trauma (or secondary trauma) is a process and shift that occurs within the worker because of empathetic engagement with the client’s trauma experience, and often alters the world view of the worker.

As I reflect on all of those questions I kept asking myself, what I noticed is that I was putting the emphasis on myself as the individual, and blaming myself for burning out and experiencing symptoms of vicarious trauma. Basically, I could keep trying to sweep the flood water away from the driveway, but it wasn’t addressing the bigger picture of why it was flooding in the first place.

If you were to look at the many solutions to burnout and VT, you’d see that the work environment is a major factor, and how your place of employment supports the prevention of burnout. Some organisations do it well, and others still see prevention as an individual responsibility. If you work for an organisation, or are going to an interview, ask the interviewer what they do to prevent burnout. This will be telling.

Within the healthiest of work contexts, and supportive systems, I would say that burnout is preventable, but it needs to be at the core of working in the trauma field.

Whilst self-care is important, it has become a way of shifting the responsibility to an individualistic one and adding more responsibility to what are already overwhelmed helping professionals. If we were to look at the way self-care is pushed onto workers, and the history of the self-care movement, it becomes a form of gaslighting that as I have personally experienced, I thought I must be doing something wrong! Feelings of overwhelm, physical and emotional safety and lack of support become individual responsibilities. Lack of support shows up in many different forms. It can be limited program funds, lack of training opportunities, lack of variety in tasks, large caseloads, single worker programs, workplace supervision from managers who may not be trained in providing appropriate and trauma-informed supervision.

Questions to explore in a workplace might be:

· Is there flexibility in schedules?

· How big is my caseload?

· How often can I access internal supervision?

· Is my supervisor experienced in delivering trauma-informed supervision? If not, is there is

capacity to access an external supervisor?

· Am I able to access debriefing when needed?

· Are there opportunities to diversify in my work?

· Does my workplace support mental health days?

· Can I see positive outcomes within the field I work in?

· What is the teamwork like?

· What are the expectations from my workplace?

· Is there a sufficient training budget?

Dean Spade states, “Mutual aid is collective coordination to meet each other’s needs usually from an awareness that the systems we have in place are not going to meet them.” With systems in place to provide collective care within organisations, we are able to ensure that everyone is safe, protected, and has their needs met.

Is burnout preventable when working as a sole provider in private practice? Again, I believe it is preventable with the best possible systems set up before entering into private practice. My life circumstances and things going on for me personally meant that I definitely did not set up the best systems to start with and I had to learn ‘on-the-go’ due to a variety of factors. Because I have always held a strong reflective practice framework, I was able to look at situations, and say to myself, “Mmmmmmm, won’t be doing that again!” I could explore why and put changes into play. Strong boundaries need to be in place.

Ask yourself the questions:

· How big will my caseload be?

· What work will I bring home with me?

· Do I accept client or prospective client calls on my day off?

· Do I accept after hours clients, and if so, do I offer these at a higher fee?

· What kind of referrals will I accept – private or mental health care referrals, or both?

· Do I have the financial capacity to take mental health care days?

· Do I have space in my day for non-client related activities?

· Do I take a proper lunch break?

· Do I see back-to-back clients or have a break in between each client?

· Do I have the financial capacity to attend paid trainings?

· Will I accept bulk-bill clients, and if so, how many?

· Will I make the time to connect with other mental health professional networks?

· Have I arranged client appointments so that I don’t have all the complex clients on one

day?

· What happens when I am sick? Can I take the time off?

· Do I have the financial capacity to have regular professional supervision?

If you ask me whether vicarious trauma is preventable then I would say that if you hold a humanistic and empathetic view, you will be touched by the work that you do. “The expectation that we can be immersed in suffering and loss daily but not be touched by it is as unrealistic as expecting to walk through water without getting wet.” (Rachel Naomi Ramen)

Research conducted by Pearlman & Maclan (1995) suggests that if we have a personal history of trauma, then we are at greater risk of developing vicarious trauma than therapists without a trauma history. Other research suggests that if you work with complex trauma clients whereby you are hearing their stories on a regular basis, then you are more likely to experience vicarious trauma (Campbell, 2019).

If organisations have an obligation (and hopefully a framework) to provide an environment that supports safety and accountability (which they do under the Workplace Health and Safety Policy, Workplace Health and Safety Act), then if we work as sole providers, we need to have that framework for ourselves. Vicarious trauma is not inevitable however, because we can find ways to grow beyond the trauma stories. We can remind ourselves of the helpful and positive outcomes we have had with clients in the face of adversity. I often think of clients’ triumphs who to the outside world might seem very small, but I remember these moments and the strength and courage it took for those clients to make that move that supported them to overcome adversity, and I also remember the space that I held for them to be able to find that strength and courage.

If after reading this blog, you’d like to discuss your supervision needs around self-care and burnout prevention, please contact me via claremacleodconsultancy@gmail.com or via 0483 822 615.

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