The subject of self-care for counselors is one that receives plenty of attention in the literature, as well as during conversations in the classroom, staff rooms, supervision, and the dialogues inside our heads. It has been evident since the earliest days of our profession that counselors and therapists must be clear-headed, as well as relatively free of distractions and pressing personal issues, in order to do our best work. And yet, in spite of all the attention on this subject, self-care remains one of the most critical and pressing issues. Even among so-called experts on the subject, there is a certain amount of hypocrisy and failure to practice what is preached.
Self-Care, Self-Neglect, and Hypocrisy
Let’s begin by talking about illusional (or delusional) self-care. I’m (Jeffrey) someone who has made a living these many decades by talking, writing, and preaching about the importance of counselors taking care of themselves. I’ve written several books on the subject (Kottler, 2001, 2010, 2011, 2015). I’ve delivered innumerable keynote speeches on the topic of counselor self-efficacy. One of my strongest beliefs is that who we are is just as important as what we do. And the more strongly and passionately we fortify ourselves, the more effectively we can help and heal others. This is not only because such clarity and personal mastery leads to more accurate diagnostic impressions and less likelihood of mistakes, biases, and miscues in sessions, but also because we become models for our clients to emulate. We demonstrate in all kinds of ways the importance of practicing what we preach, employing self-talk during times of crisis or stress, following healthy lifestyle regimens, and treating others with compassion, respect, and caring—even when we aren’t on duty. Furthermore, I’ve always considered those among us who don’t do so to be hypocrites.
So it is with a certain amount of shame and reluctance that I confess that during the months that we have been working on this article I have clearly failed to live up to my most cherished ideals and expectations. I am an expert on depression and yet for quite some time I have been helplessly depressed; even worse, I failed to recognize what was going on. My despair, and its corresponding neglect, began with a series of disappointments that occurred at work and in other areas of my life. I began to feel sorry for myself. I became lethargic and listless. I saw little hope for my future, feeling that my age and stage in my career now rendered me obsolete. I felt invisible and confirmed this belief in a multitude of ways. I was even bored with myself. And then, all of a sudden, I found myself “retired” from a job and a charity that defined my very identity. My closest friend was dying of cancer and I began to notice symptoms that I must be dying as well. I lost my appetite and my weight plummeted. I was sleeping twelve to fourteen hours each night. I consulted physicians and they could find nothing wrong in blood tests. Yet I was certain I had some lingering infection from my trauma work in Nepal during and after the earthquakes, or perhaps malaria from my work in remote jungle areas.
And then the election hit. It wasn’t only the outcome that I found disconcerting, but also the discourse and disrespect that had now become normative and viral. Many of my students and clients who are Latino/Latina, some undocumented, as well as my Muslim students, were despairing and feeling hopeless about the future. These feelings became contagious and I felt even more “sick.” Self-care was out of the question during a time when I found it difficult just to crawl out of bed.
On Thanksgiving evening I hit bottom. After cooking a feast for my family and guests, we sat down at the table to celebrate and eat when I started to feel nauseous and dizzy. I announced to those in attendance that I didn’t feel well and went to bed, sleeping for fourteen hours. I was now despondent and convinced I was dying.
The next morning I made myself get dressed because I had long ago committed to do a workshop with refugee case workers. These are the individuals—most of whom were refugees from Africa, the Middle East, Eastern Europe, and Asia—who had been hired to greet new refugees and help them get settled in their new country. They were the ones who retrieve new immigrants at the airport, find jobs and homes for them, and situate their children in school. I found them to be among the most courageous, important people in our country, especially during these turbulent times of the “new world order.” And that’s exactly what I told them—how much I appreciated their challenging work, how much I wanted to honor their contributions, how much I wanted them to know they were appreciated even if they often felt so marginalized themselves.
I felt tears running down my cheeks as I spoke to them. I told them that they were my teachers and I wanted to learn from them; I wanted to join them in their efforts. All of a sudden, I realized that in caring for them, I was caring for myself. My work felt meaningful again. I felt like I was once again making a difference. I could feel energy return to my body. I could hear passion in my voice. I started to feel more like myself again.
After the workshop was over, the participants invited me out for a meal to an Afghani restaurant run by refugees. As we entered the place, I realized that “authentic” didn’t quite capture the mood. I was the only Caucasian present and everyone was eating with their hands. Goat meat, and other things that I didn’t wish to inquire about, were put in front of me—and for the first time in months I was starving! I ate three helpings of everything. And ever since then I was cured. My appetite returned. My sleep cycle normalized. I gained some weight back and the cloud hovering over me slowly dissipated. I was left to reflect on the reality that although I very likely did suffer from some lingering health issues, it was depression that had inhabited me. I didn’t recognize it because I’d never been depressed before—at least since adolescence. And then I remembered that I had this article to write with Ryan and wondered whether I still felt qualified to contribute to it given my own self-neglect.
It was that feeling of hypocrisy that partially motivated me to get back into my rigorous athletic pursuits and exercise regimen. I changed my diet. Rather than complaining about how my clothes no longer fit now that my body was permanently smaller, I gave away most of my old clothes and began again. It felt like, at my advanced age, I was starting over. I would relocate to be closer to my granddaughters. I would find ways to continue my work with refugees. I would reinvent myself and launch a whole new chapter of my life. After all, isn’t that what we try to do with our own clients?
Living with Uncertainty, Self-Doubt, and Imperfection
Jeffrey’s story is important at the outset, if for no other reason than he is hardly alone in his experience—not by a large margin (Skovholt, 2000; Skovholt, Grier, & Hanson, 2001). Indeed, Sapienza and Bugental (2000) remark that most counselors have never been prepared for the critical life mission of taking care of themselves since our jobs are so focused on caring for others. And even when clinicians are encouraged to practice self-compassion, Norcross and Barnett (2008) point out that most of us are so busy hustling and multitasking, trying to help clients, keep practices afloat, and take care of families that there is precious little time left over to focus on ourselves. During those rare instances when we might take opportunities to nourish ourselves, this behavior may be viewed as self-indulgent. It is clear that self-care is just not considered much of a priority; even so, many among us feel disillusioned and hypocritical for their inability (or unwillingness) to live up to even minimal standards of self-care (Penzer, 1984). Several decades ago Pope, Tabachnick, and Keith-Spiegel (1987) reported that 60 percent of counselors surveyed admitted that they continue to see clients even when they believe themselves to be too distressed to be effective. This is consistent with a more recent study conducted by the American Counseling Association (2010) that revealed that a similar number of counselors continued practicing during times when they felt impaired.
Such data is even more disturbing when we consider what it is that we actually do with clients, how we primarily use ourselves as an instrument of diagnosis and treatment. It is through the clarity and stability of our own personal functioning that we work to establish and maintain meaningful connections with our clients, free of biases, distortions, and self-indulgence. Yet, no matter how fully functioning we might feel during the best of times, there are still instances when we are triggered, grieving some loss, lapsing into personal issues or even responding impulsively or inappropriately. Consider the much greater effects when we walk into a session depressed, highly anxious, disappointed or otherwise preoccupied.
It is often assumed that counselors are drawn to the profession because we are incredibly adept at relating to others while at the same time experts who have something significant to contribute to deep, vexing, and hitherto unresolvable practical, mental, emotional, existential, and even spiritual questions. In other words, we are expected to have a certain degree of finesse, and to have it all together, sometimes even close to perfection in personal functioning. We reinforce this image with the presentation of ourselves as almost always calm, unflappable, and in control; we seem to have an answer for everything—and even when we don’t, we act like this is completely acceptable and appropriate. Clients have no idea that inside our hearts and minds, we are sometimes churning with self-doubt, confusion, disorientation, and a sense of helplessness. Disturbing questions are constantly popping up:
“What does this client really mean by that?”
“How come I can’t yet figure out what’s going on?”
“Did I just miss something important?”
“Why did I just say that? Now what should I do?”
“Is it noticeable that I have no clue what’s going on right now?”
Of course we can’t exactly admit that we are distracted or confused some of the time, so we must live with a certain degree of deception in which we are used to pretending to know and understand more than we really do. Of course that eventually takes a toll on our psyche given how infrequently we are permitted the option of taking a “sick day” (or month).
Sometimes our personal motives for becoming a counselor in the first place may also get in the way, tending to organize around common themes that are often unconscious and unaddressed within clinical supervision (Adams, 2013; Sussman, 2007). The themes often involve lingering struggles from childhood loss and ongoing needs for recognition and approval (Barnett, 2007; Kuchuck, 2013), as well as trying to clarify and bring resolution to our own problems (Orlinsky & Ronnestad, 2004). There is also a recurrent theme related to learning greater authenticity, as well as feeling a greater sense of power and control over both others and ourselves (Hamman, 2001).
Although there are certain advantages to presenting ourselves as models of personal effectiveness in order to intensify our power and influence in sessions, there are also certain side effects that get in our way, especially when we start to believe in our own omnipotence. As it turns out, being honest and clear about our failures, mistakes, and imperfections is one of the most important attributes to improve our personal and professional functioning in a multitude of areas. Likewise, it is just as important that we have a clear sense of how our appearance, comportment, and behavior conveys to others the image of the consummate professional.
The other day I (Ryan) was making a house-call for a client who had recently been in a car accident and was unable to walk. At one point in the session, I was delighted when his wife stuck her head in the door and said hello. During this brief interaction with her, she mentioned that her own counseling was going well. Since I’m always looking for good referral sources, I asked who she was seeing. In telling me the counselor’s name, she also mentioned that this professional was always dressed meticulously and really seemed to have her stuff together. Not missing a beat, my own client chimed in and said, “I know—this guy is the same way,” referring to me and my own style of dress and approach. I explained that the way I carried myself was an effort to help them “buy me” and believe that I could help.
That was true to some degree, but the deeper truth is that while the veneer of mystique may be enough to get clients in the door and through the first few sessions, it isn’t nearly enough to go the distance with them, especially if it is in fact just spit-and-polish. After all, something like half of all clients terminate counseling before they achieve any real or tangible benefits (Teyber & Teyber, 2010).
Ultimately, clients need and deserve counselors who are people of depth, capable of seeing beyond the superficial insights and advice-giving that have already been offered to them by their family members, coaches, pastors, bosses, and others before they ended up on our doorsteps. They need counselors who are self-possessed enough to have the capacity to sit with them through difficult and sometimes painful work (Ghent, 1990). There are often times when we are indeed confused and overwhelmed, when we don’t know what to say or do or how to circumvent or remove the obstacles obstructing their desired path. We may try to pretend that we are all-knowing and all-powerful, but at our core we must also live with ourselves as flawed, imperfect beings who are struggling just like everyone else.
In his quintessential essay, “The Necessary and Sufficient Conditions of Therapeutic Personality Change,” Rogers (1957) introduced the concept of “congruence,” which he defined mostly negatively, talking far more about what congruence wasn’t rather than what it was. For Rogers, incongruence initially referred “to a discrepancy between the actual experience of the organism and the self-picture of the individual insofar as it represents that experience” (1957, p. 96). Therefore, individuals were considered congruent when their actual experiences were in line with their self-image.
But this definition is insufficient in many ways, and as he honed his conceptual framework, Rogers (1961) broadened congruence into a deeper, richer experience, and one that was not so locked-in to one conceptual perspective. Throughout most of his life, Rogers sought to research and describe ideas and practices that might be useful to practitioners regardless of their particular approach and orientation. Gendlin (1967) furthered explored the concept of “realness” as a central fixture of congruence, extending it beyond a subjective inner experience on the part of the counselor and outward toward the client. Being real and congruent in this sense naturally means beginning to remove the cloaks of power and authority which are implicit to our vocation as aforementioned. Gendlin believed that counselors need not necessarily present themselves as figures of perfection, as always wise and strong, since it is precisely our own vulnerabilities and limitations that make us more accessible and relatable. “I find that, on occasion,” Gendlin admits, “I can be quite visibly stupid, have done the wrong thing, made a fool of myself. I can let these sides of me be visible when they have occurred in the interaction” (1967, p. 121).
Even half a century after these contributions, many of us still tend to present ourselves as models of perfection even if this means we live with incongruence, inauthenticity, and to some extent, a degree of hypocrisy when we can’t practice in our lives what we advocate for others. This moves counselors in the opposite direction from what Rogers and Gendlin first proposed, setting us up as experts who always know what’s best and are usually infallible (Gendlin, 1967). Bohart (2015) believes that this causes us to “dice” our clients into pieces that we can manage or control, rather than experiencing the whole of them and our work together, which is much more overwhelming and difficult to wrap our arms around. In so doing, we naturally limit our ability to see clearly the rest of the pieces that compose our clients’ lives and experiences. When we hold such a fragmented view of others, this can lead to a similarly fragmented view of ourselves. Limiting what we’re willing look at in our clients and pretending that we have counseling all figured out is precisely the same kind of philosophy at work when we limit what we’re willing to look at in ourselves and pretending that we have our lives all figured out.
This kind of indictment of modern-day counseling resonates deeply with many of us on some level, but we just can’t help but hide all of our own struggles—we find ourselves loathe to admit struggle or to challenge the dominant narratives which seem to present counseling as an exact science, each intervention empirically supported and every approach evidence-based. At conferences and workshops, not to mention in our professional training, we are often led to believe that even though it is certainly desirable and commendable to select and employ scientifically validated strategies and interventions, most of the time we are operating based on what feels right in the moment. Given that at times counselors’ “feelings” may very well be distorted, exaggerated, and polluted by their own unresolved issues, this can indeed place clients at risk.
Bearse, McMinn, Seegobin, and Free (2013) found that social stigma, anticipated risks, and fear of self-disclosure all contribute to our tendencies to minimize our personal issues, ignore our own needs, and pretend we are invincible. Even our colloquialisms betray the climb back into the power seat. Counselors often say things like, “We can’t transmit what we don’t have” (actually a paraphrase from the Big Book of Alcoholics Anonymous, 1939) to indicate their awareness of the need for self-care and growth, but this kind of sentiment actually returns us to the place of presumption, of Bohart’s (2015) interventionist philosophy, where counseling is a process by which those who have much (presumed to be counselors) give to those who have little or nothing (presumed to be clients).
What is more accurate and consistent with reality is to say that we cannot help people when we are not operating genuinely from the core of who we are. This does not mean, as Gendlin (1967) and others have pointed out, that we must have it all together, but that we humbly acknowledge to ourselves, and sometimes, cautiously and appropriately for their benefit, to our clients, that we are struggling. This means we must come to terms with the struggle itself. Working our struggles through to resolution is even better, but it isn’t really the resolution that counts—we know that life is full of core issues which refuse to allow us to tie a neat ribbon of finality around them.
In short, for our purposes, congruence is simply being ourselves—all of ourselves—well-timed and with clients’ best interests at heart, because we can’t be anything other than who we are anyhow. And research seems to indicate that who we are is ultimately if not immediately vitally important to the process side of counseling. Our willingness to be who we really are, and to operate from that core without shame or hiding, is the clarion call to counselors everywhere. Even as clients ask, “Will you see me? Will you accept me for all my struggles and all my successes alike?” we must ask the same of ourselves about ourselves. Congruence, meaning being and acting as ourselves in counseling, is the ultimate form of self-care.
There’s No Shortage of Advice
Considering all the research, articles, and books reporting that counselors don’t adequately take care of themselves, there is certainly no shortage of literature telling us how to do it best. Perhaps unsurprisingly, the suggestions range somewhat broadly in terms of approach, technique, theory, duration, frequency, and concreteness. For example, Bradley, Whisenhunt, Adamson, and Kress (2013) suggest that creativity is paramount to effective counselor self-care, envisioning each of us as a plant, observing the color of its leaves, access to sunlight, fed with nourishment. Another conceptualization of counselor self-care literature in recent years is based on mindfulness. Shapiro, Brown, and Biegel (2007) found that a cohort-design, mindfulness-based, stress-reduction program reduced counselor stress, negative affect, rumination, and both state and trait anxiety. Christopher, Christopher, Dunnagan, and Schure (2006) reported positive changes in counselor trainees’ stress levels after providing a course which integrated mindfulness with yoga and meditation. Similar gains were reported with interventions in other studies (Newsome, Christopher, Dahlen, & Christopher, 2006; Christopher & Maris, 2010). Based on their mostly positive outcomes, Boellinghaus, Jones, and Hutton (2013) also recommend the use of mindfulness loving-kindness meditations as an approach for increasing counselor self-care and compassion. Along with mindfulness, Datillo (2015) suggests a range of options derived from our therapeutic work itself: CBT self-emotion-scanning and self-cognitive distortion monitoring, positive thought statements, ACT-based nonattachment and compassionate self-observation, and finally, a series of pointed questions for evaluation, including items like, “Have there been any comments from others about their observations of me, specifically as it relates to family members, friends, or colleagues?” and “Have you noticed any differing reactions from others who know you well?”
Some of these sources barely scratch the surface of the available material at our disposal. It isn’t like there is a dearth of techniques and strategies for self-care; there are even workbooks completely devoted to the subject for counselors (Kottler, 2011). Yet, as valuable as such structures and advice may be to organize self-care efforts in a meaningful and strategic way, the main impediment to consistent action isn’t a lack of options, but rather sustained behavior over time. This is no less true with respect to our clients who have little trouble getting started with their own self-care programs, whether they involve exercise, lifestyle adjustments, relational connections (or disconnections) or self-talk; the greatest challenge involves maintaining those efforts over time such they become part of daily functioning without exception. Most people, and perhaps especially therapists, tend to respond better to general principles of self-care than they do any specific techniques or prescriptions (Norcross, 2000).
In other words, there have been so many such articles and books published in the literature, all of which preach similar themes, and perhaps present the latest and greatest program, but ultimately self-care is about an attitude, a cherished belief that we can only do our best work taking care of others when we also take care of ourselves. And we take care of ourselves most fully when we work from the core of who we really are, when the whole of us is in plain view rather than just the parts we think are acceptable. This not only leads to greater clarity and effectiveness in our sessions, but also demonstrates to clients that we live exactly the same principles and ideas that we are teaching to them. This includes, at appropriate times, presenting ourselves as imperfect and flawed individuals, but also absolutely committed to our own growth, learning, and improvement.
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