Chapter 14

Self-Care for Psychologists

Erica H. Wise and Jeffrey E. Barnett
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Along the way to becoming professional psycholo- how the factors that draw people to this work may
gists, people make many personal sacrifices. The put them at increased risk for stress-related prob-
training process entails long hours of demanding lems and for failing to adequately attend to their
academic study and intense dedication to honing own self-care. This discussion leads into a review
clinical skills in a doctoral program, internship, of current approaches to self-care for psychologists.
postdoctoral setting, and beyond. Although the We end the chapter with specific suggestions and
work offers much satisfaction, it is undeniable that strategies for inculcating self-care into clinical prac-
many professional psychologists spend a substantial tice that can be introduced at the outset of graduate
portion of their working lives listening to the pain training and sustained throughout the professional
and suffering of others. The challenges of clinical life span. An overarching conviction is that self-care
work, coupled with stressors in their personal lives is an ethical mandate for all who choose to work in
and the vulnerabilities associated with their personal this profession.
histories and predispositions, put psychologists at These ideas are not new. A well-known quote
great risk for experiencing distress, burnout, vicari- attributed to Rabbi Hillel the Elder more than
ous traumatization, and problems with professional 2,000 years ago captures several dialectics that are
competence if they do not take the necessary steps addressed in this chapter: “If I am not for myself,
to protect their effective functioning on an ongoing who will be for me? If I am only for myself, what
basis. am I? And, if not now, when?” A thoughtful con-
Despite these many challenges, we believe that sideration of this ancient quote uncovers layers of
psychologists are deeply committed to benefiting meaning. It begins with the recognition that self-care
those whom they serve. Given the importance of is fundamentally an individual responsibility: that
psychological services to the public, it is imperative people each, as individuals, must be for themselves
to safeguard psychologists’ well-being and compe- and that they cannot fully rely on others to attend
tence throughout the professional life span. The to their needs. The next question, “If I am only for
ongoing use of effective self-care is an essential pro- myself, what am I?” serves as a reminder that people
fessional focus and activity to ensure that psycholo- must also be for others to live a life that has meaning.
gists provide clients with the competent services Most psychologists would readily subscribe to this
they deserve. aspirational objective, and it is clear that patients are
In this chapter, we synthesize the literature on most commonly the others for whom psychologists
self-care for psychologists in the spirit of encourag- care. Psychologists also commonly include those
ing psychologists to attend to their own wellness. with whom they have personal relationships, such
We begin with a review of the challenges inherent as family and friends. More rarely do they include
in the practice of psychology and a consideration of their professional colleagues in this group.

http://dx.doi.org/10.1037/14774-014
APA Handbook of Clinical Psychology: Vol. 5. Education and Profession, J. C. Norcross, G. R. VandenBos, and D. K. Freedheim (Editors-in-Chief)
209
Copyright © 2016 by the American Psychological Association. All rights reserved.
APA Handbook of Clinical Psychology: Education and Profession, edited by J. C.
Norcross, G. R. VandenBos, D. K. Freedheim, and L. F. Campbell
Copyright © 2016 American Psychological Association. All rights reserved.
 Wise and Barnett

When we discuss self-care strategies later in the we provide an expanded conceptualization and a
chapter, we demonstrate broad concurrence that review of evidence-based self-care strategies.
the maintenance of strong interpersonal relation-
ships and an interconnected professional commu- Vicarious Trauma
nity is an essential aspect of psychologists’ self-care. Many clinical psychologists work with clients who
Finally, the last sentence of the quote, “And, if not have been the victims of trauma, which brings
now, when?” captures the urgent need for self-care; with it unique challenges. The process of assist-
regardless of where psychologists are in their career ing clients to describe, work through, and come to
(e.g., graduate student; early career, mid-career, or terms with the trauma they have experienced can be
senior psychologist), actively engaging in self-care is traumatizing. Psychologists may experience intru-
essential for them and for their clients. sive ideation of the client’s traumatic experiences,
avoidance behaviors, physiological arousal, somatic
complaints, and distressing emotions that may
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KEY DEFINITIONS
result in impaired competence termed secondary
In the sections that follow, we define several key traumatic stress disorder (Figley, 1995). Others (e.g.,
concepts that are essential to our consideration of Bride, 2004; Courtois & Ford, 2013; Pearlman &
professional challenges and self-care for psycholo- Saakvitne, 1995) have termed this process and its
gists. These concepts include self-care, vicarious resulting symptoms vicarious traumatization, second-
trauma, distress, and burnout. ary victimization, or compassion fatigue. The latter
term is used to refer to the emotional toll of work-
Self-Care ing with traumatized patients in particular as well
The term self-care seems to have originated with the as distressed patients in general. Clinical work with
12-step self-help movement, and it has more recently clients with a history of trauma brings special chal-
been adopted by psychologists and other health pro- lenges that require careful attention to self-care.
fessionals beyond the recovery community. Stated
broadly, self-care includes routine positive practices Distress and Burnout
and mindful attention to one’s physical, emotional, Distress is a broad term that describes the negative
relational, and spiritual selves in the context of emotional state that psychologists may experience
one’s personal and professional lives. When speak- in response to the stresses in their professional
ing of self-care, we are focusing on the activities and and personal lives (Smith & Moss, 2009). If the
strategies each psychologist uses to establish and various stresses and the resulting distress are not
maintain wellness while working to minimize the adequately treated over time, they may lead to what
effects of distress and to, one hopes, prevent a deg- Freudenberger (1975) termed burnout. Burnout may
radation in professional functioning. Self-care has represent “the terminal phase of therapist distress”
been described as consisting of three interrelated (Baker, 2003, p. 21). Burnout includes feelings of
factors: self-awareness, self-regulation, and balance emotional exhaustion, depersonalization, and a
(Baker, 2003). The goal of self-care is functioning decreased sense of accomplishment and achieve-
well, something described by Coster and Schwebel ment (Jenaro, Flores, & Arias, 2007). Although
(1997) as “the enduring quality in one’s professional each psychologist has likely experienced many of
functioning over time and in the face of professional the symptoms of burnout to some extent at vari-
and personal stressors” (p. 5). Self-care may involve ous times, experiencing a significant amount of
a wide range of activities that will vary across indi- burnout symptoms over time can result in prob-
viduals, but in general they are positive actions that lems with professional competence (Elman & For-
promote wellness and effective coping. Moreover, rest, 2007). “Distress, per se, does not necessarily
effective self-care involves the avoidance of negative imply impairment” (O’Connor, 2001, p. 345), but
coping behaviors that will likely exacerbate one’s dif- when distress is not adequately attended to, it can
ficulties over time. In a later section of this chapter, develop into burnout and have a deleterious effect

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on psychologists’ professional functioning and Being assaulted by a client is a significant risk

competence. factor for psychologists, with between 35% and 40%
Guy (2000) described how distress, burnout, and of psychologists being the victim of an assault by a
vicarious traumatization can lead to a decrease in client during their career (Gately & Stabb, 2005).
professional competence. He explained that Of course, practice setting and client population
have an impact on risk factors. In one national study
spending hour after hour in clinical work
(Pope & Tabachnick, 1993), 18% of psycholo-
can leave our sense of self weak and apa-
gists had been assaulted by a client, but a full 80%
thetic, lacking in confidence and energy,
reported living with the fear of such an assault.
thereby hindering our ability to be atten-
Psychologists’ concerns about personal safety are
tive and effective in helping our clients.
surprisingly common.
Consequently, it is useful to develop
ways to replenish and strengthen our Nature of Therapeutic Work
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inner self in order to remain fresh and A number of occupational hazards are associated
motivated. (p. 351) with being a practicing psychologist (Norcross &
Guy, 2007b). The confidential nature of psychologi-
COMMON STRESSORS FOR cal treatment severely limits how much a practitio-
PSYCHOLOGISTS ner can discuss with friends and family, effectively
The stressors for psychologists come from the limiting the opportunity to share concerns with
nature of the work itself, personal histories and vul- partners or close friends. In addition, in many psy-
nerabilities, ongoing daily challenges in professional chological practices, indicators of positive change
and personal lives, and the synergistic interaction of are subtle rather than overt. As an example, many
all these factors. In one survey of practicing psychol- clients experience therapeutic change as subtle shifts
ogists (Cooper, 2009), the most common stressors in interpersonal relationships, in subjective mood,
and frequent sources of distress for psychologists or in enhanced meaning, leading to an elusive sense
were challenging clients (91%), documentation and of accomplishment. Psychologists treating clients
record keeping (91%), managed care (59%), risk of with serious pathology will likely have clients who
client suicide (54%), financial pressures (50%), and experience relapses and who do not demonstrate sig-
risk of ethics or licensure board complaints (47%). nificant improvement over time. Rather, for many of
these clients the goal is to maintain their functioning
High-Risk Clients and to prevent relapses. Finally, both patients and
Psychologists frequently feel responsible for oth- their families commonly have unrealistic expecta-
ers’ welfare, especially when working with highly tions for the potential benefits of treatment. The
troubled and at-risk individuals. In particular, clini- possibility of being sued for malpractice or receiving
cal work with clients suffering from suicidality and a licensing board or ethics complaint is an ongoing
other self-destructive behaviors; aggressive and stressor. Even a frivolous lawsuit or complaint can
violent clients; and clients with eating disorders, be emotionally trying, and the defense against a suit
substance abuse disorders, and serious mental ill- can be an emotionally exhausting and financially
ness can be taxing and at times even overwhelming devastating experience (Baerger, 2001).
(e.g., Wurst et al., 2011). Clinical work with poten- The day-to-day emotional toll of psychologi-
tially or actively suicidal clients has been reported to cal practice can be easily overlooked. As O’Connor
be one of the most stressful clinical experiences for (2001) described,
psychotherapists, and the effects of a client’s suicide Many clinicians can relate to the expe-
can prove emotionally devastating (Baerger, 2001). rience of an emotionally intense and/
Furthermore, the suicide of a client is reported “to or exhausting session, which is quickly
have understandably traumatic consequences for the followed by the next hour’s patient,
therapist” (Pope, Sonne, & Greene, 2006, p. 175). without time to process, or fully recover

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from, the impact of the previous hour. working in managed care have reported a number
As clinicians, the role encourages, if of conflicts and dilemmas that make their work
not requires, a heightened sensitivity to more stressful and less satisfying (Murphy, DeBer-
people and environment, a willingness nardo, & Shoemaker, 1998). Examples include
to meet others’ needs before one’s own, intrusive utilization review systems that challenge
and the ability to withhold emotional clients’ confidentiality, responding to adverse utili-
responses in the face of reported trauma zation review decisions when clients are clearly in
and intense emotion, and the ability to need of ongoing treatment, and feeling pressured to
tolerate intense emotion and ideation provide treatment more quickly than the psycholo-
with limited or no outward personal gist perceives is clinically appropriate.
response. (p. 346)

Furthermore, the practice of psychotherapy can BECOMING AND BEING A PSYCHOLOGIST

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prove an isolating endeavor, with psychologists

In the sections that follow, we consider some of the
having little contact with others (except clients)
common developmental and personal factors related
throughout each workday. The focus on clients and
to becoming and being a psychologist. These under-
their needs, the limited opportunity to process or
lying factors may interact with or exacerbate both
discuss the work, and the need to hold and indepen-
stressors that are endemic to the profession and
dently manage the emotional demands of the work
those that are common in daily life.
throughout the day can each add to the stressful
nature of psychological treatment.
Common Factors
It is intriguing, but not surprising, to realize that
Business of Practice there may indeed be common paths that draw indi-
Psychologists who work in independent practice set-
viduals to the practice of psychology. Those entering
tings must also cope with business and bureaucratic
the mental health field are more likely to report a
demands, including personnel issues such as staff
history of abuse, neglect, and dysfunctional patterns
hiring, training, and oversight responsibilities as
of parenting and caregiving within their families of
well as possibly responding to subpar performance
origin (O’Connor, 2001) that may result in their
and firing staff; advertising and marketing demands;
feeling especially comfortable with, or even drawn
documentation, utilization review, and insurance
to, serving in caregiver roles. Enacting this role can
filing requirements; pressures to manage referrals;
also allow psychotherapists to work through these
charging and collecting fees; advertising and mar-
early family patterns. Although this history may be a
keting one’s practice; responding to and managing
source of strength, empathy, and deep commitment,
the financial impact of fluctuations in one’s case­
it may also place psychologists at greater risk for
load; being on call and responding to emergencies
developing distress and engaging in unprofessional
and crises; and, for those in individual practice, pro-
conduct.
fessional isolation.
A recent series of articles linked the reasons for
Dealing with the many challenges of working
becoming a psychotherapist to the personal career
with managed care or provider networks can also
choice narratives of eight prominent psycholo-
prove quite demanding. The emotional exhaustion
gists. Both the literature review and the narratives
component of burnout tends to be greatest in psy-
highlighted common themes, such as cultural mar-
chologists with “less control over work activities,
ginalization, psychological mindedness, and the
working more hours, spending more time on admin-
experience of childhood pain (Farber et al., 2005).
istrative tasks and paperwork, seeing more man-
As Farber et al. stated so eloquently,
aged care clients and fewer direct pay clients, and
having to deal with more negative client behaviors” Do some of the “darker” motivations
(Rupert & Morgan, 2005, p. 544). Psychologists need to be worked on more so they don’t

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interfere with effective clinical work or Daily Stressors

other relationships? Finally, we all need In addition to developmental stressors, clinicians
to remind ourselves of why we are in this must deal with the many small and not-so-small
field and how the work has led to unique stressors that affect everyone’s lives, from receiving
and profound, if sometimes elusive, plea- a speeding ticket to having a child get in trouble at
sures. (p. 1030) school, to being in a car accident and having more
expenses and bills to pay than anticipated. People
Developmental Factors may prefer to believe that they can keep their profes-
In addition to personal and experiential factors that sional and personal lives from affecting each other,
may be more common in the profession, psycholo- but there is no impermeable barrier between them
gists (like all others) also experience the stresses (Pipes, Holstein, & Aguirre, 2005). For example, a
of day-to-day life. These general life stressors can psychologist going through a contentious divorce
include financial and other normative pressures and custody battle will likely not be impervious to
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such as mortgage and car payments; saving for col- the effects of these events on his or her personal life
lege education for children as well as for one’s own (e.g., disrupted sleep, emotional upset, fears about
retirement; relationship and family conflicts; feeling the future), possibly affecting the psychologist’s
pressure to meet others’ needs when desiring time focus at work or even influencing his or her reac-
for oneself; and health problems of oneself or one’s tions to clinical interactions. Similarly, a psycholo-
family, including caregiving demands. In fact, it has gist who has experienced a client suicide may find
been noted that psychologists have developmental the emotional impact of this event affecting his or
stressors in common with others that may interact her clinical work with other clients as well, perhaps
with unique professional roles (e.g., Wise, Hersh, & seeming preoccupied, not fully engaged with clients,
Gibson, 2011). and even being more emotionally reactive to clients.
Intriguing data support the hypothesis that
developmental factors may increase the risk of disci-
STRESS–DISTRESS CONTINUUM
plinary action among psychologists. An examination
of national disciplinary data determined that the The stress–distress–impairment–improper behavior
average elapsed time between date of licensure and continuum was initially proposed by the American
first disciplinary action was 20.8 years, that 94.5% Psychological Association (APA) Board of Profes-
of disciplinary actions occur more than 5 years sional Affairs Advisory Committee on Colleague
after licensure, and that 70% of disciplinary actions Assistance (n.d.). This conceptualization provides
occur between 11 and 35 years of practice (Hall & a robust model for considering the negative impact
Boucher, 2003). Why do disciplinary problems peak of stress on the lives of psychologists and the poten-
when psychologists are mid-career? Although the tial downward spiral that can occur when stress
data cannot provide a definitive answer, they lead to is not managed. In this model, stress is defined as
questions. As psychologists move further from their the body’s reaction to demands that are placed on
foundational academic training, is there a subtle it that are generated from either internal (e.g., self-
deterioration in professional competence? Is there expectations) or external (e.g., work-related) sources.
an insidious accrual of personal and family stressors Distress is defined as the subjective state of reacting
that undermine psychologists’ competence and leads to either internal or external stress and may also
to increased risk of improper behavior? As profes- be caused by reactions to past events that are unre-
sional psychologists get further from their graduate solved. Impairment refers to an objective change in
training, do they become more professionally iso- the psychologist’s professional functioning that may
lated and rely on others less for emotional support? result in ineffective services or cause harm to those
Whatever one believes about the data, they certainly with whom the psychologist works. Improper behav-
call attention to the importance of maintaining self- ior refers to professional behaviors that clearly trans-
care and competence throughout one’s career. gress ethical boundaries and constitute professional

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 Wise and Barnett

misconduct. Examples of impairment include an in nonmandating jurisdictions (Neimeyer et al.,

inability to use one’s clinical skills and responding 2010). Demonstrating the links between self-care
to clients inappropriately, such as with boredom, and ethics may be a strategic step in inculcating self-
irritation, or anger. Examples of improper behavior care as a value in the profession.
include sexual or fiscal improprieties with clients. The APA’s (2010) Ethical Principles of Psycholo-
The phenomena described in this model parallel to gists and Code of Conduct (Ethics Code) is based
some extent the definitions of distress and burnout on a set of underlying virtues that are the values
provided earlier in the chapter. on which ethical practice is based. These virtues
Although the model proves useful in support- include (Beauchamp & Childress, 2008):
ing a more nuanced and less all-or-none view of
psychologist functioning, it has some limitations in ■■ Beneficence: the obligation to do good and to help
other respects. One clear-cut limitation is that the others in psychologists’ professional interactions
term impairment is inconsistent with the contempo- with clients;
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rary focus on professional competence. In addition, ■■ Nonmalfeasence: the need to avoid doing harm
referring to impairment may lead to legal dilemmas and to minimize all risks for exploitation of and
given the overlap with terminology in the Americans harm to clients;
With Disabilities Act of 1990 (Elman & Forrest, ■■ Fidelity: professional obligations to others, both
2007). Another concern is the unintentional nega- explicit, such as through the informed consent
tive orientation, in that this model suggests that psy- agreement, and implicit, such as those general
chologists (at best) start at neutral and spiral down. expectations clients and others may reasonably
In focusing on stress, distress, impairment, and be expected to have of psychologists;
improper behavior, the model has no vision of well- ■■ Autonomy: the obligation to promote oth-
ness or flourishing for psychologists. More recent ers’ functioning independent of psychologists
conceptualizations (e.g., Wise, Hersh, & Gibson, and not to promote clients’ dependence on
2012) have incorporated the substantial research psychologists;
that has been done on positive psychology and ■■ Justice: the obligation to treat others justly,
flourishing (e.g., Fredrickson, 2001) and applied it equally, and fairly, both in terms of the quality
to increasing the effectiveness of self-care for psy- of services provided and in terms of providing all
chologists. This approach is discussed in more detail individuals with equal access to the same quality
later in the chapter. of care; and
■■ Self-care: the need to attend to, and take ade-
quate care of, oneself so that the psychologist
AMERICAN PSYCHOLOGICAL will be able to adequately implement the preced-
ASSOCIATION ETHICS CODE AND ing five virtues.
SELF-CARE
It is interesting to note the role of self-care in
Embedding self-care in an ethical framework these foundational virtues on which ethical practice
provides a meaningful context for psychologists is based. The aspirational statements in Principle A,
(Wise & Gibson, 2012). In addition to the concep- Beneficence and Nonmaleficence, of the APA Ethics
tual interrelationship between ethics and self-care, Code (2010) include the explicit acknowledgement
it has been well documented that the inclusion of that psychologists’ physical and mental health are
ethics content makes continuing education work- key underpinnings of their ability to provide compe-
shops more appealing to psychologists. In a survey tent service:
of more than 6,000 psychologists concerning their
participation in continuing education, ethics was the Psychologists strive to benefit those with
most frequently selected topic of interest (Neimeyer, whom they work and take care to do no
Taylor, & Wear, 2010). Ethics is also the most fre- harm. . . . Psychologists strive to be aware
quently attended continuing education course even of the possible effect of their own physical

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 Self-Care for Psychologists

and mental health on their ability to help Standard 2.06 is at the heart of psychologists’
those with whom they work. (p. 3) ethical obligation to guard against personal prob-
lems that have a negative impact on their profes-
sional functioning. Although this ethical standard
Ethical Obligation to Maintain
is most certainly essential, it can be challenging to
Competence
enact. As is the case with other professionals, psy-
Standard 2.03, Maintaining Competence, is relevant
chologists may have difficulty unambiguously mak-
to self-care. This standard reminds psychologists
ing the determination that a particular manifestation
that they “undertake ongoing efforts [italics added]
of personal problems is likely to have an adverse
to develop and maintain their competence” (APA,
impact on their clinical competence and effective
2010, p. 5). Although this section of the Ethics Code
functioning.
may have been specifically intended to address tra-
Also relevant to this discussion is research indi-
ditional educational endeavors to support compe-
cating that psychologists’ ability to effectively self-
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tence, there is a solid foundation for advocating that

assess competence may be more limited than they
psychologists include self-care among their ongoing
would want to believe (Dunning, Heath, & Suls,
efforts to help minimize the risk of distress, burn-
2004). It has been found that those possessing the
out, and vicarious traumatization leading to a degra-
lowest levels of competence also tend to be least
dation of professional competence.
effective at making accurate self-assessments of their
functioning (Kruger & Dunning, 1999). Studies
Personal Problems
of this phenomenon with health care profession-
Standard 2.06, Personal Problems and Conflicts,
als have found that those with the lowest levels of
more specifically directs psychologists to anticipate
professional competence are least able to correctly
when their personal problems may prevent competent
self-assess their competence difficulties (Hodges,
functioning and how they are to respond when they
Regehr, & Martin, 2001). Furthermore, when health
become aware that personal problems may be interfer-
professionals do become aware of decreases in their
ing with their ongoing functioning and professional
professional functioning, they are likely to attribute
competence. In contrast to the explicit focus on self-
them to other factors in the environment (e.g., this
care as an aspirational virtue, the APA Ethics Code
is an especially difficult or complex client) rather
emphasizes protecting others from one’s personal
than to take ownership of these difficulties and take
problems rather than encouraging proactive self-care.
corrective action (Campbell & Sedikides, 1999). In
Standard 2.06 states,
examining the self-assessment bias of mental health
(a) Psychologists refrain from initiating clinicians, Walfish et al. (2012) found that 25%
an activity when they know or should rated their clinical skills to be in the 90th percen-
know that there is a substantial likeli- tile in comparison with their peers. Furthermore,
hood that their personal problems not a single mental health clinician they surveyed
will prevent them from performing rated him- or herself as being below average. Mental
their work-related activities in a com- health clinicians overestimated the extent to which
petent manner. their clients improved and underestimated the
(b) When psychologists become aware of extent to which their clients did worse in response
personal problems that may interfere to their clinical interventions. Taken together, these
with their performing work-related findings clearly suggest caution in assuming that
duties adequately, they take appropri- psychologists can accurately self-assess their own
ate measures, such as obtaining pro- competence and effectiveness. They certainly sup-
fessional consultation or assistance, port the importance of including self-care as part
and determine whether they should of an ongoing commitment to maintaining compe-
limit, suspend, or terminate their tence, rather than waiting until a distressed individ-
work-related duties. (APA, 2010, p. 5) ual is convinced that he or she may need it.

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These challenges in accurate self-assessment would violate confidentiality rights or

highlight the important role that colleagues can when psychologists have been retained to
serve in ensuring one’s ongoing professional com- review the work of another psychologist
petence. This may be through participation in peer whose professional conduct is in ques-
consultation and supervision groups, informal pro- tion. (APA, 2010, p. 4)
fessional interactions, and the creation of networks
that provide mentoring, support, and feedback, such Even though the focus of these standards is on
as the creation and use of competence constellations ethical violations by colleagues, we would encour-
(Johnson et al., 2012). We believe that active rela- age psychologists to more openly discuss their self-
tionships with colleagues are an essential compo- care and to provide supportive feedback when they
nent of effective self-care. become concerned about one another. Research
has demonstrated that many psychologists expe-
Ethical Mandates Related to Colleague rience burnout and problems with professional
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Concerns competence for which they do not seek assistance

The Ethics Code includes two standards related to (Barnett & Hillard, 2001), and despite knowing of
how psychologists are expected to respond when the possible deleterious effects on their competence,
they suspect that a colleague may have engaged in many of them continue practicing. Possible factors
an ethical violation. Standards 1.04 and 1.05 relate to consider include professional and personal blind
to informal resolution and reporting of ethical viola- spots, stigma and fear of consequences to one’s
tions, respectively: practice and license, feelings of invulnerability,
overestimating one’s ability to manage stressors,
1.04 Informal Resolution of Ethical and underestimating the effects of these factors on
Violations effective functioning (Barnett et al., 2007). Expand-
When psychologists believe that there ing the sense of professional responsibility for one’s
may have been an ethical violation by colleagues would be beneficial for the field and the
another psychologist, they attempt to public psychologists serve (Johnson et al., 2012,
resolve the issue by bringing it to the 2013) and is consistent with the aspirational virtues
attention of that individual, if an infor- that form the foundation of ethical practice.
mal resolution appears appropriate
and the intervention does not violate
any confidentiality rights that may be INTEGRATING SELF-CARE INTO DAILY
involved. PRACTICE

1.05 Reporting Ethical Violations In the sections that follow, we discuss the recent
If an apparent ethical violation has articulation of a positive dimension for psychologist
substantially harmed or is likely to sub- functioning as it relates to our conceptualization of
stantially harm a person or organiza- self-care. A review of the foundational principles
tion and is not appropriate for informal that we believe support effective self-care serves as
resolution under Standard 1.04, Informal an introduction to our recommendations for ongo-
Resolution of Ethical Violations, or is ing self-assessment and self-care strategies.
not resolved properly in that fashion,
psychologists take further action appro- Positive Dimension to Psychologist
priate to the situation. Such action might Self-Care
include referral to state or national com- The stress–distress–impairment continuum has
mittees on professional ethics, to state focused professional attention on the risks of spiral-
licensing boards, or to the appropriate ing downward in professional functioning. As the
institutional authorities. This standard emphasis shifts to include a positive dimension,
does not apply when an intervention psychologists can orient efforts toward sustainability

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and workability (Wise et al., 2012). We briefly 4. What would you say are your current profes-
describe these foundational principles as an intro- sional concerns or stressors?
duction to specific self-care activities. First is the 5. How do you know when you are under stress?
notion of surviving versus flourishing (Keyes, 6. What do you consider your greatest challenge
2002). When people focus on surviving, they inad- regarding self-care?
vertently maintain a barely good enough status quo 7. How does your work as a psychologist differ
and focus their efforts on preventing the negative, from what you expected?
which would be tantamount to the goal of seek- 8. What has been most helpful for you regarding
ing to just meet minimal professional standards. taking care of yourself and maintaining resiliency
However, when people aspire to flourish, they are in your professional and personal life?
open to a more creative and innovative approach
to self-care consistent with positive or aspirational
Self-Care Strategies
ethics (Knapp & VandeCreek, 2012). Second is
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Self-care can focus on emotional, physical, relation-

intentionally choosing a flexible self-care plan that
ship, and religious or spiritual aspects of one’s life
a person can adapt when current strategies are no
and can include what have been described as positive
longer as effective. Third is reciprocity that recog-
career-sustaining behaviors (Kramen-Kahn & Hansen,
nizes the importance of applying the same principles
1998), such as engaging in regular exercise, maintain-
used with one’s clients to oneself. Fourth is the use
ing a healthy diet, managing one’s caseload, taking
of self-care strategies that are integrated into rather
regularly scheduled breaks from work, maintaining
than added onto one’s already busy and stressful life.
relationships, and the like. One study of 400 psychol-
ogists (Case, 2001) found that psychologists benefited
Ongoing Self-Assessment from the use of meditation and prayer, socializing
The use of broad-based self-assessment questions pro- with friends, maintaining a diversity of professional
vides a critical step that allows psychologists to more roles, maintaining relationships with one’s family of
effectively target their self-care needs. Although psy- origin as well as with friends, and engaging in relaxing
chologists should not rely solely on self-assessment for activities. In another study (Cooper, 2009), psycholo-
reasons mentioned previously, thoughtfully respond- gists managed the stresses of their lives through the
ing to the eight questions below (adapted from Baker, use of humor (91.4%), relaxing activities (medita-
2003, pp. 55–58) can help identify likely areas of dis- tion, yoga, reading; 85.6%), vacations (82.9%), exer-
tress or imbalance. Responses may also draw attention cise (75.2%), scheduled breaks throughout the day
to aspects of one’s professional functioning that are (67.6%), positive self-talk (66.7%), and email group
meaningful and rewarding. Articulating areas of sat- or professional affiliations (61.3%).
isfaction can foster a sense of well-being and provide In addition, we recommend two self-care
direction for one’s ongoing focus and efforts. In fact, resources for psychologists to consider. The first is
simply practicing gratitude on a regular basis has been a principle-based model developed specifically for
found to have many benefits and can cushion one psychologists (Norcross & Guy, 2007a). Norcross
from distress (Emmons & Crumpler, 2000). Honest and Guy integrated research-supported methods
self-appraisal is an invaluable tool in creating an effec- from traditions of spirituality, mindfulness, and pos-
tive self-care plan. itive psychology in addition to cognitive–behavioral
1. What initially drew you to the field of therapy and physical wellness. Excerpted below
psychology? with brief elaboration are the 12 basic principles or
2. Briefly describe what makes a good day for you at strategies (as opposed to specific techniques) that
work. In contrast, what makes a bad day? psychologists can flexibly incorporate into their pro-
3. What have been the significant periods or chal- fessional lives:
lenges during your career related to professional 1. Valuing the person of the psychotherapist
or personal stresses? (appreciate the person of the therapist as an

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indispensable curative agent; apply the skills that physical health. The therapeutic lifestyle changes
one uses for clients to oneself). also incorporate an awareness of people’s evolution-
2. Refocusing on the rewards (remember to focus ary need to be in nature and the negative impact
on the benefits and privileges of one’s work; of overexposure to contexts of hyperreality and
practice gratitude). media immersion. Although the therapeutic lifestyle
3. Recognizing the hazards (acknowledge and change approach is intended to be incorporated
accept the occupational challenges that are into psychologists’ professional work with clients,
endemic to the field). research is cited that suggests that, for example, psy-
4. Minding the body (remember to practice the chologists who recommend exercise to their clients
essentials of healthy living; sleep, eat, and exer- are more likely to exercise themselves (McEntee &
cise well). Halgin, 1996). Self-care also includes avoiding mal-
5. Seeking nurturing relationships (cultivate sup- adaptive coping strategies, such as self-medicating
port among colleagues, family members, friends, with food, alcohol, and other substances; working
Copyright American Psychological Association. Not for further distribution.

and mentors. Ask the question “Who has my harder and harder; engaging in denial; and engaging
back?”). in professional isolation.
6. Setting boundaries (establish and maintain bound-
aries between yourself and others and between
ENHANCING SELF-CARE THROUGHOUT
your personal life and your professional life).
THE CAREER
7. Restructuring cognitions (notice perfectionistic
and self-critical thoughts; manage them with We conclude with specific recommendations to help
compassion). establish and support positive self-care patterns,
8. Sustaining healthy escapes (seek restorative organized into the primary stages of professional
activities that keep you vital and engaged). development.
9. Creating a flourishing environment (intention-
ally create a positive environment for yourself in Graduate School
terms of setting, colleagues, and comfort). For graduate school self-care, we emphasize the
10. Undergoing personal therapy (engage in personal integration of self-care practices and principles into
psychotherapy on a periodic basis as a form of formal academic course work and early supervision.
positive self-development. Consider alternative We also recognize the importance of fostering a
approaches such as taking a yoga or meditation sense of community among graduate students and of
class). faculty mentoring.
11. Cultivating spirituality and mission (connect to
sources of meaning and values in your life). ■■ Introduce self-care into professional seminars,
12. Fostering creativity and growth (diversify your ethics classes, and practicum training.
professional activities; seek growth, develop- ■■ Model self-care self-disclosure. Faculty and
ment, change, and renewal in your work). supervisors can share specific steps they take to
effectively manage stress (e.g., exercise, setting
The second approach is based on an evidence- limits, stopping work for lunch) and remain
based systematic review of therapeutic lifestyle positively engaged with professional activities
changes—lifestyle behaviors that have a positive (e.g., diversification, advocacy, professional asso-
impact on mental health—that were proposed for ciation work).
psychologists to promote to their clients or patients ■■ Introduce students to the importance of develop-
(Walsh, 2011). As does the approach outlined ing, maintaining, and actively participating in a
above, this model explicitly incorporates elements supportive professional community.
of mindfulness, spirituality, and positive psychology ■■ Emphasize a proactive and preventative approach
in addition to specific evidence-based recommenda- to self-care that focuses both on the individual
tions for nutrition and exercise designed to promote and on one’s colleagues.

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■■ Introduce principles of self-care once train- ■■ Remain cognizant of typical developmental chal-
ees have developed some comfort with their lenges such as establishing relationships, pur-
new role. The focus can be on how to manage chasing a home, and starting a family that can
appointments, paperwork, vicarious trauma, and be sources of stress that add to the challenges of
other common psychotherapist experiences. establishing yourself professionally.
■■ Assign and discuss relevant articles (many of the
readings in this chapter’s reference list would be Mid-Career
appropriate). For mid-career psychologists, we emphasize
■■ Integrate into the discussion the ethical mandate awareness of common developmental stressors,
to be aware of emotional distress that might com- maintenance of professional competence, and the
promise one’s professional work (Standard 2.06). importance of active involvement in lifelong learn-
Faculty and supervisors can also share how they ing and peer support.
have handled such challenges and errors (Wise &
Copyright American Psychological Association. Not for further distribution.

■■ Promulgate, through professional organization

Cellucci, 2014). presentations and newsletters, awareness of com-
■■ Create a support system for advanced graduate mon stressors, such as adolescent children, aging
students for the internship application process parents, empty nest.
that can prove helpful and also models the com- ■■ Maintain awareness of how challenges in your
munities of care. personal life interact with and influence profes-
■■ Inculcate values of lifelong learning (consistent sional functioning.
with current accreditation standards). ■■ Consider participation in a diverse range of pro-
fessional activities to help prevent burnout.
Early Career ■■ Be aware of common risks for burnout and vicar-
For early career psychologists, we focus on the impor- ious traumatization, thoughtfully monitoring and
tance of staying in touch with recent graduate students managing caseload mix.
and becoming active members of professional commu- ■■ Actively take on a supportive role with col-
nities and networks. We also provide a reminder that leagues and actively work to avoid professional
this is a time, for many, of major life changes such as isolation.
starting a family or purchasing a home. These devel- ■■ Foster participation in professional associations.
opmental transitions can lead to increased stress. ■■ Become involved in a peer support or writing
■■ Offer to stay in touch with recent graduate stu- group.
dents to provide continued support and input. ■■ Remain an active lifelong learner.
■■ Actively pursue ongoing supportive relationships
with colleagues, such as peer support groups that
Late Career
For late career psychologists, we emphasize remain-
are frequently offered through your state psycho-
ing current and competent, and planning proactively
logical association.
for the transition to retirement. Giving back to the
■■ Seek a referral through your state psychological
profession is important at all phases of professional
association if they offer a colleague assistance
development but may be especially meaningful for
program or some other mechanism for providing
late career psychologists.
referrals for psychologists.
■■ Seek a mentor through your state or national ■■ Continue developing, modifying, and using your
psychological association. Many experienced competence constellation.
psychologists are delighted to serve in this role ■■ Ensure ongoing competence to include effective
for early career colleagues. cognitive, physical, and emotional functioning.
■■ Continue to use professional networks for ongoing ■■ Make plans for transitioning to retirement.
consultation and support, not only maintaining ■■ Consider ways to maintain a sense of meaning
them, but adding to them as one’s needs change. and value through professional activities, service

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 Wise and Barnett

to your community, and important relationships Unpublished doctoral dissertation, Loyola University
in your life. Maryland, Baltimore.
■■ Give back to graduate students or early career Coster, J. S., & Schwebel, M. (1997). Well-functioning in
psychologists through supervising, lecturing at a professional psychologists. Professional Psychology:
Research and Practice, 28, 5–13. http://dx.doi.
local university, and serving as a mentor. org/10.1037/0735-7028.28.1.5
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