When we consider risk management in psychological practice, we readily think of: informed consent, documentation, consultation, personal characteristics of patient and provider, best-practice clinical strategies and levels of risk. But rarely do we think of self-care.
And yet, self-care might be the most foundational, most all-encompassing risk management tool of all.
Imagine for a moment an accomplished violinist whose music is deeply moving. Each note aches with expression, flowing forth from the violin and filling the space with sounds that hold performer and audience together in the melodic currents of music.
Years of practice precede such enchanting, passionate playing. And when the violinist stops her playing, she cleans her instrument well and encloses it in a comfortable high-quality case. She attends carefully to the environment in which it is kept, protecting it from elements that might damage it. She regularly assesses the condition of the strings, pegs, bridge and body.
Each day after practicing she releases the tension on the bow, letting it rest without unnecessary stress, cherishing and preserving her instrument as a kind of extension of her own body – as a most personal companion who lives at the very heart of her artistry, at the heart of her craft.
In psychological practice we are our most powerful instrument. Research confirms again and again that the most important element of successful mental health treatment is not clinical orientation or treatment modality, but the clinical relationship itself. Just as the violinist requires a well-cared-for violin to achieve her artistic goals, as psychologists we too rely on a well-maintained, intimately cultivated instrument that is our own self.
There are many ways to support and protect our professional work and careers. But great generosity toward our patients, frequent consultations when things get tricky, perfectly worded informed consent and attendance at every CE event within a hundred miles, all amount to very little if we don’t tend to ourselves.
Caring for this most essential instrument is at the root of our professional work – not only the quality of our work year to year but the number of years we’ll be able to maintain it.
I’m reminded of a quote by Edward Stanley, “Those who think they have no time for bodily exercise will sooner or later have to find time for illness.” The same is true in our own practices.
If we do not create space for self-care, we will eventually be forced to find time (and money) for the consequences:
*Errors in judgment (e.g., clinical errors, boundary violations)
*Failure to meet legal and ethical obligations (distress left unaddressed often results in impaired competence and an inability to practice effectively in accord with prevailing professional standards).
*Licensing board complaints and/or civil suits (resulting from the above).
But as Patanjali says in the Yoga Sutra, “heyam dukham anagatam” or, in translation, “the suffering that is to come can be avoided.” We do not have to operate from a place of deficit. We do not have to sacrifice our own self-care for the care of others. And more than that, we simply can no longer afford to do so. The risks to ourselves and our patients are just too great.
So, how do we “do” self-care? Multiple strategies for therapists have been suggested: value the person of the psychotherapist, refocus on the rewards, recognize the hazards, mind the body, nurture relationships, set (and keep) boundaries, restructure cognitions, sustain healthy escapes, maintain mindfulness, create a flourishing environment, profit from personal therapy, cultivate spirituality and mission and foster creativity and growth.
But those are not things we can put on a ‘to do’ list and check off once and for all. Genuine self-care is not a one-time ‘to do’ chore. It is a habitual – or even ritual – practice, “an embodied reality of how we live our lives” (C. Arylo), a choice made again and again.
As a beginning, maybe we start with compassion for ourselves, reflecting on the day-to-day condition of our most valuable instrument. How might we treat this embodied spirit, this hard-working instrument, as if it were a thing of beauty like a violin?
Whatever our particular answers might be, finding ways to safeguard our own self with regular “tunings” not only protects our patients and our clinical practice, but also enriches our lives.
References available from author
Leisl M. Bryant, Ph.D., is a risk management consultant for The Trust with decades of experience in clinical and forensic practice as well as ethics and risk management consultation. Her email is: firstname.lastname@example.org.
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