“We have about five minutes left for today,” you manage to squeeze in as your client abruptly switches to another topic.
Upon reaching the final wrap-up moment and saying your goodbyes until next week, what do you typically do?
Are you poised to write your progress note, use the bathroom, eat a quick snack, or make a phone call to insurance or a collaborating clinician?
Or perhaps you manage to do all of these at once, unbeknownst to the scouts at the Guinness Book of World Records. (I actually do know a therapist who does 3 out of 4 of these activities, and yes, one of them includes the bathroom. Please don’t think too hard about it though).
This post is all about the precious moments between our sessions and how we intend to use them. This is about 3 key principles to help integrate self-care between therapy sessions.
4 Main Task Domains Between Sessions
We can think about several broad-brush (and sometimes overlapping) categories of time allocation for these five or 10 minutes.
Insurance calls, recording of payments, email reminders for upcoming client sessions, tracking of attendance, etc.
Clinically, Ethically Practical
Progress notes, calls/emails to collaborating clinicians, etc.
Using the bathroom, eating a snack, texting your partner/friend about evening plans, looking up flight for an upcoming trip, calling your doctor to make an appt, etc.
Seemingly Frivolous Practices
Deep breathing, perspective-taking, gratitude practice, mindful check-in, 3-minute breathing space, jumping jacks, loving-kindness practice, energy clearing, push-ups, brief Qigong practice, etc.
Why Attend to Those Seemingly Frivolous Practices?
You might guess that I’m going to call your attention to those seemingly frivolous practices.
Who has time for them? Really.
Between the “truly important” tasks, like writing your progress note and using the bathroom, is there really any more time or room to do a gratitude practice for the client you just saw or the one you are about to see?
At this point, a useful question to ask yourself might be: “what is the cost of not doing those seemingly frivolous practices?”
What happens when you move, on relative autopilot, from client to client to client?
What happens when all the energy you can muster is directed at throwing five almonds down your throat and taking a quick gulp of (once hot) coffee?
What happens when you dive right in to write your 4-minute progress note on how that frustrating client once again didn’t utilize your suggestions or his own insights and finds himself in the same boat of misery he has been in for weeks or months? (Of course we are not writing down our frustrations, but you get the picture).
Of course you must eat and use the bathroom and write your notes.
And yet, can you also pay attention to your other, less obvious needs? Can you also, in a relatively seamless manner, integrate self-care practices in between your sessions and throughout your day?
Can you even venture to engage in self-care practices in the middle of your sessions?
Yes, you can (and deserve to) integrate vital self-care practices in between your sessions, while also taking care of your more “practical” needs and requirements.
Let’s explore and consider the following three important principles that can help you move in this direction.
3 Basic Principles of Integrating Self-Care
1) Acknowledge the depth and breadth of your own humanity
You too are human and deserve to attend to your deeper emotional experience.
When you listen intently, attend with utmost compassion, care deeply, feel what your clients feel, and help problem-solve complicated situations, you are inevitably expending precious energy and perhaps receiving energy you did not ask for and ultimately do not want to take in as your own.
Reclaiming your own sense of vitality, compassion, and energy is of utmost importance for personal reasons as well as for the next four clients who walk through your door.
(Hint: Clients are not there to take care of you. Only you are responsible for this for however many hours you are at work [and at home]).
2) Self-care is not self-pity, self-indulgence, or for those “other” therapists who really need it
When you care for the self, you are engaging a basic act of self-kindness and self-compassion.
If you don’t do this for yourself, who will?
You may have long-standing beliefs about what self-care really means and how it should operate in your life. You may have had supervisors who never emphasized this as vital to clinical training (or who even devalued it).
You may feel like paying attention to your own needs is selfish, which promotes a feeling of guilt if you try to take care of yourself in earnest.
Self-care may indeed feel frivolous or self-indulgent because there are simply too many other things to do in those precious moments.
As you begin to question your distant or strained relationship with self-care, you are actually engaging in healthy self-care itself!
3) Self-care practices can be integrative rather than additive
“Doing self-care” does not have to involve large chunks of time taken out of your day.
Self-care can be done in numerous ways and integrated relatively seamlessly into the five to 10 minutes between sessions.
When we think of self-care only as going to the gym, going on a long hike, or taking a long vacation, we are doing ourselves a disservice and likely setting ourselves up for more avoidance of pragmatic, moment-to-moment self-care practices. (Going to the gym, hiking, and going on vacation are still really good though!).
What Can Integrative Self-Care Practices Actually Look Like?
Self-care practices may literally involve taking 30 seconds after you close your door to take 3-4 deep, diaphragmatic breaths to induce the relaxation response.
You may then take the next minute to offer yourself some loving-kindness wishes.
This might sound like this:
“May I find strength to work with this anxious energy in the room. May I let go whatever anxiety is not useful to me.”
Repeat these phrases three to four times as you breath deeply. Then turn your wishes of goodwill toward your client.
“May So-and-So be kind herself this week as she works on her self-doubt. May So-and-So find peace amid her suffering.”
Repeat these phrases about three to four times.
Brief integrative practices like these not only help to let go of tension and negative energy, but they also can promote a broadened perspective and set of affective responses to the work that can be so draining to us.
This breadth of responsivity can help us process our frustrations more fully, problem-solve difficult cases more effectively, and even invite positivity to flow more easily.
Drop a comment below – I’d love to hear how these principles are working for you!
Hi Matt! Thank you so much for the self-care reminders. It’s not always so automatic for me to remember to honor myself by giving myself time to regroup and breathe. Not breathing due to working for an agency that kept pushing for me to do more and more and not askng for my own needs to be met brought me to not realizing I was ill with pneumonia. It caused me to relook at what I was doing to myself from forgetting to give to myself! The good news is, it made me start my own practice and self care now for me is a priorty even if I have to schedule one less client a day to accomplish my self-care goals. If you lse your health because you aren’t paying attention to your body, mind and spirit, you won’t be helping any clients! Thanks again for the reminder of what is really important.
Thank you so much, Nina, for your candid comment. Yes, the implicit hinting of ourselves as worthy of self care might be the hardest but most foundational element. It sounds like you allowed the illness to be a wake up call for you. I had something similar happen many years with a serious medical condition, and so I never go beyond a certain # of clients/week. I know it’s just too much for my sensibilities and not worth the health effects. This is very tough though when working for an agency. So you did what was probably wisest, most courageous, and certainly most self compassionate to start your own practice.
Thanks, and be well! Matt
Christina- so glad you found this helpful. It’s great to hear of your commitment to such integrative practices for wellness promotion and burnout prevention. Welcome back to the practice scene!
I will soon be coming out with an audio program on self care for busy, stressed health care practitioners. Stay tuned!
Thank you so much for this post!! I’m beginning my therapy practice again after a hiatus, and I find myself craving some concrete self-care practices to incorporate into my day. I think it is so important not only to practice self care (yoga, exercise, etc.) in your life, but also in the moment and throughout the day as you are working with clients to keep yourself refreshed and rejuvenated between clients. Thank you for the great ideas!