Eduweek 2019 Topic Spotlight: You cannot pour from an empty cup: Self-care for the carer

We interviewed Safia about the topic she presented at Eduweek 2019. Her presentation and workshop were so well received and we wanted to bring this topic to you in an article.  

To be the best version of oneself, self-care is necessary. Although most therapists are familiar with self-care — even preaching the concept religiously to clients — many of us find it a challenge to put the concept into practice in our own lives. We are asked as professionals to provide a tremendous amount of empathy to our clients. We often listen to very tragic and emotionally difficult stories, offering this empathy and providing a safe space in which our clients can share these stories, yet our profession is not meant to be a two-way street. Somehow, when we do this work on a daily basis, there is a need to have a channel in place to receive positive and supportive input. Otherwise, we end up depleting ourselves and don’t have anything more to give. 

What is burnout?  How does it manifest in carers?

Any employee can be burned out, where there is a mismatch between an employee and their work environment, whether through being overwhelmed or overloaded by a heavy work schedule, or experiencing a feeling of lack of control where decisions are made above one’s head.  It could result from a lack of support from the powers that be or one’s superiors.  It could stem from an inability to create work-life balance due to a hectic schedule or the demanding nature of being connected by technology with the need to always be available.  It could result from an employee’s perception that they are being treated unfairly or even through a disconnect between a person’s values and the work that they do.

Where burnout becomes a more pressing issue for carers and care givers who practice in the employee assistance field, is that our workload is getting heavier and heavier. Every time there is an incident of crime, every time someone is traumatised, whether it is personal trauma or work-related, beyond the experience of psychologists and social workers in South Africa we as employee assistance practitioners are inundated with employees who are truly struggling.  The pace can be like a revolving door, where one client leaves and another enters – and you have to be present and actively engaged with them. Our clients need somebody who can offer them some support and containment.  Carers are much more at risk of burnout both because of the nature of the work that we do and the kinds of things that we hear. 

Burnout becomes detrimental because of how it may manifest in carers: in anger towards clients and in not being able to give them what they deserve in terms of the quality of listening and attention.  It leads to being exhausted yet feeling that you need to give more of yourself, so you steal quality time from your family and from rest time.  Burnout leads to detachment and to no longer being impacted.  It is at this point that we have lost something – we’ve lost some of our human-ness.   I think a lot of carers are struggling with this. They want to be there and yet they feel like they are running on empty. 

For the work that we do our reaction to our own burnout is often reactive because we don’t always recognise the signs well enough in ourselves – we recognise it in other people, but looking in the mirror it is not so easy for us to spot as professionals. So often, as carers, our response becomes a reactive one. For example, where a client phones and cancels your reaction is, “Yes, I am so glad that client cancelled – I just want that one hour to myself”.  This is when you need to start asking the question, “Am I burned out, or where is my reaction coming from?

What is vicarious trauma?

Burnout and vicarious trauma are not mutually exclusive.  A carer can have both, because of what they have been listening to and the changes it brings within one as a clinician.  Vicarious trauma leads to burnout very easily because of the nature of the work that we do.

Vicarious trauma is secondary traumatisation stemming from the need to be able to visualise what the client is describing to me.  In order for me to be effective as a therapist I need to be able to visualise what my clients describe. They will paint a picture with their words and where there are gaps I need to ask the right questions to be able to see the big picture.  In order for us to be most effective we have to be able to visualise and experience the trauma together and we can’t cop out of the visualisation.  We can’t hear what someone is saying to us and say, “Gosh that sounds horrific, I am not going to listen anymore.  I just want to block my ears and go la la la” – that’s not an option. 

And, beyond this we also have to have mastery over our emotions.  If someone is describing something to me I can’t have a look of disgust on my face.  Beyond just the being present with all our senses we have to be able to take what they share on board in a way that still makes the other person feel like there is hope, that there is a way forward from their experience.

Prevention is better than cure

Part of self-care is being able to open the pressure valve and our training teaches us how to, to a certain extent.   So, how do we as therapists practice self-care? How do we unwind from the intensity of our individual practice and client issues?  An easy mnemonic for the elements of self-care are A-B-C-D:

A: Assess yourself before you wreck yourself

Physiologically speaking it is important to keep a check on ourselves:  How is my health? Am I run down? Am I eating properly and getting sufficient rest?  Beyond the physiological aspect there is also a psychological element to self care – in the releasing of it.  Interestingly, at my Eduweek presentation I asked how many of the practitioners in the room – about 120 people attended the presentation – have a therapist they can offload to.  There were only a handful of people who put their hand up to indicate they have a therapist that they offload to.  From a personal development point of view this is not necessarily because we as practitioners don’t know the importance of it – we just make very bad clients. We think that we’ll be judged which is very contrary to what we tell our clients.

It may not be necessary to offload on a weekly basis, but when our container is reaching the top it important to speak about how we are feeling and coping – if not in a therapeutic sense then on a professional level.  One of the things I have personally tried to cultivate is a clinical peer support group, which I have been a part of from when I was in the police service, where all the psychologists would get together on a quarterly basis; and then when I left the police service a few of us maintained contact with one another where we can call one another, almost like a peer review group. It is beneficial to be sharing your own experience – not necessarily the clinical part of the case as in, “I have this case and I am feeling a little bit stuck” but rather, “I have this case and it involves an abused child and I am really struggling with my own emotions”.  I do the same with my staff with the eThekwini account. I have five highly experienced, registered practitioners who work onsite at the municipality and I am their clinical supervisor, but also keep up to date on difficult cases and make myself available if they need me to offload and share with. Within Careways we have made this a must-have – because the support structure allows us to be more competent practitioners and better carers.

When it comes to self care – when I talk about A B C D of it – there needs to be an internal locus of control to ensure that when it comes to taking care of ourselves it is not reactive, that it is proactive. It is important to make sure to care for ourselves before a reactive intervention is required– from a relationship, emotional/psychological, physical and professional point of view. 

B: Finding the balance

Whether it is in finding work-life balance or the balance between taking care of yourself and taking care of others, we all need to be taking on some level – not that it is appropriate for our clients to be the ones doing the giving.   I think that many of us believe that how busy we are is an indication of how badly we are needed or how competent we are.  The truth is that there is never enough time to do all that we want to do, and self-compassion should not be an indulgence.  It is a necessity and it requires self-discipline for us to find balance, because nobody will create it for us – we have to create it within ourselves. We have to create our boundaries and we have to stick to them – and this comes from within us.

C: Finding the connection

Finding the connection comes with knowing yourself and finding yourself, where introspection is part of it, but also entails finding a connection to others, whether with other professionals or others in your professional life or people in your personal life.  Connection is about relationships.   If you are a religious or spiritual person it could be a connection to something larger than you are – or it could be a connection with a coach or mentor.  Even if it is that everything is dust, so we are all part of the same universe – we all live under the same sky. It does not matter where we live or what we do, we are all linked in some way. Finding the connection helps people feel like they are part of something bigger.    It may be found through participation in a non-professional organisation through a particular interest, for example attending church, attending mediation sessions or making time to go out to a movie with friends – and all of these things are essential for making the connection – and for achieving balance.  If you ask an employee assistance practitioner, “What do you do in your ‘me’ time?” the answer may well be “Me time’ is for sleep. Sleep is in short supply, so I’d rather sleep than go to the movies.” 

D: Developing your own self-care plan

Having a plan makes the difference between having a dream and a goal. One may ‘kind of’ have plans for what you would like to achieve, but until you have an action plan, and put some flesh to it by writing it down, it is just a dream.  I tell clients all the time to write their plan down – to write down their short-term, medium-term and long-term goals – because then these really are goals and not just a dream.  Then, having written your plan down, it is powerful to pin it up where you can see it every day – not only because you need to be reminded, but because your conscience will be pricked if you are not on route to doing something about it.

It’s like having a study plan. Unless you have a plan you don’t even know what you need to cover. 

Following this plan creates a sense of accomplishment.  If I know that I have to study this many chapters by the end of the week I have a measure of my shortfall or accomplishment – of progress. This provides a sense of achievement, because when we have concrete plans for what we want and are going to do, we are more committed to working towards it.

Life is a journey and will always throw us curve-balls, but when we have goals that are dynamic we can keep changing – the route to our required destination can keep changing as long as we are moving forward; and we don’t have to loop back to our original route, just as long as we keep moving.  We never know what life is going to throw at us and this is part of the adventure.

Helping people is something that I am passionate about and it is not a job – I see it as a calling. For my colleagues who do what I do and who feel my level of passion for helping and getting involved for the love of humankind, my parting words are,  “We are better in the work that we do when we are better to ourselves.”