Self-Care for Therapists

Twin Pull ~ Sara Roizen

Vicarious Traumatization
As therapists, most of us have been a secondary witness to the accumulated traumas that many of our clients have experienced first hand: Physical and sexual abuse, drug and alcohol addiction, rape, illness, and the list goes on…Even the most seasoned therapist cannot help but absorb some of this energy and trauma. This is known as vicarious traumatization. Therapists (as well as other kinds of caregivers) may all experience this form of trauma throughout their work. As we bear witness to our client’s trauma, we act as a “container” for many of the feelings that are too painful for them to hold at the moment. But if we are the container, who contains us? The answer is: we do. But we do not need to do it alone. There are many ways that we can engage in self-care: and it is vital that we do…not only to avoid professional burnout, but also because we cannot truly be present for someone else if we are not present for ourselves. 

Practicing Self-Care
Here are a few methods of self-care that you may find helpful. Some can be practiced in between sessions with clients, while others you may find useful to do after your work day. 

1) You don’t have to be an art therapist to make art!
Many art therapists utilize art making after a session as a way to express and then process any feelings that were triggered by a client. This can be a quick sketch or a painting that is developed over days. The finished product is nowhere near as important as the process of creating it. While making the art, be gentle with yourself and try to suspend judgment. Work as spontaneously as possible. After completing the image, spend some time with it. What is the tone of the picture? How does it feel looking at it? If the image could speak, what would it tell you? If you are in supervision or therapy, it might be helpful to bring this image to your next session and discuss it. Often these images serve two important functions: 1) To release strong emotions (which might otherwise be buried, and 2) Provide us with greater insight into our work with the client, as well as illuminating some of our personal “blind spots” as therapists.

2) Write it out – process notes
Process notes are different from progress notes. Progress notes are clinical chart notes that are written for the purpose of documenting therapy sessions and formulating treatment plans. They are written as objectively as possible – often using phrases such as, “client stated” and “therapist observed” etc. Process notes on the other hand are much more subjective, and tend to be a personal exploration of the therapist’s thoughts and feelings regarding a session. Process notes are never included in a client’s chart. Sometimes therapy intern supervisors will ask for the intern to share his or her process notes during supervision. This is a way for the supervisor and intern to better understand the intern’s approaches and feelings during client interactions. In my second year internship I kept a process note/sketchbook journal, where I processed my feelings and also created imagery related to my experiences. I gained invaluable self-insight through this process, and was able to take greater advantage of my supervision time as well.  

3) Before leaving the building: closing rituals…
Make it a daily habit to create a small separation ritual for yourself before leaving the building each day. Some therapists have a ritual movement that they perform, such as jumping up and down a few times and shaking off the accumulated energy of the day. For others, the simple act of washing hands can bring closure for the day. I often close my eyes for a minute and take a few deep breaths before stretching and shaking my arms. I visualize the heavy layers of traumatic stories sliding off of me. I remind myself that they will be there the next day to dive back into, and that I need the resting space in between to care for myself. 

4)  A hot shower after work
A good friend recently suggested that I begin taking showers at night, when I get home from work. It seems simple, but it can be a powerful ritual. The water physically and metaphorically washes away the accumulated stress and emotions that have built up over the work day. Sometimes I will even spray some lavender oil into the shower, to create an even more relaxing experience!

5) Massage therapy
Most of us can’t afford a weekly massage (myself included), but what about a monthly one? I know that in NYC there are a number of massage schools offering lower priced (and sometimes free) massages, since their students are required to accumulate practice hours to become licensed. Wherever you live, do some searching around, and you might be pleasantly surprised! A massage is beneficial on so many levels. On a physical level it can relax us, release toxins from our body, and ease tense muscles. On an emotional level it allows us a space to just “be.”

6) Don’t forget to socialize
My internship supervisor during my second year of grad school taught me many things. However, one of the most basic pieces of advice that she ever gave me was this: Make plans with friends before work and then tell them not to let you cancel! After a day of work, you will be tired, emotionally drained, and just wanting to collapse. Force yourself to go out and socialize anyway. She was right. After most days of work as a therapist all I want to do is put on a pair of sweats and curl up on the couch…in a way, isolate myself from the world for the evening. However we need to stay connected to the people that matter most to us in life: friends, family, spouses, and children. It is all part of creating a well-balanced life, filled with loved ones, hobbies, adventures, and relaxation time.


7) Join a therapist supervision group
A therapist supervision group is a place where therapists come together to offer each other support and gain insight. Supervision groups come in all shapes and sizes. Some groups are very informal, and might meet just once a month – others meet weekly. There are many art therapy supervision groups that utilize art making as a way of processing thoughts and feelings related to work. Some groups may encourage therapists to take turns giving case presentations about a specific client that they are feeling “stuck” with or confused by. The most important aspect of group supervision is having a place to share and be supported by fellow therapists.



8) Therapists in therapy
This could easily be number one in terms of self-care. (It’s only at #8 because my mind works in a very non-linear way). Not all therapists are in therapy, but I would hope that all therapists have at least been in therapy at some point in their lives. I’ve never been able to fully understand how someone could become a therapist without ever being in therapy themselves. It just seems counter-intuitive to me. (I know not all therapists would agree with this, but it’s my perspective). After all, “You can only take someone as far along the path as you’ve gone yourself.” In order to care for others, we need to care for ourselves. Each person (and therapist) has his or her own personal history, baggage, and accumulated emotions. We do not have to “transcend” all of this to become a therapist, but we do need to be aware of it. Otherwise, the things we have not examined in ourselves may become a barrier to effective therapy with our clients.

9) Pet therapy
My husband and I have two amazingly loving cats (Louie & iko). As soon as I get home they are there – waiting to be picked up and cuddled. Animals are a natural way of connecting to that still place within. When was the last time you saw a cat or dog driven to anxiety by their racing thoughts? Probably never. Spending time with animals often has a calming effect on us. If you do not live with animals, do you have a friend with animals? Offer to take their dog for a walk! (I’m sure they’ll be happy to let you help). Try volunteering at a local animal shelter. Even in a city like NYC, you can certainly find some relaxing entertainment in watching the squirrels dart around the park!


10) Take a breather

 Do not skip your lunch break. I repeat…do not skip your lunch break (and if you’re feeling guilty about grabbing some fresh air, remember that most of us don’t get paid for that time!) A breather can be as short as 5 minutes. You may simply step outside of your building’s doors and take some slow, deep, conscious breaths. If time allows, take a short walk around the neighborhood. If for some reason you truly cannot step outside that day, take a “breather” wherever you are. Turn your attention inwards and place your attention on your breath and any bodily sensations that arise. Check in with yourself…what are you experiencing in this moment?

2 Comments

  1. Lanie Smith   •  

    Wonderful blog Sarah! My thesis was on vicarious trauma and I’m coming back around to the intersection of vicarious trauma, art therapy, and ecopsychology. Love your blog.

    • ats   •  

      Thank you Lanie! And I’m a huge fan and follower of your art therapy work and blog! I would love to read your thesis sometime. Fabulous topic! Your comment was rather synchronistic, as I had been forgetting to utilize some of my own self-care methods in the past couple months – and just now remembering how crucial it is for me so that I can continue doing the work I love. When I saw your comment just now, I actually went back and re-read the post. 😉 Good reminders to self!

Leave a Reply

Your email address will not be published. Required fields are marked *