Self-Care: The Vanquisher of Distress

“The heart pumps blood to itself, before the rest of the body.”

In the previous blog, we discussed self-care and how it ought to be made essential for a practicing psychologist. Self-care is defined as the behaviours and actions taken to increase one’s mental and physical well-being and resilience. Self-care helps in increasing a therapist’s competence as it models healthy behaviour for the client, enhances self-esteem and confidence, expands the therapist’s reservoir of empathy, and reduces the occupational hazards of compassion fatigue, emotional burnout, and vicarious trauma. Self-care is not a voodoo science. Extensive research has shown that self-care improves attention, immune functioning, self-esteem, empathy, and counselling skills (Schure, Christopher, & Christopher, 2008; Shapiro, Brown, & Biegel, 2007).

Empathy and vulnerability form the basis of self-care. These terms are often used casually in conversations, yet one may have failed to understand them. Wiseman (1996) classified empathy into four crucial parts. Empathy is built upon the cornerstones of perspective taking, non-judgementality, emotional recognition or understanding another’s feelings, and communication of the understanding. A therapist ought to apply the same concepts to themselves; for instance, they must not judge their own thoughts and feelings. A competent therapist would have to recognize their own emotions and communicate this understanding to their conscious mind. Empathy can’t be limited to clients only but has to be extended to therapists themselves. Empathize with your body, empathize with your brain, and empathize with your own depleting empathy.

Vulnerability is a vital part of self-care. Brene Brown, one of the pioneers in research on vulnerability, says that “Vulnerability is the birthplace of innovation, creativity, and change.” She found that embracing one’s vulnerability and breaking the power of shame helps people in forming connections and fostering self-growth. Therapists should not see themselves as all-mighty superheroes. Accept your vulnerability, acknowledge your limits, and don’t be ashamed of seeking help when needed.

Hence, a self-care regime should involve practices that help you empathize with yourself and cultivate acceptance of your vulnerability. There is no one correct method of self-care. It can be tailored to your own interests and needs. Practicing mindfulness, exercising, practicing yoga, walking, reading, listening to music, or even watching trashy reality TV can be a form of self-care. I have had a colleague tell me that she would take 30 minute nap every day in order to reenergize herself. A therapist should also seek supervision as it acts as a constant source of support. Often a supervisor would be able to spot the signs of compassion fatigue or emotional burnout in a therapist and would prevent him/her from falling down the rabbit hole.

You must have surely noticed how vital self-care is, as well as how easy it is to practice. However, one of the common barriers to self-care is lack of knowledge. It is not an aspect of formal training. There might be PowerPoint presentation on it but that’s where it stops. It should be promoted just like any other counselling or clinical skill. Hence, self-care should be a fundamental part of a therapist’s daily regime. It should treated as a vital skill for we often hear the age-old adage “Prevention is better than cure.”

Here are some resources to get you started, because the first step to practising self-case is learning about it.

Brene Brown: The Power of Vulnerability

Caring for Ourselves: A Therapist's Guide to Personal and Professional Well-Being by Ellen K. Baker, PhD

Prachi Bhuptani

Rethinking Scarcity in Economics

Mullainathan, S., & Shafir, E. (2013). Scarcity: Why having too little means so much. Penguin UK, 2013; pp. 304, Rs. 504.

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Economics is often described as the science of scarcity; indeed, if there is any single foundation for economic science, it may well be in understanding the way society utilizes resources. While almost every theory in economics hinges on understanding decision-making under various conditions (uncertainty, initial endowments, among others), it is only in the past three decades that psychological factors have been incorporated into economic models of decision-making. Scarcity is the latest in a spate of behavioural economics research that looks to build a comprehensive and cohesive economic theory of decision-making with strong foundations in psychology (see also: Nudge [Thaler and Sunstein, 2003]; Thinking, Fast and Slow [Kahneman, 2011]; The Honest Truth About Dishonesty [Ariely, 2013]). In defining scarcity as a ‘mindset’, Sendhil Mullainathan and Eldar Shafir are able to argue for altered decision-making processes and outcomes when we perceive that we have too little, which is not as ubiquitous as physical scarcity of resources that economics studies.

First, the authors propose a taxonomy of various concepts (drawing from psychological science) that define scarcity. At the heart of this theory are two interrelated ideas of mental bandwidth and tunnelling. Intuitively, bandwidth refers to the mental capacity of an individual to focus on the task at hand under constrained processing capacity, while tunnelling refers to the refinement of our mental faculties toward a task that requires our immediate attention, that is, the one that is ‘causing’ the scarcity. Over the course of the book, the authors propose a cost-benefit approach to understanding how scarcity works: it often endows us with the short-term benefit of being able to focus better on the task at hand, but also tends to cost us our attention toward other concerns, leading to suboptimal decisions.

Scarcity is often seen in the form of three dimensions: (a) money or financial considerations; (b) time or temporal constraints; and (c) social constraints. While (a) and (b) are common areas of research in economics (particularly behavioural economics), the influence of social constraints on decision-making has only recently been explored. The authors argue that scarcity in the social dimension could refer to social isolation; for example, not having many friends or an active social life. Thus, socially isolated individuals may tend to perform worse under situations with high scrutiny, such as a date or a job interview, relative to situations where their every action is not observed.  However, simply being commonly drawn from the underlying theory of scarcity need not imply that poverty influences decision-making in the same way that being socially isolated or busy would.

The final part of the book deals with applying scarcity to everyday situations, organizational behaviour, and designing policy for individuals affected by scarcity (not unlike the libertarian paternalism in Nudge). Taking varied examples from commercial airline pilots to parenting, the authors provide cogent arguments about how people’s decisions are affected by their mental capacity as well as the environment that creates such constrained mental capacity. Despite the strong background work carried out by the authors, the book relies heavily on theoretical and hypothetical arguments, rather than employing empirical evidence (as most well-formed economic theories eventually do).  Additionally, there is little discussion of the types of psychometric tests that may be used in order to comprehensively measure scarcity, perhaps in an effort to keep the material accessible to non-scientific readers. This is perhaps a notable future course of research in scarcity and decision-making, bolstering empirical evidence for its influence.

The theory of scarcity as proposed is a novel conceptual leap for the fields of economics as well as psychology. This book is better taken as a starting point to an evolving area of research and thinking that holds considerable weight for understanding what goes on in the process of human decision-making. To some extent, Scarcity also deals with the issue of how much the environment in which the decision-maker is placed in influences decisions, and further how this environment may be endogenously determined by the decision-maker. Indeed, there is much to be learnt about behavioural economics by pursuing this line of inquiry.

Anirudh Tagat

Self-Care: Create your own calm

“Self-Care is not selfish. You cannot serve from an empty vessel.”

Over the course of their training, psychologists have often been told to maintain objectivity in their work. They are supposed to suspend their personal beliefs and feelings and look at clients with clear glasses. However, psychologists cannot discard empathy and compassion for they are the tools that help them connect with clients. Without these two, a psychologist is rendered as a mere robotic device that hears their clients, but does not listen.

However, the act of being compassionate and empathetic comes with a hidden cost, especially for clinical psychologists as they traditionally see clients with more complex issues. Compassion fatigue and emotional burnouts are prevalent in increasing rates amongst helping professionals. Compassion fatigue is a psychologist’s reduced capacity to feel empathy, positive regard, or authenticity for their clients and is usually “the natural consequent behaviours and emotions resulting from knowing about a traumatizing event experienced or suffered by a person” (Figley, 1995, p. 7, as cited in Adams, Boscarino, & Figley, 2006). Psychologists use compassion to increase the effectiveness of their therapy. Unfortunately, feeling compassion for clients also puts psychologists at the risk of compassion fatigue. It becomes a serious issue as it decreases psychologists’ competence in helping their clients. The APA Ethical Principles of Psychologists states that “psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.” This means that a psychologist shouldn’t practice when they find themselves experiencing compassion fatigue as it affects their ability to foster the well-being of their clients.

Experiencing compassion fatigue for a longer duration can lead to an emotional burnout. It is characterized by emotional and physical exhaustion, depersonalization, and reduced personal accomplishment (Maslach, Schaufeli, & Leiter, 2001). When psychologists do not release their emotions regarding their work, the resulting emotional exhaustion provides the perfect breeding ground for emotional burnouts. All mental health practitioners experiencing burnout disengage from work, which consequently leads to decreased competence. Both compassionate fatigue and emotional burnouts can create feelings of depression, anxiety, and helplessness amongst therapists. Ironically then, the therapist herself/himself becomes the client.

All helping professionals like nurses, emergency room personnel, police, and mental health providers are equally at risk for becoming victims of both compassion fatigue and emotional burnouts. However, clinical psychologists who tend to survivors of trauma are at a unique risk of experiencing vicarious trauma. Vicarious trauma occurs when psychologists develop trauma reactions after being exposed to their client’s traumatic experience (Trippany, Kress, & Wilcoxon, 2004). Psychologists start exhibiting symptoms of Post Traumatic Stress Disorder such as experiencing intrusive thoughts and images of their client’s stories along with physiological arousal and somatic complaints. Researchers working in the field of trauma are also not safe from vicarious trauma (Bell, Kulkarni, & Dalton, 2013). All psychologists are vulnerable to compassion fatigue, emotional burnouts, and perhaps, vicarious trauma. The only thing that can buffer the effect of this debilitating kryptonite is self-care. This includes all behaviours and actions taken to increase mental and physical resilience and well-being. Self-care acts as a safeguard against psychological distress caused over the course of a psychologist’s career; it recharges the therapist and helps them cultivate optimism.

Thus, self-care helps a therapist navigate around these pitfalls of compassion fatigue and emotional burnout. The next blog in this series will include various kinds of self-care techniques as well as some common things that get in way of it.

Prachi Bhuptani