Self-Care: The Missing Link in Best Practice – Part II
This is Part II of a two-part article. Part I, published last month, highlighted the ethical mandate for self-care among school psychologists to effectively manage stress and prevent burnout. Part II describes an effort to promote self-care, its application to preservice training, and student responses.
Recognizing the critical need for self-care not only for graduate students but also for school professionals, pro bono self-care workshops were offered last year and eagerly attended by colleagues in public school districts across the state of Connecticut. School psychologists and teachers seemed desperately to want permission to set aside time to focus on themselves. Initially, it appeared that the ethics and burnout arguments for self-care were not persuasive enough to extract a long-term commitment until two additional pieces were added to the message. The first was a neurobiological explanation of the importance of being good role models for students and how self-care facilitates being at one's best. The second is increasing the likelihood that people actually engage in self-care by helping them customize a plan that works for them, including strategies that have long lasting effects.
A Neuropsychological Rationale for Modeling Self-Care
We are a perverse profession when it comes to self-care. We self-sacrifice; we put others first; it's who we are. There is a reluctance to take care of oneself because it is perceived as being selfish. Neuroscience research describing the development of a child's prefrontal cortex (see Hatfield, Cacioppo, & Rapson, 1993; Montgomery & Schore, 2013; Moore, Pfeifer, Masten, Mazziotta, Iacoboni, & Dapretto, 2012; Porges, 2004) was shared to persuade workshop participants and students to put themselves first for the sake of the children with whom they work. The prefrontal cortex, where responsible decision-making and self-regulation occur, is still developing until the mid-20s for some. Youth learn to self-regulate through emotional contagion (“catching” another's emotions by unconsciously mimicking facial, vocal, and postural feedback) and mirror neurons (transmission of internal states from one to another). The condition of an adult's nervous system, as expressed in the adult's behavior and perceived by the student, has a great influence on children and youth– more so than what comes out of an adult's mouth. A child's parasympathetic nervous system is incomplete; it is completed through the unconscious attunement to adults in their environment–for better or for worse.
Once, after I had shared this simplification of brain science with a group of teachers, one of the teachers looked a bit horrified. She recounted an incident that had happened that afternoon with her class. She was walking around the room, as she often did, telling her students to “relax.” But she herself was clearly not relaxed and the students got louder and more unsettled until she realized, not in the moment but in the workshop, that she was shouting “Relax!” in an extremely unrelaxed way. It was a powerful moment for the group and really drove home the critical importance of our ability as adults to provide a calm, self-regulated presence for students’ nervous systems to involuntarily emulate. This is especially crucial for those children who may have unstable, dysregulated adults in their home environments. I have found this information to be most persuasive in motivating practitioners to commit to engaging in self-care.
It is a somewhat counterintuitive mindset that cares for the self before others, especially for a school psychologist. The goal is not just to mitigate burnout, but to proactively promote well-being. In the field of school psychology, putting all others before oneself is the norm. Practicing self-care proactively requires a drastic paradigm shift. Consequently, workshops were designed according to the ADKAR model for change (Hiatt & Creasy, 2003). Hiatt and Creasy maintain that there are five steps for promoting successful change: 1) raise Awareness for the need for change, 2) nurture a Desire to participate in the change, 3) provide Knowledge regarding how to change, 4) develop the Ability to change, and 5) Reinforce the change. The workshop content described below is not provided to preservice graduate students in as concentrated a form; instead, using the same model for change, students receive content gradually and repeatedly throughout their program (e.g., practica and internship classes begin with a 5–10 minute self-care strategy). Professional workshops were developed corresponding to the ADKAR steps as follows.
Raise awareness of need to change. Using video clips, empirical data, and neurobiological research, participants were introduced to self-care as an ethical imperative. I define self-care as the intentional, proactive pursuit of integrated wellness through balancing mind, body, and spirit personally and professionally. This definition has several elements. Intentional means to do something deliberately. It is a purposeful premeditated act (self-care should be planned and scheduled to ensure it is accomplished). To be proactive is to be preemptive (doing something before it has to be done). It is the difference between treating mental illness and promoting mental health. It is essential to proactively practice self-care; otherwise, one is likely to miss warning signs of imminent burnout. Integrated refers to caring for and functioning as a whole person. Finally, to achieve balance one must attend to all aspects of their person (mind, body, spirit) with equal frequency.
Nurture a desire to change. A rationale for and benefits of practicing self-care were shared to create an incentive to engage, including ethical behavior, avoiding burnout, and the effects of adults’ internal states on children. Mindful awareness practices (MAPS) were introduced as a means for creating a calm emotional state (Crum, Salovey, & Achor, 2013; Jazaieri et al., 2013; Neff, Kirkpatrick, & Rude, 2007). MAPS comprise a variety of nonjudgmental, present-moment focus strategies and produce two primary benefits: (a) greater focused attention and (b) self-regulation (Holzel et al., 2010). There is an emerging literature demonstrating the benefits of educators avoiding burnout through practicing mindfulness. One study found that teachers’ mindfulness was negatively correlated with Maslach's burnout components: emotional exhaustion, depersonalization, and perceptions of low accomplishment (Abenavoli, Jennings, Greenberg, Harris, & Katz, 2013): There are other researchers who have found similar results using mindfulness as a primary self-care intervention for educators and therapists to effectively manage stress and combat burnout (see for instance Flook, Goldberg, Pinger, Bonus, & Davidson, 2013; Jennings, Frank, Snowberg, Coccia, & Greenberg, 2013; Roeser, Skinner, Beers, & Jennings, 2012; Shapiro, Brown, & Biegel, 2007).
Educators' mindfulness is one aspect of social–emotional competence that may protect them from experiencing burnout and its negative consequences ... the protective effect of mindfulness was most pronounced among more stressed and more ambitious educators. This study adds to accumulating evidence that mindfulness promotes resilience in educators and may foster healthy educators, classrooms, and students. (Abenavoli et al., 2013, p. 57) Provide knowledge of how to change. After reviewing the literature, I conceptualized two categories of self-care: temporary and enduring. When employing temporary strategies, neurotransmitters are released in the brain depending on what is happening in different regions. For example, dopamine is released when gratitude is practiced, while norepinephrine is discharged when looking at a picture of a loved one (Hanson, 2013). Examples of temporary strategies are spending time with friends (spirit), eating more protein (body), and reading for pleasure (mind). These strategies do not have long-lasting effects because the “feel good” neurotransmitters are released and then subside.
Enduring strategies permanently strengthen the neurological functioning of the brain (see Carter, 2015; Davidson & Begley, 2012; Hanson, 2013; Newburg & Waldman, 2009). Simply put, when information flows through the nervous system, consciously and unconsciously, and neurons fire collectively in regular patterns based on the information represented, neural structures change. Enduring strategies have a mindfulness component. Activities in this category include practicing mindfulness (spirit) and gratitude (spirit), journaling positive events (mind), being awe inspired (spirit), exercising aerobically (body), and conversing about abstract ideas (mind).
Develop ability to change. Participants practiced various self-care strategies to determine those that felt comfortable.
Reinforce the change. The final portion of the workshop was devoted to developing comprehensive self-
care plans, using SMART goals (Specific, Measurable, Attainable, Relevant, Time-Bound) to create habits that cement self-care into daily routines. An example of a temporary SMART goal is: I will meet a friend for a dinner or a movie on the last Friday of every month (spirit, mind, and body). An example of an enduring SMART goal is: After making my tea in the morning, I will focus on my breath for 7 minutes and then study one chapter in my Bible (spirit and mind). As mentioned, the most critical element in developing a self-care plan is to choose strategies that are likely to be regularly utilized based on particular stressors and life circumstances.
Proactively practicing self-care is a necessity to productively manage stress and prevent burnout and, as such, should be required practice and reflected in all professional documents, including those that guide ethical behavior and training. Specific issues can be addressed by practicing concepts like taking in the good to increase optimism (Hanson, 2013), for example. Self-care may seem out of reach for those who think they are too busy (or too anxious, depressed, physically hurt, etc.). But there are strategies that can actually reduce perceptions of busyness by finding the minimum effective dose (Carter, 2015). Selecting the right self-care activities and them consistently in small quantities several times a day can help to alleviate the negative effects of stress (Carter, 2015; Hanson, 2013). Small efforts can produce big returns. Carter, a former marathon runner describes adjusting her expectations so she can be more efficient with her time, ultimately feeling less busy and doing more.
This morning I ran for only nine minutes ... For a former marathon runner, slowly jogging less than a mile a few days a week seems pathetically unambitious. But here's the thing: I'm now consistently running twenty miles more per month than before I drastically reduced my ambitions.” (Carter, 2015, p. 11) She goes on to write that she is stronger, physically healthier, pain-free, and sporting her prepregnancy, athlete weight by exercising consistently in small doses. For this reason, workshop participants are encouraged to thoughtfully develop their self-care plans and adjust them as often as necessary.
In preservice training, self-care has been increasingly spotlighted in my courses in the last 2 years, from the first introductory course to the last internship seminar. Students in a variety of ways have informally highlighted the importance of intentionally making self-care a focus of the program. Primarily, appreciation for the self-care focus has been anecdotal. Students have brought up the wisdom of practicing self-care in conversation with advisors and in class, and a few students have referenced their gratitude for self-care in my course evaluation data.
As described in the literature and in the personal stories of alumni, being a school psychologist is an extremely challenging job. The most persuasive and poignant data I have that self-care is a worthwhile preservice initiative is from unsolicited intern reflections I have received over the last 2 years. I secured permission to share them and I have included excerpts from two of them here.
As a child, my parents always taught me how important it was to go to work. They embodied the concept of a “Protestant work ethic” and expected me to follow in their footsteps. Regardless of their health condition, they would arrive at work to do their duty and make sure to take care of their responsibilities. In addition to going to work, they would ensure that everyone else's needs were met before their own. They always emphasized hard work, dedication, and most importantly, putting others before you. No matter what, they found a way to take care of family members, coworkers, and friends even at the expense of themselves. Therefore, when I began this program I found it very difficult to grasp the concept of self-care.
As I began to practice self-care, I struggled to fully accept the idea and was concerned that practicing self-care would be contrary to my family's values. In fact, at times, I felt like putting myself first was selfish or even self-indulgent. Certainly, I did not want to be accused of being self-absorbed. However, I found that taking a small amount of time to practice self-care helped me to feel better and be more efficient. In the end, I found myself having an internal debate about self-care.
As the new school year approached, I started to think about how I could be the best me and what goals I could set for myself. While searching the Web, I found a quote that spoke to me: “Self-care is not selfish. You cannot serve from an empty vessel.” The more I thought about the quote, the more I realized that I needed to make self-care a priority. I have come to accept that I need to take care of myself and that self-care is an act of survival. I need to find a way to be as compassionate toward myself as I am to others. I recognize that self-care is not narcissistic or selfish but an act of self-respect. So this year, I promised myself to take time to practice self-care and take time off when I am ill, ultimately knowing that taking the time to practice self-care will help me to be healthier, happier, and better equipped to do my job.
All that being said, I am proud to say that when I got sick recently, I stayed home. Despite feeling a bit guilty, I resisted the temptation to go to work ill. I was proactive and went to the doctor. While this may not seem like a big step to some, this was a huge success for me. Overall, I am thankful that my graduate program has challenged me to practice self-care.
REFLECTION 2: ILLNESS AND SELF-CARE - I THINK FAIRFIELD IS SAVING MY LIFE
In the past week, I developed a tonsil infection, learned I am allergic to clindamycin, and have a pending referral to visit an ENT to explore the possibility of surgically removing my tonsils. Being sick and having to slow down has made me focus a lot on self-care, which has made me reflect on the impact of our program on my practice of self-care. It may not seem related to self-care, but I am glad on a weekly basis that I got into Fairfield [University].
The truth is, I have taken horrendous care of myself through my academic career and hadn't really realized the extent of which until this week. I am no stranger to all-nighters, or to forgetting to eat or drink water while completing work, or to consuming far too much caffeine to try to get myself through “the rest of the day,” when I knew I was going to continue the same pattern all week just to keep up. When I got to Fairfield, I was sleeping between 4 hours and 30 minutes a night, driving over 2 hours a day 6 days a week, and consuming probably 250mg of caffeine daily just to keep myself from falling asleep behind the wheel, at work, or in my classes. I spent all my time working, going to school, commuting, and taking care of other people who took my effort for granted. I was not taking care of myself. Naturally, this had an impact on my mood and my body. I was angry and sad and afraid most of the time, doubting my choice to continue directly into graduate school instead of taking a year off, and feeling like I was barely able to keep my head above water. I made it through my first year and decided to continue on with the program.
At the beginning of year 2, I really started to notice the effect that caffeine and sleep deprivation was having on my body. In our counseling methods class, I volunteered to share the difficulties I was having with sleep and got to explore some different options for changing my habits. I made little progress in changing these habits that semester, but I was becoming aware that this was not a sustainable way to live if I didn't want to burn out in my first year on the job. Things started changing for me when we started practicum supervision. Practicum supervision really woke me up to the amount of stress I was under and how little I did to cope with that stress besides smash it down inside and try to go about my day as normal. As we started to go through our different group facilitations, I noticed that I was almost always close to tears, and that my back was holding so much tension that my hands frequently felt numb. I set goals for myself based on our screening tools: I wanted to get at least 6 hours of sleep a night, and spend time doing physical activity instead of spending all of my free time lying in bed watching movies and YouTube videos. Sure enough, as I started to make changes, I started to feel a little better. I cut down on caffeine because of a recommendation by my doctor. I started practicing yoga during some of my free time. At the end of the semester, I made the commitment to find a counselor by the end of the summer to develop better coping skills for dealing with stress.
Without the facilitation of honest reflection and skill building that has been built into our program, I know now that I would have burnt out. I have been too hard on myself with the standards that I set for my own behavior and what I expect that I should be able to do in a day. I have to slow down and listen to my body. Thank you for focusing on self-care with us. I think this is something that many more academic programs need to explicitly teach as a prevention strategy.
Consider this analogy. At the beginning of every airline flight, passengers are told, in the event of a drop in cabin pressure, to put on their own oxygen masks before helping others. These instructions ensure that the persons who are in a position of responsibility are not compromised so they can do what needs to be done to care for others. It recognizes that people cannot help those in their charge unless they protect themselves first. Even this analogy is slightly flawed in that it does not account for the proactive, self-aware necessity of self-care that would not require a reminder to put on the oxygen mask first because the primacy of self-care has been ingrained.
A healthy school psychologist has appropriate boundaries, objective insight into the issues of those with whom they work, the ability to self-regulate their behaviors, and is a model for wellness and adaptive coping. That can only happen through ongoing self-care. It is posited here that proactively practicing self-care is a necessity for school psychologists to productively manage stress and prevent burnout and, as such, should be required practice and reflected in all professional documents, including those that guide ethical behavior and training. There are precedents to guide us. To truly engage in best practice, we must begin with self-care.
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Lopez, Paula Gill. (2016, December). Self-Care: The Missing Link in Best Practice – Part II. NASP Communiqué, 45(4).
