Leaving It At The Office
Alyssa Button, Stephanie Rovig, and Angela Scarpello
Key WORDS
| Abundance Gaps | Opposed to organizations identifying deficit gaps, the authors recommend they identify abundance gaps, asking: how can we be more responsive, more equitable, and more rewarding? |
| Behavioral Boundaries | The act of temporarily separating yourself from the clinical world by means of routine and time |
| Demands-Supports-Constraints Model | Clinical positions will continue to be demanding, but increasing support and reducing constraints make it rewarding and manageable. This involves increasing support both inside and outside of the office |
| Me-center | A refreshment center, for yourself…in your office! Use a drawer or a file cabinet. Add in personal hygiene tools to refresh yourself in between appointments as well as fresh snacks and water |
| Sensory Diversions | The use of sensory tools (in being aware of surroundings using vision, hearing, touch, gustation, and olfaction) to temporarily mollify forms of painful affect and replenish overtaxed senses |
| Systems of Self-Care | Includes the individual level, the physical environment, the organizational context, and the larger systems of mental health professions (e.g., training programs, licensing boards, mental health professions) |
| Genesis and Maintenance of Self-Care | Involve that of the workplace, the systems, the physical environment, the administration, and the sociocultural context. Self-care needs to be addressed at multiple levels (multifaceted systems approach) |
KEY TAKEAWAYS
- We have a significant capacity as humans to remake our environment. “Psychotherapists are far more comfortable and skilled in changing behavior than in changing the environment.”
- However, psychotherapists tend to overestimate internal determinants and underestimate external determinants of our behavior.
- Organizational and managerial factors also contribute to clinician self-care and the prevention of burnout; it is not solely the individual psychotherapist
- Making changes at the practice/office was the lowest rated self-care activity, yet the environment can have major impacts on us. Perceived quality of care and comfort improve with increase in office softness, personalization, and orderliness. Color choice also tends to impact the experience of an environment. Display credentials/degrees and invest in a good, high-quality chair! How do you make your workspace/physical environment attractive/soothing/professional? To personalize; or not to personalize?
- We can reduce painful affect and replenish our overworked senses. Think of beautiful vacation resorts where we pay to hear music, acquire luxurious fabrics, eat gourmet food, and wear pleasant scents. Consider adding in a refreshment center (e.g., mouthwash, cologne/perfume, brush, comb, washcloth, etc.) and keeping snacks to stay refreshed between appointments. Bring natural light in when possible (use softer colored bulbs when you do not have windows), as natural light boosts comfort and mood.
- In a 2016 review (Pope & Vasquez), more than 80% of psychotherapists feared that a client would physically attack them and about 20% had actually been attacked by a client. We deserve to feel comfortable and safe in our work!
- To prevent violence in the workplace you can: 1) refuse to treat certain clients 2) see clients in secure settings only 3) decline to disclose personal data 4) arrange seating so you sit closer to the door 5) avoid working alone 6) remove objects that could potentially be used as weapons 7) install an office alarm system. What environmental safety implementations have made you feel safe in the past? Anything in these environments you noticed made you feel unsafe? How does multiculturalism and intersectionality come into play?
- Consider your practice as a complete and separate entity. Look at it in a dispassionate and distant way to understand the time that you are spending in ways that are not meaningful to you (e.g., paperwork, scheduling, billing, cleaning). You can hire office assistance, streamline office practices, and hire a business coach or consult for cost-effective approaches. You want to maximize our time doing what we enjoy and do well and minimize what we despise and can outsource. Approach your practice with love, not from a place of fear.
- Separating yourself from the clinical world by means of routine and time (e.g., be mindful of your time between patients or after your last patient go to the bathroom, wash your hands throughout the day, listen to music, consider a longer commute to decompress after the day, etc.). Extra time between patients may be poor time management, but it is good stress management. Keep your caseload at a manageable level. Limit number of high-risk and high-demand patients and schedule final patient of the day carefully.
- Comprehensive research has demonstrated that there is strong relation between a clinician’s sense of control and reported levels of burnout.
- The elements of enhanced control/lowered constraints include: 1) responsive management 2) greater autonomy 3) creative work patterns 4) honest communication and 5) respect for the person of the clinician. How does this apply to us as students/beginning clinicians/being in position where we feel or experience little control? How does this apply through a social justice lens?
- In one study of grad students in psychology, 83% said their training program did not offer written materials on self-care and 63% stated that self-care activities were not provided. How does your graduate program encourage self-care? Where do you still feel discouraged? What improvements can you suggest at a systems level (i.e. licensing boards, mental health leadership, graduate training programs)?
- Advocate for self-care as a means of increasing productivity, enhancing outcomes, and promoting employee satisfaction/retention. Challenge stigma and inaccurate beliefs that psychotherapists who seek support are weak and punishable. Model self-care and build it into the structure of operations (put it on the agenda of each staff meeting, track it as you would client outcomes, organize in-services, include it in staff evaluations).
