Leaving It at the
Office:
Psychotherapist
Self-Care
John C. Norcross, Ph.D.
Description
Conducting psychotherapy places
additional and special burdens on
the person of the therapist. This
workshop puts the Socratic dicta
of “know thyself” and “heal
thyself”into practice. We shall
focus on 12 self-care strategies
that are clinician recommended,
research based, and practitioner
tested.
Learning Objectives
Participants will be able to:
 Generate at least 6 self-care
strategies supported by the
empirical research
 Conduct periodic selfassessments of their own
self-care.
 Leave with an individualized
action plan.
What We Will NOT Do
 Light
candles
 Inflate balloons
 Burn paper regrets
 Meditate together
What We WILL Do
 Traverse
the accumulating
research on self-care
 Emphasize self-care
principles or strategies
 Think with the mind of a
scientist, feel with the heart of
a humanist
 Embrace multiple strategies
associated with diverse
theoretical orientations
 Individualize your self-care to
your own vulnerabilities
The Paradox, Irony, &
Ethics of Self-Care
The Paradox: No time to
sharpen the saw
The Irony: Not availing
ourselves of what we
provide/recommend to clients
The Ethics: Personally
essential and professionally
ethical
Theoretical Orientation
and Patient Care
In treating patients, change
processes vary reliably with
the therapist's theory
E.g., CBT therapists use
counterconditioning,
contingency management,
and stimulus control
significantly more
E.g., Psychodynamic
therapists rely more on the
therapy relationship and
catharsis
Theoretical Orientation
and Self-Care
No differences in self-care
processes due to therapist’s
theory
Not even a few statistically
significant differences
expected by chance alone.
Results strongly argue for
considerable similarity
among psychotherapists in
their own self-care
Why No Differences?
1. In psychotherapist role,
people rely heavily on
theories. But in selfchange role, people are
not as influenced by
theory.
2. Possible duplicity
between public careers
and personal lives.
3. Therapists become more
pragmatic, eclectic, and
secular in their own selfcare.
12 Self-Care Strategies



Principles or strategies, not
techniques. Dozens of
techniques under each
strategy.
Probably more effective to
use multiple strategies than
to extensively use a single
strategy.
Must tailor to your own
resources and vulnerabilities
to insure long-term success.
1. Valuing the Person of
the Psychotherapist
 Easier
to be wise and
available for others than for
ourselves.
 Self-care begins with the
premise of valuing the person
of the therapist.
 Alas, this runs against the tide
of managed care and
interchangeable “providers.”
Self-Awareness and
Commitment
 Top-ranked
contributor in
studies to optimal functioning
 Assess your self-care &
satisfaction as you would a
patient’s
 Writing, journaling, logging,
self-monitoring, tracking
 Honest feedback from loved
ones and coworkers
 Making self-care a priority
 Quis custodiet ipsos custodies
(Who will guard the guards?)
2. Refocusing on the
Rewards
 Re-experience
 Notice
 Feel
the privileges
the life rewards
the career satisfaction
 Practice
the mental set
3. Recognizing the
Hazards
 The
classic stressors of
“impossible profession”
 The
new & evolving distress
 Acceptance
 Begin
with self-awareness
and self-liberation
4. Minding the Body
 Don’t
overlook the
biobehavioral basics
 Sleep
 Bodily
rest
 Nutrition
and hydration
 Exercise
 Human
contact
5. Nurturing
Relationships
 Emphasize
the human
element
 At
the Office
Clinical colleagues
Peer support
Supervision groups
Clinical teams
Staff
Professionals in community
Mentors
Clients
5. Nurturing
Relationships (cont)
 Outside
the Office
Spouse/partner
Family members
Friends
Colleague Assistance
Programs
Personal mentors
Personal therapist
6. Setting Boundaries
 Delegate
 Boundary
 Balancing
set
client desires and
self-preservation
7. Restructuring
Cognitions
 Avoid
wishful thinking & self-
blame
 Monitor your internal dialogue
 Watch for selective abstraction,
overwhelming tasks, and
assuming causality (Judy Beck)
 Manage countertransference:
self-insight, self-integration,
empathy, anxiety management,
& conceptualizing ability
(Charles Gelso)
Five Therapist
Musterbations (Ellis)

I must be successful with my
patients, practically all of the
time.
 I must be one of the world's most
outstanding therapists.
 I should have no problems. After
all, I am a therapist!
 I must be liked and respected by
all my clients.
 Since I am a hard-working
therapist, my clients should be
equally persevering.
8. Sustaining Healthy
Escapes
True happiness, we are told,
consists in getting out of one’s
self. But the point is not only to
get out – you’ve got to stay out;
and to stay out you must have
some absorbing errand (Henry
James).
 Beware the prevalent unhealthy
escapes: substance abuse,
isolation, sexual acting out
 Variety in and outside of the
office
Some Absorbing Errands
Vital breaks
Relaxation
Humor
Hobbies
Days off
Vacations
Restorative solitude
Personal retreats
Play: How do you play?
9. Creating a Flourishing
Environment
 Use
stimulus control - the most
neglected strategy
 Avoid the fundamental
attribution error (FAE)
 Take an environmental audit
 Work safety
 Business support
 Behavioral boundaries
 Institutional practices (high
demands plus high constraints
are toxic)
 A self-care village in a
workaholic world
10. Undergoing Personal
Therapy

Commence personal tx at
beginning (90% plus benefit)
 Pursue couples & family tx as well
 Confront your resistance not to
pursue personal tx
 Supplement psychotherapy with
personal analysis
 Return to tx periodically without
shame (52% to 65% reinitiate)
 Obtain annual satisfaction checkup
 Only one form of self-development
(e.g., creative arts, meditation,
yoga)
11. Cultivating
Spirituality & Mission
Spirituality at the Office
 Remember your calling
 Reclaim your “mission” in
life (Maslow)
 Care for others
 Commitment to growth
 Spirituality in clinical work
11. Cultivating
Spirituality & Mission
Spirituality Outside Office
 Pursuing ultimate questions
 Becoming a citizen-therapist
(Tikkun )
 Integrating religion/
spirituality into your
personal life
 Letting your life speak
12. Fostering Creativity
& Growth
 Passionately
committed
therapists: adaptive & open
 Everything comes together
in the creative process
 Diversify: your therapy day,
your clients, your prof
activities
 Growth (e.g., CE, videotape
yourself, prof organizations,
interdisciplinary research)
 And, in the end, do more
than survive: Thrive
In Closing:
A Curious Blend
1. How to
2. You should
3. Chill out
Ave Atque Vale
(Hail & Farewell)
Please
♥ be gentle with yourself (selfempathy)
♥ remember that your life is a
work in progress (temper
corrosive expectations)
♥ recall that you cannot master
or profit from all self-care
possibilities (individualize)
♥ practice self-care as a skillful
attitude and lifelong
commitment
Hail & Farewell