Interview with Erica H. Wise, Ph.D., Clinical Professor and Director of Psychological Services at the University of North Carolina
Some would believe that living in paradise or in Hawaii offers every opportunity to consider, plan, and implement regular self-care strategies. After all, I am surrounded by the mountains, ocean, and sunny weather…with a chance of more sun. Although these vivid and simple reminders exist as they do anywhere, there is more to be understood about being mindfully aware and engaging in self-care both in clinical practice or training. Fortunately, there appears to be a growing interest in the literature on psychologist self-care with various recommendations on how to build and maintain a healthy career in our profession. It seems that with the increasing awareness and significance placed on self-care, there will be a positive impact on students and their practice. I turned to Dr. Erica Wise, who has published in the areas of self-care, ethics, and education and training to help, as she would say “spread the word,” about psychologist self-care and training students.
LCS: How did you become interested in providing education and training on the topic of sustainable psychologist self-care?
EHW: In about 2005, I had recently completed several terms as a member and chair of the North Carolina Psychology Board and was serving as co-chair of the North Carolina Psychological Association (NCPA) Professional Affairs and Ethics Committee. I was contacted by my colleague, (Steve Mullinix, Ph.D.) who was then chair of the NCPA Colleague Assistance Committee (CAC), to discuss a program development request that had come from the NCPA Program Committee. The request was an intriguing one: to develop a formal continuing education workshop for psychologists in North Carolina that would integrate self-care and ethics. This was completely new territory to me. For many years I had presented traditional ethics workshops and taught a graduate seminar that focused on complex ethical dilemmas in various areas of psychological practice, teaching and research. It was not at all clear to me how ethics and self-care could be coherently integrated into a workshop. In addition, I was not particularly interested in self-care, which at the time seemed to be a rather fuzzy concept to me--something that fit best in a self-help book. However, I was also intrigued with exploring the notion of reducing the risk of ethical problems through a consideration of positive psychology and stress management. It has been frequently noted (albeit anecdotally) that psychologists who are isolated, highly distressed or overwhelmed are more likely to engage in unprofessional conduct. Conversely, it is commonly understood that ethical/legal complaints and high risk clients are a source of tremendous stress for psychologists. We reviewed the literature and we were impressed by the formulation of the “stress-distress-impairment-improper behavior continuum for psychologists” as identified by the APA Advisory Committee on Colleague Assistance (ACCA, n.d.) and realized that this construct could serve as an organizing principal for our workshop. As defined by ACCA, “stress” refers to how our bodies react to external or internal demands, “distress” to the subjective state of experiencing anxiety, pain or suffering, “impairment” to resultant compromised professional functioning and “improper behavior” to the resultant unethical or incompetent practice. With these ideas in mind I carefully re-read the APA Ethics Code and it became clear to me that the standards on competence were directly related to self-care. In fact, as I worked to develop the didactic ethics content, I was struck by how easily the concepts (once identified) flowed. Since that time I have gradually become more familiar with (and have begun to contribute to) the burgeoning literature on self-care for psychologists. (Response adapted from Wise & Gibson, 2012).
LCS: In the multiple roles we balance, what might help us to integrate self-care strategies into our daily routines?
EHW: In about 2010, in collaboration with a former graduate student (Matt Hersh, Ph.D.) and a then-current graduate student (Clare M. Gibson, Ph.D.) my ideas about self-care for psychologists began to evolve significantly. In our work together we developed the notion of underlying principles that we believe contribute to effective and sustainable self-care. We considered these to be the “how” of self-care (as in how to approach self-care) as opposed to the “what” of self-care (as in specific strategies or techniques). There are an array of resources devoted to potential strategies and techniques. As defined in our article (Wise, Hersh & Gibson, 2012), we identified four foundational principles:
LCS: What are some ways that a supervisor might incorporate self-care encouragement, education, and instruction into supervision with students?
EHW: I believe that there are many opportunities within the supervision context to focus on self-care. For example, the supervisor might discuss the notion of reciprocity—that we need to “practice what we preach”. For example, the trainee might be encouraged to select an area of stress or distress in their own life and practice CBT or other psychological approach. This has the benefit of increasing awareness of what it is like to actually apply the techniques that we recommend to others. In addition, these strategies are likely to improve the functioning of the trainee. Trainees in our field are exposed to a wealth of wisdom from within our own field for how to improve personal functioning and can benefit from being encouraged to incorporate the principles into their own lives. Early training is an ideal time to learn sustainable skills, such as how to effectively manage administrative responsibilities, establish healthy boundaries, etc. Supervisors can be an important source of positive influence by modeling self-care.
LCS: How can we influence clinics or training programs to be proactive toward the practice of sustainable self-care?
EHW: Self-care is now recognized as a foundational professional competency by the American Psychological Association. I believe that the four foundational principles outlined above are the best approach. Training programs, clinics and other sites at which psychologists work can provide support and encouragement to set high standards while also recognizing the professional hazards of psychological practice and engaging in sustainable self-care. Support from supervisors or administration can create a positive expectation within training programs and agencies.
Thank you, Dr. Wise, for taking the time to help us understand more about sustaining self-care. The four principles: flourishing, intentionality, reciprocity, and integrating, seem essential to maintaining a reflective practice and making the necessary adjustments. Through this, self-care can steer us away from the stress-distress-impairment-improper behavior continuum. It is good news that self-care promotes healthy change in our own practice and that of our trainees as well as the agencies and communities that we serve. In returning back to the start of this entry, it appears that self-care is better than any simple reminder.
Dr. Laura Cho-Stutler is a Deployment Behavioral Health Psychologist with CDP at Tripler Army Medical Center in Hawaii
Wise, E.H., Hersh, M. A. and Gibson, C.L. (2012). Ethics, self-care and well-being for psychologists: Re-envisioning the stress-distress continuum. Professional Psychology: Research and Practice, 43, 487-494.
Wise, E.H. & Gibson, C.M. (2012). Continuing education, ethics and self-care: A professional life span perspective. In: Neimeyer, G.J., Taylor, J.M. (Eds.) Continuing Professional Development and Lifelong Learning: Issues, Impacts and Outcomes. New York: Nova Science Publishers, 199-222.
Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66, 579-592. doi:10.1037/a0021769