Self-Care: Being a Therapist as a Highly Sensitive Person

Since 2015, I have slowly increased my weekly clinical hours. Along with this, my clinical skills have been refined. As mentioned in previous posts, I have moved more towards a clinical orientation rather than 100% focused on research.

Here's some background: One of my first jobs was in a psychiatric rehabilitation job that was full-time after graduating college. I loved this experience, but it was stressful for me. When working FT, my office was right in the middle of  the "milieu" area and the office was bright yellow. I had constant visitors. The bright yellow was very abrasive and I think it wore on me over time. I burned out in about 3 months of my 10 month position there. I continued to enjoy working with clients but was constantly stressed and didn't know what to do about it. So I told myself I never wanted to be a full-time clinician because I couldn't handle it. I thought it was just a personality flaw that I was too anxious or too sensitive to work 1-1 with people 40 hours a week. I knew I'd have to do some clinical work with my training, but accepted the fact that I'd never be a clinician.

My view of myself as a non-clinician continued until 2016 when I started my first clinical experience with some skills and more knowledge under my belt. This job completely flipped my career path plan 180 degrees. The work was more rewarding than any other job I had. I saw people improve drastically and built real therapeutic relationships with people. However, along with this experience, the stress has continued.

I recently discovered a personality trait called "Highly Sensitive Person" (HSP). This is defined by people who are very sensitive to a range of things: sensory information, social interactions, hunger, pain, etc. This has been eye-opening for me and has helped me gain insight into this trait and how to harness it.

I think being an HSP as a therapist is a blessing and a curse. On the one hand, I feel that I often am attuned to how people feel and subtle changes they show. My sensitivity to this can enhance the therapeutic alliance with empathy or simply bringing my observations to light. On the other hand, sometimes clinical work can be overwhelming for me. Too much social interaction is tiring for me (both as an HSP and an introvert). When people are feeling intense emotions, I feel it too. When I have a full day of therapy, I'm exhausted.

I've been thinking about self-care lately because I went over the edge recently. I was feeling really anxious for a few weeks. I had a socially-busy weekend coming up. On the first event on Friday, I did not want to go out but decided to anyway. I told myself "Just stay out a little while. You can go home early, but showing up is important to maintain friendships." So I went out. The event was in a busy area of town, and parking took about 10 minutes. As soon as I parked I received a text saying that plans had changed location, so I had to re-park. At this point my anxiety was building from the busy environment, stimulation, parking, people, etc. I was annoyed but decided to "go with the flow" of the plans. So I drove to the new location and looked for parking. This area was even worse. Only parallel parking was available. Cars were all around. Pressure was mounting. I tried parking 3 times with no success. I didn't realize how high my anxiety was until I had a low-level panic attack while driving. So I went straight home and tried to calm down. I lied on the couch and got under the covers. I put on my favorite self-care movie "Little Miss Sunshine" and hung out with my cat. 

That night, I had a lot of time to think. I thought about the past week. I realized I did not once take a lunch without working through it. I did not have one work day less than 9 hours. I did not eat enough green veggies. I thought, "Wow. What terrible self-care." And the past few weeks before this one were almost equally as bad. I've always been told, as a therapist, you have to take care of yourself first to take care of your clients. Self-care is something I know is important, but I never really think about it. But after this week, I realized how important it is. I decided to stay in that whole weekend to recharge. Even though I felt guilty for cancelling on my friends, I knew staying in was what I needed more than going out.

I have to remember to listen to my body and mind and take care of both. My job as a therapist is so important to me. But I can't be an effective clinician if my insides are deteriorated. I have my own battery that needs to be recharged daily. I think HSPs need even more self-care than someone who isn't an HSP because of the "easily overwhelmed" quality. I've thought about self-care before in its relationship to being an introvert. But realizing the addition of being an HSP has increased my awareness of self-care even more.

I am the type of person who sometimes has to go past my limits to realize them. I will use this experience to remember my boundaries of self-care. Prevention and maintenance are very important in self-care and maintaining mental health. I went over the edge that week and do not want to experience that again. It might happen, but I will do my best to remember my own boundaries.

Professional Identity Thoughts

This past year has really made me think about my professional identity and future career. I always used to say "I never want to be a therapist! I can't imagine having to listen to people's problems all day." But now, as I enter my third year of supervised clinical work, my perspective is completely different.

My first year of clinical work was not very fun. I worked at an outpatient community health facility that serves low-income people. Supervision was less than ideal, student interns were very under-valued, and client turnover was huge. This first year basically reinforced my idea that clinical work was not for me.

My second year of clinical work was completely different. I worked at a state hospital in a long-term psychiatric unit. The majority of the people on my unit had schizophrenia and are often treatment-resistant (meaning they do not respond well to anti-psychotic medication). I did both group and individual therapy. All my individual therapy clients were diagnosed with schizophrenia. I was supervised by a psychology intern weekly as well as informal supervision from the unit psychologist.

This year really changed my view of clinical work. First of all, it was the first time I really experienced formal, individual therapy with people diagnosed with schizophrenia. It was very challenging, eye-opening, and rewarding at the same time. As I continued to gain experience, I realized my own strengths as a clinician and my ability to effectively work with individuals with schizophrenia. I feel that working directly with this population is not something every clinician is good at, or even wants to do. Second, I learned how much progress can happen in a full year of consistent therapy. When it got closer to my year as a practicum student ending, I knew I couldn't leave. So, I spoke to my supervisor and figured out a way to stay and continue seeing a few of my clients. I decided to do this because all of the clients I started therapy with were still hospitalized. I figured I could continue to build the progress I had seen while learning clinical skills along the way. The course of recovery from schizophrenia can be a long one, and I feel very grateful that I can continue to help a few people I started with to build their growth.

I think I enjoyed it so much because of the clinical presentation of the clients and the setting. I had experience with schizophrenia in the past, but this was in psychiatric rehabilitation programs, which can be pretty different than formal therapy. Also, I really enjoyed the inpatient setting. It helps maintain consistency with sessions and rapport-building with clients. And I enjoy collaborating with professionals at the hospital. Some of the nurses are really amazing and I love getting their perspective on clients. The psychiatrists are really good and the chair of psychiatry is doing a great job building the department. And there are several psychologists who are amazing and really care about the clients. Finally, there are some great techs who have their own views of the clients and welcome collaboration daily.

The culture of the hospital is different than other places, too. A few of the clients (sadly) have lived there a long time. Some of them between 5-10 years. Most of them want to get out, but sometimes people want to stay there forever. While you are there, you really get to know the clients well. Certainly the people I have met with for therapy, but many others through groups and informal interactions. It is amazing to get to know people there and really experience how amazing people are underneath their shells. I have had such a great experience here that I am seriously thinking of being a full-time clinician. I hope to do this and still be involved with research. I think staying in touch with research is so important to be an effective clinician.

Well, those are my thoughts for now...

Clinical Work is a Challenge

Today I am thinking about how challenging clinical work (and being a Psychologist) is.

Lately I've thought about the intimacy of individual therapy specifically.  I currently work in a long-term inpatient hospital, so most individuals are in the early stages of their recovery. Many have not accepted that they have a mental illness, and are doing their best to disentangle their experiences. So, when clients share their experiences with me, I feel very fortunate to have gained a level of trust that allows this.

The experience of psychosis seems very scary and can include extreme paranoia and hallucinations. When these symptoms aren't controlled, they can take over your whole being and be very overwhelming. I can completely understand a person questioning whether or not this experience is a "mental illness" or if it's reality. If something so powerful and compelling to surround your world, it is your experience, which is your reality. I think being in the system focuses a lot on labels, which are very difficult to comprehend in the early stages of recovery. Labeling your experience as a "mental illness" has its pros and cons, and I think each person has the right to interpret their experience however they want.

I really love doing therapy with individuals diagnosed with schizophrenia. Last year, I really hated therapy (I think this was because of the setting I worked in) and a few years ago, I hated clinical work (I think that was due to lack of experience and other factors). This year has made me question (again) my career path. I'm starting to feel like I need to do clinical work in some capacity. I feel like my skills will be wasted, and they could be used for good. I love research, too, but I need to figure out how to balance the two.

People often ask me how I became interested in schizophrenia -- well, that's a complex question with many answers. One of my answers is because I really do love it, and I think my strengths as a clinician fit well with this population. Also, there are unique challenges that accompany the diagnosis, and I believe being a schizophrenia specialist is valuable. So, I've put a lot of energy over the past 10 years in learning and working with this population. Maybe this is why I've felt overwhelmed at times while at the hospital, or after a long day of clinical work. So much of my energy is often devoted towards my specialization, and this year I've really had the opportunity to put these skills to the test. I really care about the people I work with, and hope the best for them. Maybe I put pressure on myself. But that's OK. I want to live up to my potential and really help those in need. Everyone deserves to live a meaningful life. I seek the skills necessary to make this possible for as many people as I can help.

I am feeling very contemplative today. I look forward to returning to the hospital on Monday...

Inpatient Therapy Reflection: First 5 Months

I missed a week of therapy with my clients, and I really missed it! Two of my clients missed two sessions because they did not want to meet twice in a row, and all of my clients missed another session with my week out.

I was at the hospital Thursday, and was reminded how much I love it. On top of that, I had three out of three really great sessions with my clients. Last year, my first year of conducting individual therapy, was really challenging. I constantly worried about my clients' well-being and never felt like I was doing an "evidence-based practice". Therapy was stressful most of the time, and did not feel very rewarding. This year is feeling very different. I look forward to going to the hospital every day (which never happened last year), I am starting to feel like I am really integrating evidence-based practice correctly (which I rarely felt last year), and I am a lot less stressed than I was last year. I think part of this change might be the setting (I am really loving inpatient) and part of it might be that I'm feeling more comfortable conducting therapy. A big part of it is also the population. I really love working with people with serious mental illnesses and schizophrenia.

I met with a coworker to discuss some clients and coordinate treatment. One thing she said that stuck with me was "You have to find their strengths", referring to people with serious mental illness (specifically schizophrenia). She really emphasized each person's qualities that make them unique and clearly cared for each person she works with. It takes a certain clinician to speak in this way, and I really love working with these types of people. If we, as clinicians, are able to show people their strengths, and highlight those, every person can have a meaningful life.

I have been wanting to do this for so long -- sometimes it feels surreal. Working with this population is the most rewarding thing ever. People really appreciate the time you spend with them and are very open. This population has a horrible reputation, and I find that very sad because some of them are the best people I've ever met. When the day comes to leave this place, it will be a very sad day. I am thankful to spend time with these individuals.