Psychotherapist for Severe & Persistent Mental Illness (SPMI) clients

by Christine Guza, M.A., QMHP
(Eugene, Oregon)

If there has been a specific, particularly frightening interaction with a client (e.g., suicide attempt, homicidal ideation, violence related to psychosis), the first and foremost way I engage in self care is to talk to trusted colleagues that may have also witnessed the incident. I believe we need to "tell the story" about what was witnessed to process it on a deeper level to reduce the chances of PTSD symptoms. This story made need more than one telling in different settings with colleagues, supervisors or with close family/family (still retaining HIPPA requirements of confidentiality to protect clients' identity).

In addition to telling the story to others, it is helpful to speak with a trusted supervisor to discover what I (or others) could have done different in the incident and what I learned from it. Then, to take this valuable information to a possible similar incident in the future.

Lastly, for myself, I find that I need quiet time, such as walking in the woods, to independently come to my own conclusions about the incident, objectively, without input that I may have received from others. This can align me with an understanding of how I have perceived the incident while it occurred and in retrospect. I can then see if there may be some distortions or possibly some of of my own vulnerabilities that may have came into play and guided my interventions and my developing belief system as a therapist.

The slow build-up of stress is a bit more tricky to recognize. Usually, it is someone else, in the same or similar profession, that recognizes it first. Heed their warnings!

To keep stress and burnout from increasing its intensity, I have a designated time at night, every night for at least an hour to allow, I do mean allow, myself to stop all thoughts of work (and taking care of my two sons) and engage in activities such as reading, taking a shower & watching a benign movie. I do this before bed each night and look forward to it daily.

I resist thoughts of clients or other work related stressors to try not think of them while in bed. This is my safe place. In a mindfulness approach, I "hear" the thought, recognize, and guide it to recede. If it comes up again, I repeat the latter. It takes practice and is usually quite effective and protects my sleep.

Another way to reduce stress buildup, is to take time away from my home (keeping thoughts of work & clients in their respective territories of the office and client sites) and go for a walk to deeply concentrate on a upsetting topic such as an ethics issue, what direction to take with a client who is struggling or recognizing that maybe there is no more I can do with a client, etc.

As always, consult, consult consult. An additional integral way is to reduce chances of creeping stress is regular supervision. We, as therapists and social workers, absorb so many others' traumatic stories and difficulties experienced in present day lives. We are receptacles and we cannot possibly hold onto these stories alone, for in fact, after all, we are still human, like our clients and need respite.