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Intern Self-Care: An Exploratory Study Into Strategy Use and Effectiveness.



In this exploratory study, 363 interns were surveyed to assess the frequency of use and effectiveness of self-care strategies used during the internship year. Among the most frequently used strategies were family and friend social support, active problem solving, and humor. The most effective strategies were family and friend social support, seeking pleasurable experiences, and humor. A strong positive relationship was found between total scores for Frequency and Effectiveness subscales, and women reported significantly more use and effectiveness of strategies. Recommendations and resources are provided for interns and internship sites that seek to further understand and encourage intern self-care. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Marquette University
Education Faculty Research and Publications Education, College of
Intern Self-Care: An Exploratory Study Into
Strategy Use and Effectiveness
Joseph A. Turner
University of California - San Francisco
Lisa Edwards
Marquette University,
Iverson M. Eicken
Los Angeles, California
Kayoko Yokoyama
John F Kennedy University
Jennifer R. Castro
University of Southern California
See next page for additional authors
Originally published in Professional Psychology: Research and Practice, Volume 36, No. 6 (December
2005), online at:
Joseph A. Turner, Lisa Edwards, Iverson M. Eicken, Kayoko Yokoyama, Jennifer R. Castro, Amber Ngoc-
Thuy Tran, and Kristee L. Haggins
This article is available at e-Publications@Marquette:
1 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
Intern Self-Care: An Exploratory Study Into Strategy Use and
Authors: Joseph A. Turner, University of Californian, San Francisco; Lisa M. Edwards,
Marquette University; Iverson M. Eicken, Los Angeles, California; Kayoko Yokoyama,
John F. Kennedy University; Jennifer R. Castro, University of Southern California; Amber
Ngoc-Thuy Tran, Kaiser Permanente; Kristee L. Haggins, University of California, Davis
In this exploratory study, 363 interns were surveyed to assess the frequency of use and
effectiveness of self-care strategies used during the internship year. Among the most frequently
used strategies were family and friend social support, active problem solving, and humor. The
most effective strategies were family and friend social support, seeking pleasurable experiences,
and humor. A strong positive relationship was found between total scores for Frequency and
Effectiveness subscales, and women reported significantly more use and effectiveness of
strategies. Recommendations and resources are provided for interns and internship sites that
seek to further understand and encourage intern self-care.
To what extent do psychology interns use self-care strategies to manage the rigors
associated with internship training, and how might psychology professionals and trainees
conceptualize intern self-care behaviors? The internship experience has been described as a
significant time in the career of a professional psychologist (Kaslow & Rice, 1985), and numerous
stressors have been associated with the internship experience (Solway, 1985). These include
things like adjustment to demanding fulltime clinical work, a changed sense of professional
identity, and concern about performance evaluations (Lamb, Baker, Jennings, & Yarris, 1982).
Little research or theoretical literature has focused on how interns manage the demands during
the internship experience. Similarly, no specific framework of self-care has been applied to
self-care for interns. This exploratory study represents the first empirical attempt to examine the
use and perceived effectiveness of self-care strategies among doctoral-level psychology interns
at American Psychological Association (APA)-accredited internship sites.
Psychotherapists report that their jobs and job responsibilities are demanding
(Kramen-Kahn & Hansen, 1998). Clinicians may be vulnerable to symptoms of depression (Gilroy,
Carroll, & Murra, 2002; Heath, 1991; Pope & Tabachnick, 1994) and when compared with
2 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
research psychologists, they have reported higher rates of anxiety, depression, and emotional
exhaustion (Radeke & Mahoney, 2000). Moderate to high levels of stress were observed in a
sample of British clinical psychologists, and specifically, women and the less experienced, less
socially supported participants reported greater psychological distress (Cushway & Tyler, 1996).
Several theories have been proposed to account for the stress that helping professionals
experience. Figley (2002) suggested that in the process of helping traumatized or suffering clients,
therapists became fatigued and stressed as they supported and empathized with the client
(secondary traumatic stress). Zapf (2002) reported that burnout and emotional dissonance stem
from the occupational requirements of sensing, displaying, and managing emotions (“emotion
work,” p. 237).
In addition to the occupational hazards they face, psychotherapists may lack adequate
self-care practices that are critical to offset the effects of stress (Baker, 2003; Figley, 2002; Gilroy
et al., 2002; Guy & Norcross, 1998; Norcross, 2000; Skovholt, Grier, & Hanson, 2001). Among
studies that have assessed practitioner self-care, Mahoney (1997) found the most commonly
used behaviors were reading for pleasure, exercising, taking vacations, having a hobby,
supervising peers, and praying or meditating. In a series of studies by Coster and Schwebel
(1997) and Schwebel and Coster (1998), practitioners and heads of psychology programs
reported the factors that contributed to preventing and coping with stress (“well-functioning,” p.
284) included self-awareness, balance between personal and professional lives, relationships
with family and partners, and personal values.
Skovholt et al. (2001) stated that “[C]ounselor training, congruent with the nature of the
work and the people in it, is predominantly other-focused...with relatively little attention given to
care for the self” (p. 168). This has been echoed in anecdotal reports in which graduate students
have said they lack adequate training and role models for self-care (DeAngelis, 2002). This is
cause for concern for interns. Because they lack experience and confidence, interns may be more
vulnerable to clinical stressors. For example, Rodolfa, Kraft, and Reilley (1988) found that
practicum and intern trainees perceived clinical experiences like lack of client progress, inability to
help clients feel better, and giving painful feedback to clients as more stressful than professionals
did. Inadequate training in serious clinical experiences such as suicide, violence, and
interpersonal victimization (Kleespies & Dettmer, 2000) may further add to trainee stress. In
addition to clinical stressors, interns struggle with personal problems as evidenced by one study
of British psychology trainees; Brooks, Holttum, and Lavender (2002) reported that 24% of
trainees in their sample scored significantly higher on self-esteem and work adjustment problems,
3 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
depression, and anxiety compared with a normative sample.
Research on the personal resources of interns has found that the perception of training as
manageable and the maintenance of social support are related to fewer problems in
psychological adaptation (Kuyken, Peters, Power, & Lavender, 2003). Despite this promising
research, no studies have investigated the types of self-care strategies that interns use. Given the
demands and stressors associated with the provision of psychological services in general and the
unique nature of the predoctoral internship specifically, it seems imperative that interns, like
seasoned professionals, work to maintain adequate self-care.
In response to the need to identify self-care strategies and encourage practitioners to use
them, Guy and Norcross (1998) provided a checklist of therapist self-care strategies. This list
summarized commonly used self-care strategies like exercise, awareness of the rewards and
hazards of the field, maintenance of nurturing relationships and boundaries, cognitive
restructuring, healthy escapes, personal therapy, development of a flourishing environment,
spirituality, and creativity (pp. 388–391). Norcross (2000) subsequently compiled a list of “10
consensual self-care strategies” (p. 710) based on recommendations from clinicians and the
scant empirical research about the use and effectiveness of self-care methods. These categories
of strategies formed the springboard for this exploratory study on intern self-care and included:
1. Recognize the hazards in conducting psychotherapy. This category encompasses
strategies that help identify the “negative toll exacted by a career in psychotherapy” (p.
710) such as distress, emotional exhaustion, and overpersonalization.
2. Think about strategies of self-care rather than specific methods or techniques.
This category draws attention to broader strategies for self-care rather than
any one individual behavior alone.
3. Use self-awareness and self-liberation to assess distress. This category
includes behaviors geared toward self-assessment of stress along with
feedback from others (e.g., coworkers, friends) to assess stress.
4. Embrace strategies from diverse theoretical orientations. As with Strategy 2,
this category includes behaviors that reflect a diversity of frameworks (in this
case, psychotherapy frameworks) to impact levels of stress and distress.
5. Use stimulus control and counterconditioning when possible. This category
includes two types of specific “action-oriented strategies” (p. 711) focusing on
control of the environment and skill building to address problems directly.
6. Emphasize the human element. This category of strategies consists of social
and professional supports that offset stress.
7. Seek personal therapy. This category emphasizes the beneficial role of
help-seeking behaviors (in this case, through mental health services) to
increase well-being.
8. Avoid wishful thinking and self-blame. This category of strategies represents
the maladaptive coping behaviors that may magnify distress, lower adaptive
4 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
coping, and thus, should be avoided.
9. Diversify activities. This category of strategies suggests that engagement in
multiple activities and roles (both personal and professional) leads to greater
10. Appreciate rewards of conducting psychotherapy. This category of strategies
includes active reflection benefits from conducting therapy (e.g., positive
influences, personal insights or changes).
Even as attention has been drawn to self-care issues for mental health practitioners
(Baker, 2003), interns remain under-studied.
Interns experience a wide range of developmental and clinical stressors during their
training that advanced professionals may not (e.g., evaluation concerns in supervision; Solway,
1985). Consequently, the present study focused on interns’ self-care strategies. In particular, the
types of self-care strategies that interns used and the perceived effectiveness of those strategies
were assessed. For the purpose of this study, the word strategy included any physical, mental, or
emotional behavior that contributed to the reduction of stress as well as the replenishment of the
intern (Guy & Norcross, 1998).
The Intern Self-Care Survey
Procedures and Participants
We used the 2002–2003 Association of Psychology Postdoctoral and Internship Centers’
(APPIC’s) Directory of Internship and Postdoctoral Programs in Professional Psychology (APPIC,
2002) to identify 448 training directors at fully accredited APA predoctoral psychology internship
programs in the United States and Canada. In February of 2003, training directors were sent an
e-mail that described the project and requested that they distribute an announcement of the
project to each of their current interns. The announcement that was distributed to the interns
described the study and provided a URL address to a Web-based survey. After completion of the
survey, participants were provided with a list of resources on self-care (e.g., books, Web sites,
and articles). A reminder e-mail was sent to each training director approximately 2 weeks after the
initial announcement.
A total of 463 surveys were submitted online. Of these, 100 were not included in the
analysis because of incomplete self-care data. Multivariate logistic methods were used to model
the probability of survey completion when controlling for age (less than 29 years of age, 30 years
and older), race (White, non-White), and internship site (counseling center, Veterans
Administration [VA] center, hospital, other). Respondents aged 29 and younger were less likely to
5 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
have completed the survey compared with respondents aged 30 and older. We were unable to
calculate an exact response rate because interns were not contacted directly (rather, they were
made aware of the project by their training directors), but the most conservative estimate would be
17.0% (on the basis of a total of 2,194 professional psychology doctoral interns on internship
during the 2002–2003 year; APPIC, 2002). The majority of the sample were women (76.0%, n =
354), White (78.1%, n = 361), and on internship at hospitals, university counseling centers, or VA
centers (68.0%, n = 353). On average, participants had been at their internship site for 9.1 months
at the time of survey (SD = 0.87). The average age for the sample was 31.7 years (SD = 6.10). On
the basis of the statistics provided by the APA 2001 Survey of Internship Applicants (APA
Research Office, 2003), our sample was representative of the larger intern population regarding
gender and race but had a larger percentage of interns from hospitals, university counseling
centers, and VA centers (80.0% vs. 64.0%) than did the cohort in 2001.
Intern Self-Care Scale (ISCS)
We designed a 35-item questionnaire to assess the frequency of use and perceived
effectiveness of self-care strategies that were based on Norcross’s (2000) description of
categories of self-care strategies. In addition, Norcross suggested that the authors include one
additional category, mind the body (J. Norcross, personal communication, December 17, 2002),
to encompass strategies such as adequate sleep, diet, and exercise. Of the 35 items, 6 came
from the employ stimulus control category, 5 came from the recognize the hazards, begin with
self-awareness, and emphasize the human element categories, 4 came from the avoid wishful
thinking and mind the body categories, 3 came from the appreciate the rewards category, 2 came
from the diversify activities category, and 1 came from the seek personal therapy category.
Norcross’s description of the think about strategies of self-care and embrace strategies from
diverse theoretical orientations categories did not contain sufficient examples for us to create
items that accurately represented these categories. In the process of scale development, each of
us created, reviewed, and edited each item, and items were not included in the final scale until a
full consensus was reached about how well it described and represented the specific category
theme. The entire survey was piloted on two postdoctoral fellows (one woman and one man) and
three newly licensed psychologists (one woman and two men) in counseling or clinical
psychology to determine the total time needed for completion (about 15 min) as well as semantic
clarity. Participants completing the ISCS were asked to provide two ratings for each item: the
frequency of use of each strategy and the perceived effectiveness of each strategy. Ratings were
made using a 5-point Likert-type scale ranging from 1 (never) to 5 (always). Individual responses
6 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
were summed to create Frequency and Effectiveness subscale scores; the possible range was 35
to 175 for each. The internal reliability estimate for the Frequency subscale was .80, and for the
Effectiveness subscale, it was .90. One consideration for data analysis was to group items that
came from the same Norcross category and explore the distribution of Frequency and
Effectiveness scores by categories. However, the results of an exploratory factor analysis (EFA)
did not support the Norcross category structure. Factors derived from the EFA did not contain
similar Norcross items and accounted for only a moderate percentage of explained variance
(explained variance
= 56.9%; explained variance
= 57.1%). The EFA results,
combined with our primary interest in exploring self-care strategies (rather than scale
development), led us to focus on responses to individual items and summed scale scores.
Frequency of Self-Care Strategy Use
The average summed Frequency subscale score for the sample was 116.3 (SD = 23.3).
Of the 35 self-care items presented to interns, 60% were used frequently, 37% were used
sometimes, and 3% were used rarely. As seen in Table 1, the items with the highest mean ratings
represented active problem-solving strategies, social support from family and friends, exerting
control over internship choices, maintaining awareness of the impact of internship, the use of
humor, and intern consultation. The 5 items with the lowest mean ratings were the use of therapy,
the use of faith and spiritual practices, cultural activities, and social support from one’s academic
program. Multivariate regression methods were used to model gender differences when
controlling for age (less than 29 years of age, 30 years and older) and internship site (counseling
center/VA center/hospital, other). Summed Frequency scores for women were significantly higher
(M = 117.6, SD = 22.5) than those for men (M = 111.4, SD = 26.0; B = .129, p = .02).
Effectiveness of Self-Care Strategies
The average summed Effectiveness subscale score for the sample was 119.3 (SD = 27.3).
Of the 35 self-care items presented to interns, 77% were frequently effective and 23% were
sometimes effective. As seen in Table 1, the items with the highest mean ratings were social
support from family and friends, pleasurable experiences, humor, sleep and exercise, and active
problem-solving strategies. The 5 items with the lowest mean ratings represented the use of
therapy, cultural activities, faith and spiritual practices, cognitive reframing, and use of feedback
from others. Again, multivariate regression methods were used to model gender differences when
controlling for age (less than 29 years of age, 30 years and older) and internship site (counseling
center/VA center/hospital, other). Summed Effectiveness scores for women were significantly
higher (M = 120.4; SD = 26.5) than those for men (M = 114.4, SD = 30.4; B = .107, p = .05).
7 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
Frequency and Effectiveness Relationship
Overall, the correlation between the Frequency and Effectiveness summed scales was
strong (r = .87, p < .01). A visual inspection of the mean ratings in Table 1 indicated some
commonality between Frequency and Effectiveness ratings (e.g., ratings for “I utilize my close
friends, significant others, or family as a source of support” were relatively high). To further
investigate the relationships between Frequency and Effectiveness, we rounded and plotted
mean item scores on a matrix. None of the strategies fell into the always (mean score of 4.5 or
higher) or never (mean score of 1.4 or less) range and the resulting 3 (Frequency) X 3
(Effectiveness) matrix is presented in Table 2. As seen in Table 2, cells along the diagonal
represent concordance between ratings for Frequency and Effectiveness subscales of the same
strategy. The majority of self-care strategies (19 out of 35) were frequently used and effective and
another 5 items were sometimes used and effective. Items such as “I have lunch/take a break out
of the office one time a week” were sometimes used and frequently effective. Other items
demonstrating discordance for Frequency and Effectiveness subscale ratings included “I seek
therapy for myself” (rarely used, sometimes effective), “I attend to feedback from others regarding
my level of stress and functioning,” and “I identify the aspects of internship that impact me
negatively and work to resolve or deal with them” (both frequently used and sometimes effective).
Discussion and Implications
Student self-care is the collective responsibility of organized psychology, training
programs, and the students themselves. Further, self-care should be viewed by all as a lifelong
process and not limited to any one group of professionals or preprofessionals. The purpose of this
exploratory study was to identify the use and effectiveness of interns’ self-care behaviors. The
data collected represent a description of self-care patterns for a sample of interns in the later
stages of the internship year (about 9 months into the internship).
Although other studies have documented intern stress (Brooks et al., 2002), it will be
important for future studies to assess intern stress in relationship to self-care strategies
(particularly given the events of September 11th, after which the present study was conducted).
For example, internship-specific stressors (like clinical stressors, concerns about evaluation, and
developmental shifts in professional identity; Lamb et al., 1982; Rodolfa et al., 1988), academic
stressors (like incomplete dissertations and dissertation proposals; Krieshok, Lopez, Somberg, &
Cantrell, 2000), and personal stressors (such as self-esteem and adjustment issues; Brooks et al.,
2002) may all impact the need for, use, and effectiveness of self-care strategies. Gender-specific
8 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
stressors or stress levels were not explored in this study, but women interns have reported higher
levels of stress in at least one study (Cushway & Tyler, 1996). Women’s significantly higher use
and effectiveness scores in our study could reflect their need to offset higher levels of stress or,
alternatively, reflect men’s disinclination to report distress or seek help (Addis & Mahalik, 2003).
Implications for Training Sites
One theme woven throughout the literature on practitioner self-care is that of concern for
the client and avoidance of impairment (Baker, 2003; Guy & Norcross, 1998). Indeed, an indirect
result of effective self-care would be improved client welfare, and thus it is critical that mental
health professionals at a minimum begin to think about effective self-care for themselves and their
trainees. In this spirit, we would advocate that intern training programs be intentional about their
promotion of self-care through the use of modeling, didactic and experiential workshops, and
other activities that involve all members of staff. Although agencies, training sites, and training
directors hold diverse views on how and when to intervene with interns about self-care, it would be
important for internship sites to consider doing a number of things.
1. Document the internship site’s stance on self-care in program materials. Workers at
internship sites see intern struggles as a developmental process—some may assume too
much or too little responsibility for intern self-care. In the absence of a common definition
of self-care across sites, this may be an important variable for prospective interns
(perhaps women) to understand during the match process, and thus, the availability of
such information in program materials would be key to clarifying expectations for all. It
would be interesting to know the degree to which self-care is discussed in program
materials (like mission statements), but to our knowledge, no self-care content analysis of
internship materials has been conducted.
2. Consider the organizational and professional factors that facilitate or block self-care. Each
internship site will contend with unique barriers, weaknesses, strengths, and preexisting
self-care learning resources. Small sites may not have the adequate staff or resources
that larger sites do, rural sites may not be able to access community resources that more
urban sites can, and hospital-based sites may have a wealth of self-care learning
opportunities built in when other sites lack these. The geographical locale of an internship
may limit some types of self-care behaviors (e.g., hiking in the mountains, swimming in the
ocean). Finally, the lack of available funds during fiscal crunches may present as a barrier.
When faced with increasing numbers of clients and limited resources, a director of a
department or organization may be unable to allocate further training time to interns (e.g.,
9 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
to attend an additional seminar on self-care). Future research on intern self-care would
benefit greatly from the training director’s perspective, including definitions of adequate
training in self-care, staff attitudes around intern self-care, and other organizational factors
that facilitate intern self-care.
3. Think about self-care from various theoretical perspectives. Self-care need not be viewed
only as a method of coping or problem remediation for interns. Osborn (2004) provided an
excellent discussion of a practitioner’s well-being from a strengths-based view and
referred to this as “counselor stamina.” She noted,
A discussion of stamina intends to draw attention to the cultivation,
amplification, and routine use of one’s strengths and resources, as opposed to
focusing on a problem (i.e., burnout) and outlining attempts to rid oneself of or
continually fight against the problem (i.e., coping). (p. 319)
In this way, self-care, well-being, and stamina can be introduced to interns in the context of
theoretical perspectives like medical models, human strengths models, and diversity models.
Additional research on the resources that interns possess (e.g., their curiosity, their dispositions,
their identity) would be an important complement to the study of specific self-care behaviors and
Suggestions for Prospective and Current Interns
We suggest that even before starting internship, students consider their self-care needs
and their expectations for self-care during internship. One strategy would be for students to think
about past atmospheres, organizations, and individuals that supported and/or discouraged the
prioritization of self-care and to compare them with internship sites of interest. As students
engage in the process of internship preparation (e.g., reviewing internship materials, contacting
students from the program who are currently on internship, and talking with current interns at
prospective sites), they should be cognizant of the potential (mis)match between their needs and
the environment. Current interns could also benefit from this type of exercise as they begin job
searches—self-care is a lifelong process and not limited to the internship year. Students and
interns can begin to document the activities and strategies they find helpful as well as the
frequency with which they have been able to engage in these strategies.
Once on internship, we suggest that interns be intentional about and take responsibility for
addressing self-care needs and for understanding how particular strategies help to combat stress
and promote optimal functioning. Interns, in collaboration with training directors, family, and
colleagues, can work to monitor stress, solicit feedback from others, consult, and use and explore
10 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
strategies that best fit for them. Familiarizing oneself with the resources available is a first step. As
a point of departure, we recommend students and interns review the APA’s Board of Professional
Affairs Advisory Committee on Colleague Assistance Web site, which contains self-care
resources and information (accessible to APA members at In addition, the authors have
compiled a list of readings for students and interns (see Appendix). In part, these readings were
selected because they provide concrete suggestions that students and interns may adopt, but
more important, many provide suggestions within the context of professionals’ narratives.
Joseph A. Turner received his PhD in counseling/clinical/school psychology from the
University of California, Santa Barbara. He is currently an analyst at the Child Services
Research Group at the University of California, San Francisco. His areas of research
include multicultural issues and mental health services.
Lisa M. Edwards received her PhD in counseling psychology from the University of
Kansas. She is currently an assistant professor in the Department of Counseling and
Educational Psychology at Marquette University. Her research interests include
multiracial and Latino issues, biculturalism, and well-being.
Iverson M. Eicken received his PhD in counseling psychology from Oklahoma State
University and is currently in independent practice in Los Angeles. His research
interest is men and masculinity.
Kayoko Yokoyama received her PhD in counseling psychology from Arizona State
University. She is currently an assistant professor in the clinical psychology doctoral
program at John F. Kennedy University. Her areas of interest include multicultural
training and body image.
Jennifer R. Castro received her PhD in counseling psychology from Michigan State
University. She currently works with student athletes as a learning specialist and
tutorial coordinator in the University of Southern California’s athletic department. Her
areas of research include perfectionism, cognitive anxiety, and performance
Amber Ngoc-Thuy Ttran received her PhD in clinical psychology from Pacific Graduate
School of Psychology. She is currently a staff psychologist in the adult psychiatry
department of the Rancho Cordova clinic at Kaiser Permanente. Her clinical focus is on
11 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
multicultural issues and interpersonal dynamics.
Kristee L. Haggins received her PhD in counseling psychology from The Ohio State
University. She is currently the director of training at the University of California, Davis’
Counseling and Psychological Services. Her areas of research include multicultural
issues and supervision and training.
Correspondence concerning this article should be addressed to Joseph A. Turner,
Child Services Research Group, University of California, San Francisco, CA 94109.
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research psychologists. Professional Psychology: Research and Practice, 31, 82–84.
Rodolfa, E. R., Kraft, W. A., & Reilley, R. R. (1988). Stressors of professionals and trainees at
APA-approved counseling and VA medical center internship sites. Professional
Psychology: Research and Practice, 19, 43–49.
13 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
Schwebel, M., & Coster, J. (1998). Well-functioning in professional psychologists: As program
heads see it. Professional Psychology: Research and Practice, 29, 284–292.
Skovholt, T. M., Grier, T. L., & Hanson, M. R. (2001). Career counseling for longevity: Self-care
and burnout prevention strategies for counselor resilience. Journal of Career
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Psychology: Research and Practice, 16, 50–54.
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Suggested Self-Care Readings and Resources
Baker, E. K. (2003). Caring for ourselves: A therapist’s guide to personal and professional
well-being. Washington, DC: American Psychological Association.
Brooks, J., Holttum, S., & Lavender, A. (2002). Personality style, psychological adaptation and
expectations of trainee clinical psychologists. Clinical Psychology and Psychotherapy, 9,
Davis, M., McKay, M., & Eshelman, E. R. (2000). The relaxation and stress reduction workbook
(5th ed.). Oakland, CA: New Harbinger.
Grosch, W., & Olsen, D. (1994). When helping starts to hurt: A new look at burnout among
psychotherapists. New York: Norton.
Guy, J. D. (2000). Holding the holding environment together: Self-psychology and psychologist
care. Professional Psychology: Research and Practice, 31, 351–352.
Kleespies, P. M., & Dettmer, E. L. (2000). The stress of patient emergencies for the clinician:
Incidence, impact, and means of coping. Journal of Clinical Psychology, 56, 1353–1369.
Kottler, J. A. (1999). The therapist’s workbook: Self-assessment, self-care, and self-improvement
exercises for mental health professionals. New York: Wiley.
Lazarus, A. A. (2000). Multimodal replenishment. Professional Psychology: Research and
Practice, 31, 93–94.
Mahrer, A. R. (2000). How to use psychotherapy on, for, and by oneself. Professional
Psychology: Research and Practice, 31, 226–229.
Norcross, J. C. (2000). Psychotherapist self-care: Practitioner tested, research informed
strategies. Professional Psychology: Research and Practice, 31, 710–713.
14 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
Norcross, J. C., Brown, R. A., & Wolfe, J. L. (2000). A vacation from musterbation. Professional
Psychology: Research and Practice, 31, 581–583.
Osborn, C. J. (2004). Seven salutary suggestions for counselor stamina. Journal of Counseling &
Development, 82, 319–328.
Sapienza, B. G., & Bugental, F. T. (2000). Keeping our instruments finely tuned: An
existential-humanistic perspective. Professional Psychology: Research and Practice, 31,
Skovholt, T. M. (2001). The resilient practitioner: Burnout prevention and self-care strategies for
counselors, therapists, teachers, and health professionals. Needham Heights, MA: Allyn &
Varma, V. P. (1996). Stress in psychotherapists. London: Routledge.
Weiss, L. (2004). Therapist’s guide to self-care. London: Taylor & Francis.
Williams-Nickelson, C. (n.d.). Mentoring, balance and self-care—especially for women: A
collection of articles and resources. Retrieved February 27, 2004, from .html
15 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
Table 1
Frequency and Effectiveness Means and Standard Deviations for Intern Self-Care Scale
(ISCS) Items
Frequency Effectiveness
07. I utilize my close friends, significant others, or family as a
source of support.
4.3 0.74 4.1 0.71
29. I seek solutions of difficulties I encounter.
4.3 0.67 3.8 0.70
14. I use humor.
3.9 0.75 3.9 0.74
31. I choose internship activities that interest me.
3.9 0.74 3.8 0.82
01. I maintain self-awareness of the impact that my internship
experiences has on me and my work.
3.9 0.76 3.6 0.79
20. I seek out pleasurable diversions outside of internship.
3.8 0.90 4.1 0.83
11. I consult with my fellow interns.
3.8 0.80 3.7 0.80
25. I set realistic goals for myself regarding internship.
3.7 0.80 3.8 0.84
02. I seek supervision from my clinical supervisor.
3.7 0.93 3.8 0.88
19. I work to create a comfortable environment for myself.
3.7 0.92 3.7 0.88
05. I express my feelings openly and honestly.
3.7 0.72 3.7 0.79
32. I diversify my internship activities.
3.7 0.81 3.6 0.89
09. I eat well.
3.6 0.78 3.8 0.90
22. I utilize my intern peers as a source of support.
3.6 0.94 3.7 0.87
10. I actively try to be in touch with my feelings in the
3.6 0.83 3.5 0.83
13. I am aware of how I react to stress and recognize this in
the moment.
3.6 0.69 3.5 0.73
12. I identify the aspects of internship that impact me
negatively and work to resolve or deal with them.
3.6 0.80 3.4 0.85
06. I attend to feedback from others regarding my stress level
and functioning.
3.6 0.84 3.3 0.88
18. I take time to be by myself.
3.5 0.92 3.8 0.92
30. I avoid using self-blame and self-denigration.
3.5 0.84 3.7 0.85
27. I ask for things that I need to help me at my internship
3.5 0.85 3.5 0.92
17. I get adequate amounts of sleep.
3.4 0.97 3.9 1.02
04. I have lunch or take a break outside of my internship site
at least once a week.
3.4 1.44 3.8 1.18
35. I seek consultation from other staff member.
3.4 0.84 3.6 0.82
26. I exercise.
3.2 1.00 3.9 1.04
08. I prioritize self-care issues and accordingly make
changes in my life.
3.2 0.86 3.7 0.85
16. I utilize cognitive reframing of my mistakes.
3.2 0.84 3.3 0.87
34. I think back to positive, life transforming, or breakthrough
moments with a client as a way to appreciate the rewards of
clinical work.
3.1 0.87 3.5 0.94
03. I take time to celebrate the successes of my work.
3.0 0.86 3.5 1.02
28. I use relaxation strategies.
3.0 0.86 3.5 0.94
15. I take time to connect with my peers and mentors from my
home (academic) program.
2.8 0.96 3.4 1.05
16 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
21. I engage in activities related to cultures other than my
2.8 0.85 3.1 0.95
23. I work to spend time with people who are culturally similar
to me or who share similar cultural values as me.
2.8 0.99 3.0 1.00
33. I turn to my faith or spiritual practices (e.g. attending
church, praying, meditating, etc.).
2.7 1.32 3.2 1.32
24. I seek therapy for myself.
2.3 1.28 3.0 1.47
Note. Items are preceded by the survey item number and are sorted in descending order on Frequency
mean score. Total ns range from 309 to 361.
1 = never; 2 = rarely; 3 = sometimes; 4 = frequently; 5 =
From the emphasize the human element category.
From the avoid wishful thinking category.
From the employ stimulus control category.
From the diversify activities category.
From the recognize the
hazards category.
From the begin with self-awareness category.
From the mind the body category.
the appreciate the rewards category.
From the seek personal therapy category.
17 Turner, Edwards, Eicken, Yokoyama, Castro, Ngoc-Thuy Tran, & Haggins
Table 2
Cross-Classification of Intern Self-Care Scale (ISCS) Frequency and Effectiveness Item Ratings
Frequently Sometimes Rarely
1. Maintain self-awareness 3. Celebrate successes
2. Seek supervision 4. Have lunch out of office
5. Express my feelings 8. Prioritize self-care
7. Utilize friends for support 26. Exercise
9. Eat well 28. Use relaxation strategies
10. Try to be in touch with my feelings 34. Appreciate rewards
11. Consult with interns 17. Get adequate sleep
13. Recognize my reactions to stress 35. Seek consultation from staff
14. Use humor
18. Take time to be by myself -
19. Create a comfortable environment
20. Seek out pleasurable diversions
22. Utilize interns for support
25. Set realistic internship goals
27. Ask for things I need to help me
29. Seek solutions to difficulties
30. Avoid self-blame/denigration
31. Choose interesting activities
32. Diversify my internship activities
6. Attend to feedback about my stress 15. Connect with faculty member 24. Seek therapy
12. Identify negative aspects 16. Utilize cognitive reframing
21. Do activities outside my culture
23. Be with culturally similar people
33. Turn to faith
- - -
Note. Items are preceded by the survey item number.
... At baseline, psychology trainees are highly vulnerable to stress with estimates as high as three-quarters of graduate students reporting moderate-to-high levels of stress (Richardson et al., 2020). The psychology internship and postdoctoral training year(s) in particular are critical, time-limited periods during which trainees are often adjusting to full-time clinical work and may experience burnout (Turner et al., 2005). Trainees may also face unique stressors related to their health care roles, such as conflicting desires to directly help patients (e.g., face-to-face), achieve training goals, and minimize increasing discomfort or fear of contract-ing the virus, particularly if other options for patient care (e.g., telepsychology) are not possible. ...
... Aligning with previous research, over 40% of participants in the present study endorsed clinically significant anxiety symptoms, with nearly 25% endorsing clinically significant depressive symptoms. While stress, anxiety, and depression are common in psychology trainees (Myers et al., 2012;Richardson et al., 2020;Turner et al., 2005), unique stressors during a global pandemic may exacerbate and prolong these symptoms, and ultimately elicit burnout. The overlap between anxiety, depression, and burnout is well-established (Bianchi & Brisson, 2019) and can undermine helping professionals' ability to not only care for themselves, but also to care for their patients (Bearse, McMinn, Seegobin, & Free, 2013). ...
... Taken together, emotional support should be considered a priority among training programs. According to a study conducted following the September 11th attack, psychology interns' primary source of self-care included seeking social support from family and friends (Turner et al., 2005). Given social distancing and traveling restrictions during the COVID-19 pandemic, trainees' primary source of social support may not be as readily available. ...
The impact of infectious disease outbreaks on mental health among health care workers is well-established. Minimal research has focused on healthcare trainees’ well-being, especially during unprecedented events such as the 2019 coronavirus pandemic (COVID-19). Trainees are vulnerable to inherent power and resource differentials, which may exacerbate stress. The present study used a mixed methods approach to examine mental health symptoms, perceived safety, and ongoing and desired support among a national sample of psychology interns, postdoctoral fellows, and residents during the COVID-19 pandemic (N = 400). Participants reported clinically elevated anxiety and depressive symptoms. Participants working on-site who felt that their health or safety was at risk reported more anxiety symptoms. Most common workplace safety concerns included inadequate protection against risk and face-to-face patient care requirements. Trainees desired more support, better communication, more remote work and telehealth options, and flexibility in training requirements. Themes also emerged related to supervisor pressure and disregard of trainees’ concerns. Results have significant implications for the training environment and quality of patient care. Increased support of psychology trainees is vital during the current and potential future public health crises. Public Significance Statement: This study suggests that like the general public, trainees may be at risk for elevated anxiety and depressive symptoms during the COVID-19 pandemic, especially when feeling their health or safety is at risk, and trainees desire more support from their training programs. By enhancing trainee support, trainees will be better equipped to assist their community through public health crises, such as the COVID-19 pandemic. © 2020, American Psychological Association. This paper is not the copy of record and may not exactly replicate the final, authoritative version of the article. Please do not copy or cite without authors' permission. The final article will be available, upon publication, via its DOI: 10.1037/tep0000343
... Therapists need support like all humans do. That may come from colleagues-if we know how to garner it-from friends or family, from mentors or from supervisors (Johnson, Barnett, Elman, Forrest, & Kaslow, 2013;Turner et al., 2005). When things do not go well, professionally, aside from reaching out for our support network, there are colleague assistance programs which are there to provide resources that may help psychotherapists address the sources of stress and promote their wellbeing (American Psychological Association, 2006). ...
Full-text available
COVID-19 is a frightening, stress-inducing, and unchartered territory for all. It is suggested that stress, loneliness, and the emotional toll of the pandemic will result in increased numbers of those who will seek psychological intervention, need support, and guidance on how to cope with a time period that none of us were prepared for. Psychologists, in general, are trained in and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others. The article, which aims to heighten clinicians’ awareness of the need for self-care, especially now in the post-pandemic era, describes the demanding nature of psychotherapy and the initial resistance by therapists to engage in self-care, and outlines the consequences of neglecting to care for themselves. We covered the demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, the professional hazards faced by those caring for others, and the creative and insightful ways that mental health practitioners can care for themselves for the good of their clients, their families, and obviously, themselves.
... Myers et al. (2012) examined stress and self-care behaviors among clinical psychology graduate students and found that sleep hygiene, social support, and mindful awareness were related to lower stress levels. Turner et al. (2005), in a survey of school psychology interns, identified a number of strategies used by interns to manage stress including self-awareness activities, social activities, exerting control over professional activities, and appreciating intrinsic professional rewards, all of which were identified by the interns as being effective strategies. These studies provide some correlational evidence for the importance of self-care for graduate training, but the question of whether self-care behaviors can be successfully modified by training programs remains largely unexplored. ...
It has long been established that school psychology practitioners experience high levels of burnout. As a means of preventing burnout among future practitioners, school psychology training programs are frequently encouraged to teach and model self-care to students. This is particularly important as the current generation of graduate students experience high levels of anxiety and depression, but there have been very few examples in the research literature of how training programs should teach self-care and whether it is actually effective. The current study presents results from an exploratory case study, which integrated self-care instruction into graduate school psychology curriculum with a small sample (N = 22) of first-year school psychology students across two separate cohorts. Students created written plans with self-care strategies that they attempted to implement over the course of their first semester in graduate school. A qualitative review of their plans and written reflections revealed that students described many sources of stress upon entry into training, and most needed to revise their strategies for coping as stresses changed during the semester. Overall, student reflections revealed that the self-care activities were helpful to meet the demands of their graduate education.
... Yep, you guessed it: close friends, significant others, and family as sources of support. It receives a mean rating of 4.3 on a 5point scale (Turner et al., 2005). ...
Psychologists are skilled in assessing, researching, and treating patients’ distress, but frequently experience difficulty in applying these talents to themselves. The authors offer 13 research-supported and theoretically neutral self-care strategies catered to psychologists and those in training: valuing the person of the psychologist, refocusing on the rewards, recognizing the hazards, minding the body, nurturing relationships, setting boundaries, restructuring cognitions, sustaining healthy escapes, maintaining mindfulness, creating a flourishing environment, cultivating spirituality and mission, fostering creativity and growth, and profiting from personal therapy. The latter deserves special emphasis in the making of health care psychologists. These strategies are recommended both during training and throughout the career span. Recommendations are offered for enhancing and publicizing systems of self-care throughout the profession.
... As others have argued, a self-care focus should occur across all training stages and settings, including clinical training sites and should be integrated into clinical supervision during practicum, internship, postdoctoral training (Barnett & Cooper, 2009), and supervised practice for licensure. Internship programs should similarly be intentional about promoting self-care through modeling and teaching (Turner et al., 2005). Just as with academic training programs, the CPA accreditation standards for internships in clinical psychology, counselling psychology, school psychology, and clinical neuropsychology psychology require interns to acquire knowledge and skills with respect to self-knowledge (Standard II.B.4.v) and reference work-life balance with respect to timely completion of internship requirements (Standards IV.E and V.C; CPA, SELF-CARE AND THE CANADIAN CODE OF ETHICS 20 2011). ...
Full-text available
Self-care as an ethical imperative for psychologists necessitates a continuous, proactive engagement in behaviours that promote psychological, emotional, and physical wellness. Graduate training programs have an ethical obligation to equip students with the knowledge and skills necessary to practice ethically and competently; there is, however, a considerable lack of emphasis on self-care in graduate programs as well as in the profession as a whole. This article reviews principles relating to self-care from the Canadian Code of Ethics for Psychologists, particularly the principles of Responsible Caring and Integrity in Relationships. The professional psychology training context is described as it relates to self-care, with a review of the training literature and accreditation standards. Given the lack of systematic training in self-care currently provided by professional psychology training programs, it is suggested that programs conceptualise self-care beyond impairment, view self-care as a competency to be taught and practiced, and integrate training opportunities across the spectrums of training and professional practice.
... As mentioned in the introduction, moral quandaries concerning the balance between the private sphere and one's career may be a concern among newcomer psychologists (Solbrekke, 2008). In a study of selfcare strategies among psychologist interns, the researchers found that one of the most effective strategies was getting social support from family and friends (Turner et al., 2005). Are the issues context related, that is, relevant only to psychologists and other caring professions, or are they relevant to other work groups in general? ...
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The purpose of this article is to evaluate how well Taormina’s Multidomain, Continuous Process Model of Organizational Socialization (Taormina, 1997) applies to the data from qualitative interviews with newcomer psychologists, and to explore the interview content that does not correspond with the model. A total of 64 interviews with 22 recently graduated psychologists in Norway were subjected to deductive content analysis by use of the model. The interview content that did not fit with the model was then explored by inductive content analysis. Largely, the model covered the interview material. However, the model’s categories are wide, and perhaps they too easily embraced the data. Moreover, the model did not embrace issues concerning the work/non-work interface and the participants’ own health and well-being, and an extension of the model is therefore discussed. These issues may be relevant in other professional contexts as well, and not only to newly graduated employees. The findings suggest that organizational socialization researchers could benefit from expanding their view of newcomers’ situation. To practitioners in the field of HR, the model may provide a framework for developing introductory programmes. In addition, attention to the newcomers’ personal well-being and life situation in general is recommended.
In recent years, self-care has become the topic of much discussion within the helping professions. The goal of this article is to examine the issue of counselor burnout prevention through the practice of self-care. Mindfulness is recommended as one of the most well-studied and effective forms of counselor self-care, providing relief from the risk factors associated with burnout and enhancing protective factors. While counselor burnout, compassion fatigue, self-care, and mindfulness have all been well represented in the literature, this is the first paper to use the latest research to discuss all of these concepts as interrelated. This review is meant to be a call to counselors to practice self-care in the form of mindfulness, both for their own well-being and that of their clients. Suggestions for future research are discussed.
The provision of high-quality practice in psychology has been assumed to require the support of high-quality supervision. Yet the characteristics of high-quality supervision and of high-quality supervisor/supervisee relationships have not been as well known in school psychology as in other aspects of psychology particularly in clinical and counselling contexts. In addition, the availability of suitable supervision has at times been observed to have limited the development of school psychologists especially in some regions. This chapter discusses what is known about the provision of supervision in school psychology in America and Australia, some of the parallels and dissimilarities in its development in these countries and some aspects of the regulatory requirements around both. It discusses the contextual challenges of conducting psychological practice in educational organisations and the consequent issues likely to arise in supervision. In making the case that school psychologists frequently act in relative professional isolation, surrounded by members of another profession, it highlights the importance of supervision in helping school psychologists to be alert to their professional development needs and to avoid the effects of stress and possible burnout associated with their complex and demanding roles. Further, it presents case examples illustrative of the issues likely to arise in the provision of school psychology and suggests factors associated with resolution of these potential issues.
Research has shown that psychological well-being is positively associated with student engagement, persistence, and performance. To learn more about the behaviors that underlie well-being, 206 (predominantly female) university students completed measures of well-being and six self-care practices. Four such practices (mindful acceptance, seeking social support, sleep hygiene, and food habits) uniquely predicted well-being, but physical exercise did not. Findings can aid the development and implementation of interventions to increase self-care and well-being in student populations.
Dissertation status of intern applicants is an issue for training directors and students alike. Two major concerns are that students may fail to finish the dissertation after the internship and that they may be distracted during internship while also working on the dissertation. The dissertation status and progress of 1,025 psychology interns is described, as well as obstacles to and predictors of dissertation progress. While 20% of all interns start the year with their dissertations complete, students who start internship with completed proposals make more dissertation progress while on internship than those beginning at preproposal stages.
Discusses how psychotherapists can use psychotherapy on, for, and by oneself. The author suggests that in order to feel better, and want to accomplish some of the wonderful things that psychotherapy can help bring about, one needs to have regular psychotherapy sessions, preferably experiential sessions, on, for, and by oneself. There are several questions that the author addresses: What personal life circumstances invited me to search for some way of undergoing self-care? What can a practitioner do to have deep-seated sessions by oneself? How can a psychotherapy be created for one's own self-sessions? What does one do in an experiential session on, for, and by oneself? If you trust what you do with clients, why not do it with yourself? If you trust what you do with yourself, why not do it with clients?
Presents a model of self-assessment. The multimodal orientation is predicated on the assumption that most psychological problems are multifaceted, multidetermined, and multilayered, and that comprehensive therapy calls for a careful assessment of seven parameters or "modalities": behavior, affect, sensation, imagery, cognition, interpersonal relationships, and biological processes. The first letters from the 7 modalities form the acronym BASIC I.D., although the "D" modality represents the entire panoply of medical and biological factors. A weekly, or at least fortnightly, self-assessment of one's BASIC I.D. is recommended.
Notes that the transition from graduate school to a professional internship provokes considerable unexpected turmoil in the lives of psychology graduate students. Some individuals may display symptoms often associated with an emotional crisis. The clinical, institutional, and personal stressors created by this transition are discussed. Personal stressors involving the loss of meaningful relationships and difficulties in mourning are perceived to be of paramount importance. Because of the instability experienced in this transition, new interns may not function at their best, and supervisors should be wary of establishing base rates of competency for interns. Recommendations are presented on how graduate programs and professional internships can help students deal with the turmoil of this period. (9 ref)
Discusses some of the major stresses of the internship year from the perspective of both a recent intern and an internship director. These stresses include adjusting to a new program, developing a sense of trust in the training staff, questioning one's competence as a psychotherapist, taking risks to learn new skills with different patient groups, accurately assessing one's own strengths and weaknesses, and planning one's professional life after the internship. It is suggested that the internship year can be viewed as part of the professional adolescence of clinical psychologists. Interns pass through the stages of the separation–individuation process, similar to that described by M. Mahler (1958, 1975). Staff can be helpful by being aware of the personal and professional developmental needs of each intern, encouraging them to take more initiative, reinforcing them for becoming involved in the overall activities of the center, and being willing to develop more collegial working relationships. (47 ref)
The heads of 107 programs in professional psychology certified by the American Psychological Association participated in a questionnaire study designed to learn their views about well-functioning in professional psychologists and what they had done and would like to do, programmatically, to maintain and enhance it. Their responses were compared with those of 339 licensed psychologists in a prior study. Although the 2 groups both assigned high ratings to self-awareness, a balanced lifestyle, relationship with spouse or partner, and personal values, overall the program heads put more emphasis on the didactic-supervisory items, whereas the practitioners emphasized the personal-existential items. Modifications of psychology programs to place well-functioning of students on par with other major purposes are described in detail.
The author applies H. Kohut's ideas about maintaining emotional health to the role of psychotherapists and makes a few suggestions about how to nurture one's own sense of self.
Balancing self-care and other-care is often a struggle for career counselors and others in the helping professions. The process of caring is made up of a constant series of empathic attachments, active involvements, and felt separations. The ability to continually engage in “the caring cycle” is important for success. However, the constant need to re-create the cycle of caring can lead to counselor depletion and burnout. This article provides a developmental framework for assisting career counselors to avoid depleted caring while prolonging their professional longevity. The model of self-care includes recognizing the hazards of “high touch” work, such as limited resources and constant one-way caring. Also addressed are specific means of professional and personal sustenance, such as maximizing experiences of professional success and balancing personal wellness throughout one's career.