Reprinted with permission from: Norcross, J. C., & Guy, J. D. (2007). Leaving it at the office: A guide to
psychotherapist self-care. New York: Guilford. Copyrighted material; please do not reproduce without
VALUING THE PERSON OF THE PSYCHOTHERAPIST
Adhere to the ethical imperative of engaging in “self-care activities to maintain and promote your
emotional, physical, mental, and spiritual well-being to best meet your professional responsibilities”
(American Counseling Association).
Ask your patients, if you have not done so recently, what has been most helpful in their psychotherapy.
Take to heart their frequent compliments about your presence, affirmation, and support.
Resist the pressures of managed care to define yourself as a nameless and disembodied “provider” of
mental health services. Maintain your individual identity as a distinctive practitioner of psychological
Internalize the relational crux of the work. Yes, we conduct treatments to eradicate DSM disorders, but
we also offer relationships that heal people.
Assess your deep motives for becoming a psychotherapist beyond the altruism of “to help people.” How
are these motives facilitating or hindering your effective self-care?
Prioritize your self-care: Put specific times in your schedule to sharpen the saw.
Develop self-empathy: the capacity to notice, value, and respond to our own needs as generously as we
attend to the needs of clients.
Practice what you preach to your clients about nourishing the self: avail yourself (when applicable) of
what you provide or recommend to clients with similar needs.
Embrace an integrative mix of effective self-care strategies (as opposed to relying on a single theoretical
Avoid concentration on a single self-care technique, and promote cognitive and experiential growth on a
broad front. Do you rely on only one or two self-care methods?
Assess your own self-care, as you might a student’s or a patient’s—on a weekly or monthly basis.
Track your self-care by maintaining a journal, calendar, or behavioral log of activity.
Complete structured questionnaires on burnout and self-care periodically to facilitate your self-awareness
Contract for some honest feedback from significant others about your work week, functioning, and self-
care. Let others supplement and enhance your self-monitoring.
Put your consequential self-care activities in your schedule/calendar first thing every month. Literally
schedule your self-care.
Alleviate the distress of conducting psychotherapy, to be sure, but also value and grow the person of the
REFOCUSING ON THE REWARDS
Recall that career satisfaction among psychotherapists is consistently high and rivals (or exceeds) that of
Remember your reasons for entering the profession in the first place as a means of refreshing your sense
of calling and professional fulfillment.
Build into your weekly schedule a concrete method to count your blessings, such as an imagery exercise
or a gratitude journal.
Attend to the profound satisfaction of helping others; vividly recall the life-transforming psychotherapies
in which you were privileged to participate.
Look for ways to create a greater sense of freedom and independence in your work.
Variety and intellectual stimulation are indispensable. What can you do to increase their impact on your
schedule and professional duties?
Satisfaction from helping others is crucial, so be sure to include at least some clinical activities that
demonstrate you are helping someone!
Enjoy maintaining relationships with clients that span years, even decades, involving intermittent courses
Your work will ideally capitalize on both your natural and acquired abilities. Do what you do well.
A sense of humor and the absurd is one of your most potent stress relievers. Practice!
Be careful when applying your expertise to your family of origin... fools rush in where angels fear to
Self-monitor the quality of your friendships. Do they sustain you?
Remember: you are actually self-employed, regardless of who you work for. Maintaining this perspective
brings great freedom of choice.
Clinical practice may not make you rich, but if it is your calling, it is a wonderful way to make a living.
Bear in mind, particularly during your beleaguered moments, that there are typically many more benefits
than hazards associated with the practice of psychotherapy.
RECOGNIZING THE HAZARDS
Repeat the mantra “Psychotherapy is often a grueling and demanding calling” in order to establish
Affirm the universality of occupational hazards by sharing your stressors and distress with trusted
Identify the impact of clinical practice on you and your loved ones. All accounts indicate that clinical
practice exacts a negative toll on the practitioner, particularly in the form of problematic anxiety, moderate
depression, and emotional underinvolvement with family members.
Consider the amount of physical isolation you experience each day. What steps can you take to create
more opportunities for contact with other clinicians?
Create variety in your day, such as intermingling psychotherapy sessions with supervision, consultations,
study breaks, a trip to the gym, and so on.
Invite family and friends to point out when you become too interpretive and “objective” when it would
be healthier to be spontaneous and genuine.
Know the actuarial data about the probability of a malpractice lawsuit or licensing complaint and
thoughtfully consider high-risk aspects of your practice (e.g., involvement with borderline and
narcissistic personality disorders, suicidal and violent patients, “recovered memory” cases, contested divorce
Calculate the possibility of patient violence in your office and take steps to enhance your personal safety
Take Coach John Wooden’s advice and refuse to believe either your most idealizing or your most
demeaning client—you are neither God nor the devil.
Limit your exposure to traumatic images outside the therapy room by choosing movies, literature, and
other entertainment carefully.
Reevaluate your involvement with managed care, particularly its possible contribution to your
experience of depletion and burnout. How might you restore some control in your work to enhance your
sense of autonomy?
Adopt a team approach in dealing with high-stress clinical situations; distribute the burden and lighten
the individual load.
Beware of inadvertent domestic violations of patient confidentiality, and limit the amount of client
material you share with your significant others.
Consider how you have managed the delicate balance between empathic connection and self-preserving
distance in your clinical work. When you find yourself on one end of the pendulum, pursue balance.
Reflect on the number of clients that you’ve said good-bye to over the years. What has been the
cumulative impact of these terminations?
Address your own limitations and needs in an open manner instead of playing competitive therapist
Periodically reevaluate why you became a psychotherapist and why you continue to practice. Look for
ways to work through those unhealthy motivations.
Proactively discuss your professional and parental commitments within significant relationships.
Accept some spillover from your professional life into your personal life as an inevitable cost of being
Discuss with your spouse/partner the topics covered in this chapter. How does he or she perceive their
impact on your relationship?
Learn how to handle distracting intercurrent life events. Perhaps consult with a trusted and more
Implement proactive steps to reduce the low but real possibility of burnout.
“Start where you are”: cultivate self-empathy regarding occupational hazards so that you can develop
empathy for others.
Tailor your self-care to your personality and context by disentangling transient, paradigmatic, and
situational difficulties in your practice; each requires a different self-care plan.
Reconcile and balance the hazards of psychotherapeutic practice with its rewards—“fountain of sorrow,
fountain of life.”
Adopt the long perspective as a healing practitioner; most psychotherapists enjoy lengthy, successful
careers and would elect to do it again.
MINDING THE BODY
Mind your body as part of your self-care; do not become preoccupied with sophisticated self-care methods
at the expense of your biobehavioral basics.
Track the quality and length of your sleep. How many hours of sleep are you averaging each night,
compared to what your body needs?
Take your own advice: exercise regularly.
Schedule minibreaks between sessions to self-massage your face, neck, and leg muscles; perhaps schedule
regular massages to nourish yourself and relieve muscle tension.
Stretch your muscles and reconnect to your body as antidotes to the sedentary nature of psychotherapy.
Get moving during your workday: go for walks between sessions or during meals and avoid motionless
sitting positions that reduce circulation and energy.
Secure sufficient hydration during the day.
Eat balanced, nutritious meals before, during, and after work; avoid the empty calories of comfort foods.
Monitor your use of substances. Are you self-medicating with alcohol, tobacco, drugs, or food?
Arrange for contact comfort and sexual gratification away from the office; it’s your responsibility to meet
your physical needs.
Self-assess your peer support at the office. How does it fare? In one study of well-functioning
psychologists (Coster & Schwebel, 1997), peer support emerged as the highest priority.
Identify the three most nurturing people in your life. What can you do to increase the amount of support
you receive from them?
Insist on sufficient alone time. Do you know what to do with it when it’s available?
Pursue ongoing nurturance at the office with your clinical colleagues; take lunch, conversations, and
walks with one another.
Join or organize a peer support, supervision, or cuddle group.
Participate in clinical teams and periodically conduct cotherapy to keep you fresh and vital.
Seek nurturance from professionals in the community for both business assistance and collegial
Develop arrangements for ongoing supervision or consultation. If it is unavailable or ineffective at your
employment setting, then purchase it.
Determine which clients “recharge your batteries” and brighten your day. Within the constraints of ethics
and transference, structure your daily schedule and review your caseload to ensure that you see some of these
patients on a daily basis.
Identify the interpersonal gratifications you receive from favorite clients and what happens following
termination with them.
Name your most significant mentor during your career. How are your needs for mentoring being met
Follow the evidence: The highest-rated career sustaining behavior for psychotherapists is spending time
with one’s spouse/partner and friends.
Try to include phone calls, lunches, and breaks in your workday several times each week to provide
contact with family and friends.
Maintain your old, civilian friends who keep you grounded in life outside of clinical work.
Utilize your family-of-origin relationships to help you reality test and to confront your grandiosity.
Beware if your friendships are becoming fewer in number or diminishing in significance over the years of
professional practice. Take corrective action if necessary
Take advantage of Colleague Assistance Plans, should practice troubles come your way.
Something may be amiss if you are habitually giving out more nurturance than you are receiving. Seek a
personal mentor or personal therapist to remedy the imbalance.
When confronted with occupational stress, tend and befriend, rather than fight or flight.
Begin by understanding concretely your roles, responsibilities, and limitations as a psychotherapist; only
then can you communicate and establish these boundaries with patients.
Work under capacity (90%) so that emergencies, family demands, and self-care can be routinely
Be explicit with your clients about your professional expectations and limitations. Setting boundaries
emerges in our research as the most frequent self-care strategy of mental health professionals.
Secure goal consensus in a collaborative manner with patients early on in treatment to avoid subsequent
boundary misunderstandings and confusion.
Clearly delineate your policies regarding extra sessions, late appointments, extrasession telephone
contacts, payment for services, and the like.
Consider adopting an informed consent form as a written treatment contract.
Establish a monitoring method to determine when a particular boundary has been crossed.
Cultivate shared responsibility with patients for the change process and treatment outcome; avoid taking
sole responsibility for psychotherapy.
Craft your own professional bill of rights. What are your inalienable rights as a psychotherapist?
Demand a livable wage and a “good enough” income.
Set caseload boundaries: maintain your caseload at an effective number for you and limit the number of
at-risk patients at any one time.
Minimize as possible your out-of-session exposure to emergencies and patient excursions into your
Take protective measures to ensure your physical safety and that of your loved ones. Decline to treat certain
clients, refuse to disclose personal data, prohibit clients from appearing uninvited at your home, and make your
Customize treatment to individual patients, but limit your bending. Determine whether you are bending
Learn to say “no” to clients, referral sources, agencies, and administrators; become a responsible assertive
Rebuff inappropriate incursions into your practice by managed care organizations and other entities that
would compromise your integrity and ethics.
Delegate nonclinical work to staff or external services; focus on doing what you uniquely are trained and
interested in doing.
Be clear about posttermination contacts with clients. Saying good-bye to clients properly requires explicit
statements concerning how, when, and why treatment may resume in the future.
Beware of avarice. Are you working long hours out of financial necessity or getting greedy?
Bridge the gap between work hours and your loved ones by building in phone calls, personal visits, and
Demarcate the transition from work to non-work with regular rituals, such as music, exercise, change of
clothes, or meditation.
Transfer difficult patients—for an evaluation, a second opinion, or for treatment elsewhere—from a
position of strength.
Remember that your clients are not there to meet your needs; treatment relationships are not reciprocal.
Define your relationships with colleagues with care. Transference influences these relationships, too.
Let your hair down with family and friends. They want you to be genuine, spontaneous, and
Establish an identity and life apart from your psychotherapist role. Don’t get stale!
Zealously protect your personal time with family and friends; work is work and home is home.
Avoid friendships exclusively with clinical colleagues, as social gatherings may quickly deteriorate into
Embrace a mature synthesis of the dialectic between commitment to self and commitment to patients. It is
possible to balance both with realistic boundaries.
Self-monitor your internal dialogue regarding your performance and your patients via thoughtful
reflection, collecting data to dispute cognitive errors, or sharing with significant others.
Compare your clinical and scholarly performance to same-aged peers in similar circumstances, not to
Track your overly busy schedule and rate pleasure and mastery of activities to help you discover what
changes need to be made.
Self-treat the error of selective abstraction by determining actual successes and failures, accepting the
inevitable limitations of your therapeutic skills, and distinguishing between case failures and yourself as a
Think through the transferential feelings directed to you; to whom are they aimed and to whom do they
Beware of absolutistic thinking: musturbation (“I must be…”) and the tyranny of the shoulds (“I should
have…”). They can affect you as much as your patients.
Dispute the common fallacy that "good psychotherapy is equivalent to having all patients like us."
Recall that the other side of caring consists of confrontation. Caring about others includes being honest
and tough at times.
Reassure yourself that the conditions in psychotherapy, as well as in life, are not always easy. This is
unfortunate but not catastrophic.
Remind yourself that you cannot cure every patient and that some patients will not succeed with you.
Balance the amount of time you dwell on your successful cases and your frustrating cases.
Redefine success as a process rather than an end-result. Success includes your effort, and mini- or partial
achievements, not simply the complete remission of patient symptoms.
Assertively reduce unrealistic demands made on you: don't take on more work than you need to or
wrongly believe you're expected to do more.
Recognize that your patients do not have to be as hard-working or persevering as you.
Ask three critical questions—did that really occur?, What are the probabilities?, and What is the worst that
could happen?—when you catastrophize about you and your clients.
Catch yourself when assuming blame (i.e., personal causality) for events in clients' lives and consider
Calculate real probabilities when thinking about treatment outcomes. The worst happens only infrequently
—to you or to your patients.
Evaluate treatment success on a continuum to avoid dichotomous thinking; psychotherapy outcomes
rarely fall on either extreme of a continuum.
Use self-insight, empathy, anxiety management, and conceptualizing ability when experiencing
Confront the ultimate psychotherapist fallacy: “I should not have emotional problems. After all, I am a
therapist!” Yes, you are an expert on human behavior—but you’re still nutty at times!
Create realistic expectations for your self-care; avoid perfectionist tendencies toward eradicating your
Offer yourself unconditional self-acceptance (USA) as a psychotherapist and as a person.
SUSTAINING HEALTHY ESCAPES
Undertake a candid assessment of what purposes and significance overwork has for you. What really
prevents you from engaging in healthy escapes?
Perform an honest appraisal of unhealthy escapes (e.g., substance abuse, isolation, sexual acting out) and
determine whether the problem applies to you.
Make relaxation part of your workday; it improves your energy, empathy, and attention.
Take vital breaks between patients and between clinical responsibilities.
Maintain your sense of humor; it is a career-sustaining behavior.
Join your colleagues and staff for get-togethers in the office and spontaneous escapes from it.
Include phone calls, lunches, and breaks in your workday several times each week to provide contact with
friends and family.
Practice balance: over 80% of therapists routinely engage in reading or a hobby, take pleasure trips or
vacations, and attend artistic events and movies as part of their self-care patterns (Mahoney, 1997).
Schedule a weekly Shabbat – a regular day of rest and respite from the week’s demands.
Monitor your vacation time. Is it less than you as a psychotherapist would recommend to patients in
similarly stressful occupations?
Follow Freud’s example: every year take several weeks away from the office, and stay largely out of
Create adventure and other diversions away from the office. Is play a steady staple of your emotional
“Chop wood, carry water”: participate in concrete physical activities with a clearly visible and obvious
outcome to counterbalance your psychotherapeutic work.
Balance your socialization and alone time; determine how much restorative solitude you require.
Take personal retreats that enable you to distance yourself geographically, emotionally, and
Lengthen retreats into periodic clinical sabbaticals devoid of psychotherapy responsibilities.
Reject ordinary thinking and adopt a more observational stance: Meditate.
Try new and exciting activities for the first time: river rafting, camping, snorkeling, deep sea fishing and
Avoid wishful thinking and self-blame in contemplating self-care; instead, pursue action-oriented
Make a contract with yourself to integrate healthy escapes into your routine. Monitor and chart your
Ask yourself once a year (perhaps on your birthday), “How do I play?”
CREATING A FLOURISHING ENVIRONMENT
Avoid falling prey to American individualism and the fundamental attribution error: Harness the power of
your work environment to flourish.
Conduct an environmental audit of your work space for comfort and appeal.
Improve your work environment by providing pleasure in your furniture, aesthetics in your décor, and
replenishment in your cupboard.
Increase sensory awareness: using vision, hearing, touch, and olfaction counterbalances the cognitive and
affective work of psychotherapy.
Take protective measures to ensure your safety and that of your practice environment.
Give yourself time between patients, 10 minutes to breathe, relax, make notes, review notes, return calls,
and process what has happened during the preceding 50 minutes.
Determine whether your clinical talents and interpersonal interests are poorly invested in paperwork. If so,
consider a computer, a clerical assistant, a billing service, or other alternatives.
Delegate, defer, and simplify the business aspects of your clinical position.
Build behavioral boundaries to temporarily separate yourself from the clinical world by means of routines
Increase supports and reduce constraints to keep high-demand institutional jobs bearable and rewarding.
Search for ways to create greater freedom and independence in your work.
Beware of false interventions and short-term fixes in dysfunctional institutions; treat the systemic roots,
not just the acute symptoms.
Create a self-care village in a workaholic world by advocating for self-care as a means of improving
productivity and outcomes.
Assist your colleagues and administrators in acknowledging the occupational hazards and in offering
group support, Me-Time, and other replenishment opportunities.
Cultivate a self-care ethos in clinical training by improving the selection of students, broadening the
training goals, increasing the availability of personal therapy, modeling the commitment to personal
development, and encouraging research on psychotherapist self-care.
Begin self-care at the top: insist that your professional associations include self-care in their ethics,
accreditation standards, publications, conferences and continuing education.
UNDERGOING PERSONAL THERAPY
Heed the evidence: personal therapy is an emotionally vital and professionally nourishing experience
central to self-care.
Give yourself 50 minutes of time every few weeks in a holding environment; practice what you preach
about the value of psychotherapy!
Confront your resistances for not pursuing personal therapy. Are these “good reasons”—or convenient
rationalizations to avoid accepting the patient role?
Take seriously Freud’s recommendation that every therapist should periodically—at intervals of five years
or so—reenter psychotherapy without shame as a form of continued education. Do you heed his sage
advice? Do you struggle with the shame?
Beware the illusion that mental health professionals do not experience a need for personal therapy once
they are in practice. More than half of psychotherapists do receive personal treatment following completion
of formal training.
Seek family therapy and family-of-origin work as well; do not limit yourself to individual therapy.
Supplement personal therapy with regular self-analysis.
Consider an annual satisfaction checkup with a valued mentor, trusted colleague, or former therapist.
Pursue other personal development activities in addition to personal therapy. These might include the
creative arts, Buddhist training, meditation seminars, dream work, or self-help groups.
CULTIVATING SPIRITUALITY AND MISSION
Identify and then resonate to your abiding mission in life. What mission do you want written on your
Embrace your sense of calling to be a clinician. What are the spiritual antecedents to your career choice?
Cultivate awe and wonder at the human spirit; it will enable you to pull hope from hell.
Invoke and augment your client’s spirituality to enrich their experience of psychotherapy.
Connect to the spiritual sources of your hope and optimism regarding human behavior. If you have lost
your enduring sense of caring and concern for others, get help.
Assess periodically your belief in the potential for personality change, a prerequisite for good clinical
Take 10-15 minutes and write a stream of consciousness letter to your God, Nature, Spirit, or a higher
power. What did you learn or relearn about your connection to spirituality?
Evaluate the integration of spirituality and personal growth in your own life. How are you doing? What
are you doing to promote such a synthesis?
Confront squarely your own yearnings for a sense of transcendence and meaning.
Create a hope-protecting philosophy of life that will help inoculate you from the despair of your clients.
Cherish and practice your Tikkun (healing and repairing the world).
Pursue the ultimate questions and find meaning in your personal life so that practicing psychotherapy does
not become the ultimate meaning for you.
Become a citizen-therapist by merging your vocation with social activism.
Let your life speak—manifest your values and vocation in daily life.
FOSTERING CREATIVITY AND GROWTH
Strive for adaptiveness and openness to challenges—the defining characteristics of passionately
Upload your creativity through innovative treatments, valuable metaphors, therapeutic irony, and novel
Diversify, diversify, diversify. Involvement in diverse professional activities balances your workload and
expresses the full array of your skills.
Mix up your therapy days: individual, couples, group, and family formats; younger and older patients; talk
therapy and action therapy. What else can you do to increase variety and novelty in your schedule?
Imagine periodically your future possible selves as a psychotherapist and then set sail in that direction.
Embrace continuing education as kaizen—continuous improvement and lifelong learning.
Attend clinical conferences, read literature, and form study groups to access the life springs of a
committed professional. Do you feel you are just getting continuing education hours or refining and
expanding your skills?
Engage actively with professional organizations to shape our collective mission and to keep yourself
Create your own personal mission statement to sharpen your focus and prioritize your activities.
Convert the skillful attitude of self-care into concrete behavior—lest your soul be lost to the demons.
Invest in interdisciplinary movements to investigate and remediate the cries of the world.
Be gentle with yourself—shed the heavy burden of expectations about personal perfection that
Expect a lifetime of struggle for awareness and growth; self-renewal is a process of creativity and growth.