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Self-Care: The Missing Link in Best Practice-Part I The Ethical Mandate for Self-Care



Self-care is not selfish. You cannot serve from an empty vessel."-Eleanor Brownn This work describes a journey I have undertaken that has revealed a detrimental omission in the way we train and practice as school psychologists. The good news is that steps can be taken to remediate the omission and a whole new generation of school psychologists can learn how to protect themselves against burnout and, more fundamentally, care for themselves in proactive, healthy ways. Self-care is an ethical imperative of the utmost importance. For the purpose of this discussion, this claim is supported from three perspectives: (a) ethical codes, (b) burnout literature, and (c) neuroscientific research on the development of the prefrontal cortex; followed by a brief description of global self-care intervention. Communiqué Volume 45 Issue 4
Self-Care: The Missing Link in Best Practice – Part I
The Ethical Mandate for Self-Care
By Paula Gill Lopez
“Self-care is not selfish. You cannot serve from an empty vessel.”
— Eleanor Brownn
Several years ago, something happened that changed the way I think about school psychology and how I
train school psychologists. During a break at a PREPaRE workshop, a school psychologist working at a
middle school approached me. He shared that while I was defining trauma and crisis, he realized that his
entire school sta was currently traumatized and in crisis as a result of all the recent emphases on the
Common Core, standardized testing, and personnel evaluations. His words touched a chord in me and I
reflected deeply on what he said.
Similarly, I have more than once heard from former students who lament the fact that they did not know that
their lives as school psychologists would be so stressful. The defeat in their voices made me wonder if there
was more I could do to prepare them.
This work describes a journey I have undertaken that has revealed a detrimental omission in the way we train
and practice as school psychologists. The good news is that steps can be taken to remediate the omission
and a whole new generation of school psychologists can learn how to protect themselves against burnout
and, more fundamentally, care for themselves in proactive, healthy ways.
Self-care is an ethical imperative of the utmost importance. For the purpose of this discussion, this claim is
supported from three perspectives: (a) ethical codes, (b) burnout literature, and (c) neuroscientific research
on the development of the prefrontal cortex; followed by a brief description of global self-care intervention.
The conversation begins in the field of ethics itself. Regardless of the field of practice, the universal ethical
principle across all professions is do no harm. Specifically, “School psychologists have a legal as well as an
ethical obligation to take steps to protect all students from reasonably foreseeable risk of harm” (NASP,
2010, p. 2).
Volume 45 Issue 4
Several authors writing in the area of clinical psychology have urged us to “[b]egin self-care at the top”
(Norcross & Guy, 2013, p. 752) by petitioning professional associations to explicitly include self-care in their
ethics, accreditation standards, and beyond (Barnett, Baker, Elman, & Schoener, 2007; Norcross & Guy,
2013, Wise, Hersh, & Gibson, 2012).
The NASP Principles for Professional Ethics (NASP, 2010) hold school psychologists to the highest
standards. Yet, noticeably absent is any explicit mention of self-care in service of that high calling. The same
omission is found in the American Psychological Association Ethics Code (APA, 2002). However, self-care is
implied in both documents where they highlight the importance of psychologists, in their words and actions,
demonstrating respect for and a commitment to just and fair treatment of all individuals with whom they
work (APA, 2002; NASP, 2010).
Jacob, Decker, and Hartshorne (2011) criticize ethical codes “because they tend to be reactive” (p. 3). Take,
for instance, Standard II.1.3:
School psychologists refrain from any activity in which their personal problems may interfere with
professional eectiveness. They seek assistance when personal problems threaten to compromise their
professional eectiveness. (NASP, 2010)
Although self-care is necessary to ameliorate one's “personal problems,” in a field that has prevention as
one of its 10 prioritized domains, proactive self-care should be one of the ethical standards in its own right.
In the same way that mental health is much more than the absence of mental illness, nurturing positive
emotional states through self-care is not the same as alleviating harmful disruptive emotional states after the
There is precedent for including self-care proactively in ethical codes in an attempt to avoid personal
problems. The American Counseling Association's Code of Ethics (ACA, 2014) names self-care as an ethical
requirement, as does the Feminist Therapy Code of Ethics. See the relevant excerpts below:
IV. Therapist Accountability
E. A feminist therapist engages in self-care activities in an ongoing manner outside the work setting. She
recognizes her own needs and vulnerabilities as well as the unique stresses inherent in this work. She
demonstrates an ability to establish boundaries with the client that are healthy for both of them. She also is
willing to self-nurture in appropriate and self-empowering ways. (Feminist Therapy Institute, Inc., 1999)
Section C. Professional Responsibility – Introduction
[C]ounselors engage in self-care activities to maintain and promote their own emotional, physical, mental,
and spiritual well-being to best meet their professional responsibilities. (ACA, 2014, p. 8)
Additionally, the American School Counselor Association (ASCA, 2010) mandates that school counselors
“practice wellness” for optimal ethical practice.
E. Responsibilities to Self
E.1 Professional Competence
Professional school counselors … E.1.b. Monitor emotional and physical health and practice wellness to
ensure optimal eectiveness. (ASCA, 2010).
Jacob et al. (2011) define ethics as a “system of principles of conduct that guide the behavior of an
individual” (p. 1). We require school psychologists to employ best practice; to accomplish this they must be
at their absolute best. If this is true, it follows that one of the principles of conduct that guides behavior in the
field of school psychology without question must be to proactively practice self-care.
Is it really necessary to legislate self-care? The answer is a resounding yes. There is an epidemic of stress in
our society today and working in schools can be the epitome of stressful, especially in the current climate.
Stress that is not mitigated eectively can lead to burnout. Those who practice in the mental health field
have very high burnout rates due to the stressful nature of the work (Barnett et al., 2007; Shapiro, Brown, &
Biegel, 2007; Wise et al., 2012). Moreover, school psychologists may have the highest burnout rates among
all helping professionals (Burden, 1988; Huebner, Gilligan, & Cobb, 2002; Wise, 1985). Perhaps, this is due in
part to the fact that “psychologists employed by the schools may have less control over aspects of service
delivery than practitioners in private practice” (NASP, 2010, p. 2).
According to Maslach, burnout is defined as “a syndrome of emotional exhaustion, depersonalization, and
reduced personal accomplishment that can occur among individuals who work with people in some
capacity” (Maslach, 1986, p. 61). Emotional exhaustion develops when work demands exceed personal
resources, resulting in weariness to the point of no longer caring. Depersonalization happens as a
consequence of not seeing people as people any longer but, instead, as problems to fix. Perceptions of
reduced personal accomplishment foster a learned helplessness of sorts—the realization that no matter how
hard one tries, nothing makes a dierence. Maslach and Leiter (1997) cite work variables that can lead to
burnout: work overload, lack of control, insucient reward, unfair treatment, breakdown of community,
values conflict, and lack of fit between the person and the job. There is a strong likelihood that anyone who
works in schools has experienced at least one of these work variables at some point in their career.
To counteract the negative mental health eects of stress and burnout, practitioners must take care of
themselves before they can care for others; otherwise, those with whom they work may be put at risk. “Poor
therapist self-care is associated with increased personal vulnerability, reduced self-monitoring, poorer
judgment, and, as a result, greater ethical breaches” (Keith-Spiegel & Koocher, 1985 as cited in Porter, 1995,
p. 248). In contrast, characteristics of a healthy fully engaged worker are: energetic, involved, and ecacious
(Maslach & Leiter, 2008). These characteristics can be cultivated through self-care.
Wityk (2003) maintains, “Self-care is one of the primary methods of preventing and treating therapist
burnout” (p. 5). Furthermore, when discussing the sometimes seemingly insurmountable stressors
psychologists face that can lead to burnout, Barnett pleads, “[W]e must engage in active attempts to
eectively manage these challenges and demands through ongoing self-care eorts. Failure to do so may
result in harm to our clients, our profession, ourselves, and others in our lives” (Barnett et al., 2007, p. 603).
In the literature on burnout prevention in mental health professionals, several authors address preservice
interventions. The importance of emphasizing and practicing self-care in preservice training programs
increases the odds that self-care will be practiced in service (Barnett et al., 2007; Bamonti et al., 2014;
Heubner et al., 2002; Newell & MacNeil, 2010; Shapiro et al., 2007).
One way this can be done is through the modeling of wellness, stress management, and personal growth by
faculty (Heubner et al., 2002). Self-care facilitates these positive psychological states. If self-care figures so
prominently at the training level for protecting against practitioner burnout, shouldn't it be included in training
At least one helping profession agrees. Section 2.F.1.l. of the Council for Accreditation of Counseling and
Related Educational Programs (CACREP) states “self-care strategies appropriate to the counselor role” must
be included in the training curriculum included in Area 1. Professional Counseling Orientation and Ethical
Practice (Retrieved from
To address concerns about maintaining well-being and practicing eectively given the current stressful
educational landscape, I resolved to promote self-care to members of my community (inside and outside the
university). My eorts to promote self-care and subsequent outcomes will be described in Part 2 of this
article published in next month's issue of Communiqué.
American Counseling Association. (2014). 2014 ACA code of ethics. Retrieved from
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Bamonti, P. M., Keelan, C. M., Larson, N., Mentrikoski, J. M., Randall, C. L., Sly, S. K., … McNeil, D. W.
(2014). Promoting ethical behavior by cultivating a culture of self-care during graduate training: A call to
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Barnett, J. E., Baker, E. K., Elman, N. S., & Schoener, G. R. (2007). In pursuit of wellness: The self-care
imperative. Professional Psychology: Research and Practice, 38(6), 603–612. doi:10.1037/0735-
Burden, R. L. (1988). Stress and the school psychologist: A comparison of potential stressors in the
professional lives of school psychologists in three continents. School Psychology International, 9(1), 55–59.
Council for Accreditation of Counseling & Related Educational Programs (CACREP). Section 2: Professional
counseling identity. Retrieved from
Feminist Therapy Institute, Inc. (1999). Feminist Therapy Institute code of ethics (Revised, 1999). Retrieved
Huebner, E. S., Gilligan, T. D., & Cobb, H. (2002). Best practices in preventing and managing stress and
burnout. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology IV (pp. 173–182). Washington,
DC: National Association of School Psychologists. Retrieved from
Jacob, S., Decker, D. M., & Hartshorne, T. S. (2011). Ethics and law for school psychologists (6th ed.). United
Kingdom: Wiley.
Maslach, C. (1986). Stress, burnout, and alcoholism. In R. R. Kilburg, P. E. Nathan, & R. W. Thoreson (Eds.)
Professionals in distress: Issues, Syndromes and solutions in psychology (pp. 53–76). Washington, DC:
American Psychological Association.
Maslach, C., & Leiter, M. P. (2008). Early predictors of job burnout and engagement. Journal of Applied
Psychology, 93(3), 498–512. doi:10.1037/0021-9010.93.3.498
Maslach, C., & Leiter, M. P. (1997). The truth about burnout. San Francsico, CA: Jossey-Bass.
National Association of School Psychologists. (2010). Principles for professional ethics. Retrieved from and Certification/Standards/1_ Ethical Principles.pdf
Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress,
and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians
and researchers. Best Practices in Mental Health, 6(2), 57–68.
Norcross, J. C., & Guy, J. D. (2013). Psychotherapy self-care checklist. In G. P. Koocher, J. C. Norcross, & B.
A. Greene (Eds.), Psychologist's desk reference (pp. 745–758). New York, NY: Oxford University Press.
Porter, N. (1995). Therapist's self-care: A proactive ethical approach. In E. J. Rave & C. C. Larsen (Eds.)
Ethical decision making in therapy: Feminist perspectives (pp. 247–266). New York, NY: Guilford.
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based stress reduction on the mental health of therapists in training. Training and Education in Professional
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PAULA GILL LOPEZ, PhD, is the director of the school psychology program and associate professor at Fairfield
University, Connecticut
National Association of School Psychologists
4340 East West Highway, Suite 402, Bethesda, MD 20814
P: 301-657-0270 | Toll Free: 866-331-NASP | F: 301-657-0275
© 2017 National Association of School Psychologists
... Application of self-care strategies has frequently been recommended as a means of preventing burnout and increasing meaning derived from work. In fact, engaging in self-care has been described as an ethical imperative by multiple authors (Lopez 2016; Barnett and Cooper 2009). Newman (2020) defined self-care behaviors as ones that are used to "establish and promote physical and emotional wellness, and to allay stress" (p. ...
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.
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The National Association of School Psychologists (NASP) emphasizes the role of school psychologists across a variety of domains, including engaging with families across multiple tiers of support (NASP, 2010a). However, the national school psychology shortage, leading school psychologists to work across various schools, may play a large role in the ability to work with families successfully and provide them with appropriate supports in the school setting. This study investigated the relationship between the current number of schools served by school psychologists, the availability of family-based engagement and intervention programs, and those responsible for implementing such programs. Survey results from 232 practicing school psychologists indicated 75% serve multiple schools. The number of schools served significantly related to the availability of parent education programs in schools, as well as those responsible for implementing parent education, parent involvement, and parent training programs. Other school-based professionals, such as teachers, school counselors, school social workers, and practicum students, were responsible for implementation when school psychologists were serving multiple campuses. Implications for training and future research are discussed.
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Self-care practices maintain strong professional functioning and decrease risk of burnout and exhaustion. Limited research has examined how these practices are learned and practiced by graduate students. The current study examined self-care-related policies and practices in psychology graduate education, focusing on clinical psychology doctoral programs associated with the Council of University Directors of Clinical Psychology. For all member programs, departmental and/or clinical training area handbook(s) were evaluated for a mention of terms related to self-care. Of 177 programs sampled, handbooks were available online for 136 (76.8%) of them; of these, 15 (11.0%) had an available general psychology department handbook that referenced self-care and 44 (32.4%) had an available clinical psychology training area handbook with such a reference. A simple reference to psychotherapy or mental health services for impaired students was the most common self-care theme observed. Given these findings, and the importance of self-care practices to the professional psychologist, it is suggested that graduate programs adopt clearly articulated and readily accessible self-care statements as well as institutionalized self-care practices that are encouraged and/or supported by faculty and administration. A call to action urges psychology training programs to consider initiating a shift from cultures of self-care that are reactive in nature to ones that instead are proactive and preventive, with a focus on wellness.
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It is well-accepted that occupational hazards are endemic to the profession of psychology and that psychologists bring both strengths and vulnerabilities to their choice of career. Given the pressures faced by psychologists in contemporary society, how can we most effectively meet our ethical obligation to maintain competence throughout our professional life span in order to provide high quality care to those we serve? In this article, we propose to expand the current conceptualization of psychologist functioning as embodied in the widely promulgated stress-distress continuum. Through the incorporation of a positive dimension, we can envision the potential for psychologists to spiral up via their practice of enhanced self-care. Four foundational principles are interwoven throughout our consideration of effective self-care for psychologists: an emphasis on flourishing (rather than merely surviving), intentionality, an awareness of reciprocity in care of self and others and the benefits of integrating self-care into our daily practices and routines, rather than being added onto existing personal and professional obligations. A review of the literature on psychologist self-care strategies, healthy lifestyles, mindfulness, acceptance-based therapies, and positive psychology informs our endorsement of mindfulness-based positive principles and practice (MPPP's) for psychologists. These MPPP's are broadly conceptualized as the how of effective self-care that supports the what (as in what to do) in this realm. Finally, we envision a future in which effective self-care embedded in MPPP's is truly valued, supported and promoted by the profession in a manner that complements and sustains our ongoing well-being and professional competence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Preparation for the role of therapist can occur on both professional and personal levels. Research has found that therapists are at risk for occupationally related psychological problems. It follows that self-care may be a useful complement to the professional training of future therapists. The present study examined the effects of one approach to self-care, Mindfulness-Based Stress Reduction (MBSR), for therapists in training. Using a prospective, cohort-controlled design, the study found participants in the MBSR program reported significant declines in stress, negative affect, rumination, state and trait anxiety, and significant increases in positive affect and self-compassion. Further, MBSR participation was associated with increases in mindfulness, and this enhancement was related to several of the beneficial effects of MBSR participation. Discussion highlights the potential for future research addressing the mental health needs of therapists and therapist trainees. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Representative groups of English (n = 20) and Australian (n = 34) school psychologists were asked to complete the School Psychologists and Stress Inventory (SPSI) and their responses compared with those of a larger but more disparate US sample. Similar levels of stress were reported in all three countries but specific differences as well as similarities were found in the identification of sources of stress. Some possible reasons for these differences are speculated and the strengths and weaknesses of the questionnaire approach to stress is discussed.
The issue of stress among school psychologists and other helping professionals has achieved a position of prominence in recent literature. Critical stressful events in the professional lives of 534 school psychologists are identified and rated. The demographic data for the subjects and the mean rankings of the 35 stressful events are reported. In addition, a factor analysis was performed on the stressful events, yielding nine factors: Interpersonal Conflict, High Risk to Self and Others, Obstacles to Efficient Job Performance, Public Speaking, Time Management, Keeping District “Legal,” Hassles, Professional Enrichment, and Insufficient Recognition of Work. Analyses of variance were performed, pairing the 11 demographic variables with the nine factor scores. One or more statistically significant (p<.05) factor loadings were obtained for gender, age, type of community, number of districts, number of years, and salary.
the inclusion of therapist self-care issues is one of the most innovative aspects of the Feminist Therapy Code of Ethics / it exemplifies the proactive, educational, and preventive ethical approach feminist therapists have advocated / the inclusion of self-care issues as an ethical imperative is based upon a common assumption about therapy: that therapist well-being is positively related to the client's therapeutic outcome definitions of therapist self-care / therapist self-care protects clients [boundary violations, power abuses, inappropriate emotional involvement] / therapist self-care enhances growth in clients / therapist self-care protects the therapist (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Ethics and Law for School Psychologists was written to provide up-to-date information on ethics, professional standards, and law pertinent to the delivery of school psychological services. It is intended as both a textbook for school psychology students and as a reference for professionals. (PsycINFO Database Record (c) 2012 APA, all rights reserved)