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

Abstract

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

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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 staff 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).
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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 effectiveness. They seek assistance when personal problems threaten to compromise their
professional effectiveness. (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
fact.
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

Burnout
Professional school counselors … E.1.b. Monitor emotional and physical health and practice wellness to
ensure optimal effectiveness. (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 effectively 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 difference. Maslach and Leiter (1997) cite work variables that can lead to
burnout: work overload, lack of control, insufficient 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 effects 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 efficacious
(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
effectively manage these challenges and demands through ongoing self-care efforts. 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).

References
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
standards?
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 http://www.cacrep.org/section-2-professional-counseling-identity).
To address concerns about maintaining well-being and practicing effectively given the current stressful
educational landscape, I resolved to promote self-care to members of my community (inside and outside the
university). My efforts to promote self-care and subsequent outcomes will be described in Part 2 of this
article published in next month's issue of Communiqué.
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PAULA GILL LOPEZ, PhD, is the director of the school psychology program and associate professor at Fairfield
University, Connecticut
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