Self Protection: A Therapist's Guide
I often get asked about how I can listen to my client's distress all week without crumpling with exhaustion or getting distressed myself. I tend to give a short answer so as not to put people off asking me anything ever again, something like, “My training involves learning to protect myself/ I make sure to have plenty of supervision". But there's a much better, longer answer that involves re-calibrating how I empathise in order to ensure my own self protection.
Supervision is part of the self-care necessary for any therapist, but it is also an ethical requirement. In fact, without being in regular supervision, a therapist's professional registration may be under threat (speaking for the main professional organisations, the BACP and UKCP). When in training or newly qualified, you need more supervision than when you become experienced, although however experienced you may become, you should never be without it.
What supervision means
Supervision offers a confidential space to talk about your client work with someone more experienced than you. This way of co-opting another mind to think about your work can help lighten the load, but it also offers new ways of helpful thinking that you may not come up with spontaneously – however experienced you are. Ideally you would talk about aspects of your work that feel problematic or difficult, although talking about the 'easier' stuff is important too - as we can be blind to things that a supervisor may spot.
But beyond mandatory supervision, there are myriad ways we could be attending to ourselves so we can do our job as best we can. Therapy isn't mandatory after qualifying, but being a big fan of it (funnily enough), I still go each week. Client's issues may touch me in particular because of my own history and ever-lasting sore points, and if so, they will need a good airing so as to minimise any risk that my own distress intrudes in my work. But, like my clients, I also live in the world outside the consulting room with its endless slings and arrows. I find therapy a valuable space to make sense of my responses to them all, and to rely on someone who roots for me pretty much unconditionally.
But therapy is only 50 minutes a week, and supervision another hour too. These combined wouldn't be enough to wholly protect me from becoming worn out – nor with the additional running, meditation and other relaxing pursuits I enjoy. What has helped however took a while to take on board - learning to use the difference between empathy and compassion. While the latter clearly contains the former, it also contains essential added ingredients that nourish me while I also feel deeply for another.
Why compassion is so valuable to therapists
Empathy, in short, is our ability to feel what another feels. Neuroscience tells us that similar areas of the brain are activated both in the person who suffers and in the one who feels empathy for this person's suffering. So my brain responses will (in part) match another's. Now clearly you'd expect a therapist to have empathy, and indeed we work hard to enter into our client's inner world to understand as best we can what it feels like to experience our client's distress. However, if we rely solely on this process, we will continue to trigger responses in our brain that can, over time drain us out. 'Compassion fatigue' (as it is commonly called, but more accurately should be 'empathy fatigue') is a potential and real problem for many health care workers or others in the frontline of emotional distress.
Compassion however starts from a different but related place and can serve as an antidote to this type of burn-out. Contrary to empathic distress, compassion creates a positive state of mind that can scaffold our ability to confront others' sufferings. Neuroscience is increasingly backing this up too. While it seeks to alleviate another, it can also tuck ourself into the area of concern. Compassion, effectively done, includes all.
One example is to think of a desperately sick child. A family member who is calm and soothing, grounded and mindfully present will serve her child better than if she is completely overwhelmed by anxiety and empathic distress. I'm not doubting the strength of the love or depth of anxiety of either, but the person who can look after herself through the embrace of compassion won't run out of emotional steam so fast (or indeed at all).
For more on this, dig into the work of the brilliant Tania Singer and the monk who has offered up his brain for study, Matthieu Ricard here. Not forgetting of course, the Dalai Lama, who talks beautifully about this too.