Self Care of the Therapist in Session


I’m guessing most of you are familiar with self care for therapists, yet have you thought about self care during sessions and what that could look like. If you’re sitting in a room with a client who is hunched, the neurons that fire in your brain when you hunch over are likely activated, even if you’re sitting up right. This is due to mirror neurons; neuroscientist Vittorio Gallese, MD, PhD, describes “this neural mechanism (as) involuntary and automatic.” When you are feeling a little stressed, nervous, depressed, or emotionally off kilter, it’s likely the client is feeling similar or worse. When this happens in session, I suggest guiding the client/s through regulation exercises. These could be some of the ones listed in Grounding exercises, or something completely different.

It can be helpful to have several exercises that you know will benefit the group that also allow you to step out of the room for a minute so you can take a breather, get a drink of water, or take a shake. An exercise I commonly use for this purpose is a listening exercise. I prompt the group to list the traits of their ideal listener. The group usually comes up with characteristics like accepting, patient, loving, kind, fully present, etc. Before creating the list, I ask the group if they would prefer the list to be what it is, not what it’s not. Usually the group wants this, so if non-judgmental is suggested, you can respond with a yes, and ask the group a way to describe what that would mean to them, so usually accepting or open minded may be used instead. Pair up all participants, and instruct them to select who wants to be the first listener. The other person will then speak for 4 minutes about something they want to explore in their life. The listener only listens and doesn’t speak, yet practices embodying the characteristics of the ideal listener. You can then step out of the room for a couple minutes, say if you need to change your shirt as someone spilled coffee on it as they were coming to group or if you just need a two minute breather to reset. You showed up as the professional, even though you may not have felt like starting group with coffee on your shirt. You role modeled what it’s like to maintain a commitment even when it was challenging for you, and you are still able to care for yourself and change your shirt out during the break you created for yourself.

Especially in the substance abuse treatment center I work with, it’s important for the clinical team to model showing up. Clients could be struggling with much more difficult challenges than the treatment team, such as detoxing and not feeling so great. Clients monitored our behavior closely to see if we were walking our talk.

At the end of the four minutes, guide a discussion for the both the listeners and speakers about what was challenging about the exercise, what beliefs came up, and what was easy about the exercise. Common things that come up are:

  • Difficulty in listening and not offering suggestions
    • Ask how else this applies to their lives, eg do they have the ability to sit with the discomfort of their own experiences or are they constantly trying to fix something so they don’t have to feel discomfort? What is it like to bear witness to the pain of another? What would it be like to be present to their own discomfort?
  • Beliefs around boring the other (underlying of not being good enough) – How else does this apply to their lives? In what ways do they dismiss their concerns and focus on another?
  • “It was easy, no challenge whatsoever on both listening and speaking”
    • Evaluate for dissociation, people pleasing, ability to connect with others, or maybe this was easy for them. The questions for follow up would be tailored to what you believe may be happening.

You’ll begin to see different patterns based on your theoretical lens and develop questions that will support the clients in recognizing patterns, seeing how these patterns affect their lives, and ways to operate differently. There’s frequently the desire to want to be able to offer this type of present listening more often to others and also to themselves. I would frequently pair this exercise with a assignment to do outside of listening to practice this style of listening of others and themselves a couple times a day for the next week.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.