“The difference between successful people and really successful people is that really successful people say no to almost everything” ~Warren Buffet

An easy definition for boundaries is: what’s okay for me and what’s not ok for me. Each of us defines this uniquely, drawing from values, worldview, past experience etc. For both boundaries and self-care, some of this knowledge is easy, but some of the nuances of how it will apply for a new counsellor is hard-won. 

You’ll be a dumpster fire if you don’t build and consistently apply these skills. Yes, these seem like stereotypes, but

the truth is, anyone who survives decades in this field knows that healthy boundaries require finding a middle ground between compassionate care without carrying the entire world around.

Much of the burnout new therapists experience is caused by over-involvement in client stories. Yes, some days will get to us, but being careful not to become too involved or overly empathetic is prudent for longterm practice. Don’t set yourself on fire to keep others warm, put your own oxygen mask on first when the plane is going down, etc etc.

It’s critical that we learn what works uniquely for us; the more consistent the application of this self-knowledge the higher its value. The times we least feel like doing it are actually the most important moments for self-care. 

Healthy work boundary examples:

• Don’t work harder than your clients

• How many sessions in a row can I do before I need a break? (I think 2 or 3 is okay)

• Not being at work outside scheduled hours (get good at prioritizing, being efficient, and tolerating a lengthy to-do list when needed. Something that guides me on heavier days: “is anyone going to actually die if I don’t get this done today?”)

• Not doing therapy outside of sessions (e.g., lengthy calls, emails. Typical therapy environments are not crisis centres) 

• Never checking work email or voicemail outside the office

• Not thinking about clients much outside of work, if needed I’ll email myself a quick note in my free time and let it go

• Limiting free time spent on therapy reading or similar activities, we need a balance

  *safety is a clear exception to most of the above

I know some of this sounds callous and overly pragmatic, but I think being a therapist is challenging, and the reality is we have to be pretty serious about boundaries and our health if we want to do this long term.

As with any field, newer therapists are often somewhat taken advantage of via professional naivety or their desperation to keep a job. You’d hope that therapists who manage others or run a business would be caring, reasonable people but this is not universally true. Saying “no” to a manager when they ask you to take on yet another responsibility without a raise or change in title is a hard to do, no doubt. Go in with your eyes open, and I hope you find roles that are reasonable for a human being to do (rather than see 35 clients a week plus endless insurance paperwork etc).

Therapists and clients alike can struggle with maintaining good boundaries. More often than not it’s a question of internal discomfort at setting the boundary, rather than the skill deficit that people often report the problem as. Practice with this can be very helpful, though it can be somewhat awkward to do (scripting, role play with a peer/supervisor).

What are your most important boundaries? Lately mine has been “I’m not responsible for other people’s choices”

Self-care

Most large therapy organizations have joined the trend of co-opting ‘self-care’ as part of gaslighting employees into blaming themselves for how awful it feels to be overworked and poorly managed. The term “self-care” has become so over-used it’s nauseating. If I sound jaded or paranoid, spend time talking to a variety of people who work in front line mental roles in major cities. Burnout is all over in the healthcare field. If you disagree, I assume you either work in private practice, live in a wonderful small town, or have a fairly senior position and are out of touch.

In the early 2000s, a marketing team at BP oil came up with the disgusting/brilliant idea of the personal carbon footprint. It was a way for massive companies to avoid taking responsibility for their pollution (i.e., the extreme majority of the problem) and instead to convince regular people to blame themselves for polluting the planet. Now I do sound paranoid, except this actually did happen. Google it, or see here or here. Yes each of us still has an ethical obligation to do our best environmentally, etc etc.

Ok, ‘self-care’ wasn’t created by a marketing team, but I think many companies have happily adopted it as a way to overwork people, undervalue them, and not have to bother treating people with dignity—and then having a convenient way of blaming the employee for how soul-crushing it is. “Oh you’re feeling overwhelmed by your expectation to see 32 clients each week? Why?! These are 50 minute sessions, so you have 10 entire minutes every hour to use the bathroom, have a snack, walk around the office, finish up paperwork, or send an email or two. How’s your self-care? Are you spending enough of your time outside of work effectively recovering from my absurd expectations?” Yes, yes, as with the environment, each of us has to take responsibility for our health, and the idea of purposeful self-care is generally a good one. But, it simply can’t make up for an awful work environment. Don’t let a shitty employer try to convince you otherwise. I’ll stop ranting now.

These early years can be a real challenge. I do think we have an obligation to show up to sessions with as many of our needs met as possible so we can be present and respond based on what the client needs, rather than trying to get one of our needs met (which can be very subtle at times). 

It may seem strange to think about efficiency as a form of self-care, but I encourage you to try it. Personally, I use an app (e.g., Trello, todoist, Kanbanflow, TickTick, Habitica) that shows me the scheduled tasks I want to do that day to take care of myself thoroughly. It’s on a rotating weekly schedule, so while tidying my desk and writing in my gratitude journal are both on there every day, meditation only shows up MWF, climbing on Sun/Tues/Thurs, weights on Sun/Wed/Fri, etc. I tweak it over time and currently there are 14 unique tasks that rotate throughout the week (I’m neurotic and healthy!). I have a weekly reminder in my calendar to reflect on any avoidance I’ve been doing, and a bi-weekly reminder to reflect on symptoms of burnout. What helps each of us varies, so find yours and do it.

Hard choices: easy life. Easy choices, hard life.

“Firsts” tend to hit harder, as in the first time a client gets angry with you, tells you you’re incompetent, fires you, quits therapy and blames you, hurts themselves, dies, etc. This happens to everyone and we need to debrief, ideally at work and with someone you trust. Be honest with your supervisor about strange, upsetting, or confusing experiences. 

Bad shit will definitely happen to you at some point. More likely it will be the upset/angry clients who blame you and so on, but clients die in accidents, sometimes clients hurt or kill themselves. I had a client assault me during my community mental health days!

You’re not alone. Hopefully you have peers at work, but also consider finding support groups for newer therapists in your city and online. Someone else has already had the same questions and problems as you. If you’re short on ideas to take care of yourself and be balanced, google the Self-care Wheel. This is also a classic for clients.

So, if you haven’t already, get your shit together and do your best to keep it that way because life will throw you curveballs. The more we’ve been working on ourselves the more resilient we can be in these situations. Luck is the last dying wish of those who want to believe success can happen by accident.

PS

Re-reading this I realized my tone is harsh. I’ve seen too many people crash and burn because of poor self-care, all the while rationalizing the unhealthy behaviour as them being very caring, passionate people. I also didn’t give much specific guidance. There are tons of resources and books out there. Generally, I suggest you more frequently ask yourself how you’re feeling and what you need—then listen to and act on the answers. Check out a feelings wheel. As I stated in Fear, Humility, and Responsibility Taking, it’s usually not a question of not knowing how—it’s more how we decide or why.

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