The ABCs of SOS (Strategies of Self-Care): Self-Reflection for the ED Clinician

By Sandra Wartski, PsyD, CEDS
Silber Psychological Services, Raleigh, North Carolina

Clinician self-care is critical. We know this to be true, yet making time to mindfully attend to this practice amidst a busy practice week is often put last on the commotion list. Clinicians working in the field of eating disorders in particular face a number of complex challenges and varied comorbid conditions. The work is invigorating and stimulating yet can be overwhelming and deceivingly difficult. Putting off, ignoring or resisting self-care can result in blind spots, distraction, mistakes, compassion fatigue, and even burnout. We want to avoid an emergency situation, where we are sending an emergency SOS (believed to have originated with sailors signaling for help from a vessel in distress to mean “Save Our Ship”), and instead to more regularly apply a therapeutic type of SOS (“Strategies of Self-Care”).

Research into the science of self-care supports a multitude of its benefits: sustaining stamina, increasing flexibility, improving creativity, maintaining optimism, and enriching therapy. By reflecting on our own professional process with a focus on proactive application, we can begin to apply the ABCs of SOS. Let’s briefly examine each of the ABC steps (Assess, Build, Continue).

A Stands for Assess

In order to take care of the caretakers, we need to assess our own status on a regular basis. Being aware of the subtle but significant changes occurring in our brain, body, and behaviors is key. Some individuals notice sleeping difficulties, concentration lapses, more irritability, increased avoidance of social activities, or changes in substance use. Assessment also can apply to increasing awareness of the barriers that stand in the way of engaging in necessary self-care behaviors. Here are a few questions to ponder:

• Are you aware of your signals of vulnerability or your “red flags” when overload is looming?
• What are your top two sources of stress?
• What most often gets in the way of actively engaging in self-care?
• Are you conscious of any conflicted feelings, greatest challenge, or most common “excuse” about self-care?
• Is there a way to make a more conscious decision to regularly tune in and assess your centered-self status?

Your self-care requires tuning in intellectually, psychologically, biologically, and somatically. Knowing when external and internal events are disrupting your sense of well-being is the first step in being able to make some changes, but such shifts are not possible if you aren’t paying attention. The distinct occupational hazards that accompany work with ED clients, especially in our current pandemic world, only make this more essential.

B stands for Build

Every individual needs to explore realistic options for their SOS and to develop personalized plans for application that can be incorporated regularly, including developing practices of mindful attention to active rejuvenation and resilience routines. There are certain universal foundational factors (such as attending to regular eating, sleeping, and play), known professional elements (such as regularly engaging in peer consultation, utilizing mindful attention to optimism, and focusing on the rewarding process of recovery). Add to this dialectical dynamics to maintain (such as by taking decisive action while also being patient, stepping forward to take action but also stepping back to rest, accomplishing small steps but remembering the bigger picture). However, each clinician must also develop his or her own personalized plans for maintaining mindful self-repair. Each of us has different ways of minding the body and mending the mind, and clinicians have a varied set of diversions that can allow healthy escapes.

We alone can tell ourselves what should be in our personal care plan. A few questions can help put this in clearer focus:

• What specifically do you do to take care of yourself (what, when, where, and how)?
• What deepens and strengthens your sense of personal well-being?
• What are you doing to prevent low-grade fatigue or burnout? What are you not doing?
• What makes for a good workday or week? When do you feel most in flow with your work?
• What recharges your battery in terms of therapeutic work? How do you enhance your “bounce-back” capability?

Building in regular routines assures that we are more likely to do this more consistently. Just as we work hard to assist our clients in creating new and improved routines around eating and body appreciation, we, too, need to patiently do the work to add in routines on which we can more easily rely. With more mindful attention to regular self-care implementation and personalized professional adjustments, therapists and therapy are enriched.

C Stands for Continue

Just as maintaining recovery from an ED requires a set of skills that must be maintained over a lifetime in order to sustain recovery, clinicians must continue applying proactive SOS skills across their personal and professional lives. Contrary to what many experienced clinicians may believe, this is not limited to beginners who are new to the field and potentially more overwhelmed at the start. In fact, those who have been in the field longer are at greater risk for fatigue from the cumulative effects of the enormity of the work over the years. Reflecting on the changes needed over time and looking forward to the future can be helpful to consider. A few questions can be helpful:

• How has your own self-care changed over time?
• What is better in how you approach self-care, and what is more lacking?
• What are resources (internal or external) that you didn’t have earlier in your career but now have in order to meet upcoming challenges?
• What do you want to do more of and less of in the coming years?
• What helps you to feel hopeful about the future?

What was rejuvenating for us earlier in our careers may need transformation. There is actually benefit to periodically diversifying our SOS portfolio because novel activities can provide freshness, energy, and new neural networking opportunities. And, by being attentive to resources we may need for the future, we are planting the seeds for continued maintenance of self-care and building in self-accountability.

Summing Up

While most of us know that self-care is a responsibility that benefits ourselves and our clients, application and systematic execution are often inconsistent. We all want to prevent burnout but don’t always fully accept and commit to this goal. Given that our profession is unique in that one of the most essential “instruments” of our work is ourselves, keeping fine-tuned through ongoing self-awareness and regular bouts of mindful personal-battery-recharging across our personal and professional lifespans is imperative. And, just as importantly, taking care of ourselves is not just a good idea, it is an ethical responsibility.

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