International Self-Care Day 2021: Self-Care for Therapists and Other Helping Professionals

July 22, 2021 Mark Wilhelm

For those who work in the helping professions—such as medicine, nursing, therapy and counseling, social work, education, public health, human services, criminal justice, and religious leadership—caring for the well-being of others is all in a day’s work.

However, spending so much time caring for others can sometimes cause problems for helping professionals. Stress, burnout, and compassion fatigue are all fairly common in these professions, which can lead to high employee turnover and have lasting negative effects for workers’ health and wellness. For example, an estimated 21–67% of workers in mental health services may be experiencing high levels of burnout, which can lead to a variety of physical and emotional health impairments, research shows.

The good news is that robust self-care practices can help to mitigate or even prevent symptoms of work-related stress and burnout. With International Self-Care Day coming up on July 24th, we’d like to help caregivers and helping professionals who are looking for ways to improve their self-care.

In this blog post, we approach self-care by dividing the self into its many unique dimensions and explaining how you can care for each facet of yourself. We share some tips and suggestions that may be useful for helping professionals, and we highlight some situations that are very harmful to self-care and should be avoided at all costs. This post draws inspiration from the book The Resilient Practitioner: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals by Thomas Skovholt and Michelle Trotter-Mathison, which we think is a great resource on the subject.

Exploring the Many Dimensions of the Self

To begin, it should be noted that we each have a professional self and a personal self, and both of these must be nurtured to maintain good self-care.

Our professional self is that part of ourselves that identifies with the work we do for a living. It is nurtured when our work is personally meaningful to us and when we believe our career is progressing in the way we’d like it to. A healthy professional self is important to our overall well-being, but we’d like to focus more closely on our personal self, which comprises all the parts of us that are not associated with our work.

In fact, our personal self can be divided into 12 distinct parts, which are:

Emotional self: the part of us that thrives on experiencing and expressing emotions of all kinds
Financial self: the part of us that looks for ways to earn and save money
Humorous self: the part of us that loves a good laugh
Loving self: the part of us that needs to express affection and receive affection from other people
Nutritious self: the part of us that craves healthy foods to provide fuel for our bodies
Physical self: the part of us that enjoys being active and exercising our body
Playful self: the part of us that likes to “joke around” and be silly and light-hearted
Priority-setting self: the part of us that’s most comfortable when our to-do list is organized
Recreational self: the part of us that likes to have hobbies and interests outside our professional obligations
Relaxation and stress-reduction self: the part of us that desires peace and serenity
Solitary self: the part of us that enjoys being alone from time to time
Spiritual or religious self: the part of us that seeks connection to something larger than ourselves

Caring for Each Part of Our Personal Self

The dimensions of the self described above are universal to all of us. We each have these unique selves inside us, although how they are expressed and how much nurturing they require varies from person to person. In order to achieve good self-care, you’ll need to determine how much you must nurture each dimension and what methods work best for you.

However, there are a variety of activities that are successful at nurturing these parts of the self for many people. Here are the 12 parts of the self again, this time listed alongside ideas and strategies for nurturing each part:

The emotional self: keep a journal of your thoughts and feelings; engage with different forms of art; talk with friends and family
The financial self: create and maintain a financial budget; put money into a savings account or 401k; keep money set aside for emergency expenses
The humorous self: look for humor in everyday life; use humor and laughter to lighten stressful situations
The loving self: spend time with friends, family and loved ones; volunteer or donate to causes you believe in
The nutritious self: eat a diet high in vegetables, fruits, lean proteins and whole grains; avoid highly processed foods and refined sugars
The physical self: engage in physical activities that you enjoy; exercise regularly; get plenty of sleep to rest and recover
The playful self: develop personal relationships with work colleagues; find ways to respectfully joke about work situations; do things just to make others laugh
The priority-setting self: set realistic goals for yourself; maintain control over personal and professional responsibilities
The recreational self: engage in leisure activities that you enjoy; take up a hobby you enjoy; take vacations or travel in your free time
The relaxation and stress-reduction self: balance your personal and professional life; practice self-awareness and mindfulness; take vacations from work
The solitary self: spend time by yourself; read for pleasure or education; engage in quiet leisure activities
The spiritual or religious self: develop a set of personal values; develop personal spiritual practices

Poor Self-Care Situations to Avoid

As we mentioned above, self-care can look a bit different for everyone, because the ways we choose to nurture our personal selves may vary between individuals. One person’s successful self-care regimen may appear insufficient to another person, depending on how their priorities differ. Therefore, it’s important to discover which balance and which self-care activities work best for you.

There are some situations that are almost universally harmful to a person’s self-care and well-being, though. You should be on the lookout for these situations in your personal and professional life and take action to rectify them if at all possible.

These situations include:

Toxic supervisor and/or colleagues. Poor relationships with our work peers can be extremely draining on our motivation and emotional state. Sometimes, we can compensate for this by increasing self-care in other areas and seeking emotional support from friends and loved ones. In other cases, it may be necessary to change our working situation.
Little fun in life or work. Taking life too seriously all the time can often make it seem joyless and dull. If we find ourselves in this situation, we can work at “manufacturing” fun by actively exercising our humorous and playful selves.
Lack of a professional development process. We may lose all joy in our work over time if we’re unable to see a clear path of professional progression. It can be helpful to map out the “big picture” of where we’d like our career to go and then strategize each step we can make toward that goal. This might also be a topic to discuss with a supportive supervisor.
No energy-giving personal life. Even the most fulfilling work in the world can leave us feeling empty if we don’t have a rich personal life to balance it. This is why it’s so important to develop and nurture the 12 dimensions of our personal self!
Inability to say no to unreasonable requests. As helping professionals, helping others is what we do, sometimes at our own expense. But we must have boundaries in place that prevent us from giving so much that we can no longer care for ourselves. This is where our priority-setting self comes into play.
Giving too much in our personal relationships. Again, it can be easy for helping professionals to slip into the habit of giving too much, even in our personal lives. We must work to build relationships where we both give and receive support in order to keep our emotional and loving selves well cared for.
Constant perfectionism in work tasks. Being consistently too demanding of ourselves is a guaranteed recipe for frustration and burnout. We must give ourselves permission to make the occasional mistake, just as we do for the individuals we serve.
Professional success defined solely by client success or appreciation. When our job is to help other people get better, it can be difficult to separate our success from their success—or even from their appreciation of our efforts. To counteract this tendency, it can be helpful to develop the parts of our personal self that are more inwardly focused, such as our solitary and spiritual selves.

Proper self-care is important for everyone, but especially for those who spend their professionals lives caring for others. Therefore, we encourage you to take some time to assess your own level of self-care!

Write down the 12 dimensions of the personal self and what activities you are currently doing to nurture each one. Then give yourself a score between 1 and 5 to indicate how well each part of yourself is being nurtured.

When you’ve finished, take note of your three strongest personal self-care areas and your three weakest areas. For your weakest areas, brainstorm activities you could do to nurture these areas. If appropriate, you could even set schedules to work on these areas of weakness.

We hope the information in this post helps you strengthen your self-care practices so you can continue your important work of caring for those you serve!

EMDR Therapy: A Primer for Cummins Consumers

July 15, 2021 Mark Wilhelm

“Changing the memories that form the way we see ourselves also changes the way we view others. Therefore, our relationships, job performance, what we are willing to do or are able to resist, all move in a positive direction.” — Francine Shapiro, creator of EMDR therapy

We are all susceptible to traumatic experiences and the negative effects they can cause. According to the National Council for Behavioral Health, 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. Individuals who have experienced abuse, homelessness, economic hardship, who have intellectual and developmental disabilities, or who have served in the Armed Forces may be especially vulnerable to the long-term effects of trauma.

One of the most common ways to treat post-traumatic stress disorder is with cognitive behavioral therapy, or CBT. This type of therapy focuses on changing patterns of thought, with the goal of replacing maladaptive beliefs with more constructive beliefs. CBT has been proven effective at treating trauma and PTSD, but it can take time to produce significant results for some people. For example, although CBT or “talk therapy” for PTSD can produce results within 6 to 12 weeks according to the National Institute of Mental Health, some people may continue to struggle with symptoms for much longer.

However, there is an alternative type of therapy for PTSD, anxiety, depression and some other disorders that often produces results much sooner. Eye movement desensitization and reprocessing, or EMDR, is a newer form of treatment that also helps people change maladaptive beliefs they may have about a traumatic experience. But unlike CBT and traditional talk therapies, EMDR leverages physiology and neuroscience to facilitate these changes. As a result, many people experience relief from their symptoms much sooner than with CBT—sometimes after only a few sessions.

Here at Cummins, several of our care providers are trained in EMDR therapy, and we’ve begun offerings trainings for others who want to learn. In order to familiarize our consumers with this newer form of treatment, we spoke to Laura Coffey, MSW, LSW, who has experience working with several of her consumers using EMDR. In this post, Laura explains the fundamentals of EMDR, including how it’s different from other therapies, how it affects the brain, what a typical session is like, and how she has seen it help her consumers.

What Is EMDR Therapy?

At its core, EMDR therapy is designed to help the client reframe upsetting thoughts and feelings about past experiences. As Laura explains, “It’s a phased, focused approach for treating traumatic and other symptoms that reconnects clients to the images of their trauma in a safe way. It works with thoughts, emotions and body sensations that are associated with the trauma, and it helps the brain move toward an adaptive resolution for the client.”

The major difference between EMDR and other forms of cognitive therapy lies in how these goals are achieved. As its name suggests, EMDR incorporates controlled eye movement—often referred to as “bilateral stimulation”—into the therapeutic process.

In a typical EMDR session, the therapist asks the client to recall a traumatic experience while moving their eyes from side to side. Traditionally, the therapist might hold up one finger and ask the client to follow it with their eyes, but there are alternative techniques that also work, such as moving lights or moving shapes on a screen. In fact, other forms of bilateral stimulation can also be used, such as a sound that moves from the left ear to the right ear or alternating touches on each side of the body.

Although it may seem unusual at first, this combination of cognitive therapy and bilateral stimulation is very effective at treating post-traumatic stress and anxiety. In fact, EMDR therapy tends to produce positive results much more quickly than other forms of treatment, as Laura explains:

“With traditional cognitive-based therapy or dialectical behavior therapy, you might see a therapist for six months to a year for trauma, and sometimes longer. I’ve had trauma patients who I saw for two to four years, and we still didn’t get to the core of everything with cognitive therapy. Using EMDR, I’ve seen that time cut at least in half, depending on the amount of trauma. For a single trauma, symptoms can sometimes be alleviated within three or four sessions using EMDR.”

How Does EMDR Work?

Why does adding eye movement to cognitive-based therapy improve results for clients? It has to do with the structure of our brains and how they operate.

First, it’s important to understand the difference between short-term memory and long-term memory. Short-term memory is where new memories are formed, and this information is stored near the front of the brain. By contrast, long-term memory stores this information for later retrieval, and it’s believed that this happens near the back of the brain. Traumatic experiences can sometimes make us believe negative things about ourselves—such as that we were responsible for the event or that we are worthless because the event happened to us—and these negative self-beliefs may get stored in long-term memory.

When a client recalls a traumatic experience in therapy, they move it from long-term memory into short-term or “working memory,” where it can then be reprocessed so that it no longer triggers symptoms of post-traumatic stress. Laura explains,

“First the person chooses the experience they want to reprocess, then they choose a negative belief they have about themselves because of that experience, and then they choose a positive belief they would rather believe about themselves. That protocol is then used for the desensitization process and the reprocessing process. The idea is to remove the negative belief that they have about themselves because of that experience, and then to replace it with a positive belief that they want to have about themselves, so that when they recall that event, or anytime they experience something that’s similar, they won’t have the negative belief anymore.”

During EMDR, bilateral stimulation serves to activate both hemispheres, or halves, of the brain at the same time, which affects our cognitive functioning in a few important ways. First, it serves to desensitize the client to the memory of their traumatic experience, which makes it less upsetting to recall during the treatment session. Second, research suggests that bilateral stimulation also makes it easier to reprocess traumatic memories in a more positive light.

“Our brain already has the healing capacity to be able to deal with this trauma and to fix the things that are wrong,” Laura says. “It just needs a little help sometimes to stimulate those healing abilities, and EMDR does that extremely well.”

What Happens in a Typical EMDR Session?

Almost anyone can be a candidate for receiving EMDR therapy, even children ages 7 and older. If you’re considering giving EMDR a try, then it might help to know what you can expect in a typical session. Treatment with EMDR is carefully regimented and separated into eight distinct phases.

Phase 1: History taking and treatment planning

In your very first appointment with a therapist, you’ll mostly discuss why you sought out treatment and what you hope to achieve from it. The therapist will ask about any thoughts or self-beliefs that are bothering you, and they’ll work with you to create a list of items you’d like to address. “It’s a client-based assessment,” Laura says. “They tell me what’s going on, and I’m listening very closely to hear what things are the most traumatic for them, or are causing the greatest anxiety or depression, or whatever it is that they’re experiencing right now.”

Phase 2: Preparation

Once planning is complete, the therapist will explain how treatment works and help prepare you for the kinds of emotions and experiences you can expect during your sessions. One way this is done is by helping the client create a mental “safe space.” Laura explains, “I ask them to think of a real or imagined place where they feel safe. We do some visualization exercises to make sure that everything they see there is safe and nothing there is disturbing to them there. And I have them create a box in their safe place, and that box represents where we will pull the memories from. At the beginning of every session we open the box, at the end of every session we close the box and lock it.”

Phase 3: Assessment

When both you and the therapist are confident that you’re ready to begin treatment, you’ll choose the first memory that you want to work on. This is known as choosing your “target.” “We choose a very specific memory with a very specific feeling, and they will gauge it for me on two different scales,” Laura says. “One is the positive belief they want to have and how much they believe that now. And the other scale is how much this memory bothers them right now. That’s how I assess where they are at the beginning of every session.”

Phases 4–7: Desensitization, Installation, Body Scan, and Closure

During the next four phases, the therapist will begin bilateral stimulation in conjunction with cognitive therapy, with the goal of removing the negative belief associated with the memory and instilling the positive belief instead. This process might take several sessions to complete, and it will likely elicit some amount of emotional distress. “Almost all the time, there are emotional reactions during bilateral stimulation,” Laura says. “Sometimes they’re very difficult, because they’ll reveal past trauma or past experiences that are very hurtful for the client, and they’re reliving the emotion. Clients will often feel tired or sleepy after these sessions, and I will warn them about that, because it’s emotionally draining to go through.”

At the end of each session, the therapist will lead you in a “grounding exercise” to ensure that you leave feeling calm and relaxed. “I help them re-enter a state of relaxation and safety before they ever leave my office or the computer screen. And after the first session, I always call the next day to make sure they’re doing OK,” Laura says.

Phase 8: Re-evaluation

At the beginning of each subsequent session, the therapist will evaluate what progress has been made toward your target and what still remains to be done. If you have not yet achieved, or “cleared,” your target, then treatment will resume at Phase 4. If you have cleared your target, then you and the therapist can discuss other targets that you’d like to work toward next. “After they’ve cleared a target, I revisit that in the next session just to make sure that they have cleared that target and that there’s no residual feelings or emotions as a result of clearing that target,” Laura says.

Like any form of therapy, EMDR is not a surefire recipe for recovery. However, it has been shown to greatly help many people who suffer from trauma and PTSD as well as other challenges like anxiety and depression. For her part, therapist Laura Coffey has seen the difference it’s made for a number of her consumers: “More often than not, they say they feel like a huge weight has been lifted off their shoulders. They say that they feel so light. And they’re smiling and laughing by the end of the session, even if it’s been difficult. They come out very, very happy.”

If you’re an existing Cummins consumer and you think you might like to try EMDR for yourself or your child, we encourage you to bring it up with your care provider. They will be able to discuss treatment options with you. Or if you aren’t yet a Cummins consumer, you can call us at (888) 714-1927 to speak with someone about receiving services.

Cummins Behavioral Health Systems, Inc. to Enhance Treatment for Youth Experiencing Trauma in Montgomery County with Award Funding

July 8, 2021 Mark Wilhelm

Will Use $5,000 Grant from Montgomery County Community Foundation to Train Staff in Trust-Based Relational Intervention

CRAWFORDSVILLE, IN – The Montgomery County Community Foundation (MCCF) has awarded Cummins Behavioral Health Systems, Inc. with $5,000 to improve its ability to treat children and teens who suffer from psychological trauma in Montgomery County. The funding comes as part of MCCF’s first grant cycle for 2021 and was awarded based on a proposal submitted by Cummins Behavioral Health staff.

“The grant will be utilized to provide specialized training to two counselors who will subsequently provide Trust-Based Relational Intervention in community youth and school-based environments,” said Doug Phillips, Cummins’ Director of County Operations for Montgomery County. “Cummins currently specializes in school-based counseling, and this grant will strengthen and innovate the therapeutic approach used with this important population.”

Statistics show that Montgomery County has a high rate of childhood adversity and early harm. In 2020, the Department of Child Services received ninety-four reports of sexual abuse alone. This was 10.4% of all reports received in the county, compared to the state average of 11.6%.

Youth who have experienced trauma may have complex needs and find it difficult to trust others. Trust-Based Relational Intervention (TBRI) is a therapeutic framework that takes these factors into account, allowing treatment providers and caregivers to more effectively help children who suffer from trauma.

“We are very excited to be able to receive training in TBRI,” said Shelby Rusk, a youth therapist who co-wrote the grant application for Cummins. “This program will allow us to teach and offer support to caregivers and children to see the need behind certain behaviors and to focus on the whole child. This will help create attunement, attachment, and empowerment for the child and caregiver.”

Cummins Behavioral Health will apply for Rusk and fellow therapist Keri Francis, the grant’s other co-author, to receive training in TBRI through the Karyn Purvis Institute of Child Development when training sessions become available in 2022. After they have been trained, Rusk and Francis will conduct community outreach to educate the public about childhood trauma and trauma resiliency. They will also begin implementing TBRI in their counseling services when appropriate.

To learn more about Trust-Based Relational Intervention, visit the website of the Karyn Purvis Institute of Child Development at child.tcu.edu/about-us/tbri/. For more information about Montgomery County Community Foundation and its charitable initiatives, visit www.mccf-in.org.

Cummins Behavioral Health Systems, Inc. is a community behavioral health center serving Marion, Hendricks, Boone, Montgomery and Putnam counties in Indiana. Our mission is to inspire the hope of recovery, to achieve excellence in all aspects of care, and to make the goals and aspirations of those we serve our highest priority. For more information about our services, please call (888) 714-1927 or visit www.cumminsbhs.org.