The Two Biggest Myths About the Time and Energy Involved in Launching a New Group

Recently I connected colleague and friend Katie K May (the Group Guru) who shared all about her success in marketing and filling groups in private practice.

Katie has 6 full groups that are the foundation of her practice (and bring in $8000 per month!) If you’ve considered starting a group in your practice, but you’re worried about the time and energy involved in making that happen, Katie is debunking the two biggest myths about launching a new therapy group.

(Want to know 7 ways to save your sanity and protect your self-care when launching a new group or program? Be sure to join me and Katie this Friday at 2 pm EST when we go live to share the 7 Ways to Avoid Burnout When Launching a New Group. Register at ​www.becomeagroupguru.com/sign-up​)

Here are the two biggest myths about the time and energy involved in launching a new group, according to Group Guru, Katie K. May…

“I need tons of time in my schedule and I’m already strapped for time as it is!”

Truth:​ While it may take you a couple hours of one-time setup, once you have the framework, you can automate and repurpose content for wash, rinse and repeat group launch success. I use the exact same system (and emails) to launch every single one of my new groups. It’s going out to a new audience so it’s not a repeat for them anyway!

“I’m already drained from my caseload. I don’t have the energy for groups!”

Truth: ​Groups take the pressure off because you’re not the only one doing all the work of validating and normalizing! Plus, you can help more clients all at once while also doubling or tripling your hourly rate so you’ll end up spending less time in the office!

If you’re curious about groups, but not yet sure if they’re for you, read on for

Katie’s top 3 reasons that groups are the ultimate way to practice more self-care…

1. Running groups has allowed me to make a bigger impact on clients by connecting them to others to feel heard and understood. I leave the office every

day feeling energized and fulfilled by this. And my clients see amazing outcomes

in less time than individual therapy alone.

2. Offering groups has given me the gift of more FREEDOM! Because groups bring in more income per hour for me, I’m able to spend more time out of the office, with my family and practicing self-care. (Helloooo weekly massages and daily yoga classes!)

3. Because groups are typically not the primary level of care, I’m able to take more vacations and travel with my family… all while trusting that each client from group will be taken care of when I’m gone (No urgent calls while I’m waiting in line at Disney!)

So there you have it… 3 reasons to start your therapy group this year so you can have MORE time for self-care and help more clients at the same time!

 

If you’ve thought about starting a group and still have concerns about how to make that happen (and not completely burnout at the same time) be sure to join us on Friday to learn more! Sign up and show up by registering here

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Self-Care and Ethics (part 2)

We have been discussing this topic of self-care and how it is an ethical issue for helping professionals. If you have not been following along click below to read part 1 of this post and you can catch the initial post “Self-Care as it Pertains to Ethics” while you are over there on the blog.

Self-Care: Where does the Onus Fall?  (Part 1)

As mentioned previously, to be successful it is vital that helping professionals have the characteristics to be able to hold space for people’s worst stuff. This requires compassion, empathy and a nurturing caring persona. When we have a profession that by its very existence exposes its primary workers to real life stories of trauma, abuse, death, depression and other significantly distressing events, who is responsible ultimately for ensuring those same front line staff take care of themselves? Does the onus lie entirely with the helping professional themselves? Do we hold the agencies that hire them or the insurance companies that often manage care or anyone else responsible at all? I posed the question of self-care programs to clinicians regarding what they had encountered at agencies or facilities they had been employed by and the following are a few of the responses that I got.

  • “The worst supervisors that I ever worked for would have a fit if I planned to take a mental health day off. As a fairly healthy person, I had tons of unused sick time that I almost never used”.
  • “We are denied paid time off if we do not meet the billing requirement”.
  • “If I take a day off then I have to make up hours with my billing even though I had to use my vacation time”.
  • “The jobs I have held have been restrictive when it came to the self-care of the employees. The last job I held did not like it if you missed a day of work (there was no PTO and few holidays). All employed there would be encouraged to be in office even if they were running a fever.
  • “I have never worked for an agency that any kind of self-care program. For the most part, I could take periodic time off, but it was still frowned upon.”
  • “I had two jobs that had formal self-care programs but they weren’t accessible due to scheduling and the type of jobs I had.”

It’s not all bad though. I did get a few good reports that give me hope that maybe we can begin to move in the right direction.  Here are some of the good stories I heard.

  • “The company I worked for previously would reimburse up to a certain amount for gym, yoga, Cross Fit, or any other physical activity center.”
  • “My previous company was a mental health center but it was located in a community Hospital so that probably affected our benefits and such, but we had an EAP program that we were encouraged to use and the first six sessions were free, we also had a health program that encouraged healthy lifestyles, exercise and healthy eating. They were always doing monthly activities to encourage physical health. If we completed our annual goals which weren’t usually very hard we got a $350 bonus at Christmas. And my supervisors in my department were very understanding of mental health days. We were not really allowed to “comp” time but our supervisors gave us a little bit of leeway. We had very few holidays and our department rotated in the on call schedule.”
  • “I currently work for large mental health company that encourages wellness by frequently offering wellness completions with rewards examples are weight loss reward was free health insurance for employee for 6 months, walking completions with rewards up to $50 gift cards and various walking activities for employees.”
  • “At one location we had a gym. My current practice has free mindfulness and yoga classes (space permitting) and discounts on massage and Reiki therapy. Also get to use the yoga and art studio for individual self-care use if it’s available.”

These went on and on and are representative of different areas of the United States. There were many with little to no active self-care plans or programs that were actually “usable” and even more concerning is the fact that even time off was often discouraged. There were some who report good experiences and have been with companies that do value the mental health of the employee. Thankfully there are also reports of individual supervisors being supportive giving me hope for the future. If we do indeed look at self-care as an ethical imperative then it is a definite concern however that so many do nothing for self-care. A reality that really alerts me to many problems is the refusal or discouraging of allowing clinicians to take time off. Overall in the research done for this article I was not able to find evidence of self-care for clinicians being a priority for agencies or employers. This is a trend that I would love to see change and my hope is that by starting some conversations it will become a priority of more. What do the governing agencies say? THE FOLLOWING CODES OF ETHICS ARE CITED: APA, NASW, APA and ACA in this document. They all mention self-care in one or more ways. Download the PDF to read them all for yourself. What we have is the organizations that govern the mental health clinicians are mandating something that there is no evidence of being upheld in the general employment places of clinicians. What happens then? This will typically lead back to having the onus placed on the helping professionals themselves.

What Agencies Can Do to Support Wellness from the ACA

  • Educate your staff and supervisors on the concepts of impairment, vicarious traumatization, compassion fatigue and wellness.
  • Develop or sponsor wellness programs (such as in-service trainings and day-long staff retreats)
  • Provide clinical supervision (not just task supervision)
  • Encourage peer supervision >Maintain manageable caseloads
  • Encourage/require vacations >Do not reward “workaholics”
  • Encourage diversity of tasks and new areas of interest/practice
  • Establish and encourage EAPs

This article from APA gives away the content with the title “Self-care is not just for emergencies” It lists social support, creating balance and being aware as a few ways to “self-care.”  This article also from APA gives us more ideas on tips for self-care but again does not address the question of how to fit it in and how to actually make it happen. I would love to hear your thoughts on this topic? Do you have a personal experience you would like to share about self-care in your workplace?

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Self-Care and Ethics (part 1)

Why are we, as helping professionals, not taught to handle burnout? Other professions are trained to remain at the ready. However, the concept of self-care has not been ingrained in therapists, counselors and social workers, psychologists and other helping professionals as a general rule.  We have not traditionally identified ourselves, with the concept of ethics as it relates to self-care.  We are expected to be professionally fit and available. We are supposed to be able to handle the day in and day outs of holding space for others.  It’s as if having knowledge of compassion fatigue and burnout should be enough to keep it away.

We are led to think that the occasional CEU workshop is sufficient to fulfill our professional responsibility to ourselves and our clients.  We know that most people do not seek the services of helping professionals until or unless they are in crisis.  We do ourselves and our profession a great disservice if we think we are immune to our own humanity.  At the same time, we also provide daily care for our own family members, those in our organizations, those we work with and others. We do not have super powers and if by some chance we do then this is our kryptonite.

Psychologists who fail to take care of themselves are less likely to be competent providers, said Erica H. Wise, PhD, a presenter at an “Ethics and Self-Care” continuing-education workshop at APA’s 2006 Annual Convention. In addition, when psychologists’ mental or physical health affects their work, it can create an ethical problem because their ability to help clients is compromised, said Wise, a psychology professor at the University of North Carolina at Chapel Hill.

Impairment doesn’t always take an obvious form like substance abuse, said Wise during the APA Continuing Education Committee-sponsored session. Snowballing personal stressors-such as health problems, marital problems or even day-to-day stressors-can foster mental distress that can impair a psychologist’s effectiveness or even cause improper behavior, such as inability to set appropriate boundaries, breach of confidentiality, fraud or negligence.

We can teach the importance of avoiding such problems through preventive self-care.

Applying the Code of Ethics to the Concept of Self-Care
The following sections have been copied from the ACA Code of Ethics (eff. 1995). How do they apply to the issue of self-care as discussed in the module? Do you comply with additional professional codes? What do they say about the importance of counselor self-care?


C.2. Professional Competence

  1. Impairment. Counselors refrain from offering or accepting professional services when their physical, mental, or emotional problems are likely to harm a client or others. They are alert to the signs of impairment, seek assistance for problems, and, if necessary, limit, suspend, or terminate their professional responsibilities. (See A.11.c.)

Definition:

Burnout

An emotional condition marked by tiredness, loss of interest, or frustration that interferes with job performance. Burnout is usually regarded as the result of prolonged stress.

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

Burnout

Emotional and physical exhaustion resulting from a combination of exposure to environmental and internal stressors and inadequate coping and adaptive skills. In addition to signs of exhaustion, the person with burnout exhibits an increasingly negative attitude toward his or her job, low self-esteem, and personal devaluation.

Strategies for preventing and managing burnout include utilizing assertiveness techniques, improving problem-solving and decision-making skills, clarifying personal values and setting realistic personal goals, learning and using coping mechanisms to deal with emotions, ensuring oneself adequate relaxation and recreation, maintaining a healthy lifestyle, and minimizing stressors at work and at home.

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

Definition:

Compassion Fatigue: Also called “vicarious traumatization” or secondary traumatization (Figley, 1995). The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burn-out, but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.

Mother Teresa Understood Compassion Fatigue

She wrote in her plan to her superiors that it was MANDATORY for her nuns to take an entire year off from their duties every 4-5 years to allow them to heal from the effects of their care-giving work.

Medical Definition of compassion fatigue

  1. : the physical and mental exhaustion and emotional withdrawal experienced by those that care for sick or traumatized people over an extended period of time <Some researchers consider compassion fatigue to be similar to posttraumatic stress disorder (PTSD), except that it applies to those emotionally affected by the trauma of another (eg, client or family member) rather than by one’s own trauma.—Michael K. Kearney et al., The Journal of the American Medical Association, 18 Mar. 2009> <Clinicians should be aware of how their emotional withdrawal or lability and “compassion fatigue” can jeopardize the care of dying patients and their families.—Deborah Cook and Graeme Rocker, The New England Journal of Medicine, 26 June 2014>

Definition:

Vicarious Traumatization

This is a term coined by McCann and Pearlman (1990). It refers to the transmission of traumatic stress through observation and/or hearing others’ stories of traumatic events. This results in a shift / distortion to the caregiver’s perceptual and meaning systems.

“Vicarious traumatization is the transformation of the therapists’ or helpers’ inner experience as a result of empathic engagement with survivor clients and their trauma material. It refers to the cumulative transformative effect on the helper working with the survivors of traumatic life event.”   (Saakvitne & Perlman, 1996)

How does self-care relate to ethics?

It has been researched and shown that the single biggest factor in determining outcome of therapy is the relationship between the therapist and the client. This makes a more significant difference than the type of technique used or any other factor in the relationship.

Can you be effective if you are not healthy? If you are negative, exhausted and overworked can you be fully present for your clients? I would argue you cannot and research shows the same thing. The big question is can you be a danger if you are burned out or not taking the time to take care of yourself? Who has not snapped at a family member or co-worker every now and then? This does not happen intentionally but it happens. What if this is bleeding over into the treatment of the most vulnerable of the clients who come to see us. I venture to say we have all gone to work when we didn’t have enough sleep, didn’t have any down time for ourselves, we push on and push through and at times this works for us. What makes me argue that self-care is an ethical imperative is the times that the pushing through does not work for us.

Self-Care is vital – not a luxury- a look at helping professionals and self-care

You signed on as a helping professional to serve and to heal.  You may be a psychotherapist, a doctor, a teacher, a nurse or a mother, a caretaker or a combination of several of these.  You are anyone who serves others. Many of you are helping professionals and that is just where it starts.  You have sick kids, your aunt is in the hospital and your husband wants to host his work retreat all while you have a cold and are working full time.  You help, you serve and you provide the utmost care….for other people.  What about you?  You need to navigate your own self-care because “as simple as self-care sounds you are finding it’s not”.   The serious and super scary aspect that is often overlooked is the “dark side” shown in research that we don’t always read.   The following paragraph gives some somber stats on what can happen if we are not proactive.

This Medscape article  shows how physician drug abuse is not a new problem — William Stewart Halsted, the father of American surgery, was addicted to cocaine — but it’s a persistent one.[1]    A number of surveys, conducted by Guy and others, reveal some very real and somber statistics about therapists’ lives and well-being. At least three out of four therapists have experienced major distress within the past three years, the principal cause being relationship problems. More than 60 percent may have suffered a clinically significant depression at some point in their lives.  Read the entire article here.  Even more sobering and making an even stronger case for the need for helping professionals to have an active self-care plan is this statistic found in the same article.  One out of every four psychologists has suicidal feelings at times, according to one survey, and as many as one in 16 may have attempted suicide.  A study initiated by that task force, published in 1980, concluded that “psychiatrists commit suicide at rates about twice those expected [of physicians]” and that “the occurrence of suicides by psychiatrists is quite constant year-to-year, indicating a relatively stable over-supply of depressed psychiatrists.” No other medical specialty yielded such a high suicide rate.  Self-care and finding support are necessary and not a luxury for “other people”.

First find yourself?

Before we really start to dig into all the aspects that self-care encompass’ let’s see where you are now.  To get a baseline of how much self-love you are giving yourself click here to take my self-care quiz if you have not taken it yet.  Check out number ten – people often laugh at it but they also have to admit that they can’t answer yes either.  Come back and let up know how YOU answer number ten.  Please remember we are letting this serve as a starting point and not an excuse to say “I can’t even pass a self-care quiz, I give up”.

If you are one who would say “I don’t have time to take care of myself”.  My response is that you need it even more than someone who does have time.  You are the keeper of yourself, your body, your mind, spirit and most importantly your soul.  If you need more convincing go back to the first paragraph and read through the statistics again. This is important.  Self-care is a term which I define as any action intentionally done to improve your physical, emotional and/or spiritual wellbeing.  When you can integrate those aspects of self then you fully move into who you are and only then can you truly help others. 

Stay tuned for more on the ethical imperative of self-care for helping professionals.

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