Clin Soc Work J (2017) 45:33–38

DOI 10.1007/s10615-016-0575-4

ORIGINAL PAPER

Reconsidering Self Care

Published online: 25 January 2016

Abstract In light of diminishing resources in service redefined the self, and in turn, the use of self in the context
settings, and the subsequent high risk for worker burnout, of collaborative worker–client relationships. This recon-
self care remains an important vehicle for promoting sideration, based in relational models and a recovery ori-
worker well-being. However, traditional definitions of self entation, contrasts with a traditional view of self care that
care are based in formulations about the nature of the self seeks to maintain equilibrium between personal and pro-
that don’t reflect paradigmatic shifts in social work practice fessional realms. Instead, it emphasizes nurturing selves
that place increased emphasis on the multiplicity of that are reflexive and dialogic in relationship with clients
workers’ selves, use of self and a collaborative frame for (Foucault 1997; Miehls and Moffatt 2000). In particular, the
the worker–client relationship. Thus, a reconsidered defi- aim of self care moves away from protecting the personal
nition of self care is proposed that reflects intersubjective, self from the professional self and vice versa, but rather
relational, and recovery-oriented frames for practice and frames self care as encompassing strategies for coping with
posits strategies for self care that make the self appear. the uncertainties and liminal spaces that emerge from the
social work relationship. Furthermore, self care activities
Keywords Self care
Use of self
Worker burnout are offered as moments for the self to be touched, shaped
and re-imagined in response to professional experiences.

Introduction
Burnout and Self Care
Social work practitioners increasingly operate in service
settings functioning under the strain of diminished resour- Following a landmark nationwide study of the social work
ces. In these contexts, self care has emerged as a core labor force, the NASW Center for Workforce Studies cau-
intervention for promoting worker well-being and avoiding tioned that ‘‘social work, as a profession dedicated to helping
the emotional exhaustion and depersonalization character- individuals, families, and communities achieve the best lives
izing the condition of worker burnout. This paper recon- possible, finds itself at a crossroads as it tries to ensure there
siders the goals and objectives of self care in response to will be a qualified workforce to meet the service needs of
shifting paradigms in the field of social work that have these vulnerable populations’’ (Whitaker et al. 2006, p. 7).
Social workers increasingly function within treatment set-
tings charged with doing more with less, and thus profes-
& Sara K. Bressi sional burnout and its sequelae remain a substantial threat to
sbressi@brynmawr.edu the development of an effective and sustainable workforce.
Elizabeth R. Vaden Over 40 years ago, Freudenberger (1974) helped coin the
evaden@brynmawr.edu term burnout as involving a process of ‘‘wear[ing] out, or
1 becom[ing] exhausted by making excessive demands on
Graduate School of Social Work and Social Research, Bryn
Mawr College, 300 Airdale Road, Bryn Mawr, PA 19010, energy, strength, or resources’’ (p. 159). A contemporary
USA review of the studies on burnout reported rates of burnout

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among mental health professionals across studies that ranged well-being, attending to one’s needs, or providing stress
from 21 to 67 % (Morse et al. 2012). Although the construct relief (Lee and Miller 2013; Newell and Nelson-Gardell
of burnout is underdeveloped and varies in research studies, a 2014). While self care might involve others such as peers,
widely used conceptualization from Maslach and colleagues supervisors, one’s personal therapist, family or friends, it is
(2001) delineates burnout to be a psychological syndrome presumed to be care that is by the self and for the self.
involving emotional exhaustion, a resultant tendency
towards depersonalizing client groups, and a feeling of
decreased efficacy on the job. As such, burnout contributes to
Self Care: Maintaining Equilibrium Between
a withdrawal from engagement with clients, threatens major
the Personal Self and the Professional Self
disruptions in continuity of care through eliciting high
turnover rates within agencies, or hastens exit from the field
Discussions of self care in the social work literature
all together (Chiller and Crisp 2012; Schaufeli et al. 2009).
inherently include assumptions about what the self is and
Prior literature delineates a diversity of organizational
how it functions. In this discourse, the self has typically
and person-level risk factors associated with burnout in an
been divided either implicitly or explicitly into two primary
effort to contextualize and ultimately combat worker dis-
component parts; namely the professional self and the
tress. First, resource-strapped and insurance-driven treat-
personal self. The professional self is the aspect of self that
ment settings for vulnerable persons living on the margins
is engaged at work in relationships with clients and is
with complex trauma histories subject workers to higher
guided by professional role expectations which provide the
caseloads, demand greater resources for documentation,
rules of engagement for these relationships with clients.
yet offer low levels of training and supervision (Arnd-
The personal self is the self that exists outside of the
Caddigan and Pozzuto 2008; Newell and Nelson-Gardell
workplace. The personal self is guided by other role
2014). Supervisory relationships are often focused on
expectations outlined by family life, economic functions,
managing tasks and procedures as opposed to offering
community, and many other diverse ecologies.
space for processing reactions to client interactions (Chiller
This construction of the self is related to pre-modern
and Crisp 2012; Figley 2002; Newell and Nelson-Gardell
theoretical orientations rooted in ego psychology and sys-
2014). Other forms of support such as peer debriefing may
tems theory which construct the self organically as a sin-
also be discouraged by organizational structures and cul-
gular entity that ideally functions when its component parts
tures (Newell and Nelson-Gardell 2014). At the level of the
are operating with balance, coherence and integrity (Miehls
individual practitioner, a lack of personal coping strategies
and Moffatt 2000). Thus, the overarching goal of self care
and supportive relationships, both in and outside of the
activities has been to maintain equilibrium or homeostasis
workplace, put a practitioner at higher risk for burnout. The
within a self system such that the professional self does not
literature also sets a parabolic developmental frame to the
impinge on the personal self and vice versa. Within this
experience of burnout and suggests novice practitioners, as
frame, the experience of worker burnout results from a self
well as those with a great deal of exposure to client suf-
that is not in balance.
fering are at higher risk for burnout (Hunter and Schofield
Inspection of the discourse on self care suggests many
2006; Newell and Nelson-Gardell 2014).
iterations of how this imbalance between the personal and
The substantial threat to client and worker well-being
the professional might emerge. These include, but are not
associated with burnout, coupled with workers’ embedded-
limited to, experiencing a severe infringement of the pro-
ness in resource-compromised human service agencies, has
fessional self on the functioning of the personal self. This is
resulted in a renewed interest in self care as a crucial strategy
colloquially known as ‘‘bringing one’s work home at night’’
for maintaining the social work labor force (Lee and Miller
(Lee and Miller 2013) and is assumed to result in a personal
2013; Whitaker et al. 2006). It is notable that the term ‘‘self-
self that is overwhelmed by or over-identified with the
regulation’’ now appears twice in the newly crafted list of
emotional distress of clients (Berzoff and Kita 2010; Siebert
practice behaviors that concretize the core competencies of
2005). In contrast, a professional self may suffer from a
the 2015 Educational Policy and Accreditation Standards of
personal self that is too impinging on the work through an
the Council on Social Work Education (CSWE 2015). The
over use of self, or when the worker’s emotional function-
insertion of this language foregrounds the critical responsi-
ing in personal relational matters is poor.
bility of the worker in practice to manage one’s professional
Following a review of the social work self care litera-
activities in part through nurturing the self.
ture, Lee and Miller (2013) offered the following definition
As with professional burnout, the construct of self care is
of personal and professional self care;
variably defined in the literature. Self care generally refers
to activities or processes that are initiated and managed by Personal self care is defined as a process of pur-
the worker for the purpose of supporting one’s health and poseful engagement in practices that promote holistic

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health and well-being of the self, whereas profes- and transparency, self disclosure of informational content
sional self care is understood as the process of pur- regarding the worker’s experiences, attributes, and identi-
poseful engagement in practices that promote fications, as well as here-and-now self disclosures of the
effective and appropriate use of self in the profes- practitioner’s emotional and cognitive processes during an
sional role within the context of sustaining holistic interaction with a client (Knight 2012). The profession has
health and well-being. (p. 98) a strong tradition of charging social workers to use self
conscientiously within the confines of professional role to
This definition of self care draws on the idea of a self in
promote client growth. This process, which is furthered by
balance in its aim at protecting the integrity of the personal
self awareness, is considered a prerequisite for meaningful
self in an effort to be one’s best at work, alongside
engagement in the social work relationship (Heydt and
facilitating a protection of the professional self through
Sherman 2005; Shulman 2012).
cautious use of self on the job.
However, use of self also ushers in a profound fear,
First, in this construction, personal self care is focused
almost a phobia, of inviting a disruption in the equilibrium
towards behavioral strategies that promote subjective well-
between the personal self and professional self (Burton
being, reduce stress and promote containment of the impact
2012). Thus, professional self care as previously defined
of the professional self on the personal. This includes
aims to prevent use of self from going too far and
attempts at basic regulation of the body and mind through
unknowingly harming a client by subverting the profes-
sleep hygiene, good nutrition, an exercise regimen, build-
sional self and its requisite role expectations to the personal
ing a supportive matrix of relationships with one’s com-
self (Heydt and Sherman 2005; Reupert 2007). This cau-
munity, family or peers and those activities that promote
tion is captured in the now obsolete 2008 CSWE EPAS
creativity, pleasure and rest and relaxation (Lee and Miller
which directs workers to ‘‘recognize and manage personal
2013; Morse et al. 2012; Newell and Nelson-Gardell 2014).
values in a way that allows professional values to guide
Some proposed self care strategies such as hobbies, phys-
practice’’ (p. 4) highlighting the trepidation that workers
ical activities, or socializing are also thought to promote
would consciously or unconsciously use their positionality
wellness by distracting the personal self from the profes-
and power to subjugate the emotional needs and values of
sional. These strategies allow for space to actively disen-
clients to their own needs. Worse, it alludes to the fear that
gage from or avoid professional experiences in an attempt
a worker would engage in a gross encroachment of the
to keep them from infiltrating personal, relational, emo-
personal self by coercing or intruding on clients through
tional and cognitive experiences (Skovholt et al. 2001).
breakage of professional role boundaries.
Towards the same aim, Lee and Miller (2013) suggest that
These current conceptualizations of self care are helpful
workers set clear boundaries around engaging in thoughts
in encouraging practitioners to intentionally formulate self
or discussions about work while at home. Likewise, Figley
care plans as an aspect of professionalism. However,
(2002) suggests this kind of disengagement is preventative
constructing self care as maintaining the ideal of a singular
of the emotional exhaustion of burnout and purports a
self with personal and professional parts that are bounded
worker must make ‘‘a conscious, rational effort to recog-
and balanced has important limitations that may discourage
nize that she or he must let go of the thoughts, feelings, and
engagement with clients and use of self. For example, this
sensations associated with the sessions with the client in
perspective places the personal self in competition with the
order to live their own life’’ (p. 1438).
professional self for limited psychic resources. Subse-
Second, formulations of professional self care center on
quently, workers may adopt a defensive stance aimed at
using strategies to avoid the personal self encroaching on
protecting the personal self from the professional or
one’s professional role in a way that is harmful to the self
diminishing the importance of the personal self on client
or to the client. Lee and Miller (2013) write ‘‘maintaining
interactions. In other words, in an attempt to maintain the
[emotional] boundaries while in the professional role may
status quo, a resistance to the client emerges that may
then better enable a practitioner to have the energy and
operate against change and growth in the worker and in the
space to sustain and preserve the depth of emotional con-
client (Ghent 1990). Workers may presume the affective
nection in personal relationships’’ (p. 99). In this vein,
and identity dysregulation spurred by interactions with
professional self care focuses in on strategies that allow for
clients is a sign of weakened personal boundaries or they
managing a worker’s use of self with clients. Use of self
may begin to see clients as intruders on their psychic
emerged as a rejection of a historical emphasis on thera-
wellness. This approach contrasts with viewing the intense
peutic neutrality, and is a core social work intervention that
affects and relational experiences inherent in therapeutic
directly draws the personal self into the work. It encom-
work as an expectable aspect of the work with oppressed,
passes a set of practitioner interventions which include
traumatized and vulnerable people that is useful for
Rogerian person-centered concepts such as genuineness
building an effective client change process.

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Next, when workers feel too much danger around use of encourages a stance of embracing not-knowing and
self, which may be heightened by current definitions of uncertainty in the clinical situation. It requires direct con-
professional self care, they may begin to imagine they should sideration and use of self in placing primacy on here-and-
abandon use of self for their own protection and for protec- now countertransferential material and relational enact-
tion of the client. Elements of use of self, such as self dis- ments that emerge in the work. As such, the strong affects
closure, may take on a pejorative meaning because of that emerge from work with clients are transformed into
trepidation around an over-engagement of the personal self important communications from clients that must be
in the professional role. In a small qualitative study, a attended to, as opposed to avoided. Ganzer writes (2007);
respondent stated that he felt use of self ‘‘contaminated’’ his
Use of self in this configuration requires that the
work with clients, and that keeping his personal self separate
therapist not only tolerate ambiguity and uncertainty
was vital for self care (Reupert 2007, p. 112). In the name of
but also immerse herself in it; for it is by entering the
self care, any use of self may be discouraged outright, and
patient’s world and experiencing it that the therapist
instead be replaced by a sense that the personal self is closed
can work with the patient to emerge from it. This
or off-limits from one’s professional life. In turn, this posi-
process often involves an inquisitive and curious
tion may lead to strong prohibition against engagement with
stance on the part of the clinician and the self dis-
clients emotionally or with intense intimacy and may draw
closure of the countertransference. (p. 119)
workers to construct the personal self as a closed system, held
separate and distinct and also fully subversive to the pro- A relational mode of practice poses that strong emotional
fessional self in interactions with clients (Reupert 2007). and cognitive responses resulting from close connection
with other selves is required for workers to truly empathi-
cally enter into and be with clients around a range of
Reconsidering the Self and Self Care experiences including those related to structural inequalities
related to race, class and gender. Likewise, in inviting the
In recent decades, social work scholars and practitioners worker to be in close interaction with the client, there is also
have operated in diverse clinical and therapeutic settings the potential for the worker to be touched, changed, and
and have been influenced by paradigmatic shifts in theo- moved by the client’s change process. Unlike prior con-
retical orientations to practice around the construction of ceptualizations of a personal self that is bounded from the
self and thus, the use of self. They have steadily chal- client, this frame for practice welcomes and encourages
lenged a pre-modern conceptualization of a personal self self-discovery and poses these ‘‘risks to the self’’ as
that is separate, dissociated, or distinct from a profes- opportunities for finding personal meaning and a clearer
sional self. Shulman (2012) called the separation of the acknowledgement of one’s privilege through relationships
self into two parts, the personal and the professional a with clients (McTighe 2011, p. 302). In essence, the work
‘‘false dichotomy’’ (p. 37). Instead, a post-modern con- provides a space for the self to appear (Foucault 1997).
structivist stance based in intersubjectivity and relational These therapeutic models are in sisterhood with changes
models advocates for a self that is not a single bounded in the service sector that promote an egalitarian approach
entity but rather postulates workers have multiple selves to the worker–client relationship. In particular, the recov-
that are co-constructed in relationship with each client ery-movement in the field of psychiatric rehabilitation
(Benjamin 1998; DeYoung 2015; Ganzer 2007; Ganzer alongside feminist critiques of the service system has
and Ornstein 2004; Knight 2012). These selves are ‘‘re- supported a move towards greater collaboration and part-
flexive, complex and dialogical’’ and ideally open to the nership in the social work relationship. In this orientation,
influence of professional relationships (Miehls and Mof- clients are postulated to be the experts on their own lives
fatt 2000, p. 339). Influenced by feminist theory, in this and on their own care. They are held as full partners in the
view, a multiplicity of identities in the worker that occupy change process as opposed to passive recipients of expert
both oppressed and privileged positions intersect in knowledge or good will. Most importantly, and commen-
complex ways and ‘‘cannot be teased apart or stand on surate with intersubjective and relational frames to thera-
their own’’ (Garran and Werkmeister Rozas 2013, p. 102). peutic work, a recovery orientation requires workers
In addition to redefining the self, intersubjective and believe they will learn and change in parallel with the
relational models have also significantly reshaped use of client (Stanhope and Solomon 2013).
self in therapeutic practice. As, Miehls and Moffatt (2000) In light of these shifts in the field, the goal of self care
note; ‘‘the subjective social worker can no longer illumi- activities needs reconsideration. They must incorporate and
nate the struggles of another person or group of persons respond to these changes in the construction of self and in
from a safe distance’’ (p. 342). Relational theory shifts the the practice modalities that increasingly ask practitioners to
clinical social worker from their role as expert and instead work in close contact with clients within the context of

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uncertainty and vulnerability. As such, the following Conclusions and Implications for Practice
reconsideration of the aims of self care is offered:
This reconsideration of self care, rooted in a relational
Self care is inclusive of agentic self-regulated activ-
frame, is aimed at sustaining workers’ capacity to enter
ities that purposefully a.) bolster the ability to sit
into and thrive in the context of work environments that
within, tolerate and understand the affective and
involve continued and prolonged exposure to oppression
identity dysregulation related to experiencing vul-
and human suffering. Returning to the concept of burnout,
nerability and uncertainty in the social work rela-
the proposed definition of self care seeks to disrupt the
tionship, and b.) make meaning of the ways workers’
drive towards being overwhelmed by powerful emotional
selves are changed from work with clients.
experiences, and the subsequent pull to disengage from
First, the goal of self care is no longer limited to clients who have been labeled as intrusive or ‘‘other’’. It
decreasing anxiety from disequilibrium in the self or pro- provides a framework for allowing the worker to anticipate
tecting the self from one’s professional life. Rather it and expect strong affects and increased vulnerability. As
should specifically function to allow workers to tolerate the opposed to being engulfed by these emotional experiences
expected affective and identity dysregulation related to or avoiding them altogether, it incorporates self care
entering the client’s world (Miehls and Moffatt 2000). In strategies to contextualize and reflect on them. In addition,
sitting in these spaces, it is presumed that a worker can then self care activities that build and encourage meaning-
appreciate the client’s past, current relational matrix, and making and self-discovery directly work against psycho-
attachments (Knight 2012; Miehls and Moffatt 2000). logical distancing from clients through depersonalization.
Reframed, self care activities such as exercise regimens, It is important to offer the following caution: self care is
mindfulness meditation, hobbies, and the like move beyond a necessary but insufficient response to worker burnout. It
the purpose of stress reduction or diversion. Instead, they is insufficient because agency-level supports, consistent
bolster the worker’s capacity for affect regulation and for and process-oriented supervision, personal therapy, and
sitting with and understanding feelings of vulnerability, peer support are crucial for promoting safe work environ-
uncertainty, and identity dysregulation that emerge from ments (Chiller and Crisp 2012). An over-reliance on self
the work (McTighe 2011). care to resist work-related distress is aligned with a prob-
Second, self care strategies need to include mechanisms lematic yet prevailing discourse about the amelioration of
for meaning-making and self-discovery. Relational models stress and its negative outcomes. This discourse is rooted in
and a recovery-orientation assume that the social work the medical model and frames stress as an individual
relationship is the vehicle for interventions that produce problem to be addressed with individual-level interventions
change in both the worker and client, in a bi-directional, as opposed to attending to the complex social and structural
co-constructed fashion. These models normalize and patterns that create it (Becker 2013). However, as evi-
encourage workers to actively reflect on the ways work denced by the emergence of models of care such as the
with clients brings meaning to their lives. Self care activ- sanctuary model, safety and support for workers in human
ities oriented towards meaning-making might include service organizations opens the door to parallel processes
journaling, creative writing, artistic endeavors, peer to peer that also promote client well-being (Bloom 2013). In
discussions, or engagement in advocacy efforts that high- addition, relational work requires workers to engage in
light specific self discoveries that emerge from deep their own therapeutic processes towards developing the
engagement with others in therapeutic contexts. capacity to hear difficult narratives, recognize and manage
Using this reconsidered frame for self care, social workers strong emotions, deal with complexity, and know them-
should be explicitly directed that emotional disturbances, or selves at a deep level (DeYoung 2015).
other signs of distress are a normal and important aspect of The proposed focus for self care activities requires
work with vulnerable persons. With this as a starting point, educational programs in social work, field practicums, and
social workers may then be directed towards a range of professional supervision to underpin skill-building around
activities aimed at (a) moving through and coping with dis- self care with theory. This paper argues for an approach to
tress in the body and mind, (b) locating their own reactions as self care that must be contextualized and understood within
communications from clients or countertransferential a knowledge-base of relational theory. The linkage
responses to clients, (c) providing spaces or opportunities for between theory and core social work skills is a perennial
reflection on their own internal assumptions about clients challenge for educators and supervisors. For example, in
and their own lives, (d) and working against use of avoidance examining self disclosure as an aspect of use of self, a
of affects and thoughts related to clients as the primary form recent study (Knight 2012) suggested that clinicians’ were
of self care or frame for use of self. often unable to connect their use of self disclosure to

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evidence-based or theoretical models. Therefore, it may be for social work supervision. Clinical Social Work Journal, 32(4),
most effective for classroom and field instructors, as well 431–449.
Garran, A. M., & Werkmeister Rozas, L. (2013). Cultural competence
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