Self-care was already a hot topic before the pandemic. But 2020 has highlighted how important it is for people to take care of their physical and mental health. Yet the idea of self-care is often oversimplified in a discussion about yoga and bubble baths. “The way we talk about self-care risks sounding like a rich white lady’s occupation,” said Laura Boxley, PhD, ABPP, a board-certified clinical neuropsychologist and director of clinical neuropsychology training at Ohio State University. “But it’s much more complex than that, and there’s a certain depth to it that we haven’t yet addressed.”
As chair of the APA Advisory Committee on Colleague Assistance (ACCA), Boxley has spent a lot of time thinking about how psychologists can rethink self-care. She spoke with the Monitor about where self-care goes from here.
What’s wrong with the way self-care is typically defined?
Self-care is generally seen as an individual process – almost a noble mission to take care of yourself, because no one can do it for you. And it has always been focused on health: sleeping well, eating well. Of course, these general principles are good for all of us, but this focus risks creating a superficial understanding of self-care. This is a reductive, bottom-up understanding. But we also experience top-down pressures on self-care. What is our work culture? Social culture? Work flexibility? During the pandemic, the many competing demands on our time have moderated our ability to advocate for ourselves and care for ourselves, often unequally across occupations and socioeconomic status. We need to consider both bottom-up and top-down perspectives of self-care. You don’t have to stop doing yoga. You don’t have to stop eating well. But also consider how groups, organizations, employers, and governments play a role in our access to and implementation of self-care and work-life integration strategies.
The people who most need resources to care for themselves are often the ones who have the hardest time accessing them. For example, members of marginalized communities and underrepresented groups tend to have limited professional power or influence while facing significant social, financial, and professional stressors. There are hundreds of books on self-care, but they can’t help you if you don’t have time to read them. And even if you are lucky enough to read them, not all concerns about self-care and balance are things that the individual has direct control over. We cannot simply place the greatest responsibility on those with the least power.
How should mental health professionals think about self-care?
We have an ethical mandate to take care of ourselves so that we can take care of others. We are also uniquely trained to be able to do this in a sophisticated way. Yet even though we preach a lot about self-care, we don’t necessarily follow through on it all. And our patients and students are good at detecting hypocritical behavior. By examining the reasons why we don’t always practice what we preach, we’ll begin to get to the heart of the problem.
A few years ago, ACCA conducted a survey of about 400 APA members about self-care. We found that respondents had a very superficial understanding of self-care. Typically, their graduate programs did not teach them the principles of self-care. It was something they had been set adrift to discover for themselves without any structured, systematized way of approaching it. If taking care of yourself is an ethical imperative, it should also be imperative to teach it in higher education. But the first thing we need to do is convince people that there’s a problem, and I don’t think we’re there yet. We need their buy-in, as many psychology and medical practitioners still do not believe that self-care is a systemic issue.
What self-care lessons has the pandemic taught us?
The pandemic has helped highlight the fact that self-care is not just an individual issue. It is also an organizational problem, an economic problem and a social problem. During the pandemic, for example, women published significantly less than their male colleagues due to the disproportionate demands placed on them and their multiple roles as professionals, mothers, and caregivers. The sector loses people when working conditions do not match the lives they lead. Just as previous generations of women advocated for my right to maternity leave, which made a huge difference in my ability to succeed in my career, I hope we see more people excited about the idea to advocate for self-care.
We were able to overcome the pandemic thanks to individuals who bore the brunt of systemic failures. The lesson we must learn from this is that we can no longer neglect these systemic pressures on the individual when it comes to self-care. And if we try to make people at the bottom of the power structure responsible for things over which they have no control, we will inevitably fail. I hope that instead of just taking care of ourselves, more of us can also advocate for our colleagues, students, and staff. To create an environment of fairness and success, we must advocate for each other and our domain. We are building our professional future now.
How can psychologists promote systemic changes in self-care?
The first and most obvious entry point is to think about the leadership roles you hold. For me, that means checking in with my students and colleagues during the pandemic and really thinking about the different types of risks they’re facing. This isn’t the experience of everyone I work with, it’s not because I’ve had a relatively unremembered pandemic experience. In the context of these pressures, I make sure that what I ask of my students is to respect good boundaries and good expectations, and I make sure to follow the things that I prescribe to others.
In academia and academic medicine, we have a culture that requires us to try hard enough from a work perspective and sometimes set questionable boundaries. If we truly want to change the culture, we need to evaluate how we judge others – and reward others – based on their activities. If expectations for career advancement are extreme, you won’t have a workforce that takes care of itself. They won’t have meaningful personal relationships outside of work because you’ve made that impossible. We know that the quality of work also suffers.
