Hans Reihling, Ph.D., LMFT
Ethics, Meditation, and Self-Care for Therapists: A New Approach
“This client is a mess!” On multiple occasions, I have heard therapists talking about the people who seek their consultation in patronizing, disrespectful or even abusive ways. This ranged from lack of empathy and reducing somebody to psychopathology to blunt insult. Sometimes I felt outraged. Why do marriage and family therapists, clinical counselors, social workers, and psychologists who have chosen a profession dedicated to serving people to recover from a mental illness lose empathy?
I came to the conclusion that mental health professional's lack of empathy and compassion must be about burnout in a high-stress work environment. Of course, there were times when I was talking or at least thinking of clients in less than appreciative ways, sometimes probably without being aware of it. When I’m not doing well I can’t support others. Therapists have the responsibility to be their best selves in order to assist their clients and to make ethical decisions on an ongoing basis. I believe that self-care can help prevent burnout and compassion fatigue through a reflective meditation practice.
Today, self-care is imperative in highly stressful therapeutic work environments with ever-higher workloads and training requirements. It has become a buzzword in the mental health professions than can obscure larger social and organizational problems that cannot be resolved by individual therapists. Burnout, compassion fatigue, and vicarious trauma may be the result of unrealistic expectations of productivity in which numbers rather than people count. In order to prevent them large health care companies commonly encouraged therapists to “take care” of themselves. Meditation and mindfulness are readily associated with self-care in order to recharge exhausted therapists so they can get the job done. I found that self-care through reflective meditation can be more than just becoming better equipped to stay on a treadmill. It may be about changing body and mind as well as relationships with others in unexpected ways. For me, meditation has become a comprehensive form of self-care that helps me to cultivate pleasure, to know myself better, and to become ethical.
Caring means cultivating pleasure
The first avenue towards self-care through meditation is probably the most intuitive: meditation can help relax and recharge the exhausted therapist in order to foreclose knee-jerk reactions to challenging situations. It can help shift gears and activate the parasympathetic nervous system that makes me ‘rest and digest’ – if I allow it.
“Is it selfish to just take time for me to rest and enjoy?” a colleague asked me recently. I was able to relate to the question. For me, the main obstacle to benefiting from tranquil and pleasurable states during meditation has been my reluctance to allow them.
Many years into my meditation practice I noticed that there was a sense of guilt when it came to relaxation and pleasure. In part, this was a result of inflexible instructions that caution practitioners vehemently to not become attached to pleasurable states. I often worked too hard to calm the mind, which was of course counterproductive. Now I know for sure that I don’t want meditation to be some sort of self-discipline that has the result of treating myself harshly. Don’t get me wrong, it can be helpful to have a schedule for sittings and to stick with one particular instruction for a while, but I found that this only makes sense when it leads to more ease and gentleness with myself, more care.
I don’t want self-care through meditation to become another “should” that makes me feel bad about myself when not performed “correctly”. For me, just taking some time to step out of everyday life’s busyness in order to do nothing can be a form of meditation. I found that adjusting my posture, changing it, laying down, and letting my mind wander can all be part of an open meditation practice. I don’t have to pay attention to anything in particular to allow a whole range of pleasurable states to arise. Just permitting myself to rest may lead to deep relaxation that can come with a feeling of interconnectedness and being cared for, perhaps the ultimate form of ‘self-care.’
Once my nervous system has calmed and becomes less emotionally reactive, I am usually in a better position to make ethical decisions in everyday life as well as in consultations with clients. Relaxing, calm, and pleasurable states during meditation may set the stage for distinguishing ‘right’ from ‘wrong’ off the cushion. Yet, I found that the cultivation of tranquility is not enough for self-care to become fully transformative.
Caring means getting to know the self
Self-care through meditation can be about more than taking a break from hard work to recharge and go back to the same situation. It can lead to self-knowledge and insights about how to act ethically. In order to care for the self, I have to know the self. In my life, this can include an awareness of a boundary-crossing that had gone unnoticed. During meditation and in reflections afterward, I can catch unconscious needs and wants. Just noticing them during the sitting and redirecting myself to the safe heaven of the breath might not be enough to really get to know what is going on in my inner world.
Self-care through meditation can also be about processing and integrating thoughts, emotions, body sensations, and desires. For me, this is only possible if I am ready to follow a train of uncomfortable, embarrassing, or even painful experiences for a bit during meditation. For me, this became an ethical practice that requires ongoing self-reflection. When I meditate I allow myself to experience whatever comes to mind. It is not about getting rid of my needs and wants but rather to become aware of them. Attended to with care my inner world may hold surprising answers to ethical dilemmas that I’m unable to tackle through linear rational thought. I might get answers to questions I couldn’t even think of when I allow myself to be curious. As a result, it may become easier to feel empathy and more likely that I remember values that I want to live by because I am able to put thoughts and feelings about my own and other’s actions into perspective.
In my humble opinion, the key to knowing myself and my experience through meditation is a sort of doubling that can take place by writing down what has been going on during the sitting and thereby opening up the possibility of reflecting upon it afterward. Moreover, talking with other people about the experience and being asked questions about it sheds light on blind spots that I would not have thought of before. An awareness of my unconscious habits and desires is key to making choices about where to go next and what ethical decisions to take in order to take care of others and myself. This reflective process may result in the development of longer-term dispositions in regards to how I want to present with people who seek my consultation as well as in relationships more generally.
Caring means becoming ethical
Finally, self-care through meditation can result in the development of moral qualities. If I get to know my inner world and myself, I can start to make conscious choices about how I want to act and about the type of person or therapist I want to be. This is about the development of a ‘character’ or a preferred identity.
Momentary insights about myself in relationship with others gained upon meditative reflection can lead to what has been called virtue in philosophy. Virtues such as honesty, integrity, or kindness may have universal value. However, what qualities to focus on and how to apply them may depend on where you come from as well as on the particularities of an ethical challenge. I learned that in Greek philosophy the care of the self was the foundation of ethics, a notion of self-care that has been largely forgotten today. It was about skillfully monitoring, managing, and challenging personal needs and wants to develop one’s moral character. Today, virtue ethics can complement the ethical codes of professional organizations that require conformity rather than personal development on behalf of the therapist.
Virtue ethics take into account that the personal and the professional are interconnected. It is about how to be a good person or a morally good therapist who can make choices about how to show up with people who seek consultation and how to handle power differentials adequately. Thus, virtuous therapists are motivated to do what is right because they judge it to be right, not just because they feel obligated by their professional associations or the fear of negative consequences of an action.
A reflective meditation practice that includes journaling and conversation about the content of one’s experience allows for the ongoing ethical development of the therapist. It does not give universal answers but rather prepares the ground for better-informed decision-making that takes into account more variables of a situation. This approach goes with questions like, "What thoughts, emotions and body sensations am I aware of as I consider this ethical dilemma, and what are they telling me to do?" What decision would best define who I am as a person or who I want to be as a therapist? Caring here is about cultivating personal qualities that I can feel good about in the face of ethical dilemmas and actions that are congruent with my therapeutic approach as well as my self-image.
meditation, self-care can take the form of relaxation, self-knowledge, or the development of virtues. One session may be primarily focused on one of these processes. However, for me most of the time they are interlinked, both in a particular meditation sitting as well as in an ongoing practice over time.
Sometimes self-care requires calm states of mind for undervalued or hidden thoughts and feelings to arise. Once I get to know them better within a particular situation I can make a conscious decision about care that is often no longer just about myself. It involves making decisions about who I want to be in relation to others. This may involve correcting some of the stories my mind makes up to divert my attention from boundary crossings or violations. Insights in the wake of meditation can lead the way. Some bright moments have made me reduce my workload and therefore the risk of burnout and compassion fatigue. Other insights motivated me to challenge unethical practices at work. When they were resolved, I felt less stressed, no need to return to a treadmill.
A comprehensive approach to self-care cannot guarantee ethical decision-making in the everyday practice of clinical counseling, mental health therapy, and life. But it can make it more likely to move into a more thoughtful, considerate, and compassionate direction. This is an ongoing process that does not end with relaxation, a particular insight, or virtue. Self-care through a reflective meditation practice seems to require the whole person to become ethical anew again and again to take good care.