Self-care was already a hot topic before the pandemic. But 2020 brought into focus just how important it is for people to tend to their physical and mental health. Even still, the idea of self-care is often oversimplified into a discussion of yoga and bubble baths. “The way we talk about self-care runs the risk of sounding like a rich White lady occupation,” said Laura Boxley, PhD, ABPP, a board-certified clinical neuropsychologist and director of clinical neuropsychology training at The Ohio State University. “But it’s much more complex than that, and there’s some real depth that we have yet to address.”
As chair of APA’s Advisory Committee on Colleague Assistance (ACCA), Boxley has spent a lot of time thinking about how psychologists can reenvision self-care. She talked with the Monitor about where self-care goes from here.
What’s wrong with the way self-care is usually framed?
Self-care is usually talked about as an individual process—almost a noble mission to take care of yourself because nobody can do it for you. And it has traditionally been health focused: sleep well, eat well. Of course, those general principles are good for all of us, but that focus runs the risk of creating a superficial understanding of self-care. It’s a reductive, bottom-up understanding. But we also have 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 and take care of ourselves—often in unequal ways across occupations and socioeconomic status. We need to consider both bottom-up and top-down perspectives of self-care. You don’t have to quit yoga. You don’t have to quit eating well. But also consider how groups, organizations, employers, and governments play a role in our access and implementation of self-care strategies and work-life integration.
The people most in need of self-care resources are often the people 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 shouldering significant social, financial, and occupational stressors. There are hundreds of self-care books out there, but they can’t help you if you don’t have time to read them. And even if you get the chance to read them, not all concerns about self-care and balance are things that the individual has direct control over. We cannot be satisfied placing the most amount of responsibility on individuals with the least amount of power.
How should mental health professionals be thinking about self-care?
We have an ethical mandate to engage in self-care so that we can care for other people. We’re also uniquely educated to be able to do this in a sophisticated way. Yet while we do a lot of preaching about self-care, we don’t necessarily do all the follow-through. And our patients and students are good at sniffing out hypocritical behavior. By unpacking the reasons why we don’t always practice what we preach, we’ll start to get to the crux of the issue.
A few years ago, ACCA conducted a survey of about 400 APA members asking about self-care. We saw that respondents had a very cursory understanding of self-care. In general, they weren’t taught self-care principles in their grad programs. It was something that they had been set adrift to figure out for themselves without any structured, systematized way of approaching it. If it’s an ethical imperative to engage in self-care, it should also be imperative that we teach it in graduate training. But the first thing we have to do is convince people there’s a problem, and I don’t think we’re quite there yet. We need buy-in, because a lot of practitioners of psychology and medicine still don’t believe that self-care is a systems issue.
What self-care lessons has the pandemic taught us?
The pandemic helped to highlight the fact that self-care isn’t just an individual issue. It’s also an organizational issue, an economic issue, and a social issue. During the pandemic, for example, women published a whole lot less than their male colleagues because of the disproportionate demands on them and their multiple roles as professionals and mothers and caregivers. The field loses people when the conditions of the work aren’t consistent with the lives they lead. Just like previous generations of women advocated for me to have maternity leave rights, which have made a huge difference in my ability to succeed in my career, I hope we’ll see more people excited about advocacy for self-care.
We have been able to hobble through the pandemic because individuals shouldered the weight of systemic failures. The lesson we should take from that is that we can no longer neglect these systemic pressures in self-care on the individual. And if we try to make people at the bottom of the power structure accountable for things they do not have control over, we will inevitably fail. My hope is that rather than self-care just being about the self, more of us can also advocate for our colleagues, our students, our staff. To create an environment of equitability and success, we must advocate for each other and our field. We are building our professional futures now.
How can psychologists promote systemic changes in self-care?
The first and most obvious point of entry is to think about what leadership roles you have. For me, that means I’m checking in with my students and coworkers during the pandemic and really considering the different kinds of risks they face. Just because I’ve had a relatively unmomentous pandemic experience, that’s not the experience of everyone I work with. In the context of those pressures, I’m making sure that what I’m asking of my students is practicing good boundaries and expectations and making sure that I’m following the things that I’m prescribing for other people.
We have a culture in academia and academic medicine to push pretty hard from a work perspective and to have some questionable boundaries at times. If we really want to change the culture, we need to evaluate how we’re judging other people—and rewarding other people—based on their activities. If the expectation for a job promotion is extreme, you’re not going to have a workforce that has a good pattern of self-care. They’re not going to have meaningful personal relationships outside of work because you’ve made that an impossibility. We know that work quality suffers as well.
