Mental health professionals work in intensely stressful environments. Clients, organizations, policies, and in a broader sense, society, place high expectations on mental health practitioners. Students new to the profession, clinical practitioners, supervisors, and case managers alike, deal with difficult, stressful issues on a daily basis. For individuals who have difficulty coping, these stressors can take a heavy toll over time. As mental health practitioners, it is our responsibility to meet these challenges, to develop strategies to manage these stressors in positive ways lest we render ourselves ineffective. Not only do we suffer if we are unable to cope with our stress, so too do those with whom we work.

This module was designed to provide mental health practitioners with learning opportunities focusing on both self-care and stress. By recognizing the causes of stress in our life, we can then utilize or develop coping strategies to move forward. We demand this of our clients. So too should we demand it of ourselves.

In This Module

The Dimensions of Self-care

“Self-care” can be understood in many different ways. In its simplest form, the term refers to our ability as human beings to function effectively in the world while meeting the multiple challenges of daily life with a sense of energy, vitality, and confidence. It also implies that we are active participants in that process. Self-care is not “other-care”. Rather, it is care that is initiated and maintained by us as individuals. It requires our active engagement.

The term “self-care” has been understood in many different ways. Its spans a full range of issues from the physical, the emotional, the intellectual, and the spiritual. Some conceptualize this construct by considering the dimensions of mind, body, and spirit. Others contend that it encompasses the dimensions of thinking, feeling, and behaving. It has also been broken down into personal and occupational aspects. It is referred to as “wellness”, a “healthy balance”, “resilience” and simply, mental health. It is important to note, though, that no matter how one breaks down the dimensions of self-care, in the end, all of these different aspects are interconnected. Failure to take care of oneself in one realm can lead to consequences in another.

There are many negative consequences that can result from an inability to take care of ourselves. Stress as the most prevalent issue is the focus of the following section.

Example of Consequences

Phil is a middle school counselor. At the beginning of the school year, Phil’s good friend, Jason, gets into a bad car accident. Someone runs a red light and hits Jason as he is driving through a busy intersection. As a result, Jason is hospitalized with a broken arm and leg and multiple lacerations. He is placed under observation for a possible head injury. Upon notification, Phil has an outpouring of emotions. He is sad for his friend, angry with the person who ran the red light, frustrated that he cannot make everything better. He goes to visit Jason in the hospital but does not share his feelings with Jason or anyone else. It is the beginning of the school year and there are a lot of things that have to be taken care of at work. He decides that he doesn’t have time to deal with the emotions brought on by his friend’s misfortune. He focuses on his work for the next few days visiting Jason in the hospital each night. The intensity of Phil’s feelings increases with each passing day, but he still does not reveal this to anyone. He begins to notice some sleep difficulties and a loss of appetite. Normally a regular at the gym, he skips his work out sessions at the end of the day in order to visit his friend.

On the third day after the accident, one of the teachers Phil has worked closely with for several years comes down to ask him for help with a student who is having some difficulties adjusting to school. Phil looks at the teacher and loses it: “You know what? Aren’t there more important things to worry about?! So this kid’s having a little difficulty. So what! Some things are a lot more important than a kid who can’t handle being in school!” The teacher is stunned.

By neglecting his emotional well-being, Phil is beginning to manifest new and negative behaviors in other areas of his life. This brief example illustrates how stress that manifests itself in one dimension can quickly lead to changes in other realms. This illustrates the importance of proper self-care.


As practitioners in the field of mental health, it is important for us to constantly ask the question, “How am I doing”? If we begin to neglect ourselves, our ability to care for others can rapidly become compromised.
This section looks at stress across two different life realms: the personal and the occupational.

The Four Dimensions of Stress

Any understanding of self-care is incomplete without a concomitant understanding of stress; what it is, what it does, and how it is caused. It is important to note that stress in and of itself is not a bad thing. In fact, in manageable doses, it can serve as a motivating factor in our lives. It can push us to do more or to make changes with the things in our lives that are not working for us. It forces us to reflect on what is going on, to take stock. However, if left unchecked, it can also have negative impacts. While some of these impacts are quite minor, others can be far-reaching.

Stress can be viewed along four different dimensions : the cognitive, the affective, the behavioral, and the physical and can impact individuals in one or all of these areas. While human beings have a remarkable ability to self-regulate, in large enough doses stress can dramatically compromise functioning. This can result in compromised intra-personal and/or interpersonal health.

  • Cognitive Dimension: The cognitive manifestations of stress have to do with our thinking and thought processes. If one’s stress level is elevated and remains unchecked, concentration, focus, organization, and clarity of thought can be compromised. Elevated stress levels can also affect one’s ability to remember important details, and to listen to others. Time management and organization can all suffer in the cognitive realm when stress increases.
  • Affective Dimension: Likewise, at the affective level, one’s emotions can be effected by stress. Irritability, rapid mood swings, unpredictable anger, and sadness are all accentuated by increased stress levels.
  • Behavioral Dimension: Increased levels of stress can also result in behavioral changes like alcohol and substance use and abuse, and absentee issues. It can also compromise our relationships with others. As stress increases, we become less capable of positive interactions with others.
  • Physical Dimension: Physically, high levels of stress have been linked to changes in appetite and sleep patterns (either increases or decreases), weight gain or loss, and other health issues like high blood pressure and ulcers. Stress can also impact exercise regimens that in turn can have dramatic impacts on our behavior, our emotions, and our cognitive functioning.

Personal Stress and its Causes

At the personal level, there is no way to provide a comprehensive list of the different stressors that people experience. Some examples however, might suffice. Personal issues like divorce, the death of a loved one, parenting stress, and national catastrophes can all have an impact on an individual’s level of stress. Other stressors might include increased family responsibilities or personal commitments outside of work. What is stressful for one person, however, may have little or no effect on another. This fact calls attention to the importance of self-awareness. By finding the time to monitor our own stress, we can better deal with things as they arise.

Professional Stress and its Causes

As already noted, mental health practitioners work in highly stressful environments. If allowed to escalate, stress can lead to many negative job-related outcomes including job dissatisfaction, a decreased commitment to organizational goals, lower performance evaluations, an increased sense of powerlessness, high turnover rates, increased absenteeism, decreased work productivity, and low job effectiveness. How we choose to negotiate these environments has a lot to do with whether or not our stress is alleviated. As is the case with personal stress, the causes of occupational stress are also many. Some identified factors are listed here:

  • Caseload: One’s caseload can contribute to stress in many different ways. The size of one’s caseload can be directly linked to levels of stress. As caseload size increases, there are more things to manage and do. This can elevate levels of stress. Second, the type of caseload that one carries can have an impact on levels of stress. Some clinicians work with severely traumatized individuals and/or groups. This can make daily work more difficult. Finally, caseload can have a direct impact on the amount of paperwork and documentation that must be completed. Increased paperwork that is the result of larger or difficult caseloads can cut down on the amount of time one has to perform direct service. Clinicians may end up feeling like they have to make compromises with client care. These dilemmas, too, can add to one’s stress.
  • Clientele: From community mental health agencies to rehabilitation agencies, from schools to drug and alcohol recovery centers, practitioners work in many different settings. The very nature of our jobs is to provide care and therapy for others while receiving little care in return. This treatment of others is a one-way street known as one-way caring. Given the roles that we play in our profession, it is important to recognize that we need to find ways to have our own needs met also. If left unattended, this job pattern of one-way caring can leave us drained and lethargic. Another issue related to our work with clients is that of vicarious trauma. Clinicians who work with very troubled individuals or groups can begin to take on some of the symptoms of those with whom they work. As committed professionals, it is our job to really work with our clients on the issues they bring to us. As a result, we oftentimes have to delve into past events that people have experienced. At times, we may be deeply affected by the traumatic events that others have experienced. When this happens, our stress levels can increase. Self-care strategies become increasingly important when we are affected in this way.
  • Job Expectations: There are a number of job expectations that can contribute dramatically to our levels of stress. The types of clients we serve, and the size of our caseload have already been noted. As they relate to job expectations, a few additional terms are worth noting here.
    • Role Ambiguity- In some cases one’s job duties and responsibilities are not entirely clear. Confusion about the different aspects of one’s job is called role ambiguity. If expectations are not clearly stated, supervisors can be expecting one thing while peers and colleagues are expecting something entirely different. This kind of role ambiguity can be very stressful. It is important to work towards clarifying one’s job roles as much as possible. Job role clarity can provide individuals with important structure. It can also provide people with a sense of what tasks they can say yes to and which ones they need to decline. This is very difficult to do when roles are not clearly defined.
    • Role Incongruity- Although somewhat like role ambiguity, role incongruity takes on a slightly different meaning. Role incongruity is the difference between what one believes needs to be done in a certain job and what one actually does. It is frequently an offshoot of role ambiguity. Without clearly defined job expectations, people may end up performing duties that run contrary to their beliefs and understanding about what they ought to be doing. Again, this can dramatically increase levels of stress. It is important to address role incongruity in the workplace.
    • Role Conflict- Professionals frequently have to make decisions about what needs to be done on the job. Paperwork expectations sometimes fly in the face of direct client needs. Making difficult decisions about what needs to be done and when, deciding when one task takes priority over another is known as role conflict. While this is a part of any job, recognizing these dilemmas and finding ways to address them are important skills to develop. Increased stress can develop otherwise.
    • Task Overload- A final concern as it relates to job expectations is the idea of task overload. It is not at all uncommon for practitioners in different work settings to reach a point where they are completely overloaded with responsibilities. As responsibilities increase it can become increasingly difficult to complete anything. This can compromise the level of care that we provide for our clientele. It is important to develop ways to cope with task overload. Unless we find ways to recognize when the tasks have gotten too great, we will not be able to address this important aspect of work.
  • Organizational Issues: One additional factor that can cause increased job stress is the organization itself. As you well know, some organizations have a reputation for being wonderful places to work while others are known for their poor working environments. Organizational issues definitely play a role when it comes to individual stress levels. Organizations that pay attention to the needs of their employees encounter a more satisfied work force and a more positive work environment. Issues like professional development, employee benefits, and the level of administrative support can have a direct bearing on how people approach their daily work tasks. It is important to consider one’s work environment when looking at levels of stress. A non-supportive work environment can make all of the other challenges seem that much greater. Likewise, an environment that fosters care and a sense of teamwork can make the daily stresses of work seem far more manageable.

While some people choose to deal with issues as they come up, others choose to avoid them. To some extent, our personal coping styles dictate these choices. Our coping style has certain implications for how we deal with stressful situations. Norman Endler and James Parker (1988) developed an inventory to assess individual’s coping styles. This 48-item inventory, the Coping Inventory of Stressful Situations, yields subscale scores along three different dimensions: task-oriented, emotion-oriented, and avoidance-oriented. People whose primary coping style is task-oriented tend to focus on the issues at hand. Those who deal with stress on an emotional level tend to immerse themselves in the feelings associated with the stressful situation. And finally, there are those who deal with stress by simply avoiding the situation altogether. All of us utilize each of these coping styles to different degrees. It is believed that people deal with mounting stress by resorting to their “primary” coping style. It is also possible, however, to develop multiple strategies for coping. Learning which coping strategy works best for a given situation is yet another way for individuals to deal with stress.

This section has presented information on stress and some of its possible causes. Click here if you would like to complete a very brief individual stress assessment. You will note that many of the previously mentioned stress concerns are included in the stress assessment. Are there other stressors in your life that are not reflected in the stress assessment? How have you been coping with them?

Stress Prevention and Intervention Through Self-care

As discussed earlier, self-care can be understood as an individual’s ability to address personal and occupational issues in proactive, health-promoting ways. Any discussion of self-care, however, would be incomplete without a section on some of the actual skills and strategies for self-care maintenance.

Personal Self-care

Identifying the source (or sources) of stress in your life is often the first step towards change. A certain amount of self-awareness is implied if individuals are to do this for themselves. When sources of stress are properly identified, individuals can then begin problem-solving and developing strategies to address them.

All of the suggestions included in this section and many others might be components of a solution to deal with a stress-inducing situation. Sometimes, however, people are only able to notice that they feel stressed but cannot readily identify the reasons why. In this event, it may be wise to enlist outside help. In the most extreme case, people do not even recognize the symptoms of stress- they just think this is the way life is. This situation may also require the efforts of an outside source for assistance. Following, however, is a partial list of the different ways to address stress.

  • Counseling: We advocate for counseling and therapy as professionals. It is equally important that we be willing to utilize this valuable resource for ourselves. Counseling is an appropriate arena to address many of the stress situations that have been discussed thus far. Not only does it provide individuals with a forum for clarifying personal issues, it can also address the change process and skill building that is oftentimes necessary. As educated consumers of mental health services, we are at an advantage to make informed decisions about the types of interventions that may be helpful to us in a given situation, but we need to know when we need help and we must be willing to ask for it.
  • Journaling: For many, the opportunity to reflect on life and its challenges is rare. It is so easy to get caught up in daily expectations and responsibilities. Journaling can provide people with an opportunity to do some of that reflection and contemplation. Advocates of journaling often note how liberating it can be to put thoughts and feelings down on paper. Those who journal also report that they frequently develop plans to deal with their issues that might not have been considered without the journaling process. It can provide people with the time and space to collect their thoughts and make plans for change. All of these functions, “personal time”, “reflection”, and “planning” are elements of self-care. Journaling is one way to make time for these important personal needs.
  • Coping Skills: Just as we teach coping skills to those with whom we work, so too can we benefit from continuing to learn such skills. Behavioral techniques are effective ways of dealing with stress. Relaxation skills like deep breathing, guided imagery, and stretching can do wonders for stress reduction and can be wonderfully restorative. Assertiveness training can also be beneficial for those of us who have a difficult time advocating for ourselves. Recognizing areas for self-improvement and acting to change our personal weak spots can do wonders when it comes to dealing with stressful situations. By constantly acknowledging the human need to continue learning and developing, we can continue to update our own skills. In addition to the personal benefits, by refining our personal skills, we become more adept at helping others to refine theirs.
  • Healthy Balance: Much has been written about the benefits of living a well-balanced life. This healthy balance requires us to consider diet, exercise, work life, family life, leisure time, and more. It goes without saying that a well-balanced lifestyle that addresses as many of these different dimensions as possible enhances one’s sense of well-being. Those who make time for exercise and family, for example, are better able to approach the stress that is a part of everyday living. Finding time to balance one’s life is crucial for self-care. That balance will mean something different to each person. However, the term “balance” is key. Stress can be dramatically increased when people begin focusing solely on one or two things in their life. While admittedly there may be times when one’s “balance” is thrown off due to the time of the year (e.g. holidays) or particular needs at work, it is important to frequently assess one’s life choices in order to determine whether or not changes need to be made.
  • Time Out: Sometimes it is just important to get away from everything. A timeout can be as brief as five minutes or as long as a weekend away or an extended vacation. Timeouts provide us with opportunities to restore ourselves, to clear our minds, and to re-enter situations with a sense of calm and focus. Recognizing when things get to be too much is an important component of the time out. Furthermore, identifying what needs to be accomplished in a given time out period is also important. Sometimes all that is required is a few minutes to walk around in order to calm down. At other times, a time out can serve as a break that allows us to clarify where we are in our lives and where it is that we want to be heading. It is always used as a break from what is currently going on. Used wisely, it can be a wonderful stress reducer.

There is an underlying theme to each of these suggestions: each indicates the importance of self-awareness. In many ways, you may want to consider self-awareness as the single-most important key for fostering your own self-care. It is self-awareness that enables individuals to continuously monitor themselves and to make adjustments in their lives as things come up. Lacking self-awareness, small issues can grow larger thereby leading to increased stress. To the contrary, individuals who are highly self-aware have the ability to make more immediate decisions about how to deal with issues as they come up. This promotes stress reduction.

Professional Self-care

The skills utilized to deal with personal stress hold true in the workplace, too. Monitoring yourself and your responses to the work environment are key elements of professional self-care. Some of the following additional suggestions can prove beneficial in heading off professional stress as well as dealing with it once it occurs.

  • Professional Development: Just as personal coping skills help us to deal with stress, so too does professional development. It is important to continue learning new professional skills. Not knowing what to do in a certain situation or feeling uncomfortable with a certain kind of client can definitely be a stress-inducing situation. By taking stock of how we spend our time as clinicians, we can begin to determine where it is that we could benefit from additional training. In addition to learning new skills (which can certainly alleviate some professional stress), professional development seminars and conferences provide us with valuable opportunities to network with other colleagues and to get away from the daily work environment for a period of time. Many professionals note how restorative a good professional conference can be. They return to work feeling energized and restored. This can be of great value to practicing clinicians at every level of experience.
  • Clinical Supervision and/or Consultation: Practitioners in our profession work with a variety of different and difficult clients. It is important to continuously insure that each individual is receiving the best of care. It is also important to take care of ourselves as practitioners and as individuals. Clinical supervision and consultation are two ways to insure that this is happening. Clinical supervision allows us to present difficult cases and to increase our understanding of those with whom we work. By its very nature, it also provides us with a way to check out how we are doing. It is also important to develop consultative relationships with other professionals. Establishing these kinds of relationships allows us to connect with other professionals. It also allows us to continuously assess how we are handling things such as stress. These relationships can be invaluable in keeping us grounded in what we are doing and how we are doing it.
  • Time Management: While there are certainly additional professional self-care issues, time management is one that merits particular attention. As noted throughout this module, counselors in all settings deal with numerous responsibilities. Client contact, paperwork, accountability, managed care… these are all possible components of our work. As such, it becomes crucial that we find ways to manage our time in ways that allow us to complete all these various duties. Individuals who do not find ways to deal with the multiple expectations of their jobs in timely and efficient ways will quickly find themselves in very stressful situations with themselves, their supervisors, their clients, and those with whom they work. There are numerous ways to address time management difficulties. The first step, however, is to determine where your strengths and weaknesses lie. Is paperwork a challenge for you? Do you have a hard time keeping appointments? Arriving for meetings on time? Identifying weaknesses will provide you with a sense of where you need to begin. It is then important to begin taking steps to change. Networking with colleagues who seem to have a good grasp on time management issues might be a good initial strategy. There are numerous ways for people to organize their time. Investigating some of these techniques may be worthwhile. Trying things out to see what works best for you will also be important. The bottom line, though, is that it is crucial to develop time management strategies. Stress can definitely increase without them.

In order to effectively serve those with whom we work, it is important that we find ways to take care of ourselves in the process. The previous section provided an overview of self-care. Stress was defined and some of its causes were presented. As a result, readers hopefully have a more comprehensive understanding of the interrelationship between stress and self-care.

Self-care Assessment of Understanding

The following questions are designed to assess your understanding of the content in this module. Each question is linked to an appropriate page to assist you in locating the answers.

  1. Define “self-care”.
  2. Name the four different dimensions of stress.
  3. The potential outcomes of stress can be both positive and negative. What are some of those different outcomes?
  4. What is the difference between personal and professional stress? How are the two related?
  5. Name three factors that can contribute to elevated levels of professional stress.
  6. List three positive ways to deal with personal stress.
  7. List three positive ways to deal with professional stress.

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. Boundaries of Competence. Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Counselors will demonstrate a commitment to gain knowledge, personal awareness, sensitivity, and skills pertinent to working with a diverse client population.
  2. New Specialty Areas of Practice. Counselors practice in specialty areas new to them only after appropriate education, training, and supervised experience. While developing skills in new specialty areas, counselors take steps to ensure the competence of their work and to protect others from possible harm.
  3. Qualified for Employment. Counselors accept employment only for positions for which they are qualified by education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Counselors hire for professional counseling positions only individuals who are qualified and competent.
  4. Monitor Effectiveness. Counselors continually monitor their effectiveness as professionals and take steps to improve when necessary. Counselors in private practice take reasonable steps to seek out peer supervision to evaluate their efficacy as counselors.
  5. Ethical Issues Consultation. Counselors take reasonable steps to consult with other counselors or related professionals when they have questions regarding their ethical obligations or professional practice. (See H.1.)
  6. Continuing Education. Counselors recognize the need for continuing education to maintain a reasonable level of awareness of current scientific and professional information in their fields of activity. They take steps to maintain competence in the skills they use, are open to new procedures, and keep current with the diverse and/or special populations with whom they work.
  7. 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.)

A.11. Termination and Referral

  1. Abandonment Prohibited. Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, and following termination.
  2. Inability to Assist Clients. If counselors determine an inability to be of professional assistance to clients, they avoid entering or immediately terminate a counseling relationship. Counselors are knowledgeable about referral resources and suggest appropriate alternatives. If clients decline the suggested referral, counselors should discontinue the relationship.
  3. Appropriate Termination. Counselors terminate a counseling relationship, securing client agreement when possible, when it is reasonably clear that the client is no longer benefiting, when services are no longer required, when counseling no longer serves the client+s needs or interests, when clients do not pay fees charged, or when agency or institution limits do not allow provision of further counseling services. (See A.10.b. and C.2.g.)