Ethics, Meditation, and the Need for Therapists Self-Care

“This client is a mess!” On multiple occasions, I have heard therapists talk 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 mental illness lose empathy?

I concluded that it must be about burnout in a high-stress work environment when therapists talk disrespectfully about their clients. Of course, there were times when I was talking or at least thinking of clients in less than friendly ways, sometimes probably without being aware of it. When I’m not doing well, I can’t support others. Psychotherapists have the responsibility to be their best selves 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 an imperative in highly stressful therapeutic work environments with ever-higher workloads and training requirements. It has become a buzzword in the mental health field that can obscure more significant 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. To prevent them large healthcare companies commonly encouraged therapists to “take care” of themselves. Employers may readily associate meditation and mindfulness with self-care. These practices are supposed 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 contentment, to know myself better, and to become ethical.

 

Caring means cultivating contentment

The first avenue towards self-care through meditation is probably the most intuitive: meditation can help relax and recharge the exhausted therapist 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, a central obstacle to benefiting from peaceful 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 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 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 and to do nothing, in particular, 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 a deep relaxation that can come with a feeling of interconnection 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. But I found that the cultivation of tranquility is not enough for self-care to become wholly 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. To care for the self, I have to know the self. For me, 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 save heaven of the breath might not be enough to 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. This openness to my mind as it is in the present moment 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 can put thoughts and feelings about my own and other’s actions into perspective.

For me, the key to knowing myself and my experience through meditation is a 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 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. Ethical self-reflection is about the development of ‘character’ or a preferred identity.

Momentary insights about myself in a 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 an 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 do 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.

 

Comprehensive self-care

During meditation, self-care can take the form of relaxation, self-knowledge, or the development of virtues. One session may primarily focus 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 in a particular situation, I can make a conscious decision about the care that is often no longer just about myself. It involves making decisions about who I want to be in relationships with others. This mindful awareness may include 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, psychotherapy, and life. But it can make it more likely to move into a more thoughtful, considerate, and compassionate direction. Comprehensive or integrative self-care 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 in every new situation to take ‘good’ care.

 

Increase Compassion by Remembering the ‘Good Stuff’

Recently, I asked participants in a domestic violence offender group about how they would define compassion. Some connected it with sympathy, others with doing what others want you to do. The fact that for most of them the word was not part of their daily vocabulary did not mean that they had never been compassionate. Unsurprisingly, they could remember some ‘good stuff’ and doing so may also help you to feel more secure in your relationships this year.

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The term compassion is not something we readily hear on the news; it’s hardly used in block buster movies. Although the word ‘compassion’ sounded strange to some men in the offender group, they were all familiar with acts of kindness that come out of concern for another person. They also agreed that there is a difference between feeling what another feels and acting upon this feeling.

Commonly, in psychology this distinction is made to distinguish between empathy and compassion. Empathy has been defined as the vicarious experiencing of an emotion that is congruent with, but not necessarily identical to the emotion of another individual, as well as the knowledge or understanding of another’s feelings tied to it (Eisenberg and Janet Strayer 1990). Compassion is more than that.

In broad terms, the term compassion refers to the ability to be touched by the suffering of others and the desire to alleviate their suffering. It has been associated with the vicarious experience of distress in response to another person’s suffering, a variant or blend of sadness or love, and as an evolutionary adaption that motivates helping behaviors for the sake of survival, reproduction, or both (Goetz, Keltner, and Simon-Thomas, 2010).

The great news is that compassion also spreads. It reproduces itself because the recipients of compassion tend to become more compassionate themselves. Some researchers argue that higher “attachment security” is closely related to higher levels of compassion towards others and altruistic helping behavior (Shaver and Milkunicer (2004).

Attachment security or feeling valued, safe, and cared for in a relationship may be a result of your past experiences. It includes instances of having been treated supportively as a child, being involved in security enhancing close relationships during adulthood, being able to call upon mental representations of being cared for, being influenced by a security enhancing context, or a combination of these factors.

From this perspective, our human capacity to experience compassion is enhanced through trusting, secure, and protective relationships. While people with more attachment security are said to be able to show more compassion, little is known about the positive effects of compassion on attachment security and wellbeing in relationships.

In my own clinical practice, I found that even people who went through intense trauma, including many domestic violence offenders, “big” and “small” acts of compassion are common. Sometimes they are not seen as such and remain undervalued or not integrated into a coherent story about personal values and relationships.

For the men who had abused in the past, communication in the group provided a way to expand awareness about the benefits of compassion. In the past year, several had cared for sick family members, supported someone who struggled with everyday life problems, or intended to do so in the year to come. The group discussion provided them with a rare forum to develop a language around these act, to share and celebrate them.

In my opinion, one of the keys to cultivating compassion is to remember and become aware of the “small” compassionate acts we already perform. Once we value, understand, and enjoy them, we may create more possibilities to practice compassion – perhaps with the result of enhancing our own and other’s sense of safety and “attachment security.”

When I focus attention on the ‘good stuff’, I change neural pathways in my brain, a process called neuroplasticity. The term neuroplasticity is used to refer to our ability to change the physical structure of our brains throughout the lifespan (Siegel 2010). We can literally grow new synaptic connections through sustained and focused attention on compassionate acts. Is this going to increase your compassion? Try it out.

By reflecting and talking about past instances of turning empathy into action you may turn neural pathways into superhighways that inform future action.You turn something that is already present into the forefront and thereby make it more powerful. How have you acted compassionately lately?