More and more people are going to therapy. Over the last twenty years or so, the number of adults seeking mental health treatment nearly doubled. And that data doesn’t even account for the global pandemic and the huge surge in demand for services mental health professionals saw over the course of 2020.
In many ways, it’s great that people are prioritizing their mental health, and that there’s less stigma associated with asking for help. But at the same time, this presents a burden for practitioners—providing top-quality care to more people than ever while simultaneously avoiding burnout.
Dr. Nikki Rubin, a clinical psychologist in Los Angeles, prioritizes mindfulness in her private practice. And setting boundaries with her clients is a critical part of that. Another important aspect is changing the mindset in the field to prioritize self-care for clinicians in general.
Think of Self-Care as a Responsibility
Self-care can be misconstrued as self-indulgent or frivolous. But true self-care looks like rest, nourishing meals, or simply making your bed in the morning. Regardless of what self-care looks like for you, Dr. Rubin thinks the field as a whole needs to get better at it.
“We really need to do better at helping clinicians recognize that we do need to take care of ourselves,” she says. “When we don’t take care of ourselves, we end up with a lot of burnt-out professionals, which can lead to people leaving the field and compromised clinical care.”
For many private practitioners, it can be hard to know how to incorporate self-care in a busy work schedule. Most people get into private practice because they want to help people, and they have a hard time attending to themselves. But to provide the most effective care, Dr. Rubin says, practitioners must prioritize their own needs.
In addition to seeing clients in private practice, Dr. Rubin works directly with clinicians to help them get better at prioritizing their own well-being. “Self-care and boundary-setting behaviors are things that I directly and intensely train my doctoral students in,” she says. “Clinicians tend to get so little training to prioritize our own self-care. So I make it a point to remind people that in order to be skilled as a clinician, you need to be healthy. And in order to be healthy, you need to first take care of yourself.”
Set Your Boundaries, Then Stick to Them
Part of personal wellness is maintaining a sustainable work-life balance. Creating and honoring the boundaries you set is as important for yourself as it is for your clients.
If you set the expectation that boundaries are important all year, when you do take time off, it won’t come as a surprise to your clients. Dr. Rubin says it’s also important to model healthy behaviors, and to remind clients they’re learning to rely on themselves, not their clinician.
“Most clients can absolutely tolerate the break. They may not like it or prefer that I’m available, but it’s also important for them to see that taking care of yourself is a healthy behavior,” she explains. “I’ve actually had clients say this to me! Seeing me take a vacation is a good reminder to themselves to do the same.”
Dr. Rubin also says taking vacations can serve as important reminders for clients that their providers are people too. “Sometimes there’s a perspective-taking problem in recognizing that I’m a person just like they are, and I need breaks,” she says. “And if someone is overly upset that I’ll be gone for a week or two, that’s actually clinical information. They might be too attached or overly reliant on me. All these things are problematic, and should be targeted in therapy.”
In her work with other clinicians, Dr. Rubin noticed that people can sometimes struggle to see themselves outside of their job. “We need to remember that as clinicians, our lives outside of work matter too,” she says. “We’re not just therapists. Being a therapist is our job. It may be a job we’re really connected to and get a lot of fulfillment from, which is great. But it’s still just a job.”
Just as clients sometimes need to be reminded that their provider has a life outside of the therapy room, clinicians themselves often need that reminder as well. To combat this, Dr. Rubin shares, “I encourage clinicians to try and become less attached to the identity of being a clinician. Try to think of it more as a single aspect of your entire lived experience.”
Set Your Clients Up for Success
Once you’ve come to terms that you need a vacation, now you have to actually take one. Regardless of what kinds of clients you work with, Dr. Rubin says, the process for taking time off is pretty much the same. The key is communicating with your clients and then setting up the right kind of backup support system.
For more routine time off, you don’t need to make a big announcement or do a lot of prep. In her practice, Dr. Rubin says she gives all her clients, regardless of whether they’re higher risk or not, about two to four weeks’ notice that she’ll be out of the office. She sends everyone the same note letting them know she’ll be gone, and that someone will be covering her practice if they need anything.
If a client is higher risk, Dr. Rubin says they’ll work out a more detailed coverage plan together before she leaves, but she informs them the same way as the rest of her practice. For longer absences, like maternity leaves, she suggests having a larger conversation. “Those longer breaks should be brought up sooner, so you can adequately plan for coverage while you’re gone,” she specifies.
Plan Your Coverage
If you’re a solo practitioner, make sure you have a network of colleagues you trust that you can lean on while you’re gone—and then you can offer coverage for them in return. It will take some stress out of taking time off if you have a reliable network in place before you take a vacation.
If you know your clients are seeing other providers in addition to you, you can encourage your client to lean on them in your absence. Dr. Rubin says she will often make sure that her clients have sessions scheduled with their psychiatrist while she’s away.
It’s tempting to stay reachable even while you’re supposed to be out of the office. People do it all the time—responding to just one email quickly, or telling their colleagues to call anytime. At the end of the day, Dr Rubins says, you just have to cut the cord.
“Here’s the thing about vacation—if you’re on call, you’re not on it,” she says. “We all work with people who may be higher risk, and may need support while we’re away. Remaining on call for these clients while you’re on vacation is more about reducing your own anxiety and remaining in control than actual effective client care.”
She goes on to say that if you do work with clients who are high risk, all you need to do is make sure they have their support plan with other licensed clinicians in place before you leave. “Rely on your trusted colleagues, and know that they’ll take care of things,” she says.
How to Take a Vacation at the Holidays
Dr. Rubin says she’s firm in her belief that breaks are important, but that the nature of the job makes the holidays a bit more of a challenge. “Every job has its downsides,” she says, “And one downside of our work is that this time of year tends to be high stress for many people, which often leads to increases in psychological distress.”
Taking time off during the holidays is by no means impossible, she says, as long as you do your due diligence with communication and setting up coverage. But it is a little more challenging than during other times of year.
“My personal policy has changed over the years, but I usually take about a week and a half off from seeing clients, and leave a voicemail that I’m away,” she says. “However, I do usually stay on call for my clients who have my emergency contact number, and I might schedule a phone check in with them if I think it’s necessary.”
Taking breaks doesn’t mean you love your job any less, or that you’re disrupting continuity of care for your clients. It just means that you recognize the importance of your own mental and physical health, and are prioritizing your own self-care. “Most of us got into this field because we’re empathetic people who are skilled at thinking about and caring for others,” Dr. Rubin says. “But your own hopes, dreams, interests, family, and friends are all just as important as this work.”
Pollen Magazine examines the health and wellness industry through the lens of the professionals that are redefining private practice. Find inspiration, learn from others, and discover insights on how to build the best version of your practice.