The Oxygen Mask

The stewardesses on airplanes always make sure parents know that if they oxygen masks come down, to put their own on first, and resist their instinct to put their child's oxygen mask on before their own. Because, if the parent passes out from no oxygen they aren't going to be much help to the kid after that anyway. I like that thought as an analogy for self care in mental health professionals. If you don't take care of yourself FIRST, you aren't going to be much good to anyone else.

I wanted to take a minute this week and reflect upon the importance of self care when dealing with clients who are personality disordered. I'm speaking from experience on this one as I've been struggling through treatment for a client with significant Borderline Personality Disorder. I've found myself exhausted, running around in circles talking to every family member under the sun (appropriate in inpatient facilities) and, as hard as I've tried not to, fallen right into the tangled web of manipulation that is BPD. I've also learned about the "Borderline split" which is a concept I was unfamiliar with. I use "split" here, not is as much of the psychodynamic defense mechanism sense, but more of the dividing and conquering of staff (or family members) that are manipulated to the point where they find themselves set against each other. Sound extreme? I agree, but I've been in the trenches over the last few days and have seen this ALMOST play out. Lucky for me I have a phenomenal supervisor who has been instrumental in the maintenance of my sanity. She is no stranger to BPD games and manipulations and is well aware of the dynamics that can occur when treating a patient with BPD.

So, my focus is not on how to provide appropriate treatment to the patient, my focus is how to deal with BPD and not loose your mind. I've already mentioned what I think the most important thing is: having a rock star supervisor. Or if you are the supervisor, seeking supervisor from a colleague. Someone who is well versed in the battle tactics of BPD can look at the sea of manipulation you are swimming in and fish you back out onto try land. My supervisor has been awesome in providing guidance as to what direction to go and helping me to not "work harder than the client," which is actually a lot harder than it sounds. This brings me to my next thought, which is, not to work harder than the client. After all, you as the counselor are not responsible for their wildly traumatic past or desperately hopeless future (in their opinion). The individual is responsible for finding the motivation to pull it together, to the capacity that they are capable, and the counselor is there as a tool to help. Creating and maintaining boundaries so as to not become overly invested is incredibly important because other wise you will always be working harder than the client.

My last thought is make sure you develop and maintain appropriate self care strategies. After you've set your boundaries and done all you can to ensure you are not working harder than your client, the next step is to take care of yourself so that you do not burnout. Over the last two semesters I've come a long way in my self care and have developed self care tools and coping strategies to use to help me unwind after an emotional exhausting day and to help me leave the thoughts of my patients at the hospital until tomorrow. These are vastly different for everyone but for me cooking a nice dinner and taking a scalding hot bath works wonders. My boyfriend is also in the Mental Health field so venting to him my feelings is also helpful for me so that I can let go, relax and enjoy my leisure time.

What's your Oxygen Mask? What self care strategies are you employing that are helping you "leave the drama at the office?"