It was a series of upending life events over a period of years—some bad, some good, all unexpected and disorienting—that gradually propelled me into a state of mind-numbing, body-exhausting burnout. First, there was my husband’s cancer, his surgery, and the seven months spent watching him suffer through the spirit-breaking ordeal of chemotherapy. During those months, I’d prayed and cried and white-knuckled my way through an endless, dark valley of alternating fear, anguish, and desperate hope.
But then it was over. My husband got better. The casseroles stopped appearing on our doorsteps, and the encouraging cards and calls stopped coming. We both plunged heart and soul back into our lives. Daniel, as if to make up for the time he’d lost, started full-time graduate school in mental health counseling. I began expanding my practice to cover the costs of his schooling and the pile of medical bills we’d accumulated. I also signed a contract on a book deal, with a deadline looming. Meanwhile, we had five children of our blended family still at home, four of whom were teenagers. Life felt something like walking uphill, against the wind, in a blizzard.
And I got tired—tired all the time, and irritable much of the time with Daniel and the kids. Worse, I began feeling apathetic at work, even as my clients’ painful stories began following me home, haunting my dreams at night. Then my back blew out, as if telling me I couldn’t bear the weight of my life. As I recalled the story of a burnt-out colleague who’d quit the field altogether to open a Greek restaurant, I began to wonder if this was my fate.
At work, the final straw came one evening when my seventh client of the day—a 34-year-old woman devastated by the unexpected loss of her mother—sat across from me, and I found myself, a grief counselor for more than 20 years, wanting to slap her across the face and say, “Get over it!” That I could even think such a thing was a body blow to my sense of professional ethics and self-respect. What kind of therapist feels like that about a grieving client?
Suddenly, I felt not only overworked and undernourished, but potentially unhelpful, or even damaging, to the people I wanted to help. So I started reading any book I could find on burnout, anything about being personally or professionally fried, toasted, mashed, boiled, and charred.
The dominant advice was simple: do more self-care. Unfortunately, the suggestions, which I’ve since come to call macro self-care, usually seemed to require substantial commitments of time, effort, and often money: take more vacations, meditate 40 minutes daily, join a health club or at least do yoga and get aerobic exercise four or five times a week, begin painting or cooking or gardening, go to a spa, spend time in nature, make lists every day of what you’re grateful for, get more sleep, and so on. It wasn’t that there was anything necessarily wrong with these suggestions, but always implicit was the idea that self-care needed to be a big, life-changing project, and that unless you approached it with that kind of investment, you were wasting your time.
This seemed unrealistic and exasperating, if not downright ludicrous. It seemed that only people who already lived pretty stress-free lives could summon the time, energy, and emotional wherewithal to take up this demanding new career in self-nurture. Already overwhelmed, I felt even more paralyzed by these endless lists, especially when added to the long list of obligations and duties of my daily life. But I was desperate. I had to try something, anything. Which was the easiest? I wondered.
I decided to try a walk outside during lunch, satisfying two goals: get fresh air and exercise. Even that proved too hard. Each day, I’d start with the best of intentions, but by the end of the day, I kept finding that I just couldn’t squeeze it in or, truth be told, summon the motivation. So what else could I try? The spa day was expensive and didn’t appeal to me, while trying to meditate for 40 or even 20 minutes a day with my to-do list hammering at my brain would’ve sent me shrieking from my lotus pose.
So there I was, failing at my work life and home life, unable even to get it together for basic self-care! This was demoralizing.
Fortunately, a few days later, something happened that started me on a different kind of route to burnout prevention—an approach that even I could follow. It all began when I started to come unglued during an intake interview with a grieving mother, who was telling me in excruciating detail about discovering her 18-year-old son’s dead body in his bedroom after he’d hung himself with a belt.
Although I’d heard numerous graphic and heartbreaking stories throughout my career, this time, I actually started to feel lightheaded. I considered excusing myself to go to the bathroom but was afraid I’d faint if I stood up. I thought about redirecting the conversation, but in that moment, I couldn’t actually speak. I just kept nodding.
And then I remembered an exercise called “strong back, soft front” I’d heard about in a webinar by Buddhist abbot Joan Halifax, author of Being with Dying. She’d devised the practice for people working with the dying and their families to help them strengthen their back for support and soften their front for compassion. So right there in the session, I pulled my belly button toward my spine and straightened my back, imagining a string pulling me up from the top of my head. Then I took a deep belly breath, relaxing my stomach outward and mentally softening toward my client. This process took all of 15 seconds, while my client kept tearfully telling her story, unaware of my experience.
It worked. I felt better. The deep breathing had stimulated my parasympathetic nervous system, making me immediately more relaxed. I regained my dual awareness and recognized that my client’s feelings weren’t my own. I felt more present in the room as my mind cleared.
After my client left, I asked myself, What just happened? I’d had a freakout followed by a turnaround. I’d engaged in a spontaneous, brief practice that had helped me feel calmer right in the midst of a disturbing experience. I’d interrupted a stress response without interrupting the session—and it hadn’t cost any money or taken much time. In essence, I’d protected and replenished myself through the use of a directed and intentional practice of micro self-care.
I felt I was onto something, and the germ of an idea—micro self-care—began to grow. Self-care wasn’t just a remote possibility outside the office: it was available inside the office, even during a session. So why not try more quickie, self-replenishing practices throughout the day, every day? While macro self-care was great when I could fit it in, micro self-care was available at all times, on demand. I could assemble an array of brief tools that would be simple, free, and doable.
Micro self-care, I decided, is about the benefits of making small changes with reliable frequency. This mirrors what we’re learning from the newest developments in self-directed neuroplasticity—that the brain’s ability to reorganize itself with new neural networks happens with the targeted use of brief, repetitive experiences. The emphasis is on repetition. Small and frequent works better to create desirable neural pathways than big and seldom.
I’ve heard Rick Hanson, author of Hardwiring Happiness, call this the “law of little things.” I’ve heard Linda Graham, author of Bouncing Back, quoting British psychologist Paul Gilbert’s words to describe it as “little and often.” She’s said that 5 minutes of mindfulness meditation every day for a week yields better results than 20 minutes of mindfulness meditation just on the weekend.
Targeting creates the biggest bang for the buck. So just as neuroplasticity practices can be targeted for more self-compassion, more peacefulness, or less emotional reactivity, I learned I could target my micro-practices for the three effects I needed most: relaxing, energizing, and grounding. Why these areas? Because they’re the antidotes to our three biggest occupational hazards: burnout, compassion fatigue, and secondary traumatization.
• When we’re burning out, we need relaxation to help us dial down so that we feel replenished, at ease, and in a place to begin again.
• When we’re feeling compassion fatigue, when our empathy is flagging and we lack the motivation for emotional engagement, we need to energize our sense of purpose and wellness.
• When we’re exposed to trauma, we need to ground ourselves so we don’t drift off in a dissociative fog. Grounding allows us to be a safe harbor in the midst of a tempest.
We’re exposed to all three of these hazards daily and therefore need protection and restoration daily as well.
I knew that for these behavioral changes to have any effect on my life, they needed to become routine—a series of habits as ingrained as brushing my teeth or drinking my afternoon cup of tea. And I knew that habits are best formed when they include a trigger, or prompt. So I strategically incorporated a grounding tool at the beginning of my workday to start the day feeling anchored and steady, an energizing tool right after lunch to counteract the afternoon energy slump, and a relaxing tool at the end of my workday to help me leave work at the office before transitioning to home.
My initial grounding practice was a one-minute meditation, timed on my phone, inspired by Martin Boroson’s book One-Moment Meditation, which argues that it only takes a minute to reduce your stress and refresh your mind. I focused on one minute of breathing but added a few words. On the in-breath, I thought, I am calm and on the out-breath, I thought, I am grounded. Occasionally, I added a background sound of ocean waves from a free app of nature sounds. What I noticed is that this short practice allowed me to start my day from a place of peaceful centeredness, rather than from the usual careening rush of a breathless “go, go, go.”
For my postlunch practice, I marched in place, knees high, arms swinging, crossing my right elbow to my left knee and my left elbow to my right knee. I learned this exercise, called the Cross Crawl, from Donna Eden, author of Energy Medicine, as a way to balance and energize the nervous system. I added the words I am awake and ready to the practice. After doing this, I could feel the blood flowing through my body, readying me to face the next appointment with enthusiasm, rather than the sluggishness that often comes with the postlunch blues.
My end-of-day practice was an ancient yogic breathing technique I learned from Andrew Weil. You inhale for the count of four, hold your breath for the count of seven, and exhale your breath as if blowing out through a straw to the count of eight. This is repeated three times. Called the 4-7-8 breath or diaphragmatic breathing, this is a standard relaxation resource in the EMDR therapy protocol. For me, it created a state shift in which I could truly leave my work behind and transition more freely to a pleasant evening at home.
For a week, I diligently worked with these three practices. As I used them, I told myself, I’m doing this to take care of myself today. I’m doing this because I need restoration and I deserve self-care. In fact, highlighting the compassionate nature of these activities increased my felt sense of being renewed and fortified my intention to continue.
Immediately, I noticed that I actually felt better, both in and out of the office. Because the brain loves novelty, I scoured my therapist toolkit for simple practices I could add that I’d already learned at one time, including meditation, prayer, visualization, affirmation, positive psychology, yoga, breathing, energy medicine, tapping, poetry, and song. I searched for short, simple, easy but powerful practices.
While it might have seemed overwhelming to amass a concoction of to-do tools, I started small and I thought “morsel.” If a practice felt like a chore, I tossed it. It had to be brief and effective but enjoyable. My criteria for inclusion was “Is this practice the behavioral equivalent of a morsel of chocolate?” In this way, I named the best practices and wrote them down on notecards. I consistently used the basic plan of three a day. Within a month, I felt inspired to add more of these very short exercises, depending on what I felt like I needed—sometimes before a session, after a session, before writing case notes, after a hard session, during a distressing session, in the bathroom, during lunch, during tea break, or in the car. At first, I had to stop and remind myself each time—now for a moment of meditation, now for a visualization, now to read a short poem. But the more I practiced, the more natural and automatic these moments of self-care became.
The beauty of each micro-exercise was that it provided a moment of respite and restoration during the onward rush of the day. Each small, intentional pause to refresh or relax made me feel nurtured and confident that I was doing something good for myself and perfectly attainable. I didn’t have to move mountains—or even hills!—but these small gestures of self-repair, like shaking a small, sharp stone out of your shoe, had a cumulative effect over the course of the day, an effect much larger than the smallness of the effort would suggest.
As the weeks passed, I felt less overwhelmed by life, increasingly calmer and centered. I also felt more open to my clients and their struggles. Even throughout days when I was exceptionally busy, I knew that I had an arsenal of simple, effective means for self-care. I could check my calendar, see a full day ahead, and not panic. I could prepare for multiple emotional sessions without becoming daunted.
Today, years later, I’m more on equanimity cruise control than in crisis mode. That said, life is still life. Last year, I grieved the loss of my beloved 15-year-old golden retriever. This year, I launch another child to college, which includes a mixture of pride and joy, as well as emotional and financial strain. And clients continue to come with heartbreaking stories.
So what have I learned? It’s true that self-care is fundamental to my ability to be my best self, personally and professionally. And I haven’t thrown out macro self-care with the bathwater, engaging in those activities as time allows. But it’s the paradigm shift to targeted micro self-care, the cultivation of small replenishing moments throughout the day, that continues to make a crucial difference in my ongoing stress level. I guess my grandmother was right when she told me that “less is more.”
Targeted Micro Self-Care
Targeted micro self-care is a vastly overlooked way of preventing burnout, compassion fatigue, and secondary traumatization. Here are several practices to get you started.
1. Ease on Down the Road
When: After a particularly tense session with an individual, couple, or family.
What: Progressively tense four major muscle groups for 5 seconds and then relax for 10 seconds. As you relax, say a cue word or phrase such as relax or I release or it’s okay, and notice feelings of relaxation enter your muscles. Repeat the cycle of tense and release twice before you move on to the next muscle group. Start with your lower limbs and feet, move to your chest and abdomen, then to your shoulders and arms, and end with your neck and face.
Why: Progressive muscle relaxation has been shown to stimulate the body’s relaxation response. It’s become a standard intervention for stress and pain relief in many clinical settings. For the therapist, its benefits are threefold: it relaxes the body, focuses the mind, and renews awareness of our feelings and inner sensations.
2. Wring It Out
When: At the end of the workday, before you go home.
What: Sit upright in a chair. Slowly and gently twist your body to the right from your hips to your head. Turn around as far to the right as you can. (You might wish to grab the chair handle to help you turn further.) Hold for 10 seconds or longer, allowing your muscles to relax and stretch. Add an extra stretch with a deep inhale, letting your chest expand. Then exhale as you come back to the front. Then repeat this process to the left. As you wring yourself and exhale, imagine that you’re a sponge that’s absorbed your clients’ energies. You want to squeeze out this sponge, freeing yourself from their concerns. Take a moment to notice how your body feels after you twist. Once you’re done, shake your arms in front of you as you release the day’s work.
Why: The essence of this micro self-care practice is in the stretch. As we sit in our therapy offices, conference rooms, lunch tables, and in our cars, the muscles of the back, chest, and shoulders tighten and clench to keep our posture. These tight muscles act as reservoirs for our stress and create discomfort and pain. Gentle and slow twisting relaxes them, signaling to our bodies and minds that it’s time to leave work at the office and lighten our load for our homecoming.
1. Circle of Care
When: First thing after you’ve settled into your office and before you begin your workday activities.
What: Take a circular object and hold it in your hand. I have a small rose quartz circle that I keep in my desk drawer. Hold the object in your hand and say, “I’m part of a vast circle of helpers around the globe.” As you say this, close your eyes and imagine helpers and healers of all persuasions in your town, state, country, and in countries around the world. Know that you’re part of this web of helpers.
Why: Whether we work in private practice, in a clinic, or some other setting, at some point we close our doors and are alone with our clients. This can feel isolating, as if we’re alone in our endeavors. If there’s one thing all schools of psychology agree about, it’s that relationships are crucial to our well-being. This brief technique reminds us that we’re part of a tribe.
2. Doorknob Confession
When: As you put your hand on the doorknob to open the door and welcome in your client.
What: Think to yourself, I do this work because_______. Maybe you do your work because you want to alleviate suffering, help people, understand yourself better, make a difference in the world, or simply because it’s interesting. Get in touch with your motivation before each and every client encounter.
Why: Most of us forget what propelled us into this career in the first place. That initial motivation may still be the primary glue keeping you in the field. Or perhaps different motivations have surfaced through the years. Whatever it is, something is inspiring you to do this work on this day. It’s too easy to get bogged down by the day-to-day realities of our jobs, especially if we lose sight of our purpose. Placing your primary motivation front and center in your mind with the turning of the doorknob initiates a sense of purpose before meeting each client.
1. Hark How the Bells
When: At the start of a session.
What: Ring a Tibetan singing bowl (or other chime) three times with your client. Listen to the sound as it dissipates into the air around you and then begin the session.
Why: This mindfulness-based ritual helps you and your client transition to your time together. Daniel Siegel, in his book The Mindful Therapist, reminds us that mindful awareness not only offers us resilience in the face of uncertainty and challenge, but is a crucial determinant in our ability to help others.
2. Imagine That
When: When you feel disconnected, anxious, spaced out, or melancholy.
What: Close your eyes and imagine yourself in a favorite place, happy and peaceful. It could be a real place that you remember or a fantasy place of calm and bliss. Summon as many aspects of the place as possible, including sounds, smells, temperature, tastes, and visual details. Let these sensory cues come alive in your imagination and then bask in the glow of warm, happy sensations. Enjoy this image for a minute or two.
Why: When you summon a happy place in your mind, your brain and body begin to respond as if you’re actually there. You feel instantly at peace. In EMDR, safe-place imagery is taught to clients as a way to deescalate when they notice being triggered by their emotions.
Photo © Getty Images/Jose A. Bernat Bacete
Ashley Davis Bush
Ashley Davis Bush, LICSW, is a psychotherapist in private practice with over 25 years of experience. She’s the author of 6 self-help books, including Transcending Loss.