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Practice: More Than Just a Job

Posted on December 2, 2016

I’m spending the next several weeks focusing on some major revisions to our Thrive: Self-Care training. Over the years, Thrive has been an integral part of many of my Trauma Informed trainings, and I have had the opportunity to present my thinking on this topic around the country. One of the lessons I’ve learned from this journey is that there is something deeper that connects us to this work.

When I ask people about why they give up fame and fortune to do this work, I hear some very powerful answers. Some people feel called by God to this work. Others have experienced severe trauma themselves and want to use the wisdom and strength gained through these experiences to help others who are struggling. Still others speak about how they can live their values every day by doing this work. This deep connection has challenged me to think differently about self-care, and over the next several weeks, I would like to share these evolving insights. Plus, I know the holiday season and the current political reality makes self-care a timely topic.

As I’ve focused on this topic, one word has stuck in my head and started to organize my thinking: Practice. Practice is both a noun and a verb. In its noun form, it speaks to the application of a belief, knowledge, or idea, and how, if strategically repeated, it leads to mastery. Practice as a verb describes the actual action taken on the journey to mastery.

For the 2015 National Health Care for the Homeless Council Conference, Juli Hishida asked me to do a pre-conference session titled, “Self-Care is Quality Care.” I was happy to take on the challenge of creating a full-day training under this title. As I started the process, I began to realize that self-care is not something we do outside of our work. Instead, self-care is the most critical part of anyone’s healing practice.

A healing practice entails being part of a transformational process. An essential element of this practice is the mastery of skills such as Motivational Interviewing, certain medical procedures, classroom management, and other skills and approaches. The more we practice medicine, teaching, therapy, or outreach, the better our skills become. As Carol Dweck has shown, expertise emerges with repeated deliberate practice, with 10,000 hours roughly being the point of mastery.

There is plenty of evidence that a healthy and engaged worker is better able to implement learned skills effectively (Rock, 2009), showing the relationship between self-care, healthy work environments, and performance. For the helper, skills are only part of the challenge, and are almost meaningless if not delivered within the context of a healthy therapeutic alliance or relationship. Unlike many professions, we must first establish a strong working relationship based on trust and safety before our knowledge and skills can realize their desired effect.

This is where Juli’s insight is so important. A burnt-out or traumatized worker will not have the resiliency or social/psychological energy to do the hard work of building a healing relationship with clients who have experienced intense interpersonal traumas. Health of the helper becomes a real driver of quality care when we consider the research from Lambert (1999), which showed that the relationship between helper and client accounts for 30% (skills/techniques account for 15%) of successful outcomes in a helping relationship.

We all know that working with clients experiencing trauma exposes us to many painful emotions, such as depression, suffering, worthlessness, shame, and anger just to mention a few. In our healing practice, we work through this pain to help the client find the good and worth that is lost in traumatic experiences. This calls on us to implement our knowledge, and practice our skills from a place of compassion, love, and hope.

Unfortunately, burnout and helping trauma limits our ability to meet despair and shame with hope and compassion. I often state, “To help others we must take care of ourselves first.” Self-care MUST be as integral to our healing practice as our medical training, MI skills, or experience. We would never intentionally implement a treatment or approach that would directly harm a client; however, do we not do equal harm when we are unable, due to our lack of well-being, to fully engage in the healing process?

Trust me, as the poster boy for burnout, these words ring hard in my ears. But they also challenge me to take the topic of self-care seriously, and to stop thinking about it as something to focus on if there is extra time. Over the next few weeks, we’ll dig deeper into the concept of practice. This week, my question is: When you think about your healing practice what does that mean for you? I want you to think deeply on this question and connect it to how this work allows you to express something that is at the core of you as a person.