Self-Care

Overview of Self-Care: One meaning of self-care is the ability to take care of basic, daily needs (sometimes called activities of daily living, or “ADL’s”) such as feeding oneself, showering or bathing, brushing one’s teeth, dressing in clean clothes, and attending to medical problems. Having difficulty with this kind of self-care can stem from several different areas of concern.

• Depression can bring with it a total lack of care for one’s condition, a loss of appetite or motivation, a lack of energy, or a sense of self-loathing, all of which can impair the ability to care for one’s self

• Cognitive declines associated with dementia can impair self-care skills

• Psychosis – a split from reality that may include hallucinations or delusions – impairs self-care skills

An extended failure to care for one’s self is a serious concern to therapist, and can even result in hospitalization.

Another meaning of self-care can be the ability to care for one's emotional needs, manage anxiety, anger, sadness and other feelings, set boundaries with people, and generally attend to one's more complex needs, even when other people's actions or demands make this difficult. family members, employers, children, friends or society at large may have expectations of us that, as we attempt to meet them and to please or care for others, can interfere with our own well-being and our ability to care for ourselves. People with an anxiety disorder, dependent personality disorder, or depression, as well as codependent people, may fail to care for themselves in this way .

The Medical Model and Self-Care: Therapy can uncover the root of a failure to care for one’s self. If depression is the cause, therapy can help improve one’s mood thus leading to functional self-care. If dementia is occurring, therapy can help in the early stages by teaching new coping and communication skills, and can help families learn to cope with having a loved one with dementia, however it can significantly alter the course of this biological conditions. If psychosis is present, therapy alone can do more harm than good. A high level of care – such as daily group activities at a hospital or community mental health center, and/or a residential placement, unless family members are available and capable to provide consistent care – along with medication is usually the appropriate course, and can significantly improve self-care skills. The failure to care for oneself due to wanting to please or care for others, such as in a codependent relationship, or in the case of overly demanding family members, can indicate some difficulty with self-image and/or with setting boundaries.

Case Examples of Self-Care Issues:

Jennifer, 32, comes to therapy wearing the same clothes several sessions in a row. She originally came to therapy to deal with marriage issues, and since her marriage ended she has been very depressed. Her lack of self-care is a sign that the depression is worsening. Upon questioning, she reports she has no energy and sees no need to care for herself since “he’s gone.” Her therapist encourages her to care for herself even when she doesn’t feel like it. She demurs. The therapist asks about suicidal thoughts, noting how severely her mood has worsened. Jennifer admits to some passing thoughts. The therapist recommends hospitalization, and Jennifer accepts this intervention passively. Inpatient, she is given medications and attends groups, which begin to turn her mood around slightly and slowly. Returning home and restarting therapy, she is able to begin working through her grief and caring for herself, though it is a great struggle for several months.

Ralph, 32, is anxious and angry regarding his parents. Though Ralph is married and has a young child, his parents "constantly" make demands of him, asking for his help with everything from minor household chores to major decisions, even though his parents are healthy, wealthy and intelligent. The therapist helps Ralph recognize his need to set boundaries and teaches him communication tools for doing do, while also helping him uncover and manage emotions and beliefs that interfere with his boundary-setting.

Christopher, 19, has suddenly stopped bathing, smokes three packs of cigarettes a day, and often goes for days without eating more than a few candy bars and drinking a beer. Asked about his condition, he is withdrawn and unresponsive. His mother, who brings him to his first sessions, reports a normal childhood and adolescence. A history reveals a family history of schizophrenia, and the therapist tentatively diagnosis this illness in Chris. Medications are prescribed by the family doctor, and Chris returns to a functional state rather quickly, though it becomes apparent he will be disabled for life by his condition.

Therapy for Self-Care: There is a wide range of Psychotherapy Treatment Models or types of therapy used in the treatment of self-care. Most of these approaches fall into three historic camps of psychology: Psychoanalytic / Psychodynamic approaches; Behaviorism and; Humanism. Regardless of the type of therapy, there are some generally agreed upon elements of healthy therapy which are universal to all forms of psychotherapy. Before beginning therapy for self-care or any other issue, it is helpful to familiarize oneself with these elements.

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Self-Care Article Summaries

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