June 9, 2022
Cindy Lopez:
Welcome. My name is Cindy Lopez, the host of this CHC Podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen. Today we’re happy to partner with Common Ground, a local speaker series resource for parents in our schools. Common Ground currently has about 40 member schools, and each of those schools include school counselors and/or other mental health professionals. So today’s episode is targeted at those folks, mental health professionals in schools and beyond that it’s really a resource for any mental health professionals. To be honest, it feels a bit ironic to be talking with mental health professionals about mental health, but the reality is that your own wellbeing is essential to providing positive outcomes for your students and clients, and one of the best ways to make that happen is to practice some self-care. So join us today as we talk about how important it is for mental health professionals to prioritize their own wellbeing. With Dr. Grace Gengoux, Clinical Professor and the Well-being Director within Stanford University’s Department of Psychiatry and Behavioral Sciences and Dr. Ramsey Khasho, Chief Clinical Officer at CHC.
Welcome Dr. Gengoux and Dr. Khasho.
Ramsey Khasho, PsyD:
Hello. This is Dr. Khasho. I’m really excited to be here. Thank you for making the time for this important discussion, really appreciate it.
Dr. Grace Gengoux:
And I’m Dr. Gengoux, I’m really looking forward as well to talking about this topic with both of you today.
Cindy Lopez:
Yeah, thank you so much for being with us today. So, why do you think it’s so important for us to have this conversation?
Dr. Grace Gengoux:
School counselors, mental health professionals already know so much about mental health and actually that’s a really big advantage. When you have that professional background then you’re somebody who already has a wealth of expertise to draw on and that’s a really major strength, but as we all know it’s often harder to practice what we preach. We’re all human and just like everyone else we struggle with the normal ups and downs of life. We have the same fears, the same disappointments, the same kind of heartache that other people feel, and honestly school counselors have one of the hardest and most emotionally demanding jobs you could imagine. Then to add to that, most school counselors go into the field probably because of a deep desire to help students. And the research shows that those of us who do that kind of mission focused work, we’re at particular risk for burnout. And especially when we work in systems where the people that we want to help are really suffering and when you look around you, and you can’t personally fix all the problems that you see. So, I mean, I think the reason these types of conversations are so important is that the work we do is really hard and the harder the work, the more seriously we have to take our mental health. It’s the people who care for other people emotionally for a living that really do have to pay extra attention to their own emotional self-care.
Cindy Lopez:
I’m sure there are lots of heads probably bobbing up and down, like agreeing with you: yes, yes, yes. For those of us who are in these helping professions we want to make a difference, and it’s hard right now when we see other people suffering and feel like unable to help or the things that we’ve done traditionally don’t seem to be as effective as they were. So Dr. Khasho, do mental health professionals do what they need to take care of themselves?
Ramsey Khasho, PsyD:
Yeah, it’s a great question. I would say that mostly mental health professionals are really good about caring for themselves. I do think we still struggle and the reason for that is it’s so much easier being objective about the needs of others over the needs of oneself and sometimes that’s really where we get stuck, and this is especially true during difficult times when our attention and our helping others is really completely stretched. The best case of this is actually happening right now where behavioral health professionals have really been on the front lines. They are helping people deal with the pandemic and the impact of the pandemic. They’re working with people with the pain and healing around racial inequities. You know here in California we’ve dealt with wildfires. There’s just been so much going on. Now people are processing a war overseas and inflation and the impact that that has on people living day to day, and this is just outside of what many mental health professionals have to do within their own homes and caring for their own families. And so I think that makes it incredibly difficult, and this is an incredibly vulnerable time for mental health professionals to take care of themselves and this is where sometimes the self-care ball is dropped.
One of the other things that I see sometimes with mental health professionals within the context of helping others is that we may have a tendency to minimize our challenges against the larger challenges of those we’re helping, right? And it ends up being dishonoring to ourselves when we minimize our respective struggles, and what we need to do is move to a place that we’re more compassionate with ourselves and with our own struggles and not getting caught up in sizing our struggles against others and measuring our worthiness of self-care. And I think that’s incredibly important for mental health professionals to remember.
Cindy Lopez:
I was just thinking that comparison piece, well, I shouldn’t feel so stressed out or I shouldn’t feel so burned out because you know other people have it worse than I do and I think that comparison thing doesn’t help us.
Ramsey Khasho, PsyD:
Yeah. You know, like here am I, I’m working with someone who’s dealing with housing insecurities or food insecurities, and I’ve got a roof over my head, and I’ve got food on my plate, and we go into this place sometimes very unconsciously, like I need to be grateful, right? And we talk a lot about gratitude, which is a good thing. We talk a lot about blessings, which is a great thing. And, you know we can lean into this place of not honoring our own personal struggles when we do a lot of that comparative thinking.
Dr. Grace Gengoux:
As I’ve been listening to Dr. Khasho talk about these ideas I’m struck by the fact that anyone can experience burnout, but there really are things that we can do to protect ourselves. I have a colleague here at Stanford, Dr. Mickey Trockel who’s done some research on a concept called self-valuation and what he’s been able to show is that this concept self-valuation, which is basically having a growth mindset about making mistakes and also giving yourself permission to prioritize self-care, that this kind of magical combination, is really good for preventing burnout. There seems to be a direct relationship between our experiences of burnout or mental health struggles as clinicians and our ability to take that self-compassionate approach that Dr. Khasho’s talking about to accept the idea that we’re human, and we make mistakes and keep ourselves open to growing and still taking care of ourselves even in those hard circumstances.
Ramsey Khasho, PsyD:
Yeah and I would just add to that we would be remiss not to identify one of the barriers in terms of self-care and reaching out for help. I still believe that there is a stigma around mental health professionals having their own mental health struggles and getting their own help and therapy. And we need to create a culture where we and the community acknowledges that mental health professionals also have mental health struggles, and it’s okay to be in our own therapies. It’s okay to take our own psychotropic medications and breaking the stigma starts with us really being vocal about that. I’m encouraged because I’m starting to see more and more of this happening on social media platforms where medical and behavioral health professionals are going public with their diagnoses and with medications that they’re taking and demonstrating that they’re still very highly functioning and very successful and really encouraging seeking help behaviors amongst the mental health community. And that’s something that’s important that I’d really like the school counselors listening today to really think about and reflect on and pay homage to, you know, where might we as mental health providers be getting stuck, and where is stigma getting in the way of us reaching out for some help and support?
Dr. Grace Gengoux:
I’m so glad that you’re mentioning that, as I talk with my colleagues about their own self-care and their own burnout prevention and that’s why these conversations are so important. We start to learn that, you know, we’re not alone. I certainly got interested in this topic not because I’m good at it or because I’m perfect or because it comes easily, honestly it’s the opposite. I got interested in this topic for personal reasons because I was experiencing a lot of trouble managing the work that I wanted to do and to be the mom I wanted to be, and the wife I wanted to be and the human that I wanted to be and realized I couldn’t do it all without taking better care of myself. And many of us have gotten to that point, and the more we talk about it out loud and know that other people feel the same way, we kind of show some of that vulnerability and start feeling like we’re not the only ones struggling, even just that kind of community building and support can make a big difference.
Cindy Lopez:
Yeah, thank you for sharing that Dr. Gengoux and Dr. Khasho. It’s important to nurture your own wellbeing on an individual level, and it also seems like at a systems level, a culture of wellness in an organization is important too, and I’m just wondering how accurate is my thinking about that?
Dr. Grace Gengoux:
Yeah, absolutely. I think we make a mistake sometimes talking about burnout like it’s an individual problem and the reason we do that is because it really does affect individuals. Individuals are the ones who suffer, but that could lead us to blame the individual for getting burned out or conclude that somebody just wasn’t, you know, resilient enough. And that’s a huge problem in healthcare right now, but the data show really the opposite, burnout is a system issue. It’s really a problem with the workplace, with the work environment. Like for instance there was a recent study of doctors that was showing that even the most resilient doctors, like the physicians who were off the charts on the resilience scales almost so high in resilience that it couldn’t really be measured on the scale, even those doctors about 30% of them were still experiencing burnout and that’s way too high. And what it means is that system supports are really needed so that the dedicated and hardworking, empathic people can do the good work that they want to do.
At Stanford, we have a new center that’s called the WellMD Center, and it’s focused on advancing wellbeing for healthcare workers, and they’ve developed this model of professional fulfillment that’s kind of a three pieces of pie – kind of a pie chart where you have one piece of the pie that’s personal resilience and those are the things that we’re each responsible for our own self-care, like getting enough sleep or exercise or social connection, but the other two pieces of the pie are really important too. One of those is the efficiency of our practice environment. It turns out that all the little like daily hassles that we have to cope with really can erode our sense of wellbeing. And then the third piece of the pie is the culture of wellness and the way that colleagues interact with each other and the way that leadership sort of acts in a way that shows that people taking care of themselves is important. So in an organization like a school for instance, we need to think beyond what one single person can do to take care of themselves and start thinking about how the practice environment can better support wellbeing for everyone: for teachers, for administrators, for students and then how leaders can communicate that wellbeing is also important, that it’s an important part of the culture of a school. So I think the challenge is, you know, if you’re working in a system that’s under resourced, you’re never as a single person going to be able to fix it all yourself. So you have to give yourself permission to do the work that’s going to have a meaningful impact and then do the things we’ve been talking about: take real breaks and get emotional support so that you can keep going.
Cindy Lopez:
It’s so true, I was actually at one of our local schools last week, and they had a professional learning day for their whole staff, and they brought everyone together, pre-k through 12, and they had sessions for their staff, just fun things like some of the staff actually did sessions like making sauerkraut and rock climbing. And then some of our CHC clinicians also offered like mindfulness and yoga or creative expression, like art. So, it was great to see that at that system level, right, honoring the fact that people need that kind of a break, especially in the schools and I think that it’s just so important.
Having been in schools for a number of years myself both as a teacher and administrator, the recognition of your staff and taking care of them is a big piece of a school’s success.
So thinking about me as an individual in a school, how can I affect system change?
Ramsey Khasho, PsyD:
I just want to underscore Cindy what you and Dr. Gengoux have been talking about. As an administrator at CHC one of my roles and responsibilities is working with executive leaders to identify people who are struggling with burnout and when burnout is a specially high and work collaboratively as a system to determine small and big ways and practices that we can help our community of providers engage in more self-care and combat burnout. One of the things, for example, that we did when you know we first went to shelter in place and COVID hit pretty hard is we actually reduced our billable hour expectations for our clinicians because we knew they were dealing with a lot of undue stress, not only caretaking for the community, but also within their own families and how COVID was affecting them. So I think it’s incredibly important for leadership and all organizations need to understand that if their helping professionals are not well, nobody benefits. Their consumers lose out, the organization loses out actually as professionals tend to leave organizations in which they don’t feel supported, and we’re seeing that happening more and more and that’s a problem for the system itself, but to go back to your original question, yeah, I imagine there are some school counselors listening to this and saying, “well, great, systems changes needed and maybe we see that at our school, and I’m not an administrator. What can I do about it?” And I would say that while administrators certainly hold the responsibility of creating cultures that sustain staff wellbeing, I would also encourage healthcare providers to vocalize with administrators the pain points in the organization that they suspect or have experienced lead to burnout and not enough space for engaging in self-care. And in addition to that any recommendations that they have to mitigate burnout, sharing that with administrators is incredibly important. These are the systemic problems that really need systemic solutions. And sometimes administrators may not be privy to the pain points that are creating problems by way of burnout for staff, and they can really draw creative solutions from frontline staff who are there doing the work and are experiencing the burnout and can really help the community course-correct on ways to prevent burnout and engage in more self-care as a community.
Dr. Grace Gengoux:
One thing to piggyback on that idea, sometimes I like to think about sort of two spheres of control, like we each have our own sphere of direct control, things that we are in charge of and we can directly influence without anybody’s permission. We can just make change if we decide to and that’s a great place to start.
The second sphere is this sphere of influence where we can play more of an advocacy role. And there we’re really having to partner with like Dr. Khasho was mentioning the administrators who have the final say on these decisions, but if you as an individual listening get really clear on what is it I want to change? Is there anything within my sphere of control that I can go ahead and try to change, or am I playing more of an advocacy role and partnering with people to try to convince them to change things?
In our experience, like in our department we’ve tried to start really small, but small things can make a big difference. So you know, a policy like, “hey, everybody let’s end our meetings at 10 minutes before the hour because everybody needs a break.” That doesn’t cost anything, most people are on board, and it’s more of a culture shift. We also have instituted a policy where we try not to send non-urgent emails nights and weekends, you know, try to delay delivery so that we’re not just bombarding each other with things that could wait at all hours of the day or night. So those are the kinds of just really small changes that actually can start to slowly shift the culture in a community for the better.
Cindy Lopez:
Those are great actionable ideas for our listeners. And I also just want our listeners to know at CHC we work with our local schools, and we’re happy to consult with you and talk about what’s happening in your schools and if there are ways we can help. So it could be at that systems level, it could be at individual levels, it could be with students or families, but you can reach out to us, and you can find all of that information at chconline.org.
Mike:
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Cindy Lopez:
So, how is self-care and wellbeing tied to client outcomes?
Dr. Grace Gengoux:
Yeah, this is a really rapidly growing area of research, but there’s already quite a large body of literature that gives us some important clues. We know for instance that clinicians who are burned out make more errors. We also know that their patient satisfaction is also lower. Dr. Khasho mentioned how clinicians who are burned out are also more likely to leave an organization or quit the profession and that’s of course terrible for client outcomes for continuity of care. And we also know that when healthcare providers model good self-care practices their patients are actually more likely to follow their health advice and believe the advice and take it seriously. So in my view, I’d say it’s safe to say that clinicians for our own mental health is totally critical for our work to be effective.
Ramsey Khasho, PsyD:
Yeah, and I would just add, I know everyone has heard this analogy, but I’m going to belabor the point because I think it bears kind of repeating the analogy of the oxygen mask on the plane and having to put yours on first before assisting others. I mean, there’s a reason for that, and we simply cannot take care of others before we take care of ourselves through wellness and self-care practices. By the way, I should have mentioned that I’m a practicing psychologist at CHC in addition to being an administrator and a father of three, and so I’m speaking with the school counselors, not at the school counselors, and I’m speaking as a provider myself.
I can’t possibly be there for someone if I’m stressed, if I’m having challenges, it will ultimately interfere in me helping others, whether consciously or unconsciously. So apart from the research, it just makes intuitive sense and I do believe that most mental health professionals get that. And of course the opposite is true, right? So when I, as a mental health professional, I’m well, I have the clarity of mind and the clarity of heart to be present, to be other focused, to be reflective on the sole needs of the client or the person that I’m working with, and I’m able to better draw on my experiences and expertise to give someone the help and support that they need without my own challenges getting in the way. And that of course very clearly and intuitively and obviously leads to better outcomes for clients.
Cindy Lopez:
Yeah, thinking about our listeners, and if you’re a part of a school, school counselor, mental health wellness coordinators or specialists, you’ve been on the front lines for the past couple of years and supporting students and families during this highly stressful time and sometimes scary time. Dr. Khasho, Dr. Gengoux, I’m wondering what words of advice you have for them right now?
Ramsey Khasho, PsyD:
Yeah, I would say probably the most critical piece of advice especially during this time when healthcare providers are feeling incredibly stretched is create community. One of the things that we’ve heard in our work at CHC with school counselors is that sometimes school counselors end up being the sole counselor at a school site or a district, worse, and on top of that I can imagine validating head nods from school counselors based on what I’m about to say, but not only are they the school counselors for the students, but they’re passively, inadvertently the school counselors for staff and for faculty and administrators because they’re great at being a listening ear. And of course, again, on top of that many of them are balancing, you know, being counselors and emotional leaders within their own family and that’s an incredibly heavy burden to carry alone. And so having a network of counselors and therapists to lean in for support, for consultation, for accountability to set boundaries with the load that we’re carrying is an important part and probably the most important advice that I want to give to school counselors in self-care and managing burnout.
One of the things that we did at CHC was to recognize the isolation that school counselors experience, again, not for a lack of trying, but there’s just a lack of forums and bandwidth is always an issue. We actually created a counselors breakfast, which meets monthly and as part of CHC’s convening role, we knew that this was a need in the community because of what we heard from school counselors. And so it’s a forum where school counselors can connect, can support each other, can learn from each other, can find resources in the community and not have to just try to figure everything out by themselves. And so I think that building a community of like providers for support is essential in this work and essential during these difficult times.
Dr. Grace Gengoux:
It’s such an important point that school counselors were already really important leaders within their school system, but this pandemic and kind of epidemic level mental health challenges that are facing our youth have put school counselors in an even more important leadership role in their schools. And I think the challenges that leaders sometimes feel that extra pressure to make personal sacrifices for the benefit of their organization, you know, they know the need is so great and they care deeply, and so they want to do every single ounce that they can to support the people around them, but the problem is that everyone really suffers when a leader themself is burned out or overextended. The data suggests that when leaders take better care of themselves it actually has a positive impact on everyone around them.
In addition to the self-care we’re discussing, in some of the data that have been collected in healthcare organizations like Stanford and other institutions, they’ve shown that leadership practices make a big difference for team wellbeing – things like recognizing people for doing good work, providing feedback and coaching, encouraging other people to develop their skills and suggest ideas for improvement. So those are things that school counselors will be naturally very gifted at doing and can really bring as a major asset to their organizations, but just like you’ve been saying Dr. Khasho that no way will you have the energy or fortitude to do that in the long-term without really having some compassion and taking care of yourself.
Cindy Lopez:
Dr. Gengoux thank you for those comments.
Dr. Grace Gengoux:
Another idea I’ve used that kind of adds to this is an idea of your own personal resilience recipe, like, think about, in fact I was teaching this to a group of parents and one of the moms I was teaching it to said, “I don’t really like to cook, but I like to fish, can it be like a tackle box?” And I said, “oh yeah, sure, that’s fine. It could be a recipe or it could be a tackle box, whatever imagery works for you,” but the idea is that, you know, we all have our own kind of list of ingredients that are really important for keeping us resilient. Again, going back, it could be sleep, it could be exercise, it could be connection with friends, whatever for you are the kind of key ingredients that you always have to keep in the pantry. And I think the recipe analogy works pretty well with the COVID pandemic too because sometimes you can’t get an ingredient at the grocery store or, you know, you have to think about a substitute ingredient, like I’m thinking, you know, back when if you couldn’t go to the gym or you couldn’t go out to dinner with friends or things like that, you think of substitute ingredients, but, you know, you could jot down right now a few ideas of, you know, things that would be on your recipe for resilience and when you get stuck or you’re starting to feel like your battery’s really drained make sure that you’ve done a couple of those key ingredients.
Ramsey Khasho, PsyD:
I love the analogy Dr. Gengoux of the recipe, and, you know, what I’d add too is sometimes the recipe needs to change based on what we’re going through, right? And so sometimes, sometimes I need to fill that recipe with a little bit more sleep in certain weeks or sometimes a little bit more friend time or alone time. So it can change as well. One of the things I remember learning in graduate school, and I remember being so struck by it, is the statement that burnout, in our field of counseling and clinical psychology, that burnout is an occupational hazard. And I remember it hitting me like a ton of bricks because in my concrete mind I’m thinking occupational hazard like a construction worker needing to wear a hardhat because of bricks falling on their head, but it’s, it’s true. We will get burnt out. First it’s an acknowledgement that it will happen, and we also have to be aware and that awareness is key. I think sometimes part of the challenge some mental health professionals know what they need to do for self-care, but they may not always be checked in and be fully aware that they need to engage in that self-care. And so just having that awareness, identifying the signs, being clear about ourselves when we are getting into that place where we’re getting burnt out and this can be an occupational hazard is really critical even before we think about those so-called lists of self-care things that we need to do. I would add to that sometimes when I talk about self-care, I feel really bad because it feels like we’re telling behavioral health professionals to do more, right? Like add this one more thing to your list of things to do. And, you know, I always like to say that self-care is not always doing a thing. It’s sometimes identifying what we need to take away. It’s sometimes it’s setting that boundary, you know, asking ourselves is this load that I’m carrying too much? What can I delegate? What can I give to others? What can I take off my plate? What can I say no to in the coming weeks as a way of self-preservation and ensuring that I’m engaging in my self-care?
One of the things too that I think about as I teach at graduate school at the University of San Francisco, I teach a traineeship class, which is really talking about professional development and talking about how to work with clients. We start every class with how are you showing up today? How are you doing personally? And what’s the one thing that you did this last week for self-care, and it’s a way to engage students in practicing that self-awareness and accountability of oneself and others around self-care. And one of the things that comes up in these conversations is, you know, they sometimes like really struggle. They want to come up with this really great thing that they did for self-care, like go to the spa or get a massage or take a week off and go to Hawaii. And it’s not always about that, and it’s not realistic, you know, to have those big self-care moments. And so I talk to behavioral health professionals about capitalizing on what I call sort of micro moments of self-care. So pausing within your workday and going between meetings, going for a walk out in your neighborhood or walking the dog, or one thing that I always like to share about my own self-care is I love coffee, and I love dark chocolate and mixing the two, dropping a dark chocolate in my coffee is the most amazing thing for me. And sometimes I take literally 10 minutes to just do that and be with myself and block the world out and just be aware of the moment and indulge in this thing that feels really good for me. When you do those micro moments of self-care throughout the day, five, six times, it builds upon each other, it gives you strength and resiliency.
One thing too that I just want to mention, and I think this is research that came out of Stanford. There’s a lot of research that’s coming out around the importance of being in nature and what’s called forest bathing; it reduces cortisol levels. I think Stanford did a study where they had people walk, same amount of time, same time of day, one group walked along a sidewalk where there’s cars and things going on. And another group walked amongst trees and greenery, and there was a significant difference with the cortisol levels and the wellbeing of those who walked in a more sort of forest like area than those in a more sort of urban area. And so really encouraging people, the type of self-care is also really important, getting out and being amongst nature.
Cindy Lopez:
Yeah. Something that one of our board members actually said in a meeting a few months ago, kind of thinking about COVID, like what are you saying no to and what are you saying yes to? What kinds of learnings have we come away with because of the COVID experience and that whole saying no to things is important, but also realizing what are you saying yes to. Those things are the things that feed you. So Dr. Gengoux and Dr. Khasho as we wrap it up what final thoughts you want to share with our listeners?
Dr. Grace Gengoux:
I just want to recognize that everyone listening is in a different place, you know, we’ve all had ups and downs and our experiences have been really different and all the mixed up feelings you might be feeling, you’re certainly not alone. My advice would be to give yourself permission to do what you already know works, but to do it for yourself because the people who have the hardest jobs really have to be the most deliberate about resting and recharging. And the more you care about the work that you do, the more seriously it is important for you to take care of your mental health.
Ramsey Khasho, PsyD:
Yeah, I agree, and I would just add, I really would love for the mental health, behavioral health community to really begin seeing the need for self-care as a strength and as a superpower and as fuel to keep you going over a band-aid for burnout. I think culturally in our Western American culture, we’ve been really conditioned to believe that time off and self-care in all of its forms is somehow self-indulgent or anti-hardworking, and we end up squeezing bits and pieces of self-care in our lives. And I would say that this is especially true, you know, that the expectations for women in careers and being mothers is ridiculous and outrageous, and there’s a ton of pressure there. And the greatest preponderance, I think of people in behavioral health do tend to be women. And so really thinking about how would our lives look different if we took the opposite approach. What if we believed and lived in the philosophy that self-care is critical to be high-functioning to be well balanced and thoughtful human beings? The question to ask ourselves is how might we live differently if we lived self-care as the priority that is a key for life success and not as a so-called treatment for burnout? That’s one thing that I’d love to leave with the counselors today to really chew on and to think about and reflect on and try to practice moving forward.
Cindy Lopez:
We are so grateful for your time Dr. Khasho and Dr. Gengoux and to our listeners, thank you also for listening in. We do have a list of resources so some of the things that you heard about today, like the school counselors collaborative that Dr. Khasho referenced, we’ll have that resource in our resources list. Dr. Gengoux mentioned Stanford’s WellMD Center that will also be in the resources along with her book about professional wellbeing and just school engagement, if you’re interested in connecting with CHC for your school we’d be happy to talk with you. You can find those resources on our Podcast webpages at chconline.org, podcasts.chconline.org, and you can also find those resources in the show notes for the Podcast episode. So thank you Dr. Khasho, Dr. Gengoux and to our listeners, and we hope that you’ll listen in again for our next episode.
Cindy Lopez:
Visit us online at podcasts.chconline.org. Make sure to subscribe to Voices of Compassion so you never miss an episode, and we’d love it if you’d leave us a rating and review. Have a question? Send us an email or a voice memo at podcasts@chconline.org. We’re here for you when you need us.
