Who Helps the Helper? Initiating and Maintaining “Self-Care” for Muslim Mental Health Practitioners

 

“While employees in various fields experience burnout, social service and mental health professionals are particularly vulnerable because of the high levels of empathy required by our jobs.”

 

Self-care is a necessary competency for mental health and social service professionals. We will explore self-care assessment and priority setting using a holistic framework that includes professional, spiritual, physical, personal, and emotional aspects with a particular focus on Muslims in the field.  We will discuss and define “self-care,” its importance and common misconceptions, and tips for Muslim mental health practitioners to develop a personalized self-care action plan.

 

So, what is “self-care?” It is the practice of taking action to preserve or improve one’s own health and taking an active role in protecting one’s own well-being and happiness, especially during periods of stress (1). Self-care may be considered the antidote to burnout which is a combination of mental, emotional, and physical exhaustion. While employees in various fields experience burnout, social service and mental health professionals are particularly vulnerable because of the high levels of empathy required by our jobs. We also experience the stress of working with clients who are often in crisis and working for agencies where resources may be limited. Our focus is to improve the quality of life for our clients while striving to ease their suffering, which can lead us to become emotionally and physically drained (2).

 

“Burnout is one of the most widely discussed mental health problems in today’s society.”

 

Recently, the World Health Organization identified “burnout” as an official medical diagnosis. Psychologist Herbert Freudenberger is credited with beginning the formal study of the state of burnout in 1974. Linda and Torsten Heinemann conducted a review of hundreds of studies  over the past 40 years.  They had noted that burnout was not considered an actual mental disorder even though it is “one of the most widely discussed mental health problems in today’s society (3).”

 

Most of us in society are not taking care of our well-being. “More than one-third are obese . Only about 20 percent get minimum aerobic and muscle-strengthening activity recommended by the Centers for Disease Control and Prevention (CDC). Studies also reveal that 42 percent of American adults aren’t doing enough to manage their stress, 20 percent say they never do any activities to relieve or manage their stress, and one in five say they have no one to rely on for emotional support. One in three working Americans are chronically stressed on the job (4).”

 

“The cost of self-neglect for mental health professionals is high and ranges from nagging stress that can erode health and well-being to the aforementioned theme of compassion fatigue.”

 

There is growing recognition of the importance of self-care for novice and veteran mental health professionals.  In her book, “Burnout and Self-Care in Social Work,” Sara Kay Smullens addresses both burnout and self-care. She identifies three major root causes  of burnout:  [1] compassion fatigue [2] counter-transference, and [3] vicarious trauma. Compassion fatigue is characterized by service providers lack of ability to connect with clients in therapeutic relationships because previous situations have caused them to expend significant amounts of emotional energy. Counter transference is often referred to as “projecting” and is when professionals see issues or behaviors they are experiencing consciously or subconsciously in others. Vicarious trauma is the absorption or soaking up of trauma from other individuals or one’s environment that impacts one’s health even though there was no direct exposure to the traumatic event. This is frequently seen in clinicians who regularly treat clients suffering from trauma.

 

The cost of self-neglect for mental health professionals is high and ranges from nagging stress that can erode health and well-being to the aforementioned theme of compassion fatigue and job burnout so crippling that individuals may walk away from their career all together (6). As a result, the profession loses quality practitioners and the clients, community members, and larger society lose an essential resource.

 

“Who helps the helper?” is the question that led to a presentation by two of the authors of this article, Aneesah Nadir and Dahir Nasser, at the Annual Muslim Mental Health Conference in Tempe, Arizona this year.   Through the course of  co-authors Nadir and Cheryl El-Amin’s professional careers as social workers and their volunteer work as active community members, they observed too many community leaders failing to take care of themselves.  They also had family problems, health concerns, and other issues affecting them, but no plan for counseling, therapy, peer support or other self-care strategies.  Their high-profile positions were oftentimes consuming and stressful and they had little access to professionals they felt they could confide in.  They also didn’t have a self-care plan. This neglect undermines healthy mental health and social work practice but can be corrected if clinicians not only pay attention to client care but also to self-care (6).”

 

Why is a focus on self-care important for Muslim mental health providers?

 

“Muslims in America are increasingly experiencing elevated levels of trauma and stressors compounded along multiple strands of identity.”

 

In addition to the challenges faced in society at large as Muslim mental health professionals, we have additional stress and challenges within the specific societal context we are currently experiencing. Nasser recalls bouts of anxiety and depression over the last 10 years while getting his master’s degree and working in public health. He notes, “I was having a really hard time taking care of myself. Enrolling in graduate school, conducting research, getting married, having children, securing my first career job, all things that are supposed to be exciting positive milestones, ended up being things that created a lot of stress and pressure to care for and prioritize others in my personal and professional life. My expectations of what I could give to others became something I struggled to manage. Additionally, as a Muslim who is a Black man, I felt the community trauma increasing as violence against Muslims ratcheted up around the 2016 presidential election and the unarmed killing of Stephon Clark (a 22-year-old Black American Muslim man in Meadowview, Sacramento, California) by police, which happened in my neighborhood. The support systems and behaviors that previously helped me through stressful situations were insufficient and I was not able to adapt to the toxic environment. I started experiencing severe symptoms and eventually ended up in the emergency room in the winter of 2017.”

 

Mr. Nasser’s story is not unique. We regularly hear similar stories, whether it be from professionals with family members in countries dealing with conflict such as Palestine, Burma, Somalia, Yemen, Iraq, Syria, Afghanistan, and others, or indigenous Muslims persisting through ongoing systemic racism, police brutality, and sexism. Muslims in America are increasingly experiencing elevated levels of trauma and stressors compounded along multiple strands of identity (i.e. Intersectionality). For example, take Congresswoman Ilhan Omar, who is a woman, mother, refugee from Somalia, and a practicing Muslim who wears hijab. She is expected to be a leader and advocate at all times. Can you imagine the trauma she needs to heal from? Can you imagine the stress she needs to process day-in and day-out? Various forms of social stratification such as class, race, age, religion, creed, disability and gender can contribute to the discrimination or oppression of marginalized groups including American Muslims and this must be considered when we attempt to understand how much stress we are dealing with and thus the amount and intensity of self-care we need to engage in.

 

“Self-care is often put on the ‘would be nice to do’ list, rather than the ‘must do’ activities for social workers and mental health care providers. This reality has to change.”

 

Practitioners are often hard pressed to be “on duty” to serve identified clients and consult directly or indirectly with members of the Muslim community at all times. The Council on Social Work Education (CSWE), which accredits schools of social work, requires students to identify and develop “self-care” plans as part of their ongoing practicum experience. Nadir reminds her internship students to take the learning contract objective seriously and utilize their internship to develop and refine a plan that not only works while they are in school but can become the basis for a plan during their professional career.  Self-care is often put on the “would be nice to do” list, rather than the “must do” activities for social workers and mental health care providers. This reality has to change.

 

Obstacles to Self-Care
As mental health experts we understand the impact of stress on our psychological and physical health, so why don’t we take better care of ourselves? It’s certainly not a lack of knowledge, interest, or concern. There are real barriers standing in our way. Barriers like the messages we were raised with, a lack of focus on prevention, a lack of healthcare coverage, poor health habits, and difficulty saying no to requests and opportunities that exceed our capacity. Other obstacles experts identify as standing in the way of self-care are a lack of energy, too many responsibilities, and the fear of appearing weak or vulnerable.

 

Good Self Care Habits

So what can we do to maintain our health and wellbeing and establish good, consistent self-care habits? First and foremost, it is essential that we recognize the importance of practicing habits that promote our health and well-being and to remember that our bodies and minds have rights over us requiring that we take care of ourselves. We must recognize that we can’t be everything for everyone in our lives and community. If we don’t take care of ourselves and remember to put our oxygen mask on first, as the flight attendants remind us, we won’t be any good for our clients.

 

Self-care strategies can include:

• Setting time for spiritual development (prayer, dhikr, reflection, Quran study, halaqa)
• Implementing personal time for reading, a bath, nails, hair salon, spa
• “Couple time” if you’re married, such as date night, vacations, walks
• “Family time” such as game nights and Islamic discussions
• Time with friends for movies, visits, travel, attending conferences and retreats

 

Other important healthy lifestyle habits include:

• Improving your nutrition by adding more organic plant-based foods to your diet.
• Meal prep to ensure healthier choices
• Exercise at least 30 minutes most days (cardio, walking, stretching, yoga, strengthening, basketball, soccer)
• Get 7-8 hours per day of sleep
• Increase your water intake
• Limit and schedule social media involvement
• Use “time blocking” on your calendar to schedule and get your primary activities done
• Schedule time for activities of lesser importance such as returning phone calls and checking/replying to social media.
• Schedule vacations and breaks away for yourself and family

 

Finally, it is important to identify your support system of family, friends, colleagues, and mentors who are encouraging and who provide positive and constructive feedback.  Participating in a peer support group and seeking therapy when needed can make a difference in your mental health.  And as a mental health provider, scheduling time to debrief, especially after working with challenging clients. Schedule mental health days off is an important part of self-care. Remember that you are only human – be careful not to overwhelm yourself.  Remember that Allah does not place a burden on us greater than we can bear – surely with hardship comes ease.

 

Specific Steps to Develop your Personal Self-Care Plan

Step 1: Schedule time to build your plan

Step 2: Take out a piece of paper, your laptop, or cell phone to begin drafting your plan

Step 3: Consider physical and mental health issues you think are most important to focus on over the next 12 weeks (i.e. blood sugar levels if you are a diabetic, stress due to family matters, sleep schedule, nutrition and diet)

Step 4: Identify self-care strategies that resonate with you and make a plan to apply them in an attainable, realistic, consistent, measurable and time-specific way based on your life. (i.e. walk 3x per week for 30 minutes each week for the next 12 weeks until August 1)

Step 5: Identify an accountability partner or support team

Step 6: Utilize your calendar, phone app or journal to track and measure your activity and implementation of your chosen strategies. (i.e. the days you walk, the hours you sleep, your blood sugar levels)

Step 7: Assess your plan weekly. Reward yourself (i.e. a new outfit, a trip). Refine your plan as needed.  Restart new and revised plan for the next 12 weeks.

 

The Islamic Social Services Association, USA (ISSA) has promoted mental health awareness in general and as it relates to American Muslims for approximately 20 years. Emphasis has been placed on serving the diverse needs of Muslim clientele (i.e. depression, grief, trauma related illness, suicide, coping challenges, domestic violence, pre-marital, marital counseling, etc.).