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Self Care: Toward a Model of Ethical Self-Care for Social Workers
By Melinda Gushwa, PhD
Social Work Today
Vol. 22 No. 4 P. 6

In 2021, NASW added a selfcare section to its Code of Ethics: “Professional self-care is paramount for competent and ethical social work practice. Professional demands, challenging workplace climates, and exposure to trauma warrant that social workers maintain personal and professional health, safety, and integrity. Social work organizations, agencies, and educational institutions are encouraged to promote organizational policies, practices, and materials to support social workers’ self-care.”

For years, social workers have been talking about the importance of self-care on their own. With this revision to the Code of Ethics, self-care has formally entered the conversation as an ethical necessity in social work practice. Given the exposure to multiple forms of trauma they face daily, social workers experience high rates of burnout and stress. The COVID-19 pandemic has only exacerbated the situation.

To address these challenges, social work agencies must develop organizational cultures that support the selfcare of their employees.

Burnout and Secondary Traumatic Stress (STS) Among Social Workers
Christina Maslach’s model of burnout centers on three components (subscales): emotional exhaustion, depersonalization (seeing clients/patients as problems rather than people), and lack of self-efficacy (feeling like no matter how hard you work, nothing changes). Social workers can experience one, two, or all three of these components at once. Symptoms of burnout may include physical exhaustion, headaches, insomnia, and low morale. This cluster of symptoms can generate fatigue and apathy. Research studies have found 25% to 75% of social workers have high rates of burnout. Social workers’ burnout also affects their clients, leading to inadequate assessment, treatment, and evaluation.

In addition to burnout, social workers may develop STS, a type of emotional stress that surfaces when one hears about the first-hand trauma of others. Since most social workers are constantly exposed to acts of violence and human cruelty, they are susceptible to STS. The symptoms of STS mimic those of PTSD and may include disconnecting from others, insomnia, impaired memory, depression, and emotional numbing. To date, studies indicate that up to 50% of social workers develop some form of STS.

Burnout and STS rates are typically higher for Black, Indigenous, and People of Color social workers who experience the effects of systemic racism and discrimination as part of their everyday lives and then work with clients and client systems who seek help as a result of the effects of discrimination and marginalization. This is a heavy burden with high emotional costs. The toll that the practice of social work can take on an individual’s mental health illustrates the profession’s paradox.

Being a social worker is an amazing opportunity to help empower people to experience change, growth, and healing as they manage some of the worst experiences imaginable. However, the flip side of that is that there are high rates of burnout and STS or vicarious traumatization. For too long, the impetus has been on individual social workers to take care of themselves and to seek their own therapy. This is a professionwide challenge that shouldn’t be left to individuals to resolve.

The pandemic has heightened social workers’ stress by creating a collective trauma. In the early days of the pandemic, most people were terrified that if they contracted the virus, they could die. Social workers felt this while also providing services to people who were experiencing that same terror. Social workers had to overlook their own fears in order to provide needed support to clients. This collective trauma has further increased burnout and STS rates among social workers.

About three months into the pandemic, I and Emily Douglas, PhD, a professor in the department of social work and child advocacy at Montclair State University, conducted a study of child welfare workers. Workers were asked about their access to personal protective equipment and their concerns about their clients’ welfare. Workers who reported overlooking risk factors because of the pandemic exhibited high rates of STS.

The pandemic has spotlighted what could be argued was already festering in social work. Now, more than ever, the social work profession has come to a place of urgency in which organizations and agencies must embrace a culture of self-care in support of a workforce desperately in need.

Organizational Self-Care Culture
Self-care practices can have an impact on burnout and STS in formative ways. For instance, self-care has been found to promote greater well-being, lower stress, and increase positive thinking.

There are evidence-based self-care practices that social workers can engage in that are generally effective. Journaling, or any kind of writing, is helpful, along with mindfulness exercises. Specific hobbies that activate creativity, such as music and the visual arts, help individuals take their minds off work.

However, self-care should not be an isolated practice. Often when it comes to self-care, there is an expectation that the onus is on social workers to take care of themselves. What they need are informed organizations that incorporate a self-care perspective into their cultures.

What is a self-care–oriented culture? First and foremost, the leadership must understand the consequences of burnout and STS, as well as the benefits of self-care. This means creating work environments in which social workers are not expected to work overtime or perform uncompensated work.

Leaders should not expect social workers to go beyond what they are contracted to serve. Doing so will only serve to exacerbate the symptoms of STS and burnout. A self-care–informed organization will understand that it is unreasonable to expect everyone to work at full capacity during moments of crisis such as the pandemic. Self-care–oriented organizations do not exploit their workers.

Social work agencies and organizations must develop policies and procedures that reflect a culture of self-care. More specifically, these organizations must engage in practices that support well-being. Informal conversations among social workers can often turn to concerns about taking time off: “Who will cover my caseload when I’m gone?” “There’s no point in going away if I come back to three times the work.” “Vacations are not possible for me.” “I’ll worry too much about who is looking after my clients. It’s not worth it.”

Providing coverage for employees while they take time off is a hallmark of a self-care–informed organization. Furthermore, leaders (from supervisors and managers to CEOs) need to take note of the toll the work is taking on their staff. An ethical organization knows that burnout and STS are inevitable and not the exception to the rule. Employee handbooks and other orientation material should acknowledge burnout and STS and include specific information on how the agency strives to respond to them.

Self-Care Ideas
Hosting employee events in which people can engage in a creative or artistic activity promotes self-care in an institutional setting. As many have learned during the pandemic, providing more remote work options increases flexibility and can decrease childcare and commuter costs.

Tuition benefits are also desirable. For example, suppose an employee wants to obtain a master’s in social work. It can cost the organization less over time to provide tuition assistance and/or time off for school rather than to hire and train someone new.

These examples demonstrate how self-care can become a partnered act rather than the responsibility of individuals.

Finding the Money
During interviews for a new position, social workers should inquire about the organization’s self-care practices. If there is a long pause or no answer, it’s likely that not much thought has been given to creating a culture of self-care.

Social work agencies can learn from technology and Fortune 500 companies, many of which have started to pay attention to their employees’ mental health. For instance, these organizations might offer retreats that include art therapy, stress reduction workshops, or yoga.

Nevertheless, many social work agencies are financially strapped, with most of the budget devoted to clients and services. Ironically, it’s this altruism that limits the options for agencies that would like to expand self-care practices. Therefore, agencies must reimagine what a client-centered budget looks like.

— Melinda Gushwa, PhD, is a visiting associate professor at Simmons University in Boston and head of the department of applied social sciences at the Technological University of the Shannon Midwest.