Abstract

In March 2020, the world was thrust into an unprecedented situation with the onset of the global Covid-19 pandemic. Psychotherapists had to contend with this radical change in our work and life; however, few experiences by way of professional training prepared us how to manage this change well. Over the past two years, many have noted the emotional, relational, and spiritual/existential toll that the pandemic has taken. For those who are trusted to provide mental health care for others in their communities – including psychologists, psychotherapists, medical and spiritual care providers – the burden can feel doubly heavy, as we are expected to offer care to patients and at the same time also observe the ethical and clinical imperative to also care for ourselves.

In this article, we draw on a wellness framework from Existential Analysis (EA) to explore an existential-phenomenological approach to self-care. EA is a phenomenological and person-centered therapy that promotes living with inner consent, making free, authentic choices, and discovering a responsible way of dealing with oneself and the world. The framework of EA articulates four conditions for fulfilled existence: the ability to be, experiencing goodness in life and relationships, being oneself authentically, and engagement with meaningful activities.  In applying these existential conditions to self-care, our hope is to move beyond merely coping with the challenges of the pandemic and instead explore the ethical imperative of self-care with an aim for personal and existential fulfillment.

Keywords: Existential Analysis, Ethics of Self-Care, Wellness and Pandemic

Observing the Ethical Imperative of Self-Care during the Covid-19 Pandemic: Opportunities from an Existential Analytic Framework of Wellness

As we write these opening lines of this article, the Covid-19 pandemic and its consequent restrictions have been with us collectively for over 2 years. Much has happened in these last years, and it seems hard to imagine that the world will return to its pre-pandemic ways of being in the near future. For psychotherapists, the pandemic has in some ways been the great equalizer; starting on March 11, 2020, we were forced to deal with the same stressors faced by our clients. Many well-noted psychotherapists, especially in the existential and humanistic traditions, have long advocated for a more human and less technocratic approach to psychotherapy (van Deurzen, Craig, Längle, Schneider, Tantam & du Plock, 2019). And in unexpected ways this pandemic has challenged psychotherapists of all orientations to deal with the fundamental existential questions of a common human dilemma.

In this article, we aim to explore to explore an essential question for psychotherapists in the pandemic, namely how we have offered care not only to our clients but also to ourselves throughout these last two years.  The literature on self-care is a growing area of research and clinical application that has consistently argued that caring for ourselves as psychotherapists is not only a personal and clinical responsibility but also an ethical imperative.  The purpose of this article is to offer an existential-phenomenological approach to self-care, an approach that is personal and intentional, theoretically grounded, and transcends the common aspiration to avoid distress and impairment.

The context for this investigation into existential-phenomenological self-care is our current global situation – the Covid-19 pandemic. As most of us likely know from our psychotherapeutic practices, the health challenges and restrictions of the pandemic have left their mark on the mental health of the public and also on psychotherapists throughout the world. A few recent studies serve to highlight what many of us are seeing anecdotally in our practices. Rettie & Daniels (2020) explored the coping practices and tolerance for ambiguity of 842 members of the general public in the context of pandemic in the United Kingdom. They reported a significant increase in anxiety and depressive symptoms for nearly ¼ of the research participants and noted that the findings were mediated partially by maladaptive coping responses. Best, Law, Roach, & Wilbiks (2021) noted similar mental health challenges in a Canadian study of 1381 members of the general public and also found that even short-term social distancing practices were associated with increased levels of distress.

Investigations into the effects of the pandemic and restrictions on psychotherapists and other mental health providers have revealed similar findings. A review of 50 investigations by Stuijfzand, Deforges, Sandoz, Sajin, Jaques, Elmers, & Horsch (2020) revealed that healthcare professionals who are working with patients during the pandemic were at heightened risk for numerous adverse psychological effects, including general psychological distress, insomnia, alcohol/drug use, PTSD, anxiety, depression, burnout, and problematic forms of anger. Phillips, Thompson, Edelman, & Ruiz (2021) investigated the experience of the pandemic and resulting restrictions in the US on 207 psychologists in independent practice. Results indicated that there was a moderate increase in stress for these psychologists and that self-care practices (e.g., receiving professional support, engaging in professional development, having daily and life balance, etc.) were instrumental in managing stress. This increased risk serves as an additional reminder for psychotherapists of the importance to manage their own self-care during such unprecendented times.

The Ethical Imperative of Self-Care

For the past 13 years, I (Derrick Klaassen) have taught a 2^nd year Masters course on ethics related to the discipline of psychology.  The major project for this class constitutes choosing an area of ethical practice and focusing on gaining increased competence in this area throughout the course. One of the trends that I have noticed for the past several years in relation to these projects is that an increasing number of students are choosing to explore self-care as a topic that not only has personal and clinical relevance, but is also related to the ethical dimension of psychotherapy. What I have witnessed anecdotally, has also been confirmed in the scholarly literature on professional ethics; there has been an increased attention paid to issues related to self-care (Miller, 2021; Wise, Hersh, & Gibson, 2012), especially in light of the fact that psychotherapists face considerable burdens related to occupational stress and compassion fatigue (Rivera-Koeppel & Mendenhall, 2021).

In addition to the fact that self-care is a relevant clinical and personal topic for psychotherapists, it is also widely regarded as an ethical imperative.  To put it plainly, care for oneself as a psychotherapist – both personally and professionally – is not merely a matter of personal preference or good clinical practice.  Rather, it is now widely regarded as an ethical imperative in the professional ethics and clinical training literature (Tamura, 2012). We provide a few examples from the professional ethics literature in North America to substantiate this claim. 

The ethics code of the American Psychological Association (APA; 2017) is likely one of the most widely distributed codes in the professions of psychology and psychotherapy.  While the APA has not named self-care explicitly as an ethical imperative, the code does suggest this connection implicitly.  In section 2 of the code, under the rubric of personal problems and conflicts, the APA notes that “(a) psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner. (b) When psychologists become aware of personal problems that may interfere with their performing work- related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties” (p. 5).

The professional ethics literature in psychology and counselling in Canada, the jurisdiction in which both of us practice, is more explicit about the ethics of self-care than the APA.  The most recent version of the Canadian Psychological Associations (2017) code of ethics encourages psychologists to “engage in self-care activities that help to avoid conditions (e.g., burnout, addictions) that could result in impaired judgment and interfere with their ability to benefit and not harm others” (II.12, p. 20).  The Canadian Counselling and Psychotherapy Association’s (CCPA, 2020) ethics code, likewise, implores psychotherapists to develop and maintain self-care practices.  In its standards of practice, a companion document to the code of ethics, the CCPA (2021) elaborates on the rationale for self-care practices. “The very qualities that facilitate empathic connection in the helping professions also increase the risk for psychological distress can result in burnout, compassion fatigue, secondary trauma, and vicarious trauma. Investment in self-care can prevent or mitigate the harmful effects that can sometimes be associated with caring for others. Consequently, the exercise of self-care is a crucial consideration for clinical supervisors and supervisees. Beyond representing sound practice, self-care is an ethical requisite. Clinical supervisors and supervisees are called to engage in self-care not only to nurture their own wellbeing, but to safeguard the wellbeing of those with whom they interact professionally. Attention to self-care also may reduce the risk of ethical complaints and litigation” (p. 68).

Self-Care in the Extant Literature

It goes beyond the scope of the present article to provide a comprehensive overview of the extant self-care literature. For these kinds of reviews, the reader is referred to recent to recent articles on training psychologists in self-care (Callan, Schwartz, & Arputhan, 2020), on self-care measures for professionals and trainees (Jiang, Topps, & Suzuki, 2020), and on emotional competence and well-being (Tamura, 2012).  However, even a cursory review of the literature reveals that there has been a proliferation of self-care research over the past decade.  For our current purposes, we want to highlight a few themes from the self-care literature that reveal both strengths of this area of scholarship and also avenues for growth.  With respect to the latter, we believe that our existential-analytic understanding of fulfillment makes a substantial, theoretically coherent, personal and humanistic contribution to this literature.

One increasingly common understanding of self-care in North America is as one of many different clinical and ethical competencies (Fouad, Grus, Hatcher, Kaslow, Hutchings, Madson, Collins, & Grossman, 2009).  Competencies are conceptualized as “elements or components of competence, and consist of discrete knowledge, skills, and attitudes” (p. S6). Within this context, self-care is understood as “attention to personal health and well-being to assure effective professional functioning” (p. S11).  The emphasis of this model of self-care centres around developmentally appropriate components that are evidenced by behavioural anchors. 

The understanding of self-care as a core professional competency, a competency that can be trained, behaviourally evidenced and then assessed, fits well with the emphasis on self-care practices that are meant to assist the psychotherapist in coping with the stressful aspects of the profession.  The vast majority of the self-care literature that addresses both self-care assessment (Jiang et al., 2020) and self-care strategies (Barnett, 2020; Bryant, 2020), focuses on the development of activities that are meant to come together into a self-care plan that is tailored to the individual’s unique stressors and self-care activities.  Commonly identified self-care activities include things such as prayer and meditation, socializing with friends, maintaining relationships with one’s family, and engaging in relaxing and rejuvenating recreational activities.   

While we are not inherently opposed to the elements of such a self-care plan – its emphasis on self-awareness, self-assessment, self-care strategies and so forth – there seem to be numerous challenges with such an approach.  Three such challenges that stand out to us are the fact that self-care in this model is, (a) inherently impersonal, (b) not grounded well conceptually, and (c) solely aimed at the amelioration of stress, or the avoidance of distress or impairment. When we say that the literature on self-care is impersonal we mean that the general approach to self-care is largely devoid of the self; it tends to consist of self-care strategies and activities that many psychotherapists and persons in general might find helpful, but it does not necessarily address the particular vulnerabilities and challenges of the psychotherapist as a unique individual.  These strategies are generally offered to the psychotherapist with little conceptual rationale or supportive theoretical structure; rather, the approach seems to be focused on behavioural activities that are meant in some way to counter the harmful effects of stress.  Finally, the literature concerning self-care seems to be focused almost entirely on psychotherapist distress, which is presumed in general to be harmful.  No positive framework for health and well-being for the psychotherapist is offered; the aim of self-care is not meant to help the psychotherapist to experience flourishing or existential fulfillment but rather merely to avoid distress and impairment (cf. Wise, et al., 2012).

While self-care strategies that aim to compensate for stress and prevent impairment are not inherently problematic, we believe that psychotherapists could benefit from an approach that addresses these limitations.  Thus, in contrast to this impersonal, atheoretical and pathology-oriented approach, we want to offer an existential-analytical understanding of self-care that is more conceptually coherent (Längle, 2003), that takes the psychotherapist seriously as a person who can act intentionally and meaningfully (Kwee & Längle, 2013), and that transcends the emphasis on coping with stress (Längle, 2005).  We will elaborate on this approach in general and then address the ways in which it can be elaborated specifically in relation to the four fundamental conditions for a fulfilled existence.

Four Pillars of Wellness in the Context of Caregivers’ ‘Double Burden’

The authors of this article are both practicing psychologists, educators of psychotherapists in a master’s program and in Existential Analysis training, parents of school-age children, and active members of our community. Despite our extensive training as professionals, we were caught together with the rest of the world without preparation for the stressors and demands of a global pandemic. During this time, our own children were required to stay home from school, our teaching, training, and psychotherapy activities were suddenly shifted to virtual spaces, contact with local friends and family was put on hold, public spaces were shuttered, and travel across borders was eliminated. At the same time as we learned to navigate these stressors in our own lives, we were called to care for the heightened distress of our own patients. Moreover, we began receiving calls to provide additional mental health services to the healthcare professionals who were at the front lines of caring for Covid patients, and to religious leaders who were shepherding their congregations through these unprecedented times. In the last two years, we have collectively experienced multiple “waves” of this public health crisis, each with a new set of public health guidelines and expectations, each with the continuing threat of illness and the ongoing responsibility to mitigate the risk for our loved ones.

Like our colleagues in this profession around the world, we are personally familiar with the “double burden” of being care providers who are trusted and relied upon to provide mental health care for others in our community while having few answers and being pushed to our own limits of our resources. The question of how to live this responsibly, with attention to the ethical imperative of self-care as psychologists, has been immediate and challenging. The commonly held view of “self-care” as being comprised of compensatory leisure time and spa-like activities didn’t fit appropriately for the demands of the current times, and we have been grateful for the four pillars of wellness presented by Alfried Längle’s (2003, 2005) framework of Existential Analysis.

In the midst of profound stress, we indeed find opportunities to deepen our personal development according to the four pillars of wellness of each fundamental motivation of existence. Rather than eliminating or bracketing the stressors of real life, wellness in the framework of Existential Analysis calls us back to being and becoming in the context of the givens of our existence. In this framework, wellness is not the absence of suffering and wellness is not the absence of stressors. In the midst of these unavoidable sorrows, losses, and demands that we experience in our journeys of being human, we have the opportunity to find and sense ourselves as persons and to deepen our affirmation to life. Our fourfold yes to life, in the framework of the four pillars of wellness of Existential Analysis includes the following affirmations,

• I can be here

• I feel connected to life

• I may be who I am

• I am held in a larger context

The rest of this article addresses each of these pillars, which correspond to the four fundamental motivations, in turn.

Framing self-care activities according to the personal activities pertaining to each fundamental motivation of Existential Analysis offers conceptual coherence to self-care practices. Moving beyond the existing literature on self-care that focuses on impersonal and atheoretical behavioural practices, this existential analytical approach to wellness aims to foster growth and fulfillment in care and inherent reverence for the person of the psychotherapist. In this framework, the wellness of the psychotherapist matters not only because it reduces the risk of them causing harm to others but also because their growth and fulfillment matters for them as persons who accompany and encounter other persons on the human journey of suffering, growth, and fulfillment.

We start with the question of the first pillar, can I be? The question of the second pillar is, do I like to be? The third pillar brings us to the question, may I be myself? Finally, the future-oriented question of the fourth pillar is, what is this for? For each pillar, we offer a description of this fundamental existential motivation, self-experience questions for personal reflection and self-assessment, and a discussion of the specific personal activities that Längle has identified as pertaining to each pillar. The behavioural practices of the extant literature on self-care may be conceptually organized within the framework offered by Existential Analysis. For this article, we have chosen to focus on the personal activities that affirm “yes” to each pillar, as a unique contribution of Existential Analysis to understanding and practicing the ethical imperative of self-care among helping professionals.

Can I be?

The first condition for fulfilled existence relates to the ability-to-be in the world into which we are born and today in which we find ourselves. We were thrown into a global pandemic, which became part of the facticity of our being, something that none of us chose and yet we needed to deal with in our specific life-world contexts. This situation both constrained us and enabled possibilities for being. We found and find ourselves in unchangeable and unwished-for realities that we need to actively deal with in order to survive and potentially even thrive.

In this pillar of wellness, we are concerned with the dual dynamic of being-accepted (inwardly) and the ability to accept (outwardly). The framework of EA teaches that we are always engaged and embedded within a dual-dialogue, including an inner dialogue with ourselves and an outer dialogue with our worlds. From the outside, our house of existence requires ground that supports us, walls that protect us, and a space in which we can move and actualize our being. The experience of having a stable, well-rooted place in the world, belonging, and acceptance allow one to be (as they are). The result of being able to say “yes” to the world is the experience of trust in their bodies, in the world around them, and ultimately to experience a deep sense of being held, or fundamental trust.

In the context of the pandemic, we experienced threats to our houses of existence, threats to the places where we were previously able to feel at home, calm, safe, at ease, protected, and secure. For many, this has been a time when the demands of the world have exceeded their capacities to remain in it. This comes from the experience of the world as too threatening and too overwhelming, or from the experience of our abilities to face the world being insufficient. This results in feeling weak, unsure of ourselves, overwhelmed by the threats, demands, and dangers of the world, and ultimately in anxiety.

Self-Experience Questions

•  How is this situation for me? •  Can I accept my world as it is? Can I say ‘yes’ to it, can I really be in it? •  When I think about the experiences or struggles that I am facing related to my personal and professional situation, what do I find easy or more difficult to accept? •  What can I accept easily in my life and in the world? •  Where, when, with whom do I feel “I can be here?” •  Where, when, with whom do I feel “I cannot be here?” •  What is more difficult or even feels impossible? •  Are there experiences of emotional or physical suffering, or even my own emotions, that are difficult for me to accept? •  Where do I feel physically tense, tight, narrow, constricted, or anxious when I think about experiences that I don’t accept?

Personal Self-Care Activities of Being: Acceptance and Endurance

In addition to finding ourselves in the world with its opportunities and constraints, we each have the opportunity and capacity to develop and take a position on ourselves and on our being-in-the-world. We are not merely thrown passively into the world but have the capacity to evaluate ourselves and our worlds, and to receive ourselves with our abilities and weaknesses, and to thus involve ourselves personally and actively in relation to our being. The personal activities pertaining to this pillar of wellness include accepting and enduring. The activity of endurance draws on our power to stand what is difficult, to brace oneself, to remain with what is unavoidable with courage and inner strength. The focus is on one’s own strength to endure, and this is what is necessary in difficult situations where one can do nothing. Acceptance is consenting to something as belonging to life, giving it permission and space to be. To accept something requires an attitude of humility and letting to, so that the given conditions become part of one’s life reality. In acceptance, we are able to release our resistance. In endurance, we experience the power to resist, to remain in a situation that we have no power to change.

There are some aspects of our life situations, including the personal and collective suffering of a global pandemic, that we have a particularly difficult time coming to terms with. These can be outer and inner realities both. When one has the feeling, “I am not able” or “it is too much for me”, what is needed is a letting be, which is accomplished in the personal activities of acceptance and of endurance. A personally aligned self-care plan emerges from one’s insights pertaining to the self-experiential questions above. From these, one has the personal opportunity to challenge oneself to a greater letting be of the givens of your own existence at this time. This requires humility and courage to let go of wishes and to live with what is. It requires accurate self-assessment of the boundaries of one’s own capacity. When nothing more is possible, it is still paradoxically possible to take an active stance of endurance, to remain personally present in the challenges and constraints of the situation.

Do I like to be?

The second condition for a fulfilled existence relates to being connected to life itself, including experiencing emotions and relationships in the context of time. Although being alive is a given over which none of us had any control, life can only be fully taken up subjectively, through our lived experience, relationships, and emotions. As people, we participate in life and in what moves in and through us. As subjective persons, we are able to detect feelings of liking and not liking. Life gives our being (the first pillar) strength, energy, and vitality as we experience being moved. It is in this vital power that human beings are able to experience warmth, closeness, connection to what is good, emotionality, and relationships. This pillar of wellness leads to a feeling of closeness with the goodness of life itself. It also brings us into the inevitable connection with suffering, loss, grief, and pain. Our feelings emerge through exchanges between the world and our inner selves. As living beings, we have feelings and sensations, and are not indifferent to what we experience. In our connection to life, we experience losses and suffering through death and lost relationships. In connectedness to life, we experience a danger, in a sense, of loss and disconnection.

The central theme of this pillar of wellness is life, characterized by values (what is good). In it, we are concerned with the dual dynamic of receiving care through turning towards and being drawn towards values through liking. Where the first pillar of wellness focuses on survival in being itself, this pillar draws our attention to the quality of our existence, and our felt experience of existence. Wellness in this pillar is not the absence of suffering but a felt connection to emotions and to the value of one’s life. Through having the necessary time, closeness, and relationship, one experiences intimacy with self and others. The basic question of this pillar is, how is it to be alive? Do I like my life? The result of being able to say “yes” to life is the experience of the fundamental value of being, that life is good.

For most of us, during the pandemic, the way we have experienced relationships and closeness with our loved ones and patients has been profoundly disrupted. Suddenly, our lives were characterized by physical distancing, restrictions on travel, and working from home. The things we may have looked forward to normally, including connections with friends and loved ones, physical contact and affection through handshakes, hugs, shared meals, and normal activities such as buying a coffee or participating in group activities, were halted. People around the world were becoming sick and dying, and we experienced the grief of the loss of life, of so many around us. When we cannot say yes to life, we become cut-off and disconnected, lonely, pushed down by the suffering of life and the helplessness to do anything about it, ultimately leading to depression. 

Self-Experience Questions

•  How is it for me to be alive? •  Do I feel connected to life, to what is good, to what is painful? •  What warms up my life and gives me a sense of coziness? •  Do I feel alive and like life is flowing in me? Where, when and with whom? •  What feels most important or valuable to me in my life? •  Does my use of time reflect my values? •  How well am I connected to people that I love? •  Are there people with whom I feel warmth and closeness? •  Do I experience pleasure in my life? •  Do I feel blocked in my life? Where life is stuck or cold or even frozen? •  Are there things in my life that I do not like to do, or that feel costly to do? •  Do I receive care and closeness from others? To whom do I give closeness? Do I give myself care and closeness? •  What are my likes and dislikes? •  What are the losses in my life? Have I been able to turn towards loss, to allow myself to feel the pain of the loss of something or someone of value?

Personal Self-Care Activities of Living: Turning Towards and Grieving

In the miracle that life can be taken up subjectively, through our own experience, we have a powerful opportunity to turn towards our own inner and outer lives. The central personal activity of the second pillar of wellness is in fact turning towards. This is the activity that allows one to contribute towards being more alive and to bringing life more into subjective existence. Turning towards is a motion that starts with me towards life or towards someone else. When we turn towards, we turn our attention to the other, and allow relationship with the other to be taken up. Turning towards implies a readiness to be reached and moved by the other. We both receive turning towards, and give turning towards. In giving turning towards, we turn towards others, towards life, and even towards our inner selves. Turning towards oneself is taking up relationship and closeness with oneself, not just being there, but taking time for oneself tenderly, giving oneself an inward hug.

There are countless self-care activities that focus on giving practical attention to oneself. We assert that these activities can be done with inner care and attentiveness to one’s relationship with oneself and in such a posture be a true affirmation of one’s life. However, a relationship with one’s sacred inner self is never taken up merely by engagement in self-care behaviours and can never be forced by such things like going to the spa or taking a nap. To be a true affirmation of life requires a personal position of turning towards oneself and towards one’s life, and of allowing closeness and tender care for oneself to develop.

Inevitably in life, and in particular, during the pandemic, there are losses of jobs, dreams, and people. These are the situations in which we inevitably encounter pain. The central existential question we face in loss is, can I and would I like to continue living under these new circumstances? Can life still be valuable with this loss? When we turn towards our wounds and towards our losses and experience the pain of them, the tears come. They speak to us about the fact that we are poorer in life in some way, that we have lost something or someone of great value. These tears paradoxically reconnect us to life, and engage us with the value of what has been lost. Through grieving, we are able to heal and take up renewed relationship with life. Grieving is a particularly important expression of turning towards when we encounter that things are not as they should be in life. Grieving is rarely acknowledged as an activity of self-care. However, in the pillars of wellness offered by Existential Analysis, grieving is indeed an essential pathway back towards life and towards the feeling of value in life.

May I be myself?

The third condition for fulfillment in life relates to the person, to who we are uniquely and authentically. The central theme of this pillar of wellness relates to being oneself, in one’s own irreplaceable uniqueness. We are here in this world as ourselves. I am myself, uniquely and essentially me. This comes from being known and being received as one’s self from the outside, starting in early development and through ongoing relationships. We also have a choice to be oneself or to not really meet oneself in one’s unmistakable identity. Our singular nature and originality allows us the possibility of behaving in ways that are consonant and real in our decisions, resulting in experiencing authenticity and self-worth. In EA, we understand the person to be endowed with natural authority and dignity.  From the outside, the development of the person comes from being seen, attended to, appreciated, given justice.

In this pillar of wellness, we are concerned with the dual dynamic of receiving appreciation from the outside and engaging with appreciation from the inside. There is an existential dialectic of myself and the other. We are ourselves from the moment of our birth until we die, and nobody can replace oneself in their own life. At the ame time, we are always in relationship with the other. In a humbling sense, we also require the other to become truly ourselves. When one can affirm who they truly are, there is a sense of identity, freedom, and appreciation. This awareness of oneself through being personally involved in one’s own life results in a clear sense of boundaries and limits between oneself and others. It results in being able to sense one’s own authenticity, to detect one’s own conscience, and to stand behind one’s own activities.  Ultimately, affirming the basic question of this pillar of wellness, may I be who I truly am?, results in fundamental self-worth or the inner knowing that it is good that I am me.

The tragedy of not developing a “yes” to one’s own person is self-alienation or loss of self, ultimately feelings of worthlessness. If one cannot be who they truly are, they do not develop a clear sense of identity. This comes with loss of orientation, struggle to make decisions, feeling lost, and struggling with boundaries in relationship. From not sensing clearly what is one’s own, struggles with boundaries in relationship emerge in the form of others overstepping one’s own boundaries and overstepping into the boundaries of others.

Self-Experience Questions

•  Do I have the sense that it is truly good and right for me to be who I am? •  Where and with whom do I experience do I feel seen? •  Where and with whom do I experience being appreciated? •  Are there people with whom it is possible to truly be myself, as I am? •  Where and with whom do I feel the need to hide? •  Where have I experienced wounds of not being seen? •  Am I familiar with shame, hurt, contempt, and despair? •  What is essentially part of my person, my own, belonging to me? •  How much does my life revolve around myself, around my own needs, vs. adapting for the others? •  How do I differentiate myself from others, doing what is mine and standing with myself? •  How well do I detect a “yes” and “no” in drawing boundaries in my life? •  Can I show up truly as who I am, being seen in my uniqueness and encountering others in dialogue?

Personal Self-Care Activities of Being Oneself: Beholding and Appreciating

As persons, we have the capacity to reflect on our experiences and actions and to develop positions in relation to our own persons. This pillar of wellness calls us to take a position towards ourselves in our precious and singular uniqueness, to speak out of what is one’s irreplaceable own, in respect and appreciation and standing for oneself and with respect and differentiation from what belongs to the other. Positions are more than opinions. They are integrated, anchored in our convictions of what is good and right in a given situation or in relation to a given matter; they come from our authentic inner selves.

The central personal activities of this pillar of wellness are beholding and appreciating.  This follows the activities of the first pillar of wellness, which calls us to accepting and enduring our conditions; and then follows the activities of second pillar of wellness, which calls us to turn towards our lives in relationship to life. Beholding requires stepping back from closeness to really see the other as their own, and to be able to be truly seen as one’s own. In beholding, one’s own person becomes visible and encounter with oneself is made possible. In the act of beholding, we draw on respect and take seriously oneself and the other, in order to be able to experience true encounter. The physical act of beholding releases the other from the closeness of embrace, and allows them to stand on their own, holds them in attention, and allows the essence of the other to be seen. Appreciation means to be attentive, considerate and mindful towards the other with recognition of the inherent value of the other. Appreciation is more than liking. It requires personal effort to evaluate the value of the other. We can even appreciate something that we do not spontaneously and effortlessly like. Appreciation arises from looking deeply at the other, with attention and consideration. If the essential becomes visible through this open-minded attention, then the value appears. From this evaluation of value, we are able to experience appreciation.

The pressures and stresses and loss of control that we have collectively experienced in the pandemic has resulted in polarization of attitudes and opinions. Some of the challenges that we have observed in our personal lives and among our patients has been related to how people handle public health measures and how they make decisions to keep themselves and their families safe and cared for during this time. The moral positions that people have taken up related to mask wearing, vaccination, restrictions on physical gathering have been polarizing. Departing markedly from the early refrain, “we are all in this together” many have found themselves fighting to defend their own dignity around their choices to exclude friends and family from physical contact to their choices of breaking rules and regulations due to their own conscience. The burden of carrying judgment and disrespect for each other doesn’t allow the space for them to live what is their own, and takes us away from living what is our own.

At the heart of this pillar of wellness is authenticity. Common language of the self-care literature conceptualizes the psychotherapist as an instrument that needs tuning so that it does not do damage to the public. We would suggest that this third pillar of wellness is at the heart of self-care dialogue and calls us far beyond tuning our instruments of self so that we don’t do damage and instead calls us to standing with deep attunement to ourselves as persons. The personal activities of beholding and appreciating facilitate inner resonance, and finding ourselves and what belongs to our own persons. Through the activities of beholding and appreciation, we anchor our existence and experience in what is our own and resist getting pulled into the activities, needs, pains, and opinions of the world that do not belong to us and can become disorienting and self-alienating.

This requires the psychotherapist as well as every other human being, to touch their own depths and grow in appreciation for one’s self and uniqueness as an ungraspable person. Engaging in self-care activities authentically emerges from knowing and trusting and responding to one’s own self-worth. No amount of physical exercise, good wine, or meditative breathing exercises can in themselves become a position towards one’s own person. Some practices of self-care may affirm one’s self worth, but without a “yes” to one’s own person, self-care activities are empty practices, without resonance, and without one’s self there to receive the goodness. In developing the art of appreciation for yourself as the one who is cared for in your self-care practices, consider what you appreciate about yourself, about your body, about your feelings and emotional experience, about how you show up in the world. Consider how well you are able to behold yourself, to really look at yourself, inwardly gaining distance from yourself and facing yourself so that you can be encountered in your own intimacy. Do you really take up your own life that lives and expresses your authenticity?

What is this for?

Finally, we come to the fourth pillar of wellness, the call to live meaningfully, in a broader context and for a purpose beyond our own individual lives. This fourth condition for fulfilled existence relates to the call of one’s life-world situation, in which each person stands, and to understanding the context in which one realizes one’s being and the world. When we are able to perceive and understand and respond to the call of a situation, we find a way to live meaningfully or according to the greatest value. In the first pillar of wellness, we ascertain and affirm what we are able to do; in the second pillar of wellness, we detect and affirm what we like to do; and in the third pillar of wellness, we evaluate and affirm what is correct and authentic to us as unique persons. However, merely affirming I can, I like, and it fits to me as a person, does not automatically imply that I should. The question of what one should do remains a question in the fourth pillar of wellness. Among all of the possibilities arising from our abilities, our likings, and our persons, we still need to choose what is most valuable in order to fulfill a meaningful existence.

When one affirms yes to a meaningful existence, they have a sense that they know what they are here for, what they were born for. They know what activities and relationships give meaning to their life. Lived, existential meaning is sensing that one’s life is meaningful, that it is enacted in the most valuable possibility. Even the suffering that is unavoidable may be fruitful for something larger, and life experienced as part of a wider horizon of being and becoming. When we say “yes” to meaning, we orient our lives towards a greater value that transcends human subjectivity and encompasses the world and being. The meaning of a situation is always an interplay of the unique characteristics of a person and the unique situation.

The unpredictability of life – as we know so well from the context of this global pandemic – also opens up other possibilities. These include the experience of unfinished business, a sense of meaninglessness in light of bigger suffering, the abyss of emptiness and unfulfilledness of existence, and ultimately the despair of the experienced meaninglessness of life and the absurdity of the world. Sometimes as a result of losses of capacity or opportunity, what was previously meaningful is cut off from one’s existence. The suffering of lack or loss of meaning can lead to existential despair and apathy. We hear, “what’s the point?” and “for what is my life good?” as rhetorical complaints that nothing is worth investing in because the world situation is absurd and hopeless. Indeed, as human beings, we are in a continuous flow of change, which takes place in the heart of unpredictability. We are always in the process of becoming, and change is a fundamental principle of being, of life, and of existence. In this reality, we face the primary existential question of this pillar of wellness, which is “what should become/develop in my life, with my life, from my life, and through me in my life? We step back and ask, what is my life all about, a life where everything is always in a flow, where nothing remains unchanged?

Self-Experience Questions

•  Do I experience my life and my vocation as meaningful? •  Do I have a sense of being called to this work at this time? •  Do I experience a lack of meaning or despair or hopelessness towards my future? •  Where have I been fruitful in my life in the past? •  Where am I most active, engaged, and creative? •  Where do I feel I make the most valuable contribution to somebody or something? •  What challenges and opportunities am I facing? •  Which questions of life do I answer with my actions? •  Do I listen to the call from the outside? •  Do I attune to myself and what I want to give from the inside? •  In what situations or activities do I feel lost or unfulfilled? •  Where do I sense being needed in my own life-world? •  What is the most valuable possibility for me to invest my capacity, energy, and person into, at this point in my life and in the current situation?

Personal Self-Care Activities of Living Meaningfully: Attunement and Decisive Action

As human beings, we have the freedom to both attend to the questions which life is posing to me, to listen to the call of one’s life and the world, or to turn away and not respond to it. Whether we act or do not act, we take a position. The personal activities of the fourth pillar of wellness include attunement and decisive action. The attunement takes place inwardly and outwardly. Inwardly, we have abilities, likes, and personal congruence. Outwardly there are needs, demands, and possibilities. The inward dimensions are rooted in our histories and experiences of development. The outer dimension is current and future oriented. In the process of attunement, we ask, what do I have to do to bring meaning to my life, this one-and-only life, in the broader context of my own life and the world. From this, we act. What is most meaningful is not abstract, or absolute. It corresponds intimately to the person, their situation, and the needs and possibilities around them.

We engage meaningfully and actively with a contribution towards the future, with the anticipation that some good can come of what we do with our lives. As a result of this inner and outer attunement, we exercise our freedom of being with decisive action. We are not abstract philosophical beings who merely think of a meaningful existence, but flesh and blood beings who are exist actively and dynamically in our life-world contexts and respond to real needs. In any potential activity, we decide what we are doing it for or why we are not doing it. This results in decisive action, a realization of our finite lives in the context of where we find the most meaningful possibility. In decisive action, when we “bring our will to earth” in activity, we stand up for something, dedicate ourselves to something valuable, and open ourselves to reality.

The situation of the pandemic has certainly shaken the status quo of our respective life situations in many different ways. The news has been at times bleak, at times hopeful, and always out of our control. What we used to do and how we previously inhabited our respective fields of life activity has changed. What may have been most meaningful previously, for many people was taken away. People around the world are dying. Issues of (in)justice became glaring in terms of which populations around the world were most negatively impacted by the pandemic, who had access to prevention and treatment and information, and even private living quarters. For many, this resulted in a sense of absurdity about what meaning can come as a result of anyone’s dedication to anything. Is it pointless or can there be a meaningful field of activity for a fruitful existence?

To grapple with these questions, we invite you to the personal activities of attunement and decisive action, which can only take place in the dynamic and ever-changing realities of our lives and the world. As you attune to your own lives, ask yourself what tasks and actions you have experienced as meaningful? Do you attend to these? Do they best fit your abilities, likes, and unique person? Do you pay attention and notice them? Do you have a longing to contribute in a special way that fits to you and to your situation? Where do you sense yourself being needed in the world right now? What do you hold in your innermost as the purpose of your life? Do you have an inner sense of being born for something or of the meaning of your unique life? The activities of attuning and decisive action are ongoing and dynamic. The answers to these questions are likely to evolve as you develop personally and as your life situation evolves over time.

Conclusion

As psychotherapists and human beings, we are undeniably dealing with an existential situation that we have not faced before. In addition to the stress of having to deal with the threats and restrictions related to the Covid-19 pandemic, psychotherapists today also face the double burden of having also to offer care for clients who are facing the same stressors. This highlights the personal, clinical and ethical importance of caring well for ourselves. In this article, we have aimed to offer a new approach to self-care, an approach that addresses some of the limitations in the extant literature, and an approach that is conceptually grounded, personal and decided, and offers a positive approach to growth rather than merely avoiding distress and impairment. This approach encourages psychotherapists to ask themselves practical questions that address the four fundamental conditions for fulfilled existence – our ability to be in the world, to turn towards life with its joys and losses, the responsibility to be oneself uniquely and authentically, and the invitation to live a life that transcends solipsism and asks self-transcending questions of meaning and fulfillment. In so doing, we hope that we have offered the reader a new take on self-care, and that this approach to self-care stimulates us individually and collectively to face the existential situation of this pandemic with courage and honesty.

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