An Early Lesson in Self-Care, by B. Imei Hsu, RN, LMHC

As I sat alone at my desk in my psychotherapy office on a cold and grey Monday morning, I hung up the phone, looked for the waste paper basket, and threw up. Then, I sobbed.

It had only been a few months since I took a second job working as a counselor for an Eating Disorders outpatient treatment center. While building a private practice a young patient with an Eating Disorder had been assigned to me for her first session, a transfer from another clinic. The hospital had promised a large stack of photocopied records would arrive before the following Monday morning, so the first session was this green therapist going in blind with a quiet, gaunt, and guarded teen who did not believe anyone could, or would help her. She made an appointment to see me again in three days. I will never forget how she smiled briefly as she left the room.

The voice over the phone notified me that this patient of but a fifty- minute session had taken her life. Over the next few hours, I watched myself grow numb as I learned more details — the missing photocopies of her medical records that was on its way to the office — about why she had taken her own life. Wave after wave of nausea hit me. I barely slept the next couple of days, and somehow stumbled through the rest of the week’s sessions with others.

Later in the month, I caught myself in the reflection of the window, staring absent-mindedly across a pond and the greenery of the grounds outside the office park. A mother duck and her babies swam in a straight line, and I admired both their beauty and simplicity of the life cycle: birth, reproduction, growth, adulthood, death. Suddenly, I noticed I was breathing, not my usual shallow, pained breath as of the previous weeks, but deep, full breaths, ones that went all the way into my belly and came back up into my clavicle bones. I put my hand on my neck, and I felt the air fill my lungs again.

It sounds crazy, but it was a moment where I recognized I had survived deep trauma, shock, and sadness. Because of  confidentiality surrounding my patient work as a therapist, I had few people I could talk to. No one suggested I talk to someone about the kind of vicarious traumatization I experienced in witnessing a young teenager stage the beginning of her exodus from the pain and suffering of a horribly abusive home life. Unlike family and friends, I wasn’t a part of her life to have been invited to the funeral to pay respects, and my grief did not have a sense of closure.  I had swallowed all of it in the pages of those records, in the police investigation that followed, and in the quavering voice of her parent over the phone. I felt haunted.

I began to question myself. If I was saddened to the point of practically forgetting to breathe because of the suicide of a client who was my client for one hour, what business did I have believing I could be of help to people who would be entrusting me with their stories for many more hours, months, or perhaps years? I wondered if I had what it took to be the kind of counselor that people could rely upon to care, yet have strong boundaries, and a resilient core.

I’d be lying if I told you there was some magic formula or ritual I did that made it all better. Yet I can say that everything I had learned about practicing self-care came into play. If I needed to feel sad, I felt sad. If I needed to take a walk, I took a walk. When it was time to eat, I ate. I did my best to get in bed on time and at least close my eyes to try to get some sleep. I journaled, spent time with friends, tried to look for things in life to feel grateful. Over time, I could see myself pulling away from the sadness that bound me to this young girl, the absence and the horror, her helplessness, and the violence in her life.

Nearly seventeen years later, I can look back at my career and the many people I’ve had the privilege to help, and I understand that one thing has not changed. I continue to use “Relentless Self-care”, my own program of activities, space, breathing, meditation, and movement to help me stay strong and resilient as I work with people going through some of the most vulnerable, scary, and tumultuous events of their lives. I’ve also taken on becoming an Ironman and an Ultrarunner, spending hours swimming, biking, running, and hiking, as I find that these activities allow my mind to do what it needs to do to hold that space for questioning, for embracing pain and uncertainty, for challenging the mind to hold onto itself when the body has long since tried to give up.

Self-care routines remind me that I don’t need perfection to do my job. I am human, just as my clients are; I hurt like them, I need patience like them, and I need time to heal, just as they do. When I’m catching my breath after a hard run, I remember it’s hard for everyone; no one escapes the work! And when I am constantly reminded that we never get away from the same routines to take care of our bodies and minds, we are in closer connection with one another; that is, we are reminded that we have an, “I – Thou”  relationship, no matter the apparent differences that separate us from bosses, our clients, our friends, or our family members.

For example, when I am feeding myself a plate of food, I remember that my clients are struggling to do the same, sometimes with meager incomes or in unstable homes or relationships. When I lay my head on the pillow and fall asleep almost instantly, I am also aware that some of my patients don’t sleep well because of the stress in their lives. It’s our humanity — even our bodily needs! — that help me understand why I’ve been a counselor for almost 18 years, and in healthcare for nearly 26 years.

When I take the time to care for myself, I find I can do my best work with people. The kind of care and compassion I can show myself is just as easily translated into the care and compassion I can encourage and teach my clients to show themselves. It’s not magic juju. It just feels like it, from the client’s side.

Imei Hsu is an active retired RN and Licensed Mental Health Counselor in the State of Washington. She recently transitioned her practice from an office to telemental health and works from her home that she shares with her husband and one extra fluffy Applehead Siamese cat. She enjoys yoga, dance, hiking, Ironman, and ultrarunning, and never seem to be without a book in hand. In her spare time, she’s all about making food fun again for people with Autoimmune Disease, Food Allergies, and Chronic Illness.,


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