2019 Butleretal Sixdomainsofselfcare
2019 Butleretal Sixdomainsofselfcare
2019 Butleretal Sixdomainsofselfcare
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To cite this article: Lisa D. Butler, Kelly A. Mercer, Katie McClain-Meeder, Dana M. Horne &
Melissa Dudley (2019) Six domains of self-care: Attending to the whole person, Journal of Human
Behavior in the Social Environment, 29:1, 107-124, DOI: 10.1080/10911359.2018.1482483
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ABSTRACT KEYWORDS
Self-care has long been of concern to helping professionals at risk for Self-care; physical;
burnout or vicarious traumatization. In this paper we argue that the professional; relationship;
need for self-care is broader than preventing these outcomes. emotional; psychological;
spiritual
Instead, it requires consideration of the whole person and mindful
attention and intentional efforts to achieve two general aims: to
guard against or manage stress and other negative states, and to
maintain or enhance well-being and overall functioning. We propose
and delineate six life domains—physical, professional, relational,
emotional, psychological, and spiritual—that may require attention
in each person’s self-care practice, and briefly summarize some
empirical findings that support self-care practices within each. We
observe that self-care practice in each domain is closely bound to
practice and outcomes of other domains. Steps in developing an
overall self-care plan, including both maintenance and emergency
practices, are also outlined. Because we believe that self-care is not a
one-size-fits-all pursuit, we contend that helping professionals would
benefit from examining each area of their life, and defining for
themselves what self-care means and how they plan to implement
their own personal practice. Above all, self-care requires a commit-
ment to one’s own well-being as a priority.
CONTACT Lisa D. Butler ldbutler@buffalo.edu Buffalo Center for Social Research, University at Buffalo, 229 Parker
Hall, Buffalo, NY 14214-8004, USA
© 2019 Taylor & Francis Group, LLC
108 L. D. BUTLER ET AL.
develop in demanding work-related settings. This aim is a major focus of the overall
academic self-care literature, and derives primarily from studies of helping professionals,
workers, and workplaces. The second aim is to promote broad positive outcomes, speci-
fically, to maintain or enhance well-being and overall functioning. This aim seems to be the
focus of more recent, mainstream discussion of self-care, which has moved from its work-
related-stress origins to nonacademic discussions of general ways of coping and making
oneself happier (Harris, 2017; Trombettea, 2018). In short, self-care is about taking
proactive steps to enhance resilience and overall well-being.
Our interest in self-care arose from both our professional training and personal efforts
to balance life’s demands across personal and school/work spheres, as well as our profes-
sional interests to develop self-care-related educational materials to support students in
our master’s level clinical training program and to formulate research to contribute to the
knowledge base on the topic. With respect to educational resources, we include self-care
modules in our instruction and our school website offers an online self-care starter kit
(Butler & McClain-Meeder, 2015) for use by our students and professionals in the
community. We have also begun to explore factors that can make clinical training
stressful—or even (re)traumatizing—for some students, and whether self-care practice
can be protective in educational settings. Our research to date (Butler, Carello, & Maguin,
2016; Butler, Maguin, & Carello, 2017) has established that students in clinical training are
at risk for retraumatization experiences (i.e., reactivation of trauma symptoms related to
prior life events), secondary traumatic stress symptoms, and negative changes in health
status related to the stresses and trauma exposures involved in their coursework and field
experiences. Importantly, we also found that if students maintained or increased their self-
care practice, it was protective against these risks.
Through these efforts, we have observed that the construct of self-care, while sensibly
defined, needs a more solid conceptual foundation and whole-person perspective to guide
empirical investigations and ground guidelines for practice (see also Lee & Miller, 2013).
With this paper, we seek to start that discussion. In the following, we describe six domains
of self-care and some of what each encompasses. The scope of self-care is broad, and
consequently we are only able to summarize briefly some of the empirical findings that
support self-care practices as they relate to the two main aims outlined previously: limiting
negative outcomes and enhancing positive ones.
therapeutic lifestyle changes that can significantly improve physical, emotional, cognitive,
social, and spiritual functioning. Although Walsh’s review is not framed in self-care terms,
it provides compelling evidence for the efficacy of many of the self-care interventions that
are typically proposed.
Although it would be hard to argue that any particular domain of functioning is
conceptually preeminent, in many cases it is clear that some are more basic (and possibly
essential) to functioning in the other domains. In the following, we propose six domains of
self-care in an order that broadly reflects Abraham Maslow’s (1943) hierarchy of needs. In
his typology, Maslow arranged human needs as a pyramid, in the order in which he
believed they needed attention, beginning with the most basic physiological needs, and
then those of safety, love/belonging, esteem, and ultimately self-actualization. In the
present article, we start with physical self-care as the most fundamental domain that
underpins all functioning. Then we move to professional/workplace self-care because, in
general, we believe that work-related stress and its consequences are primary potential
threats to general feelings of emotional safety and well-being. Then we turn to relation-
ship, emotional, and psychological self-care in turn. In the latter two domains, we empha-
size different aspects of the experience of self for the purposes of the present discussion;
however, we believe that a clear demarcation between these two domains is arbitrary. We
conclude with spiritual self-care. Undoubtedly, self-care practice in each of the proposed
domains is closely tied up with the requirements and outcomes of the other domains, and
so some connections and findings across domains are also mentioned. A conceptual
thread that runs throughout is the need for mindful attention to and intentional action
in self-care practice.
Physical domain
At the foundation of self-care is the physical body. Physical self-care involves tending to
the needs of the physical body in order to achieve or support optimal functioning and to
avoid breakdowns or deterioration within systems. Factors such as receiving adequate sleep,
proper nourishment, frequent exercise, and engaging in maintenance health care are some
of components that support good physical health. Failure to attend to the needs of the
physical body can lead to a host of complications that can negatively affect functioning
across virtually all body systems and spill over into other areas of life.
Sleep
Sleep is a primary mechanism for daily rejuvenation, and therefore plays a vital role in
maintaining good overall health. Adequate sleep allows the body and mind to each restore
itself after daily exertion and mental strains (Carmichael & Reis, 2005). Without adequate
sleep, one is at risk for reduced quality of life and productivity (Centers for Disease
Control and Prevention, 2017), impaired cognitive functioning (Lo, Groeger, Cheng, Dijk,
& Chee, 2016), chronic diseases such as diabetes, cardiovascular disease, and obesity
(Cappuccio, Cooper, D’Elia, Strazzullo, & Miller, 2011; Knutson, Ryden, Mander, & Van
Cauter, 2006; Sperry, Scully, Gramzow, & Jorgensen, 2015), and even mortality (Liu et al.,
2017). To reduce the probability of chronic health issues, the CDC (2017) recommends
that adults sleep seven or more hours per 24-hour period.
110 L. D. BUTLER ET AL.
Nutrition
Just as adequate sleep decreases susceptibility to chronic health issues, so does a well-
balanced diet that includes a variety of nutrient-dense vegetables, whole grains and fruits, fat-
free or low-fat dairy, varied proteins, and healthy oils, while limiting sugar, saturated fats,
sodium, and highly processed foods (U.S. Department of Agriculture, 2015). According to
the USDA Dietary Guidelines, more than two-thirds of American adults are overweight or
obese, which increases the risk of chronic health problems such as heart disease and diabetes
(Hruby et al., 2016), and health care costs related to the health complications of obesity. In
addition to obesity and chronic diseases, poor-quality diets are associated with some negative
mental health outcomes (Won, Kim, & Yang, 2016). In contrast, high-quality diets can
enhance cognitive and academic performance, ameliorate some mental health conditions,
and may also be neuroprotective against age-related cognitive decline and Alzheimer’s and
Parkinson’s diseases (Gómez-Pinilla, 2008; Walsh, 2011).
Exercise
Physical exercise plays a critical role in maintaining good physical and psychological health,
both as prevention and as therapeutic intervention (Walsh, 2011). According to the CDC
(2015), physical exercise is considered to be anything that gets the body moving and heart rate
elevated, including a range of activities, from stretching exercises while seated in a chair,
taking a walk, or sexual activity, to moderate-to-intense aerobics and strength training
conditioning such as team sports, running, and weight lifting. A growing literature suggests
that those who engage in moderate and regular physical activity reap both physical and mental
health benefits (Penedo & Dahn, 2005). Daily exercise can enhance sleep, cognitive perfor-
mance, and mood. It can also help in the prevention and management of myriad ailments,
including psychiatric, metabolic, cardiovascular, pulmonary, and musculo-skeletal disorders
(Pedersen & Saltin, 2015; Penedo & Dahn, 2005; Walsh, 2011). To reap the benefits of exercise,
the CDC (2015; see also Walsh, 2011) suggests that adults should aim for 150 minutes of
moderate to intense aerobic activity per week and two or more days that include muscle group
strengthening activities. Although any increase in activity is good, the cognitive benefits of
exercise appear to accrue after the first 30 minutes and with activities that are more strenuous
or combine strength and aerobics training (Walsh, 2011).
Professional domain
Self-care in one’s professional life can also play a tremendous role in overall functioning.
The purpose of professional self-care is to manage or prevent work-related stress and
stressors, reduce the risk or mitigate the effects of burnout and other workplace hazards,
JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 111
and increase work performance and satisfaction. As we have mentioned, much of the self-
care literature to date concerns self-care related to work; in the following we describe
several of the work-based issues.
Job engagement
Maslach and colleagues (2001) note that job engagement is the “positive antithesis of
burnout” (p. 397) because it involves energy, involvement, and efficacy. While well-
established interventions to combat the elements of burnout and foster job engagement
are limited (Maslach et al., 2001), taking steps to increase individual coping capacities and
identify and remedy mismatches in job-person fit would be recommended. Lee and Miller
(2013) emphasize that professional self-care involves attention to workload and time
management, one’s professional role and reactions in the work context, work-based social
support and self-advocacy, and professional development and revitalization (see also
Jensen, Trollope-Kumar, Waters, & Everson, 2008; Killian, 2008; Newell & Nelson-
Gardell, 2014; O’Halloran & Linton, 2000). An additional caution: professionals need to
ensure they are not seeking to meet all (or most) of their needs at work. Achieving a
practicable work-life balance is a cornerstone of self-care.
reported by the client, particularly in the context of high empathy (Figley, 2002). A related
construct, vicarious traumatization (Baird & Kracen, 2006; Pearlman & Saakvitne, 1995),
describes the cumulative impact on the therapist of working with trauma survivors, including
widespread and negative effects on the therapist’s identity, worldview and beliefs, psycholo-
gical needs, and memories. An additional related hazard is compassion fatigue, which also
involves STS symptoms but highlights the emotional or psychological enervation that may
arise from practicing empathy and compassion (Figley, 2002; Newell & Nelson-Gardell, 2014;
Stamm, 2010), and that would appear to relate to the emotional exhaustion component of
burnout. Therapists who have their own trauma histories and who work with trauma
survivors are also at risk for retraumatization (reactivation of feelings and thoughts asso-
ciated with prior traumatic life events) (Butler et al., 2017). Having such a history or reaction
to client reports can increase the risk for both STS and VT (Baird & Kracen, 2006; Bride,
2004; Butler et al., 2017). The importance of workplace self-care extends beyond the needs of
the professional; a lack of self-care can limit the professional’s ability to address client needs
effectively (Barnett et al., 2007), in part, because it “reduces our capacity or our interest in
bearing the suffering of others” (Figley, 2002, p. 1434).
Compassion satisfaction
One additional goal could be to further specify the predictors of compassion satisfaction—
the pleasure helping professionals derive from doing their work effectively (Stamm, 2010;
Wagaman, Geiger, Shockley, & Segal, 2015)—and strive to foster this satisfaction, both
personally and in the workplace. In one study, social support from friends, family, and
community was the most significant predictor of resilience and compassion satisfaction
among therapists (Killian, 2008).
Relational domain
Relationship self-care refers to the efforts we make to maintain and enhance our inter-
personal connections to others. These connections typically comprise a network of people—
close family members and fast friends—that we interact with regularly, who greatly enrich
JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 113
our day-to-day lives, and to whom we can turn for emotional and practical support even
in the most difficult of times. Additionally, for some, the closest bonds are with compa-
nion animals, and sustaining these relationships is correspondingly important. (The term
“man’s best friend” speaks to the essential role that companion animals play for many
humans.). Extended family, old friends (whom we might connect with less regularly), and
newer acquaintances (where there is promise of a possible deep future friendship) may
enlarge this network, as can peers in the school or work setting, professional or recrea-
tional groups, or support or psychotherapy groups.
Altruism
Although the benefits of receiving social support may seem obvious, an interesting
question is whether providing support is also beneficial. This question is of particular
relevance to health and mental health professionals, whose life’s work echoes Kagan’s
(2002) definition of altruism, that it involves actions intended to benefit another that flow
from an awareness of need in the other. Walsh (2011) asserts that engaging in altruism can
“reduce unhealthy mental qualities such as greed, jealousy, and egocentricity, while
enhancing healthy qualities such as love, joy, and generosity” (p. 587). There is also
now a considerable literature establishing that being altruistic and providing instrumental
and emotional support to others can increase the happiness, mental and physical health,
114 L. D. BUTLER ET AL.
social well-being, and even lower mortality for those who provide it (Brown, Nesse,
Vinokur, & Smith, 2003; Walsh, 2011). The motivations behind these behaviors (pleasure
vs. duty/obligation), however, may affect their benefits for the giver.
Emotional domain
As difficult as it is to separate relationship self-care from emotional self-care, it is even
more challenging (or at least arbitrary) to specify the boundary between emotional and
psychological self-care. For purposes of differentiating domains of self-care, however, we
define emotional self-care as practices that are engaged in to safeguard against or address
negative emotional experience as well as those intended to create or enhance positive
emotional experience and well-being.
relief from disagreeable affect, it may be worth taking time to consider whether and how
to address the situation. In other words, distraction techniques are no substitute for
finishing unfinished business. Barnett and colleagues (2007) have observed that many
helping professionals are at increased risk of overlooking or discounting their own needs.
Lyubormirsky and colleagues’ (2005) scholarly review and model of how to achieve
sustainable happiness through intentional activity.)
In short, to reduce negative emotional experience and enhance happiness and well-
being, we argue that it is necessary to bring mindful attention and intentional action to the
full range of one’s self-care needs (we take up this topic in the next section). One simple
emotional self-care directive could be: figure out what makes you happy and do more of it!
Interestingly, the importance of positive emotions extends well beyond their inherent
pleasurableness. Fredrickson (2002) has argued that, “through experiences of positive
emotions people transform themselves, becoming more creative, knowledgeable, resilient,
socially integrated, and healthy individuals” (p. 123).
Psychological domain
Psychological self-care encompasses a broad spectrum of practice concerning the life of
the mind and experience of self. For the purposes of the present discussion, we propose
that psychological self-care is essentially twofold: it concerns practices aimed at pursuing
and satisfying intellectual needs and purposeful and reflective efforts to understand and
attend to the overall needs of the organism. Although many of the benefits of psychological
self-care are emotional (such as the satisfaction derived from solving a puzzle or the
feeling of agency associated with success in implementing one’s self-care practice), they
are primarily experienced as products of the mind and experience of self.
and rumination, but increased mindful attention and awareness, positive affect, and self-
compassion (Shapiro et al., 2007). Some investigators (e.g., Morgan et al., 2015) distin-
guish between learning to apply specific mindfulness tools to specific circumstances (such
as alleviating stress and negative affect) versus adopting mindfulness as a way of being that
can be generalized across contexts. Our present discussion concerns the latter.
Self-awareness and mindful reflection can also be cultivated in psychotherapy to deepen
understanding of one’s own personal history, motivations, and behavior patterns, to make
meaning of experience, and to enhance resilience and personal growth. Self-awareness,
mindful reflection, and intentional behavior are also integral to the development of one’s
self-care plan, which we see as a central aspect of psychological self-care, but will discuss
in its own section.
Spiritual domain
At the core of spiritual self-care is one’s understanding of spirituality—how we view
ourselves in the context of the broader world; how we find purpose, hope, and meaning
in life. Spiritual self-care practice creates space to reflect on our own inner needs and our
role or place within the world and universe. Spiritual self-care may be rooted in faith or
religious affiliation, but it can also be an entirely secular pursuit. A key element of spiritual
self-care is awareness of what helps us feel connected to the larger world and/or gives
meaning to our lives and work. Spirituality, as with all of the self-care domains, is deeply
personal. For some, spirituality centers on organized religion and belief in a God or gods.
For others, it is a deep connection to humanity, or nature and the earth. For many, it
yields experiences of awe, wonder, and transcendence.
Dombo and Gray (2013) describe maintaining one’s spiritual practice as a “cushion of
support” (p. 96) for professionals working with clients. Helping professionals often work
with individuals in crisis, those struggling to find meaning in difficult life events; and in
turn, they struggle to make sense of these events themselves. Koenig, McCullough, and
Larson (2001) found that engaging in what are described as forms of spiritual practice
(e.g., meditation, prayer, drumming, or other practices) can reduce stress, buffer the
impact of working with trauma, and enhance overall well-being. Spiritual well-being has
been found to reduce emotional exhaustion and protect against burnout among nurses
working in high-intensity settings (Rushton, Batcheller, Schroeder, & Donohue, 2015). In
the following, we distinguish between faith-based and secular practices as aspects of
spiritual self-care.
Faith-based spirituality
For many, spirituality is deeply rooted in faith—a belief in a higher power that gives life order
and purpose. Faith provides comfort and meaning in times of stress, and can enhance one’s
sense of identity and overall wellbeing. By providing a sense of purpose to life, faith helps
many people identify what is important to them and offers perspective in difficult times.
members of the congregation or group. Research has found associations between religious
participation and positive coping behavior (Braam, Beekman, Deeg, Smit, & van Tilburg,
1997), reduced rates of depression, greater feelings of wellbeing (MacKenzie, Rajagopal,
Meibohm, & Lavizzo-Mourey, 2000), and even longer life expectancy (McCullough, Hoyt,
Larson, Koenig, & Thoresen, 2000). It can also buffer the impact of stress (Kendler,
Gardner, & Prescott, 1997), help individuals make sense out of distressing events, and
promote healing and resiliency (Bryant-Davis & Wong, 2013; Van Dyke, Glenwick,
Cecero, & Kim, 2009). The positive health effects of religious involvement are thought
to be due, in part, to the social bonds created during a shared ritual or by membership in a
particular religious group (Idler & Kasl, 1997).
Prayer. Prayer is a religious practice of quieting one’s mind and seeking connection with
a higher power, which allows for reflection and perspective-taking. Ferguson, Willemsen,
and Castañeto (2010) found that the use of centering prayer (a prayer routine based on
centering one’s thoughts and intentions on a sacred word) led to lowered stress and
increased positive coping behavior among parishioners. Prayer can be used as a contem-
plative practice, a way to find connection and discernment, or as a way to express thanks
to a higher power. Collins (2005) discusses the importance of expressing gratitude and
recognizing the things we are thankful for.
Spiritual meditation. While there are hundreds of meditative practices, spiritual medita-
tion moves beyond relaxation and stress management techniques, beyond repetition of
simple words or phrases, to encourage one to create space for reflecting on one’s place in
the world. Spiritual meditation requires a shift in thinking from present day-to-day
concerns to the universe and one’s place in it. Whether it is contemplating one’s relation-
ship with God, Mother Earth, or the universe, spiritual meditation allows for reflection on
one’s role within the larger cosmos.
Transcendental meditation (TM) is a form of meditation rooted in spirituality that has
been shown to reduce stress (lowered heart rates, lowered blood pressure) and improve
mental health (Wachholtz & Pargament, 2005). A comparison of spiritual versus non-
spiritual meditation practices in college students found that spiritual meditation resulted
in greater decreases in anxiety, increases in positive mood, and increases in spiritual health
compared with the secular meditation groups (Wachholtz & Pargament, 2005).
Connecting with nature. Connecting with and revering nature is an important spiritual
practice for many. Walking through the woods, noticing buds and flowers, star gazing, and
marveling at the interconnected universe, are all activities that can be deeply spiritual.
American zoologist Edward O. Wilson (1984) employed the term “biophilia” to describe
“the connection that human beings subconsciously seek and need with the rest of life.”
JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 119
Being in nature provides humans with a connection to a system, an ecology, that is larger
than themselves. While some seek divine encounters through nature, others view the
connection with nature as spiritual practice in and of itself. O’Halloran and O’Halloran
(2001) argue that time spent in nature (including gardening, hiking, and camping) can
provide professionals and students opportunities for rejuvenation and renewed hope.
Indeed, regular exposure to nature or “forest bathing,” as Lee and colleagues (2011, p. 93)
have described it, has emotional benefits, as well as psychologically restorative ones (Kaplan,
1995). It can also be a source of healing, hope, and peace (Davis & Atkins, 2004), which may
be of tremendous value for those working with survivors of trauma and violence. In
nonclinical populations, natural settings contribute to greater emotional, attentional, cogni-
tive, subjective, and spiritual well-being, and appear to reduce symptoms of stress, depres-
sion, and attention-deficit hyperactivity disorder (reviewed in Walsh, 2011).
If anecdotal reports from students and colleagues are any guide, spiritual self-care may
be the least attended-to self-care domain, especially among those who are not religious.
Yet, its centrality to our experience of ourselves as fully human is incontrovertible.
Whether it be a walk in the woods or attending a religious service, taking time and
making space to reflect on what gives life meaning is vital for many.
for you in the past. We recommend listing the following in a readily accessible format (such
as a card you can keep in your wallet; Rinfrette, 2010): (1) Specific (to you) activities that are
soothing, relaxing, distracting, or mood enhancing (as well as activities to avoid, particularly
those that could isolate you). (2) People who can provide meaningful emotional support or
help you distract yourself (as well as those to avoid under these circumstances). (3) Positive
self-statements and ways to combat negative self-talk. And (4) whatever else you want to
remember to do (or avoid doing) during emotionally challenging times.
We strongly believe that one size does not fit all when it comes to overall self-care
practice. Instead, we propose that the person-practice fit is critical, whatever that means
for that individual practitioner. In other words, each of us needs to employ ongoing self-
awareness and mindful reflection both to specify and prioritize our personal values and
needs with respect to self-care and to determine the relative importance of different areas
of function in sustaining and enhancing our own well-being.
Conclusion
In sum, we believe that bringing mindful attention and intention to addressing the range
of one’s self-care needs across all life domains is vital for helping professionals. Self-care
activities in any domain need to be self-determined and meaningful, and their results
regularly appreciated, evaluated, and updated as necessary. Although there is no “one-size-
fits-all” way to approach self-care, there is a common thread in all self-care efforts: they
involve making and honoring a commitment to one’s own well-being. While there may
appear to be an uncomfortable tension between care for others versus care for self, it is in
many ways a false dichotomy. As Dean Nancy Smyth (personal communication; Butler &
McClain-Meeder, 2015) often observes, a common airline safety directive is (metaphori-
cally) instructive: you must put on your own oxygen mask first before you can help others.
Thus, many commentators (and professional bodies) now view self-care as an ethical
imperative for helping professionals (e.g., Barnett et al., 2007; Newell & Nelson-Gardell,
2014). Nonetheless, self-care also requires a commitment to one’s own well-being as its
own priority. For some, taking this step may be the primary challenge and, therefore, the
best place to start the practice of self-care.
Acknowledgments
The authors would like to thank Elaine S. Rinfrette, Sandra A. LopezShirley Reiser, and Elaine K.
Hammond for their invaluable contributions to our evolving thinking about self-care, and Robert
W. Garlan for his thoughtful feedback on an earlier version of this manuscript.
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