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An Issue of Ethics: Spring 2006

Most of us are familiar with the Hippocratic maxim “physician heal thyself” and while Hippocrates clearly was not specifically referring to self care, I think we can apply this maxim to the ethical virtue of self-care.

September 30, 2009  By Cidalia Paiva

Most of us are familiar with the Hippocratic maxim “physician heal thyself” and while Hippocrates clearly was not specifically referring to self care, I think we can apply this maxim to the ethical virtue of self-care.

Perhaps the most difficult and challenging aspect of our roles as health professionals and caregivers involves the expectation to take care of ourselves. Many of us, certainly by nature, training and the ethical and legal requirements of practice are focused on taking care of others. In fact, we typically pride ourselves on the quality of care we provide to others and sometimes even define ourselves and our work in terms of our ability to care for and meet the needs of our clients and patients.

ethics1.jpgHowever, frequently and sometimes far more often than we would like, at the expense of our own self-care (a practice that has implications both for us and for our patients and clients), not heeding the Hippocratic maxim “physician heal thyself” can result in stress, burnout and potentially the loss of the ability and/or interest in continuing our careers as healthcare providers.

How can we heed the duty and ethical imperative to take care of us?


Well, first of all, given the nature of the work we do, and the fact that massage therapy can be extremely taxing on the hands and body, we need to be able to take care of our physical bodies.

There are many massage therapists who end up having to leave the profession because they suffer from carpal tunnel syndrome or other repetitive strain injuries.

Specifically, some things we can do to take care of our bodies include:

  • Learning proper body mechanics and posture and ensuring that we apply these in our work;
  • Ensuring we eat a healthy diet and that we drink sufficient water;
  • Ensuring sufficient sleep and relaxation practices that enable us to recover, recuperate and be fully present physically for ourselves and our clients;
  • Ensuring that we exercise so that we are strong enough to meet the demands of our work;
  • Practicing what we preach and ensuring that we receive regular massage therapy treatments ourselves.

At a deeper level, taking good care of us invariably involves a much broader and more encompassing
imperative to take care of us as whole persons, physically, mentally emotionally and spiritually.

We need to begin to practice self care by creating time for self-care in our busy schedules. Most of the time we argue and rationalize that there just isn’t enough time for us to take care of us. Often, time for us is last in our long list of to do’s and then typically only if something else doesn’t present itself and take priority.

Many of us believe that self-care is a luxury that we will ‘someday’ be able to include in our schedules. We need to be able to appreciate that ‘someday’ may never come and that if we do not take care of ourselves we will be unable to take care of others. Moreover, we need to realize that in taking good care of us we become better able to take care of others. This, in turn, means setting aside some time in our daily schedules and routines for regular and consistent self care practices.

We need to believe that self-care is a good and positive thing and dismiss the notion that self-care is somehow selfish. The reality of our work is that we must be able to take care of ourselves in order to be able to take care of others. We will be very limited in this capacity if we do not have the health and well-being that we need in order to provide the knowledge, skill and commitment that our clients, patients and families need from us.

We need to focus on prevention rather than remediation. By building self-care into our daily schedules we can live healthier lives that will help us to prevent stress and impairment (not to mention setting good role models for our clients and patients) instead of continually finding ourselves in a place of having to seek remedial care.

The general principles of professionalism and responsibility compel us to be sensitive to our distress and to take preventative action so that we will indeed be able to be fully present for our clients and ourselves.

More importantly, as massage therapists we need to be able to say “no” and to stop working so hard to help our clients; sometimes at great expense to ourselves.

We need to know our own limits and not overextend our boundaries in order to meet our client’s needs to our own detriment. We need to be able to set reasonable limits and realistic expectations for ourselves and consistently re-inforce our boundaries in order to support ourselves in good self-care practices. The massage therapy profession as a whole has a very high rate of burn out and we need to be conscious and conscientious of this fact and this means ensuring strong boundary management and practicing preventative self care as a proactive measure.

On an ongoing basis, we need to monitor our efforts to take care of ourselves and to watch out for our ‘blind spots’ so to speak. This means conducting periodic inventories of our stress levels and seeking help when needed. In this regard, it is sometimes useful to solicit the support of family, friends and colleagues and perhaps even professional help if required. Sometimes, others are better able to provide us with insight into our ‘blind spots’ or those areas where we are over extended and consequently significantly stressed. We need to become familiar with the warning signs i.e., fatigue, depression, insomnia, and the inability to focus on the client or patient’s needs, to cite a few common ones.

As members of a healthcare profession and community we need to support our colleagues in their self care practices and in effect when necessary ‘be our brothers and sisters keeper.’ This means proactively, when the occasion presents itself, by providing feedback in an emotionally sensitive manner to our colleagues when we perceive distress, burnout and even possibly professional impairment. We have a duty ethically to support our colleagues and to facilitate to the best of our abilities their efforts to take care of themselves. Remember that these efforts in turn facilitate our commitment to the public and to the profession of massage therapy.

For massage therapists working in isolated regions, isolation can be an issue. For therapists in these situations, contact with colleagues is extremely important as is some form of involvement with the massage therapy community at large and in some capacity that enables them to feel connected and part of a community that cares for and about each other.

Most important of all we need to remember that good self-care and positive self esteem are integral factors in determining personal fulfillment and satisfaction with our work and our lives. As such we need to make constant and consistent efforts to remember why we do what we do or what motivates us. This means renewing on an ongoing basis the very real and inspiring commitment that grounds our lives as healthcare professionals.

We need to be able to live in our work, one day at a time, live our desire to give what we can give to our patients and clients and to allow the nurturing and caring nature that defines us to flourish and grow
emotionally and spiritually.

In doing this we need to remember (especially when life gets in the way) that there is a reason, a very important reason for doing what we do and that reason is the fact that we care about others but also and no less importantly, about ourselves.

How to become a Success as a Person

Remember that being a success as a person is about who you are, not what you do,
possess, achieve or become.

Remember that you are a human being with infinite possibility and unlimited capacity and never settle for less than who you are

Remember that you are not perfect You will make mistakes you will fail from time to time
and you will grow

Remember that there will always be a difference Between making a living and making a life Choose to make a life and remember you always have a choice

Remember that the decision to be a healthcare professional is not just a choice, it is a commitment and a promise to protect the vulnerability of those placed in your trust

Remember that although you treat your patients with your hands you can only facilitate their healing with your heart

Remember that there is no success without fulfillment and no fulfillment without showing up in life

Remember that in the end what makes life good and true and beautiful are the people in our lives and our relationships with them tend your relationships With time, energy, kindness and compassion and you will watch success grow

Remember each and every day that there is a reason for being here and that reason is love

Remember that you are never alone We are all sustained by a higher power you can always take refuge in your faith whatever form that faith may take for you

Remember that the greatest gift we possess is ourselves

The greatest gift we can bestow upon another is ourselves

The greatest lesson we can learn in this life is who that self is

Finally, know that you are a success as a person

– Cidalia Paiva

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