20 Ways Shrinks Stay Sane

It's mental health month! Like many of you, I've been actively sharing mental health information as a way to increase education and reduce stigma surrounding mental illness. While it's an honor to be in a profession that focuses on supporting the mental health of others, being a therapist often requires regularly going to "dark" places with clients, and that can take a toll on our own mental health. After nearly 20 years in the field, I've noticed that a lot of therapists (myself included) tend to be caretakers, people-pleasers, and self-sacrificers, making us particularly vulnerable to neglecting our own mental health in the name of caring for others. I have learned to become fiercely dedicated to self-care, self- awareness and to maintaining my own relationships in order to protect and nurture my own mental health.

I wanted to reach out beyond my own experience to therapists around the world to see how they nurture their own mental health in a profession that can be emotionally and mentally exhausting. Here's what they had to say.

1. Live in the present

"I make myself more present by asking 'Where am I in space right now? What do i hear? What do I feel? What do I taste and smell? What do I see?' " Natalie Robinson Garfield.

"I find 20 minutes a day to escape from the world and enjoy the peace and quiet." Deborah Serani, Ph.D.

"I meditate regularly and journal about my dreams."  Dr. Will Courtenay

2. Surround yourself with positive people

"I rid myself of toxic relationships and situations immediately and I engage in religious activities, especially prayer," says Leticia R. Reed, LCSW.

Surrounding yourself with positive people also includes you. Kim Olver, LCPC checks the stories she tells herself about her own life. "If they serve me great, if they don't I'll change them. I'm the one who makes them up after all," says Olver.

3. Go to your own therapy

"I go to my own therapy on a regular basis." Dr. Will Courtenay

"I take care of my mental health by checking in with my own counselor when I need someone objective to bounce things off of and get centered or grounded." Xiomara A. Sosa

"I have entered therapy 3 times since my core training. 3 different styles to suit the issues I was experiencing. I also do workshops and retreats throughout the year for personal/spiritual development." Jodie Gale

4. Get moving

"I have two Labrador retrievers who demand a lot of attention. I find a great escape just going out into the backyard and throwing the Frisbee for an hour." Regina Bright, LMHC

“I salsa dance! I rely on the nonverbal connection with my partner and happy music to get through some challenging weeks.” Dr. Amy E. Keller

"Every day I take time to meditate or participate in Pilates or yoga." Diane Petrella, MSW

5. Nurture a sense of humor 

"I try to maintain a good sense of humor and find ways to laugh during life’s challenges." Ashley Bretting, LMFT

"My spouse and I attend a comedy show every week."  Stacey Kinney, LMFT

6. Maintain friendships

“I make sure to have tea or lunch at least once a week with a friend that is supportive and makes me laugh." Nerina Garcia-Arcement, Ph.D.

"I find that participating through friendship in the life of someone outside the field is even more refreshing and grounding than the peer consultation we used to do." Mark E. Sharp, Ph.D.

7. Take a break

"I love vacationing to Costa Rica."Dr. Amy E. Keller

"I enjoy watching funny and/or inspirational YouTube videos." Hugh A Forde, PhD

"Hiking is a great activity that helps reduce my stress levels." Dr. Karen Sherman

8. Catch some zzzz's regularly

This one is an important one for me. I try to take a long naps every Sunday afternoon.

"My goal is to get at least eight hours of sleep every night." Stephanie Moulton Sarkis PhD

9. Uplifting media

"I like to read books, listen to music, and subscribe to inspirational Facebook pages." Dr. Matthew Clark

10. Reach out to those in need

“I do volunteer work with Mission Outreach, a non-profit group that collects unused medical supplies in the United States and sends them to third world countries. Being able to help others in such a simple, easy way does wonders for one's outlook on life.” Sujatha Ramakrishna, M.D.

11. Create fun each day

"I ask myself, 'Have I had fun today?' If the answer is no, then make it happen before the night is over!" Natalie Robinson Garfield

“I pursue my hobbies of photography, painting, and jewelry making.” Stacey Brown 

12. Say no

"I have found that out is easier to say "no" when I realize that if you say "no" to one thing, you are always saying "yes" to something else. If I say "no" to a new client, I am saying "yes" to time with family and a less busy mind." Joseph R. Sanok, LPC

"I hold stringently to my practice days and hours—keeping mornings for myself to exercise and write, using afternoon to early evening for clients, and taking off Fridays for whatever I want to do." Karen R. Koenig, LCSW, M.Ed.

13. Celebrate nature

"I love to spend time in nature by walking through the woods or listening to the birds chirp." Sujatha Ramakrishna, M.D.

"I work in a professional office setting and need to be reminded that I am an animal. Getting out to a park or the beach or a hike in the mountain, or even a drive up the coast with the top down are instant healing techniques." Nancy B. Irwin Psy.D

14) Express yourself creatively

"I nurture my own mental health through my other profession which is as a comic/writer....in writing my own material I get to see the humor in almost every situation and in performing it, I get to bring laughter...one of the greatest stress reducers of life....to others." Jane Stroll

"I write in a journal often." Xiomara A. Sosa

"I take a writing class, so that I can stay creative and do something that's just for me!" Janet Zinn, LCSW

15. Get pampered

My personal favorites are a message and a pedicure. I try to do at least two pampering activities a month to help me relax and to nurture myself.  Ashley Bretting, MFT gets pampered by having her hair washed by someone else. Whether it's a hot bubble bath or a leisurely walk, do something that feels nurturing on a regular basis.

16. Be a kid

Ashley Bretting "I bring out her inner child by coloring with crayons or paints!"

“I spend time with animals and children. The unconditional, pure love and affection from these creatures soothes the soul.” Nancy B. Irwin Psy.D

17. Get out of your head

“I bike to work as much as I can -- this is a 30 minute commute by bike, 20 minutes by car.  In doing this, I ensure that I arrive at work very relaxed & calm (having just spent time close to nature -- hearing the birds chirp and the wind blow and seeing green around).  When I leave the office at the end of the day, all of my worries get worked out by the time I get home.  So, I arrive at home very relaxed also!” Sally Palaian, PhD

18. Process your feelings regularly

Karen Hylen, Ph.D, of Summit Malibu Treatment Center suggest regularly sharing  your feelings with a friend or a loved one to avoid emotional explosions. Hylen shares this analogy:

When you bottle up your emotions, you are figuratively assembling a bomb in your head. Each feeling you bury in your head is you  putting together another piece of the bomb. Keep enough of your feelings to yourself and before you know it you'll have an emotional explosion.

19. Focus on family

I enjoy spending time with my family. Going to the beach and reading or walking is especially refreshing. I take two trips a year with the family and then one with just my husband. Regina Bright, LMHC

"I make sure I make time for my loved ones. It is an anchoring force," shares Dr. Anandhi Narasimhan.

20. Consult regularly on difficult situations

When I first went into independent practice I set up to have lunch or breakfast with a colleague also in independent practice every couple of weeks. It allowed us to bounce ideas off of each other and not feel so isolated in our work. Mark Sharp, Ph.D. I want to hear your mental health tips! Post them below

What I Wish I'd Known Before Starting A Private Practice

If you're considering going into private practice, it's always smart to talk to other clinicians who have been there. When I opened my practice years ago, I had very little business experience. Luckily, I did a few things right that allowed me to be profitable (and it didn't hurt to be married to a CPA). Over time, I learned that I have a knack for marketing and networking that has allowed my practice to continue to grow, even during a recession. Few private practitioners are armed with small business skills when they venture into private practice. According the U.S. Small Business Administration, around 50% of new businesses will close their doors within 5 years.  The realities of making a profit and running a successful private practice can be discouraging and exhausting. If you're considering opening a practice, I think you'll enjoy several seasoned practitioners answer the question,"What do you wish you'd know before starting your private practice?

Private practice is a business

Like most of therapists, Emma K. Viglucci, CFT, LMFT, CIT  of New York City didn't really understand what it takes to run a business when she opened her practice. "I had some ideas about running a business as both of my parents owned businesses, and about running a practice from assisting run my graduate program's clinic. But, I didn't know the nuts and bolts of being in business."

It's easy to overestimate profit and underestimate the amount of work it takes to start and build a private practice. Psychologist and professor Karen Sherman, Ph.D. says she wished she'd know that working for herself  "wasn't going to be as lucrative" as she thought.

Save for self-employment taxes

When you go into private practice you'll be paying self-employment taxes. If you're used to working for an agency where your taxes are automatically withdrawn each paycheck that catches new practitioners by surprise. Just to give you an idea of how much to save, self-employment taxes for 2011 in the U.S. are around 13% (SBA.gov).  Psychologist Roberta Temes, Ph.D learned about taxes the hard way. "My first year I did not diligently deposit half my fees into a bank account earmarked for taxes. That was a learning experience."

Understand managed care

Texas counselor Shannon Purtell MA, LPC, LPC-S, NCC wishes she'd better understood the world of behavioral health insurance before she opened her doors.

Before entering private practice, I wish that I had truly understood behavioral health insurance and Employee Assistance Programs. Trying to learn the ins and outs of insurance while building a private practice was not only frustrating and time consuming, it was costly. Without completely understanding the industry, I failed to negotiate better rates, was unable to qualify for certain panels, and did not always understand the reimbursement structure. Each company had a different way of handling referrals, authorizations, and reimbursement. Unfortunately, I started in private practice prior to electronic billing and online benefit verification/authorization which has dramatically streamlined the process.

Importance of marketing skills

New York City therapist Diane Spear, LCSW-R wished she'd been better armed with marketing know-how when she opened her doors. Spears says, "You can be a terrific therapist and have a tiny practice if you're not good at marketing. And if you're not naturally good at marketing and networking? Practice! A lot."

Developing a niche and area of expertise is what Clinical Psychologist and author Dr. John Duffy wished he'd known before opening his practice.

I wish I had known the importance of establishing a niche when I started, developing a particular expertise. I found that I work well with families, in particular teens, tweens and their parents. Specializing in this area, I've found that I have a strong knowledge base in this area, and I am more and more confident in my work. As a result, I have a full practice, a waiting list of clients, a popular book, speaking engagements. I am also now considered an expert in a number of media outlets.

Stay on top of billing and record keeping

When you're your own boss it's easy to set some of the less enjoyable and often tedious business details on the back burner. Arizona therapist Lisa Gomez MA, LPC wishes she'd known the importance of staying on top of those tedious administrative tasks. Gomez wishes she had understood the importance of staying "on top of your billing and having good records in regards to accounting."

Practice ebbs and flows

Many private practitioners are surprised by the fluidity of referrals and fluctuating direct care hours. My own practice always dips to the lowest number of referrals and fewest client hours every December. I learned through not getting a paycheck one December to save 10% each month throughout the year to cover the holiday lull.

Portland individual and couples counselor Julie Jeske M.S. has also learned by experience to trust the ebb and flow of her private practice. "I wish I had known more about the way things can fluctuate. Some weeks (or times of year) are really busy and others are slower. The first time things slowed down for me I got really nervous, but it always picks up again," Jeske says.

Solo practice can be isolating

When you practice in a clinic or agency it's easy to take social interaction and peer relationships for granted. There's always someone to grab lunch with or to consult with on difficult cases. For many therapists, the transition to private practice often means a loss of built in professional support system, and the need to actively seek social interaction and professional consultation.

When therapist Amy Luster, M.A., LMFT of Santa Monica, CA opened her practice she found solo practice to be isolating. Luster says, "It would have behooved me to learn about the benefits of participating in a group practice while I was in my graduate program."

Importance of setting boundaries

Maryland therapist Dr. Mary Sidhwani wished she'd know the importance of setting boundaries with clients.

Before I began my practice, I wish I would have created healthier boundaries. I wanted to be available for all my new clients and so returned phone calls and emails 24/7. As time went by, it became increasingly difficult to maintain that with the growing practice. I was able to put healthy boundaries in place, however, it would have been much easier if I had done that initially.

Now it's your turn. What do you wish you'd known before starting a private practice? Please post your comments below.