Practicing Self-Reflexivity in the New Year as a Clinician

Due to the nature of our profession, clinical work is rewarding and burdening. We are susceptible to carrying the pain, stress, anguish and distress that our clients carry. This is due to the essential skill of attuning to our client’s experience, affect and cues. For clinicians to be effective at staying present with these moments, it requires a high level of mindful attention, a reflexive response to turning our attention, and a high ability to tolerate and regulate our own emotions and responses.

Self-reflexivity can help clinicians avoid becoming burned out or fatigued in their profession. Defined as the “process a person goes through to take account of the self and the impact they have on another person’s self” (Holland, 1999), in the most ideal form self-reflexivity is, “maintaining the tension between subjective and objective self-awareness, to connect thought and affect, mind and body, and the observational and the experiential of self” (Aron, 2000). This is not a simple skill that can be acquired after one practice session, rather it is a pursuit that as a clinician has worth and value.

How Subjective Self or Bias May Impact the Client

As clinicians if we do not build awareness of our experience and build the muscle of concentration and attention, we may become blind to the way we impact our clients and work. As clinicians we need to attune to our clients and their emotions, experience, and verbal/non-verbal cues. However, this skill is an instrument that must be tuned every day. As if we were a guitarist or violinist, no matter how many times we have played, we pick up our instrument after it has been at rest and tune it. We are as vulnerable to being out of tune or to the changes in our environment as a string instrument.

Burnout reduces the ability to attune to the client due to the barrier and burden of the compassion fatigue, personal emotions, and lower tolerance for disturbances and ability to regulate affect. We may misread situations, let counter-transferences take over, take work home with us, personally defend ourselves and our pride, etc. Loss of awareness and sense of self can chip away at the compassion, attunement, and unbiased perspective that our clients need.

Self-reflexivity is different than self-reflection. Self-reflection is the act of reviewing or contemplating past events, thoughts, and actions. Self-reflexivity is about taking in the emotional and physical response and experience of ourselves within the context of the world and self. It is an advanced skill of observing a dialectical experience, “seeing oneself as the subject and object. While, also, experiencing the self as a subject and reflecting on the self as an object” (Aron, 2000).

How to Practice Self-Reflexivity

So how do we build the skill of self-reflexivity? We can create a consistent practice of sitting with ourselves and our experience. This can be done through:

• Mindfulness Practice: being present non-judgmentally and one-mindfully to our experiences, thoughts and emotions. Through the practice of observation and letting go we build a sense of equanimity with all feelings, thoughts and emotions. Improving our ability to effectively attune and feel our experience for what it is rather than what we imagine it to be.
• Self-Enquiry: recognizing moments of discomfort or tension in the body, a desire to avoid or dissent, or turn away. Rather than following the urge, we sit with the experience and asking oneself, “is there something I can learn about myself in this moment?” Self-enquiry is used as an evidence-based intervention in Radically Open-DBT.
• Loving Kindness Meditation: sitting with the mantra, “May I be…” and filling in the blank with well wishes for the self and others creates a sense of interconnectedness and compassion for self, others, and the world around us.

Resources

Aron, L. (2000). Self-reflexivity and the therapeutic action of psychoanalysis. Psychoanalytic Psychology, 17, 667–689.
https://doi.org/10.1037/0736-9735.17.4.667

Holland, R. (1999). Reflexivity. Human relations, 52, 463–484.
https://doi.org/10.1177/001872679905200403