Why did I stop telling my patients to do activities to nourish their self-love?

Take a bubble bath! Get a massage or pedicure! Go for a walk and take a deep breath!

I previously considered myself an unquestionable person to encourage my patients to practice self-love. My question was always, What are you doing for your self-love?

I gave talks on self-care, and I did one in particular at the library in downtown Los Angeles. It was so successful and convincing that I was invited to give another lecture related to the same topic for the next meeting of the local librarians' union. The most viewed article on my blog is “100 Strategies To Help You Practice Self-Care.” Also popular, since the end of March 2020: “50 Coronavirus Self’-Care Tips.”

Now, when I use the phrase “self-care,” I do it in a somewhat subversive. The main page of my website says that “Swearing is a form of self-care.” From time to time, I tell my patients, “self-care isn't just long walks on the beach; it can also be making a to-do list or shouting into the abyss.”

Because after two and a half years of being a therapist in a pandemic (not to mention parenting in a pandemic), it has become abundantly clear that traditional definitions of self-care are insufficient. Worse yet, they can actively cause harm and make people feel worse.

Here are some of the reasons I've stopped telling people to practice self-care, at least in the traditional way:

The self-care doctrine blames the victim

Here's a classic example: a corporate workplace requires its employees to essentially be on call all the time. The company pays its staff generously and in return expects its employees to work late into the night, on weekends, and sometimes during “vacations.” Someone in a position of power learns that the company has a high burnout rate. As a result, there is higher than ideal turnover and it costs the company money.

So the company asks someone in human resources to enact mental health initiatives. Suddenly, there are a lot of little perks in the office: kombucha on tap, a company-paid membership to the Headspace meditation app, yoga classes every Wednesday morning, and scheduled email reminders at the beginning of each week, reminding all employees to take some time for themselves. (I started calling these types of benefits “waffle parties” like the

Apple TV show called Severance).

The employees are still struggling, but now they feel like it's their fault. "Look at everything our company does for us, they must really care! I don't know what's wrong with me, I still feel terrible!"

When someone is overwhelmed and we say “what are you doing to take care of yourself?” we ignore the systemic problems that created burnout in the first place. It allows the people in charge of these systems to be off the hook and puts the responsibility on the individual to handle the difficulties of being in a system that doesn't work.

The work example is really tangible and concrete, but the same kind of burnout can occur just from being an empathetic person living in a difficult world. This can happen when you are desperate because you feel unsafe in a pandemic that the world is now ignoring, or when a police officer was acquitted after shooting an unarmed Black man, or when LGBT rights and abortion rights are at risk. Now I am calm that I am no longer the therapist who says: “Oh, but how are you?”

practicing self-care during these difficult times?”

Labeling something as self-care quenches curiosity about its actual function.

That being said, it is important to take care of yourself when you are a member of an unjust system. The problem is not the idea that there are things you can do to feel better, is the phrase “self-care.” Sometimes labels can serve as thought brakes that dampen curiosity, and this is one of those labels.

How can drinking a bottle of wine, going for a run, journaling, having lunch with a friend, flossing, having an adult coloring book, limiting your news consumption, setting boundaries with your mom, eating more vegetables, eating more ice cream, and hiring someone to clean your house be all the same?

They are not.

And the thing is, going back to those ways of practicing self-care, I actually support all of those suggestions. Most of them are great things to do. Personally, I love bubble baths and massages, and I know my life is better when I set the right boundaries and floss regularly.

The problem is not the specific actions. The problem is the way we label them. What you're doing... Is it relaxing? Is it a creative outlet? Is it a way to relax that could harm you in the long term? Anything that helps your body feel better? Something basic you should be entitled to without having to label it as a special privilege (like a lunch break at work)?

So, to be clear, I still want my patients to take proactive steps to take care of themselves. And that can sometimes even look like things traditionally labeled as self-care. But instead of “how are you practicing self-care?”, here are some of the things I ask:

● Where do you find joy?

● Do you feel like you are getting enough rest?

● Do you take your space to recharge your battery, especially if you are an introvert?

● What gives you energy?

● What is your social life like these days?

● You are caring for so many people; who takes care of you?

● While you are sitting in ambiguity, are you doing something to occupy your brain on something else?

● Are you numbing your feelings or allowing yourself to feel them?

These things may seem like they are suggestions for practicing self-care. If that's what you're thinking, you wouldn't be the first person to accuse me of getting caught up in semantics. But unlike a suggestion to practice self-care, these are specific, targeted questions to delve deeper into an unmet need.

Self-care is not the central project for building a meaningful life.

If you have a headache, you can take a pain reliever and (hopefully) the intensity of the headache will decrease. If the headache is a symptom of a deeper medical problem, the medical problem is not solved, it just doesn't hurt as much.

This is often how self-care is used. “Everything is terrible and overwhelming, so how can I feel a little better? Oh, I know, an hour in the beauty salon.

But I don't want my patients (or my friends and family, or myself) to feel even a little bit better about a horrible life. I want them to build a life they don't need to escape from.

I want to help patients build what psychologist Marsha Linehan calls “a life worth living”. This is much harder work. It can mean changing relationships, changing jobs or careers, changing your narratives and attitudes about things, questioning things you take for granted. This shit is hard work.

And ugh, it's so tempting to say, “Have you considered doing yoga at sunset?” It's much easier to do yoga when the sun goes down than to reexamine the pillars of your life and risk changing things in a really big way. But it's escapist, not durable.

The things we call self-care are often integrated into a full and

exciting. You may feel strong when you do yoga and relaxed when you take a bubble bath. (I do both, and feel great!) But the fundamental change here is not to sprinkle a few moments of restoration into an unsustainable life; It is examining what works and what does not work in that life.

Jennie Steinberg, LMFT, LPCC, PMH-C

Licensed Marriage and Family Therapist, Licensed Professional Clinical Counselor, Certified Perinatal Mental Health Professional, Certified Daring Way Facilitator