Combating Caregiver Burnout With Self Care: The Toolkit

In this essay, I shared how my lack of boundaries and self care habits contributed to my own season of professional burn out. It took me almost a full year to recover from that time in my life, and it wasn’t pretty.

I wish someone had told me that sometimes, we need to give ourselves permission to take a break, in order to prevent the breakdown.

I feel fortunate to have had the luxury of a lengthy sabbatical and want to share what I learned during that time so you can stop the runaway train, if you’re headed off the rails yourself.

Recognize it

Caregiver burnout can be characterized as physical, mental and emotional exhaustion and can manifest with any number of symptoms: an unrelenting feeling of being stressed out/overwhelmed, fatigue, depression, anxiety, etc. The signs may include changes in appetite (eating more or noticeably less), changes in sleep patterns (sleeping more or less, including a broken sleep pattern), headaches or digestive problems including constipation or diarrhea.

Compassion fatigue, often a complementary condition, is the indifference to the needs of others, due to the overwhelming exposure. Francoise Matthieu says it’s “…the gradual erosion of all the things that keep us connected to others in our caregiver role: our empathy, our hope, and of course our compassion — not only for others, but also for ourselves.”

It’s being chronically cared out. It’s the acquired apathy that breeds inaction.

If you experience this, it’s not because you’re a bad person.

It’s because you’re a good person that gives and gives and gives. You’ve either been ill-equipped or unpracticed at creating and enforcing boundaries and habits that will keep you going, and the good news is that that’s absolutely within your power to change.

What is self care?

It’s the combination of habits and practices that keep you feeling present, energized, engaged and physically able to do all the things you want to do. Psychology Today defines it as “…a continuous process of proactively considering and tending to your needs and maintaining your wellness. This ongoing process can be tricky.”

Why is it tricky?

Well, for me, my own care is the first thing I de-prioritize when I start to get overwhelmed. As an ENFP and an Enneagram 7, you could say I’m sort of a bleeding heart creative. I love new ideas, making things, and helping people. I get excited about everything and feel all the things deeply. I love that about me, and when I’m in a healthy place, I am full of energy to pour into the things I want to do. But, I’ve also let it go to an unhealthy place. I overcommit and over-schedule and let my obligations gobble up my self-care time.

I say yes, when it’s in my best interest to say no.

It’s tricky because it requires the self-awareness to be able to honestly assess the level of integration and balance in our lives between the activities that fill us up and the ones that leave us feeling empty. It requires being open when we receive feedback that suggests we may be out of balance when denial and hustle may feel more familiar.

It’s tricky because self care insists you keep your innate value in mind — not just for what you can do, but that you are — and continually practice the things that have you experiencing renewal when putting others’ needs first may be more comfortable for you.

Self care is not a one and done. It demands more than responding to feelings of stress or overwhelm and exhaustion, but also building resilience against them through consistent self care practices.

Now.

If you’re a mom (like me), and you are telling yourself that you have no free time because you’re busy coaching and volunteering and car pooling and managing homework and schedules, and that’s why you have no time for self care? …That you’re being altruistic and selfless? …That that’s what you should do? Oh, I get it, but I need to tell you a hard thing. Come sit by me, Mama, and lemme pour you a warm up. (We both know that coffee got cold while you were doing all the things.) Here it is: you’re misinformed.

What you think is selfless, is actually selfish.

If you’re a caregiver or clinician, and you are telling yourself that you have no time for self-care because you’re busy satisfying your patients’, clients’ or loved one’s more urgent and important needs, there’s room for you, too, at this table.

Why does self care matter?

Very simply, you can’t give what you don’t have.

When we are worn down and burned out, we’re short with people. We become cynical. We forget agreements and commitments. We break promises. We don’t aren’t present with individuals or singular tasks, because our brains are distracted by the seventy other things it’s working on. We make critical, clinical errors. No matter how we justify it, none of that feels very caring.

You can’t loan me a dollar if you don’t have a dollar, and you can’t take care of me if you’re not taking care of yourself.

Francoise Mathiew quotes Naomi Rachel Remen in The Compassion Fatigue Workbook:

The expectation that we an be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. This sort of denial is no small matter. The way we deal with loss shapes our capacity to be present to life more than anything else. The way we protect ourselves from loss may be the way in which we distance ourselves from life. We burn out not because we don’t care because we don’t grieve. We burn out because we’ve allowed our hearts to become so filled with loss that we have no room left to care.

In “The Body Keeps The Score,” Dr. Bessel Van Der Kolk talks about the science of interpersonal neurology. “You can’t pour from an empty vessel” sounds axiomatic, but science backs it up. We are who we are, for better or worse, because of our relationships, starting with the one we have with ourselves. Self care literally change our brains to be more resilient against the more draining elements of consistently providing care.

So, what can we do? What does self care look like?

First, start with compassion.

The idea of compassion can be amorphous, but Melissa Miller, PhD, a therapist in Amherst, Massachusetts explained, “Self-compassion has three main parts: being kind to ourselves, like we might be to a friend or loved one; recognizing the reality of our ‘common humanity’ or shared experience; and being aware of our current experience/emotion without judging it.”

We gotta start somewhere, so start with cutting yourself some slack.

Next, rest.

When I was honest and gentle enough with myself to admit I had let my scale get way out of balance, I realized I needed to rest in order to get clarity on next steps. I was so exhausted, I didn’t even know what would bring me renewal, and I was so apathetic, I wasn’t curious about or interested in anything anymore.

When I think of rest, I think of a nap first. I’m the type of person who can fall asleep anywhere. Where it was once a sign of exhaustion, now I consider it a sign that my brain and body are conditioned to rest. Naps are great, and sleep is a HUGE part of self care, but there’s more to it than that:

Rest starts with giving yourself permission to say no.

Sometimes, we find ourselves overcommitted, and rest is permission to responsibly step away from a commitment for a season or forever. Delegate the task or project. Step off that board or committee. Take a break from that league.

Is your PTO asking for volunteers for something you don’t really have time to do? Is your loved one saying they prefer you to run errands and clean for them rather than the professional caregiver you’ve hired to lighten your load? Say, “No,” and give yourself permission to let no be the full answer, devoid of any defense or justification. If you feel like explaining or offering context — ok, but no is enough.

Sometimes, we find ourselves worn down by the daily responsibilities of caring for a loved one. Rest can be sending the kids to a grandparents’ for a weekend, or getting a sitter for a date night, or using a drop-in daycare to get your hair done or a pedicure. Sometimes, it means setting up professional caregiving or home health. Sometimes it means arranging for respite care at a nursing home to get a reprieve from your care responsibilities or facilitating a move-in to an assisted living or skilled nursing facility.

Have you been on all day? Have you led a series of meetings at work, made dinner, gotten two kids from school, to soccer practice, showered, to bed and you can see the laundry needs to be folded and put away, the dishwasher needs to be unloaded so you can load it again, but you think a little Candy Crush would be really good right about now?

Give yourself permission to be unproductive. Be mindful enough to recognize when it becomes a numbing mechanism or escapism, but pockets of non-productivity can be exactly the break you need.

If you’ve parented or spent any time with a toddler, you’ve seen someone with full ownership of no. Practice that level of agency over your “no.”

No can sound like:

• “I can’t commit to that right now.”
• “I don’t care to participate in that.”
• “I’m not interested in that at this time.”
• “That’s not really my speed/style.”
• “I’m not into that.”
• “There’s no room on my plate for that right now.”
• “I’d rather be alone right now.”
• “I’d rather do XYZ.”

Saying no is your first line of defense in combating caregiver burn out, and it doesn’t make you rude. It’s the gateway to rest, and the cornerstone of any other self-care practice.

Then, take inventory.

During my sabbatical, I went to visit my sister in Florida. I traveled alone, and with a reprieve from the demands of work and family, I felt rejuvenated. I bought myself a new journal at a Barnes & Noble and while enjoying a chai latte, I got comfy and jotted down some things I wanted to accomplish. I started feeling overwhelmed, so I broke my action areas into the following categories:

• Physical
• Mental
• Emotional/social
• Spiritual/purpose

I realized quickly, that without creating new habits by daily self care practice, I was never going to get traction on my goals. I was too busy reacting to the next need or ask.

The action steps I took toward my goals became my self care practices.

Finally, practice.

It’s called a self care practice for a reason.

Like a baby learning to take its first steps, we all stumble and fall. Sometimes we hit the ground hard, and sometimes we have a soft landing. We don’t scold babies when they fall — we make sure they’re okay, give them a dose of lovin’, and set them off in the right direction again. No matter our age or the new skill we’re learning, we deserve the same compassion.

Self care is not one size fits all; this is just very specifically what worked for me. Knowing I would stumble and fall, here is what I set out to accomplish.

Physical Self Care

I needed to not be in so much physical pain.

I started working with a nutritionist who put me on an elimination diet to help me identify dietary sensitivities and reduce systemic inflammation. I practiced this daily by using her “Mood, Food, Poop” journal and logging what I was eating.

I also wanted to increase my strength and regain my flexibility. I started going to yoga in addition to Zumba and started training with my yogi. We trained once a week via FaceTime, and I used an app to record two additional work outs per week that tracked my heart rate, time spent, and calories burned. I used a smart scale to send him my progress in terms of weight, but also BMI and percentage of water.

I started weekly meal planning using the Todoist app and using a grocery delivery service, because I HATE grocery shopping and wanted to use my time other ways.

I went back to getting monthly massages and chiropractic adjustments to address my weak SI joint and pain in my low back.

Realizing I hadn’t been to see my doctors for a check up in over a year, I scheduled check ups with my PCP, my gyno, my optometrist, and my dermatologist.

These were all radical self-care practices considering I had been working non-stop, driving (ergo sitting) between appointments and drive through because it was convenient.

I also treated myself to regular wax appointments, occasional mani/pedis, and long, hot bubble baths. Why? Because it has me feeling good about and in my physical body. Without other physical practices in place, though, a bath or a manicure was never going to be enough to fill me up when I felt so depleted.

Mental Self Care

I first heard about “monkey mind” in Elizabeth Gilbert’s book, “Eat, Pray, Love.” You know how you try and clear your mind to relax as you fall asleep, and that’s precisely when your brain reminds you of every thing you didn’t do today and have to do tomorrow? That’s monkey mind. Toss in a little anxiety, and I start replaying conversations and thinking through what I should have said or done or worrying about conversations I need to have tomorrow. It’s… not awesome.

To quiet the monkey mind and address the anxiety, I started practicing mediation using the Headspace app nightly. One of my sons has ADHD, and the other has anxiety. I shared the app with both of them, and now we all use it to care for ourselves as part of our nighttime routine.

I realized I needed to have outlets for my creativity, so I started using time blocking to earmark creative time. I sang, I refinished furniture, I wrote. Time blocking allowed me to make room for the things that filled me up a couple times a week, and knowing that time was set aside quieted my anxiety.

I also Konmari’d the hell out of my house. I organized/purged clothes, toys, paper and digital files until I could put my finger on everything at a moment’s notice. It cleared up SO much mental bandwidth.

Emotional/Social Self Care

I had allowed my work schedule to gobble up my social life and contributed to the disintegration of my marriage.

I made a list of friends I missed and made room to catch up over dinner with one person a month. It felt goooooood to see them, but also to be vulnerable with people that loved me about what my life actually looked like in that season. It created a support network I had taken for granted, and I recommitted to nurturing those transparent, accountable relationships in my life on a regular basis.

I signed up for a class to get tools and support around making resolutions in my marriage. I decided to end our spousal relationship, but was able to do so with integrity and compassion and create an amazing co-parent relationship with my ex-husband.

Spiritual/Purpose Self Care

I’m not sure where I am on religion these days, but I believe in purpose and vocation. I know living in alignment with those values feels really good to me.

I let burnout rob me of the joy I felt in the connection between my calling and my work, which — by extension — had me neglecting my spiritual needs. Resting gave me the energy to once again look at how I wanted to satisfy what I believe my purpose to be. I hired a coach with whom I meet weekly to outline and review my professional goals. Self care is supporting me in building a business.

Many people find upholding a faith tradition, attending services and being part of a faith community an essential part of their week while others satisfy a need for purpose by volunteering.

When practicing self care, I don’t check all the boxes every day. Every task doesn’t get accomplished every week, but I use a good mixture of compassion, accountability, and support to keep me on track.

Whether you provide care within your family for someone older or younger than you or are a professional caregiver, nurse or social worker, a robust self care program is essential to maintaining your vitality in this role.

Your family matters.

Your work matters.

You matter most of all.