Self-care: A concept analysis

Objectives

There is extensive literature from various disciplines on self-care, an important aspect of nursing intervention via evaluation and education, but its meaning remains unprecise due to the difficulty integrating the diverse definitions developed over time across disciplines. Therefore, it is vital to clarify the meaning of self-care and formulate the defining attributes, antecedents, and consequences to self-care.

Methods

Walker and Avant’s concept analysis approach was used to analyze the concept of self-care. A search of the literature was completed using the databases CINAHL, PubMed, and EBSCOhost for years 1975–2020; literature search included peer-review articles, full-text publications, and available in English. A total of 31 articles were reviewed, and saturation was reached.

Results

An extensive review of the literature revealed salient characteristics that reflected the most frequently used terms associated with the concept. Guided by Walker and Avant’s method, three defining attributes emerged as common themes: awareness, self-control, and self-reliance.

Conclusions

A clarified definition was identified: the ability to care for oneself through awareness, self-control, and self-reliance in order to achieve, maintain, or promote optimal health and well-being.

Common Factors: What Are They and What Do They Mean for Humanistic Psychology?

Although common factors have been widely discussed in the clinical literature, the two questions addressed in this article remain relevant: (a) What are the common factors? (b) What do they mean for humanistic psychology? The first question is important because there is no “definitive list” of common factors, and lists presented in the literature often differ dramatically. In response to this question, the article suggests that an evidence-based list of nine common factors by Wampold provides a useful and credible list. The second question is also important, particularly to humanistic psychologists. Among other answers, the article shows that research findings on common factors provide scientific support for humanistic psychology’s emphasis on the importance of the human and relational factors in psychotherapy.

Non-Violent Empowerment: Self-Help Group for Male Batterers on Recovery

This research focused on a new and unique therapy group for male batterers who were violent toward their intimate partners. The group is based on a small self-help group model, where a professional accompanies the group and serves as the facilitator of the process undergone by the group without interfering with the management of the group and its meetings. A total of seven group members were interviewed in a qualitative and phenomenological-interpretive research, which combined an outside observation by two authors with an inside observation by a professional who facilitated the group. The study focused on the method of empowerment of the group members, and it found three central themes: self-efficacy, group efficacy, and social efficacy. The research findings are explained from the new perspective of positive criminology.

A Time-Sensitive Existential Method for Assisting Adults in Transition

Principles of time-limited psychotherapy can be compatible with an existential approach to assisting adults in transition. This is supported by presentation of a method derived from analysis of an interview with a client who had completed a series of existentially focused therapy sessions. The transcript was analyzed using concepts, such as temporality and authenticity, from Heidegger's Being and Time. The resulting method is presented as five thematic phases, involving intermittent sessions interspersed with ample time for clients' independent reading and self-reflection. The description of the phases, which includes concepts employed and suggestions for therapeutic intervention and readings, is organized around illustrative excerpts taken from the interview.

Emancipatory Therapeutic Practice in a Turbulent Transmodern Era:A Work of Retrieval

Within the community of psychotherapists, there has always existed philosophical and methodological tension between objectivists who follow a medical model, romantics who favor humanistic approaches, and social constructivists who take a more sociopolitical path. The current health care crisis is forcing practitioners to take sides, is threatening to unravel this always uneasy coherence among psychotherapists, and is forcing practitioners to revisit questions of epistemology, ethics, and practice. The author argues that as medical insurance funds dwindle and the assessment of "medical necessity" comes increasingly to be defined according to strict patterns of specific "symptoms," and as insurance-allowable treatment becomes restricted to short-term, emergency care or medication-based treatment, humanistic psychologists should restate their commitment to a psychology that approaches the struggles and promises of human life in human terms and should refocus their efforts on quality of life, spiritual, and emancipatory concerns.

What is a good life?

How should we understand the nature of reality?

What is happiness?

What is the nature and meaning of consciousness?

How do relationships, families, and communities thrive?

How should goods and privileges be distributed among people?

What should guide ethical human conduct?

What is our relationship to and responsibility for the natural world?

How can we face pain, loss, and death without losing hope or the will to transcend suffering?

The Healing Word: Its Past, Present, and Future

After presenting a brief review of the history of helping people solely by language (listening and speaking), the author reemphasizes the intrinsically verbal, noncoercive nature of the cure of souls (and of psychoanalysis as a model of psychotherapy); the intrinsically non-verbal, voluntary nature of the cure of bodies (medical treatment); and the intrinsically physical-and-verbal, coercive nature of the cure of minds (psychiatric treatment). Commingling and confusing these distinct enterprises and the accompanying emphasis on diagnosis and treatment have destroyed the cultural and legal conditions required for the practice of purely verbal, noncoercive helping (psychotherapy).

Psychoanalysis is, in toto, a language art, a language praxis. There can be neither mute patients nor deaf analysts. Psychoanalysis is as immediate to word and syntax as mining is to the earth.

(Steiner, 1989, p. 107)

How Using the Dsm Causes Damage: A Client’s Report

This case study illustrates the potential for the application of Diagnostic and Statistical Manual of Mental Disorders ( DSM) diagnoses to exacerbate clients’ symptoms and inhibit the healing process in psychotherapy. Passages are excerpted from therapy sessions to demonstrate that the multiple diagnoses imposed on “Steve” coalesced into his core construct of himself as “crazy.” When his diagnoses became internalized as a construct, his world became viewed through a lens that believed itself to be defective. The use of diagnoses may also have negative consequences for the process of psychotherapy. Alternatives to traditional DSM diagnoses are reviewed. It is proposed that diagnoses should be tentative and rejected if they reify negative self-concepts and do not promote change in clients.

From Self-Help to Professional Care

The process of an enhanced application of the spiritual self-help 12-step program of Alcoholics Anonymous in a professional counseling approach is described. Two integrated enhancements are outlined. The first is the enhancement of the addressed problem as applied by several 12-step self-help groups. Assuming a three-dimensional view of human existence—physical, mental and spiritual—it is argued that a more far-reaching program is obtained when the problem is defined as originating primarily in the mental dimension, but the most inclusive 12-step program may be defined by emphasizing the problem’s definition as originating in the spiritual dimension. Second is the program’s expansion from self-help to professional practice. Although in the past this trend derived mainly from the addiction-treatment field, it is argued that professionals can practice a more inclusive 12-step program called Grace Therapy. Basic assumptions of this program as reflecting a theory of applied spirituality are outlined and supported by clinical illustrations.

The Immovable Object Versus the Irresistible Force: Problems and Opportunities for Humanistic Psychology

The immovable force of an increasingly reductionistic approach to understanding and treating psychological life and the irresistible force of people searching desperately for solutions to struggles that allow for meaning, purpose, and richness in life create serious challenges and great opportunities for humanistic psychology. Humanistic psychology, if it can grasp these opportunities, has the chance to transform the field of psychology. To do so, humanistic psychology will have to deal adequately with three major manifestations of this reductionistic approach to psychology: the DSM as the means for understanding human distress, manualized treatments as the only scientifically based treatments of distress, and randomized controlled trials as the best way of determining treatment effectiveness. This article, after describing each of these reductionistic challenges, briefly reviews the current state of the humanistic response and concludes with a template that, if followed, offers us the chance to create a science that is both intellectually rigorous and experientially rich.

Reflexivity and Personcentered Counseling

This article is organized around the claim that reflexivity, defined asself-awareness and agency within that self-awareness, isfundamental to being a self. Carl Rogers’s concept of the person is examined inthe light of this claim. It is argued that his notion of the person hasmore to do with ethics than ontology and that his lack of distinctionbetween self and self-concept obscures agency, his tacit recognitionof it in his practice of counseling notwithstanding. HarryFrankfurt’s and Charles Taylor’s writings are drawn on to support this. Itis suggested that the humanistic prizing of the dignity of the client,making up the ethic of person-centered counseling, is both protectedand enhanced once the approach is revised in the light of reflexivity.Implications of this revision for the durability of person-centeredcounseling in a climate of increasing endorsement of manualized,technical approaches to counseling and psychotherapy arediscussed.

Person-centered therapy and solution-focused brief therapy: An integration of present and future awareness

The authors propose an integration of person-centered therapy, with its focus on the here and now of client awareness of self, and solution-focused therapy, with its future-oriented techniques that also raise awareness of client potentials. Although the two theories hold different assumptions regarding the therapist's role in facilitating client change, it is suggested that solution-focused techniques are often compatible for use within a person-centered approach. Further, solution-focused activities may facilitate the journey of becoming self-aware within the person-centered tradition. This article reviews the two theories, clarifying the similarities and differences. To illustrate the potential integration of the approaches, several types of solution-focused strategies are offered through a clinical example. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

What's therapeutic about the therapeutic relationship? A hypothesis for practice informed by Perceptual Control Theory

Evidence clearly suggests that the therapeutic relationship is important to successful outcomes in psychotherapy. It is less clear as to why this might be the case. Throughout the literature, various factors such as warmth, empathy, compassion, unconditional positive regard, and openness are identified as key. The way in which factors such as warmth and empathy bring about an amelioration of psychological distress, however, is not entirely obvious. We suggest that one possible mechanism through which these factors become important is by helping to create an environment where clients can examine their problems freely. Furthermore, we propose that when the therapeutic relationship is therapeutic, clients feel comfortable to consider whatever comes into their mind; with any filtering or evaluating happening after the ideas have been expressed, and not before. Psychological processes identified as maintaining psychological distress (e.g. thought suppression, avoidance, rumination) block this capacity. Our suggestion is that as internal experiences are being examined, the client has an opportunity to become aware of facets of the problem that were previously unattended to; and to continue this process outside therapy. Through this awareness-raising process the client's problem can be reorganized via intrinsic learning processes to achieve a more contented state of mind.

The active client: The boundary-spanning roles of internal consultants as gatekeepers, brokers and partners of their external counterparts

This article examines the active client of management consultancy as a key agent in managing and mediating knowledge flows across organizational boundaries. From a qualitative study of a particular case of active clients—internal consultants managing their external counterparts—three boundary-spanning roles are identified. Active clients can act as a gatekeeper, broker and partner with respect to both consultants and the knowledge they bring. These roles are shown to vary according to a client’s expertise, formal project responsibilities and personal reputation, as well as the different phases of consulting projects. They not only elucidate an otherwise neglected or static dimension of management consultancy—client activity—but highlight the dynamic and essentially political character of serving as knowledge barriers and/or bridges in the intermediation and co-production of management knowledge across organizational boundaries.

Can a control model approach assist case formulation in psychotherapy?

This paper looks at issues regarding case formulation in psychotherapy. Case formulation is well recognized as being helpful in the conceptualizing of psychological problems and as a useful tool in the practice of cognitive therapy. Control, as opposed to behaviour, is increasingly being seen as that human process most relevant to psychopathology. We look at the diagnosis and treatment of a small number of people, treated in a naturalistic setting, who were selected without any specific criteria other than being people whose problems were treated using the Method of Levels, a form of cognitive therapy based on the principles of Perceptual Control Theory, and who completed both pre- and post-treatment questionnaires. We then consider how the problems these people presented with, and their treatment, might be formulated as a result of taking this approach.

A pesquisa intervenção em psicologia da educação e clínica: pesquisa e prática psicológica

Este estudo integra reflexões acerca do ato de pesquisar a partir dos trabalhos de pesquisa e supervisão de estágios realizados por duas docentes vinculadas a programas de pós graduação stricto sensu em Psicologia Clínica e Psicologia da Educação. Após breve consideração acerca do método qualitativo aplicado ao campo da Psicologia, o ponto de vista aqui desenvolvido considera que toda a investigação psicológica implica sempre uma intervenção, na qual tanto participante como pesquisador são afetados pela situação de pesquisa. Pesquisas que acompanham a implementação de práticas educativas e clínicas em instituições educacionais e de saúde têm sempre um caráter de intervenção e desencadeiam um processo de criação e adequação de uma metodologia de pesquisa apropriada aos fenômenos estudados em seus contextos naturais, respeitados o rigor dos procedimentos, o compromisso de construção do conhecimento científico, a ética da prática profissional e a responsabilidade social de oferecimento de serviços de qualidade para a população. Acrescentam-se exemplos de estudos levados a efeito por ambas as autoras.