Care/of Conversation: Working in Mental Health Care

By Sym Kehr, May 2021

Sym Kehr, Care Syllabus intern and MCLA Class of ‘21, sat down with Heidi Riello, Counseling Services Director at MCLA, in March 2021. Kehr and Riello discussed definitions of self care, setting boundaries when caring for others, the costs and potentials of working in mental health care. The following transcript has been edited and condensed for clarity.

Sym Kehr (SK): Why did you choose to get into counseling services?

Heidi Riello (HR): As an undergrad, I majored in psychology and I suppose probably since middle school, I knew I wanted to go into counseling in response to my own personal experiences and things that happened to me during that time. My second-year internship when I was in graduate school, getting my master's degree in social work was at the Framingham State College Counseling Center and I had a really positive experience there. And it wasn't an area that I had ever considered or really had an awareness of. hat's where my interest specific to college counseling came from.

SK: How would you define self-care in relation to mental health? 

HR: For me, self-care is really getting back to basics and just focusing one's attention on the really most basic things that we should be doing on a day to day basis to take care of ourselves. I imagine almost like Maslow's hierarchy of needs and at the bottom of that are ones related to safety and security. And I imagine focusing on those more bottom level needs before we can really progress to some of the higher level needs that we might have. For me, self-care is, getting adequate sleep, making sure you are eating in a healthy, well-balanced way, making sure you're getting sufficient physical activity, getting back to thinking of the hierarchy and some of the more foundational needs. It's hard to really evolve any further than that when you're just focusing on what you need to survive on a day to day basis. So, yeah, physical activity, food, sleep, making time to do things that you enjoy. it's harder to move up the self-actualization ladder when you're constantly in this more basic level of tending to your basic health care needs. It's not going to be a realistic expectation to be improving your depressed mood or managing your higher levels of anxiety when you're not tending to self-care needs such as sleep or eating or physical activity.

SK: What is your role as a mental health professional’s role who works with students, in terms of care?

HR: I see a big part of what we do in counseling services as mental health professionals is providing students with what we call psychoeducation. Educating students as to some of the self-care strategies I was just mentioning. What does it mean to get adequate sleep? OK, well, for me that means, you should probably be getting seven to eight hours of sleep a night. So providing that kind of psychoeducation for students like, well, “I don't know what a healthy, well-balanced diet looks like,” trying to provide some information about what that means and what that can perhaps look like in their life. Really identifying some small, achievable goals that students can begin to set for themselves consistent with self-care strategies. And then again, seeing our role as a person the student can then kind of report back to on progress towards those goals.

SK: As a mental health professional, how do you maintain healthy boundaries around the struggles that your patients are experiencing and which you are invested in helping them through?

HR: It's a challenge. I would say it was more challenging earlier in my career. I definitely think that it's a skill that needs to be developed and honed over time. Just like anything professionally. When the workday is over, resisting checking my emails and resisting checking my voicemail and all that kind of stuff, so really in an intentional way, maintaining my work life to the hours in which I work and then my personal life is the rest of the time. It's been very challenging obviously, during this pandemic. I'm at home with my 10-year-old and I have been since March 2020, and there are no physical boundaries between my work and personal space. So, I've had to be that much more intentional about time like -- ‘Okay, it's 4:30, I'm done and now I need to transition into my personal life without actually leaving a building and getting in my car and driving home’ -- because it's all just in one space at this point.

SK: What are some ways that people can help themselves if they're low mental health, specifically focusing on anxiety or depression? 

HR: I do sometimes talk to students about having a toolbox and kind of creating a number of tools that they can put in a toolbox. What works for one person isn't necessarily going to work for another person. I like to throw a number of tools at somebody that they can at least have and then they can take what they like and they can leave behind what they don't like. 

The first strategy I always talk to students about when it comes to managing anxiety is developing the ability to really breathe properly. When we're anxious, we're experiencing a stress response. So all the physiological systems get amped up and our heart races and we start to sweat. And it's really hard to do anything else until you've countered that stress response with a relaxation response rate and the best way to achieve the relaxation response is to kind of engage in some deep breathing. So many of us don't really know how to breathe properly. I'll talk to students about mindful meditation as a way to manage your anxiety. I'll introduce yoga as a way to manage anxiety. I might send students some YouTube videos from yoga instructors that I really kind of like. If it's somebody who's struggling with maybe PTSD, I'll be more specific with trauma informed yoga. There's yoga for sleep. I mean, again, self-care, physical activity, healthy eating, because there are studies that show all those things directly affect our moods. So, to make sure you're checking all of those boxes, I feel like those are usually the main tools. 

I also like to tend towards a cognitive behavioral therapy approach.  I'll introduce CBT tools, like cognitive restructuring exercises as a way to manage anxiety. Focusing on your cognition, your thoughts, and how can we sort of explore them. Usually when we're anxious, our thoughts are irrational. And so, it's usually like, well, what's the evidence that supports what you're thinking? What's the evidence that disputes what you're thinking? What's the worst thing that's going to happen if what you're thinking is true and then walking students through cognitive restructuring exercises so that you can get to a more realistic counter statement by the end of that exercise.

SK: Is there a personal cost to providing care?

HR: Burnout is real, I mean, there is certainly an emotional cost, which for me highlights the importance of mental health care providers modeling that self-care for their clients, for their students, really showing the importance of it. Because if we're not tending to our own care, the potential for burnout is there because it's exhausting. It can be emotionally exhausting to be the person who's holding all the feelings and traumas and experiences of other people.

During the pandemic, that has been particularly difficult. The primary way I have for the last 20 years, is accessing my support team, the people with whom I work in counseling services, talking to them, talking about how we feel, talking about the toll that sometimes the work takes on us and having those supportive listeners and those reciprocal relationships. I think that's probably one of the most important things for me. I'm really lucky that right now we have a really close, supportive, strong, competent team. And we're all really there for each other as best we can be. This past year has been particularly challenging because we haven't been able to be in person with everybody else. And you start to feel a little isolated and alienated.

SK: When is it better to care less-- either from a mental health professional standpoint or even just from a personal standpoint? When is it better to take a step back and not put so much care into an aspect of your life or work?

HR: One of the things that we often say in counseling services is it's important for us as the clinicians to not work harder than the students. If we're finding that we're really working really hard to support this student or to provide them with resources or suggestions or whatever it might be and not really feeling like the student is putting the same effort in, then it's time for us to take a step back and say, wait a minute, I'm working way harder. It's a two-way relationship. And just like any relationship, it doesn't feel good to be working harder than the other person. Always be reflecting on the therapeutic relationship. Is the effort reciprocal? Does it match or does it feel like I'm working really hard here? If there is an imbalance, I'm going to stop doing that, and see if that makes a healthy change within the relationship.