The 6 Domains of Self-Care

As clinicians we go on and on about how important self-care is, yet I’d argue this topic is not necessarily well-understood. Let’s unpack the self-care issue. What exactly is it? How do you know whether you’re doing it? What does the science add to this discussion?

Let’s take a deep dive into self-care.

What is self-care?

Interestingly, even though we refer to self-care both academically and casually, it’s not been easy to define. Godfrey and colleagues (2011) reviewed the literature, and found self-care was defined 139 different ways, with little progress since on establishing a universally accepted definition (Matarese et al., 2018; Riegel et al. 2021).

I like the definition offered by Posluns & Gall (2020), who define self-care as “attending to one’s own holistic well-being”.

Another definition, which gives it action-orientation, is “refilling and refueling oneself in healthy ways” (Gentry, 2002, p.48). Doing this may involve increasing behaviours which maintain and advance well-being (Myers et al., 2012, p. 56), as well as adjusting behaviour to lessen stress or anxiety. Essentially, this means turning up the engagement with health-oriented behaviour, and turning down engagement with health-draining behaviour (Williams et al., 2010, p. 322).

Self-care involves tending to and nurturing one’s well-being, a skill referred to as self-stewardship (Hossain & Clatty, 2021). I like the concept of us embracing our roles as self-stewards.

Benefits of self-care observed in the scientific literature include improved well-being, lower morbidity, lower mortality, and lower healthcare costs (Riegel et al., 2021).

Posluns & Gall (2020) conducted a literature review on self-care in mental health professionals and found it was essentially comprised of six domains: awareness, balance, flexibility, physical health, social support, and spirituality. In this piece, I’ll expand on these core domains to pave a path for you toward assessment, evaluation, and planning action for self-care.

1.Awareness

Awareness in this context involves noticing our experiences both internally and externally, as well as the reflection needed to decide how to respond to these experiences, with an emphasis on attending to one’s needs (Skovholt et al., 2001; Wityk, 2003; Posluns & Gall, 2020).

Noticing is a cultivated skill, one not necessarily well taught in our various rearing environments. It involves aspects of mindfulness, that is, “paying attention, on purpose, in the present-moment, non-judgementally” (Kabat-Zin, n.d.). Reflection is used to form an understanding of what has been noticed, or what may be needed to best utilize this skill.

Noticing skills can be learned through mindful awareness, the most accessible form of which include audio or video- guided mindfulness meditations on various platforms like YouTube, Calm, or Headspace (Hossain & Clatty, 2021).

Once you get a taste for what mindful awareness involves, you can practice it just about anywhere or anytime, such as taking a moment to notice the breath (mindful breathing; Hossain & Clatty, 2021), mindfully eating a taco (yes, I have done this- highly recommended), or having a mindful shower. Building present-moment awareness has extensive benefits which extend beyond the topic at hand though are highly evidenced in the literature.

Reflection is a skill often cultivated through questioning, evaluation, ponderance, and writing. Noticing can help us to identify our individual needs, while reflection can help us to identify what may be needed in responding to them, as well as our ability to address noted discrepancies.

2.Balance

Balance in self-care refers to being satisfied with important domains of functioning with little or no negative effects on other domains (Sirgy and Wu, 2009, p. 185; Posluns & Gall, 2020).

This requires awareness and evaluation, followed by the ability to take action on noted inequities.

Balance may involve attending to work versus leisure time, to scholarly pursuit versus creativity, to time spent with family or with friends, or to energy and time poured into self versus to others.

The right balance may be highly individualistic, but there are some things we generally know about striving for balance. For example, leisure time is considered a primary aspect of self-care, as is maintaining good boundaries, taking breaks, and setting realistic goals (Grafanaki et al., 2005; Nurit & Michal, 2003; Patsiopoulos & Buchanan, 2011; Posluns & Gall, 2020).

Think to yourself, are any areas of your life suffering and in need of enrichment or attention? If so, which ones? What are you possibly pouring too much of yourself into that could use some redistribution to other areas? Problem-solve the answers. Turn to SMART goals for a sense of how to realistically create more balance in your life.

3.Flexibility

The skill of flexibility involves the effective use of coping skills alongside an openness to learn and grow from difficult circumstances (Kashdan, 2010; Posluns & Gall, 2020). This skill represents a dynamic process which calls for different responses at different times, necessitating the use of ongoing reflection and evaluation of unfolding events, alongside commitment to consider different perspective and multiple potential responses to events. Responding to events flexibly calls for responses which tend to be adaptive, open to unexpected change, and generally compassionate.

Skills which increase flexibility include mindful awareness in a space of non-judgement towards experiences, acceptance and tolerance of difficult experiences, mindful responding to difficult circumstances, and choosing actions which prioritize core values.

As may be clear by now, flexibility is a complex skill derived from multiple areas of functioning, however increasing flexibility is associated with enhanced wellness and coping, and thus contributes greatly to self-care.

4.Physical Health

Perhaps unexpectedly, physical health is primarily defined by important factors relating to sleep, activity, and diet (Harrison & Westwood, 2009).

How stress is managed significantly influences sleep, which then influences stress after poor sleep (Åkerstedt et al. 2007). Due to this compounding issue, managing stress more effectively is a self-care action with manifold benefits.

I’m going to assume the reader has a fair understanding of the primary factors contributing to physical health (sleep, activity, & diet). So, when it comes to this topic, it can be helpful to note the well-studied barriers to healthy habit formation, which include attachment to unhealthy behaviours, lack of motivation to enact change behaviours, difficulty maintaining healthy behaviour, interactions of life events on behaviour, and difficulty integrating self-care across comorbid conditions (Riegel et al., 2021).

The literature recommends we target these barriers by providing knowledge about the influence of habits and goals on behaviour. Goals influence habits by motivating action towards behaviour change, and then, once habits begin to form, contextual (circumstantial) cues begin to automatically activate the new habit (Riegel et al., 2021). So, it may be helpful to remind ourselves that habit formation only requires intentional goal-oriented behaviour for a limited amount of time before habit takes over.

I like the idea of setting an intention of doing the best you can for your health today. This allows behaviour change to be flexible enough to accommodate unforeseen or challenging obstacles, but firm enough to reflect a commitment to restorative and preventative health. As the steward of your own health, what can you do to care for yourself in diet, activity, and sleep today?

5.Social Support

The concept of social support refers to the benefits derived through connection to others with some form of meaningful engagement, which allows us to alleviate the burden of stressors (Posluns & Gall, 2020).

We can gain social support from personal, professional, or structural relationships or interactions depending on both the support that is needed, as well as the support which is offered. To highlight a few examples, we may benefit from emotional support from a friend with a supportive ear, assistance with daily living tasks from a partner or family member, professional support or guidance from a colleague or supervisor, or health support from a trusted health care provider.

As you can see, social support is widely varied, but it is ultimately an aspect of self-care in which we reach outside our selves to meet some of our needs, and is a major protective factor for well-being.

Our ability to engage social support relies on a number of factors, some of which include our ability to recognize need within ourselves, our ability to communicate that to others, as well as many factors relating to the ability to gain access to supports.

The factors within our ability to action allow personal work such as increasing self-awareness and communication skills to become actions of self-care. Other actions, such as reducing social or geographical isolation, may also facilitate access to increased social support.

Clearly, not all factors relating to social support are within our control, but it can help to remember that, of those factors which are, we hold the power to make decisions in our own best interest for our well-being. Depending on the situation, this may look like opening up, making new connections, asking for help, restoring lost connections, relating to others in boundaried ways which feel safe to us, or even taking small risks we feel comfortable enough to take.

Ask yourself, are there any ways I could enhance my social support at present? How can I approach this to increase my self-care?

6.Spirituality

Much like self-care looks different across individuals, so does spirituality. The definition then becomes highly personal.

What is it that you hold sacred, which brings you meaning, and defines a sense of purpose in your life?

Spirituality involves personal beliefs about self and others, and “the divine” (Posluns & Gall, 2020), which provide a sense of organization to our experiences, fostering connection, purpose, and meaning.

Spirituality can be comforting, and can provide a foundation of understanding as we strive to comprehend life’s unfolding events and our role in them. Connecting with our spirituality carries the potential to provide personal comfort and also to organize our stressors into our life’s story, providing a sense of personal meaning or some sense of control over life events.

Examples of actions related to spirituality may include prayer, communing with one’s Creator, spending time in nature or in ceremony, practicing mindfulness or meditation, or congregating with others in spirituality.

Other examples of the use of spirituality in self-care include releasing part of our burdens to the Universe/Creator/Divine, releasing attachment to specific outcomes/ ”sitting with open hands” ([quotation], unknown, n.d.), asking for help, assistance, guidance, strength, etc. from the Universe/Creator/Divine, and taking comfort in the value of our efforts and the genuineness of our intention.

Not unlike other domains outlined above, spirituality may also involve the use of other areas of self-care, such as awareness, reflection, and flexibility. Is this a skill of self-care worth further consideration in your life?

Putting it All Together

This post explored the topic of self-care, in an effort to deconstruct the broad scope of this topic and take it from the abstract to the actionable.

Given the variety of domains of self-care, it becomes clearer how many opportunities we have to enhance our actions of self-care, as well as helps make clear just how much of what we do in these realms can be considered self-care. Our task then as self-stewards, charged with attending to our holistic well-being becomes clearer, easier to define and identify, enhance and amend as needed, as well as celebrate our efforts within.

My wish is that this post helped you to reflect on this topic and notice any areas which may be beneficial to put additional effort into, but also recognize what you are already doing which can be identified as self-care, and celebrate your efforts as successful self-stewardship.

Compiling this information has been helpful for me in these ways, as I’ll be keeping these areas of self-care in mind when things again begin to feel a bit stretched in my own life. Writing this has helped me to personally celebrate present attendance in areas of awareness, flexibility, social support, and spirituality, and has also helped me to identify and put into action needs in the areas of balance, flexibility (yes, there are successes and also needs in this one), and physical health.

I’m going to celebrate my attention to this topic by mindfully eating a taco this week. Yes, I’m serious and I really cannot recommend this enough. I hope this topic finds you ready to reflect on and perhaps enhance self-care in your own world in this season of renewal. Wherever it finds you, I wish you wellness and hope you rejoice in what you already do to support yourself in this area.

References

Åkerstedt, T., Kecklund, G., & Axelsson, J. (2007). Impaired sleep after bedtime stress and worries. Biological Psychology, 76, 170–173. https://doi.org/10.1016/j.biopsycho.2007.07.010

Gentry, J. E. (2002). Compassion fatigue: a crucible of transformation. Journal of Trauma Practice, 1(3/4), 37–61. https://doi.org/10.1300/J189v01n03_03.

Godfrey, C. M., Harrison, M. B., Lysaght, R., Lamb, M., Graham, I. D., Oakley, P., (2011). Care of self –care by other –care of other: the meaning of self-care from research, practice, policy and industry perspectives. International Journal of Evidence Based Healthcare, 9(1), 3–24. doi: 10.1111/j.1744-1609.2010.00196.x

Grafanaki, S., Pearson, D., Cini, F., Godula, D., McKenzie, B., Nason, S., & Anderegg, M. (2005). Sources of renewal: a qualitative study on the experience and role of leisure in the life of counselors and psychologists. Counselling Psychology Quarterly, 18, 31–40. https://doi.org/10.1080/09515070500099660.

Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mental health therapists: identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, 46(2), 203–219. https://doi.org/10.1037/a0016081

Hossain, F., & Clatty, A. (2021). Self-care strategies in response to nurses’ moral injury during COVID-19 pandemic. Nursing ethics, 28(1), 23-32. https://doi.org/10.1177/0969733020961825

Kabat-Zin. n.d. [Quotation]. Unknown.

Kashdan, T. B. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878. https://doi.org/10.1016/j.cpr.2010.03.001.

Matarese, M., Lommi, M., De Marinis, M. G., Riegel, B., (2018). A systematic review and integration of concept analyses of self-care and related concepts. Journal of Nursing Scholarship, 50(3), 296–305. https://doi.org/10.1111/jnu.12385

Myers, S. B., Sweeney, A. C., Popick, V., Wesley, K., Bordfeld, A., & Fingerhut, R. (2012). Self-care practices and perceived stress levels among psychology graduate students. Training and Education in Professional Psychology, 6(1), 55–66. https://doi.org/10.1037/a0026534

Nurit, W., & Michal, A. (2003). Rest: a qualitative exploration of the phenomenon. Occupational Therapy International, 10(4), 227–238. https://doi.org/10.1002/oti.187

Patsiopoulos, A. T., & Buchanan, M. J. (2011). The practice of self-compassion in counseling: a narrative inquiry. Professional Psychology: Research and Practice, 42(4), 301–307. https://doi.org/10.1037/a0024482

Posluns, K., & Gall, T. L. (2020). Dear mental health practitioners, take care of yourselves: a literature review on self-care. International Journal for the Advancement of Counselling, 42(1), 1-20. doi: 10.1007/s10447-019-09382-w

[Quotation]. n.d. Unknown.

Riegel, B., Dunbar, S. B., Fitzsimons, D., Freedland, K. E., Lee, C. S., Middleton, S., Stromberg, A., Vellone, E., Webber, D. E., & Jaarsma, T. (2021). Self-care research: where are we now? Where are we going?. International Journal of Nursing Studies, 116, 103402. https://doi.org/10.1016/j.ijnurstu.2019.103402

Sirgy, J. M., & Wu, J. (2009). The pleasant life, the engaged life, and the meaningful life: what about the balanced life? Journal of Happiness Studies, 10(2), 183–196. https://doi.org/10.1007/s10902-007-9074-1.

Skovholt, T. M., Grier, T. L., & Hanson, M. R. (2001). Career counselling for longevity: self-care and burnout prevention strategies for counsellor resilience. Journal of Career Development, 27(3), 167–176. https://doi.org/10.1177/089484530102700303

Williams, I. A., Richardson, T. A., Moore, D. D., Gambrel, L. E., & Keeling, M. L. (2010). Perspectives on selfcare. Journal of Creativity in Mental Health, 5, 321–338. https://doi.org/10.1080/15401383.2010.507700.

Wityk, T. L. (2003). Burnout and the ethics of self-care for therapists. Alberta Counsellor, 28(1), 4–11.

Blog Written by Justine Richard

Justine is a Registered Provisional Psychologist on our Capilano team.

“Trauma and grief are two types of experiences I have known for a long time. A difficult home life and early loss led to a lifelong journey in dealing with these experiences. Most especially, the loss of my father led to my desire to understand more about human experiences and suffering at a young age, awakening a calling that has led me here today. We are often driven to helping others because we first had to help ourselves, and after a lifetime of walking through my own trauma and grief journey, I might be the right person to assist you in walking through your journey. As a trauma-informed therapist, I aim to help empower clients and to be attuned to their needs as best I can.

As a therapist and a person, I am authentic and you can expect to be with the real me. I value being direct and honest and also very importantly, humorous. I don’t believe therapy should be any more grim than absolutely necessary, and I believe in appropriately balancing the tough work with some much needed levity. I strongly value compassion and wholeheartedness, and hold these values close in my approach to therapy.” - Justine

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