6.1: Barriers to Self-Care

Overcoming Resistance to Practicing Self-Care

Eating a vegetarian diet, walking (exercising) every day, and meditating is considered radical. Allowing someone to slice your chest open and graft your leg veins in our heart is considered normal and conservative. – Dean Ornish (Cardiologist)

I found that quote by Dean Ornish to be both striking and alarming. Striking in the brashness of it, and alarming in the truth. It is true though because of the human’s natural inclination to avoid and fear change. Several factors come into play including the psychological needs of self-esteem, confidence, control. We may wonder “will I be successful?” and “is it something I can manage?”, or neurological needs such as certainty, routine, and needing time to think about it, with thoughts such as “I don’t know what to expect” or “I’ve always done things this way.” Even social needs of wondering what others will think, and physical needs regarding what the change will mean for their security and comfort can come into play. It will be imperative to help your client process any fears or concerns they might have that could potentially interfere with the choice to incorporate self-care intervention into their current routine.

The following are some common barriers to self-care and reasons that cause resistance to client’s participating in a self-care plan, and ways to help the client think differently about them.

• Not setting or maintaining realistic expectations
• Being ashamed to ask for help or thinking they don’t deserve to be pampered.
• Misunderstood religious beliefs.
• Not recognizing the importance of self-care.
• Not putting themselves on the list of important daily tasks.
• Helping Clients Practice Self-Care When They Feel They Don’t Have Time

Not setting or maintaining realistic expectations

Helping individuals in this area involves educating them about what wellness is and helping them understand where they stand in the different areas of wellness through assessment. This offers the opportunity for them to create a specific and realistic self-care plan designed to meet their individual needs. It is also helpful to assess the individual’s readiness to change which is covered later in this chapter.

Figure \(\PageIndex{1}\): Love yourself. (Photo by Lisa from Pexels from Pexels.)

Encouraging self-compassion when facing challenges such as recognizing their feelings, practicing self-kindness, and challenging negative self-talk will also help with keeping and maintaining realistic expectations. Coupled with this is flexibility which involves anticipating set-backs, being open to change, prioritizing self-care, and not giving up.

Being ashamed to ask for help or thinking they don’t deserve to be pampered.

Figure \(\PageIndex{2}\): Self care isn't selfish; it is vital that you care for yourself. (Photo by Madison Inouye from Pexels.)

One of my favorite ways to challenge this negative thought pattern is to ask what the person asserting this would say to their best friend if they said they didn’t deserve to provide self-care to themselves. Most people would never deny a friend or anyone they care about the same things they easily deny themselves. This opens the door for a frank conversation about the source of this belief which can lead to deconstructing it.

Video \(\PageIndex{1}\): Burnout and guilt don’t serve you or anyone else. Taking care of yourself isn’t selfish—it’s necessary. ("Overcoming Guilt to Prioritize Your Self-Care" by Laura Lummer on YouTube.)

Misunderstood religious beliefs.

Figure \(\PageIndex{3}\): Religious traditions from around the world have informed practices now used in self-care. (Photos clockwise from top right by cottonbro studio from Pexels, Michael Burrows from Pexels, Daniela Ruiz from Pexels, Tima Miroshnichenko from Pexels.)

This belief is most often seen in relation to Eastern self-care practices such as mediation, yoga, and Tai Chi to name a few. Many people associate these with Buddhist or other Eastern religious practices. There is a great deal of recent Western research that supports how these practices, when used as non-religious self-care practices, have shown tremendous positive and beneficial results. Some of the best large-scale studies come from Jon Kabat-Zinn, PhD. He is a Professor of Medicine emeritus at the University of Massachusetts Medical School, where he founded its world-renown Mindfulness-Based Stress Reduction (MBSR) Clinic in 1979, and the Center for Mindfulness in Medicine, Health Care, and Society (CFM), in 1995.

Dr. Kabat-Zinn began utilizing mindfulness based stress reduction interventions with patients recovering from cardiac surgery and the results were so promising, he has since done research in many other areas including prisons, with pain relief, with inner city populations, and with dermatology. More information can be found here.

Not recognizing the importance of self-care.

Figure \(\PageIndex{4}\): You matter. (Photo by Leeloo The First from Pexels.)

Explaining the physical, emotional, mental, spiritual, social, and other benefits of self-care in a direct and thorough way is usually enough to convince most people that self-care is important. If there is still resistance, it may be necessary to explore if the reason is related to something other than not recognizing the importance of self-care.

Not putting themselves on the list of important daily tasks.

This can happen for a variety of reasons including the belief that self-care is selfish. This is a common misconception and should be processed with the client. I have found it easiest to discuss other self-care practices such as bathing and brushing my teeth with clients and asking if doing those things are considered selfish. My clients never equate those activities with selfishness, which opens the door to a discussion about creating time for practices that foster good health. Self-care practices foster good health in the areas of physical, mental, social, emotional, environmental, cognitive, spiritual, and occupational wellbeing. I ask them why this type of self-care would be any different from any other type of self-care.

Another reason may be because the individual is too focused on providing for others, either through rescuing or not setting appropriate boundaries. This is another area that we can help them through exploration into what changes may be necessary to create more focus on their needs rather than the needs of others. Consequently, a person who expects others to take care of them may not invest in their own self-care. This could be closely related to the person who takes care of others and feels resentment that this level of care is not reciprocated.

A final reason a person doesn’t put themselves on the list of important things is that they don’t feel that they are worthy. This is generally related to issues in early relationships and possible attachment styles and may require work on helping the client discover where this belief is stemming from in order work through the feelings associated with it and ultimately alter it.

Helping Clients Practice Self-Care When They Feel They Don’t Have Time

Lack of time, financial constraints, and lack of motivation, energy or interest are among the three main reasons given by graduate students in a study by El-Ghoroury et al. (2012) for not practicing self-care. These reasons may sound eerily familiar to many of us. In my own work with graduate students, I ask in classes throughout the program how may students practice self-care and the number of students with a regular practice is generally small. This is especially surprising when considering the stressfulness of a graduate program, coupled with work, and home life. This would seem like the perfect and most necessary time to implement a self-care regime’.

Figure \(\PageIndex{5}\): Time may be seen as a barrier to self-cart, but seeing it as a priority can shift how we make space for it. (Photo by Jordan Benton from Pexels.)

The problem, of course, is that self-care feels indulgent and takes time out of a schedule that is already stretched to the max. The way I like to think about it is to view it as a priority. If we start to view self-care as a priority or something that is important rather than as a luxury or as an indulgence, this casts its necessity in a different light. This puts self-care on par with brushing my teeth or washing my face. I would not leave the house without doing both anymore than I would complete my day without practicing my self-care.

In a study by Roxas (2023) participants discussed self-care as something they “give” to themselves which implies that this person felt she had a relationship with herself and saw self-care as a gift. This idea goes counter to the popular notion that self-care is selfish, but that providing care for the self is seen as important as providing care for others. Participants in this study also discussed caring for themselves as not taking anything away from others as much as focusing on creating a healthy relationship with self.

Video \(\PageIndex{2}\): Find the courage to build a life around what matters most to you. ("Three minutes that could change everything" by Simon Alexander Ong on YouTube.)

Reflection Moment \(\PageIndex{1}\)

Think about your self-care routine (or lack thereof). Are there any barriers to your practice? If so, what are they and how do you think you might overcome them?

This reflection question is also available as a PDF download: Barriers to self-care