by Brook Damour, MSW, LICSW

Self Care

A primer for how to begin thinking about healing yourself

One of the tools I have used most frequently in my six or so years as a therapist is the concept of self care, which I have found most profoundly articulated when I received training from Marsha Linehan as part of her Dialectical Behavioral Therapy (DBT) protocol. Although DBT is most famous for helping people who engage in self harm, it also has a lot of ideas that can be helpful to anyone with extreme feelings, which is probably everyone at one point or another.

My favorite aspect of the DBT interventions I have used over the years is the idea of self care. To my mind, self care is anything that you actively do to nurture yourself and cope in healthy ways. Famous self care standards include bubble baths, eating balanced, carefully prepared meals, watching a movie or TV show that provides escape or one that helps you think about and engage with some of your problems. It can be a warm bathrobe, yoga, a phone call with a friend, time with your pet, a walk in nature. The list is endless and totally customizable. But these are not things that come easily or naturally for all of us.

Self care can feel foreign if you have grown up with deficits in care: perhaps it wasn’t modeled to us by our caregivers, or as a child, we were cared for inconsistently or neglected. Self care can be seen as profoundly connected with attachment. If you had an attentive caregiver as a child, you are likely to understand innately both how to care for yourself and others. Part of being cared for in our youth is a process of internalizing these skills, learning them and feeling comfortable with them from the inside out. If you had enough of these skills young, you are less likely to question their value and more likely to simply apply them in a way that feels natural. But it is rarely this simple for most of us: self care and the ways we were or were not nurtured in our youth are as unique as we are as individuals. Perhaps a person might have grown up with a parent who was very consistent about providing basics like healthy, regular meals, structure and rules about schedule and safety, but struggled to offer emotional support and to allow one to express feelings with acceptance and safety. Though sensible eating might come naturally for this person as an adult, they might struggle to calm and nurture themselves when their emotions become intense, and instead have judgmental ways of responding to themselves in those moments.

Not surprisingly then, perhaps, one of the goals of this person we are using as an example in therapy might be twofold: one, to recognize the patterns of struggle in self care and to understand why they exist, and two, to begin to have a dialogue and process for shifting those deficits. In DBT, that dialogue is part of the name of the theory: Dialectical. This can take many forms but it is at least partly about learning to care for yourself and have compassion for yourself in the areas where you have been hurt.

If this all sounds pretty abstract, let me draw your attention to how concrete and simple self care can be. Like the examples earlier in this writing, it can be about simple acts of kindness to yourself: buying yourself flowers, tending to a hobby you love, smelling a fragrance that you enjoy, etc. Self care is both about what you do for yourself and how you think about yourself.

Another interesting aspect of self care is that it can be influenced by larger social factors than our individual families and experiences growing up. Social class or generally speaking the amount of money and associated cultural implications one experienced growing up can be directly linked to self care. There is a stereotype that people with less financial means must be impoverished in multiple areas, including the way they present themselves, which is an act of self care. This is especially clear in high school, a time in life when the way you dress says a lot about your status, aspirations, and experiences. One coping mechanism for children that have grown up without financial privilege is to express themselves through clothing: this can mean wearing things that are rebellious and punk, meshing perfectly with the mainstream of their school through carefully shopping for the right things for less money, buying vintage and therefore less expensive clothing to customize and feel “different.” Consider the classic 1980’s movie by John Hughes, Pretty in Pink, an insightful portrayal of the impact of social class on American teenagers. This protagonist, Andy, cannot afford the designer gowns her classmates buy effortlessly for senior prom. So Andy creates her own gown, which is distinctive and does not try to blend in, by sewing together parts of a dress that was a gift from her father and her adoptive mother figure’s old prom dress. She is using her creativity and skill to express herself through this choice and ultimately, it can be seen as a very active, complex form of self care.

Self care is a very rich topic. It is something that can be explored in myriad ways both within and outside of therapy. Exploring the meaning and ramifications of how you do or do not care for yourself can provide relief when people are struggling, particularly when they do not always consciously understand why. It is a great opening for growth and insight that I use daily in my practice to support clients to move forward with their lives in a healthy, authentic way.