Self-care among Slovenian social workers: understanding and barriers to self-care

ABSTRACT

In this study, we investigated what Slovenian social workers understand by self-care and what barriers to self-care are the most common. Almost all respondents in our sample agreed that self-care is very important for social workers’ well-being and professional practice. However, only 38% fully agreed that they know how to take care of their well-being, and only 23% of social workers surveyed take care of themselves on a daily basis. The most frequently mentioned self-care practices in the personal domain are eating a regular and healthy diet, spending quality time with enjoyable others, and spending time in nature. The least-mentioned practices are time away from the telephone, journal writing, engaging in personal psychotherapy, and meditation. Engaging with co-workers and attending supervision are the most mentioned practices in the organisational self-care domain, while negotiation skills and setting boundaries with users and co-workers are the least mentioned practices. The most common barriers to self-care are work overload and lack of time. As the field of self-care among social workers in Slovenia is still unexplored and unregulated, we have suggested the first possible steps on micro, mezzo, and macro levels.

KEYWORDS:

• Self-care
• resilience
• understanding
• barriers
• social workers

Introduction

The need for social work in Slovenia increases every day (Mali, 2010; Mešl et al., 2023) because of the increasing needs in healthcare, education, and wider social care. Due to the fast pace of life, we forget to stop, take a breath, and thus take care of ourselves (Bent-Goodley, 2017). The paradox of self-care in the support and helping professions is that professional workers take time for others and devote themselves to caring for others but do not have time to care for themselves. It also happens that users are advised and emphasised on self-care, but helpers do not follow it themselves (Norcross & VandenBos, 2018).

One of the main goals of all helping professions, including social work, is to support service users on their path to well-being. However, in doing so, helpers often overlook their own needs (Barnett et al., 2007; Brown, 2020; Collins, 2008). Numerous studies have shown higher levels of work-related stress among social workers than many other occupational groups (Bell et al., 2003; Collins, 2008; Frieiro Padin et al., 2021; H. Kim et al., 2011; Lloyd et al., 2002). Working in such a stressful environment, as social work tends to be, can lead to high levels of psychological distress (Hurley & Kirwan, 2020; Kinman & Grant, 2011) which can cause burnout and professional impairment (Dalphon, 2019; Posluns & Gall, 2020), lower job satisfaction (Acker, 2018), and employee turnover (Scanlan & Still, 2019). Therefore, social workers need to practice self-care to maintain their well-being and effectiveness in their work. In the literature, self-care is often mentioned as a protective factor against potential stress, burnout, and other unhealthy consequences of working with users, co-workers, and superiors (Brown, 2020; Grise-Owens et al., 2018; Lee & Miller, 2013; Miller et al., 2018; Pyles, 2020; Shepherd & Newell, 2020; Wagaman et al., 2015) and against compassion fatigue (Bride & Fingley, 2007; Cox & Steiner, 2013; Radey & Figley, 2007; Videmšek, 2021). In countries where self-care is recognised as a core intervention (Miller & Grise-Owens, 2020; Shepherd & Newell, 2020) for building resilient social workers, it is incorporated into professional standards (Grant, Kinman, & Baker, 2014; McFadden, 2020) and integrated into social work education (Griffiths et al., 2019; Moore et al., 2011; Tham et al., 2023). In Slovenia, we have one faculty (Mesec, 2020), where students can learn social work. On the Faculty of Social Work, University of Ljubljana we have undergraduate, master and doctoral programmes. But only three courses pay attention to self-care. We don’t have a specific experiential self-care course as in other countries (Tham et al., 2023) where students could be given important knowledge on how to take care of themselves already during their studies in social work and later on in their professional careers. In Slovenia, we carry out social work in the public sector at Centres for Social Work and at non-governmental organisations. The work at Centres for Social Work is more stressful (Kuhar, 2024) (e.g. child protection social work) and this is where knowledge and implementation of effective self-care are especially important, so that compassion fatigue, burnout, sick leave and employee turnover occur to the smallest extent possible.

Self-care and resilience

The World Health Organization (WHO) describes self-care as the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a healthcare provider. As fundamental principles of self-care within an individual, the WHO has identified aspects such as autonomy, personal responsibility, self-efficacy, and empowerment. The fundamental principles of self-care within a community are community involvement and community empowerment (World Health Organization, 2021).

Godfrey et al. (2011) found 139 different definitions of self-care. Based on these different definitions, they offered an operational definition of self-care. They stated that self-care involves various care activities to promote physical, mental, and emotional health, maintain life, and prevent disease. Individuals perform self-care activities on their own or in collaboration with professionals. Lee and Miller (2013) proposed that self-care is focused on behavioural strategies that promote subjective well-being and reduce stress. According to Saakvitne and Pearlman (1996), self-care includes strategies across five areas of potential stress: physical, psychological, emotional, spiritual, and professional. All these five areas are interconnected; appropriate self-care means committed working on each area, not just one or another. Physical self-care includes meeting the needs of the physical body (e.g. enough sleep, regular and healthy nutrition, exercising, maintaining health, and leisure time activities; Butler et al., 2019). We can understand physical self-care as a fundamental area that underpins all functioning. This is because a person can satisfy other needs only when the basic physiological needs are satisfied. More challenging is to separate psychological, emotional, and relational self-care (as part of emotional self-care). Within the emotional self-care area, we talk about addressing and reducing negative emotions, creating positive emotional experiences, and allowing us to express all kinds of emotions. Emotional self-care activities include self-praise, laughing, and spending time with loved ones (Bloomquist et al., 2015). We can get emotional support within relationships with loved and valued ones, and maintaining and enhancing our interpersonal connections with others represents a relational self-care area. Good relationships are associated with improvements in happiness, quality of life, resilience, and cognitive capacity (Walsh, 2011). Cognitive capacity has an impact on psychological self-care activities, such as monitoring, understanding, and satisfying intellectual needs. With self-awareness and mindful reflection, we can deepen our understanding of ourselves, our motivations, and behaviour patterns, make meaning of experience, and enhance resilience and personal growth. Spiritual self-care can be understood as a faith or religious affiliation, but it can also be an entirely secular activity (e.g. meditation, connection with nature). A key element of spiritual self-care is an awareness of what helps us feel connected to the larger world and gives meaning to our lives and work (Butler et al., 2019). The professional self-care area covers managing or preventing job-related stress, reducing burnout effects, and increasing work performance, satisfaction, and competence. Common professional self-care activities include participating in relevant training, setting appropriate boundaries with clients, seeking adequate supervision or support, and advocating for one’s own needs within the workplace (Bloomquist et al., 2015).

Even though self-care is defined as a strategy for achieving individual well-being, it should not remain only in the domain of an individual (Harris & Stout, 2022; Lee & Miller, 2013; Videmšek, 2021). Employers must ensure place and time for self-care as supportive relationships, supervision, intervision, debriefings, team building, and lifelong education. They must also be keen on the personal domain of self-care and promote it as a right and obligation of each social worker. However, as Smullens (2015) and Hamama (2012) wrote, there is often a different situation in practice. They described a lack of organisational support and an inadequate environment in which to practice self-care strategies as the two biggest barriers to self-care practice. Even where the organisational climate and culture are keen on self-care, models often do not address the unique needs of social workers (Brown, 2020). To bring self-care techniques as close as possible to the needs of the individual, Smullens (2015) offered a guidebook on prevention and coping with burnout for social work professionals and students, pointing to the practice of mindfulness, self-awareness, physical exercise, and supportive relationships through personalised plans of self-care. When we talk about self-care as a personal domain, it is frequently related to a lack of time (Smullens, 2015). Other possible barriers to self-care practice can be a lack of knowledge or education on self-care practices; limited resources or access to information and tools for self-help; busy schedules and competing priorities that make it difficult to prioritise self-care; financial constraints that make it challenging to afford self-care activities or resources; social norms or expectations that prioritise productivity or selflessness over self-care; personal beliefs or attitudes that inhibit self-care, such as a sense of guilt or shame for taking time for oneself; mental or physical health conditions that impact one’s ability to engage in self-care activities; and limited understanding or awareness of the benefits of self-care, leading to a lack of motivation or interest in engaging in these practices.

One of the results of appropriate self-care strategies is a resilient individual (Riegel et al., 2021). Resilience is the process of adapting well when life events interfere with our ability to perform self-care. These life events may include trauma, tragedy, and stressful situations such as helping professions, including social work. Resilience relies on the individual’s inner strengths and protective factors such as high self-awareness, self-esteem, cognitive and social skills, optimism, and sense of humour. Resilience may also rely on social context, for example, social support, cultural factors, and social norms (G. M. Kim et al., 2019; Zizolfi et al., 2019). Van Breda (2018, p. 4) defined resilience as multilevel processes that systems engage in to obtain better-than-expected outcomes in the face or wake of adversity. If we take an individual as a system and place him or her in a field of helping professions, authors mostly write about resilience as the ability to positively adapt to adversity (Grant & Kinman, 2014), coping strategies (Stephens, 2013), or strength gained through experience (Turner, 2001). Resilience principles draw from Stoic philosophy (Robertson, 2010) and later from cognitive behavioural theory (Beck, 2021) and learning theory (Bandura, 1977). Cognitive behavioural theory, arising from Stoic philosophy, posits that emotions and behaviour are primarily determined by how a person cognitively views the world. Social learning theory sees human behaviour as a continuous reciprocal interaction between cognitive, behavioural, and environmental factors. Social learning theory contends that people can learn by observing the behaviour of others, as well as from direct experiences, which are some of the most significant resilient traits. Southwick et al. (2014) discuss resilience as a characteristic, process, or result. For our understanding of resilience within social work practice, it is important to understand resilience as the capacity of a dynamic system to adapt successfully to disturbances that threaten its viability, function, and development and as a process to harness resources to sustain well-being. It is not enough to talk about the absence of psychopathology but also the presence of mental and emotional health (Posluns & Gall, 2020). Kinman and Grant (2011) found that social workers with stronger emotional and social skills are more resilient to stress. Grant, Kinman, and Alexander (2014) wrote that emotional intelligence, reflective skills, aspects of empathy, and social competence can be important protective qualities in the context of social work. From this perspective, resilience as a result of emotional literacy and emotional intelligence (Grant & Kinman, 2014; Morrison, 2007) may be an important quality for social workers, and it may help them adapt positively to stressful working situations and enhance their professional growth (Collins, 2008; Morrison, 2007). From our experiences in supervision processes, social worker resilience is a prerequisite for efficient collaborative relationships with service users and for the prevention of toxic empathy, compassion trap, or hostile relationships. Social worker resilience skills can also be the subject of model learning for clients.

If we talk about resilience as a capacity, then we shall observe it as an idiosyncratic process (Griffiths et al., 2019) to sustain social workers’ well-being. We understand these processes as never-ending self-care with ups and downs. Self-care involves the active and continual practice of promoting and maintaining one’s health and well-being (Salloum et al., 2015). Self-care can help build resilience by fostering a sense of agency and control over one’s life, promoting self-awareness and emotional regulation, and fostering a sense of connectedness and support. When individuals prioritise self-care practices, they become better equipped to deal with stress, adversity, and challenging life circumstances. Self-care is not just a concept, but it also involves taking specific actions. Within this connection is often mentioned acceptance and commitment therapy (ACT) (Butler et al., 2019; Collins, 2008; Grant & Kinman, 2014) with accepting and embracing difficult thoughts, feelings, and experiences, while committing to acting towards a more fulfilling life (Brinkborg et al., 2011). Some self-care practices aligned with ACT principles may include a) mindfulness as practising present moment awareness and observing thoughts and experiences without judgement, b) values clarification as identifying personal values and taking actions aligned with those values, and c) committed action as setting goals and taking steps towards achieving them, despite uncomfortable thoughts or feelings that may arise (Hayes et al., 2012).

Although many researchers (Bloomquist et al., 2015; Grant & Kinman, 2014; Griffiths et al., 2019; Turner, 2001) put self-care at the centre of social work, or as Griffiths (2019, p. 112) wrote, ‘Social work is difficult, self-care is vital’, it also makes sense to point out research whose authors did not find a positive connection between self-care, resilience, and well-being. For example, Bober and Regehr (2006) did not find any protective effects of self-care against secondary stress in therapists. Killian (2008) did not find any relationship between self-care practices, compassion satisfaction, compassion fatigue, or burnout in therapists. Salloum et al. (2015) and Bloomquist et al. (2015) found no relationship between self-care and secondary traumatic stress. Xu et al. (2019) did not find support for the hypothesis that self-care behaviours were negatively related to the compassion satisfaction of social workers. Bloomquist et al. (2015) surprisingly found that psychological self-care, such as taking time for reflection, keeping a journal, practising mindfulness, having a self-care plan, and participating in counselling for oneself, was associated with higher levels of burnout and secondary traumatic stress.

Methodology

Quantitative data was collected in March and April 2023. We published the questionnaire in the open-source web application 1 KA, which enables the possibility of online surveys. Data about engaging in a variety of self-care activities were collected by using the Self-Care Assessment Worksheet – SCAW (Saakvitne & Pearlman, 1996). The instrument measures five areas of self-care: physical, psychological, emotional, spiritual, and professional workplace. Respondents have been asked to rate each activity on a scale from 1 to 5 in terms of frequency (1 = never occurs, 5 = frequently occurs). Higher total scores for each subscale indicate more engagement in self-care activities in a particular area and lower scores indicate low engagement in self-care. A copy of the SCAW is available in multiple outlets on the internet (e.g. https://socialwork.buffalo.edu/content/dam/socialwork/home/self-care-kit/self-care-assessment.pdf). Sample items from the SCAW include: eat regularly (physical), make time for self-reflection (psychological), allow for feeling expression (emotional), be open to inspiration (spiritual), and set limits/boundaries with users and colleagues (workplace). Besides SCAW, we also include demographic questions: gender, age, profession, workplace, and years of working experience. Questions about the perception of stress at the workplace: frequency of stress experience, relational framework of stress experience (e.g. users, co-workers …), attitude to personal and organisational self-care (e.g. knowledge about self-care, time spent, barriers, organisational incentives for self-care …).

The population in the research is represented by social workers and social care practitioners employed in the field of social care in the Republic of Slovenia. A total of 75 social workers were included: 71 (95%) females and 4 (5%) males. They were from 54 different organisations in the field of social care in Slovenia, and all of them were external mentors for students of the Faculty of Social Work, University of Ljubljana. 32 (43%) of them are working in Centres for Social Work, 17 (23%) in NGOs, 16 (21%) in nursing homes, and 10 (13%) in primary schools. Their ages were 25–34 (33%), 35–44 (48%), 45–54 (13%), and 55–64 (5%) years. Half of them (49%) had 5–15 years of working experience, 25% up to 5 years, and the same percentage above 15 years of working experience.

Because this was a pilot study about self-care among Slovenian social workers we primarily needed a snapshot of the existing situation. We analysed the data collected with SCAW using 1 KA, an open source web application and SPSS, Statistical Package for the Social Sciences. By using a descriptive method frequencies were counted, and the median and standard deviation were calculated. For questions about the perception of stress at the workplace and attitude to personal and organisational self-care, we have used thematic analysis. First qualitative data were coded. Below we find themes with iterative comparison (Mesec et al., 2009).

Results

Stress experience

First of all, we wanted to check whether the research participants perceived their work as stressful. We were interested in which workplace relationships they perceive the most stress, whether stress at work affects their personal life, and whether they have ever thought about a job change because of stress at work.

The results are similar to the results of already published studies in this area (Blomberg et al., 2015; Matthews et al., 2010; McFadden et al., 2015). Regarding stress experience, 90% of respondents experienced stress at the workplace at least occasionally in the last year several times a month and 84% each day. Perception of stress is highest on Centres for Social Work (64%). For our participants was the most stressful collaboration with clients at 80%. Also, 47% of social workers from our study experienced stress about their co-workers and 44% about their superiors. Furthermore, 72% of respondents assessed that stressful events at work affected their personal lives at least occasionally in the last year. Because of stress at the workplace, 50% of respondents were at least occasionally thinking about the job change.

Self-care areas

In the following, we present how many respondents (in percentage) self-assessed that they often or very often perform an individual activity in the physical, psychological, emotional, spiritual, and professional self-care areas.

Table 1. Physical self-care.

Activity	I perform often or very often
Eat regularly (e. g. breakfast, lunch and dinner).	70%
Take vacations.	67%
Eat healthy food.	65%
Do enjoyable physical activities.	62%
Get enough sleep.	58%
Take time to be sexual.	47%
Take time off when sick.	43%
Take day trips or mini vacations.	41%
Exercise consistently.	31%
A day without the phone.	9%

Table 2. Psychological self-care.

Activity	I perform often or very often
Communicate needs and wants.	65%
Make time for self-reflection.	56%
Do something in which I am not an expert.	41%
Improve ability to say no to extra responsibilities.	40%
Try new things.	39%
Read literature that is unrelated to work.	34%
Engage in personal psychotherapy.	13%
Write in a journal.	9%

Table 3. Emotional self-care.

Activity	I perform often or very often
Maintain contact with valued others.	85%
Allow for feeling expression.	75%
Allow for quality time with others whose company I enjoy.	75%
Love self.	73%
Engage in comforting activities.	44%
Give self-affirmations and praise.	44%

Table 4. Spiritual self-care.

Activity	I perform often or very often
Be aware of nonmaterial aspects of life.	93%
Cherish your own optimism and hope.	80%
Spend time with nature.	75%
Contribute to causes in which I believe.	71%
Read inspirational literature.	51%
Meditate.	22%
Pray.	16%

Table 5. Professional self-care.

Activity	I perform often or very often
Participate in projects that are exciting and rewarding.	78%
Set limits with users.	71%
Maintain regular supervision.	66%
Allow for breaks during the workday.	64%
Negotiate needs (benefits, raise etc.).	47%
Balance workload.	47%
Set limits with colleagues.	44%

Attitude to personal self-care

Most of the respondents (96%) agreed that self-care is very important for the well-being and professional practice of social workers. However, only 38% agreed that they know how to take care of their well-being. Also, 23% of the questioned social workers cared for themselves daily, and 18% of respondents revealed that their employers encouraged them to take self-care. Furthermore, 74% of them reported that they lacked additional education on the topic of strengthening resilience and self-care, and 71% revealed their willingness to participate in this kind of education.

The questioned social workers believe that the biggest barriers to taking care of well-being and professional practice are lack of time (43%), work overload (28%), physical and emotional fatigue (11%), and relations at the workplace (6%).

To the open-ended question of how the organisation takes care of their well-being, respondents pointed out additional education (31%), promotion of health at the workplace (National guidelines for the promotion of health at the workplace programme) (24%), socialising after work (18%), supervision (16%), team buildings (5%), and debriefing (5%).

Moreover, 59% of the questioned social workers took care of their well-being in the personal domain, 9% in the organisational domain, and 32% in both domains.

Discussion

The results show that, among a sample of Slovenian social workers, stress at work is strongly present and, at the same time, interferes with their private sphere. Half of the respondents even considered changing jobs in the previous year. It is not just working with users that is stressful; stress is also present to a large extent in relationships between colleagues and superiors. Respondents do not perceive sufficient organisational support for self-care. One of the causes is that self-care is not normatively regulated for the social worker profession in Slovenia. It is not even mentioned or defined as a right and obligation in the Code of Ethics of Social Workers or the Code of Ethical Principles in Social Care. As a result, only a very small percentage (38%) of respondents report that they know how to take care of themselves. The next reason for that could also be the lack of self-care content in the curricula of social work. Furthermore, only a smaller percentage (23%) of respondents take self-care activities daily, even though they are strongly aware of the importance of self-care for their well-being and professional practice. Bloomquist et al. (2015) also found that while social workers value and believe self-care is effective in alleviating job-related stress, they engage in self-care on a limited basis. Work overload and lack of time are cited as the main reasons for the absence of self-care, which is consistent with the findings of other researchers (e.g. Smullens, 2015). Slovenian social workers have also mentioned a lack of knowledge of self-care.

Our pilot research on self-care among social workers is the first study on self-care among social workers in Slovenia. As such, it opens up many topics about self-care on micro, mezzo, and macro levels of social work in Slovenia. On the macro level, self-care should be recognised as one of the most important social work competencies, as written in the Code of Ethics of Social Workers of Slovenia (Kodeks etike socialnih delavk in socialnih delavcev Slovenije, 1998) and the Code of Ethical Principles in Social Care (Kodeks etičnih načel v socialnem varstvu, 2014). In contrast to the existing situation in the field of social work in Slovenia (Rakovec & Videmšek, in press; Videmšek, 2023) it must be clearly seen that self-care is not only in the domain of the individual but also of the organisation. Self-care should not be seen as goodwill but as an obligation of employees and employers in the field of social care and social work.

At the mezzo level, self-care learning content should be included in the curricula of the Faculty of Social Work. According to good practices in other countries (Grant & Kinman, 2012; Griffiths et al., 2019; O’Neill et al., 2019), content about mindfulness, the acceptance and commitment approach, the cognitive behavioural approach, emotional literacy and emotional intelligence, new concepts of compassion, time management, and assertive communication should be proposed. The curricula could be adapted to the actual needs in practice as well as to students who are just getting their education for the profession of social worker and, according to research findings (Grise-Owens et al., 2018; Krivec & Rakovec, 2018; Maddock & McCusker, 2022; Moore et al., 2011), already experience a high level of stress during their studies.

At the micro level, questions such as what self-care is, why it is so important for college students and practitioners in the field of social work, what is organisational and personal self-care, how they are, and why they should be interlaced provide essential knowledge. Knowledge about self-care and time management skills should be the right answer to the excuses for the lack of time for self-help among social workers. Being aware that many techniques of self-care do not take much time can encourage more individuals to start practising self-care techniques daily. If self-care becomes one’s value in both personal and professional domains, performance will be more committed because internal motivation will be present. The most important for cultivating self-care as a value is to talk about it daily as such, not as an obligation or selfish act. As Grant, Kinman, and Baker (2014) stated, it is about time to admit that social workers must first take care of their well-being to be emotionally resilient.

We noted several limitations to our study. First is a small sample of respondents, so the results cannot be generalised to the whole population of social workers in Slovenia. Second, we didn’t use validated measures for stress, we just asked respondents of their perception about workplace stress presence. The third limitation could be a closed-format questionnaire about self-care activities. With obtained data, we just got a brief insight into the field of self-care among social workers in Slovenia, which will help us to design new research in this field with a larger internal and external validity.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Primož Rakovec

Primož Rakovec, assistant professor at Faculty of Social Work, University of Ljubljana. His main research interests are resilience and self-care, hostile relationships in social work practice, coping strategies, and cognitive behavioural approaches.

Petra Videmšek

Petra Videmšek, associate professor at the Faculty of Social Work, University of Ljubljana. Her main research interests are social inclusion in mental health and disability, service user involvement in research and education, social inequalities experienced by people with disabilities, and advocacy work with disabled people or people with mental health problems who have experienced sexual abuse, and supervision in social work, self-care, and compassion fatigue.