Maggie O'Neill:

Can you tell me a little bit about yourself, your background, your journey into psychology and art therapy, and what led you to focus on self-care and life enrichment?

Lisa Hinz:

Yes. I was originally educated and trained as a psychologist. In my first job I supervised an art therapy student who was doing her practicum work, her field placement, in the place where I worked. We had a one-way mirror through which I could see her work and hear what she was doing, and it seemed very fascinating to me.

After watching her work for a semester I thought I had to learn more about art therapy.

I was at the University of Louisville, where Vija Lusebrink and Sandra Kagin were two of the art therapy professors. They're the people that originated the Expressive Therapies Continuum, from which the Life Enrichment Model grew. And I was able study with Drs. Kagin and Lusebrink and to obtain another degree in art therapy, after my doctorate in clinical psychology. So it was my fascination with watching the effectiveness of art therapy as a supervisor that started my journey into art therapy.

Figure 1: Self Care 1 - Enriching work environments allow employees’ voices to be heard and encourage personal and professional growth and change

My focus at the time was eating disorders. And I treated a lot of young women, some men, with various eating issues. And I've always been attracted to a more positive and growth enhancing way of looking at people rather than a psychopathological way of viewing them.

I believe that people have an innate desire to be whole; so, I thought, if we could focus on how people can use eating and other lifestyle habits to help themselves be well, we can tap into that desire to be whole and well.

That changed my way of looking at eating issues; it changed my way of looking at a lot of things in a more positive way. So when I found positive psychology and that confirmed this more optimistic way of viewing people.

Maggie O'Neill:

You mentioned the Life Enrichment Model. Could you tell me a little bit more about that?

Lisa Hinz:

So the Life Enrichment Model is an outgrowth of the Expressive Therapies Continuum, which is a theoretical model in which we describe how people interact with art materials and what that means about how they think, feel, or act in other areas of their life. It's a really holistic model of looking at people and the way they function and process information. And I think like many fundamental truths, this holistic approach to art therapy (the ETC) could be applied to the larger person. And so the life enrichment model is an outgrowth of that.

I  was inspired by a strong interest in applying positive psychology, interestingly, to the study of ethics. I was teaching ethics and it's a rather scary subject if you're always focused on what can go wrong or what we can do in error and harm people.

So I thought there has to be a more inviting and positive way to look at ethics.

And there was, positive psychology applied to ethics by psychologists Handelsman, Knapp, & Gottlieb (2002). I expanded positive ethics to the field of art therapy and noticed that in ethics the only thing that we as art therapists and psychologists and almost every field that I've studied except for nursing, we all look at self-care as avoiding impairment. So, ethical codes state, “avoid impairment. Or, don't work when you know that you could possibly be impaired.” That's a rather negative way of looking at what could be: make sure that you really take care of yourself well, so that you can be at your best to treat clients. Nurses ethical codes in the U.S. state, treat yourself the way that you would treat your patients. So I thought we could do better. And that was my change in focus onto self-care. Tell people how to care for themselves, rather than avoid impairment.

Maggie O'Neill:

That shift in focus and the positive approach is so interesting and you refer to shifting from avoiding burnout to a more a more positive mindset about overall optimal health in a holistic way. Can you tell me why this shift in perspective is so important?

Lisa Hinz:

Well, I think it's very important because we expend our energy anyway. So if we expend our energy avoiding what's negative, we are always focused on what's negative, and that doesn't help us grow, it just helps us maintain the status quo. If we spend our energy, which again, we're going to spend anyway, thinking about how we can enhance our health and our life, then we spend our energy in positive ways, which helps us grow.

So I think rather than maintaining the status quo, we should always be thinking about how we can grow and be better.

Maggie O'Neill:

Could you share some practical ways that people can work on this shift in mindset personally.

Lisa Hinz:

I think that we can shift our mindset when we think about, “how can I enhance excellence in myself, my clients, the institutions that I work with” - it really is a matter of shifting perspective. Because as I said before, we're going to expend energy thinking and sometimes worrying anyway.

So if we think – I'm in charge of how I think, and so I can think in terms of growing and enhancing and being my best, or I can think of avoiding the more negative aspects.

But if I change my focus to that which helps me, my clients and my institutions grow, then I'm really thinking about growth and positive things, rather than negative perspectives.

Maggie O'Neill:

You have talked about compassion fatigue and the impact of chronic empathy. Could you tell me a little bit more about this?

Lisa Hinz:

People are often mistaken about compassion. They mix compassion and pity and empathy, all these words get mixed up; but compassion, I think, was very well defined by, Henri Nowen, who was a Catholic priest, theologian and professor who said that compassion really has to do with our suffering with people, so it's compassion which is “with passion” or suffering with people, and wanting to do something about it - so we really want to do something to help. However, according to Nowen, what people really want to do is turn away, run away, protect themselves from the passion, the suffering of others.

It really takes a strong person to be in the room with someone who is suffering and help them do something about it.

We mistake how draining it is to be compassionate and help people who are suffering. Some of the early warning signs of burnout due to this expenditure of energy in being with people who are suffering, are physical exhaustion, feeling mentally overwhelmed, having some difficulty making decisions. There are lots of different signs that are physical, they are emotional, they are cognitive. This is how I think the Lifestyle Enrichment Model is helpful, because it's not just a physical approach, it's not just an emotional thing, it's not just a cognitive way of dealing with burnout - it's all of those things. So basically, we feel a chronic sense of exhaustion – physically, mentally, spiritually – and begin to dread those things – our work, our work with people – that we used to find fulfilling and very enjoyable.

Maggie O’Neill:

And how might professionals address some of those early warning signs that you mentioned

Lisa Hinz:

First, we need to pay attention. One of the things that people often do is get so busy that they don't pay attention to what they're feeling, physically, mentally, psychologically, or spiritually.

We are so busy, and the pace of our life is so fast, that we don't slow down and pay attention to what we are feeling.

I think if we can establish a practice where we check in with ourselves, either at the beginning or the end of a day we get a good idea of what we are feeling and can address burnout early on. Also, I write in the Life Enrichment Model about transitioning routines. Transitioning from work to home. What is it that we do that signals, work is over, I'm going home, I can put my work aside. Or going to work, even better. I'm leaving my home. I'm putting on my armour, so to speak, for work. Can I check in with myself, take a minute to check in and say, am I looking forward to the work? Am I already starting the day a little bit exhaustion and dreading the work? How can I assess, either going or coming home from work, how I'm really feeling about it. And if I do intentionally check in with myself, then I'm much more likely to, early on, do something that can help me physically, emotionally, spiritually.

Figure 2: Self Care 2 - Life enrichment is founded on nutritious food, regular exercise, and time spent with friends

I think that because our time is so limited, we tend to not do those things that take time, to care for ourselves. Very basic things. So we eliminate physical exercise, which has so many wonderful benefits for us. We eliminate cooking healthy meals, again, a habit that has so many benefits. We get less sleep. All of these things degrade our health physically and then take a toll emotionally and cognitively. Each of these things, if we don't exercise or get enough fresh air, or we don't sleep enough, or we don't nourish ourselves with good food, all of them cause cognitive changes as well as mood and physical changes. So if we check in with ourselves and say, how am I really feeling? And what can I do in any of these small ways, I have to do them anyway – I have to eat anyway, I have to move a little bit anyway, I have to sleep.

How can I improve those aspects of my life so I have a little bit more, a little bit richer life, a little bit more room to have a rich life.

Maggie O'Neill:

Those things you mentioned, the sleep, the sleep healthy eating and the exercise, they fall by the wayside when you're overwhelmed and that advice is so useful. Have you got any more advice that you'd give to somebody who's really overwhelmed and doesn't know where to start

Lisa Hinz:

So I would say another way to start a self-care practice since we're artists and visual people is to create a pie chart with all the aspects of life in their physical, emotional, social, spiritual, intellectual. Make the slices large, small, colour them in different colours, to indicate how much energy we're spending in each area. This could be a little bit of a wake-up call if we look and see, I'm really not spending enough time with the spiritual or enough time with the physical. This inventory can be a first step towards change. We can make a regular assessment. Another way to do this is make a regular assessment of the aspects of work that we find fulfilling. And really think, instead of just, again, automatically doing the same thing. But really think about do the aspects of my work and my personal life really fulfil me, or should I make a change? I tend to do this at the beginning of each year. I take an inventory. I'm working here. I'm spending time doing this and that and all these other things. Do they still add fulfilment to my life? I was really surprised in 2017 when I realised that my teaching at that time didn't fulfil me anymore. Very surprised – and made a surprising, to myself, decision to stop that teaching position, take a break and start a different one the following year.

Maggie O'Neill:

You mentioned that you were able to work on your teaching to better balance aspects that were enriching for you, rather than non-enriching. Can you suggest ways that workplaces can better support people to do this, to integrate life enrichment practices. What sort of supports need to be in place to enable people to make those kinds of changes?

Lisa Hinz:

I think that workplaces have a responsibility to think about their employees as whole people, and whole people need attention to the physical, the intellectual, all these areas. So very, very basically they can make sure that their employees have a lunch break where they're able to actually eat in a calm fashion, not so quickly that it's not really a break, but that they take a break to eat, and then perhaps get some exercise and fresh air, and that they have a couple of other breaks during the day.

They can help their employees leave their work on time. If leaving on time is part of the work culture, employees will leave on time rather than spend extra hours at work. Managers can provide continuing education or training exercises or some sort of development opportunities where employees feel that they're learning something that helps them perform better on their job. They can provide good supervision and access to people in power so that their voices feels heard and they feel like they have agency. People appreciate being an integral part of an organisation rather than just feeling like a cog in the wheel. Their voice needs to be to be heard. So that's sort of the spiritual piece, ‘I matter’, or the psychological piece, ‘my voice is important’. So it's physical, it's intellectual. That's that training or continuing education piece. It's physical and emotional. It's all those things.

Maggie O'Neill:

And understanding that you're being heard, does that connect to the idea of mindful participation?

Lisa Hinz:

I think so, yes. And when we talk about mindful participation, it's so important, there's so much to say about being more mindful. And I'm using the term in a very Western adaptation of an Eastern term. But what I mean is putting your full attention to something. Rather than doing things in a way that's automatic or not intentional. If we do anything with more intention, it has the ability to fulfill us in the way that it's supposed to. So physically, if we really pay attention to how our muscles are moving and how we're expending energy, it helps us gain more from the physical exercise. If we mindfully participate in our in our relationships, if we really pay attention to the people in front of us and we're in the room with them, rather than with half our mind somewhere else, then those relationships tend to enrich us and we enrich them. This includes the clients that we serve. So anything that we do with more intention can enrich us more.

Maggie O'Neill:

Does overwhelm, does that distract us from mindful participation.

Lisa Hinz:

Yes, because if we're overwhelmed, that means we're always halfway thinking about all the things that we have to do, rather than really intentionally participating in the one thing that we're doing, yes. I've worked with many people who thought they had memory problems. And in fact, did not have memory problems, had attention problems. When they really ground themselves in the present moment, and typically that is done through the senses, if we see what's around us, feel the chair underneath us, smell the room and feel it and taste it – if we're really grounded in our senses, we're more likely to take in and remember the information that we’re given, rather than if we're overwhelmed and only halfway participating. Because we're thinking about everything we have to do rather than the one thing in front of us, then we're not likely to remember the information. When people are more mindful and intentional about each thing that they're doing, or each person whom they are meeting,  their memory problems disappear.

Maggie O'Neill:

Your research also highlights the power of Flow. Can you tell me a little more about that and how professionals can cultivate Flow in their daily lives.

Lisa Hinz:

Yes. So Flow is an interesting state of being in which we are focused on the present task and it's something that we're challenged by, but we're able to master it. There's an interesting balance between challenge and mastery. If we're too challenged and not able to master a task, then we're stressed. If we're not challenged at all, then we're bored. So we have to be challenged but masterful to be in Flow. And in that perfect spot of challenge and mastery, here our attention is focused because we have to meet the challenge, and in that wonderful, focused state of attention and enjoyment, our sense of time is altered. We're experiencing great satisfaction, punctuated with moments of peak joy. That is Flow and it leads to feelings of well-being that last throughout the day. If we can do more activities in which we find that we're challenged but masterful, enjoying whatever the activity is in front of us - it can be physical, it can be mental, it can be a psychological activity, an intellectual one, it really depends on the individual - but if we can spend more time in Flow, then we have much more well-being in our life in general.

Maggie O'Neill:

And an important element of enrichment and of achieving Flow seems to be setting boundaries. Can you tell me a little bit about how people can set and maintain boundaries without feeling guilty?

Lisa Hinz:

First of all, it's really important to know that compassionate people have good boundaries.

This comes from the research of Brené Brown (2015), who's written a lot of popular books about psychology. She studied people that are compassionate and found that they have good boundaries that means that they can say no to some things so that they can really fully, and she would say wholeheartedly, say yes to others. If we know that compassion doesn't mean saying yes to everything, then we can be more confident in saying no more to some things.

Another thing that we need to remind people is that compassion fatigue tends to be highest in new professionals, that is those who are within the first five years of beginning their career as a helping professional. And it's often because they don't say no to opportunities. They say yes because they're not sure what will lead to the career that they want or what will be the job that helps sustain them. Many art therapists, or many expressive therapists in general, have to cobble together a job working a little bit here, a little bit there, and a little bit in a lot of places. And so they say yes to so many things. Therefore, it's helpful to begin to realise what's enough and what you can say no to.

Also, one of the greatest misconceptions about self-care is that it's selfish, or self-centred, or self-involved, or self-indulgent. You know, all those negative self-words and that's because there's a misconception about self-care that it's about running away to take a bubble bath and eat chocolates and drink wine.

But real self-care is having a life that you don't have to run away from.

And self-care isn't selfish. It's self-preservation. We have to preserve our energy so that we can really give to the people that we choose to work with. And that does mean saying no to some people. And trusting that they will find the help that they need, whether it's an organisation that wants an expressive therapist or an individual who wants a counsellor, we have to trust that there are other people who can fill those needs and that we have energy only for a limited number of people, or places, or employments.

Maggie O'Neill:

I feel like that's such great advice for particularly early career professionals

Lisa Hinz:

Yeah, although I know, I really understand how hard it is to say no. At the same time, I often ask my supervisees, think about what you can say no to today. Even if it's a small thing. And feel what that feels like, because you're preserving health when you maintain your boundaries.

Maggie O'Neill:

If we talk a little bit about creativity. Could you talk a little about the role creativity in enriching life. Particularly for anybody who doesn't consider themselves creative.

Lisa Hinz:

I'm thinking about, in answering this question and talking about this in the book, I refer to Ruth Richards work on everyday creativity (Richards, 2014). And she talks about what she calls, I love this term, the “virtuous cycle.” Because we all know what a vicious cycle is, when something happens that's negative and it makes us feel badly about ourselves and it's more likely to have us thinking about negative things and we go down into a negative spiral. A virtuous cycle is absolutely the opposite; it’s when we engage in a hobby, or when we put things together in our life, ideas, or things, or something.

A virtuous cycle is when we put things together in ways that are new and useful for us.

Again, if we slow down and intentionally notice, “wow, I did something small but everyday creative today’ - that makes us feel good about ourselves. It gives us a little bit of agency to do something and notice something positive the next hour or the next day, and it builds a cycle, a virtuous cycle of increased feelings, increased self-satisfaction, and motivation to do the next good thing. So we don't have to be creative in an artistic way that means that we have a well-developed artistic talent in any form. It just means that we have to notice that each day we solve problems. We put things or ideas together in new ways that are novel, they're useful, they're helpful. And this is everyday creativity, not big C creativity, as the experts would call it, but small c or even mini c creativity.

Maggie O'Neill:

And can tending to our dreams assist us in this process of self-reflection and of growth.

Lisa Hinz:

I encourage everybody, supervisees and clients and everybody that I work with, to pay attention to their dreams because we know that we experience so many things in our day-to-day life that we can’t possibly process them all consciously. And our brain very wonderfully conserves that information. It mixes it up and it serves it to us in the form of a dream, which is a disguised form.

Dreams contain things that we need to pay attention to that we didn't fully process in our waking life.

So we think about what did our dream symbols or the words (often these are engaging plays on words or symbolic things) that our dreams are telling us - pay attention to this area in your life.

Dream tending does not mean that you have to analyse your dreams. It goes back intention. Just pay attention, especially to a dream fragment, or something that sticks with you from a dream. I remember I had a dream when my oldest child was going off to college that stuck with me. I dreamed that she was tied in a chair, and I had to find somebody to get her out of it. I had to get this woman called Sharon Powers to get her out of the chair. And so that's what stuck with me from the dream. It was a long dream, but that's what stuck, that little fragment. And I thought Sharon Powers, Sharon Powers, oh, sharing powers! In order for my daughter to become independent, to get out of being tied up, we had to share powers. The dream was a reminder, share power with your daughter as she's going off to university. You don't have to keep her tied up. So clues come from dreams that are powerful and interesting reminders about our lives.

Maggie O'Neill:

And I know that you're working on a second edition of your book Beyond Self-Care for Helping Professionals, expanding the Life Enrichment Model. Are there any areas of focus that you're particularly excited about that you're exploring at the moment?

Lisa Hinz:

Yes. I didn't include in the first edition the concept of awe, A-W-E. And I think that that is an area that is so, so,  interesting.

That when we are in the presence of something that is vast and large - larger than us and larger than life - that we can have a moment of personal transcendence where we might shift our perspective.

So sometimes our life's difficulties or whatever is right in front of us takes such a large amount of mental space or it takes a large amount of our energy , whereas if we have an experience of awe, and that could be just being in the presence of a sunset. Why is it that that beautiful orange sun going down fills us with a feeling that we're a small part of this world and there's something bigger and more vast around us? It does. And that experience can shift our perspective. It can shift our perspective of, my life's problems are so huge, to one of the world is really, really, really vastly bigger and my problems might be smaller than I'm making them out to be. So I think awe helps us have moments of personal transcendence that can shift our perspective in very positive ways.

And I think I'll also include information about glimmers. So they're both kind of positive, but one is very large and one is really small. And a glimmer has been characterised as the opposite of a trigger.  We typically think of a trigger as something that triggers a little bit of a negative memory or maybe a large negative memory in a physical, emotional, spiritual, or intellectual way.

We get triggered and remember something negative, whereas a glimmer, we get triggered and remember something positive.

And so if we, again, focus on these positive moments then our life is enriched. I do write about savouring in the first edition, that savouring positive experiences enriches our life rather than, again, mindlessly moving past them in a way that doesn't appreciate these small positive things. We can take 20 seconds to savour, to focus on a beautiful thing that we saw or remembered or tasted or felt or thought and that enriches our life in a very small way. Anyone can do it. We can all do it.

Maggie O'Neill:

Thank you so much for all of that. It's really fascinating and I can't wait to read more about it. Just to finish up, is there anything that I haven't asked you about that you'd like to mention, or if not, is there one thing that you'd like to leave us with about life enrichment?

Lisa Hinz:

One thing, I really don't want people to think that they have to create a list of things to do. I really don't want people to think that they have to add a bunch of activities or that this is a “to-do list” in any way.

I hope people take away from this that they're already doing a lot of things that are good for them, but if they do them with more attention and more intention about what they're doing and how they're doing it, their life will be enriched.

They don't have to add a lot of different things, just make sure that what they are doing, they recognise and do with more intention. And also that self-care, as we just said, doesn't necessarily always have to mean adding more things to one’s life – it can mean subtracting things. Self-care can be saying no to things so that there's a balance in life that feels good. People so unique, that it's impossible to make blanket statements about life enrichment. Everybody must really think about their own life in a very personal way, and about how what they're already doing could be done with a little bit more intention. Only then they might notice that there is something that can be added. This is not a big to-do list, with having to create new habits and new things – that just gets to be similar to New Year's resolutions that fall by the wayside by mid February.

References

Brown, B. (2015). Daring greatly: How the courage to be vulnerable transforms the way we live, love, parent, and lead. Avery.

Handelsman, M. M., Knapp, S., & Gottlieb, M. C. (2002). Positive ethics. Handbook of positive psychology, 731-744.

Richards, R. (2014). A creative alchemy. In S. Moran, D. Cropley, & J. C. Kaufman, (Eds.), The ethics of creativity (pp. 119–136). Palgrave Macmillan.

Lisa Hinz

Lisa D. Hinz, PhD, ATR-BC is a licensed clinical psychologist and board certified art therapist.  She is an associate professor and director of the Art Therapy Psychology Doctoral Program at Dominican University of California.
Dr. Hinz is the author of many professional publications and three books on art therapy including Expressive Therapies Continuum: A Framework for Using Art in Therapy. She is working on a second edition of her book, Beyond Self-Care for Helping Professionals: Expanding the Life Enrichment Model which builds upon her interests in self-care and lifestyle medicine. Dr. Hinz maintains a private practice in St. Helena, California.
Dr. Hinz is a Visiting Professor for the MSc Art Psychotherapy training at the Belfast School of Art, Ulster University.