1

Self-care and well-being in mental

health professionals: the mediating
effects of self-awareness and
mindfulness.
Richards, Kelly C.
Campenni, C. Estelle
Muse-Burke, Janet L
Journal of Mental Health
Counseling Publisher: American Mental
Health Counselors, July, 2010 Source
Volume: 32 Source Issue: 3

Because mental health

professionals are susceptible to
impairment and burnout that may
negatively affect clinical work, it is
ethically imperative that they
engage in self-care.
Previous research has found direct
effects of self-care on selfawareness and well-being (e.g.,
Coster & Schwebel, 1997).
Likewise, mindfulness has been
found to positively affect well-being
(Brown & Ryan, 2003). However, no
studies currently available
demonstrate a link between selfawareness and well-being.
Mindfulness may be the link needed
to support this association. A survey
of mental health professionals (N =
148) revealed that mindfulness is a
significant mediator between selfcare and well-being. Consequently,
mental health professionals are
encouraged to explore their
involvement in and beliefs about
self-care practices.
**********

According to the core ethical

principles of counseling, counselors
have a responsibility to do no harm,
benefit others, and pursue
excellence in their profession
(American Counseling
Association [ACA], 2005; American
Mental Health Counselors
Association, 2010). Mental health
professionals are susceptible to
impairment in their professional
lives that can undermine their
therapeutic efficacy (Coster &
Schwebel, 1997). Coster and
Schwebel find that mental health
professionals are vulnerable to,
e.g., vicarious trauma, substance
abuse, relational difficulties, and
depression. Therefore, to adhere to
their ethical principles, it is
important that counselors engage in
self-care (e.g., exercise) to
decrease the possibility of
impairment and enhance their wellbeing.
The present study explored the link
between self-care by mental health
professionals and their general wellbeing. Previous research has found
direct effects of self-care on wellbeing (e.g., Coster & Schwebel,
1997) and self-awareness (e.g.,
Mackey & Mackey, 1994); however,
no studies demonstrate a link
between self-awareness and wellbeing. This omission is interesting
considering that mindfulness, which
has been associated with selfawareness, has been shown to
have a direct effect on well-being

(e.g., Brown & Ryan, 2003). This

study therefore examined the direct
effect of self-care on self-awareness
and mindfulness and how these
associations affect the well-being of
mental health professionals.
What Is Self-care?
The literature reveals few attempts
at an operational definition of selfcare, and there is minimal
agreement among definitions. For
example, Pincus (2006) defined
self-care vaguely as something
"one does to improve [the] sense of
subjective well-being. How one
obtains positive rather than negative
life outcomes" (p. 1). Other
researchers have defined self-care
by describing activities believed to
constitute self-care. Carrol, Gilroy,
and Murra (1999) classify self-care
as including "intrapersonal work,
interpersonal support, professional
development and support, and
physical/recreational activities" (p.
135). With these definitions in mind
and after a thorough literature
review, some general themes in
self-care have been identified.
Researchers have explored
physical (Mahoney, 1997),
psychological (Norcross, 2000),
spiritual (Valente & Marotta, 2005),
and support (Guy, 2000)
components of self-care.
Physical. The physical component
of self-care has been loosely
defined as incorporating physical
activity (Carroll et al., 1999), which

in this context is characterized by

bodily movement that results in the
utilization of energy, which can
occur through exercise, sports,
household activities, and other daily
functioning (Henderson &
Ainsworth, 2001). The intensity of
physical activity and the amount of
time spent on it can vary
dramatically, but recommendations
from the U.S. Department of
Healthand Human Services and the
U.S. Department of Agriculture
(2005) suggest at least 30 minutes
of physical activity for most days
throughout the week is necessary to
receive benefits
Although there seem to be many
specific advantages of physical
activity (Dishman, 2003), it also
appears to have a general wellness
benefit. It has been shown to
decrease symptoms of anxiety and
depression (Callaghan, 2004;
Dishman). Further, Lustyk, Widman,
Paschane, and Olson (2004) found
that an increase in the volume and
frequency of exercise increased the
health component of quality of life.
For instance, physical activity has
been shown to increase women's
satisfaction with their body
functioning and their ability to cope
with daily stress (Anderson, King,
Stewart, Camacho, & Rejeski,
2005). Clearly, physical activity
promotes a general sense of wellbeing.
Psychological. Psychological selfcare refers to seeking one's own

personal counseling (Coster &

Schwebel, 1997; O'Connor, 2001).
Personal counseling can be defined
as psychological treatment for any
type of distress or impairment
(Norcross, 2005). Patterson (1966)
states that counseling is a process
"involving a special kind of
relationship between a person who
asks for help with a psychological
problem ... and a person who is
trained to provide that help" (p. 1).
Because counselors spend a
significant amount of time providing
services to others, it is suggested
that they themselves seek the
benefits of counseling.
Among the benefits found through
participation in personal counseling
is alleviation of symptoms of
distress and impairment (Macran,
Stiles, & Smith, 1999). Through
qualitative interviews with
therapists, researchers have also
identified other personal and
professional benefits (Mackey &
Mackey, 1994; Macran et al.).
Personal counseling supports
personal development by allowing
one both to understand how to care
for oneself and to develop an
awareness of one's boundaries and
limitations (Mackey & Mackey;
Macran et al.,). Professional
development, which is understood
as building awareness of skills that
can benefit one'scareer, has also
been demonstrated to be a result of
personal counseling. Because
empathy requires understanding of
another person, personal

counseling has been shown to

enhance counselors' empathic skills
(Mackey & Mackey; Macran et al.).
Given the personal and professional
development that results, it appears
that becoming aware of oneself is a
significant advantage of personal
counseling (Coster & Schwebel,
1997; Mackey & Mackey; Macran et
al.; Norcross, 2005).
Spiritual The spiritual component
of self-care also must be defined
loosely, given how broadly its
meaning can be interpreted.
Spirituality can be generally
described as a sense of the
purpose and meaning of life and
the connection one makes with
this understanding (Estanek, 2006;
Hage, 2006; Perrone, Webb,
Wright, Jackson, & Ksiazak, 2006;
Saucier & Skrzypinksa, 2006). This
definition is vague enough to
ensure that all beliefs of spirituality,
including religion, are addressed.
Behaviors sometimes considered
spiritual, such as meditation, may
also be included (Schure,
Christopher, & Christopher, 2008).
Boero et al. (2005) investigated
the spiritual/religious beliefs and
quality of life of health workers.
They found that spirituality plays a
significant, positive role in their
quality of life. Physical well-being,
such as health, was also found to
be significantly, positively
influenced by spirituality (Boero et
al.).

Mental health has been shown to

be related to spirituality (Wong,
Rew, & Slaikeu, 2006). It was
found that greater spirituality
reported by adolescents was
associated with more positive
mental health (Wong et al.). In
another study using qualitative
interviews, helping professionals
discussed their spirituality and its
benefits to them. It was reported to
promote not only quality of life but
also a sense of self-awareness
(Hamilton & Jackson, 1998).
Hamilton and Jackson suggest
that self-awareness is central to
developing and maintaining
spirituality; therefore, it might be
supposed that spirituality is
important for the development and
continued progression of selfawareness.
Support. The support component
of self-care includes the
relationships and interactions that
develop from both professional
and personal support systems.
Professional support is defined as
consultation and supervision from
peers, colleagues, and supervisors
and the continuation of
professional education (Coster &
Schwebel, 1997; O'Connor, 2001;
Stevanovic & Rupert, 2004).
Personal support is defined as
relationships with spouse,
companion, friends, and other
family members (Coster &
Schwebel; Stevanovic & Rupert).
Like personal therapy, support

from others can benefit personal

and professional development.
Koocher and Keith-Spiegel (1998)
suggest that mental health
professionals should participate in
routine professional
communications with colleagues to
reduce the possibility of burnout.
Through consultation and
supervision, it is possible to
recognize and understand
oversights and errors (Koocher &
Keith-Speigel; O'Connor, 2001).
Also, professional support can
help guide a counselor through
ethical and other clinical difficulties
with cases (Coster & Schwebel,
1997). Mental health professionals
surveyed indicated that
professional support was the main
reason for their well-being
because it gave them input into
various situations (Coster &
Schwebel). Because professional
development can occur through
professional support as well as
personal counseling, selfawareness may also develop from
such support systems.
Stevanovic and Rupert (2004)
surveyed licensed psychologists
about their career satisfactions
and found that it is important not to
use personal support for
professional stressors because
personal support provides different
benefits. Specifically, it satisfies
the common need to belong
because it establishes
relationships outside the
professional world. It therefore

provides a healthy balance in that

mental health professionals will
experience their lives through both
career and outside of work (Coster
& Schwebel, 1997; Stevanovic &
Rupert). This balance can help
prevent or alleviate symptoms of
burnout and mental exhaustion, or
becoming a workaholic. It has
been suggested that personal
support enhances psychological
well-being (life satisfaction and
mood) and physical health
subjectively and objectively (Walen
& Lachman, 2000).
What Is Self-awareness?
A comprehensive literature review
reveals minimal discussion of the
construct of self-awareness,
making defining it difficult.
Additionally, most of the research
that has examined self-awareness
is outdated. Brown and Ryan
(2003) suggest that it is simply
"knowledge about the self" (p.
823). Others suggest that selfawareness is awareness or
knowledge of one's thoughts,
emotions, and behaviors and can
be considered a state; therefore, it
can be situational (Fenigstein,
Scheier, & Buss, 1975). It is
believed to be similar to or
synonymous with other constructs,
such as self-consciousness
(Fenigstein et al.; Webb, Marsh,
Schneiderman, & Davis, 1989) and
insight (Grant, Franklin, &
Langford, 2002; Roback, 1974).
Because this study is exploring

self-care and its benefits, which

have been shown at times to be
self-awareness, it is important to
emphasize distinguishing selfawareness as a state. The
outcome of a behavior usually
tends to be a state; therefore, selfawareness may be a possible
outcome of self-care.
What Is Mindfulness?
Once again, definition is a
daunting task. Mindfulness has
only recently been introduced to
Westernized culture and there is
still uncertainty about its exact
definition. Researchers have a
consensus understanding that it is
maintaining awareness of and
attention on one's surroundings;
however, several models have
been proposed for a more precise
definition (see Bishop et al., 2004;
Shapiro, Carlson, Astin, &
Freedman, 2006; Sternberg,
2000). It has been suggested that
the practice of mindfulness may
facilitate insight, which can be
understood as awareness of
oneself and one's motives
(Rosenzweig, Reibel, Greeson, &
Brainard, 2003; Schmidt, 2004).
Because insight and selfawareness have been described
similarly, any connection between
self-awareness and mindfulness
should be explored.
Despite the suggested similarities
between self-awareness and
mindfulness, some researchers

have begun to identify subtle

differences. Brown and Ryan
(2003) believe self-awareness to
be "knowledge about the self" (p.
823), whereas mindfulness can be
understood as knowledge and
awareness of one's experience in
the present moment (Byrne, 2007;
Hirst, 2003). More specifically,
Brown and Ryan propose that selfawareness is an internal
awareness of one's cognitions and
emotions, and mindfulness is both
internal and external, being
awareness of both one's
cognitions and emotions and the
surrounding environment.
Mindfulness has been used as an
intervention for physical ailments in
the form of structured mindfulness
meditation instruction, known as
mindfulness-based stress
reduction (MBSR; Bishop, 2002).
Through this meditation, the
patient begins to develop an
understanding of the self and
ultimately an ability to regulate the
self (Bishop). The technique
teaches people to notice, accept,
and regulate their emotions and
thoughts (Bishop). MBSR has
been used successfully to reduce
stress (Rosenzweig et al., 2003)
and relieve medical illness
(Bishop; Kabat-Zinn et al., 1998),
psychological distress (Williams,
Teasdale, Segal, & Soulsby,
2000), and physical and emotional
pain (Roth, 1997).
Purpose and Hypotheses

Research has thus established

that mindfulness has a strong link
with self-awareness and well-being
(Brown & Ryan, 2003), and that
self-care has a direct effect on selfawareness (Hamilton & Jackson,
1998) and well-being (Lustyk et al.,
2004). However, it has not clearly
delineated the direct link between
self-awareness and well-being.
Although it appears that self-care
leads to well-being (Coster &
Schwebel, 1997), it has yet to be
determined if self-awareness
mediates the relationship between
self-care and well-being. If
mindfulness and self-awareness
are associated, and mindfulness
leads to well-being, it would seem
logical that there would be a chain
linking self-care to self-awareness
to well-being. This study explored
such links by examining self-care
practices, self-awareness,
mindfulness, and well-being in
mental health professionals.
The following hypotheses were
examined:
Hypothesis 1: A significant,
positive correlation between selfawareness and mindfulness will be
found.
Hypothesis 2: The path from selfcare to mindfulness to well-being
will be significantly stronger than
the direct path from self-care to
well-being.

Hypothesis 3: The path from selfcare to self-awareness to wellbeing will be significantly stronger
than the direct path from self-care
to well-being.
METHOD
Participants
The study surveyed 148 mental
health professionals holding a
bachelor's degree or higher and
practicing in the northeastern
United States. According to Cohen
(1992), based on the number of
variables used a minimum of 108
participants is required to achieve
power of .80 with an alpha of .01
and a medium effect size (r = .30).
The participants were 77.1%
women; the average age was
42.38 years (SD = 14.88); and
94.3% were White, 2.1% Asian
American, 2.1% Latino/Latina,
0.7% African American, and 0.7%
Native American. In terms of
educational level, the participants
were somewhat evenly distributed
(30.6% bachelor's, 41.7%
master's, 0.7% educational
specialist/ABD, 26.4% doctorate,
and 0.7% other). Their specialties
were in social work (43.3%),
counseling psychology (24.8%),
clinical psychology (23.4%), other
(7.1%), and general psychology
(1.4%). Participants reported that
they currently provide mental
health services, defined as seeing
clients for assessment, therapy,
and psychological testing in a

variety of settings; some

respondents worked in multiple
settings, including community
mental health center (15.5%),
inpatient hospital (5.4%), partial
hospitalization program (8.1%),
practicum/internship (12.8%),
private practice (40.5%), Veterans
Affairs clinic (0.7%), nonprofit
organization (2.0%), children's
welfare center (4.7%), university
counseling center (9.5%), and
other mental health setting (8.8%).
Average years in practice was 13.8
years (range = 0 - 40).
Measures
Self-care. Participants were given
a broad definition of self-care
("Self-care refers to any activity
that one does to feel good about
oneself. It can be categorized into
four groups which include:
physical, psychological, spiritual,
and support") and definitions for
the four components. They were
asked to indicate how often they
are involved in such behaviors
based on a 7-point Likert-type
scale ranging from "One or more
times daily" (0) to "Never" (6).
There were four questions, one for
each aspect of self-care. For
example, one item asked
participants to identify how often
they engaged in physical activities
(exercise, sports, household
activities, etc.). Since each
question was developed to assess
a component of self-care that is
independent of the others, inter-

item reliability could not be

assessed. Items were reversescored to produce final scores of
zero to 24. Higher scores indicate
greater propensity for self-care.
Participants were also asked to
indicate their views of the
importance of each self-care
component. They were again
provided with a broad definition of
self-care and the definitions of its
four components. They were
asked to indicate the extent to
which they agreed with each of
four statements pertaining to the
importance of self-care activities,
ranging from "Disagree Strongly"
(0) to "Agree Strongly" (6). The
possible final range of scores was
zero to 24, with higher scores
indicating greater agreement with
the importance of self-care. Again,
reliability could not be assessed
for this measure.
Self-awareness. The SelfReflection and Insight Scale
(SRIS; Grant et al., 2002) has two
subscales, self-reflection and
insight. Grant and colleagues
defined self-reflection (p. 821) as
"the inspection and evaluation of
one's thoughts, feelings, and
behavior" and insight as "the clarity
of understanding one's thoughts,
feelings, and behavior." The selfreflection subscale can be further
divided into the need for selfreflection and engagement in selfreflection, which have been shown
to be subcomponents but are not

separated out from the main selfreflection subscale (Grant et al.).

The SRIS consists of 20 self-report
items, to be rated on a 6-point
Likert-type scale ranging from (1)
"Strongly Disagree" to (6) "Agree
Strongly." Eight of the items are to
be reverse-scored. Possible
scores range from 20 to 120, with
higher scores indicating more selfawareness. Grant et al. report that
SILLS has high internal
consistency, with Cronbach's
alphas of .91 (self-reflection
subscale) and .87 (insight
subscale). The SRIS has also
been shown to have good sevenweek test-retest reliability with
alphas of .77 (self-reflection
subscale) and .78 (insight
subscale). Grant et al. found the
SRIS to demonstrate good
convergent and discriminant
validity in that both subscales were
not related to depression; the
insight subscale was not
correlated with anxiety,
alexithymia, or stress; and the
insight subscale was positively
related to self-regulation and
cognitive flexibility. Cronbach's
alphas for the current sample were
.78 (self-reflection) and .94
(insight).
Mindfulness. The Mindful Attention
Awareness Scale (MAAS; Brown &
Ryan, 2003) was utilized in the
present study to assess
individuals' levels of mindfulness.
The MAAS is a 15-item self-report
measure scored on a 6-point

Likert-type scale, ranging from (1)

"Almost Always" to (6) "Almost
Never." Possible scores range
from one to six, with higher scores
indicating greater propensity to be
mindful. Reliability was good, with
alphas ranging from .82 to .87.
During a test-retest analysis
(Brown & Ryan), the measure did
not produce significantly different
scores between Time 1 and Time
2, again indicating reliability.
Based on two different
confirmatory factor analyses
utilizing student and general adult
samples, the MAAS was found to
measure a single factor. Good
convergent validity has been
demonstrated in that this measure
was found to correlate with
emotional intelligence, openness
to experience, and wellbeing
(Brown & Ryan). Discriminant
validity was shown by a low
correlation between the MAAS and
self-examination, self-monitoring,
and neuroticism (Brown & Ryan).
Cronbach's alpha for the current
sample was .89.
Well-being. This study used the
Schwartz Outcomes Scale-10
(SOS-10; Blais et al., 1999) to
evaluate participants' well-being. It
consists of 10 self-report items
assessing psychological health
that are rated on a 7-point Likerttype scale ranging from (0) "Never"
to (6) "All of the time or nearly all
of the time." Possible scores range
from zero to 60, with higher scores
indicating greater psychological

health. Blais and colleagues report

that the SOS-10 has high internal
consistency, with Cronbach's
alpha >.90 over three samples. It
has also been shown to have good
test-retest reliability (r = .87)
across a one-week study with a
nonpatient population (Blais et al.).
Further, there were no floor or
ceiling effects found among patient
or nonpatient populations. The
SOS-10 was found to have high
convergent validity in that it had a
significant positive correlation with
positive affect, sense of
coherence, self-esteem, and
general life satisfaction (Blais et
al.). It also was found to have high
discriminate validity, as
demonstrated by its significant
negative correlation with negative
affect, hopelessness, fatigue, and
psychiatric symptoms (Blais et al.).
Cronbach's alpha for the current
sample was .88.
Demographics. The questionnaire
asked about age, gender,
race/ethnicity, educational degree,
field of study, and professional
practices.
Procedure
Two methods were used to mail
415 survey packets, including a
self-addressed, postage-paid
envelope. First, those identified as
mental health professionals under
the "Counseling Services" and
"Psychologists" sections of the
phonebook in northeastern

10

Pennsylvania were contacted.

Second, counseling and clinical
psychology graduate students who
were actively providing mental
health services were solicited
through personal contact with
training directors. Reminder
postcards were mailed one week
after the surveys. Completion of
the survey packet constituted
agreement to participate. The
return rate was 35.7%--148
surveys. The order of the
questionnaires was
counterbalanced to decrease
potential response bias; but the
questionnaire on self-care
importance was always last so
those responses would not
influence responses to the other
measures.
RESULTS
Before analysis the data were
screened using Mahalanobis
distance to assess for outliers.
This analysis identified three
multivariate outliers, which were
removed from the data.
Descriptive Statistics
The descriptive statistics for each
measure are found in Table 1.
Bivariate correlations were
conducted on all measures (see
Table 1). Self-care frequency is
significantly, positively correlated
with self-care importance (r = 0.34,
p < .001) and well-being (r =
0.228, p = .008). Self-awareness

was also positively correlated with

self-care importance (r = 0.325, p
< .001), well-being (r = 0.174, p =
.045), and mindfulness (r = 0.293,
p < .001). The connection between
self-awareness and mindfulness
supports the hypothesis that these
two constructs would be
significantly correlated.
Additionally, mindfulness (r =
0.179, p = .035) and well-being (r
= 0.208, p = .014) were found to
be positively correlated with selfcare importance, though the
associations were weaker. Lastly,
mindfulness was found to be
positively, strongly correlated with
well-being (r = 0.541, p < .001).
Mediational Analysis
According to Baron and Kenny
(1986), a mediational analysis is
used to assess the indirect effects
of one variable between an
independent and an outcome
variable. This model demonstrates
that a relationship may exist
between an independent and an
outcome variable, while an
additional variable (a mediator)
may be significantly correlated with
both. This mediator variable may
account for a significant portion of
the correlation between the
independent and the outcome
variables. The mediator, which
explains the "how or why" of a
relationship, may be described as
an "internal psychological" variable
that accounts for the relationship
between two "external physical"

11

constructs or experiences (Baron

& Kenny, p. 1176). An evaluation
of the indirect effects that exist
between the direct effects of the
independent and outcome
variables may weaken or eliminate
these direct effects.
Multiple conditions must be met to
conduct the mediational analysis
proposed by Baron and Kenny
(1986). A series of simple and
multiple regressions is conducted
to determine if these are satisfied.
The first condition that must be
met is the presence of a significant
relationship between the
independent and the outcome
variable. There also needs to be a
significant relationship between
the independent and the mediating
variable. Next, it is essential that
there be a significant relationship
between the mediator and the
outcome variable. Lastly, the
significant relationship between
the independent and the outcome
variable must diminish when the
effects of a mediating variable are
held constant. Baron and Kenny
reasoned that a "perfect
mediation" is present when there is
no longer a relationship between
the independent and the outcome
variable when the mediating
variable is held constant (p. 1177).
Self-care Importance, Mindfulness,
and Well-being. A mediational
analysis was conducted to assess
the indirect effects of self-care on
well-being. In the first step, it was

found that self-care importance

was significantly, positively
correlated with well-being (r =
.208, p = .014). In the second, it
was found that mindfulness was
significantly, positively correlated
with self-care importance (r =. 179,
p = .035). In the third, mindfulness
significantly affected well-being
when self-care importance was
controlled for ([R.sup.2] = .292,
F[1,137] = 56.594, p < .001, Beta =
.520, p <.001). Finally, it was found
that self-care importance no longer
accounted for a significant amount
of the variance of well-being after
the variance for mindfulness was
controlled ([R.sup.2] = .013, F[1,
136] = 2.496, p = .116).
A Sobel test was conducted to
statistically assess the significance
of the indirect effect of the selfcare importance [right arrow]
mindfulness [right arrow] wellbeing relationship. The results
were significant, z = 2.09, p = .036,
which supports the indirect effect
of mindfulness as a mediator
between self-care importance and
wellbeing (see Table 2 and Figure
1). This indicates that mindfulness
is a significant mediator of selfcare importance and well-being in
mental health professionals, a
finding that supports the
hypothesis that the direct effects
between self-care and well-being
are mediated by mindfulness.
[FIGURE 1 OMITTED]

12

Self-care Frequency, Mindfulness,

and Well-being. To assess
whether mindfulness is a
significant mediator of the
relationship between self-care and
wellbeing in mental health
professionals, first self-care
frequency was explored. In the
initial step of the mediational
analysis, self-care frequency and
well-being were significantly,
positively correlated (r = .228, p =
.014), but self-care frequency and
mindfulness were not (r =. 151, p =
.079), indicating that mindfulness
is not a significant mediator
between self-care frequency and
well-being. Thus the hypothesis
that self-care and well-being are
directly mediated by mindfulness is
not supported.
Self-care Importance, Selfawareness, and Well-being. In the
first step of the analysis of whether
self-awareness mediated the
relationship between self-care
importance and well-being, it was
found that self-care importance
was significantly, positively
correlated with well-being (r =
.208, p = .014). In the second step,
self-awareness and self-care
importance were significantly,
positively correlated (r = .325, p <
.001). The third step indicated that
self-awareness did not significantly
account for the variance in wellbeing when self-care importance is
controlled for ([R.sup.2] = .030,
F[1,137] = 4.115, p = .045, Beta =
.120, p = .183). Therefore, self-

awareness was not a significant

mediator in the relationship
between self-care importance and
well-being in mental health
professionals, refuting the
hypothesis.
Self-care Frequency, Selfawareness, and Well-being. To
determine if self-awareness is a
significant mediator of self-care
and well-being in mental health
professionals, self-care frequency
was found to be significantly,
positively correlated with wellbeing (r = .228, p = .014), but not
with self-awareness (r = 104, p =
.237), indicating that selfawareness did not significantly
mediate the relationship between
self-care frequency and well-being
and offering no support for the
hypothesis that the path from selfcare to self-awareness to
wellbeing is stronger than the
direct path from self-care to wellbeing.
DISCUSSION
The purpose of this study was to
examine the relationship between
mental health professionals' selfcare practices and general wellbeing by investigating the indirect
effects of self-awareness
(knowledge of one's thoughts,
emotions, and behaviors) and
mindfulness (awareness of and
attention to oneself and one's
surroundings). Some results were
consistent with the predictions, in

13

that self-care practices may have

both direct and indirect effects on
well-being.
As predicted, self-awareness and
mindfulness were found to be
significantly, positively correlated,
which is consistent with previous
studies (e.g., Brown & Ryan, 2003;
Wall, 2005). Although these
constructs seem similar and are
correlated, it is important to note
the differences between them.
Specifically, self-awareness is
considered to be knowledge of
one's thoughts, emotions, and
behaviors; mindfulness is
maintaining awareness of and
attention to oneself and one's
surroundings. Our results suggest
that when self-awareness
increases, so does mindfulness,
and vice versa. This adds support
for the relationship between selfcare importance, self-awareness,
and well-being because
mindfulness was found to be a
significant mediator within the
relationship.
Likewise, as hypothesized,
mindfulness in mental health
professionals was found to be a
significant mediator of the
relationship between self-care
importance and well-being.
Specifically, it appears that the link
between perceived importance of
self-care and well-being is
indirectly affected by mindfulness.
This suggests that, to receive the
full benefits of well-being from

perceiving self-care as important,

one must achieve a state of
mindfulness. Although few
previous studies discuss these
connections, the findings of this
study are consistent with past
research in that self-care
importance and mindfulness have
been shown to be associated
(Christopher, Christopher, Duncan,
& Schure, 2006), and mindfulness
and well-being have also been
found to be correlated (Brown &
Ryan, 2003; Rosenzweig et al.,
2003).
Further, because mindfulness is
considered to be a purposeful
state (Brown & Ryan, 2003;
Shapiro et al., 2006), it may be
that those who practice it believe
in its importance and value being
mindful, so that valuing of self-care
activities may influence the
intentional component of
mindfulness. For example, an
individual who values engaging in
self-care activities, such as going
for a nature hike, may also be
better able to practice mindfulness.
In addition, mindfulness is
considered to be a state of being,
rather than something individuals
do (Rothaupt & Morgan, 2007),
suggesting that belief in the value
and importance of self-care may
elicit a mindful state. These
individuals may believe that selfcare practices are important to
enhance their well-being. For
example, counseling students who
found value and importance in

14

self-care activities like yoga and

meditation reported feeling more
mindful and experiencing overall
growth and wellness (Christopher
et al., 2006). This indicates that
the link between mindful and selfcare behaviors, feelings, and
outcomes may be important.
Notably, mindfulness was not
found to be a significant mediator
of the relationship between selfcare frequency and well-being in
mental health professionals. This
suggests that the frequency of
participation in self-care activities
may relate to enhanced well-being
without necessarily requiring a
state of mindfulness. These
findings do not support the present
study's predictions. The fact that
there is minimal literature
connecting self-care frequency
and mindfulness is reinforced by
the fact that this study did not find
self-care frequency and
mindfulness to be significantly
correlated.
Although these findings did not
support the hypothesis, they have
important implications. Specifically,
the significant, positive correlation
between self-care frequency and
well-being indicates that increased
participation in self-care activities
is associated with increased
general well-being. These findings
are supported in the literature
(e.g., Boero et al., 2005; Coster &
Schwebel, 1997; Lustyk et al.,
2004), which suggests that an

increase in self-care activities

increases well-being. Moreover,
mindfulness does not influence the
effects in this relationship,
indicating that participation in selfcare activities is associated with
increased wellness, and
mindfulness may not indirectly
affect this relationship. This may
indicate that self-care activities do
not necessarily require awareness
of self and surroundings; rather,
the simple act of participation in
self-care behaviors influences
overall wellness.
The relationship between
mindfulness and well-being may
also be more complex than is
examined here. For instance, for
some individuals, mindfulness may
enhance well-being, providing a
sense of grounding and
perspective, while, it may cause
others to attend more astutely to
personal struggles and negative
aspects of their lives, causing a
decrease in wellness.
The fact that self-awareness was
not found to be a significant
mediator of the relationship
between self-care and well-being
suggests that self-care appears to
enhance one's well-being without
necessarily requiring a state of
self-awareness to intervene the
effects in the relationship. These
findings were the same for selfcare frequency and self-care
importance, which suggests that
the predictions of this study were

15

not supported. Nevertheless, selfawareness and well-being were

found to be significantly, positively
correlated, which suggests that
with an increase in self-awareness,
there is an increase in well-being.
When thinking about these
findings, it may be important to
consider the relationship between
self-awareness and well-being
independent of self-care. Although
research has so far found no link
between self-awareness and wellbeing, this may be an important
relationship. For example, insightoriented psychotherapy tends to
value the importance of insight and
awareness as a means of
enhancing mental health (i.e., wellbeing). Furthermore, though
previous studies seem to indicate
that self-awareness is enhanced
through self-care, the relationship
seems to be much more evident
for psychological and spiritual
aspects of self-care than for
physical and support components
(e.g., Coster & Schwebel, 1997;
Hamilton & Jackson, 1998;
Norcross, 2005; Valente &
Marotta, 2005).

(1976) discuss psychotherapists'

beliefs in the importance of
personal therapy, which influenced
their decisions to enter treatment.
Furthermore, self-care frequency
and importance were found to be
significantly, positively correlated
with well-being, which is consistent
with previous findings (Lustyk et
al., 2004; Schnauzer, 2006;
Valente & Marotta, 2005; Wong et
al., 2006).

Self-care frequency and self-care

importance were found to be
significantly, positively correlated.
This suggests that with more
frequent participation in self-care
activities, their perceived
importance rises, and vice versa. It
makes sense that individuals
participate in activities they value.
For example, Garfield and Kurtz

Mental health professionals'

frequency of participation in and
views of the importance of selfcare activities have been found to
be significantly associated with
their general well-being. In
attempting to understand how selfcare affects well-being, it was
found that mindfulness (awareness
of and attention to self and

Self-awareness was found to be

significantly, positively correlated
with self-care importance but not
frequency. This indicates that selfawareness may not be necessary
to participation in self-care
activities; however, awareness of
the importance of these behaviors
is key. Because self-awareness is
described as "knowledge about the
self," (Brown & Ryan, 2003, p.
823), it would seem probable that
self-awareness would enable an
individual to understand what may
be important, including activities to
better oneself.
CONCLUSIONS

16

surroundings) indirectly influences

the relationship between self-care
importance and well-being but not
the relationship between self-care
frequency and well-being. This
study also examined the role of
self-awareness (knowledge of
one's thoughts, emotions, and
behaviors) in the relationship
between self-care and well-being.
Although no significant effects
were found to explain selfawareness as an intervening
variable in that relationship, it was
found to be significantly associated
with self-care importance and wellbeing.
Limitations and Future Research.
This study had several limitations.
First, the sample may have limited
the findings. Because the surveys
were mailed, those who returned
them were self-selected. Any
differences between individuals
who returned surveys and those
who did not could not be
examined.
Social desirability may also have
limited this research. Because
mental health professionals help
their clients increase general wellbeing, they may have been
compelled to positively bias their
reports of participation in self-care
activities and overall wellness.
Determining what an individual
believes to be "'socially desirable'
depends on one's reference group"
(Kirkpatrick, 1993, p. 266). This
suggests that what some mental

health professionals consider

socially desirable may not be
considered socially desirable by
other groups. Therefore, it may be
appropriate for future research to
explore social desirability.
Moreover, most of the sample
were White women. This limits the
generalizability of the results to
that group. Page and colleagues
(1997) suggest that men and
women experience self-awareness
differently, which may also affect
the generalizability of the findings.
Future research should therefore
expand the sample to a more
diverse group.
The sample has other limitations.
For instance, participants reported
working within a variety of settings,
but there were too few participants
in each job setting for the groups
to be compared. The type of work
setting may have significantly
influenced reports of engagement
in and value of self-care, but
differences could not be assessed.
Additionally, participants were
graduate students, professionals,
or both, but were not asked to
specify their professional level.
Their status may also significantly
impact the reports of engagement
in and value of self-care. Thus, it
may be important for future
research to explore how work
setting and student/professional
status may relate to self-care.
Implications for Counseling

17

Practice. The results indicate that

the frequency with which mental
health professionals participate in
self-care activities and the
importance they place on them is
associated with overall well-being,
which suggests that self-care is
important to the functioning of
mental health professionals.
Indirectly mindfulness also affects
the relationship between self-care
importance and well-being, which
suggests that one who perceives
self-care as important will receive
the benefits of well-being after first
achieving mindfulness. However,
mindfulness may not be necessary
for mental health professionals to
achieve the benefits of actively
participating in self-care.
Counselors are responsible for
their own wellness and awareness
of the effects they may have on
their clients (ACA, 2005; AMHCA,
2010). Since they may be
susceptible to impairment in their
professional lives that has a
negative impact on their clinical
work (e.g., Coster & Schwebel,
1997), it is important for them to
adhere to practices to enhance
overall well-being. Counselors who
wish to maintain and improve their
personal wellness as well as their
professional effectiveness are
encouraged to explore their
frequency of involvement with and
perceptions of the importance of
self-care. They are also
encouraged to examine their state
of mindfulness, which may further

enhance their wellbeing. Like the

programs developed by
Christopher et al. (2006) and
Schure et al. (2008), counselor
training programs should explore
the utility of developing self-care
and wellness activities for their
students within the curriculum. If
self-care practices become part of
their training, counselors may be
more likely to participate and find
the value in self-care.
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Table 1. Descriptive Statistics and

Pearson Correlations for Current
Study's Scales
Pearson
Correlations
Scale
SCI

Mean (SD)

SCF

SKIS

10
SCF
15.38 (3.75) -SCI
20.77 (3.74) .335
*** -SRIS
94.35 (12.96) .104
.325 *** -Self-reflection 58.45 (10.75)
Insight
38.71 (5.47)
MAAS
4.28 (0.73) .151
.179 * .293 **
SOS-10
48.38 (7.25)
.228 ** .208 * .174 *
Pearson Correlations

Wong, Y. J., Rew, L., & Slaikeu, K.

D. (2006). A systematic review of
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Kelly C. Richards, C. Estelle
Campenni, and Janet L. MuseBurke are affiliated with Marywood
University. Correspondence
concerning this article should be
addressed to Kelly C. Richards,
Marywood University, Department
of Psychology and Counseling,
2300 Adams Avenue, Scranton,
Pennsylvania 18509-1598. E-mail:
krichards@m.marywood.edu.

Scale
10
SCF
SCI
SRIS
Self-reflection
Insight
MAAS
SOS-10

MAAS

SOS

-.541 *** --

Note. SCF = Self-care Frequency;

SCI = Self-care Importance;
SRIS = Self-Reflection and Insight
Scale (Grant et al., 2002);
MAAS = Mindful Attention
Awareness Scale (Brown & Ryan,

23

2003);
SOS-10 = Schwartz Outcomes
Scale-10 (Blais et al., 1999)
* p < .05

Analysis Three:
Step 1: Well-Being on Mindfulness
.520 **
Step 2: Well-Being on Self-Care
Importance
.013
.115

** p = .001

* = p < .05

*** p < .001

** = p < .001

Table 2. Mediational Regression

Analysis: Self-Care: Importance,
Mindfulness, and Well-Being

Gale Copyright:

R
[R.sup.2]
Analysis One:
Well-Being on Self-Care
Importance
.208

.043

Analysis Two:
Mindfulness on Self-Care
Importance
.179

.032

Analysis Three:
Step 1: Well-Being on Mindfulness
.541
.292
Step 2: Well-Being on Self-Care
Importance
.552
.305

[R.sup.2]
change
Beta
Analysis One:
Well-Being on Self-Care
Importance

.208 *

Analysis Two:
Mindfulness on Self-Care
Importance
.170 *

Cop
yrig
ht
201
0
Gal
e,
Cen
gag
e
Lear
ning
. All
right
s
rese
rved
.