Within the depth-psychology corpus, ‘Self Care’ occupies a contested and layered conceptual space. At one pole stands the Jungian archetypal formulation: Kalsched’s ‘self-care system’ names the psyche’s own protective—and potentially tyrannical—apparatus that emerges in response to unbearable trauma, an intrapsychic guardian that may imprison as readily as it shelters. This usage is entirely distinct from, and often in tension with, the behavioral-clinical sense developed by Khantzian and elaborated by Najavits, in which self-care denotes the concrete daily practices—physical, emotional, relational—whose deficit underlies both PTSD and substance abuse. Flores amplifies Khantzian’s developmental argument: impaired self-care in addicted populations is traced to failures of early parenting, leaving individuals unable to read their own somatic signals or assess risk. Dayton introduces a third critique: the cultural over-emphasis on self-care may inadvertently pathologize interdependency, eliding the fact that relational attunement is itself a form of care. Clayton, writing from a fawning-recovery perspective, repositions self-care as the reclamation of somatic and creative life after a history of chronic self-effacement. Across these divergent framings, the shared tension is between self-care as symptom-management and self-care as transformative re-inhabitation of the self.
the self-care system provides a fantasy that ‘makes sense’ out of suffering but splits the unity of mind and body, spirit and instinct, thought and feeling.
Kalsched argues that the psyche’s self-care system, while protective, ultimately perpetuates dissociation and psychopathology by dividing the personality into tyrannical persecutor and hidden victim-self.
, The Inner World of Trauma: Archetypal Defences of the Personal Spirit, 1996thesis
other facets of the self-care system are explored, especially its role as Protector, guardian, and sometimes tyrannical imprisoner of an anxiety-ridden child-ego.
Kalsched identifies the Jungian self-care system as a dual-natured internal structure that both preserves the personal spirit and, when unmodified, becomes a persecutory imprisoner blocking growth.
, The Inner World of Trauma: Archetypal Defences of the Personal Spirit, 1996thesis
Such disturbances in self-care also lead individuals to fail to be aware, cautious, worried, or frightened enough to resist or avoid behavior that is injurious or damaging.
Flores, drawing on Khantzian, presents self-care deficits in addicted populations as developmentally determined failures that compromise affect regulation, risk appraisal, and somatic self-knowledge.
, Group Psychotherapy with Addicted Populations An, 1997thesis
Khantzian (1985) has written about self-care deficits in substance abuse; Herman (1992) discusses it in relation to PTSD; and Trotter (1992) explores it in relation to the dual diagnosis of PTSD and substance abuse.
Najavits situates her clinical treatment of self-care within an established theoretical lineage linking self-care deficits to substance abuse, PTSD, and dual diagnosis.
, Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, 2002thesis
This emphasis on self-care may have created a few problems along with solving others. It may create the impression that we should be able to solve all of our problems internally.
Dayton critiques the cultural privileging of self-care as potentially fostering an illusion of self-sufficiency that neglects the relational and interdependent dimensions of psychological health.
, Emotional Sobriety: From Relationship Trauma to Resilience and Lasting Fulfillment, 2007thesis
This is the seductive aspect of the self-care system. As long as the insular world overseen by the diabolical part of the self-care system is maintained, everything is OK, except for the already noted chronic state of melancholy.
Kalsched illustrates the self-care system’s seductive homeostasis: it suppresses overt suffering while enforcing chronic melancholy and blocking the individuation process.
, The Inner World of Trauma: Archetypal Defences of the Personal Spirit, 1996supporting
a relatively simple behavioral task—to increase safe daily pleasurable activities and to decrease those that are unsafe—may require concerted work by the therapist, and also the discovery of complex belief systems inherent in PTSD and substance abuse.
Najavits demonstrates that behavioral self-care interventions in PTSD and substance abuse are more cognitively and emotionally complex than they appear, requiring excavation of deep belief systems.
, Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, 2002supporting
What matters is getting out of our brains and into our bodies, tapping into our creativity that feeds and regulates us in a way our to-do lists cannot.
Clayton frames somatic and creative engagement as the core of genuine self-care for fawning survivors, contrasting embodied regulation with the cognitive-behavioral task orientation that often substitutes for it.
, Fawning: Why the Need to Please Makes Us Lose Ourselves—and How to Find Our Way Back, 2025supporting
Bookending our actions can be helpful, too. This means taking care of ourselves both before and after we lean into new spicy territory.
Clayton proposes ‘bookending’ as a concrete self-care strategy for fawners, framing nervous-system regulation around challenging relational moments as integral to the unfawning process.
, Fawning: Why the Need to Please Makes Us Lose Ourselves—and How to Find Our Way Back, 2025supporting
Compassion promotes growth, while harshness prevents growth. You may think that harshness is ‘true’ or is a way to ‘take responsibility’—that yelling at yourself will change your behavior. But self-hatred is a cheap trick, an illusion.
Najavits argues that genuine self-care requires replacing internalized self-criticism with compassion, as punitive self-talk actively impedes recovery from PTSD and substance abuse.
, Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, 2002supporting
Have at least 1 hour of free time to yourself per day? … Do something pleasurable every day … Have at least one person in your life that you can truly talk to.
Najavits operationalizes self-care as a structured behavioral checklist encompassing physical, recreational, relational, and treatment-attendance domains for patients with PTSD and substance abuse.
, Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, 2002supporting
such ‘primitive defenses’ are equivalent to the dyadic self-care system—one part of the personality as a ‘progressed’ false self, located in the mind, with a regressed true self as its ‘client.’
Kalsched integrates Winnicott’s true/false self distinction into his self-care system framework, mapping the dissociated dyad onto the psyche’s archetypal protective structure.
, The Inner World of Trauma: Archetypal Defences of the Personal Spirit, 1996supporting
Each helper gains some inoculation to the corrosive effects of trauma work by deliberately defining and creating one or more meaningful and supportive communities that serve to broaden identity beyond that of ‘trauma helper.’
Courtois extends self-care to the therapist, arguing that community, consultation, and identity diversification are essential protective practices against vicarious traumatization.
, Treating Complex Traumatic Stress Disorders (Adults) supporting
Keeping your commitment is a way of respecting, honoring, and caring for yourself.
Najavits frames behavioral commitment to recovery tasks as an act of self-care and self-respect, linking follow-through to the patient’s internalized sense of self-worth.
, Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, 2002supporting
If you’ve been shortchanging your whole self for the sake of everyone else, this is where you start to reclaim it.
Clayton positions self-care as the active reclamation of subjective wholeness for individuals whose chronic fawning has eroded autonomous selfhood.
, Fawning: Why the Need to Please Makes Us Lose Ourselves—and How to Find Our Way Back, 2025supporting
To reduce unsafe self-nurturing, make sure the behavioral plan is extremely clear. Create an ‘airtight’ plan so that it will be clear whether or not patients were able to reduce the unsafe activity.
Najavits distinguishes safe from unsafe self-nurturing, treating the latter as a clinical target requiring specific behavioral contracting within trauma and substance abuse treatment.
, Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, 2002supporting
Self-Soothing Techniques, within the context of DBT, refer to a set of strategies and practices that
Scott introduces DBT’s self-soothing techniques as a related but distinct skills cluster from self-care, emphasizing sensory-based regulation for emotion dysregulation.
, DBT Skills Training Manual: Practical Workbook for Therapists, 2021aside
the importance of self-awareness for survivor therapists who may overidentify, then respond to clients’ experiences in ways that are countertherapeutic and potentially hazardous for them.
Courtois addresses therapist self-care implicitly through the lens of self-awareness and supervision as defenses against vicarious traumatization and countertherapeutic overidentification.
, Treating Complex Traumatic Stress Disorders (Adults) aside
Fresh air, birdsong, communing with the forest—all of this is shown to lower our levels of cortisol, the stress hormone.
Clayton grounds somatic self-care practices in physiological research, citing nature exposure, movement, and expressive arts as evidence-based regulatory strategies for trauma survivors.
, Fawning: Why the Need to Please Makes Us Lose Ourselves—and How to Find Our Way Back, 2025aside