In nearly 30 years of work in the mental health field, the most pervasive and destructive common barrier I have observed to the mental health and overall health of women is the idea that women’s needs simply do not matter — at least not as much as the needs of others, such as family, friends and community.

During these years, some of the overt messages given to girls and women in our society and in the families I treat have improved regarding the worth and choices for women. Yet, the struggle to understand and embrace the goodness of taking care of oneself and caring for other people without sacrificing one’s own well-being remains a daily conversation with my clients. The anecdotal evidence of my clinical practice certainly includes men who also wrestle with an idea that it is wrong to take good care of oneself and right to exclusively care for others. For example, some men have been taught to measure their worth solely by rigid evaluations of their role as a “provider.” For these men, there are surely similar and quite dissimilar issues involved so I will leave that consideration for another time.

Interestingly, I have noticed two versions of this barrier to self-care for women. Predictably, the first version is an adherence to the lingering message that goodness for a woman is measured by her self-sacrifice. She has internalized this “rule” and usually feels guilty if she considers breaking it. Conversations with women who agree will often include worries about being what is often deemed as “selfish” for taking time for basic needs, such as sufficient sleep, exercise, nutrition, relaxation, fun or self-fulfillment.

When asked about the women in their family, these kind, tired and worried women often speak lovingly about mothers and grandmothers who sacrificed their own health and happiness for their family. They strive to live up to those examples, or they speak with resentment or hurt about those who neglected the health and wellness of their family and they strive to avoid those mistakes. These conversations are punctuated often with firm pronouncements of the impossibility for self-care or the rejection that she would ever be so “selfish” to take time for herself instead of to care for others, which results in an increasingly unmanageable work and stress load.

The second version of the barrier to self-care for some women is defiance or a rejection of any sort of “rule” about taking care of others or oneself.

As is common with either/or beliefs, defiance often comes first when the belief is rejected and the person experiences a lag of time between that rejection and adjustment to a meaningful and sustainable alternative. During the adjustment period, the defiance against the “rule” to care of others and sacrifice self often leads to a sort of pendulum swing reaction of defiance against caring for other people. This can lead to an internal backlash against caring for oneself, sometimes leading to isolation or impulsivity.

Women who struggle with this idea that they should not take care of themselves often focus on resentment toward people and systems that block her well-being, alternating with an intense focus on self-improvement at a pace that is unsustainable. This sort of pendulum swing is punctuated with assertions that no other options exist and is accompanied by a fatigue that also becomes increasingly unmanageable.

Destructive patterns of dismissing the importance of good self-care can be enduring and layered with both what is healthy and what drains health. It is important to be patient and to seek and accept support to identify and make these changes. Exploring the fundamental idea of self-care and relational care and the complementary connection of the two is critical to change this barrier to health. When it is confusing, it is often helpful to ask what you would advise your daughter or best friend to do for herself. That question usually cuts through negative beliefs about oneself and clarifies what is much healthier.

The journey of embracing the right and the responsibility of taking care of oneself — and of recognizing that happens in the context of healthy boundaries in relationships — can be grueling. This journey is one that is best made across a lifespan and is best done with love and acceptance for yourself and from others. Know that love — love of self and love of another — during a lifelong journey must include the practical kind that feeds nutritious food, sets and maintains good boundaries, respects dignity and remembers each person’s inherent worth.

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