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major theme of this book is personal responsibility. We are personally responsible for our ethical decisions, our actions, and the times we choose to remain silent and do nothing. We cannot hand over responsibility for what we do or fail to do to an ethics code, our colleagues, our government, our employer, an insurance company, a managed care organization, a professional association, or any other source outside ourselves. Ethics is an active process that involves increasing awareness and constant questioning. Few of us can engage in this process effectively if we are personally drained, overwhelmed, or demoralized. Self-care is crucial.

We strongly recommend creating strategies for self-care as early as possible in your education, training, and practice. Neglecting self-care early on can drain the enthusiasm, joy, resilience, and meaning out of a career, sometimes interfering with the therapist's ability to practice ethically. It can lead to discouragement, compassion fatigue, and burnout.

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