Where Do Mental Health Professionals Go When THEY are experiencing stress and mental health issues?

When mental health professionals experience stress

How mental health professionals deal with their own issues depends very much on their training and theoretical orientations. Initially psychoanalytic theory stated that countertransference or feelings towards the patient on the part of the analyst, were due to unanalyzed issues resulting from an incomplete analysis of the analyst. In English, this means that the therapist still had unresolved issues which were in danger of derailing the analytic stance, essential to understanding the patient.

Using this paradigm, therapists were to assume an analytic attitude, which is a neutral, objective stance focused on attempting to analyze and interpret the patient's defenses in order increase access to unconscious material. The focus is supposed to be completely on the client's process and feelings, so any strong feelings/associations on the part of the therapist were assumed to be irrelevant distractions to the objective focus on the client.

Later psychoanalytic therapists, namely the ego therapists, object relations and interpersonal therapists focused much more on the interaction between the client and the environment as being the primary determinants of people's reactions and behaviors. In this paradigm, these same strong feelings/associations are treated as potentially valuable information about the client and their process and are often used therapeutically.

As you can imagine, these groups had very different attitudes towards the therapist's own therapy. The original psychoanalysts placed great emphasis on the training analysis which all therapists must undergo in order to become analysts. This was supposed to be an in depth, extensive therapy in which all the potential analysts unresolved issue were brought to the fore and dealt with. Once these issues were dealt with, the analyst would no longer have their perceptions skewed by their own experiences and issues. In other words they would be able to provide the solid, objective, analytic space needed by their clients.

Having issues once you were already an analyst was pretty much a no-no and seen as evidence of the analyst's own unsuccessful therapy. Pretty rough when you're having a hard time and it's also your fault.

Compassion fatigue

The ultimate double bind

So, as you can see from the above, how the mental health professional was trained will significantly impact their tendency to seek treatment themselves and whether they see their own treatment as primarily reparative or ongoing and growth producing.

Many psychology training schools require a certain amount of personal psychotherapy for everyone enrolled in their program, with the idea being both to help resolve unresolved issues of the therapist and to give insight into the experience of being on the other side of the couch, so to speak. In this way, personal psychotherapy can help a new therapist both learn how being in therapy feels as a patient and have a (hopefully) solid and seasoned practitioner as a mentor to develop their own therapeutic skills.

From this view, it seems almost incomprehensible that any therapist would not seek ongoing therapy, but there is a surprising amount of stigma attached to getting your own treatment in the mental health world. Although most therapists will have had their own therapy at some stage - and I would recommend asking your potential therapist whether they've had their own treatment experience- many still follow the first type of thinking, seeing psychological growth as a finite attainable goal, rather than something that involves lifelong practice and learning.

This view really puts the therapist in the unenviable position of having to appear as though they had no issues, which is ridiculous, while at the same time, encouraging their clients to engage in treatment. This type of thinking also has a subtle has a subtle smugness and reinforces the expert-client relationship as well as being hugely hypocritical. Essentially the therapist has to ignore or deny any indication of psychological distress or conflict to seem healthy when the only healthy thing to do is to acknowledge and explore the conflicts - and what does that model to the client.

Much like in parenting, the therapist is often placed in the position of modelling more appropriate behaviors for the client, it's part of how we learn new behaviors, just like kids imitate their parents. So, the therapist not only helps to contextualize and problem solve with the client, but in doing this, they are providing concrete examples of these skills, which is a very important part of therapy.

One of the most important therapeutic factors in a therapist, aside from empathy is transparency and honesty. Many people come to therapy having been hurt and let down by others. Part of what makes therapy a unique and healing intervention is that the therapist is different from the person's previous experiences. The novelty of this relationship provides hope that they is something different out there in the world and the potential for change in one's self and relationships. The client has to know that the therapist has their best interests at heart (and this is different from just saying nice things - sometimes things in your best interests are not comfortable) and is a consistent, stable presence. Just like in parenting, if a parent says "no" and then gives in the moment the child throws a fit, the child learns that "no" really means "you'll have to work a little harder for this one".

So, from this perspective, having one's own ongoing consultation, support and therapy is really invaluable and part of what makes therapy work. Therapy is not a one way street, part of what makes therapy such a unique, powerful and moving experience is that as a therapist you learn as much from your clients as they learn from you - as they grow, so do you.

Dealing with burnout - Stress management

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Therapist burn out

One of the worst effects (aside from terrible stress management skill modelling) of the dichotomy we have talked about and the stigma around mental health treatment is it's gnawing away at resilience and a person's natural draw towards healing. Everyone has issues, it's really how we deal with them that makes the biggest difference - and if that's part of what people come to therapy to learn, shouldn't therapists model good mental hygiene.

One of the biggest flaws in our medicalized model of thinking, is that there is little room for a person's natural tendency towards growth and development. The medical model focuses on deficits and pathology, which have their place, but are really more part of a reactive system. When we use this type of thinking and system, we don't intervene until something is wrong. But by this time, some damage has already been done.

What follows from this in a system is that the squeeky wheel gets the grease, in other words, people do not react until there is a crisis. Aside from now having to expend twice as much energy to both contain the crisis and mop up the damage, it's a terrible modelling for people. It gives the message - don't try and help yourself, deny and ignore symptoms until they become really bad, then we'll intervene. Unfortunately much of our mental health system is like this, and becoming more so.

Another side effect of this approach is therapist burn out. Generally speaking therapists are the helpful sort and really do want to make things different. The reality of our HMO world is that things are really money driven - either with billable hours or service limitations. Can you imagine if we said to someone who needed a triple bypass - you have x amount of hours to get this op done, if we run out of time in the operating room, bummer for you, we have hour limits for this type of disorder, yet mental health sessions are routinely (yes, even after mental health parity) being limited or charged at a higher rate than physical health sessions. The effect of all these and many other factors on many young therapists is disillusionment, frustration and anger. On top of this, therapy is obviously a very emotionally involved profession and with fewer and fewer sessions allowed, clinicians caseloads are dangerously high. In this situation, again it's the squeeky wheel and the clinician ends up running from crisis to crisis, putting out fires and jerry rigging interventions.

Aside from the obvious danger of potentially missing an important symptom in the clients, this leads to a constant cycle of not ever being able to do things quite right - and for many therapists, being the somewhat perfectionistic type this is oul destroying. You undergo extensive and rigorous training in assessment, diagnosis and treatment, only to be told by someone in the accounting department that you need to get this issue under control in a week and a half when you know it needs 2 months of work.

Of course, the other side of this is that many people don't get better or could be functioning even better with appropriate diagnosis and treatment. Again, back to the triple bypass, if a doc says that's what you need, no one (usually) says "well, that's kinda expensive & it would be better if you could just do with a single bypass" All of these stressors, impossibly high caseloads with clients who could and should be doing better, and a system which focuses more on the bottomline than the best treatment for the client lead to a cycle of disillusionment, depressive symptoms, social withdrawal, anger, feelings of hopelessness and ineffectiveness by the therapist and a pervasive negative worldview known as burn out.

When a therapist is burnt out, they struggle to maintain interest in their world, may show impaired concentration, decreased motivation, negativity, hopelessness and a resigned attitude. Needless to say, given the importance of modelling in therapy, this is not a great thing for the client. The therapist may become distracted or have trouble following the client's story, forget about important issues or to follow up on something, feel sad, overwhelmed and struggle to maintain professional boundaries and competence. In this case, one would really hope you had a therapist who was conscientious about their own mental health and able to recognize when their own issues were interfering rather than denying they were struggling.

What much of the current research is showing, is that building resilience, early intervention and preventive measures are generally a good idea in almost all areas of medicine. Following from this newer model, is a focus on identifying weaknesses/areas of conflict and proactively helping the person develop skills in that area.

Comments 7 comments

Mike360 profile image

Mike360 7 years ago from The Milky Way

Where do MH professionals go when stressed? On vacation.


dr c profile image

dr c 7 years ago from San Francisco Bay Area Author

Wouldn't that be nice, huh? :)


Nordy profile image

Nordy 7 years ago from Canada

I applaud you and your hub dr c, you have encapsulated in your hub the very problem in the ethos of mental health systems worldwide! Having worked in the NHS (UK) and under Canada's so-called enviable medicare system, I can tell you that things aren't much different abroad. What I have found is that different sectors of the mental health systems have variable attitudes towards this issue - i.e. psychoanalysts working in the system of course endorse the idea of therapists having their own therapy. Some I know have had perhaps too much! But on the other end of the spectrum, some clinicians (i.e. nurses, social workers, OTs, etc) are expected to 'shut up and get on with it'. These being the people whose client contacts aren't limited to once or even twice weekly sessions, but sometimes have daily contacts, and in addition to helping those clients to manage their issues, they are also managing their whole life - housing problems, family problems, money (and helping to fight the DSS to get it in the first palce), etc. The onus is a huge one, and it is laughable that in this day in age we still see it from an us-and-them perspective, as if we are somehow immune to the superbug known as mental illness. I think the real crux of the issue is money. If the therapists need to start having therapy, then who pays for it? And when the system is already taxed and cannot provide the full service to the client, it certainly doesnt give a damn about the clinican. Sorry, not jaded, just calling it like I see it!

Well done again, a very well-written and fascinating hub!


dr c profile image

dr c 7 years ago from San Francisco Bay Area Author

Thank you so much for your comment. Having seen multiple health systems, your perspective is invaluable - and the issue of mental health access in general is becoming a larger and larger issue. Thank you for your thoughts


donotfear profile image

donotfear 6 years ago from The Boondocks

As a crisis screener (QMHP) for Crisis Services I relate very well to this subject. Fortunatley for me, I'm on a team of very supportive individuals. My supervisor tells me "if you need to sit & boo-hoo, go ahead. I'll listen..." We all recognize that our jobs are of a sensitive & serious nature. I've found that when I feel depressed, angry or hurt, going out to see a client in crisis is rejuvenating for me. We see the client in the peek of the crisis. First responders, more or less. We complete our assessment, consult with doctors, then make a recommendation. During the assessment, I use active listening, compassion, & encouragement to help my client through the crisis. This in itself brings my thought totally to the individual & their needs. I love my job. It's not like a job, it's a healing ministry for me. We aren't counselors, we are crisis intervention. It gets difficult....but the overall reward from helping somebody on the cusp of suicide is worth it all. It's healing. Finally, I can say that we as mental health professionals can go to the same professionals as anyone else. Thank God for it.


megni profile image

megni 4 years ago

One of the ways mental health could be more successful is somehow seeing mental health workers as people with problems the same as everyone and are successfully dealing with them and therefore are in a good position to help others.

It probably amounts to the false assumption by those in treatment that therapists are not to have problems. Once this thinking has been adjusted, and they begin to see their therapists as people with the same kinds of problems as they are experiencing, to a degree of course, won't this give them hope?

We're all different and are subject to our own peculiarities and seeing others viewpoints about touchy subjects such as this one will be helpful. Psychiatrists and other mental help workers must have an empathy for those suffering and they've gotten this from looking inside at the world through their own inward vision. Why should it be hidden?

I am saying these things because I devote my writing to helping others and needless to say, my desire to become mentally healthy was not a gift from above I was born with, it has been hammered out elsewhere. Along the way I've learned that society is not always right not because it dosen't want to be, but because it still has lessons about life to learn. And helping other with what we've learned is a first step.

Thank you for your insightful article.


dr c profile image

dr c 4 years ago from San Francisco Bay Area Author

Thank you for your response.

I agree with you that it's unrealistic to see mental health professionals as not having problems - whose general practitioner has not become ill from time to time ? I also agree that having difficulties of one's own certainly helps to understand another's perspective - and to develop coping skills!

Thank you for reading the hub, and taking the time to write, I'm glad you enjoyed it.

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