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.
- Stress Management Techniques, Stress Relief & Stress Reduction from Mind Tools
A great site with information and tips on everything from anger and stress management to improving your memory.
- Tips to de-stress
De-stressing tips and techniques
- Stress Management for the New Millennium
Learn to recognize signs of acute and chronic stress that signal job burnout. Describes the symptoms of burn out, techniques to deal with burn out and resilience promotion.
- Optimal Health Concepts: A Health Education-Health Promotion Consultancy
This Website includes pages on stress management and emotional health, finding health information, worksite health promotion, consulting and a variety of related topics.
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.
Therapist burn out resources
Dealing with burnout - Stress management
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resources and references
- Secondary Traumatic Stress, Compassion Fatigue and Counselor Spirituality: Implications for Counselo
Article exploring this concept and reviewing the literature in this area.
- Compassion fatigue
Link to a longer, more academic article exploring this topic.
- Compassion Fatigue Awareness Project
A site dedicated to awareness of compassion fatigue. Resources for all aspects of prevention and healing.
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.