Check out the numbers: According to studies published in 1990 and 1991, half of all therapists are at some point threatened with physical violence by their clients, and about 40 percent are actually attacked. Try to put this in context. A special, intimate relationship exists between therapist and client. So being attacked by a client is a serious emotional blow, perhaps comparable, in some cases, to being a parent attacked by one's child. Needless to say, therapists who are assaulted get very upset. They feel more vulnerable and less competent, and sometimes the feelings of inadequacy trickle over into their personal relationships.
Let's take this a step further. Imagine working with a depressed patient every week, without fail, for several years and then getting a call saying that your patient has killed herself. How would you feel? Alas, patient suicide is another hazard of the profession. Between 20 and 30 percent of all psychotherapists experience the suicide of at least one patient, again with often devastating psychological fallout. In a 1968 hospital study, psychiatrists reported reacting to patient suicides with feelings of "guilt and self-recrimination." Others considered the suicide to be "a direct act of spite" or said it was like being "fired." Whatever the reaction, the emotional toll is great.
Virtually all mental health professionals agree that the profession is inherently hazardous. It takes superhuman strength for most people just to listen to a neighbor moan about his lousy marriage for 15 minutes. Psychologists, of course, enter the profession by choice, but you can imagine the effects of listening to clients talk about a never-ending litany of serious problems -- eight long hours a day, 50 weeks a year. "My parents hated me. Life isn't worth living. I'm a failure. I'm impotent. On the way over here, I felt like driving my car into a telephone pole. I'll never be happy. No one understands me. I don't know who I am. I hate my job. I hate my life. I hate you."
Just thinking about it makes you shudder.
It's a Rough World Out There
Patients aren't the only source of stress for psychotherapists. The world itself is pretty demanding. After all, that's why there are patients.
A number of surveys, conducted by Guy and others, reveal some worri-some statistics about therapists' lives and well-being. At least three out of four therapists have experienced major distress within the past three years, the principal cause being relationship problems. More than 60 percent may have suffered a clinically significant depression at some point in their lives, and nearly half admitted that in the weeks following a personal crisis they're unable to deliver quality care. As for psychiatrists, a 1997 study by Michael Klag, M.D., found that the divorce rate for psychiatrists who graduated from Johns Hopkins University School of Medicine between 1948 and 1964 was 51 percent -- higher than that of the general population of that era, and substantially higher than the rate in any other branch of medicine.
These days, therapists face a major new source of stress: HMOs. Richard Kilburg, Ph.D., senior director of human resources at Johns Hopkins University and one of the profession's leading experts on distressed psychologists, says managed care is having a devastating effect: "Therapists are chronically anxious. It's getting harder and harder to make a living, harder to provide quality care. The paperwork requirements are enormous. You can't have a meeting of practicing psychologists today without having these issues being raised, and the pain level is rising. A number of my colleagues have been driven out of the profession altogether."
No wonder Richard Thoreson, Ph.D., of the University of Missouri, estimates that at any particular moment about 10 percent of psychotherapists are in significant distress.
The Final Resolution
Bruno Bettelheim. Paul Federn. Wilhelm Stekel. Victor Tausk. Lawrence Kohlberg. Perhaps you recognize one or two of the names. They're all prominent mental health professionals who, like Freud, committed suicide.
All too often the stresses of work and everyday life lead mental health professionals down this path. According to psychologist David Lester, Ph.D., director of the Center for the Study of Suicide, mental health professionals kill themselves at an abnormally high rate. Indeed, highly publicized reports about the suicide rate of psychiatrists led the American Psychiatric Association to create a Task Force on Suicide Prevention in the late 1970s. A study initiated by that task force, published in 1980, concluded that "psychiatrists commit suicide at rates about twice those expected [of physicians]" and that "the occurrence of suicides by psychiatrists is quite constant year-to-year, indicating a relatively stable over-supply of depressed psychiatrists." No other medical specialty yielded such a high suicide rate.
One out of every four psychologists has suicidal feelings at times, according to one survey, and as many as one in 16 may have attempted suicide. The only published data -- now nearly 25 years old -- on actual suicides among psychologists showed a rate of suicide for female psychologists that's three times that of the general population, although the rate among male psychologists was not higher than expected by chance.
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