Therapeutic failure, stress and burnout
Posted Apr 27, 2016
A recent survey by the British Psychological Society found that 46 percent of psychologists and psycho-therapists suffered from depression and 49.5 percent reported felt they were failures. The overall picture is one of burnout, low morale and high levels of stress (70 percent) and depression in a key workforce that is responsible for improving public mental health.
Since American psychologists are treating the same general public with the same mental issues, it would not be surprising to find similar high rates of depression and feelings of failure. (The most recent major American survey published in 1994, found 61 percent of psychologists clinically depressed and 29 percent with suicidal thoughts.)
Feelings of failure and depression may go hand-in-hand, since life satisfaction is closely tied to how we feel about our workaday lives. High levels of stress and burnout, on the other hand, may relate more to the lack of adequate funding for mental health services—both in the U.K and U.S.
Blaming oneself for failure to improve the lives of clients doesn’t come easily, it’s much easier to blame the client as not being ready for change. Yet, the responsible therapist will continue to feel failure for being unable to overcome resistance and improve the lives of clients. The depressed therapist can be as much a victim of circumstances, as having willfully taken on a noble profession that has few rewards.
But, rather than the therapist’s blaming his or herself for therapeutic failures, it may be time to pull back and ask why therapeutic protocols over the past 50 years have failed to prevent and treat mental disorders, while continuing breakthroughs have been made in a multitude of physical illnesses. In spite of President Kennedy’s championing the Community Mental Health Movement, public mental health has not significantly improved over the intervening years. The prevalence of depression has actually doubled in cohorts born since World War II.
We are currently stuck with the so-called “evidenced-based” protocols. According to a 2012 meta-study undertaken for Health and Human Resources, the rates of failure for Cognitive Behavioral Therapy (CBT), the foremost evidenced-based therapy, ranged between 13-36% for treating depression, 31-36% for anger and aggression, and 54% for anxiety. Actually, the failure rates were even greater, since only those with higher response rates were likely to be published.
A meta-study undertaken at the New York University School of Medicine in 2015, found the failure rate for Cognitive Processing Therapy (a version of CBT) was 51% for veterans diagnosed with PTSD. Moreover, two-thirds of those who benefitted from Cognitive Processing Therapy retained a significant PTSD diagnosis following treatment.
The problem is that the etiology of depression is not well understood. Cicero, in the first century B.C., postulated depression was the result of rage, fear, or grief. Freud held the view that depression was the result of suppressed anger, turned inward. CBT cites the cause of depression as its symptoms, a logic incompatible with medical causality.
Of even greater concern than the lack of a credible etiology has been the institutionalization of our evidenced-based protocols, whereby insurance carriers, colleges, and government research centers are all on the same page, refusing to consider research studies for promising alternatives. And even worse is that psychologists are not required to undergo psychotherapy, while in training, before licensure. As a result, we have therapists' dogmatic reliance on training manuals, preconceived notions and an inability to connect with their clients.
But the core issue is that we are currently stuck with an antiquated, ineffective, and inflexible therapeutic milieu that serves the mental health industry at the expense of practitioners and the public.
While the public will continue to suffer from the endemic failures of our present system, some Brits, at least, are willing to recognize that the problem of depression and the sense of failure among clinical psychologists do not bode well for improving community mental health, regardless all the hype on increasing the availability of mental health services.
This blog was co-published with PsychResilience.com