Should Therapists Have a Therapist? Yes, Now More Than Ever

Being exposed to the same stressors as our patients takes a toll.

Posted May 24, 2020

“Doctors make the worst patients.”

...or so the saying goes. While current data about what percent of mental health professionals seek therapy for themselves is not available (a famous study involving psychologists by Pope and Tabatchnik dates back to 1994), multiple barriers to doing so are easily identifiable. Stigma, shame, as well as the darker side of values such as selflessness and stoicism (see below), are only a few.

In addition, the longer the current COVID-19 pandemic lasts and the higher its death toll, the more prominent the need for mental health services will become. In turn, this may create a situation in which the demands on mental health professionals’ time are at their peak, while their exposure to secondary traumatic stress is increased.

Yet the American Foundation of Suicide Prevention has warned that physicians are not only more susceptible to high degrees of distress; they're also less likely to seek help. They warn that suicide risk for physicians (including psychiatrists) prior to COVID-19 was 1.5 to 2.25 times higher than the general population. 

In a study from 2011 based on APA data, Kleepsies and colleagues (2011) concluded that psychologists, too, are at an elevated risk for suicide. An earlier report (Gilroy et al., 2002) had found that 62 percent of the participating psychologists identified themselves as depressed. These trends may be changing for the worse, as we have seen in recent months in the highly-publicized suicides of healthcare professionals.

A combination of several factors, including exposure to traumatic stress, the mental health needs of society as a whole, and the unwritten code of ethics of healthcare workers, may compromise therapists’ own mental health and ability to seek help. It may be time, then, for therapists who have not yet done so, to consider therapy.

Need

A recent study conducted in China (Liang et al., 2020), where the outbreak began, sampled several hundred young people between the ages of 14 and 35 and found that 40 percent of them were experiencing psychological problems and 14.4 percent showed signs of Posttraumatic Stress Disorder (PTSD). For reference, the prevalence of PTSD among adults in the US general population is less than half that number (6.8 percent), according to the National Center for PTSD. Additionally, another study (Xie et al., 2020 ), published in JAMA Pediatrics, demonstrated that children living in confinement due to COVID-19 showed an increase in depressive symptoms.

On US soil, nearly half of adults have been reporting negative impact of COVID-19 on their mental health (Keiser Family Foundation poll), due to worries about contagion, stressors such as job loss, and being isolated from loved ones.  A recent New York Times article titled U.N. Warns of Global Mental Health Crisis Due to COVID-19 Pandemic, outlined the impact of being surrounded by death and disease on society as a whole. For mental health professionals, the increased need for their services coupled with the fact that we, as clinicians are also going through the exact same stressors of fear, isolation from loved ones, and uncertainty, means that mental health practitioners will be at a much heightened risk of burnout and secondary traumatization.     

Exposure

In a previous article (read here), I discussed how COVID-19 may become a moral injury pandemic for healthcare workers, and mental health professionals are likely to be on the front lines. For many health care providers in general, COVID-19 has created a situation, in which they have had to make life-saving and life-ending decisions, be separated from their families for prolonged periods of time due to caring for infected patients, or have felt dismissed and expendable to the institutions they work for.

For many counselors providing direct psychotherapy, the increased risk of exposure to trauma is also mirrored by another recent struggle: balancing, on the one hand, patients who are healthcare workers themselves, struggling with daily experiences of death and grief, and, on the other, patients who do not believe in the seriousness of the pandemic and who refuse to follow safety guidelines in public. Such a polarizing situation can create a certain amount of emotional turmoil. Yet in order to help our patients, we must remain caring and connected with ALL of them, and put personal opinions aside. As we would advise our own friends, this may best be done in the safety of our own therapist’s office.

The dark side of values

And last but not least, our consciously held values may create certain unconscious conflicts when it comes to self-care, seeking help when needed, and prioritizing our own mental health. As therapists, we pride ourselves in being able to endure significant emotional hardship, in being dedicated to improving the welfare of others, in being guided by certain moral code of doing no harm. We strive to constantly increase our competency and increase our skill in service of the above-mentioned virtues. However, during a prolonged crisis such as a pandemic, some unconscious aspects of these values can also cause us harm.

Selflessness, for example, can easily result in neglecting our own health. While caring for others’ well-being is a strength in our profession, selflessness may carry certain unconscious motivations, such as a belief that we are only “deserving” (of what, I will let each one of you decide in your own therapy) if we put ourselves last. Stoicism and mental toughness, on the other hand, can result in defensively failing to notice our own symptoms of distress. This, in turn, may result in secretively coping through increased alcohol consumption, isolation, disordered eating habits, which can also lead to shame and even further decrease our willingness to seek help. The value of excellence, on the other hand, may turn into intolerance of any imperfection or mistake, into self-criticism and feelings of shame.

While it may be true that our training can, to a degree, prepare us to better cope with emotional turmoil and stress, those of us who unconsciously more strongly subscribe to the darker side of these values, may have a harder time exercising the necessary levels of self-care during a particularly stressful time. As a friend used to say, you may be the strongest person on earth and bench press 400lbs, and there will come a time when the load will be 450lbs.

To learn more about why scientific research also suggests therapists should, at least at some points in their life, have their own therapy, tune in again next week. In “Should therapists have their own therapy? Science says yes.” I will explain how certain normative unconscious processes, such as implicit motivation and attribution errors, impact our professional identities as mental health professionals, and how therapy can remedy that.

References

Kleepsies, P. et al. (2011). Psychologist suicide: Incidence, impact, and suggestions for prevention, intervention, and postvention. Prof Psychol Res Pr., 42(3): 244–251.

Gilroy, P. J., Carroll, L., & Murra, J. (2002). A preliminary survey of counseling psychologists' personal experiences with depression and treatment. Professional Psychology: Research and Practice, 33(4), 402–407. https://doi.org/10.1037/0735-7028.33.4.402

Liang, L. et al., (2020). The Effect of COVID-19 on Youth Mental Health. The Psychiatric Quarterly, 21, 1-12.

Xie X, Xue Q, Zhou Y, et al. Mental Health Status Among Children in Home Confinement During the Coronavirus Disease 2019 Outbreak in Hubei Province, China. JAMA Pediatr. Published online April 24, 2020. doi:10.1001/jamapediatrics.2020.1619