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Abstract

  1. Top of page
  2. Abstract
  3. Background
  4. Methodology
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Objectives. This research aimed to expand the existing knowledge based on the effect of professional practise by providing qualitative data on the experience of distress among clinical psychologists working in Britain.

Design. Interview data were analysed using interpretive phenomenological analysis (IPA) – a systematic procedure designed to explore lived experiences which enables interpretations of meaning, cognition, affect, and action. IPA specifically enabled an interpretation of the sense participants made of personal distress as psychologists.

Method. Eleven chartered clinical psychologists (nine females, two males) participated in individual semi-structured interviews about their experiences of distress. Interviews lasted approximately 90 min and were either face-to-face or over the telephone.

Results. Analysis of interview transcripts identified 18 sub-themes organized into five master themes: (1) manifestation of distress, (2) making sense of personal distress, (3) role and affects of others, (4) experiences of help/support, and (5) using experiences of distress.

Conclusions. Distress manifested in various ways including clinical work and attitudes towards work. Personal attributions and meaning of distress mediated how this experience was conceptualized, perceptions/interactions with others, and subsequent help seeking behaviours. Experiences were positively translated into personal/professional behaviours. Implications were considered.

Practitioner Points

  • • 
    The paper presents research relevant to UK clinical psychologists and to trainers and employers of this group.
  • • 
    The data presented provides a useful insight into the perception of a sample of clinical psychologists regarding what it means to be a ‘good psychologist’ and the potential impact on their experience of personal distress and on help seeking behaviour.
  • • 
    The findings have potential relevance for individual psychologists, trainers, and managers of this group in considering how distress might be experienced and dealt with and could suggest specific questions for future research.
  • • 
    It is an example of an IPA study.

Background

  1. Top of page
  2. Abstract
  3. Background
  4. Methodology
  5. Results
  6. Discussion
  7. Conclusion
  8. References

While National Health Service (NHS) professionals experience high rates of sickness, turnover, and mental health difficulties (Williams, Michie, & Pattani, 1998), mental health workers are specifically at risk of experiencing distress. Research has suggested increased risk of depression (Gilroy, Lynne, & Murra, 2002) and suicide (Farber, 1983; Steppacher & Mausner, 1973) among psychologists. Other research suggests the therapeutic requirements of a clinical psychologist's job increases vulnerability to distress (Dunning, 2006; Moore & Cooper, 1996; Stevanovis & Rupert, 2004). Apparently clinical psychologists experience significantly high levels of distress related to physical illness, long clinical hours, professional pressures, poor organizational communication/management, professional self-doubt, and relationship difficulties (Cushway & Tyler, 1995; Deutsch, 1985; Gilroy et al., 2002; Guy, Poelstra, & Stark, 1989). This article will provide a brief overview of what existing literature has identified about psychologists in distress.

Impact of distress

According to self-report studies, psychologists felt their distress had a negative impact on the quality of care they provided (Guy et al., 1989) and their ability to remain psychologically present (Cain, 2000). Conversely, positive effects on clinical work included increased identification, alliance, empathy, patience, faith/hope, appreciation, and reduced stigmatizing attitudes towards mental health difficulties (Cain, 2000; Gilroy, Carroll, & Murra, 2001; Gilroy et al., 2002; McCourt, 1999).

Help seeking and disclosures

The Health Professions Council (HPC), as regulatory body, promotes ‘professional self-regulation’. It is the personal responsibility of the professional who has a duty to take action if mental health could affect fitness to practice (Ethics Committee of the British Psychological Society, 2009; Health Professions Council, 2008). The Division of Clinical Psychology (DCP) specifically makes it a professional obligation to seek appropriate support for personal distress (Division of Clinical Psychology, 2001). However, studies indicate not all psychologists automatically take action to address personal distress. Leiper and Kent (unpublished) found therapists were only prepared to report their distress to someone once it had become impairing. Most commonly reported barriers to help-seeking include fears about stigma (Cain, 2000), job security, mistrusting colleagues (Price, 2006), finding a ‘good enough’ person to help, dependency fears, personal prejudices (Walsh & Cormack, 1994; Walsh, Nichols, & Cormack, 1991).

Management

Common utilized strategies to address distress included seeing their GP (Thoreson, Miller, & Krauskopf, 1989), reducing client load, taking leave (Guy, 1987), medication (Guy et al., 1989; Thoreson et al., 1989), and use of personal therapy (Guy et al., 1989; Leiper & Kent, unpublished; Thoreson et al., 1989). Other self-care strategies identified as a means of resolving and preventing future distress included improving work/life balance, for example, increased individual leisure activities, time with friends and family (Cain, 2000; Cushway & Tyler, 1995; Stevanovic & Rupert, 2004).

Identity

Role Identity Theory (McCall & Simmons, 1978; Siebert & Siebert, 2007) provides a useful framework for understanding the complex interaction between internal and external role expectations for clinical psychologists. Individuals can be seen to construct a ‘role identity’ based on their social and personal identity. A psychologist's social role (e.g., role model of mental health, and helper) will be reinforced by society. However, individuals will also self-evaluate their professional effectiveness (‘role performance’), based on idealized self and personal expectations. As a member of the helping profession such personal expectations can be high (Kotler, 1993 cited in Siebert & Siebert, 2007) and may interact with professional expectations of ‘professional perfectionism’, for example, functioning under clinically high levels of psychological stress during training (Price, 2006), it could be argued that some psychologists may learn at this stage to marginalize their own emotional needs (Cushway, 1992; Walsh et al., 1991). Success or failure in achieving the expected role performance may dictate subsequent behaviours. Therefore, professional difficulties could to be perceived as a personal failure evoking negative feelings, and fears about loss of control, status, friends, clients, and career (McCourt, 1999; Perkins, 2002; Swearingen, 1990; Walsh et al., 1991; Walsh & Comack, 1994). This theory suggests that the threat to professional and personal identities hinders help-seeking, especially where colleagues are perceived as coping in their professional role (Walsh & Comack, 1994; Walsh et al., 1991).

Rationale

To date, the limited evidence examining reported experiences of psychologists in distress has been of a quantitative nature and mainly based on American therapists working during the late 1980s. This research aimed to qualitatively explore the personal accounts of a period of time experienced as distressing for practising clinical psychologists in Britain. It attempted to make sense of the meaning participants gave to their experiences of distress, therefore Interpretive Phenomenological Analysis (IPA) was considered as an appropriate analysis, as it attempts to examine a phenomenon from the participant's shared experience of it (Willig, 1964).

Methodology

  1. Top of page
  2. Abstract
  3. Background
  4. Methodology
  5. Results
  6. Discussion
  7. Conclusion
  8. References

Participants

Eleven chartered clinical psychologists (nine females) currently working in Britain, identified themselves, in response to an advert, as having experienced an unusually high level of psychological difficulty post-qualification (onset ranged from 1–8 years qualified) persisting for at least 4 weeks, and impacting on all major domains of activity, at a time when actively engaged in their clinical role. Multiple events were identified as the antecedents to the distress, for example, financial difficulties, moving house, illness of a partner, bereavement, pregnancy/baby, relationship difficulties, and work stressors. The nature of the distress also varied among participants, for example, grief, anxiety, depression, anger, bipolar. Six participants had received a mental health disorder diagnosis.

Interviews

A semi-structured interview schedule was piloted and subsequently used to conduct six telephone, and five face-to-face 60–90 min interviews.

Analysis

To interpret the sense which participants made of their experiences of distress, interview transcripts were analysed using IPA, a technique designed to examine how people make sense of their major life experiences. IPA was most appropriate to explore psychological processes determining and maintaining interactions (Smith, Flowers, & Larkin, 2009) between distress, disclosure, help-seeking, and issues of identity.

Social constructionist forms of analysis (e.g., Discursive, Potter' & Wetherall, 1987; Narrative, Reissman, 1993) are limited by an absence of interest in the individual's inner experiences (Barker et al., 2002), which was the primary interest of this research. Grounded theory may have identified a model/theory which would encapsulate this experience for everyone but, as clinical psychologists in distress was an under documented phenomenon, this could not be assumed.

Interview data were analysed as instructed by Smith (1996), transcripts were read several times, researcher's initial thoughts were noted. With the aid of a computer software package (NVivo 7, 2006) designed for managing rich text-based information, further analysis was sequenced as follows:

  • 1
    Identification of emerging themes/concepts that characterized each part of the text.
  • 2
    Clustering of themes in accordance to their relationship with each other, and development of master themes.
  • 3
    Comparison of theme tables to each original transcription.
  • 4
    Finalized summary table of consolidated themes including illustrative participant quotations.

Reliability/validity

As a qualitative study, measures of reliability and validity, as applied to quantitative research was not appropriate (according to Wolcott, 1995 and Stake, 1995). The IPA approach to data is described by Smith and Osborn (1999) as an attempt to capture the quality of a participant's experience based on the researcher's interpretation of participant accounts. Therefore, it cannot necessarily provide a true/definitive representation. As researcher interpretations may have been influenced by personal thoughts and assumptions, attempts were made to address this by documenting researchers own thoughts at the preliminary stage of analysis, use of supervision, and by providing a transparency of the results process. In addition, three peers independent from the research repeated stage three of analysis for a sample of transcripts as a validity and reliability check.

Ethics

This research obtained ethical approval from a university internal ethics panel. Guidelines regarding informed consent, confidentiality, data protection, and protocol for debriefing and identifying distress was adhered to.

Results

  1. Top of page
  2. Abstract
  3. Background
  4. Methodology
  5. Results
  6. Discussion
  7. Conclusion
  8. References

The participants had varied personal and professional experiences of distress. Overall 18 sub-themes were grouped into five master themes. Themes were not mutually exclusive or hierarchical and are clustered according to shared meanings. Table 1 lists the themes and the number of participants who represented each theme to illustrate the strength and consistency of the themes that emerged.

Table 1. Themes and number of participants whose experience represented each theme
Master themeSub-themeNumber of participants
Manifestations of distress  
 Personal indicators9
 Impact of distress on client work10
 Impact of distress on managing workplace9
Making sense of personal distress  
 Job-specific difficulties7
 Multiple/accumulated stressors7
 Professional knowledge8
 ‘It's me’6
Role and affect of others  
 Disclosure10
 Being a psychologist8
 Comparisons to others5
Experiences of help/support  
 Accepting the need for help6
 Attitudes to help available7
 Experiences that help8
 Unsupportive messages4
Using experiences of distress  
 Type of psychologist8
 Personal/professional life balance8
 Self-monitoring7
 Being less harsh to self6

Manifestations of distress

The first master theme ‘manifestations of distress’ refers to how participants’ distress presented. This was broken down into personal indicators, impact of distress on client work, and impact of distress on managing workplace.

Personal indicators

Distress for many participants was reported as presenting itself physically and behaviourally, for example, panic attacks, shakiness, appetite, hair and weight loss, sleeping difficulties, and exhaustion. Some experienced ruminations and negative cognitions including fears about death and the intentions of others. For example, Louise shared suicidal and harmful thoughts. ‘Having real thoughts about wanting to jump off one of the car parks in town, thinking “I could smother this little baby”, thinking that I couldn't cope’. Five participants became socially withdrawn. For example, Ann explained ‘I just remember kind of definitely not wanting to speak to anybody on the phone … you just really feel there's people out there and you just can't relate to them’. Others referred to an emotionless state, for example, not feeling their self, or dissociation. For example, ‘I was getting quite light headed feeling disassociated and unreal ’(Helen), ‘emotionally I quite detached myself’ (Karen).

Impact of distress on client work

Participants spoke about several ways their clinical work was affected, referring to negative emotional effects, such as feeling slightly more emotional or tearful; higher levels of anxiety, panic attacks, and passivity within client sessions.

Some experienced an increased level of empathy with clients, for Ann and Francesca empathy was all they could offer. Ann reported ‘Just sitting with him really and listening to his story and the empathy and if I had not been depressed maybe I’d have been desperately trying to CBT him out of it …, but I didn't I kind of empathized with him’.

Some participants expressed feelings of uselessness, helplessness, and indifference towards clients. Helen mentioned feeling ‘ineffective’, and Ann felt at times she ‘had no idea’. Francesca and Bianca had felt the professional demands to address other's problems when they felt uncared for reduced their professional motivation. ‘I was looking for a way of getting out of the constant demands for attention to other people's problems because I felt so neglected myself … that I just couldn't be bothered’ (Bianca). However, clinical work could also offer escape or distraction from personal difficulties (Ann, Bianca, Gerald). Ann stated ‘those clients … are almost a bit of an escape for me’, and Gerald reported his work was the one thing he could be good at during his distress.

Impact of distress on managing workplace

Participants spoke about not wanting to be at work, for example, contemplating resignation, switching off, taking leave, or simply feeling that they should not be there. Julie was supported to reduce her workload. Some participants were able to take sick leave. Others worked only for financial necessity, or a sense of guilt, and the pressure to return. ‘Had about a month off sick because I felt that my manager didn't have much tolerance… went back into work but was still struggling … just feeling quite low and everything was a big effort’ (Helen).

Making sense of personal distress

The second master theme ‘making sense of personal distress’ refers to participants’ attempts to understand their distress. Participants identified various phases occurring in understanding their distress, at the time, and upon reflection. They identified the role of external triggers, their personal attributes, and use of psychological knowledge in making sense of their distress. Sub-themes included job-specific difficulties, multiple/accumulated stressors, professional knowledge, and ‘it's me’.

Job-specific difficulties

Seven participants spoke about their job, as an additional profession-specific stressor. Participants identified a culture where you ‘don't have lunch, and work nine hours non-stop’ (Ann), disabling psychologists from admitting distress with pressure to be seen as coping.

It's a projection of our ideal which is not reality and I think it sets up people in training to say ‘that's how I should be … I think that's where the fear and anxiety stems from … if you’re not able to manage the stress, if you can't tolerate, if you can't juggle, …. – you’re not good enough’ (Francesca).

Some spoke about the volume of work and organizational expectations causing additional pressures. Calvin referred to ‘really high work load I think was part of it’, and Louise explained ‘My clinical base … miles separated from where my management part and the secretaries were based … I think it was to do with’‘those bastards out there give you too much to do’.

Others spoke about their personal attachments to their job. Two participants described their work as providing something missing from their lives. ‘I needed to have some sort of validation of who I was and work gave me that … but it probably occupied much too much of an important place’ (Gerald).

‘Partly as a result of the pain of not conceiving …I needed to create something and so I created a service and that's why it was hard to lose it because it was more than just a job … it was my baby’ (Bianca).

Multiple/accumulated stressors

Seven participants acknowledged the accumulation of stressors preceding the major episode of distress. Each participant had experienced at least two of the following major life events within the year prior to their distress: financial difficulties, moving house, illness of a partner, bereavement, pregnancy/baby, relationship difficulties, and work stressors.

Professional knowledge

Professional knowledge played various roles in participants’ understanding of their distress, Calvin and Helen described their knowledge as beneficial. ‘I’m able to think…maybe I have been depressed…so I did have quite a lot of insight into what was happening’ (Helen).

However, for some participants it provided grounds for self-criticism, for example, Elaine felt foolish and questioned herself as a psychologist. Louise had felt until then ‘being a psychologist would somehow protect you’. Her distress shocked her ‘I’m a psychologist how did this happen to me?’. Francesca also spoke about experiencing a pathologizing and judgemental ‘inner psychologist’. Participants felt given their professional knowledge and training they should have been able to recognize the signs of distress and handled it better.

For three participants their psychological knowledge increased an awareness of pre-existing personal difficulties. Their psychology training provided the knowledge and vocabulary to describe this. ‘I kind of realize it was something that happened throughout my life but I could never put a label to it’ (Ann). For Gerald psychological insight was both positive and negative ‘… I think it was being a psychologist that created this insight and unlocked the feelings which were then unable to be expressed’.

Francesca mentioned the tendency to take psychological knowledge too far by over-analysing. ‘What does that say about my personality … you think about schizoid personality … start bringing in all that knowledge and theory, start applying it, and if you weren't a psychologist you perhaps wouldn't do that’.

Another approach by participants was to formulate and normalize their experiences using statistical or psychological knowledge. However, Helen reported ‘over-normalising’ her difficulties which delayed addressing them.

‘It's me’

Some participants accepted their difficulties as inherent in their temperament or biological make-up, for others this took the form of self-blame/criticism. ‘I felt it said something inherent about me as a person …… something inherently about me not being good enough’ (Francesca).

Some participants described how the additional personal perfectionist standards were tapped into by the profession.

My other kind of psyche is about having to do things right … grade A first-class standard … an instant recipe for difficulties … taking work home and working in the evenings later and later … this thing of psychology about being perfect all the time, and given that I’ve got that as a kind of strong internal streak anyway you put the 2 things together and you’ve got a noxious combination. (Louise)

Role and affect of others

The third master theme refers to the experiences participants had in relation to other people including experiences of disclosure, thoughts, and responses based on being psychologists, unfavourable comparison of self to others, and experiences of being open. Sub-themes were disclosure, being a psychologist, and comparisons to others.

Disclosure

Regarding sharing and communicating their distress to others. Three participants experienced a positive, reciprocated exchange with a colleague about their difficulties. However, five participants also spoke about the fear and shame connected to their experiences which influenced their sharing. Ann reported being ‘petrified’ others would find out, and relieved her GP volunteered to write ‘virus’ on her sick form.

Others spoke about the need to maintain pretence. Francesca spoke about the contrast between her professional persona and actual needs.“… two people, I was the person that went to work … and put on this brave face and … me who was really needing some help and support…and that was completely lacking’.

High expectations from others also had an impact on disclosure for Francesca, she spoke about the reasons she never told her GP. ‘He makes it very clear that he's very proud of me and that prevented me from going to him and saying you know what I’m not doing really well’.

Being a psychologist

Being a psychologist influenced reactions to self and from others. Francesca explained the fears she believed existed among high achievers like her, which influenced disclosure. ‘Not wanting to be seen to be weak, functioning less well than anybody else … a fear that other people may see me as not being able to do my job as well’. Ann spoke about the assumptions made of psychologists, ‘People have this fantasy of what the psychologist is like … posh well-off, really stable … she [colleague] was just shaken … that I wasn't actually the fantasy person that she thought I was’. Some participants described the negative consequences anticipated from open disclosure. ‘Not sure whether I’m inventing this but I suppose I might think that it would influence my career and that probably they would think less of me’ (Calvin).

Francesca and Karen felt distress was ‘hidden’, Francesca referred to it as a ‘taboo’ within the health profession, Karen said this was kept ‘underground’ within psychology, more so than with doctors and psychiatrists. Although, Ann admitted to assuming disclosure ‘wouldn't be well received’ Gerald feared the response ‘what kind of a psychologist are you then?’ Others experienced responses confirming such fears, ‘The doctor patted me on the head and said “oooh a depressed psychologist now that's not very good is it?”’ (Ann). Louise described her mum's reaction ‘said something along the lines of …physician heal thyself’.

There were a mixture of perceptions around disclosure and responses regarding other psychologists. Dawn said psychologist friends did not avoid her distress as others had. Louise felt a psychologist colleague showed genuine ongoing interest in how she was coping, although other psychologists in her team were ‘weird’ in their responses, ‘attempting to wrap her in cotton wool’. Others felt less inclined to share with psychologist colleagues.

Comparisons to others

There were three ways in which participant's comparison of themselves to others impacted on their coping. Some felt inferior to their colleagues regarding either their experience or coping style. Elaine felt unable to talk to her boss about her own difficulties because she perceived her as ‘such a coper’. Francesca questioned herself ‘What's wrong with me that I’m feeling this … other psychologists are really together’. Some participants felt their difficulties were less serious compared to others.

Working with terminally ill clients made Francesca dismissive of her own difficulties. ‘There was that constant comparison of what are my problems? My children are still healthy … and we’re all still alive … it felt like who am I? I shouldn't complain’. Nonetheless, two participants described experiences in which they felt less sympathetic to others whose difficulties/complaints seemed less problematic than their own.

Experiences of help/support

The fourth master theme refers to participant's experiences of help. Sub-themes were labelled accepting the need for help, attitudes to help available, experiences that help, and unsupportive messages.

Accepting the need for help

The point at which participants accepted the need for help was straightforward for some. Calvin and Julie followed advice from people they trusted, to seek professional help. Dawn was automatically made aware of the support available to her by the hospital, she was already in therapy but was keen to access specific support for her type of bereavement.

Some had been struggling for some time before they recognized a need for professional help. For Ann this came after 3/4 years of fluctuating levels of chronic depression and following her mother's refusal to let her stay with her while on sick leave, because ‘she felt she could not cope’ with her. Helen spoke about having to reach a point of exhaustion before going to see her GP and a further year before she would see a psychologist. Francesca's difficulties were present for 8/9 months before contacting occupational health, when she felt desperate for change.

Attitudes to help available

Most frequently mentioned forms of help were medication and therapy. The use of medication elicited mixed responses. Dawn said she would have refused medication because it was natural for her to feel depressed. Five participants took medication to address their difficulties, both Calvin and Bianca actively sought it from their GPs. Bianca told her GP ‘I feel like I need to be wrapped up in … cotton wool that stops me hurting … I can't live with this hurt I feel exposed I feel like I’m just gonna make it all worse if I don’t, I need dumbing down’.

Ann explained that although she was not anti-medication, as a psychologist she was ambivalent about taking it herself. ‘I think as a profession we’re naturally inclined to be very anti-medication … that's letting the side down … it was a kind of a slightly odd belief for somebody who is not anti-psychiatry and not anti-medication’.

Neither Calvin nor Elaine was interested in receiving therapy. Elaine chose medication over therapy when her GP discussed options, ‘my inclination was to take something because I think well that's easier isn't it?… psychological therapy is bloody hard work, like all my clients I want a magic wand’.

Both Calvin and Elaine acknowledged that former unhelpful experiences of therapy may have put them off. Three participants had concerns about the standard of help they would receive from a counsellor provided through the NHS. ‘The whole term counsellor for me … was like I don't need a counsellor I need a very experienced clinical psychologist … we need someone more qualified when we’re distressed’ (Francesca).

Nonetheless, some participants used therapy and spoke positively about it, although for most seeing a therapist was a challenging process. Ann said she had to be ‘firmly cajoled’ into seeing someone. Helen's GP took a year to persuade her to get therapeutic help. Participants also spoke about how they first reacted as a therapeutic client. Francesca felt defensive and ambivalent during her first session, ‘Went along … very judgmental … saying right I’m going along and if he says anything remotely that I know is from a text book or a training course then ……’.

Helen said she hated ‘having to be dependent on someone’ and found trust difficult. Gerald initially found it hard to be a client, ‘It's taken me a very long time to get comfortable just talking about myself … I was trying to do his job for him and it's really hard to admit to not knowing something that you feel is so obvious you should know’. Confidentiality was important to all participants accessing therapy. Most participants who used therapy found this useful and some continue in therapy.

Experiences that help

Participants attempted various self-help strategies with varying success. These included relaxation, or exercise classes, and keeping busy.

Some identified work as helpful. Ann and Gerald spoke about it as an opportunity to re-build their sense of value. Louise referred to her job as a place to feel competent which provided routine, and Karen experienced work as a break from domestic pressures.

Participants spoke about the variety of ways in which they had felt supported by colleagues going out of their way to show they cared. This included managers being flexible about timekeeping and reducing pressure, or offering protection from other colleagues. Participants also gave examples of their teams accepting they were not prepared to take on particular cases. Others spoke about feeling supported by contact through phone calls, texts, letters/cards during sick leave, and visits.

Unsupportive messages

Lack of such helpful gestures were experienced as unhelpful. Inflexibility in the job was experienced as unsupportive. ‘What I was trying to do at the time was reduce my hours but I wasn't facilitated by my manager at the time’ (Helen).

Ann and Helen felt that a lack of faith among colleagues in their ability to return to work was very discouraging. Most frequently mentioned were discouraging messages that it was unacceptable to need personal support as a psychologist. For many this was a message conveyed during training and retained post-qualification, ‘The sense was that it certainly wasn't okay to talk about any of your own mental health difficulties’ (Helen). Helen also experienced this among her cohort in responses to fellow trainees who had mental health difficulties. Ann felt this message was often conveyed in supervision. ‘The bottom line is professional supervision is about helping you to do your job better and helping you to do the best you can for the clients, there's little space and time in there for talking about … the impact of the work on you as an individual’.

Using experiences of distress

The fifth master theme refers to how the participant's experiences of distress influenced them subsequently; the lessons learned, and changes participants’ experiences of distress have made to their lives personally/professionally, and self-perception. Sub-themes comprised of type of clinician, personal/professional life balance, self-monitoring, and being less harsh to self.

Type of clinician

Five participants spoke about gaining a deeper understanding of their clients making them richer as psychologists. Francesca and Dawn found the unique insight gained from their personal experiences added a special depth to their work.

Participants spoke about a shift in responses to clients. Francesca felt she was more comfortable with ‘just being with the person in their situation and not feeling the pressure to come up with the answers’ (Francesca). Ann's own experience of psychotherapy led her to decide to do more training and work with her clients psycho-dynamically. Calvin felt his positive experience with medication made him more inclined to view medication for his clients positively.

Personal/professional life balance

Participants spoke about work-life balance, ‘The balance in having good relationships outside of work I suppose my work now is more of a job than a passion. I haven't put all of myself into it’ (Bianca). Five participants spoke about being more prepared to take time away from work as necessary.

Self-monitoring

Four participants had learned to recognize and respond to the onset of their distress earlier, “I think I’d do the same but I’d do it sooner …’ (Francesca). Ann said ‘I’ve always had shades of it and I recognise the symptoms of it coming on and I put strategies in place to deal with it now’. Elaine and Louise spoke about self-monitoring for the placement of their distress ‘You’ve got to make sure that … you know where the feelings are coming from … to be very very careful about self-disclosure because it may or may not be helpful to the client. Your experience is your experience’.

Less harsh to self

Participants spoke about ways in which they were no longer as judgmental, and rigid towards themselves. Bianca said she was more prepared to tell people what her needs were and be ‘less of a martyr’. Louise spoke about the need for realistic expectations, ‘Not to … construct myself as earth mother who as well as being alpha psychologist was also going to be alpha earth mother … I … loosened my expectations’. Gerald mentioned how important it was for him not to associate his experience with failure, to adjust to not always being an expert.

Summary

The sense psychologists made of their personal experiences of significant distress could be understood across five broad themes. Although sense making was not a linear process, it seemed that signs of distress for participants initially manifested in their behaviour and feelings at work, or other personal signs. Each participant attempted to understand their distress through identifying the internal or external causes, and use of their psychological knowledge. Interactions with others added to participants’ understanding of their distress, themselves, and how they felt perceived by others. Participants had different perceptions of what they experienced as helpful, for some accepting they needed help was a lengthy process. Nonetheless, all participants were able to make use of distressing experiences for one or more areas of their lives.

Discussion

  1. Top of page
  2. Abstract
  3. Background
  4. Methodology
  5. Results
  6. Discussion
  7. Conclusion
  8. References

There were several manifestations of distress, consistent with findings in previous literature (Cain, 2000; Gilroy et al., 2001, 2002; McCourt, 1999). Many participants experienced a positive impact on the quality of their relationship with clients. Nonetheless, findings also suggested difficulties managing personal distress with the demanding nature of a psychologist's work. Although work for some was perceived as an escape, similar to Guy et al. (1989) study, experiences of this sample suggests that reducing workload, taking leave, or resigning may be indicative of attempts to self-manage. Findings indicated that if distress is unsupported or undetected, psychologists may attempt to persevere in spite personal difficulties affecting their work.

Strained or terminated relationships, personal caring roles, and work-related factors were widely shared experiences, highlighting the multiplicity of stressors, echoing previous findings (Cushway & Tyler, 1995; Deutch, 1984; Farber, 1983; Gilroy et al., 2002; Guy, 1987; Guy et al., 1989; Hellman, Morrison, & Abramowitz, 1987; Nash, Norcross, & Prochaska, 1984; Thoreson et al., 1989). Work stressors were specifically associated with high-pressure, long hours, and organizational expectations, and, for some, professional doubt.

Results suggest that being a psychologist may influence how you process distressing experiences. This finding expands on current literature, illustrating how professional psychological knowledge may be self-applied. It would appear that sometimes this is ineffective, causing a false sense of security, intense self-criticism, and professional doubt. This personal evaluation of success and failure in ‘role performance’ strengthens Role Identity Theory (as described by Siebert and Siebert, 2007), as some participants appeared to be measuring discrepancies between their idealized self-conceptions and actual role performance. Some comments made about the experiences and messages received about psychologists in distress, and the work/organizational culture of coping, suggested a discourse within clinical psychology learned, by some, during clinical training and observed in psychologist colleagues. For example, references made to taboos, being seen as a coper, being ‘good enough’, a culture of long working hours, and missed lunches.

This may also explain why some participants found disclosure difficult. Consistent with the literature (Cain, 2000; Deutch, 1985; Fisher, 1994; McCourt, 1999; Perkins, 2002; Walsh et al., 1991), inner turmoil about personal distress modulated the extent to which distress could be shared, based on fears around stigma about mental health. This suggests that some psychologists may battle with negative self-perceptions, reinforced by anticipated and actual social/professional expectations, again congruent with Role Identity Theory (McCall & Simmons, 1978). This appeared more evident for participants experiencing difficulties historically more stigmatizing in wider society, for example, mental health difficulties rather than bereavement. Interestingly, sometimes other psychologists were seen as a threat rather than source of support, either because they are seen to be ‘copers’, or representatives of an intolerant profession. This is consistent with other findings and suggests psychologists may feel unique in their experiences of distress, or less adequate than other psychologists, who may be masking their own distress. This could increase resistances to disclose to other psychologists.

It seemed that the willingness to accept help was also modulated by participants’ perceptions of the severity and source of their distress and the need for help. Actions taken to address distress (seeing GP, medication, personal therapy) were consistent with empirical studies. Findings add to existing literature by illustrating the complex/contradictory feelings participants experienced, as clinical psychologists, in response to the types of help they used, for example, refusing personal therapy or being hypercritical of taking medication, or seeing a therapist of a good enough standard. The wish to hide personal difficulties, and (for some) social withdrawal appeared to make seeking help from colleagues and friends/family harder. There was little reference made to seeking help from personal networks, perhaps in some cases because relationships were described as a stressor (e.g., terminated relationships, carer to partner). However, participants did make broad references to the importance of relationships outside of work as part of their work/life balance.

Findings suggest that continuing work and routine could be helpful in improving self-esteem, emphasizing the value placed on employer support and flexibility. Discouraging messages about being a psychologist in distress/need were perceived by some participants as representative of the profession, compounding fears around disclosure and help-seeking from colleagues.

Distressing experiences reportedly resulted in more appreciation of clients’ experiences and improved clinical practice for some. Participants reported learning to self-monitor for signs of distress and to address their difficulties sooner. Many had developed preventative strategies, involving a healthy work-life balance. Such strategies have been identified as successful in previous studies (like Stevanovic & Rupert, 2004).

Limitations

Experiences were shared at a particular point in time, within the context of the interviewer–interviewee relationship, and individually interpreted by the researcher within the context of other shared experiences (from other participants) for a wider audience, and thus would not necessary reflect the participants’ original story (Czarniawska, 1998; Mays & Pope, 2000) as they choose to represent it. Additionally, the nature of the research question and qualitative design required a relatively small self-selected sample, likely to have strong personal views on this topic. Personal perspectives and self-report cannot be objectively measured (e.g., becoming a richer clinician). Therefore, findings are not necessarily generalizable.

Although males are under-represented in clinical psychology, the larger number of women in the sample may have created a gender bias in the data, particularly regarding natal experiences. A number of other sample characteristics (class, age, ethnicity) may have impacted on the data. Equally, diversity within the sample (e.g., place of training, length of time qualified at point of distress and interview, work context) likely to influence personal experiences were not investigated. Nonetheless, the thematic agreement within the sample and parallels to previous research suggests some commonality to the findings.

Implications

Clinical psychologists do experience personal distress for which they may require support. Employers, supervisors, and psychologists (qualifying and qualified) should be aware that this does not necessarily indicate professional inadequacy. In fact, through this experience psychologists may feel they become richer, more confident therapists, and insightful team members.

Given this studies findings that some psychologists appeared to delay help-seeking apparently because of perceptions relating to what it means to be a ‘good psychologist’, it is important that the psychology profession (from training stage) provides an ethos promoting the personal welfare of psychologists, and preventative practice. Especially since the recruitment process for entering clinical psychology doctorate training is so competitive. Easy access to support services (e.g., an anonymous information/helpline, specific independent services for psychologists, self-help/peer-support services) could be considered.

The difficulty of acknowledging and disclosing distress for some psychologists requires supervisors and team leaders to be vigilant for signs of distress, such as, high leave levels (not necessarily all sick leave), requests to reduce workload, refusals to see certain clients, or other signs such as exhaustion or weight loss. Supervision should enhance reflective practice by providing a space to talk about the personal impact of work.

Some clinical psychologists may need to be less perfectionistic and more self-forgiving, reflecting on clinical practice and personal state. They must recognize that promoting a superficial image of perfection could reinforce a taboo about psychologists in distress. Self-care has limitations, and work-life balance and early help-seeking (when necessary) are important in nurturing personal and professional identity.

Conclusion

  1. Top of page
  2. Abstract
  3. Background
  4. Methodology
  5. Results
  6. Discussion
  7. Conclusion
  8. References

The relevance these findings have in terms of understanding psychologists’ experiences of personal distress is varied and complex. If their difficulties are not seen as stigmatizing or shaming, they may more easily access support. However, for some support-seeking creates an uncomfortable conflict of role identity, delaying access to support. Some psychologists may be reluctant to seek help, and initially, ambivalent about the use of personal therapy. Of note is that all participants reported making positive use of their distressing experiences.

References

  1. Top of page
  2. Abstract
  3. Background
  4. Methodology
  5. Results
  6. Discussion
  7. Conclusion
  8. References
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