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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 Leiper and Kent (unpublished) found therapists were only prepared to report their distress to someone once it had become impairing.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).
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).
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).
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).
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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).
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.
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.