Therapists, you care about others. Here’s why the world should care about you: you’re even more at risk

Raising awareness: Mental health professionals struggle too, and often in silence

For us, mental health is an important topic all year round, but since this month is about mental health awareness, we’re doing our best to learn and share what we can. Our first discovery has been that mental health providers struggle with mental health disorders more than the general population. 

For some, it may be surprising; aren’t mental health professionals, well, professionals at dealing with mental health? Aren’t they meant to always be “ok”? And if they’re not, how can the rest of us even stand a chance? The answer is, it’s not that simple. We are all human first. And we’re extremely social beings at that. 

Furthermore, mental health providers, especially those who treat trauma, are at risk of developing compassion fatigue (CF) or secondary traumatic stress (STS) from all the accounts of trauma, anxiety, depression, and stress they witness. In short, that mental health professionals would be affected emotionally and mentally, is more than understandable. It’s predictable. 

According to a survey from the American Psychological Association (APA), nearly half of mental health professionals who experience a mental health disorder do not seek help. The same survey revealed that almost half of mental health clinicians experiencing suicidal ideations were not open to talking about their thoughts and feelings. 

Unfortunately, research has shown that mental health professionals often view their mental health problems as a weakness and try to remain resilient by covering up their symptoms and pushing their feelings to the side to cope. Another fear is that self-disclosure is inappropriate and impedes the therapeutic process.

Added to that, mental health professionals may worry about the effects of their mental health on their reputations amongst both clients and colleagues, as well as being seen as fit enough to work by licensing bodies. (Thankfully, state boards can now only ask about how therapists feel in the present moment, rather than about mental health diagnoses.)

Social media has also given mental health professionals a chance to share their struggles and humanity, creating a more nuanced space for therapists who have been sharing difficult aspects of their jobs. Of course, no one wants to see a therapist with

burnout or a serious mental health disorder, but we need to allow some grace for mental health professionals who have, as a hazard of their job, developed compassion fatigue (CF) or secondary traumatic stress (STS) and are burning out. If anything, sharing has been shown to reduce symptoms and help lighten their load. 

Raising awareness: Mental health professionals are likely to be affected by trauma in the first place 

Mental health professionals report a higher prevalence of personal trauma than other professionals (Follette et al., 1994). It can be surmised that those who choose to work in the therapy space often do so as a result of wanting to help others work through their traumas too, making them even more predisposed to compassion fatigue or secondary traumatic stress. (Bessel van der Kolk, Trauma Foundation Course, PESI.)

Secondly, even if you have little previous trauma, the APA acknowledges that it is possible to become traumatized indirectly by “learning about unexpected or violent death, serious harm, or threat of death or injury experienced” by another person. Being trained doesn’t protect one from the effects of secondary traumatic stress if one is empathetic, attuned, and in close contact with such material for extended periods.

Thirdly, providers are overworked. Almost half (45%) of therapists reported feeling burned out in 2022. The literature suggests that engaging in self-care activities lowers the risk of STS (Rothschild, 2006), but if you don’t have the time to spend on self-care, then you can’t give yourself the rest and rebalancing you need. It’s not a surprise that providers struggle with mental health issues, despite being experts on mental health. A therapist who’s suffering from CF may even re-experience their client's traumatic feelings, avoidance, or anxiety, in effect displaying PTSD symptoms, disruptions to their cognitive schemas, relational difficulties, as well as physical, emotional, or behavioral distress symptoms.

Raising awareness: Burned-out and silently suffering providers can’t help their clients 

Here’s why it should matter to all of us if mental health providers are overworked. Being burned out in the mental health profession is damaging to the therapeutic alliance and the effects of therapy. Meaning, that therapy can be ineffective, and if burnout affects clients as well as clinicians, no one prospers.

Traumatic PTSD experiences and burnout affect therapists' abilities to 1) stay empathetic and attuned and 2) affect therapists’ personal and professional relationships and also impact their ability to effectively work with clients (Collins & Long, 2003). 

Burnout is not specifically limited to those working with trauma clients but is more a reaction to the demands of one's job and environment. A state of physical, emotional, and mental exhaustion caused by long-term involvement in emotionally demanding situations (Pines & Aronson, 1998). But of course, therapists spend their career lives in emotionally demanding situations.

Raising awareness: It’s not all negative, and a few things may help 

While it’s undoubtedly a lot to listen to people’s traumas and work an emotionally demanding job, it turns out that there is also a more positive side to being a therapist. A growing body of literature documents the positive effects of working with trauma. A term used for this is compassion satisfaction (CS) and Larsen and Stamm propose CS is the sense of fulfillment or pleasure therapists derive from doing their work well. Researchers have reported a high potential for CS in mental health professionals in the United States (Conrad & Kellar-Guenther, 2006) and other qualitative research further supports this. 

Furthermore, it turns out that more factors are at play than simply the number of trauma cases or clients in predicting STS or PTSD symptoms in therapists. However, this needs more investigation. For example, it is known that talking therapy isn’t always the best at treating trauma, and repeating the same story can make trauma symptoms worse, not better. Studies also need to take into consideration the type of therapy modality therapists offer and if this too has an impact on STS. 

And, it’s not all bad. Helping clients out of traumatic life problems can also make for feelings of greater job satisfaction as there is more to recover and influence. And it seems the longer one’s experience being a therapist, the higher the level of compassion satisfaction, though it also comes with higher levels of emotional exhaustion. (Baird & Jenkins, 2003). It also seems that therapists who are older and more emotionally mature tend to have higher CS, and incidentally, lower burnout rates. On top of that, choosing places of work with high levels of management and colleague support reduces burnout risk. And, perceived supportiveness of supervision predicts a higher potential for CS too. Plus, it’s also been shown that various self-care practices can help, as well as simply having more time for R&R.

We are proud to help therapists win back time through our AI documentation, but of course, having adequate rest and recuperation is a systemic issue too. More support is needed at a system level; overwork and appropriate pay are all factors that must be addressed. And, finally, MHPs working tirelessly to help others do not deserve the stigma, judgment, or shame that can come from being a mental health provider simply trying to do the best possible job. We should all care about the fact that mental health professionals are at higher risk of mental health distress, burnout, and STS.