Discursive of Tunbridge Wells
John McGowan
1326
Sue Holttum considers whether mental health professionals who have their own experience of mental distress feel silenced and whether we need them to be more open
On 5th February Mental Health Today reported on increasing stress and depression in NHS psychological therapies staff, and noted that the British Psychological Society has launched a charter to ensure staff are supported in their work. It’s a reminder that, although we don’t usually talk about it, mental health professionals can have mental health problems too.
I have worked in mental health for a number of years, especially as part of a team that trains people to become clinical psychologists. Our aim is to develop practitioners who apply their knowledge and skills to helping people suffering mental distress, either through one-to-one therapy, in a group, or through supporting staff teams and systems. Being able to talk, and really being heard by another person can be a step back to a life that feels worth living. I know because I’ve been at that low point and come back. Among many other feelings I’ve hoped that my therapist has had someone who takes the time to listen to them too. Why? Because being connected to others who care is not just for when we’re at a low point. That connection, as George Monbiot recently described very movingly in the Guardian, is what human life is about.
Training to become a mental health professional involves working with people who are in deep distress. I would like to think that when people enter training to become a mental health professional, their own experience of mental distress has value. After all, they know something about what it’s like. But can they talk about it? Or does it feel ‘taboo’? Can their fledgling work as a professional be enriched by it? Or is it seen as something that would just interfere?
At this year’s annual conference for staff who train clinical psychologists (7th to 9th Nov 2016), Dr Katrina Scior and colleagues presented their findings from a study on UK trainee clinical psychologists’ experience of mental health problems. Among 348 trainees across 19 courses, two thirds said that they had experienced significant mental health problems at some time in their life, and 29% reported that they did so currently. This is even higher than figures from MIND, which suggest that 25% of the population experience mental distress each year. However, few had disclosed their mental distress to course staff. Equality and diversity data on applicants to courses in clinical psychology show that less than 1% declare a mental health problem at application. Why would they conceal it? One reason could be prejudice against people with experience of mental distress, which can actually be worse within the mental health professions than in the general public.
To investigate further my colleague, art therapist Dr Val Huet, and I conducted a survey of art therapists (see a short video summary here and a longer paper here). We asked qualified art therapists who also had experience of mental distress to recount their experience of art therapy training. Most did not disclose having experienced mental distress when they applied to do training, with many fearing it would prevent them being accepted. Most also experienced distress during training, but few disclosed it fully to tutors.
Most interesting though, while 6 out of 19 art therapists who responded felt that having their own experience of mental distress reduced their confidence to practice as therapists, many more (13) reported positive effects on their practice. Those people reported feeling greater understanding for service users. And this is not a conclusion unique to our research. The strong suggestion of our findings is that, when mental health professionals can acknowledge their own experiences of distress of any kind, they can feel more understanding for service users. This has also been recognised in relation to training psychiatrists in a framework for mental health services called the recovery approach. This fellow-feeling can motivate professionals to support people more in their efforts to get through their difficulties.
Clearly there is a good case for our own experience being able to help in clinical work. However, we still have the issue that being able to admit to the experience of our own mental distress is clearly something that is difficult. Is this something that might change?
When clinical psychologists and art therapists are in training for their professions, they go on placements where they conduct therapy under supervision from an experienced professional. Although many art therapists in our survey had felt that telling a tutor or supervisor about their experience of mental distress was either not possible or not well received, one wrote something much more positive:
“[two placement supervisors] encouraged me to talk about my own [experiences] that were relevant. I learned more from the supervisors than any others from being allowed to do this. I could bring in all parts of myself. […] It became useful valuable knowledge that I could use as a therapist in positive ways to aid my understanding of myself and my client.”
This kind of sentiment highlights a possible role for clinical supervisors (the people whom trainees are most likely to discuss the work with) in enabling trainee mental health professionals to learn from personal experience of mental distress: to be able to see it as another kind of life experience to be employed rather than something to feel ashamed of. However, supervisors may work in situations where there are negative attitudes about mental distress, and some might themselves feel obliged to conceal it. They may need support – and perhaps training – to enable their trainees to feel safe to talk about and learn from such experiences. Perhaps it also requires a wider cultural change.
As someone who has been a service user, I would not want a mental health professional that I was seeing to feel ashamed of having experience of mental distress. Surely, if they are to be able to help me, they have to be kind to themselves about their own humanity in order to be kind to me about mine. If they didn’t experience this kindness from tutors and supervisors during training, they need it now more than ever from managers and colleagues. Perhaps there is an opportunity for people to make their voices heard in calling for this to become a general part of mental health service culture. Perhaps mental health professionals, like the rest of us, should be allowed to be human.
I worked as a clinical psychologist in the NHS from 1969 to 2000, so my comments are a bit out-dated (but possibly still relevant). When I was in my teens I had problems with anxiety and depression, but fortunately managed to overcome them by the time I started work. This experience led me to become a clinical psychologist, as I could see how interesting it would be to try to help other people with their problems. I did mention my problems when applying to University, with no negative reaction but also no actual interest, so I never mentioned them again. After starting work in a psychiatric hospital, it became clear that my colleagues (psychiatrists) regarded patients as an inferior social class, so obviously I never mentioned that I had once been one. After that I almost forgot my own history of problems in my attempt to concentrate on my patients. I wasn’t ashamed of my problems, and indeed I was proud of how I had managed to overcome them. Unfortunately on one occasion I tried to reassure a young man that he would indeed recover, by telling him that I had succeeded in overcoming similar problems, but this simply led to him feeling inferior and a failure by comparison. So I never mentioned my history again until I was safely retired, when I wrote two books: A Psychologist’s Childhood (2013) and From Tests to Therapy: A Personal History of Clinical Psychology (2011). Together, these at last tell my story.
Thank you for your comment G. I will seek out your books. It seems a shame that many mental health professionals may be in a similar position to you. I think your heart was in the right place when you made yourself vulnerable, potentially, by disclosing. I imagine that because the ‘rule’ is not to disclose, we preserve the idea that patients and professionals are somehow different. If I as a service user start out with the idea that I am inferior to you the professional, you telling me you got over something doesn’t help because I’m not you. Service users and professionals are different, I assume, so I could never hope to be like you. That is where I would have come from if it had been me hearing your disclosure. It might have been different in a climate in which professionals and service users are not seen as so different to begin with. I might have drawn hope from your honesty.
Thanks for this good blog Sue, and the book recommendations, Alan . and for the talk of the need for open honesty. I have forwarded to our trainees. at Plymouth and coincidentally ( tho is there such a thing as coincidence? ) discussion came up in a supervisor training event we were running today and we will forward it there too.
I hope at Plymouth we welcome sharing of our various vulnerabilities and resourcefulnesses, . but that is far easier said than done and there are so many multi-layered power dynamics and complexities at play. There are issues re how the material we have to cover, and the tasks we have to do around engaging with service users’ deep distress and trauma can trigger trainees’ and our own distress and trauma memories . and how we manage and support one another, and trainees especially, around this to ensure safe effective and compassionate care for patients as well as taking care of ourselves….complex and important about how we can defend and reveal ourselves in safe and kind and helpful rather than cut off ways . and how we can draw on the resiliencies and connectedness with others that our own histories give us. Relatedly, ( I think) I have been watching Aberfan: the Green Hollow by Owen Sheers today, recommended to me by a local supervisor. … just a week more available on iplayer. http://www.bbc.co.uk/programmes/b07zk9fl So well worth a viewing. Psychology features at the start – not too well….and in contrast, the social and creative determinants of community building and shared vulnerability and healing are beautifully documented.
I’m a service user and, last year, I appreciated a small disclosure from a trainee psychologist about her own prior experience of therapy, where it was appropriate and relevant to my own therapy.
Personally, I am cautious about when and where I disclose my own difficulties, not least because of the polarised views among professionals and parts of the third sector around diagnosis and the language used to describe various types of struggle. I’m dancing around words even writing this blog comment, because of the silencing impact of that debate. I can only imagine the difficulty for MH professionals who have enough to deal with juggling the demands of the job and the MH struggles, without having to pick a side and/or risk becoming a poster child in the diagnosis debate they may not have any interest in joining.
I witnessed a Twitter discussion recently where a relatively young, newly qualified CP disclosed his Bipolar Disorder diagnosis in a public way, only to have his Twitter TL jumped on by another CP who wished he had also “acknowledged that MH diagnoses are contested”. Life is hard enough as it is, I am not surprised so few clinicians are willing to disclose, under these circumstances. If, as a profession, you want your trainees to feel able to disclose, then I think the onus is on you as leaders to think about how to make that a beneficial, and not an unpleasant experience for the courageous souls who do speak up.