In this show we look at how professionals working in mental health relate to their own experiences of distress. Can a worker’s own history of difficulties enrich their practice? Or are other factors more important? Should a worker’s own experiences be taboo when talking to service users, or It is helpful for a professional to be open about things that have happened to them?
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 innocently posted an item on Twitter the other day about Marsha Linehan, one of the world’s best known clinical psychologists and the creator of Dialectical Behaviour Therapy (DBT). Linehan caused a stir a little over two years ago when she announced that she, like so many of the people she has tried to help, had suffered from the experiences labelled as‘borderline personality disorder’ (BPD). Admittedly, Twitter is a volatile medium in which people say many things free of the restraints that a less anonymous conversation might impose. But, even so, I was unprepared for the vitriol with which my tweet was greeted.