Psychotherapy Bulletin Editors’ Note: Emotionally healthy psychologists deliver a higher quality of patient care. Therefore, training programs should prioritize teaching self-care to their students.
In discussing the training of surgeons Campbell wrote, “In the classical training program we have taught how to perform surgery, but we have not taught how to live life as a surgeon” (2001, p. 702). How well have we taught our psychology students to live life as a psychologist? Ideally, our students will learn to cherish their professional relationships, feel a sense of accomplishment when working with their patients, and welcome the intellectual stimulation that comes from their work. But that goal seems difficult when “working as a MHP [mental health professional] is a mental health hazard” (Di Benedetto, 2015, p. 401).
Teaching psychology students to live life as a psychologist requires teaching them how to care for themselves. Self-care is important because all persons should seek to fulfill themselves. And self-care is important because professional psychologists can best promote the health of the public if they protect and nourish their own wellbeing. In contrast, emotionally compromised psychologists risk delivering less-than-optimal or substandard services.
For example, emotionally compromised psychologists may be less able to engage fully with patients, show empathy, or identify the emotions of their patients (Simionato et al., 2019). Mental health professionals with high levels of burnout reported that they delivered a lower level of patient care, even when other variables were considered (Salyers et al., 2015). Psychotherapists with a low sense of personal accomplishment reported more absenteeism and decreased productivity (Hammond et al., 2017).
Conversely, as measured by scores on a burnout measure, emotionally healthy psychologists produced significantly better outcomes with depressed and anxious patients (Delgadillo et al., 2018). Psychotherapists who displayed resilience and confidence had the most reliable and clinically significant patient improvement (Green et al., 2014). Professionals showing the most mindfulness and resilience were the most effective in reducing patient depression scores (Pereia et al., 2017).
Wellbeing Among Psychologists
Wellbeing among psychologists appears to result from a combination of personal and situational factors. Coster and Schwebel (1997) found that well-functioning psychologists had high levels of self-awareness, monitored themselves, had cultivated strong social relationships (from peers, spouses, friends, and others), and reported optimistic perseverance and a balanced life.
However, most of the research on psychologist wellbeing has focused on impairment or burnout, not wellbeing. Working in agencies, compared to independent practices, appears to contribute to burnout (Yang & Hayes, 2020). Perhaps agency workers have less control over their work environment, fewer resources, and greater exposure to patients with difficult or complex problems. Social support protects against burnout (Yang & Hayes, 2020).
Younger psychotherapists reported more burnout than older psychotherapists (Nissen-Lie et al., 2021; Yang & Hayes, 2020). Perhaps older psychotherapists have learned better self-care skills, or perhaps the most distressed psychotherapists dropped out of the profession. Or maybe older psychotherapists just moved into independent practices where they can screen out many patients with complex problems or difficult behaviors (Nissen-Lie, 2021). Studies have found mixed results on the impact of gender on burnout, although gender and age may interact because a higher percentage of women psychologists are younger. Data is lacking on the burnout rates among minority group psychologists. Nonetheless, minority graduate students reported more psychological distress than their white counterparts (Hobaica et al., 2021).
Some psychological factors may predispose psychotherapists to burnout. Yang and Hayes (2020) found a link between wellbeing, self-efficacy, extraversion, emotional coping skills, and mindfulness. Among psychology trainees, burnout was linked to an “unrelenting standards” schema (“perfectionism and rigid expectations of the self around performance and responsibility;” Kaeding et al., 2017, p. 1783). Among psychologists, burnout was linked to unrelenting standards and self-sacrifice (“the tendency of psychologists to sacrifice their own needs, seek approval from supervisors and colleagues and set high self-internalized expectations;” Simpson et al., 2018, p. 41). Having a history of early trauma also increases a psychotherapist’s sense of personal burden (Nissen-Lie et al., 2021).
Promoting Wellbeing Among Psychology Students
Given the importance of self-care to the emotional health of psychologists and their effectiveness as psychotherapists, it seems that teaching students to live life as a psychologist involves teaching them about self-care. This means both helping students achieve good emotional health while in the program and teaching habits and skills that will keep them emotionally stable later in their careers.
Students may not appreciate the importance of self-care when they enter psychology programs and faculty may need to embed self-care throughout the training. Trainers need to teach that self-care is important for all psychologists. No one will be immune from the emotional sequalae from having a patient die from suicide, the illness of a loved one distracting us from our work, or of the myriad of other stressors and negative events that come from life. Although a few may have services degrade to the point that patient wellbeing is jeopardized and a formal intervention is warranted, all psychologists could see the quality of services degrade, to some extent or under some circumstances, unless they care for themselves.
Trainers can address the stigma of getting mental health treatment. Students (and sometimes psychology trainers) may inaccurately believe that having the skills to help others protects them from psychological difficulties, and they may feel shame if they develop such problems. Or they may have internalized prejudices against those with mental illnesses or fear the public stigma that may attach to them if they got treatment (DiBenedetto, 2015).
Trainers can include self-care modules throughout the curriculum. For example, presentations on psychopathology can include data on work related stressors, presentations on ethics can present information on the ethical justifications for self-care, including its references in the APA Ethics Code, presentations on social psychology can discuss the stigma of mental illness, including self-stigma among mental health professionals, and presentations on interventions can discuss the relationship of psychotherapist wellbeing to outcomes, and so on. In addition, teachers can make self-care part of the process of teaching, so that they could include mindfulness moments within the classroom or just ask students how they are feeling (Meghani, 2019).
Because problematic patient behaviors are a common source of work-related stress, programs can teach skills to address those problems such as skills in working with suicidal or aggressive patients, in addressing alliance disruption, or how to manage rude or inappropriate behavior in the psychotherapy room. Such presentations can include information on the emotional reactions that psychologists often feel when dealing with such problems (Knapp, 2022).
Teaching students to flourish as a psychologist means teaching them to balance competing demands. They need to work hard without becoming exhausted, to become reflective without being overly self-critical, to focus on patient wellbeing while being mindful of their own emotions, and to concentrate on their careers while simultaneously promoting the wellbeing of their colleagues.
Graduate students often report feeling overwhelmed by the workload. While programs should not dummy down the curriculum, they can nonetheless reduce stress by making course expectations clear, providing resources or supports for those who need it, giving students precise feedback on how they can improve, and teaching mnemonics and study skills as needed.
Supervisors can teach the importance of balancing self-criticism with self-compassion. As stated in the title of an article by Helen Nissen-Lie et al. (2015) psychotherapists should learn to, “Love yourself as a person, doubt yourself as a therapist” (p. 48). Mindful self-compassion programs can improve the wellbeing of health care professionals and reduce burnout (Neff et al., 2020) which seems especially important given the role that excessive self-criticism plays in burnout.
Self-care requires some proficiency in emotional regulation. Self-care is more than just getting a hobby or taking occasional vacations. Although hobbies and vacations can be interesting and refreshing, deep self-care requires the skills to manage the daily emotional toll of working in mental health, including the willingness to attend to and articulate one’s emotions.
Trainers can encourage students to create a “competence community” or a supportive network of helpful colleagues or resources (Johnson et al., 2012). Cooperative learning assignments may help students to learn from each other and begin to view each other as supportive colleagues. Students can be encouraged to participate in consultation groups or other networks where they can receive emotional support from colleagues, get practical information that can help them make better decisions, or receive concrete assistance with specific projects. Colleagues can monitor each other and correct each other when on the verge of making a clinical error. And the converse of receiving support is giving support to their colleagues which means, among other things, knowing that they are promoting public health by helping their colleagues fulfill their jobs better.
Although trainers can promote the importance of self-care, ultimately students need to decide for themselves the best ways for them to achieve and maintain their psychological health. Not every student enters the profession with the same personal history, personality traits, or emotional skills. Not every student has the same training and supervisory experiences. Therefore, it is not surprising that not every student responds the same to a self-care intervention (Callan et al, 2020).
Learning to live life as a psychologist means learning how to care for one’s emotional health. Emotionally healthy psychologists deliver a higher quality of service to the public and have more rewarding careers. Trainers should therefore help students to develop the skills and attitudes that will help them perform at their optimal level. This includes teaching students to:
- Value self-care as a necessary goal for every psychologist.
- Appreciate the impact of self-care on patient outcomes.
- Challenge the stigma of mental illness in themselves and others.
- Learn to work hard without becoming exhausted.
- Self-reflect without being overly self-critical.
- Attend to their own emotional experiences while working, and finally
- Build productive communities with colleagues, knowing that together psychologists can be more effective than if they act alone.
Cite This Article
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