Do Therapists-in-Training Need Therapy, Too?

“We have to push ourselves beyond what we think we’re capable of.”

“I have three ‘bosses’ who all expect 100% from me, but I can’t physically give 300%. I feel like I can’t accomplish enough. It’s never enough.”

“I’m scared out of my wits. I live in panic mode all of the time. I just want more stability.”

“I’m just waiting for someone to figure out that I have no idea what I’m doing.”

“I spend so much time working, and thinking about working, that I have no time for enjoyment.”

These statements were not made by clients. They were not spoken in a counseling session, or at a support group. These are statements made by doctoral students during group supervision, after being prompted to speak about their successes of the semester. These statements certainly don’t highlight successes. Rather, they speak to feelings of stress, anxiety, hopelessness, imposter syndrome, and fear. These statements speak to mental health concerns.

Although there has not been nearly enough research in this area, the data we have on graduate student mental health is very disheartening. The following are some examples:

University of California, Berkeley sampled their graduate students in 2006 and again in 2014, and found that almost half of graduate students reported having an emotional or stress-related problem that affected their overall well-being or academic performance. Additionally, in the 2006 sample, approximately 10% had considered suicide within the past year.

Wyatt & Oswalt (2013) examined national data and found that approximately 40% of graduate students reported hopelessness during the previous year, 79% reported being overwhelmed, 55% reported high levels of stress, and 27% reported symptoms of depression.

A 2009 survey by the American Psychological Association found that 87% of graduate students reported symptoms of anxiety, 68% reported depression, and 19% reported suicidal thoughts.

While these statistics are alarming, the effects of graduate school may be best illustrated through blog posts, social media threads, and other anecdotal evidence. Some articles speak to the cultural acceptance of mental health issues among graduate students, while others attempt to normalize and lighten the harsh reality. Some posts provide advice to graduate students, while some encourage avoiding the culture, and the degree, altogether.

Research articles, blog posts, and the like point to several different factors that impact graduate student mental health:

• Graduate students are inherently high achievers who may be experiencing real or perceived failure for the first time in their lives.
• Several common tasks of grad school, such as reading and conducting research, are isolating by nature.
• Students are plagued by uncertainty about the future, in terms of career aspects and financial stability.
• Work demands and high expectations of productivity are often unmanageable, and can lead to poor sleep-hygiene, lack of exercise, and unhealthy eating habits.
• And for some, it seems that “self-care” becomes synonymous with happy hour, and “work-life balance” equates to writing while binging on Netflix.

Therapists-in-training may have unique contributing factors

In addition to the mental health issues and feelings of inadequacy that are commonplace among graduate students across disciplines, behavioral health students are on the front line, helping others with their own mental health concerns.

Therapists-in-training are expected to be empathetic and accepting of clients. We are expected to give our clients our full attention and to be completely engaged in the present moment.

By the end of the day, helpers often feel drained of empathy and exhausted by the work of remaining fully present with clients. As students, we are only beginning to learn how to balance our clients’ struggles as well as the art of not “bringing work home.”

Most of us have yet to understand how to buffer against compassion fatigue, or fully engage in self-care. Sometimes, the last thing we want to do is seek social support after a full day of helping others.

As behavioral health students, our knowledge and experience can sometimes cause us to deny or diminish the extent of our mental health concerns. We may view our symptoms and issues in comparison to what is considered pathological.

A student who experiences symptoms of depression may justify that they do not meet criteria for a diagnosis, and ultimately minimize the state of their mental health. Similarly, a student who drinks a few glasses of wine to relax might rationalize that they surely don’t drink enough to have a substance-use disorder, neglecting to address the need for healthier coping skills.

We may also be at an increased risk to compare our struggles to those of our clients. It’s easy to invalidate your own difficulties when they feel so much smaller than those of the people you help day-in and day-out.

In thinking about your own mental health, it can be detrimental to compare yourself to diagnostic criteria or your clients; instead, focus on what is normal for you, and you alone.

Therapists-in-training may have unique barriers to seeking help

Students in behavioral health programs may face unique barriers to seeking help as well. While most articles on this topic suggest professional counseling, therapists-in-training may have a difficult time finding a personal counselor or therapist that they will not also encounter in their professional life. Many students do not want to take on the role of a client when they are striving to be viewed as a colleague.

Although most behavioral health programs recommend that students experience counseling from the client’s perspective, some students continue to view help-seeking as a detriment to their professional identity.

When graduate students do decide to pursue counseling, cost can also be an issue, given that financial instability is common. Although university counseling centers and other school-affiliated resources are often free and available to graduate students, these may not be viewed as options due to real or perceived professional conflicts.

Although many institutions assure that these resources are confidential and will not compromise the student’s standing in any way, many students remain skeptical of how clear those boundaries truly are.

Even the decision to disclose mental health difficulties with an advisor is a weighted one. An APA gradPSYCH article notes that, while some programs may be supportive and helpful, others may be less so.

Students who choose to not share their difficulties with their advisor or their program may also fear sharing with other students, thus further isolating themselves. Despite working in a field that strives to reduce the stigma related to mental health, many students feel that this stigma is alive and well when it comes to the mental health of practitioners, both budding and established.

It is also not uncommon for behavioral health students to have a tendency to feel like they should be immune to such problems. It’s difficult to accept your symptoms if you know how to prevent and buffer against them. It’s hard to seek treatment from someone else when you feel that you know how to treat the issue yourself.

As therapists-in-training, it’s imperative to remember that we are just as susceptible to mental health issues as everyone else, and, while we may know how to help others, we may also need the help of others from time to time.

How to help yourself

1. Be honest with yourself about the current status of your mental health.
Don’t compare yourself to clients, and don’t try to diagnose yourself.

If you feel like you need help, then you probably do. If you are unsure, you can try tracking your symptoms or moods through the use of apps such as Optimism, to help give you an objective picture of your mental health.

2. Engage and expand your support system.
Sometimes parents, spouses, and loved ones who are not in a graduate program just don’t get it. And sometimes, even with the best of intentions, they can even make you feel worse.

Talk to people in your life who share your experience. Reach out to your classmates and alumni. Make friends with students in other graduate programs through graduate student organizations on your campus or through networking groups in your community. Find a small group of students who you trust and start a sharing community.

3. Work on your overall health.
UC Berkeley has reported that two of the top predictors of depression among graduate students are sleep and overall health. Try to eat just a little healthier, get some exercise a couple of times each week, and improve your sleep hygiene. Even if you can’t change your current routines completely, small tweaks can go a long way.

4. Put down your work, and do something you enjoy that is NOT school-related.
Do this at least every once in awhile. Your break can be as time-consuming as you want.

Spend time with friends and family. Draw, paint, write, or get lost in an adult coloring book. Try a new recipe. Go to the movies or theater. Read a trashy novel. Have a picnic. Volunteer. Travel. Play. I’m not saying you can’t write while binging on Netflix… I’m just suggesting that you try something else that is enjoyable, too.

5. Eliminate unnecessary stressors, and simplify as much as possible.
Sometimes the things that stress us out the most are the easiest to address.

Turn off the unnecessary notifications on your phone – do you really need to know about every Instagram comment immediately? Combine your email accounts, and take 5 minutes to unsubscribe from all the junk. Perform some weekly food prep, and pack a healthy lunch the night before. Add your gym schedule to your school and work calendar so that you can make it a priority. Think about your daily routine so that you can identify and address these trivial stressors.

6. Practice setting boundaries and saying “no.”
It’s okay to say “no” to something that you really don’t have time for. In fact, it’s often a sign of professional maturity. You know your limits better than anyone; listen to your gut when you’re asked to take on a new responsibility.

7. Remember that you’re not alone.
Know that many other graduate students feel the same way you do.

When you’re climbing a treacherous mountain, you’re bound to get some scrapes and bruises along the way. In fact, you may even tumble backwards a time or two, and that’s okay. You might dust yourself off and continue on your climb, or you may decide that the top of the mountain isn’t worth the hike. And either way, it’s okay, and you’re not the first person to take this path. Others have been where you are, and more will follow in your steps.

8. Seek help if you need it.
If you think you need professional help, recognize that this should be a priority and find a way to get the help you need. If you are worried about pursuing counseling in your community, look into therapists in nearby towns or through your organization’s Employee Assistance Program. If that doesn’t work for you either, then check out the alternative therapy resources, such as online counseling or self-help resources (just please use with caution, as the efficacy of such forms of treatment are not yet established).

Remember that you can always seek immediate help through a crisis line such as The National Suicide Prevention Lifeline, which offers phone support (1-800-273-TALK) and online messaging services 24/7, or Crisis Text Line, which offers 24/7 text support (text START to 741-741).

References

Wyatt, T., & Oswalt, S. B. (2013). Comparing mental health issues among undergraduate and graduate students. American Journal of Health Education, 44(2), 96-107.