A therapist may spend an entire day listening to stories of grief, abuse, anxiety and loss. Between sessions, there may be only a few quiet minutes before another client walks in expecting calm, empathy and hope.
By evening, everyone has been heard, except the therapist.
The discussion about mental health has changed a lot in the last ten years. People talk more openly about anxiety, depression, stress, burnout, and the need to get professional support. Companies offer initiatives to promote the well-being of their staff, and schools run programmes to teach kids about emotional awareness. In addition, the connection between good mental health and public health is now acknowledged.
At the same time, when discussing well-being and mental health, there is one particular demographic group that seems to be forgotten altogether – namely, those who are responsible for other people’s mental well-being.
Therapists, psychologists, counsellors and mental health experts work within the field where they deal with the most challenging parts of human existence: grief, trauma, divorce, abuse, gender identity issues, chronic stress and uncertainty. Therapists help people to understand what happened and to make sense out of the difficult things they have been experiencing.
Whereas considerable emphasis is placed on the well-being of patients, very little thought is given to the practitioners themselves.
It has been assumed for quite a while now that mental health professionals have the rare ability to endure tremendous amounts of emotional stress without ever getting affected by any of it. Maybe because they have a good understanding of the concepts of coping and self-awareness, they seem immune to the challenges posed by their profession.
This could not be further from the truth.
A review conducted on 9,000 or so mental health professionals working in various nations suggested that about 40% of the respondents suffered from emotional exhaustion, 22% experienced depersonalisation and about 20 per cent reported low personal accomplishment. It cannot be stressed enough that the figures reflect a pattern rather than isolated instances.
It is quite typical in the field of therapy for practitioners to be exposed to emotional stress. In most cases, however, this does not end after completion of the work, as therapists are required to stay present during sessions with clients who tell sad stories of loss, trauma, fear, and despair.
This process, continued for months and years, comes at an emotional price.
Various concepts such as burnout, secondary traumatic stress, and compassion fatigue have gained more relevance in recent years in order to reflect the consequences of prolonged engagement with other people’s suffering. Compassion fatigue, which is sometimes described as the cost of caring, is about losing one’s emotional energy because of empathic engagement with others.
Often, the symptoms of burnout in therapists develop subtly beneath the surface level of their profession. An individual once motivated by a sense of curiosity, compassion, and profound purpose will become more prone to experiencing feelings of being emotionally tired and detached. It will become increasingly difficult to show patience, seemingly minor tasks will become overwhelming, and the emotional connection with one’s work will be compromised. Insomnia and exhaustion are common occurrences, relationships will start receiving whatever is left of the therapist’s energy, and the sense of gratification in one’s work will start fading away. The ironic thing about this phenomenon is that the very people devoted to helping others overcome difficulties are the last to realise when they themselves require attention. All these years of listening to other people’s problems, absorbing all the negative energy they emit, and sharing all their struggles make it difficult to see when passion has been replaced by fatigue, leaving individuals feeling lonely in their profession.
None of these points indicate a lack of competence or a lack of commitment from therapists.
Ironically, many clinicians find it difficult to have the same compassion for themselves that they teach their clients to feel toward themselves. Caregiving often means putting yourself aside. You have to be accessible, work overtime for your patients, neglect yourself and keep working because others’ problems seem more pressing than yours.
Constant exposure to suffering, the rising workload, bureaucratic burden, complex ethical issues, and the need to maintain control can wear you down and lead from professional commitment to compassion fatigue, emotional exhaustion, secondary traumatisation, and burnout – occupational hazards that do not get the deserved attention.
And there is one thing about the field of mental health care that we have been learning all along: it is that it is impossible to stay well at the cost of yourself.
Promoting the well-being of mental health professionals must be done collectively and institutionally. Personal activities like mindfulness training, workouts, and hobbies can help, but they will not change the system that allows overwork.
Mental health professionals require regular supervision and consultations. Professionals must have a place to engage in reflective practice and places where being vulnerable will not be equated with weakness. It must be taken into account by the organisations that employ professionals that take care of others that their work may involve significant emotional labour while setting up their workload and schedules.
Discussions around mental health professional workforce sustainability have become particularly important with the increasing demand for mental health services. The WHO states that there is still a serious lack of mental health professionals in many parts of the world, especially in low- and middle-income countries. In India, where mental health awareness has increased but there still remain access issues, the current professionals bear huge burdens working within overstretched systems.
For mental health care to be sustainable in its provision, not only do we have to produce more professionals, but we should ensure that the current professionals are capable of working without sacrificing their own mental health.
Therapists doing well mean clients benefit from their practice. Their empathy does not get diminished. Therapist presence increases. Their clinical judgement grows.
The issue, however, is not whether mental health practitioners are entitled to moments of rest and recuperation. The real question, in fact, lies in whether our society can afford to overlook their needs for such a purpose.
For one to truly care about mental health, it means caring not only for the clients but also for the practitioners. Taking care of therapists is not merely a selfish exercise. Rather, it is necessary in ensuring that there will be something called mental healthcare left to talk about in the future.
Maybe it is now time to transcend the notion of the therapist as someone whose life revolves solely around other people’s problems. Therapists, in turn, suffer from their own exhaustion, doubt, sadness, and vulnerabilities.
The people who help other people should not be compelled to wait until their energy becomes depleted before they may allow themselves to take a breather.
(The views expressed are personal)
This article is authored by Seema Rekha, founder-director, Antarmanh.
