From Ask the Therapist - and response from Dec 2007

This exert came from here - December 31, 2007 under the title "Can Therapists Have Mental Health Issues."

"It is not uncommon for individuals with past or current mental health problems to be attracted to a career in psychology. While this is not uncommon, it is important that if you are going to enter this field that you do the work (in therapy if needed) to correct, or at least become aware of, to the best of your ability, your psychological or emotional issues before you seriously consider helping others.

<font color="red"> You do not have to be “perfect” to enter the field of psychotherapy, none of us are but you do have an ethical and moral obligation to be as psychologically healthy as you can be. </font>

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In addition, if you are suffering with major psychological issues, it will be extremely difficult to help others and to give good advice. Giving bad advice could certainly harm a client and cause further emotional distress or trauma. " </font>

I find this a really interesting issue. If you go over to the Student Doctor Network (SDN) I think you will tend to find that the significant majority of psychiatrists and psychologists are very much opposed to people who have been diagnosed with a mental disorder such as schizophrenia, bi-polar, a personality disorder, dissociative identity disorder becoming clinicians. I personally have trouble with this, and I think that it comes from a false view on the nature of mental illness.

There do seem to be a significant proportion of clinicians who think that it is okay for a person who has experienced such issues in the past to go on to be a clinician once they have made significant progress on their issues, however. I think that this is a nicer middle ground. It is one that is especially prevalent in addiction studies (the promotion of AA and NA and the idea that you have to have had experience with your own addiction in order to help others). Also prevalent with respect to sexual abuse.

There are a variety of different theoretical orientations that all purport to say what therapy is supposed to be about, and how the process of therapy is supposed to work. One view (the CBT view) is that the therapist provides education with respect to such things as cognitive restructuring. While it might be tempting to think that one cannot successfully teach another person this technique unless one is able to apply it successfully in ones own life, that simply does not follow.

I'm reminded of a professor I had who was very much a behaviorist. He taught us how to extinguish phobia. He was very good at teaching therapists the technique for exstinguishing phobia. We discovered that he had a phobia of heights. We asked him: 'Why haven't you extinguished your own phobia, or got someone else to'. He said he had no special desire to extinguish his phobia. That didn't interfere with his job, however, as whether or not he desired to extinguish his own phobia had nothing to do with his ability to help others extinguish their phobia *if they so desired to*.

Fortunately, there are a variety of theoretical orientations and techniques that one can find ones niche in. I think that quite often there are therapists who are (relatively speaking) psychologically healthy, but that doesn't mean they can work with ALL clients on ALL issues. Everyone has things that are a little too close to home. I would expect that to be the case for psychologically healthy individuals and individuals with past and / or present issues with mental health alike. It would be a problem if ones issues were extensive enough such that one couldn't treat any patients for anything... But aside from that there is room for different people to find their niche.

Would I go and see a smoking surgeon for a lung cancer operation? If the surgeon was a good surgeon you bet I would. Would I listen to an obese general practitioner tell me about the health perils of obesity? If the general practitioner was a good general practitioner then you bet I would. I would hope that the general practitioner would be understanding about just how hard it was to lose weight. I don't see that the general pratitioners experience with obesity would be intrinsically harmful or helpful to me. I think that experiences aren't intrinsically harmful or helpful, though they can be used to either. It is up to the person.

I had a friend with severe anorexia and I noticed that his main clinician was rather on the underweight side herself. She had extremely good insight into my friends way of thinking. She helped him feel understood in many respects where other clinicians were unable to similarly help him feel understood. She had a very good eye for the situations he was likely to find problematic and she had a very good eye for things that the general medical staff needed to watch out for - including keeping an eye on his hiding food and / or purging. She was able to use her experience to really help my friend, and for that I'm grateful.

I think that this is an issue that is likely to get people here feeling rather defensive about. Maybe this is partly because people who have had an experience of mental illness likely do have some worried about whether they will be able to be good, effective, helpful clinicians or whether they are going to be just as crappy as some of those they had experienced in the past. A career in clinical psychology / psychiatry is more than a mere job, it is something of a vocation. It becomes a significant part of ones identity as a helper. To suggest that people here, who are trying their best to recover from their issues and be the best clinician they can be, aren't up to the task isn't likely to be received well. I know that you haven't accused anybody of this... That that wasn't your intention. But I do think that it is understandable that people here might feel a little defensive, like you are pushing a hot spot.

How about you? Do you think that your experience with mental illness has the potential to negatively impact on a clinical practice? Is that why you decided that field wasn't for you? Is this discussion partly because you are wondering whether you made the right decision? Whether you could use your experiences to help?

Is it that you would like to truly believe that you could use your experiences to help others, but that you are afraid that you might not be able to?

I think that this issue would be best addressed here rather than on the Student Doctor Network.

Only... If only... There was a forum that combined theoretical discussion with a process of self-reflection and insight into what biases / prejudices / beliefs were driving ones theoretical point of view...

For now... There is something of a split between theoretical discussion (here referred to as 'arguing' or 'debating' in a way that has significant negative connotations) and a process of reflection and insight (sorely lacking from the Student Doctor Network).

Online process group anyone?????

Why must we keep generalizing the same issue? While it is important, it just isn't the case that it works that way for everyone.

Also, I'm not sure who added the part on the bottom of the post about giving advice, but the # 1 rule of being a therapist is-- don't give advice. That is NOT the role of at therapist.

You can suffer from from major psychological issues and still guide your patients on a journey towards reaching insight and awareness.

As a therapist, I find it to be natural that I have deep insight and awareness into my psycholgoical problems--- that seems obvious to me since I have studied in the field and been , and continue, to go to therapy.

I'm not sure whether you found my response irrelevant or whether it was just too long for you to be bothered reading...

One way to attempt to get people to consider an issue objectively is to state it in general, objective language. I think that this issue is really important to Riptide (as evidenced by it coming up a couple of times now).

One thing we can do is ask: Why is this issue so important to Riptide? Maybe Riptide has had experience with clinicians who were unable to provide what was needed because of their own issues. Maybe Riptide is concerned about this issue because Riptide is thinking that they couldn't go on to be a clinician because their own issues aren't sufficiently under control.

Those are useful things to think / talk about, I would think.

So... It doesn't need to be interpreted personally (as an attack on others). Instead, it can be understood personally (as a question one is interested in oneself for the above reasons). Putting those two personal aspects together we can transcend them to the impersonal, objective concern.

I'm not sure that there is any #1 rule of being a therapist because therapy is such a diverse thing with such a diversity of different theoretical orientations. Some forms of therapy are extremely directive, while others advocate abstaining from giving advice in most if not all circumstances.

Do you think that if therapy was directive then that would impact on your abililty to deliver it?

You seem to feel like you are being attacked. That Riptide is suggesting that you don't have insight or awareness into your own psychological processes. Empirical studies have shown that insight and awareness into psychological processes isn't correlated with behavioural change. Empirical studies have also shown that the techniques which are most effective for behavioural change (e.g., altering reinforcement contingencies) don't require insight or awareness at all (works for chickens, toddlers, the mentally handicapped, and adults alike).

It is a scary issue, though... The issue of how much (if at all) ones issues impact on ones ability to be what one most wants to be... Something that comes up outside clinical contexts, as well.

It's not all that complicated-- I was just answering her post based on my personal experience since it is so close to home.

Of course. You can choose to take it personally, and / or respond from your personal experience, if you wish. I just meant to convey that sometimes(?) most times(?) people have personal reasons for raising issues rather than their attempting personal attacks on us and / or to say things in opposition to our experience.

Even when people are intentionally raising issues in an attempt to personally attack or oppose that kind of indicates that there is something else going on...

I'm kinda interested in why Riptide is so interested in this issue... They said something before about having chosen not to pursue clinical psychology as a career... I'm wondering how this issue may relate to that...

(I apologise for the 'they' but I'm trying not to assume gender)

There will always be a risk involved in receiving therapy or any kind of direction in your life. As Riptide said (or quoted?) we are not perfect beings. As such we will make mistakes in our lives.

This problem is not as simple as the obese doctor telling patients to eat healthy or the smoking surgeon. Anyone in this field or anyone inflicted by mental illness knows it is far more complicated than these examples.

You can be a good therapist with a mental illness. I think that scares many people and society is not willing to accept that as a valid statement. Just as we will not accept that ex-convicts can be productive members of society. The stigma attached to each of these things is too far reaching for people to stand up and say "I can."

Most severe mental illnesses are self limiting. How many patients with Schizophrenia and Bipolar Disorder that do not control it can make it through college and onto graduate school?

Many people receive direction in their careers by their personal experiences. If we start classifying those experiences as mental illness we will be limiting some of the best professionals in the field.

> Empirical studies have also shown that the techniques which are most effective for behavioural change (e.g., altering
> reinforcement contingencies) don't require insight or awareness at all...

References?

There is an extensive literature on how certain behavioral techniques result in behavioral change more effectively than insight oriented psychotherapies.

Techniques include: Flooding, systematic desensitization, altering reinforcement contingencies.

We know that insight and awareness isn't required for these techniques to be effective because these techniques can be just as effectively delivered to animals (e.g., bacteria, rats, dogs), infants, intellectually handicapped people, as well as to adults.

Some theoretical orientations prize insight and awareness over behavioral change. I'm not committing to what I think is better. I just wanted to point out that successfully altering your behavior doesn't show that you have insight and are aware, and similarly having insight and awareness doesn't mean that one necessarily changes ones behavior.

Hey, DocJohn already closed this discussion in another thread -- for the reason of this being a support forum rather than a place to discuss ethics. Regardless of what was posted in the past, he has the say on what's allowed in the present! I imagine if you have a specific question though -- like an issue with your own therapist or something like that -- then it would fall under appropriate. I don't believe this does though.

Sidony

thank you docjohn and Sidony, i was getting confused w/all the big words and all. i do believe that everyone has an opinion, but thanks again..........pj56.......

DocJohn did indeed close a thread yesterday in this same vane and as such, this one is now closed.