How To Tell If Your Therapist Is Crazy (Part One)
Q: Why should we trust any of you [psychologists]? Aren’t you all crazy?
Q: Do you think there are alot of people in your profession who are pretty strange themselves? Why should anyone trust any of you?
Q: Are all therapists crazy? What about the suicide rate?
Truth is, I’ve heard some disheartening stories of incompetence, conceit, and meanness among my colleagues. Add to that various tales of boundary violations, diagnostic ineptitude, and goofy, new age therapies. It’s enough to make a guy to wonder: is it true? Do psychologists struggle with mental illness more often then the general population? As is my tradition, I hit the literature in the hopes of scrounging up some facts.
Scrounging… Scrounging… Still Scrounging…
This has been frustrating research. Psychology is meant to help people overcome challenges and adversity. Overall, my profession is pretty good at that. But when it is time to shine the spotlight inward, we get awfully shy.
Searching for reliable data about impaired psychologists is like looking for malfeasance among politicians – you know it’s there but it’s tough to pin down. Existing data, though limited, seems to suggest that we’re no worse off than the population at large. Let’s start with the question of suicide.
It seems to be common wisdom that psychologists and psychiatrists kill themselves more often than anyone else. That idea may have been bolstered by a 1980 study (Rich & Pitts) asserting that psychiatrists off themselves at a rate “twice that expected” among physicians (and that’s a lot).
Recently, broader studies have indicated that occupation is a difficult thing to quantify in suicide statistics. The American Psychological Association (2001) reported that postmortem career inventories are frequently absent or inaccurate.
To complicate matters, various occupational groups have proclaimed their own profession the most suicide-prone, affecting federal death statistics in the process. We’re droppin’ like flies, Uncle Sam. Oh, and while we’re here, may we have a grant, please? Note that the aforementioned study of suicidal psychiatrists was conducted by other psychiatrists (probably the non-dead ones).
Of the identifiable trends, APA reported, there seem to be elevated suicide rates among white male physicians, African-American male security and police officers, and white female artists. Unemployment also increases risk.
Beyond those trends, the data regarding suicide by profession are varied and contradictory. Where shrinks are concerned, the evidence that we kill ourselves at a higher rate than anyone else is unreliable, at best. Which reminds me of a classic joke: How do you bury a dead psychologist?
Shrink-wrap. Ha! I kill me.
Not Much to Offer Beyond Surveys
So we psychologists aren’t leaping off cliffs like lemmings. That doesn’t mean that we don’t have our problems. We drink, we drug, we divorce, and we have our tragedies. And, yes, it affects our work.
A 1998 survey of 522 psychologists revealed that problems related to personal relationships and difficult clients were serious enough to impair their job performance. So were major injuries, money problems, and troubled kids (Sherman & Thelan, 1998).
The results also suggested that life difficulties have a cumulative effect on job performance. No surprise there. The psychologist who looks disinterested or whacky may be simply stressed out and avoiding help. In some cases, that amounts to an ethical violation.
In a more recent study, Katsavdakis et al. (2004) examined the records of 334 impaired psychiatrists, physicians, and mental health workers. These were folks who were receiving inpatient mental health treatment and/or had a formal complaint lodged against them. Of the three groups, mental health workers were the least likely to be married (that may not be as maladjusted as it sounds, considering some of the couples we encounter) and the most likely to be divorced (that, on the other hand, is troubling).
Among all three groups, the most common mental health diagnoses were mood disorder (depression, etc.; 47%), alcohol/substance abuse (15%), and personality disorder (narcissistic, antisocial, etc.; 15%). Among psychiatrists, there was an “overrepresentation” of diddling the patient. I’ll go out on a limb and suggest psychologists share that distinction.
In a 1995 survey concerning substance abuse among counseling psychologists (Good et al.), respondents reported “modest” use of alcohol and “low” use of other substances. In the same survey, 43% said they knew a male psychologist with a drinking problem, and 28% said they knew a female colleague with a drinking problem. These numbers, if accurate, are hardly “modest.” They also suggest that we are not immune to overlooking our own problems.
While we don’t flaunt our alcoholism, we seem more willing to admit when we’re depressed. In a 2002 survey of 1000 psychologists (Gilroy et al.; 425 responded), 62% admitted to relatively minor forms of depression. A handful reported more serious forms of depression, and one psychologist reported an attempt at suicide. One and a half times as many women were depressed as men.
The depressed respondents in the Gilroy study reported some positive aspects to their depression, including greater empathy for their clients. Unfortunately, they also reported withdrawal and isolation, irritability with colleagues, and reduced professional development activities. This is a recipe for substandard care. Which brings us to the pathology-turned-profit theories.
I’ve heard it said that shrinks aren’t simply screwed up, they’re shrinks because they’re screwed up. Where did I hear that? Why, from shrinks themselves.
In a review of the literature on why people choose psychotherapy as a career, Farber et al. (2005) highlighted some of the more prominent pathological theories:
- Therapists were marginalized as children, and that experience created a “heightened awareness of inner events and a strong need to heal oneself and others.”
- As children, therapists experience more pain than others. Becoming therapists gave them the opportunity to develop intimate relationships without the risk of pain or disappointment.
- The field of psychology is attractive to those who feel “frightened and impotent” in their own lives. Being respected by patients allows the therapist to create a pleasing illusion of competence.
- Having emotionally demanding mothers, future therapists “learn to read exquisitely well the signals of others as a means of staying connected emotionally.”
- As children, therapists were rushed through childhood. They were denied of warmth and acceptance and had emotional responsibilities thrust upon them. As a result, they developed a stunted relationship repertoire in which their main role was to nurture others.
- And my favorite: therapists choose their career out of a sadistic desire to crush their patients’ spirit. By focusing on the frailties of their patients, therapists elevate themselves.
… And then they eat their livers with some fava beans and a nice Chianti.
Let us stop before we stray too far into the twilight zone. Farber et al. concluded that, “a consistent theme in the clinical literature — albeit speculative, primarily nonempirical literature — is that many therapists felt isolated, alone, sad, or hurt in their childhood and entered the profession in order to fulfill some of their unmet needs for attention and intimacy.”
Sounds reasonable enough, and I believe many therapists would concur. Personal problems may help draw us to psychology, and that’s not necessarily a bad thing.
Sometimes the Paranoid Are Right
One of my professors once asked the class if there were careers in which a bit of paranoia might come in handy.
“Police officer,” someone said. “Reporter.” “Soldier.”
“Yes, but think closer to home,” he said.
We were stumped.
“The answer is right under your nose,” he said.
We sat in sheepish silence.
“It starts with ‘psy’ and ends with ‘ologist,’” he coaxed.
We still didn’t get it.
I’m exaggerating. I think we eventually gave him what he was after. Too much paranoia gets in the way; the right amount (whatever that might be) drives a person to always look beneath the surface and ask one more question. This is a useful quality in a psychologist.
Maybe the problems that nudge people toward their professions are useful in moderation. Problems can be motivating. Personally, I prefer an accountant who is slightly obsessive over details. I want a surgeon who is just anxious enough to avoid silly risks and inattentiveness.
If I were shopping for a psychologist, I certainly wouldn’t want one whose life had been a perfect bed of roses. I’ve seen clinicians who have had it too easy, and others who have struggled too much. In my opinion, clinical skills diminish at both ends of the spectrum. I like to believe that I’ve suffered just the right amount — whatever that might be.
The Silent Affliction
It is tempting to think that all psychologists are a little crazy. So far, the data just don’t support that conclusion. If anything, there may be certain problems that are more characteristic of mental health workers than other professionals. Depression and rough childhoods seem to have the most empirical support. We’re not immune to substance abuse, and we can burn out or get stressed out.
For every one of us who makes headlines, there are an unseen number who are quietly and effectively working in the trenches. Even when we do get a little quirky, troubled, or sad, it is not necessarily a bad thing for our clients.
There is different kind of mental condition that troubles me deeply. Mental health workers seem especially susceptible to it, and we don’t like to talk about.
I believe this problem causes more damage to our clients than all of the drunk, depressed, and whacked-out therapists combined. I believe that practicing under the influence of this disorder should be considered an ethical violation. And I believe the consumer needs to know the warning signs.
What is this affliction? Check back for Part Two. Watch as I, once again, gamble with my career like the pink slip to my old ’79 Dodge Omni. (Mine was green. Ick.)
Until then, be sure to hit the comments link on the way out (at the top of this page). I’d love to hear your stories of therapy, both good and bad. Don’t name names, please. This website gets me in enough trouble as it is.
American Psychological Association (2001). Suicide by profession: lots of confusion, inconclusive data. Monitor on Psychology, 32(1).
Farber, B.A., Manevich, I., Jetzger, J., & Saypol, E. (2005). Choosing psychotherapy as a career: Why did we cross that road? Journal of Clinical Psychology, 16(8), 1009-1031.
Good, G.E., Thoreson, P., & Shaughnessy, P. (1995). Substance use, confrontation of impaired colleagues, and psychological functioning among counseling psychologists: A national survey. Counseling Psychologist, 23(4), 703-721.
Katsavdakis, K.A., Gabbard, G.O., & Athey, G.I. (2004). Profiles of impaired health professionals. Bulletin of the Menninger Clinic, 68(1), 60-72.
Rich, C.L. & Pitts, F.N. (1980). Suicide by psychiatrists: A study of medical specialists among 18,730 consecutive physician deaths during a five-year period, 1967-72. Journal of Clinical Psychiatry, 41(8), 261-263.
Sherman, M.D. & Thelen, M.H. (1998). Distress and professional impairment among psychologists in clinical practice. Professional Psychology: Research and Practice, 29(1), 79-85.