Reflecting: the impact of your own mental health on clients

Here are references relating to different types of therapeutic interventions we can offer and different types of mental health issues, developmental disorders and other presenting problems.
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miriam
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Reflecting: the impact of your own mental health on clients

Post by miriam » Mon Apr 16, 2007 1:16 am

There but for fortune: Mental Health affects us all

They say one in four people has a mental health condition. I think a lot more people have periods in their life in which they have some mental health issues that reach diagnostic thresholds, and even those diagnosed are much greater in number than reach mental health services. I don't think mental illness is something you either have had or haven't had, more something on which we have have all experienced some part of a spectrum.

I can think of two periods in my life in which I had sustained time in a lower mood than I would consider typical of myself - both reactive to cumulative life circumstances, but neither resulted in a diagnosis or any form of treatment (though I did postpone a second year exam with a GP letter, from a doctor who also offered me anti-depressants had I wanted them - I didn't think they would be helpful).

One was at a time in which the house I was living in was sold out from under me by the land-lady who was broke, at the same time as my Dad was being screened for cancer and was admitted to hospital after complications from the biopsy, at the same time as someone I knew cornered me in my bedroom and tried to sexually assault me, at the same time as I was having doubts that the undergraduate psychology syllabus interested me enough to sustain sufficient commitment to make it in CP.... I just needed time and support to work through each of those things, and thankfully they all resolved positively and I was fine.

The other was after my husband was made redundant and we moved to another area of the country where he found a new job. I had to give up a job that I loved and a house that I loved and all my social connections, and I tried to ensure that he felt no guilt about this by pretending it was not a problem for me at all. I realised a year later that the stress of moving, doing up a house in disrepair, starting a new job, and the lack of social support was exacerbated by not being able to draw on him for support and I wasn't very happy at all. Thankfully I was able to build some new social links and be more open with my husband, and the new job grew into something I enjoy more than its predecessor, with lots of supportive colleagues. However, I am aware that without my relationship, my friends and my job this could easily have become a diagnoseable depression, and been much harder to pull out of.

With clients I often think 'there but for fortune go I' and I see such amazing strength and resilience in coping with dreadful life experiences in so many of the people I work with. I'd like to think You can have empathy by being human, even if I haven't experienced the same kinds of things or had therapy myself.

So how does the therapist's mental health impact on their clients?

No living human being has no issues of their own, because every person has had experiences that impact on them, and every person has had relationships with others and been parented. That is true for every profession, and every form of therapist. It would only make any difference to the role you take as a clinical psychologist if the issues you carry personally resonate with what the client is bringing.

If that was the case then all supervision would have to do is identify that there is a personal issue that is relevant and then decide whether that means anything different has to be done differently - the solution can be as simple as being aware of what is personal, or as thorough as passing the client to a different therapist, or anything in between. Obviously if you have major personal issues that cause a more general impact on the work you are doing then one possible solution is personal therapy. I certainly don't believe that personal therapy is necessary for all therapists, let alone for all therapists all the time. And supervision is not personal therapy!

If you use a metaphor - a gardener can know a lot about different soils, different plants, potential problems/pests etc and have various techniques for helping gardens to be of good design and in optimal health. He could help other people to keep their gardens looking great, and teach them how to use his techniques to maintain them. His skill would not depend on whether he had a garden himself at present, or what state it was in (except that maybe if it was a mess he might be demoralised) and experience in his own garden may or may not be relevant to the issues in the gardens he works in, and if it is helpful he may refer to his experiences, but the focus would be the client's garden and not his own.

In the same way, a psychologist can know a lot about mental health, different conditions that may occur, different models of understanding why they occur, and have various techniques that help people improve their mental health. His/her experiences in life may or may not be relevant to understanding the client, and it may occassionally be useful to share a small amount of personal experience. However the focus is on the client's experiences and feelings and not the therapist's.

As I said above, the therapist's mental health and experiences would only be relevant if they impact counter-productively on the client, and unless they are severe issues that would be known to the therapist and their supervisor the impact is likely to be within reasonable limits (and perhaps part of variation in the "personality" of the therapist). Personal therapy is for those who want it, or those who have issues to tackle, and is not a routine part of supervision (though managing how personal issues impact upon your work might be).

To use another metaphor - doctors are not germ free, nor would they claim to be. All they are responsible for being is no more contagious with no more dangerous germs than anyone else the patient is likely to interact with on that day (and to have an awareness of patients whose own conditions mean they might be susceptible to everyday germs). In the same way, I think that a psychologist just needs to ensure that their own mental health is in the "normal range" in terms of how it impacts on others, and have an awareness that there might be clients who are more vulnerable for whom they have to be more sensitive to potential resonance with their own issues.

So, do we all need personal therapy?

The psychodynamic school would argue that process supervision should identify what is yours (therapist's) and what is the client's, and personal therapy should be used to work through your own stuff. I think you have to be a lot more psychodynamic than most psychologists that I know to think there is an inevitable significant impact of your own issues on the client, unless you are working with a client group that by definition are more likely to press buttons, such as those with personality disorder, though even then it is not inevitable.

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Content checked by a qualified clinical psychologist on 3/11/2018
Last modified on 3/11/2018
Miriam

See my blog at http://clinpsyeye.wordpress.com

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