PhD/PsyD deleted

[chrostopherhenandex]

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[temppsych123]

Yup, I sought someone out as soon as I moved here for help with recurrent MDD. It was a bit tricky to find someone not affiliated with the internship site, but when I explained the situation to potential providers they were generally understanding of my need to find someone not involved in the internship and someone who had availability on evenings/weekends. Good luck, OP.

 

[foreverbull]

Absolutely! My internship site strongly recommended that all interns attend personal therapy because of the exhaustion/burnout and demands of being supervised so closely. What you're feeling is pretty common for many interns; I had a difficult internship myself and knew several colleagues having similar challenges in their sites as well, so you aren't alone in that feeling.
I'd also suggest connecting with your colleagues from your grad program who are also on internship or your fellow interns, if you are comfortable with them. Having that extra support of "I know what that's like" can be really helpful, as well. But for sure, therapists utilize therapy too, and hopefully you aren't feeling stigma regarding seeking therapy as a practitioner. It's just good self-care.

 

[erg923]

Absolutely! My internship site strongly recommended that all interns attend personal therapy because of the exhaustion/burnout and demands of being supervised so closely.

Strongly recommend??? I really don't think that appropriate. Support it. Encourage it if issues come up that psychological counseling could actually benefit. But otherwise, this seems to be a bit histrionic and doesn't bode well for the quality of your internship program and their method of supervision.

 

[deleted343839]

My internship site strongly recommended that all interns attend personal therapy because of the exhaustion/burnout and demands of being supervised so closely

Yeah, I'm with erg on this. That's kind of an extreme expectation to set for incoming trainees. That sends the message: "your existing support and coping resources will fail you." That's just not true of everyone.

To the OP - good for you for not just recognizing your need but acting on it. Also: it DOES get better.

 

[Justanothergrad]

Man.. that's a worklife balance I'm not interested in either ... "You're going to be unhappy if you come here"

 

[CheetahGirl]

Agreed. Strongly recommend may be a little overboard (for most sites).

However, if you attend a clinic that is sometimes 'hazardous to your (own mental) health,' so to speak - meaning you are vicariously traumatized by the work (and regularly), then perhaps you better ask yourself if you should be doing that line of work? Or is it something you really want to learn to handle? If it has nothing to do with work and more to do with your personal life, than you would assess just as you would anyone else would - how much is stuff [stress, life, things, whatnot] interfering with your daily functioning? If you have it under control, great! If not, maybe some outside perspective is needed.

I had an externship that "strongly recommended" your own therapy... especially if you've never done the work on yourself (like your countertransference). Therapy (for the therapist-in-training) is in addition to other supports (individual-, group-, peer-supervision- which perhaps most find adequate - it is a lot). IME several practica were fine being peer- and faculty- supervised, where some instances - small group supervision and individual supervision were necessary and important for individual growth. But sometimes, somethings needed to be shared in private... as it relates to your own stuff. So individual therapy is always fine to discuss those private things.

In my case, I started therapy once I found out I was pregnant with one of my kids (in addition to multiple on-going stressors, including internship applications and dissertation data analysis). At the time, I provided therapy in a child and family support program where I witnessed drug addicted/malnourished babies and sexually/physically-abused children. It was emotional and I would discuss the intensity of holding onto my work throughout the week (especially when my hormones were elevated). Rather than sharing all with each supervisor and my fellow externs (yikes!), I used to go into my therapist's office to cry for the children I saw and the abuse that was happening, but also for myself, like how was I supposed to handle all of what I had to handle? Oh, and my p-values were not significant. But I'm no crybaby...

We (that program) was designed to treat and prevent the maltreatment of children. So when the goings got tough, the tough got going. And it was tough stuff. My own therapy was an extra private support where I didn't need to share with the world how I felt, and it worked out nicely. I held in there until my last day. And it was good work - I enjoyed helping the families I did and they were my youngest patients yet (love play therapy with 4-year olds!). In hindsight, wow. The stuff we do when we dedicate ourselves to something.

If you're debating it and can make time for/afford it, I say get the support. It's harder than you think. I knew when I began canceling my own therapy appts that it was time to end (became too busy and the tough stuff was over), but I put in many hours worth of work. It was worth it because the work I do now is relatively more difficult, and I have learned my own paths to self-care, and the individual therapy helped with that perspective.

And as guessed, it was very insightful.

 

[Jegg]

Gonna go against the flow a little. IMHO, you get therapy by treating people. Otherwise, you get it via supervision second hand. Between the two, you should have some sense of yourself... If not, meh....

 

[erg923]

vicariously traumatized by the work (and regularly).

I am curious if we should stop using this phrase. I would bet many people who actually experienced/lived through trauma find it insulting.

I have never felt "traumatized" by the stories I hear, because I was obviously never in any actual danger or at risk of such. I have felt disgusted, emotional, empathetic, etc., however. If you are having a true clinical trauma reaction after working with your patients, this may be reflective of a poor/unhealthy lifestyle that is not yet able to cope with the nature of your job.

 

[CheetahGirl]

If you are having a true clinical trauma reaction after working with your patients, this may be reflective of a poor/unhealthy lifestyle that is not yet able to cope with the nature of your job.

This was my point. I don't use that term lightly, and if the OP is an intern, he/she would understand the gravity of the distress that could be related to one's work (with vicarious trauma being on the heaviest end of the spectrum, and innocuous daily hassle on the opposite end).

I hear 'awful' (to put it lightly) stories daily at my current job (and I write about and research the impact of those experiences), but I have nurtured the qualities that permit me to do my job and return home with an acceptable disposition at the end of the day. If I couldn't handle it, I wouldn't do it. And my other point, was that my own therapy helped get me to this place.

 

[awishingstar]

I am curious if we should stop using this phrase. I would bet many people who actually experienced/lived through trauma find it insulting.

I have never felt "traumatized" by the stories I hear, because I was obviously never in any actual danger or at risk of such. I have felt disgusted, emotional, empathetic, etc., however. If you are having a true clinical trauma reaction after working with your patients, this may be reflective of a poor/unhealthy lifestyle that is not yet able to cope with the nature of your job.

Repeated extreme exposure to details of trauma is part of the DSM-5 definition of an index trauma now, so one can certainly be traumatized from our job. Aside from the semantics though, I think it can depend on life circumstances to a point. For many people, our clients and ourselves, it is absolutely a lifestyle/skills deficit issue. For some, though, life is just a little heavy at times. I'm on internship this year and have specialized in PTSD treatment over my training. I've usually had no problem leaving work at work, and on internship I'm also able to do this. However, there was one semester where everything was stacking up in both my personal life and graduate student life, in an absolutely atypical way, and that was the semester that I started ruminating about clients and taking their trauma stories very personally. I was still engaging in all my self-care, supervision, all that good stuff, but sometimes resources just get tapped out. So therapy was important for the same reasons Cheetah mentioned - emotional debriefing, making a cohesive narrative of what's going on, yes learning a new strategy or two for weathering the storm, but mostly just having some external validation that sometimes the going gets tough even for therapists.

Of course, if it's a chronic and regular issue, that might be where one might question lifestyle/competency/suitability for the job. I just would caution against assuming therapists who develop aversive reactions to a client or clients are weak or unsuitable for the job. There is an element of randomness to people who develop trauma - we're getting better at sorting out a vulnerability profile but it's still true that highly resilient people can experience a trauma and be clinically affected by it.

 

[erg923]

Repeated extreme exposure to details of trauma is part of the DSM-5 definition of an index trauma.

And, 4 years ago, it wasn't, right? Be careful about forming clinical opinions on an ever shifting book where stuff is voted in by consensus.

Also, what you described in not a clinical trauma reaction. It general emotional distress due to multiple factors.

 

[awishingstar]

And, 4 years ago, it wasn't, right? Be careful about forming clinical opinions on an ever shifting book where stuff is voted in by consensus.

That was a fairly minor part of my reply (nvm: saw your edit.) my work is with first responders and they certainly develop clinically significant PTSD based on repeated extreme exposure to details of trauma, so my clinical opinion is informed by an ever shifting book as well as my actual clinical experience with my clientele.

 

[awishingstar]

Also, what you described in not a clinical trauma reaction. It general emotional distress due to multiple factors.

In my case, the general emotional distress was a vulnerability, but there was a specific client trauma which precipitated the worst of it. No, it was not clinically significant PTSD, but I'm not using myself as a clinical case study - just providing an illustration of how atypical work/life circumstances can affect some therapists' normal reactions to clients, and this at the extreme end could result in posttraumatic stress.

 

[CheetahGirl]

In my case, the general emotional distress was a vulnerability, but there was a specific client trauma which precipitated the worst of it. No, it was not clinically significant PTSD, but I'm not using myself as a clinical case study - just providing an illustration of how atypical work/life circumstances can affect some therapists' normal reactions to clients, and this at the extreme end could result in posttraumatic stress.

Exactly....the specific client trauma (in my case, seeing malnourished, neglected babies with young, unprepared moms) while being in the second trimester was too much for me to handle on a weekly a basis. BUT, I got extra support with my situation...and ended up extending my externship placement to two years (rather than one).

However, during this process, I realized that I do not want to vest my career with interventions aimed at traumatized young moms and children (which is what my dissertation was on, and an area that I originally intended to specialize). I work with combat Veterans now, and find the work/outcomes equally as rewarding.

It is all about work-life balance...and if you can figure it out for yourself, there are more pros than cons when it comes to your service delivery IMO.

 

[temppsych123]

I generally believe that, if you think therapy could help you, it's worth a shot. Whether it's due to an unusually/excessively demanding internship site, underlying psychopathology or risk factors thereof, hearing about traumatic experiences that are exacerbating whatever else is going on for you (or not having other things going on with you, but not yet having received adequate supervision/support in your training environment to deal with this), whatnot, therapy can help you sort it out. The ideal outcome from therapy might vary depending on the circumstances, but therapy itself couldn't really hurt, if you can make the time to do it!

 

[foreverbull]

Strongly recommend??? I really don't think that appropriate. Support it. Encourage it if issues come up that psychological counseling could actually benefit. But otherwise, this seems to be a bit histrionic and doesn't bode well for the quality of your internship program and their method of supervision.

Let me provide context, as things seem to go to the extreme very quickly without context.

My internship site was very psychoanalytic/interpersonal and holistic in supervision practice and the rigors of supervision. The expected level of supervisees' sharing was very high (as the personal was seen as influencing the professional) and feedback was constant and draining. This was the philosophy of the site, so recognizing that supervisees would likely feel overwhelmed, personal therapy was their recommendation. For those saying "don't pick that site," we weren't aware of just how intense it would be until we got there. Things on paper don't always translate to the real experience. It was very challenging for sure, and a somewhat unique experience, but I also knew colleagues at other sites who could have benefitted from personal therapy simply due to exhaustion and being away from friends/family rather than anything supervision-related or unique to the site.

While I see your point about my site specifically (they had very high expectations), I want to be careful not to further stigmatize therapists seeking therapy. In my professional setting, I'd say about 1 in 4 or so of my colleagues currently attend therapy (and probably much higher numbers have in the past at one time). This isn't because they are poorly-adjusted practitioners who aren't using their supports effectively; they simply consider it another tool/support that benefits them at one time or another and/or gives them the chance to download to an objective party. Some graduate programs encourage students to seek their own therapy, some require it, and some are silent on the issue. It's all about personal philosophy and personal choice. I was trained with people who encouraged being on both sides of the couch at one time or another, so to speak, not just for self-care but to self-reflect and be able to understand a client's experience, and in my settings professionally in the past 3 years, I've seen similar philosophies among colleagues.

Anyway, I find this to be an interesting conversation, so I definitely enjoy hearing people's perspectives!

 

[futureapppsy2]

To throw in a bit of caution, research suggests that some sites/supervisors/faculty in professional psychology DO have negative views of trainees with psychological disabilities or conditions (and other disabilities and health conditions in general, though I think the nuances are perhaps different for psychological conditions). There was a study published in TEPP recently where trainees with invisible disabilities, mostly psychological conditions, generally recommended being very judicious and cautious about to whom you (generic) disclose anything to do with mental health, because some supervisors/sites may sadly use that against you. This isn't to say don't seek help (definitely do, if you feel it may be helpful!) but rather that being cautious about if and how you disclose any of this to your site may be a good idea.

Lund, E. M., Andrews, E. E., & Holt, J. M. (2016). A Qualitative Analysis of Advice From and for Trainees With Disabilities in Professional Psychology. Training and Education in Professional Psychology, 10, 206-213.

 

[CheetahGirl]

Yes. Caution to the wind.

However, if you have an ailment, seek assistance. And until it comes up for debate, it is pretty much your business only.

 

[smalltownpsych]

Didn't have psychotherapy, but did have some supervisors that were supportive and understanding to the psychological stressors of internship and we would discuss means of accessing various resources. Then there were the supervisors who were psychological stressors! Learning how to cope effectively with higher levels of stress is part of internship in. Y mind and helps to prepare one for independent practice so whether it is psychotherapy, religious participation, support group, skiing (that was one of my best coping tools) doand ant matter as much as learning how to utilize these resources. Self-care is not just a buzzword, it is part of our skill set .

 

[Wendi22]

Let me provide context, as things seem to go to the extreme very quickly without context.

My internship site was very psychoanalytic/interpersonal and holistic in supervision practice and the rigors of supervision. The expected level of supervisees' sharing was very high (as the personal was seen as influencing the professional) and feedback was constant and draining. This was the philosophy of the site, so recognizing that supervisees would likely feel overwhelmed, personal therapy was their recommendation. For those saying "don't pick that site," we weren't aware of just how intense it would be until we got there. Things on paper don't always translate to the real experience. It was very challenging for sure, and a somewhat unique experience, but I also knew colleagues at other sites who could have benefitted from personal therapy simply due to exhaustion and being away from friends/family rather than anything supervision-related or unique to the site.

While I see your point about my site specifically (they had very high expectations), I want to be careful not to further stigmatize therapists seeking therapy. In my professional setting, I'd say about 1 in 4 or so of my colleagues currently attend therapy (and probably much higher numbers have in the past at one time). This isn't because they are poorly-adjusted practitioners who aren't using their supports effectively; they simply consider it another tool/support that benefits them at one time or another and/or gives them the chance to download to an objective party. Some graduate programs encourage students to seek their own therapy, some require it, and some are silent on the issue. It's all about personal philosophy and personal choice. I was trained with people who encouraged being on both sides of the couch at one time or another, so to speak, not just for self-care but to self-reflect and be able to understand a client's experience, and in my settings professionally in the past 3 years, I've seen similar philosophies among colleagues.

Anyway, I find this to be an interesting conversation, so I definitely enjoy hearing people's perspectives!

Just wanted to say that after reading your first comment (as well as the comments that followed), I immediately thought that you were likely at a psychodynamic site, where attending psychotherapy is typically strongly encouraged.Trainees usually know this going in, as it fits with the theoretical perspective. Anyways, just wanted to say that I too thought things went to the extreme very quickly. I know many people that have received psychodynamic training and also said that it was "strongly recommended"that they attend personal therapy.

 

[deleted343839]

Just wanted to say that after reading your first comment (as well as the comments that followed), I immediately thought that you were likely at a psychodynamic site, where attending psychotherapy is typically strongly encouraged.

I think what people were reacting to was the rationale for encouraging personal therapy - ie, that the demands of training will necessarily lead to exhaustion and burnout and the trainee will need therapy to cope.

Perhaps it was just the choice of words, but this is different from the rationale more typically presented for dynamic or analytic trainees.

 

[Wendi22]

I think what people were reacting to was the rationale for encouraging personal therapy - ie, that the demands of training will necessarily lead to exhaustion and burnout and the trainee will need therapy to cope.

Perhaps it was just the choice of words, but this is different from the rationale more typically presented for dynamic or analytic trainees.

Sure. Again though, just wanted to let this person know that at least one person did not have that reaction and has certainly heard that before.

 

[helga]

I had a similar experience on internship- I ended up seeking tx but regret not getting help sooner. I came from a program that viewed personal therapy as a waste of time within the training experience and the internship faculty had similar views (Med School). I don't think its unreasonable or a 'red flag' for the top-tier competitive internships to acknowledge how challenging their training experience can be at times. Its a stressful year and accessing support as you need it is essential for you to continue to take advantage of training experiences. I was surprised to hear many of my more senior peers and advisors share similar stories of their internship experience, ranging from mild adjustment difficulties to full on MDD.

Good for you to seek out help!