Mental Health and Clinical Responsibilities as a PhD Student

[PhD_Throwaway]

Current 2nd-year student in a clinical psych PhD program. Am considering whether to approach DCT with concerns about my own ability to see patients (let alone function as a grad student). Tl;dr: moderately-to-severely depressed, but haven't screwed anything up yet (except my health and personal life). Should I talk to the DCT?

While I've had recurring moderate depression most of my life, I've been able to compensate well enough to get into a PhD program. However, I've decompensated very badly this year (partially due to social isolation): I have pretty severe cognitive fatigue and attention/memory issues, to the point that I'm struggling to remember and follow basic instructions from my research advisor; my mind wanders very badly in meetings; and on days when I don't have meetings, I don't get out of bed. To give some indication of the scale of the problem, I also lost about 25-30 lbs, unintentionally, in a semester; I wasn't heavy and am now borderline underweight and look visibly ill. Last semester's grades weren't pretty: I wasn't turning in work and couldn't retain information for exams. My psychiatrist is switching up my medication this spring, which may help and may go very poorly. (As a side note, he thinks I may have undiagnosed comorbid ADHD.) I've been in telehealth therapy (primarily supportive psychotherapy from a midlevel, as this is what my insurance covers) and have not found it helpful at all.

My advisor is aware that I'm having "health issues" but says he has no concerns about my research/academic performance. (I'm surprised by this, because from my perspective I'm doing very little work, but gift horses, mouths, etc.). I also haven't been flagged for bad clinical work, and my feedback has been neutral to fairly positive ("Throwaway is developmentally where he should be and is progressing well"). However, I'm really struggling with deadlines, most of my reports have been written at 2 AM, and I'm pretty much at sea w/r/t taking on any new responsibilities. (I'm also constantly forgetting departmental paperwork, even with to-do lists and reminders.) I'm concerned that it's only a matter of time until I drop a ball very significantly.

Because I haven't actually made any horrible mistakes, as far as I know, I'm concerned that approaching the DCT is premature at best and unprofessional at worst.

On a less urgent note, I'm also a little concerned about sabotaging a potential career. I have a fairly good CV for a 2nd-year at the moment, including a number of first author pubs, but most of those publications are from my lab manager job (when I was functioning much better than I am now). Since I'm struggling to eat and get out of bed, research is not happening. (I'm not enjoying research, but since I'm not enjoying anything else either, I don't think this says much about me.)

How would the professionals of SDN recommend approaching this situation?

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[nessa34]

first of all, I'm sorry you're having to deal with this, and I'm glad you're thinking about how to handle this (with the caveat that depression may be warping your sense of poor performance). That said, though, it does sounds like you're really struggling regardless of how others see your performance, and taking care of your mental health should be a priority for you right now. A couple thoughts:

1) being proactive about situations like this is better than trying to muddle through & clean up the mess afterward
2) taking a leave of absence or other measures to get things like this straightened out is not unusual, is subject to medical privacy rules, and shows maturity in handling difficult personal situations

I would recommend considering a leave of absence, though that can have financial impacts that you need to explore, and may isolate you further. Regardless of how you proceed, you can signal to your DCT and others that you are in a tough spot and need some time to figure things out without disclosing everything. Life happens, even in grad school. It may be worth checking in with services at your school (disability services, counseling center) to see if they can put you in touch with people who can help you with the process of taking a leave or temporarily scaling back responsibilities. Those people may also be able to point you toward resources to find affordable therapy that is more effective than what you're getting now.

good luck.

 

[Harry3990]

Very sorry to hear you are struggling like this. Grad school is hard enough on it's own without the added burden of a pandemic and depression. Personally, the adjustment to doing the majority of my clinical work via telehealth and conducting all team meetings via zoom has been a huge pain in the ass that has really dampened my passion for clinical work and collaboration, something I typically find very rewarding and self-reinforcing.

First thought I'm having is that I have worked with and known some incredibly sharp and effective mid-level providers. If your therapist is not helping, please know that there is nothing wrong with moving on and finding a new therapist if you believe that would serve you better (it sounds like it would), even if it is still simply a different mid-level therapist.

If I were in your shoes trying to decide about approaching the DCT, I would want to do this only if I already had made a decision and plan in mind for what I was asking for (e.g., leave of absence, taking fewer classes temporarily, other specific accomodations, etc.). If I was still trying to figure out what I needed in order to help myself, I would first seek guidance from people I trusted (advisor, professors, therapist, colleagues, friends, family). If you happen to have a close enough relationship with your DCT already, then talking to them and confiding in them might not be inappropriate if that is the context.

Just my 2 cents. Good luck and good for you for trying to be proactive with figuring this out.

 

[PhD_Throwaway]

Thanks for the feedback!

I'd prefer not to take a leave of absence if at all possible--partially for logistical/financial reasons (I'd be worried about interrupting my fellowship and/or losing my insurance, although I admit I don't really understand the procedures here), and partially because I suspect I'd be even more isolated and at sea without regular meetings and deadlines. That said, I'm also worried about doing a barely-acceptable job as a researcher and clinician and ultimately causing more issues.

I will definitely be checking in with the disability center in particular. I have a decent-to-good relationship with the DCT, but I agree that it'd probably be best to approach him with a solid plan.

 

[AlmostaPhD]

Thanks for the feedback!

I'd prefer not to take a leave of absence if at all possible--partially for logistical/financial reasons (I'd be worried about interrupting my fellowship and/or losing my insurance, although I admit I don't really understand the procedures here), and partially because I suspect I'd be even more isolated and at sea without regular meetings and deadlines. That said, I'm also worried about doing a barely-acceptable job as a researcher and clinician and ultimately causing more issues.

I will definitely be checking in with the disability center in particular. I have a decent-to-good relationship with the DCT, but I agree that it'd probably be best to approach him with a solid plan.

I'm a faculty member in a clinical program and I really encourage you to reach out to your advisor (who will probably inform the DCT) and/or the DCT about the situation. Remember that your faculty are also psychologists and they should be understanding about mental health concerns and not hold this against you (I know this is probably not true of everyone, but it should be for most faculty). Students in my program have struggled with mental health issues, divorces, deaths of immediate family members and it was always helpful when they shared that with faculty for 2 reasons: 1) faculty may be aware of options and/or able to make reasonable accommodations to better support you (e.g., here's a recommendation for a better therapist, let's reduce your clinical caseload a bit this semester) and 2) they are better able to evaluate you when they understand any extenuating circumstances.

People may be a bit more lenient right now because we know the pandemic is rough, but if your advisor decides at some point that your work isn't up to par I think you run the risk of them making a less charitable assumption (e.g., not ambitious) if they have no knowledge that you are going through a particularly rough spot. And, for what it's worth, I would not expect a student in your situation to come to me with a plan (depression makes it kind of hard to do that). I would want to hear how they're struggling and help them make a plan. I would also appreciate them addressing it proactively rather than once there's been a negative consequence. And I really would not judge them for having psychological symptoms. Students (and faculty) are people first and there no reason someone who struggles with something like depression can't be a great clinician and/or researcher.

 

[affectiveH3art]

I would consider first speaking to your advisor, possibly a faculty member you are close to and bouncing ideas off with a therapist if you have one. .I have ADHD and have noticed when I am overwhelmed my attention goes down the drain and then depression gets horrible. My check in is if I am wondering about something else and not present with my client I need to lower my caseload and have a conversation with my supervisor. Also, another cue is that I zone out in meetings and can't recall a thing - that's when I know I need vacation time. Maybe consider some off time, lowering of responsibilities and see if that works? I also had an accountability partner (another grad student in the program) who I would check in with about deadlines. I can totally understand your experience from what you shared. I had a major depressive episode and with the ADHD kinda temporarily went down hill quick. So do everything you can to address this. The earlier the better.

 

[Doctor Eliza]

I’d be really cautious about what is shared with faculty. Although they are technically psychologists, they are your professors and evaluators first. Be mindful of boundaries. I had some very negative experiences with this in grad school. Granted, I went to a very toxic program.

I would, however, register with disability services ASAP. This documentation can be very helpful if issues arise.

Happy to discuss more over private message.

Good luck to you.

 

[HPB2015]

So sorry you are dealing with this. As someone said earlier, though it seems possible your depressive symptoms may be warping your perceptions of how well you are doing with your responsibilities (per your advisor's and supervisors' positive reports), you are obviously suffering personally.

I definitely see a big red flag in you saying that you are receiving "supportive" therapy that isn't working for you. I would never provide a person with depression and ADHD with non-directed supportive therapy. I know that it's very overwhelming to find a new therapist, especially when you are depressed, but I would urge you to find a new therapist who provides something like CBT for depression. I understand you mentioned that your insurance is limited but with insurance policies so heavily favoring CBT it seems likely that some of these providers may in fact be covered. You can also check out your school counseling center or perhaps there is a sliding-scale training clinic providing lower-cost higher-quality services (like a university other than your own). If this sounds overwhelming, please consider enlisting a friend to help you. Finally you may want to check out "Mastering your adult ADHD" therapist guide and workbook (Safren, Sprich, Perlman, & Otto). I'm not an ADHD expert so others may have different suggestions but I've had a supervisor recommend that one.

Re disclosure, a couple of years ago I dealt with a very difficult personal situation and I waited until I absolutely had to share it with my advisor because we never talked about "personal" stuff and I was nervous about their reaction. When I finally did, I can't say that they become some superhero, but they were very understanding, supportive, and also revealed they had been worried about my performance because I had seemed "checked out" and "disinterested." I'm SO glad I cleared things up with them because disclosing erased any concerns about me as a scholar. That said, talking to my DCT would have been pretty worthless unless I was going to take a leave they had to administratively handle for me, and this DCT has proven many times that they are not too helpful in these situations (BUT, not harmful, so maybe the consequences would've been minor). So if you can, maybe try to assess your advisor and DCT somewhat objectively or enlist a trusted classmate to help you assess this. You can always share a little without sharing too much to test things out.

I wish you lots of luck and strength! So good you are asking for help.

 

[beginner2011]

Take my thoughts with a grain of salt, as I have not held a faculty position or provided formal mentorship for graduate students.

Others have pointed this out already, but I really want to highlight :

The first two years of graduate school are often extremely challenging in terms of adjustment, and it is probably the norm rather than the exception that students experiencing significant mental health difficulties during this period. I can only speak to the N=15 or so of folks in my program who I knew well enough that I would be comfortable estimating what was going on for them intrapersonally, but the norm was significant difficulty during the early phase of graduate school. I can only imagine how difficulty would be exacerbated by going through that challenging period during a global pandemic, significant social upheaval, and while following physical distancing guidelines. I think that I personally navigated those waters relatively smoothly (almost 10 years ago now!), and if I were doing Y1 or Y2 right now I'd probably be having a much, much harder time. Suffice to say, what you're describing going through right now makes sense.

With that said, I think folks in a supervisory position (DCT, primary mentors, secondary mentors, etc.) are likely to be excellent resources for you. Remember that your DCT and your mentors WANT you to be successful, and part of being successful is effectively managing your mental health. It is of course wise to be discerning about whether one or another of these supervisors would be better than others with some information. However, the general guidelines I would encourage you to follow is to keep in mind that these are all people who have been through many of the challenges you're facing right now themselves, have helped guide many students through this process, and above all are personally (intrinsically) motivated and incentivized (extrinsically) to help you be happy, productive, and successful. Consider how to take advantage of their support!

 

[futureapppsy2]

On a less urgent note, I'm also a little concerned about sabotaging a potential career. I have a fairly good CV for a 2nd-year at the moment, including a number of first author pubs, but most of those publications are from my lab manager job (when I was functioning much better than I am now). Since I'm struggling to eat and get out of bed, research is not happening. (I'm not enjoying research, but since I'm not enjoying anything else either, I don't think this says much about me.)

As a pre-tenure faculty member, one of the best pieces of advice I've received is that a semester or even a year of weaker research productivity definitely isn't a career ender at all, and in fact, it may be pretty unnoticable in the long run. Heck, I ended up taking off basically a month this semester break (starting back today!)--I figured if that's going to doom my tenure bid, this process was unwinnable from the beginning. Also, the expectations for publication productivity from new graduates isn't all that high when you look at the available data and also in my anecdotal experiences on both sides of the hiring process. So, try not to worry too much about this and please take care of yourself, OP.

 

[PhD_Throwaway]

Thank you for the advice and support, everyone. I appreciate all the thoughts posted.

I've contacted the disability office and, after significant thought, reached out to the DCT. I meet with the DCT this week and plan to keep my description general ("health issues," which is honest but IMHO not too much gory detail). I'm also going to emphasize that I'm pretty impaired at work when I next see my psychiatrist. I don't think taking full medical leave is my best option at this time, but I'm going to reserve judgment on that until I get the DCT's perspective.

A small clarification to my first post: I am not presently in any kind of treatment for ADHD: I had a partial evaluation (w/ collateral reports from family) in college, but never got around to making a follow-up appointment and thus never received a formal diagnosis or rule-out. Either way, my focus and memory are very badly impaired at present (and, less dramatically, most/all of the time). My psychiatrist suspects comorbid ADHD and depression and has said he's willing to write a scrip for stimulants, but I'm cautious about stimulants in the absence of a formal ADHD eval. When I get some breathing room, I will be looking for a therapist who does CBT.

It turns out this thread was well-timed: evidently I botched some paperwork badly over the weekend, and the department admins are quite unhappy with me (for non-clinic-related reasons). If I was going to drop any balls, I suppose I'd rather it be the administrative paperwork, but it's a wake-up call that I need to address this aggressively before I screw up something bigger.

Thanks again.