The Practitioners' Burden: Why You Need Someone to Talk To

Many mental health problems call for well-trained and well-supported providers.

In the aftermath of the pandemic, mental health problems have continued to be on the rise and a high-priority issue in public health today.

Approximately 20% of American adults and 17% of teens are challenged by mental health problems yearly, including depression and anxiety. While an increasing number of people seem to be seeking and making greater use of mental health services, it's not always easy to find a therapist. In rural areas, the supply of therapists is failing to meet the overwhelming need.

Clearly, we need an army of mental health providers, and those we have need far more support than they’re getting

Our providers are dealing with the same post-pandemic problems as their clients. Although some are still offering teletherapy, many, back in their offices, describe feeling uncomfortable meeting with people in person, and awkward in crowded situations.

Further, therapy is confidential. The promise of privacy extended to clients means it's unethical—and for many professionals, illegal—for the provider to talk to anyone about client-related problems, unless they've hired a consultant, an expert in their field, or a psychotherapist.

Many therapists end up isolated, with no one to talk to. They're dealing with clients' difficult dilemmas while coping with their own.

In an informal study, I asked colleagues if they meet regularly with a consultant or psychotherapist with whom they can discuss their work. Most reported they had no one to talk to. Few remembered being encouraged to seek consultation, post-training. Most believed after training, they should be able to work independently.

On a good day, they may be right.

After all, working as a mental health provider is rewarding. You witness clients overcoming their problems. Patting yourself on the back, you think, "I'm good at my job.”

But all of you—no matter how many years you’ve been at it—sometimes run into trouble. And if you're an independent provider, you may feel horribly isolated.

When Something Goes Wrong

Martin, a 36-year-old project manager at a tech company, used to begin his therapy sessions with plenty to say. But recently he'd been withdrawn, sometimes irritable. You think he's depressed but he's avoiding serious discussion. As his therapist, you feel like you can't do anything "right"; his therapy seems to have stalled.

Another client, Anna, has been canceling sessions, giving you phony excuses. Maybe you failed a test or maybe she's just grown tired of you.

You feel like a failure when you know clients seem more distant, less honest. Describing the roadblocks, the sudden silences, or cancellations to a consultant would likely help you figure out when and where something went wrong.

Coaches confront the same kinds of problems. John, an experienced life coach, described his confusion when a woman he'd been working with for months, suddenly seemed blocked. The skills she'd been mastering abruptly appeared to escape her. John found himself worried and frustrated. He knew something had gone wrong but he had no one he could safely talk to.

Most of you—whatever helping profession you’re in—have no one to talk to. You terminated your own therapy years ago. You didn’t believe you still needed it.

But then—maybe one of your clients seems bored during sessions. She starts canceling at the last moment, even though she knows she'll have to pay for it. Surprised, you don't know what's wrong or what to do about it.

Sometimes Things Get Alarming

A client’s recent dark mood may take on the shadow of depression. If you’re a coach, you know to listen with empathy and compassion—and make a referral to a professional who treats mood disorders.

If you’re a non-prescribing psychotherapist in most states in the U.S., you, too, refer your client to an M.D. to discuss medication as adjunctive treatment to the psychotherapy you’re providing.

And then, most alarming—when clients speak of “passive suicide.” Perhaps reporting: “I felt terrible this morning. Sometimes I wish I’d get hit by a bus flying by.” This situation may be serious.

If you're trained as a psychotherapist and your client refuses to consult with a prescribing physician, you may feel the buck stops with you. You start worrying: "At what point should my client be in the hospital? How safe is he at home? Should I call the police and ask them to do a wellness check?"

If you’ve been trained as a coach, you’ve probably been told to avoid issues that belong in psychotherapy, not coaching.

But not all clients know their darker moods belong in a psychotherapist's office, not with a coach. But it's you they love and trust. Many don't know the difference between a psychiatrist, counselor, psychologist, or coach. (Learn: here)

So what do you do? You know you need to act: “Sounds like you’ve been down, and I think you should call your doctor right away.”

If you have his doctor's name and permission to contact him/her, you may decide to call the physician yourself.

Safety comes first.

Later that day, you still feel the weight of your client’s suicidality lingering. Fear hovers over you. You worry you said the wrong thing, or whatever you said, you worry you said it wrong. You worry you were overly dramatic, or not overtly alarmist enough. You need someone to talk to.

Whatever kind of helper you are, you wish you'd never left your old therapist, the one you thought you no longer needed.

Even Providers Need Someone to Talk To

Throughout the day, you deal with clients’ problems with living. Clients need someone to talk to, but so do you, the provider. Despite the need for confidentiality, you, too, need someone to talk to.

In each of these roles, things can—and do—run amuck. The first thing you may do is blame yourself, wondering: “What did I do wrong?” Or perhaps it has nothing to do with you. Perhaps it was her family’s visit —but still you worry: “Why didn’t I see this coming?”

It’s never too late to find a therapist you can talk to, without violating confidentiality. You disguise clients you're talking about, using fictional names and changing identifying details.

Call your physician if you can't think of anyone you can ethically talk to. Describe the problem and get some referrals. If your doctor suggests an antidepressant for you, go ahead and try it. It can’t hurt to take care of yourself; a suicidal client is a crisis.

Working on our psychological issues is a lifelong project. Helping others work on theirs inevitably brings a whole new collection of problems and dilemmas.

As a provider, you may sometimes feel isolated, confused, and unable to untangle things because you can't discuss your clients with anyone—until you work with a psychotherapist or consultant.

Talking freely with an experienced professional breaks isolation and ultimately, helps your clients. An attorney specializing in therapists’ legal problems suggested: “Providers working with consultants may be more successful. And they’re sued less often.”

Knowing when to hire a consultant or call your old therapist is a sign of strength.

Providers need someone to talk to.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the National Suicide Prevention Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.