Source: Confessions of a depressed psychologist: I’m in a darker place than my patients
The Telegraph
HOME NEWS SPORT FINANCE
46 per cent of NHS psychologists suffer from depression, according to a survey by the British Psychological Society.
46 per cent of NHS psychologists suffer from depression, according to a survey by the British Psychological Society. CREDIT: GETTY IMAGES
8 FEBRUARY 2016 • 4:10PM
Anonymous
Last week it was reported that almost half of NHS psychologists should be on the couch themselves – an astonishing 46 per cent suffer from symptoms of depression, according to a survey by the British Psychological Society. Here, a psychologist with substantial experience offers a candid account of their own ordeal some years.
I am sitting opposite my sixth patient of the day. She is describing a terrible incident in her childhood when she was abused, sexually and physically, by both of her parents. I am nodding, listening and hoping I appear as if I appear normal. Inside, however, I feel anything but.
My head is thick – as if I’m thinking through porridge. I find myself tuning out and switching to autopilot. I put it down to tiredness – I haven’t slept well recently; last night I managed just two hours – but after the session I’m disappointed in myself. I’m worried that I might have let down my patient and I feel a bit of a failure, but I tell no one.
One week later, I am in my car, driving across a bridge. Everything should be wonderful – my partner has a new job, my career as a psychologist in the NHS is going well, plus it’s almost Christmas, the second with our young child, and we’re readying ourselves for a move to London.
NHS psychologists can be vulnerable to depression themselves.
NHS psychologists can be vulnerable to depression themselves.
Yet, my mind is thick again. My only lucid thought is, “What if I turned the steering wheel and drove into the bridge support? What if I stuck my foot on the pedal and went straight off the edge? Wouldn’t that be so much easier?”
I grip the steering wheel and force myself to think, instead, of my partner and child. They are the two people who get me home safely.
It is the sort of anecdote I have heard from clients time and time again. I became a psychologist because I have a natural nurturing tendency – I never dreamt I would be the vulnerable one. But 10 years ago I found myself suffering from an extremely severe episode of depression that lasted three months, left me unable to work for six weeks and, at my very lowest, saw me contemplating suicide.
“Had I been going to weekly therapy at the time, my symptoms might have been spotted and nipped in the bud, before I suffered a full breakdown”
I’m certain part of the reason that I sank so low is that, even in the mental health profession, I felt that there was a stigma attached to depression – which meant, even though I had a supportive boss, that I was reticent to admit, or possibly even recognise, that I needed help.
At the time I saw up to six clients a day, five days a week, and my caseload was full of people with heavyweight problems: people who were sexually abused as children by their parents, brothers, sisters, uncles and grandparents; people with borderline personality disorder and post-traumatic stress disorder; people who had lived through horrific accidents, and whose operations had gone horribly wrong; asylum seekers who had been tortured. All in a day’s work.
Psychologists can see several serious cases every week.
Psychologists can see several serious cases every week.
I had never suffered from a mental illnesses myself and, with the exception of compulsory group counselling during my psychology training, I had never had therapy. But this was part of the problem.
As frontline professionals who listen to some of the most horrific and distressing experiences imaginable, it is surprising that counselling is not yet compulsory for all NHS clinical psychologists, as a means of supporting them.
Particularly as it is obligatory for psychotherapists and counsellors. Had I been going to weekly therapy at the time, my symptoms might have been spotted and nipped in the bud, before I suffered a full breakdown.
“Generally psychologists are so keen to help other people, there’s a danger that they can forget to look after themselves properly.”
It began very suddenly and, despite my training, I had no idea it was depression at all, at first – just that I was finding it difficult to sleep. I’d go to bed feeling tired after a long day in work but wake at 1.30am , then lie there for the rest of the night, worrying.
I tried hot baths, warm milk and camomile tea, everything. But nothing worked. The lack of sleep started taking its toll so I went to my GP who prescribed sleeping tablets. I took Mogadon (or Temazapam) but they were hopeless. Another GP suggested antidepressants but Prozac did nothing and Seroxat made me feel even worse, much worse.
Our writer was eventually given Imipramine, an older antidepressant.
Our writer was eventually given Imipramine, an older antidepressant, as Prozac was ineffective.
I became increasingly miserable and pessimistic. Normally I’m happy and optimistic but I just felt flat and overwhelmed – everything was too much. I started being ratty and short tempered with our child, then feeling guilty afterwards.
Around that time the suicidal thoughts appeared. I would find myself thinking about driving my car into walls and off bridges. I felt so horrible and useless and, for a very short while, truly believed it would be much simpler if I ended things.
“Working with adult survivors of abuse is never easy, and sexual abuse cases involving children are particularly difficult to leave behind in the office”
One day I simply couldn’t get up. My GP signed me off work and my partner phoned my boss to tell him, as even that was too much of a strain. Fortunately he was sympathetic and supportive. For six weeks I sat in a chair at home, staring a wall, unable to read or watch television. Even walking was difficult, as each step was so much effort.
Eventually, my GP referred me to a psychiatrist, who prescribed me Imipramine, an old fashioned antidepressant, that seemed to work. I also started to see a psychologist myself, for the first time ever. At first I was a hopeless, hypocritical patient – I hated being on the other chair in the room and questioned everything he asked me. I’d even question why he didn’t ask me certain questions. But, in time, it helped.
My return to work was very gradual. I began with one patient and it took me months to return to my full caseload. I quickly realised that my experience had, in some ways, made me a better psychologist as I can empathise with people on a different level than before. I continue to have regular, ongoing therapy myself and, when appropriate, I even share my own experiences with patients if I think it will help us build a rapport.
Exercise can help switch off from difficulties at work.
Exercise can help switch off from difficulties at work.
I also started swimming, running and cycling, which help me switch off. Working with adult survivors of abuse is never easy, and sexual abuse cases involving children are particularly difficult to leave behind in the office, so I’ve had to find ways of protecting myself.
Generally psychologists are so keen to help other people, there’s a danger that they can forget to look after themselves properly.
On reflection, several factors contributed to my breakdown. First, the work pressure: juggling too many clients with paperwork, sessions with my supervisor, supervisory sessions with others, team meetings, allocation meetings, and dishing out cases and training.
Then, the client work itself: I worked alongside psychiatrists, occupational therapists, social workers, psychotherapists and mental health nurses, but ultimately I was on the frontline, managing very complex cases alone.
Yet I was still luckier than many fellow NHS psychologists, some of whom have struggled with bad management, bullying, very complex caseloads, unsupportive colleagues, poor administrative teams and unsuitable working environments, as well.
Some time ago I left the NHS as I decided that it didn’t suit me anymore. Its culture has become increasingly performance-driven and target-led. In private practice, you see people for as long as you need to make them better – in the NHS you have to get so many people better in a certain timeframe, as it affects the contract that the trust has with its commissioners.
It is getting better in many ways, but the monitoring of psychological wellbeing is nowhere near high enough on the agenda – particularly for heavyweight roles like mine, where dealing with distressing incidents each day can eventually prove potentially, but dangerously, toxic.
As told to Laura Powell