Psychiatrists Harnessing Lived Experiences: a Risky Business?

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COMMENTARY

A substantial proportion of mental health professionals (45-75%) have personal experience with mental health services.¹ There is some evidence that those who have used mental health services may be more attracted to work in this field.²

Simona Karbouniaris, MsC

The culture among mental health professions, however, is often not very open about this, and professionals often perceive personal mental health problems as a weakness, feeling they should be able to cope on their own.² Psychiatrists have been trained to divide the personal from the professional and have a tendency to self-diagnose and self-treat.³ Correspondingly, they may experience shame, embarrassment, and fear of being judged negatively if they disclose their own mental health histories.

Jim van Os, MD, PhD

Findings from a recent randomized controlled trial, however, reveal that physician self-disclosure of lived experience improves mental health attitudes among medical students.⁴ Patients may also profit from professionals harnessing lived experiences. Little is known, however, on how to disclose and use experiential knowledge in a professional and appropriate fashion.⁵ Research illustrates that the mental health systems in many western countries (Australia, the United Kingdom, the United States of America, The Netherlands, and Israel) has struggled to meaningfully incorporate the lived experiences of professionals.⁵ In order to address this deficit, several pilot studies in The Netherlands have focused on the implementation of experiential knowledge in mental health contexts, including peer consultation groups for psychiatrists whose personal experiences could inform their medical practice.

What Is Experiential Knowledge?

Experiential knowledge can be defined as the ability to handle or resolve a problem based on one’s own experience.⁶ It may refer to the emotional impact or to practical, spiritual, and existential insights that come with coping with certain types of distress. It has been introduced as a new source of knowledge next to professional and scientific knowledge, and has been increasingly acknowledged and formalized.^7,8

A small body of literature has studied how traditional mental health professionals have used experiential knowledge. To date, these studies have mainly looked at applied professions, such as social workers and nurses who followed post-bachelor trainings , stimulating the integration of the personal-professional identity.⁵

Being aware of one’s vulnerabilities is basic to the training of psychoanalysts and the Rogerian tradition. However, the explicit use of lived experiences in mental health care practice to date has been limited to in-vivo self-disclosures.⁵ Although some psychiatrists like Ahmed Hankir, MBChB, MRCPsych, portray themselves as wounded healers, exposing one’s own weakness generally has a negative connotation. At the same time, a broader research project in the Netherlands is now exploring the use of experiential knowledge by psychiatrists.⁸ The psychiatrist is often the lead member of a care team, so harnessing lived experience may be considered a particularly risky investment. They may feel concerned about losing authority or blurring the boundaries between professionals and patients. There may also overidentifying with and projecting issues onto clients.⁹ Anecdotal evidence suggests that psychiatrists seem wary or do not know how to navigate this.¹⁰

Obstacles

There are many potential obstacles keeping mental health professionals, particularly psychiatrists, from harnessing lived experiences in clinical practice. While there is growing empirical evidence that patients feel well supported by caretakers who share their experiences,¹¹ there is no evidence yet that would also apply in the case of psychiatrists using their lived experience. Using lived experience is also often associated with (inappropriate) disclosures and labelled as unprofessional. The fear is that it may undermine the supposed neutrality of the clinician. Consequently, psychiatrists are not trained to transform their lived experiences into experiential knowledge. Without proper training, many are insufficiently equipped to use their own experiences as part of their treatments.

Furthermore, they were taught¹² that personal disclosures may put additional stress on, and thus further burden, already vulnerable patients. They may fear it will lead to role confusion and are more comfortable in a role as unimpaired professional, especially when facing difficult decisions for example (forensic) risk assessments.

The Future of Experiential Knowledge

In the Netherlands, some psychiatrists recently joined a broader movement in which mental health professionals reveal their lived experience. They come together in peer consultation groups with colleagues to explore the meaning of their personal experiences in a professional context.

Their reflections have given rise to a few preliminary observations and guidelines. The use of experiential knowledge does not necessarily entail disclosing one’s entire private life. It requires assessing what would be useful to patients as they recover from (severe) mental health distress and trauma. If psychiatrists choose to make personal disclosures, they should take place in a training or peer consultation context, often starting with sharing a personal recovery story and unraveling its key elements.

When implicitly or explicitly using their personal experiences as a (re)source for patients, psychiatrists may contribute to a culture change in which stigma and shame around mental distress are relieved. Lived experiences are not only related to a specific diagnosis, but to broader insights related to life, such as knowing how it is to live in different realities, surviving emotional or physical trauma, and suffering from loneliness or social injustice. Psychiatrists who talk about their own struggles in these areas could serve as positive role models for their team and patients.

In general, patients express appreciation when nurses and social workers talk about their own recovery paths.¹³ Sharing personal experience can humanize and strengthen therapeutic relationships.

Concluding Thoughts

We conclude that the rationale for using lived experiences is increasingly accepted in mental health settings. However, psychiatrists appear to have reservations about this development and may hesitate due to assumptions related to their profession, as well as a lack of training. Patients seem to benefit from nurses and social workers who share their own lived experiences. Further research on if and how this applies to psychiatrists and psychologists is recommended.

Ms Karbouniaris is a researcher and lecturer at the Research Centre for Social Innovation at Utrecht University of Applied Sciences, The Netherlands. Dr van Os is a psychiatrist, Dutch professor and chair of Division Neuroscience at University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

References

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