Why Aren’t We All in Therapy?

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About the authors: Dr. Whitmore and Dr. Salg are second-year general psychiatry residents in the department of psychiatry at the University of Colorado School of Medicine in Aurora, Colorado.

RESIDENTS CORNER

The incessant demands of medical residency are well documented, as are the effects of its constant stressors that compromise well-being and lead to burnout. Many residents are aware of burnout in the periphery as they trudge along. The looming specter of emotional and physical exhaustion; the very real possibility of losing empathy; the “death-by-1000-cuts” effect of vicarious trauma-these persist early in the career of a physician and often take hold well into one’s career.

So what are we doing about it? Programs vary in the amount of time required of residents to learn the practice of psychotherapy, but actively encouraging residents to seek their own therapy-for either professional growth or personal wellness-seems to be very much a thing of the past.

Though charged with promoting the health of others, doctors tend to be poor stewards of our own wellness. Amid such discussions and revelations about the health of physicians are the discussions we have with the next generation of doctors. Though medical school applications are rising, and the number of graduating medical students is growing, half of doctors in practice say they would not recommend medicine as a career to their children and over a quarter would not choose to be a physician if they had their career to do over again.^1[PDF]

Though charged with promoting the health of others, doctors tend to be poor stewards of our own wellness.

While the factors at play are complex, the dramatic proportion of unsatisfied physicians who would choose a different career or discourage others from pursuing medicine speaks volumes about the mental health and satisfaction within our profession.

Physicians work long hours, live stressful lives, make difficult decisions, and feel squeezed to see more patients in less time for less money. To some, a sick day can jeopardize their clinic. For others, they work longer hours than their own providers. In the past, some psychiatric training programs either required, or strongly recommended, personal psychotherapy for their residents.

Then and now

In general, rates of psychiatric residents in therapy have decreased significantly over the years.^2,3 A 2014 paper indicated that in the 1950s, as many as two-thirds of residents sought personal therapy.⁴ These days, few residents pursue individual therapy. A 2010 study showed that training directors believed therapy to be useful, but that less than 33% of residents actually sought it out.²

It is not hard to speculate about the reasons why. One of the above‑referenced studies indicated shortage of time and money as primary forces involved.⁴ From anecdotal as well as personal experience, giving away precious free time to therapy may feel trivial in comparison to some of the injustices suffered by patients. Free time is also hard to come by when there is so much work to be done on the unit or in the clinic.

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6 Strategies to Prevent Physician Burnout

Training directors, especially those with a psychotherapeutic interest, might value the experience in a vacuum, but giving residents time to pursue therapy requires logistical planning that affects both patients and other residents. Additionally, an interested resident must comb through a list of therapists who take Graduate Medical Education insurance, and from there, whittle an already limited list down to those actually accepting new patients.

Despite all the roadblocks one could expect, residents should not give up on seeking personal therapy. Some programs have implemented resident wellness programs that offer counseling with encouraging results.⁴Wellness programs in which residents are aware of the available services increases the willingness of residents to seek therapy.^5,6

The bottom line

Ultimately, residents may must advocate for themselves to make time for therapy. For those with an interest in psychotherapy, it is certainly relevant to experience the view from the patient’s chair and to learn from those doctors who are more experienced than they are.

Perhaps most importantly, therapy provides residents with the ability to cope with the stress of residency and with the opportunity to seek wellness. This in turn benefits patients, who receive care from a resident who has not lost his or her drive. If physicians truly strive to “do no harm,” they owe it to their patients to be well enough physically and emotionally to give patients their best efforts.

References:

1. The Physician’s Foundation (2016, September 21). 2016 Survey of America’s Physicians: Practice Patterns & Perspectives. September 21, 2016. http://www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf. Accessed May 17, 2017.

2. Habl S, Mintz DL, Bailey A. The role of personal therapy in psychiatric residency training: a survey of psychiatry training directors. Acad Psychiatry. 2010;34:21-26.

3. Haak JL, Kaye D. Personal psychotherapy during residency training: a survey of psychiatric residents. Acad Psychiatry. 2009;33:323-326.

4. Kovach JG, Dubin WR, Combs CJ. Use and characterization of personal psychotherapy by psychiatry residents. Acad Psychiatry. 2014;39:99-103.

5. Ey S, Moffit M, Kinzie JM, et al. “If you build it they will come”: attitudes of medical residents and fellow about seeking services in a resident wellness program. J Grad Med Educ. 2013;5:486-492.

6. Moutier C, Norcross W, Jong P, et al. The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine. Acad Med. 2012;87:320-326.