Who heals the healers: how professionals find help for themselves

A hospital car park, a little after eight in the evening. A doctor sits in her car, the engine off, the key still in her hand. She finished her shift half an hour ago. At home her partner and her daughter are waiting, and her daughter will ask why she didn’t come home earlier again. But she sits there and cannot get out. She is not crying, not thinking about anything in particular. She just cannot. After ten minutes she pulls herself together, starts the engine and drives off. If a patient told her this, she would know exactly what to say. She does not say it to herself.

“I know what I’d tell other people” is a sentence you hear from doctors, lawyers, advisers and everyone whose job is to be a steady point for others. They know. And yet they do not act. In this article I write about why help for doctors and other professionals is so hard to seek, what they fear most along the way — and where they can begin.

The helpers’ paradox

When it comes to mental health, doctors are one of the most thoroughly researched professional groups. A review published in 2008 by Margaret Kay and colleagues gathered what we know about doctors as patients. The picture is fairly consistent. Doctors often have no GP of their own, or do not see them. They treat themselves, prescribe their own medication, and ask a colleague in the corridor for an opinion — quickly, informally, with no record. They seek help later than others, and often only when the problem can no longer be hidden.

The reasons they give are surprisingly human: embarrassment, fear that someone will find out, worry about their career, lack of time, and a sense that they ought to sort it out themselves. Someone who looks after others all day finds it hard to move to the other side of the desk. The helper’s role is not just a job. It becomes part of who you are.

The same pattern, only in different words, is described by lawyers, bankers and anyone who works in an environment where vulnerability is understood as weakness. I wrote about doctors as patients in more detail in When you help everyone except yourself; here I would mainly like to look at how to step out of this paradox.

What the numbers tell us

In 2004, Eva Schernhammer and Graham Colditz combined studies on suicide among doctors in a meta-analysis. They found that the risk of suicide among doctors was higher than in the general population: about 1.4 times for men and about 2.3 times for women. The studies are mostly from other countries and older, so they cannot be transferred directly to Slovenia. But the message is clear: knowledge about health does not protect against distress. Sometimes it even hides it.

The data on lawyers are not encouraging either. In 2016, Patrick Krill and colleagues found in a large study of American lawyers that hazardous drinking, depression and anxiety were more common than in the general population or in other highly educated professions. There too, among the most frequently cited reasons for not seeking help were fear that someone would find out and concern about confidentiality.

These numbers do not say that every doctor or lawyer is at risk. They do say that distress in these professions is more common than it looks from the outside — and that one of the biggest obstacles is how hard it is to talk about.

If you are having thoughts that it would be better if you were not here, or that you might harm yourself, please do not wait for it to “pass on its own”. In Slovenia, call the crisis line Klic v duševni stiski on 01 520 99 00 (every day from 7 pm to 7 am) or the Samaritan helpline on 116 123 (24 hours a day). If you are in immediate danger, call 112. A doctor, too, has the right to be on the other end of that line.

What they fear when they think about getting help

When professionals explain why they do not seek help, the same worries tend to come up. I have gathered them in the picture below.

The second point deserves some caution. In some countries research has shown that doctors do not seek help because they fear mental health questions when renewing their licence — Liselotte Dyrbye and colleagues, for example, found in the United States that doctors from states with stricter questions were more reluctant to do so. I will not write about what exactly applies in Slovenia or in individual professional chambers, because that is not my field of expertise. If this worries you, it is a good idea to find out from the bodies responsible before the worry keeps you at home.

What I can say is this: worry about your reputation and career is understandable and is not a sign of vanity. It is a sign that you care about the work you have built. That is exactly why it deserves to be taken seriously — rather than used as a reason to do nothing.

Confidentiality: what stays in the room

One of the most common worries is who will find out. In psychotherapy the answer is, in principle, simple: what you say stays between us. A therapist is bound by confidentiality and does not inform your employer, colleagues or family that you are coming at all. The limits of confidentiality are narrow and clearly defined — mostly situations in which a life is in immediate danger. I explain them in more detail in Confidentiality in therapy: what stays between us and where the limits are, and you will find a short version under the entry confidentiality.

For professionals there is something else that matters: confidentiality is not just a rule but also an experience. Many doctors fear being recognised more than they fear official records. So it makes sense to choose a therapist who is not part of your close professional network, and to ask openly in the first session how they handle notes and what happens if you ever meet outside the room. A good therapist will answer such questions without embarrassment.

Therapists, by the way, are no exception. As a therapist in training, I work under supervision, which means I regularly review my work with a more experienced colleague — and that conversation is also bound by confidentiality. I wrote about why those who offer help also need it in Where therapists take their feelings.

When the patient is you

Professionals who come to therapy often bring another difficulty with them: they know too much. A doctor knows the diagnostic criteria and has applied them to herself before walking in. A lawyer has prepared the arguments. A banker has calculated how many sessions he will need. They all know the rules of the game — and that is exactly what can stand in their way.

This is how the start of a first session might sound (composite, not a real person):

“Let me tell you straight away: in my view this is a mild depressive episode, probably an adjustment reaction. I’m sleeping badly, my appetite has dropped, concentration is fine.”
“Thank you. It sounds as if you have thought this through carefully.”
“I think it makes sense not to waste time.”
“May I ask something else? How did it feel when you sat down here?”
“…I don’t know. Strange. I usually sit on the other side.”
“And what is it like on this side?”
“I don’t like it.”

There is more in that “I don’t like it” than in all the criteria. Therapy does not begin when the professional states the diagnosis, but when they allow themselves not to be the professional. When they can simply be a person who is struggling. For many this is the hardest step, and at the same time the most freeing.

It helps to know this in advance. You do not need to prepare a summary, a differential diagnosis or a plan. You can come with the sentence “I don’t know exactly what’s wrong, it just isn’t working any more.” That is enough.

Where to turn

Once you decide to do something, the next question is who to see. The answer depends on what is going on. The picture below is a rough orientation, not a rule.

A few points to highlight. If you have physical symptoms, sleep problems lasting for weeks, or if you have started taking anything yourself just to keep going, your first port of call is a doctor — and not a colleague you ask in passing, but a doctor with whom you are the patient. When a psychiatrist is the first step rather than therapy, I explain in When you need a psychiatrist first. If the difference between the professions is unclear, Psychotherapist, psychologist, psychiatrist: who does what and where to go will help.

Some countries have special confidential programmes intended specifically for doctors — in the United States they are known as physician health programs, and in England there is NHS Practitioner Health. Whether similar support exists for your profession here, and in what form, is something to find out for yourself; I will not make claims about it here.

Psychotherapy is the right place when something keeps repeating in the background: burnout that returns after every holiday, shame you cannot tell anyone about, a mistake you cannot get out of your head, or a relationship at home that you are slowly losing. You can see how to recognise burnout under the entry burnout, and how to choose a therapist in How to choose a therapist who is right for you.

Exercise: a map of your support

Professionals often have a wide network of colleagues and a very narrow network of people in front of whom they dare to be weak. This exercise helps you see where you stand. Take fifteen minutes and a sheet of paper.

1. Draw three circles. Write yourself in the middle. In the inner circle write the people you can tell that you are not coping. In the middle circle, those you can talk to about work. In the outer circle, those you know but would not confide in.
2. Count the inner circle. Do not judge, just notice. If there is no one in it, or only one person, that is important information, not a failure.
3. For each person in the inner circle, ask yourself: when did I last really tell them how I am? Not what I am doing — how I am.
4. Choose one person from the middle circle whom you could move inwards, and this week tell them one true thing about yourself. Small, but true.
5. Add one professional. Write down the name of a GP, psychiatrist or therapist you would go to if you needed to. If there is no name, that is the first step you can take today.

You will find a similar printable tool under the entry map of your support network. Be kind to yourself while doing the exercise. If it feels uncomfortable, that is a sign you have touched something important — the entry self-compassion is about being at least as gentle with yourself as you are with a patient.

Where therapy is not the answer

It would be easy to write that therapy is the solution to professionals’ distress. It is not. At least not the whole solution.

Tait Shanafelt and John Noseworthy, who have worked on physician well-being for years, stress that burnout stems largely from how work is organised: from excessive workload, loss of control over one’s own work, bureaucracy and leadership that does not listen. Joyce Wallace and colleagues wrote in The Lancet that physician well-being should be one of the quality indicators of a healthcare system — because exhausted doctors also mean poorer patient care. If the problem lies in the system, an hour of therapy a week will not solve it. It can help you survive in it, recognise where your limits are, or decide on a change. But it cannot replace better conditions.

Nor is therapy the first step in an acute crisis or with an addiction that has already slipped out of control. Then the first help is medical, often specialised. And finally: not every professional needs therapy. For some, a good colleague, more sleep and a holiday not interrupted by the phone are enough. That is perfectly fine. What matters is that you have made the decision that you do not need it consciously — and not out of fear of what others will say.

The first step is small

Professionals are used to big decisions. Perhaps that is why they expect the decision to seek help to be big too — a kind of admission of defeat. In fact it is small. It is one phone call, one email, one hour a week that is yours alone.

Men put it off even longer than women, which is well described in Men and therapy: why they come later and what stops them. In professionals both patterns add up: the helper’s role and the expectation that you will endure.

My sessions take place in person in Ljubljana, and I also work with English-speaking clients. In relational family therapy, in which I am training, we look not only at what is happening at work but also at where the belief that you must carry everything alone comes from. Very often it turns out that a person took on this role long before medical school or law school — in a family where they were the one who looked after others. Once they recognise this, they can keep the helper’s role at work and set it down when they come home.

Let us go back to the car park. The doctor who cannot get out of her car does not need new knowledge. She knows everything there is to know. She needs a place where she does not have to be a doctor.

What to remember

• Professionals who help others seek help for themselves later — because of shame, concern for their reputation and the helper’s role, not because of a lack of knowledge.
• Research from abroad shows that distress among doctors and lawyers is more common than it looks from the outside; knowledge about health does not protect against it.
• A psychotherapist is bound by confidentiality; when choosing, it makes sense to look for someone outside your close professional network and to ask about confidentiality in the first session.
• In an acute crisis, with physical symptoms or self-medication, your first port of call is a doctor or psychiatrist; therapy is for patterns, shame and relationships.
• Therapy does not replace better working conditions — but it can help you not to lose yourself in them.