I’m a therapist and I have dark moods. I mean really dark moods. If someone were to walk into my therapy room showing the same disposition with which I am so familiar, I would immediately see red flags. There is no safeguarding muscle that would be satisfied until direct questions had been asked. ‘Are you thinking about harming yourself?’ ‘Who could you contact if things get worse?’ ‘What do you think has triggered you this time?’
Yes, I’m a therapist, and sometimes I too am my own worst enemy. This reflection is not about unprocessed trauma or hormonal imbalances; neither do I intend to highlight the experience of any one marginalised or intersectional group within the counselling community. What I aim to do is witness what rests at the root of these labels that separate us; return to the challenge of what it means to simply be alive and human, in the world we live. Perhaps there is no better time to name this than during these early months of the year, when the resolutions from January have waned and with them our intentions to become fitter, more disciplined or more polished.
I recognise how uneasy it can feel to reveal emotions beyond the accepted frames of client load, or inadequate self-care. For all the value in a therapist’s work with others, it has made me wonder how else we might model, in shared peer-to-peer spaces, that it’s OK to not be OK. We all know that common mental disorders such as depression and anxiety have risen massively in the UK. Over the past two decades the number has jumped from 55.9 cases per 1,000 in 2000 to 79.6 in 2019.1 The idea that therapists and other holistic practitioners are exempt is unrealistic and isolating.
For all the value in a therapist’s work with others, it has made me wonder how else we might model, in shared peer-to-peer spaces, that it’s OK to not be OK.
Beneath the work
Within the decision to work with people who need emotional support is an inherent optimism and belief that we’re capable of doing good, a belief that must reside in even the least confident trainee. From the beginning of study there is an emphasis on self-awareness and what it is to be fully congruent. We’re taught the importance of maintaining core conditions and how our mere presence can be the most stability some clients have ever experienced. Alongside this are the ethical codes, CPD events, supervision and reminders to care for yourself. What doesn’t seem so common are group or learning programmes directly addressing the management of active mental health difficulties while maintaining a professional practice.
In a recent Austrian study it was found that psychotherapists scored better on overall mental health than the general population, though a notable proportion still presented with clinically significant depression, anxiety and insomnia.2 In another random sample of 1,000 psychologists it was depression that surfaced as the most frequently acknowledged diagnosis, with respondents noting an increased sense of isolation from their colleagues and lessened capacity with clients.3 And statistics like these are not limited to professionals who have a focus on mental and emotional health. A study of social workers revealed that 40.2% of respondents reported mental health problems prior to their role, increasing to 51.8% during their social work career; 28% of these respondents were actively experiencing challenges.4
Conversation about practitioner mental health is often steered towards personal therapy, rightly and understandably so. But is there room to welcome more of it into the open? Fear that admission of your struggles may lead to unfair questions about your fitness to practise is a valid deterrent, but anyone making such judgments is potentially missing the nuance between useful lived experience and uncontained distress. The distinction does matter because struggle in itself does not automatically equate to incapacity. If we must examine our mental health in relation to our competency to perform our work, then surely we have to question in which ways it may also enhance rather than merely diminish it.
Acknowledging any stigmas around practising while navigating health anxiety, panic attacks or addictions may even deepen our capacity to sit with others in theirs.
Wounded healer
I come from a professional background where many of my contemporaries have built empires on presenting themselves to colleagues as utterly healed and emotionally sound. In the counselling profession there is at least the framework of supervision, both group and individual, where truths can be spoken. For those who are experiencing active mental health difficulties, however, it can still feel unsafe to acknowledge them, even as the world consistently shows us that struggle and contribution do coexist. We can find solace in the output of artists who are both wounded and the purveyors of brilliant creativity; some whose personal lives appear close to chaos but who in the right setting become a conduit to the connection and understanding we all so desperately desire. Their pain does not devalue their professional worth – on the contrary their courage helps to inspire and pull others through. This is not to romanticise or laud suffering but to illustrate that phrases like ‘fitness to practise’ and their implicit pressure can suggest an extremely narrow and binary view of life. In reality, it is more fluid than perhaps feels prudent to admit. A therapist may experience panic attacks at night and remain a grounded and attuned professional in the morning. Mental health is indeed a spectrum rather than a fixed location. In the medical industry, its own stigmas aside, if there is anxiety or depression and you are stable with sound judgment, then you are considered fit to practise: ‘The fact that a doctor has a mental health condition isn’t what’s important to the GMC. It’s whether the condition affects a doctor’s ability to work safely, how they handle their condition and how they look after themselves. 5
As therapists we know sharing heals. Acknowledging any stigmas around practising while navigating health anxiety, panic attacks or addictions may even deepen our capacity to sit with others in theirs. This is congruence at its finest. Research shows that more than 80% of psychology trainees and faculty have experienced mental health difficulties, a reality that doesn’t evaporate once qualifications are attained, and one that makes our silence even more striking.6
Being a therapist doesn’t exempt us from the impact of pretending to be untouched by fluctuating mental health. Silence can be corrosive. Suppression and secrecy can exacerbate feelings of isolation and shame. All of these can fuel self-criticism and, sadly, worsen mental health. There is a cost to our silence in peer spaces. Privacy matters, of course, but there also needs to be honesty about whether it’s the stigma keeping some of us quiet. Would we speak more freely about our OCD, PTSD or disordered eating if the first question wasn’t about whether we are still OK to see clients? We encourage people to sit with grief, with loss, with the big existential questions. We believe in self-actualising tendencies and yet do we feel the same invitation from our own extended therapeutic community? By hiding for fear of judgment, maybe we are missing the chance to model a version of authentic connection and resilience that doesn’t default to ethical codes and risk assessments.
Gaps and myths
In the spirit of resolutions in the approach to spring, an end to conflating vulnerability with the loss of boundaries might serve to demonstrate that congruence without collapse can be a lived, shared experience. Because therapists, coaches and healers are not empty vessels; we bring our bodies, our histories and our nervous systems with us everywhere we go.
If we allow silence and taboo to dominate, then the inheritance we pass to the next generation of therapists may be one of continued caution, self-censorship and shame.
When I think about this, I keep returning to the idea of co-regulation. We know how powerful it is for clients, and I’m curious how often we experience it with colleagues, deeply and without over-intellectualisation. There is a lot of talk about what has been healed prior to entering the profession, less about what is still in active healing. When I look at the CPD landscape I notice how much of it is skills-based: trauma modalities, the latest popular and evidence-based approaches. Most of it is vital but there is an undeniable gap. When the topic of practitioner mental health is touched on at all, it often presents under the useful but reductive categories of ‘burnout’ or ‘self-care’, but there are some situations that more time off and stricter boundaries will not help. The lived complexity of being both helper and human is far messier, and it would feel refreshing, even radical, to see CPD that named this explicitly. Not a course on resilience strategies but a day devoted to navigating the therapeutic role while living through depression; a workshop on holding space when you are also managing seasonal affective disorder (SAD); more panels on the impact of alcoholism, drug use, chronic pain or grief. I’m talking about peer-led reflective circles of support, not supervision; acknowledgment and solidarity, not solutions and cures. To have our humanity spoken of directly, without reducing it to pathology or professional risk, would be a different kind of continuing development, one that validates the whole of us.
This, I believe ties into a wider mythology. Society, as much as it reveres the wounded healer, also celebrates the flawless one – the wise guru. Professionals too are not immune to this; we love conferences showcasing best practice, clinical wisdom, polished theory with case studies and interventions that land beautifully. Occasionally we see glimpses into the lives of renowned psychotherapists who have dared to lay bare their battles, or crafted some refreshingly resonant fiction to dispel the myth that the only story worth telling is the tidy one. But it would also be connecting to hear about the average therapist’s dance with mental health and how it affects them as they go about their regular life.
Permission
I understand the necessity of stability and the safe space we must be for our clients. But I believe too in the necessity of standing up and saying that I am a therapist who is not overworked, not confused, not doubtful about the capabilities I have to help others, but whose own history means that sometimes I am not OK. That sometimes I can be not OK and still, with the right support, remain boundaried and do phenomenal work. That management of my own shadows means I can help to facilitate healing even as I require my own. I have noticed the relief in clients when I drop a pen and make a joke, or confess to a day of excessive biscuit consumption. I have seen their shoulders relax and faces soften at the realisation I am human as well as a therapist. It’s one of the reasons I’ve stopped treating congruence and vulnerability as if they’re separate things.
As a profession we often speak about legacy and the impact we leave in the lives of our clients. This extends to the ripple effect of change that moves outward into families, communities and cultures. Yet legacy is not only built in the therapy room; it is also shaped in the conversations we have, or fail to have, with each other. If we allow silence and taboo to dominate, then the inheritance we pass to the next generation of therapists may be one of continued caution, self-censorship and shame. But imagine if the myth of the flawless healer could be finally retired because we decided it was time. Imagine training and CPD that is not just for technique and theory but for the ongoing realities of being human while doing this work.
Maybe there is also a general shift that will naturally occur over time, when more people begin to question their own silence and talk about it. We are already seeing generational differences in how mental health is spoken about. Research shows that younger people are far more open to discussing their struggles than older generations, with one survey finding that 87% of gen Z feel comfortable talking about mental health compared with only 35% of millennials and far lower rates among baby boomers.7 If this openness carries forward into the therapy profession, then any culture of isolation may not hold as tightly as it once did. In my experience it’s rare to find a therapist who claims to be without their own challenges. We are not untouchable and we don’t pretend to be, but conversations like this seem to happen behind closed doors. Perhaps the resolution we need to offer ourselves this year is to practise trusting that being human in our community does not erode our professionalism, and that these conversations can happen on a larger, more inclusive and supportive scale.
1. Dykxhoorn J, Osborn D, Walters K, Kirkbride JB, Gnani S, Lazzarino A.l Temporal patterns in the recorded annual incidence of common mental disorders over two decades in the United Kingdom: a primary care cohort study. Psychological Medicine 2023; 54(4): 663-674
2. Schaffler Y. Probst T. Pieh C. Haid B. Humer E. Prevalence of mental health symptoms and potential
risk factors among Austrian psychotherapists. Scientific Reports 2024: 14: 3888.
3. Gilroy PJ, Carroll L, Murra J. A preliminary survey of counseling psychologists’ personal experiences with depression and treatment. Professional Psychology: research and practice 2002; 33(4):402-407.
4. Siebert DC. Depression in North Carolina social workers: implications for practice and research. Social
Work Research 2004; 28(1): 30-40.
5. General Medical Council UK. When does the regulator get involved in a doctor’s mental health? [Blog.] 2021. gmcuk.wordpress.com/2021/10/11/ when-does-the-regulator-get-involved-in-a-
doctors-mental-health
6. Victor SE. Devendorf AR, Lewis SP, Rottenberg J, Muehlenkamp JJ, Stage DL et al. Only human: mental-health difficulties among clinical, counseling, and school psychology faculty and trainees. Perspectives in Psychological Science 2022; 17(6): 1576-1590.
7. Thriving Center of Psychology. 2024 Mental health outlook: growing demand for therapy among Gen Z and millennials. [Blog.] 2023. thrivingcenterofpsych.com/blog/gen-z-millennial-therapy-statistics
