The wellbeing of psychotherapists is an overlooked area within research, although being a psychotherapist requires deep wells of emotional resources. Our wellbeing is important for our clients. Often, people choose to work with psychotherapists that appear to have their own lives together (Lambert & Barley, 2001). The truth is that our own quality of life can also impact the therapeutic alliance (Enochs & Etzbach, 2004). The COVID-19 pandemic forced us to face new challenges while navigating the same difficulties our clients were experiencing. As a result, the wellbeing of psychotherapists’ may have suffered – mine certainly did.

A recent study by Van Hoy et al (2022) explored the relationship between social support and psychotherapists’ wellbeing from 12 European countries during the global pandemic. The effect of self-efficacy (the confidence in being able to do something) was also investigated.

The study assumed wellbeing had two associated but separate components:

• Life satisfaction (cognitive wellbeing)
• Affective wellbeing (i.e. positive and negative feelings)

Life satisfaction is relatively stable compared to affective wellbeing. There may be between-country differences, for example, due to economic or political circumstances, impacting on the level of life satisfaction among clinicians.

Research on the mental health of healthcare professionals during the pandemic is still emerging. There seems to be a gap in wider wellbeing research concerning psychotherapists. This is particularly important given the current challenges within the NHS concerning burnout and staff retention. Van Hoy and colleagues (2022) examined the between-country differences for both components of wellbeing during the pandemic. They examined the relationship between wellbeing and personal and social resources.

Methods

A cross-cultural survey involving standardised questionnaires in an online format was sent to professional psychotherapeutic associations of various therapeutic modalities and distributed among their members. The study took place across 12 European countries: Austria, Bulgaria, Cyprus, Finland, the UK, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland. The survey was circulated between June 2020 and June 2021. Participants were eligible if they were certified therapists and had been practicing for at least one year. Participation was anonymous and voluntary, and no remuneration was given.

Native language versions of the following questionnaires were used:

• Satisfaction with life scale
• International positive and negative affect schedule short form
• General self-efficacy scale
• The multidimensional scale of perceived social support
• Detailed sociodemographic data and work-related questions

Multilevel analysis was used to reflect the two-level data structure: individual scores centred on the group mean for each country, and means for each country centred on the grand mean.

Results

2,915 psychotherapists trained in various therapeutic modalities were included. Across all countries, age distribution was similar (37-53 years old), and women were overrepresented (83%). Working in a private workplace was characteristic of the whole sample, although the authors don’t break this down for us further. We don’t know whether some therapists were offering therapy within the public health services too. Most utilised supervision at least once a month (although Spain did not employ supervision at all). Years of experience and therapeutic modalities varied between countries. For example, integrative psychotherapy was mostly mentioned by UK psychotherapists, while CBT was more common in Cyprus, Spain, Poland, and Romania. Psychodynamic therapy was prevalent in Bulgaria, Norway, and Sweden, and Gestalt therapy was used mostly by those in Austria and Switzerland. Most UK therapists were still exclusively offering services online at the time of data collection.

Life satisfaction was not affected by either self-efficacy, or perceived social support. Most of the differences (53.7%) in life satisfaction are explained by differences between countries, such as social and economic factors. For affective wellbeing, both self-efficacy and social support were independently associated with higher positive affect and lower negative affect. Affective wellbeing, both feeling more positive and feeling less negative, was independently associated with self-efficacy and social support. This means that both more self-efficacy, and more social support, lead to feeling more positive and feeling less negative. Self-efficacy also moderated the relationship between affective wellbeing and social support, again for both feeling more positive and less negative. This suggests that the more confident people were in their ability to complete a task, the more social support improved their affective wellbeing.

If more confidence means a greater impact on social support, the effect is said to be synergistic. For self-efficacy lower than the national sample average, the relationship between perceived social support and positive affect was insignificant, whereas, with values equal to or higher than average, the relationship was positive, highlighting this synergistic effect.

Life satisfaction was independent of all sociodemographic and work-related characteristics, as well as self-reported COVID-19-related distress. For higher affective wellbeing, older age, and lower COVID-19-related distress were significant. Higher positive affect was correlated with being female, and negative affect was negatively correlated with higher than a 20-hour per week workload.

Conclusions

Among psychotherapists, life satisfaction was country dependent, whereas affective wellbeing was mostly related to individual characteristics. The findings in the study agree with the distinct nature of both the cognitive and affective components of wellbeing. Life satisfaction seems resistant and not susceptible to any assessed factors.

The authors suggest that staying professionally active serves as a method of coping with chronic and uncontrollable conditions. I wonder also if perhaps this might be the echo effect in action, that is, we don’t feel the negative effect until after the pandemic. For example, PTSD symptoms might not manifest until after the traumatic event is over, rather than during the event itself.

Strengths and limitations

The study used a large sample across 12 countries, during a critical period during the pandemic. Their multilevel methodological approach seems sound. Psychotherapist wellbeing is under-represented within the research, so the authors have found and filled a clear gap in the research.

Despite this, there are some limitations to the study. It may be that those struggling more with the effects of the pandemic didn’t respond to the questionnaire. As a therapist myself, I don’t recall being particularly responsive to calls for research participation during the pandemic. At the time I was working as a CBT therapist and probably received an email about this study from the BABCP, which I duly ignored. This could account for some of the findings around COVID-19-related distress, as people mostly affected may have not responded. Most participants in this study stated that they were working privately. When the pandemic started the stresses of public healthcare were evident (and still are today); I wonder if this had an impact on capturing psychotherapists’ experiences over the board, particularly those who are UK-based with ties to the NHS. Between countries, differences might have been exacerbated by cultural differences in response styles, although the multi-level design did aid in this regard.

Future research may also want to examine distress and not solely focus on wellbeing. Additionally, the authors discussed that psychotherapeutic modalities varied across countries. It would be interesting to see whether there are differences in people trained in different modalities. Perhaps modalities seen as more evidential for anxiety (for example, CBT), might fare better during a public health crisis. Stress management courses often focus on CBT principles, and I have used CBT strategies to manage my own stress.

Implications for practice

The findings highlight that self-efficacy and social support both need to be considered in managing the wellbeing of psychotherapists. This has implications for employers of psychotherapists, and occupational health and staff wellbeing services. Employers should consider how to instill more self-confidence in the abilities to complete work-related tasks, as well as connect psychotherapists with social support from peers. Future research might look at the effects of interventions designed to aid both social support and self-efficacy.

Within the NHS there doesn’t seem to be much focus on improving the self-confidence of psychotherapists. Certainly, within IAPT services, clinicians are given unmanageable caseloads and encouraged to move them all to recovery with little consideration for the actual skill or confidence of the psychotherapist. Clinical psychology training may also want to consider the implications of this research; perhaps university courses should have a greater emphasis on the self-efficacy of their trainees.

From my own experience as a psychotherapist in the UK, and as a wellbeing lead within a service, I can see the usefulness of such interventions. Perhaps if I had been aided in cultivating my own self-efficacy, I wouldn’t have struggled with the effects of burnout after the pandemic. I certainly had plenty of social support, even despite the isolation that occurred during the height of the numerous lockdowns. The evidence presented here would suggest that had I increased my self-efficacy, then the social support may have been more beneficial for my wellbeing.

Statement of interests

I have no conflicts of interest with respect to the content of this blog post.

Links

Primary paper

Van Hoy, A., Rzeszutek, M., Pięta, M., Mestre, J. M., Rodríguez-Mora, Á., Midgley, N., Omylinska-Thurston, J., Dopierala, A., Falkenström, F., Ferlin, J., Gergov, V., Lazić, M., Ulberg, R., Røssberg, J. I., Hancheva, C., Stoyanova, S., Schmidt, S. J., Podina, I. R., Ferreira, N., … Gruszczyńska, E. (2022). Subjective well-being among psychotherapists during the coronavirus disease pandemic: A cross-cultural survey from 12 European countries. Journal of Psychiatric Research, 154, 315–323.

Other references

Enochs, W., & Etzbach, C., 2004. Impaired student counselors: ethical and legal considerations for the family. Fam. J. 12, 396 –400.

Lambert, M., & Barley, D., 2001. Research summary on the therapeutic relationship and psychotherapy outcome. Psychother. Theor. Res. Pract. Train. 38, 357–361.

Photo credits

• Photo by Radu Florin on Unsplash
• Photo by Towfiqu barbhuiya on Unsplash