I am going to write about something that very few therapists discuss – the common myth that therapists “have their shit together”.

And the reality that they don’t.

There’s a reason why you won’t find support groups titled “Therapists Anonymous”, “Bipolar/Depression Support Group for Therapists”, or “Help! My Significant Other is a Therapist!” and so on.

It’s simple, really, as oft-quoted by people who work in the mental health community, “We are supposed to always have our shit together.”

“Supposed to”.  Not, “actually have”. I can count on one hand the number of therapists I have met who are not suffering from some form of mental illness or substance abuse themselves.

It’s (maybe) surprisingly common.

The number one malady I have observed?  Substance abuse. Particularly of benzodiazepines (i.e., Valium, Xanax) and alcohol.

The number two problem? Mood disorders (major depressive, bipolar).

And a close third?  Personality disorders.

This last is truly alarming, because personality disorders are hard to spot and almost impossible to treat – for one thing, people so afflicted quite often do not think they have a problem.

Aside #1: There are 10 types of personality disorders, according to the DSM V (psychiatric diagnostic manual) – paranoid, schizotypal, schizoid, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive. 

Mind you, I want to make it clear that this is based on my observations.  So this is my subjective opinion, nothing more.

The substance abuse issue usually will trip a therapist up in the end, because he or she will often violate boundaries with patients (especially if he or she is a drug and alcohol therapist), act inappropriately (as in, being obviously impaired at work), or get into trouble with the law (DUI, for example).

Although it’s not good for addicted therapists to be treating anyone, for anything, it is at least somewhat self-correcting before too much damage can be done.

The mood disorder problem is the most tragic – for the therapist, anyway – because since a therapist is often unable or afraid to get help, he or she can needlessly suffer for years without anyone knowing.  It’s tragic because it doesn’t need to be that way, but it is that way because there’s no quicker way to get fired than to admit that you have a mental illness.

So no one admits it.

Hiding one’s mental illness is critical.

In other words, the people who are supposed to be so tolerant, so understanding of people afflicted with mental illness are they themselves some of the most judgmental hypocrites around.

The same people who will tell a patient, “Depression is the common cold of mental illness” (6.9% of the American population – and that’s just those adults who are diagnosed – according to the NIMH) in order to reassure the patient that he/she is not some freak of nature, are the same ones who will go to a colleague’s supervisor under the guise of “helping” and relate that so-and-so is on antidepressants that “don’t seem to be helping”.

Aside #2: I have seen it happen to others.  I have had supervisors ask for my clinical opinion of colleagues, and I have refused to give it.  I have heard colleagues complain about other “crazy” therapists, therapists who were good at their jobs and were just too open about having a mental illness – thereby “tarnishing” that “got your shit together” reputation.

It’s tantamount to a doctor getting fired because he/she caught the flu, broke a leg, or suffered from a chronic condition like migraines.  Doesn’t make sense when you look at it that way, does it?

But this is also a good segue into the third mental health problem amongst therapists that I have observed – personality disorders.  And those people are truly dangerous, to patients and staff alike.

Manipulative, self-centered, and fond of drama, a therapist with a personality problem delights in treating very sick patients because he or she – and there’s no polite way of saying this – enjoys seeing people suffer.  And, in fact, I have seen and heard therapists like this make fun of patients in treatment team meetings, display a horrifying lack of empathy, and basically treat the patient as a form of entertainment rather than someone with whom to conduct therapy.

A therapist like this will also cause disruption between staff members, just to sit back and enjoy watching the chaos.  This behavior is evident to staff when patients do it – in fact, the term is called “staff splitting” – but seldom recognized in another staff member until it’s too late (when someone usually gets fired, and it’s not the “sick” therapist).

Aside #3:  I have also seen this behavior in nurses and hospital administrators.  I don’t know if healthcare facilities/professions attract this kind of person, or if I have just had more experience recognizing it.  But I have seen situations where a nurse will go after another, “more popular” (with patients and staff) nurse and get her fired before she knew what hit her.