Therapists work at the coalface of mental and emotional health. Workplace bullying is among the many issues that our clients bring to us.
There is no universal definition of bullying1 but there are clear psychological and physical risks associated with it. According to a report from the Royal College of Psychiatrists,2 they include ‘frequent illnesses such as viral infections, headaches/migraines, tiredness, exhaustion, constant fatigue, sleeplessness, nightmares, waking early, irritable bowel syndrome, poor concentration, forgetfulness, panic attacks, sweating, trembling, shaking, tearfulness, lethargy, anger and low self-esteem’.
Potentially, workplace bullying can affect anyone, regardless of occupation or profession. In recent years the media has reported numerous incidents across all professions, occupations and grades, from the shop-floor worker to the City financier. The Dignity at Work website cites research showing that 80 per cent of managers, across all industries, admit that bullying takes place in their organisation.3 It has to be assumed, therefore, that victims will also include counsellors, therapists and psychologists working in therapy and healthcare services. In this article we explore this possibility and describe some of the experiences of workplace bullying reported to us by therapists.
The therapist as bully
Professionals working in health and social care are expected to adhere to ethical principles. Expectations are no longer implicit; they are written in charters, codes and criteria for clinical practice, the ethical basis of which is based on clinical experience, public expectations and guiding principles that prioritise the wellbeing of clients.
Criteria for good practice among practitioners – standards for how we treat one another in the profession – are less explicit and much of what we expect of one another as professionals performing self-reflective, caring roles remains implicit. What can be said, in our view, is that our expectations that fellow practitioners will behave in reasonable, sensitive or respectful ways towards each other are not necessarily prioritised by our professional and regulatory bodies.
What if it is the therapist rather than the client who suffers bullying? What if the workplace of the therapist is exposing him or her to bullying that eventually affects their client work?
Both of us have either witnessed or experienced bullying while working as therapists. Almost by accident, over a lunchtime meeting, we discussed how we had discovered the existence of workplace bullying in therapy workplaces. One of us had experienced it as a senior counsellor in a counselling service; the other witnessed it as a trainee on placement in a forensic mental health team. We wondered whether our experiences were isolated events or whether other practitioners had experienced it too.
When we asked other therapists about their experiences of workplace bullying we received a number of personal accounts. There was a shared desire among those who responded to raise awareness about the issue. This exploration of workplace bullying in the therapy profession will draw on a number of these experiences of bullying reported to us (all names have been changed to ensure anonymity).
As we further explored the topic, we discovered that there is no research into bullying in our field. Nevertheless, one source sheds light on bullying in a related mental health profession – that of psychiatric trainees in the West Midlands. Hoosen and Callaghan4 report that an astonishing 47 per cent of these trainees had felt bullied. Freeth’s recently published account of bullying in the NHS5 adds an additional personal note to this topic as she describes her own experience of aggressive management. Discussions in Therapy Today6 and letters to the editor in The Psychologist7,8 have asked if unpaid placements deter people from a wider range of socio-economic backgrounds from entering the profession and whether this practice is abusive in taking advantage of a highly competitive field to justify unpaid work. It is a pattern that can help to establish an overly self-sacrificing approach in the profession.
Considering the thousands who work as therapists, counsellors and psychologists, and our professional understanding of workplace bullying, it is curious that this issue should be ignored. How come we don’t hear about it more? Could the absence of discussion be linked with the professional identity that belongs to our specific line of work? Young, Klosko and Weishaar9 and Young10 believe that ‘self-sacrifice’, ‘unrelenting standards’ and ‘emotional deprivation’ are common among therapists. Emotional deprivation is the belief that your emotional needs will not be met by others: that you won’t be nurtured, understood or protected. Self-sacrifice as well as subjugation relates to an excessive focus on the needs of others to avoid feeling guilty or to maintain connection. Unrelenting standards give rise to the belief that you must meet excessively high standards, often to avoid criticism.
Young and colleagues propose that schemas can function as a mechanism to mediate negative emotions caused by other schemas. In other words, therapists are potentially people who have an excessive focus on others, hold unrealistic standards and believe that, generally, they will be hurt in relationships. No one expects therapists to be immune from unhelpful beliefs or behaviour patterns,11 but surely, with our understanding of the factors affecting relationships and our knowledge that therapists might have issues that could negatively affect interpersonal interactions, we should be more self-aware as a profession?
Why do we do it?
Sue, a trainer who experienced bullying after she challenged sexual intimidation, referred to a behaviour pattern to which therapists subscribe: ‘This field is about taking responsibility for your own feelings, therefore no complaints.’ Others had theories about why we don’t look at bullying within our profession more closely. Rachel, who experienced bullying from a supervisor while on placement, said: ‘It’s almost taboo and we are not encouraged to speak about it.’
Emma: ‘I wonder whether bullying within the helping professions is like mental distress and illness within helping professions: “Oh that doesn’t happen to us, we’re trained not to let it.” It’s like a defence; we (as a profession and as individuals within it) can’t admit to possessing the potential for certain qualities/behaviours. We like to think those things aren’t a part of us, when actually they’re in everyone. This makes bullying harder to recognise, as it seems so alien and so opposite to what we see ourselves as representing. It makes it harder to approach, as there might be an implicit assumption that we can avoid it happening altogether, or we have the resources to deal with it on our own if it does happen. Maybe our own curiosity/analytical thinking styles as psychologists make us believe we are overthinking things and turning them into something they’re not. Or we overthink the possible consequences of doing something about it, and so choose not to.’
Ellen described a pervasive pattern of bullying in her role as manager of a counselling department. She felt angry and demoralised when her manager began to exclude her from meetings without telling her and when he challenged her in front of others on matters of team performance without discussing it with her beforehand. All this caused her to doubt herself as a manager. Natasha was bullied when a trainee and was so stressed by it that she was prescribed beta-blockers. Rachel was also bullied by a supervisor and wondered if the supervisor’s own insecurities could play a part in the bullying behaviour.
Sue: ‘They are very clever and understand how emotional things work, and they know how to manipulate you and still smile.’
The emotional and mental effect of bullying on therapists is particularly problematic because a therapist’s emotional and mental health can determine their ability to engage therapeutically with clients. It is not just our own wellbeing that is at stake but that of our clients as well. The impact of bullying can seriously undermine a therapist’s capacity to work with clients and deal with their distress. Yet there is little evidence that the strain that therapists are under is being addressed, even in supervision.
Young and colleagues9 write about patients and therapists whose schemas collide in a dysfunctional manner, making it difficult, if not impossible, to work together. Perhaps when two therapists meet their own schemas can be triggered and showing weakness is frightening, giving rise to difficult relationships at work, and even bullying.
A recent Austrian study of the risks of psychotherapy12 found that negative side effects in therapy may be higher than you might think. The main drivers behind these negative side effects are interpersonal difficulties between therapist and client. Considering the potential effects of bullying on the mental wellbeing of the therapist, bullying can thus enter the therapeutic space and cause damage. For example, the therapist may be preoccupied or stressed by antagonistic and undermining behaviour at the hands of managers or colleagues.
Bullying in organisations
An important issue is what goes on when bullying occurs in an organisation. Klein and Martin1 point out that bullies tend to manipulate organisations into thinking that they, the bullies, are the victims. This would allow them to claim that their actions are a defence rather than a damaging way of dealing with people. This is why we think that the complexity of bullying patterns is on a par with the coercive patterns found in other abusive relationships.
Mary: ‘My first experience of bullying in counselling was during my training… I made a formal complaint to the manager of the course… Counsellors are far too concerned with being nice, being liked and being professional, whatever that means. Very often this makes them treacherous... [they] have learned to manipulate people.’
Still, bullying is poorly defined and it can be particularly difficult to ascertain who is at fault – who is bullying whom. It is conceivable that, because of their professional identity, therapists may find the experience of being bullied too difficult to handle. Additionally, therapists could be too focused on the needs of the other, including those of the bully. We received several accounts of being bullied by a supervisor or line manager where the problem was pinned on the victim, with claims that it was their behaviour that made the workplace difficult. This creates a difficult dynamic where a lack of clarity about who is the victim could easily trigger schemas leading the therapist to overly focus on the bully’s feelings or try to meet their high standards.
Two other studies into workplace bullying, one from the US,13 the other European,14 highlight a surprising trend when looking at the gender constellation in bullying. The European study, in which over 21,000 Europeans in different countries participated, showed that the risk of bullying by your manager is greater if your boss is female. Co-author Maija Lyly-Yrjänäinen, a research officer at Eurofound, suggested that this may be because female managers have often spent a long time on a lower rung of the career ladder and, when put in charge of people, may struggle to handle conflict.14 Women also could be seen broadly to use more subtle, passive means of dealing with conflict and may struggle with assertive behaviours. In the workplace, in a male-dominated profession, this could create an atmosphere of mistrust at best or, at worst, bullying.
The US study found that the US workplace is becoming more toxic for women as the rate of bullying by females on females has risen from 71 per cent to 80 per cent. These findings are worrying for the therapy profession because it is predominantly female.
Some of our respondents also saw being female as a factor in bullying.
Beth: ‘I wonder how much of it had to do with [female manager’s] personality, or even my own? I know competition and ambition can make people behave in strange ways, and in psychology there is a lot of competition for promotion/training places. I don’t think, as a profession, this is acknowledged in terms of the impact it can have on dynamics and working relationships.’
All the therapists we spoke to believed that training institutions, accrediting bodies and mental health care employers need to pay more attention to this issue. Many reported feeling unsupported by their professional body. Rachel, as a clinical psychology trainee, felt trapped when bullied on a placement. She felt that if she complained to her supervisor she would risk getting a poor review, but if she complained to the university her career would be in jeopardy.
We believe there should be more discussion about the issue of bullying within the profession, more support for victims, that regulatory bodies should set clear standards around bullying behaviours, and there needs to be more research. Klein suggests using more stringent assessment methods, such as those used by domestic violence agencies. These methods rely on an attitude of ‘sceptical empathy’ and the use of screening tools that are less open to manipulation.
We would suggest that our privileged understanding of relationships as a profession demands a closer look at this phenomenon.
Dr Werner Kierski (MBACP Snr Accred) is a psychotherapist, tutor, researcher and academic supervisor. He works in private practice and at a private mental hospital.
Jessica Johns-Green is a BPS chartered and BABCP accredited counselling psychologist at a private mental health hospital. She also works in private practice.
References
1. Klein A, Martin S. Two dilemmas in dealing with workplace bullies – false positives and deliberate deceit. International Journal of Workplace & Health Management 2011; 4 (1): 13–32.
2. Royal College of Psychiatrists. On bullying and harassment. London: Royal College of Psychiatrists; 2008.
3. http://dignityatwork.org/advice/what-is-bullying/
4. Hoosen IA, Callaghan R. A survey of workplace bullying of psychiatric trainees in the West Midlands. Psychiatric Bulletin 2004; 28: 225–227.
5. Freeth R. Who cares about the carers? Therapy Today 2013; 24(9): 6.
6. Miles G. No hope for paid work. Letters. Therapy Today 2013; 24(7): 40.
7. Down M. ‘We can’t work for free.’ Letter. The Psychologist 2012; 25(6): 398.
8. Some of us can’t work for nothing. Letters. The Psychologist 2012; 25(7): 482–489.
9. Young J, Klosko JS, Weishaar ME. Schema therapy: a practitioner’s guide. London: Guilford Press; 2003.
10. Young J. Introduction to schema therapy. Workshop presentation. London, 18/19 October, 2008.
11. Maeder T. Wounded healers. The Atlantic Monthly 1989; January.
12. Leitner A, Märtens M, Koschier A, Gerlich K, Liegl G, Hinterwallner H, Schnyder U. Patients’ perceptions of risky developments during psychotherapy. Zurich: University of Zurich; 2013. http://www.zora.uzh.ch/69327/1/L_Schnyder_J_Contemp_Psychother_Manus.pdf.
13. Workplace Bullying Institute. Gender and workplace bullying. Bellingham, WA. WBI: Workplace Bullying Institute; 2010.
14. Lyly-Yrjänäinen M, Fernández Macías E. Women managers and hierarchical structures in working life. Dublin: European Foundation for the Improvement of Living and Working Conditions; 2009.