Healthcare Professionals and Mental Health: "I feel like something is not right"

Q&A with Sara Tripalin, MS, LMFT

Founder/Owner of Peace of Mind Therapy, LLC

Hi RN’s! I wanted to write a post to discuss what to do when you feel like you are not yourself and that “something is just not right”. I’ve consulted with a licensed therapist, Sara Triplain MS, LMFT, to give expert guidance and direction on how to navigate challenges for us RN’s.

Hi Sara! We touched base in a previous article on your education, credentials and experience. I want to shift into discussion for Nurses about mental health and get everyone informed from a mental health expert.

This is an important question, what is therapy? How does it work?

Psychotherapy or talk therapy is a means of helping people cope with a myriad of illnesses or emotional difficulties. First and foremost, finding the right fit with a clinician is paramount. Depending on one’s needs and challenges, the clinician’s therapeutic approach and skill set become an important consideration. Once you find a therapist that best matches your needs and therapy commences, the clinician and client will create a treatment plan by identifying what the focus of the work is (the ways and means clinically to achieve that) and desired goals. Just as significant as finding the right therapist, it is also important to recognize that engaging in psychotherapy is healthy, and is an element of personal wellness versus the long-held stigma that something must be wrong with a person to seek such counsel.

How can we differentiate daily stress versus a growing problem?

Daily stress or what might be otherwise known as situational stress, oftentimes has a symmetry to it. You experience an event or task that increases anxiety and you have a bodily response to it. For example, you are driving and someone cuts you off. You will likely experience increased body tension, increased heart rate, shortness of breath etc. and then eventually, your body regulates back to a resting state, void of those features. When we experience prolonged stress, increased body tension, increased heart rate, fatigue, difficulty sleeping or going to sleep, lack of motivation, persistent intrusive thoughts, hypervigilance etc. become road signs of a growing problem that has exceeded situational stress. If one becomes aware that there are more persistent features that they are experiencing, it might be time to explore further supportive interventions.

When do you recommend therapy as a tool?

We all have a lot of life happening and varying degrees of experiences and disturbances within those lives. Therapy becomes a great tool when our old means of coping, that previously supported some baseline of stability, changes. When we cannot manage like we did before, whatever the reason may be, therapy might be a good option to consider. Death of a loved one, birth of a child, loss of a job, divorce, phase of life adjustments, a traumatic or disturbing event are all examples of when we might be stretched, when we might experience more enduring anxiety, depression, fatigue, etc. and our old coping methods no longer work to keep us at our previous stable baseline.

Do you treat healthcare workers? Do you have clients that are Nurses?

A large percentage of my client population are healthcare workers, many of whom are specifically nurses. The physical location of my practice is in Madison, WI and Madison is a healthcare heavy city. We have the University of Wisconsin Medical School, it’s affiliated clinics and hospitals, a world renowned cancer center, and numerous health insurance plans that support the plethora of clinics and hospitals in our region. Madison’s backbone is healthcare and therefore, my high population of doctors and nurses.

Can you give us any trends that you have seen with healthcare workers in your practice?

The last two years have put an intense focus on our healthcare workers. What has been highlighted has been the growing intensity in the job and the diminishing pool of folks able to do the job. Now, more than ever, our healthcare system is stretched thin. Ahead of Covid, we were already experiencing a shortage in nurses. Those nurses and doctors that confronted Covid did so with a diminished pool of fellow nurses and doctors and a lack of resources not previously experienced. What has come is the trend of burnout, expression of survivor guilt, increased trauma reports, and a disenfranchisement with the overall career. A common sentiment is the growing inability to manage a career in healthcare and what is now being demanded and simultaneously balancing the increased demands of one’s personal life.

Why are Nurses more susceptible to trauma?

Nurses often develop strong relationships with their patients due to the frequency in which they care for their patients. It is all too common that nurses, especially those in the hospital setting, get to know their patients and their families, their stories, their hopes and fears as their patients face whatever medical challenge is in front of them. When a patient dies, when a patient presents with trauma, nurses have the tendency to absorb that differently than doctors because of the relationships they hold with those patients. Nurses tend to internalize those losses and trauma often at a deeper, more personal level than doctors. That is not to suggest that doctors do not experience the impact of these moments, but they often are more sheltered from the deep personal feelings by virtue of how they conduct their jobs (they spend a fraction of the time with those patients in the room as compared to nurses). A great example of this is the large population of cancer patients I work with. During the times of their in-patient stays or in-clinic treatments, they come to our sessions sharing stories about their nursing staff, or even introducing me to their nurses if they come to our session via tele-health and it highlights for me, the relationships that get built when the nurses and the patient have that level of frequency with one another. Nurses become an integral part of a patient's hospital experience. It stands to reason then, that nurses will absorb a great deal when confronted with those losses and traumas.

What are red flags? What should someone do if they are experiencing one of these?

There are numerous red flags and some are more easily identifiable while others are more diffuse. For example, if a person finds themself thinking frequently about self harm, that is a fairly obvious and abrupt shift from a previous baseline. Less obvious signs might be a slow decline in motivation, shifting feelings on activities that otherwise were enjoyable, pulling away socially, eating more or less on a daily basis, changes in sleep etc. These examples may not be noticed for weeks until we can see the longer arc of the pattern around the change(s). The red flags coincide with the previous discussion around what is situational stress and what is considered a growing problem. A growing problem often has a pattern associated with it. For example, declining on one or two social events does not raise concerns, declining on numerous events consistently suggests a pattern of a growing problem/trend. One or two nights of restless sleep is normal, weeks on end, is a pattern that needs to be addressed. A good rule of thumb is not the one red flag to worry about, but the multitude of red flags. One fleeting thought about “not wanting to be alive” is different from many thoughts throughout the days of not wanting to be alive. Many flags vs one will inevitably indicate if further support is needed.

What other complimentary practices do you encourage clients to do outside of therapy?

Societally, we have been supporting the concept of personal well-being for the last several years. It has historically been a “trendy” concept. The last two years really kicked that initiative into high gear and made it very real. We confronted isolation, increased trauma, lack of resources, lack of meaningful connection, increased fear and helplessness. Personal well-being became the one space we could claim real agency over. Many of us had already been practicing some version of personal well-being. Other’s of us came to it for the first time because of Covid. Due to Covid, the opportunity to experience a slower pace of life and having the time to incorporate well-being was one of the upsides. It’s no accident that the exercise industry profited greatly during 2020. So wonderful complimentary practices include, but are not limited to, exercise (walking, running, biking, hiking, swimming etc), meditation, art, music, journaling, massage, acupuncture, reiki, yoga, cooking, dedicated family time, creating routines, mindfulness as a daily practice, mindfully eliminating elements that cause us unnecessary disturbance, being more selective, gratitude as a daily practice. While there are many “organized practices” that are wonderful compliments, the one that I nudge folks around is working towards awareness in whatever capacity that is for them. Awareness is available to us at any moment, provides us insight, slows us down, brings us to our present moment. Awareness or mindfulness, as it is commonly labeled, is a powerful way of regulating mood, of gaining insight, of developing compassion for self, helping us to stay present and connected. If I could “prescribe” one complimentary practice, it would be practicing mindfulness on a daily basis.

What are the positive impacts of therapy for Nurses?

Nurses, like all other folks who utilize therapy, have the opportunity to experience a reduction in the symptomatology that they present with. Whatever the cause for seeking therapy is, what is offered is the ability to name it, process it, find support around it, gain awareness and insight with it, and ultimately untether or unburden from it. The impact of therapy, when one finds the right therapist, is willing to engage in the work collaboratively and independently outside of the therapy space, can be life changing. For nurses in particular, to have someone who can hold space for you and the experiences who come with, who is also a part of the healthcare system and understands the nuanced impacts of it as compared to a friend or family member, where you can unpack your concerns without judgment, can all be highly affirming.

What is the single most important thing you’d like to tell RN’s?

You are a human being having a human experience. While that might sound elementary, you routinely work with one of our more vulnerable populations. To expect that you would not have difficult moments of processing your feelings when faced daily with grief, loss, anguish, pain, fear, trauma, neediness, helplessness etc. defies what it is to be human. The very nature of absorbing all of that on a routine basis and in the midst of the current times is something of an acrobatic feat. To seek support is not a failure, is not a sign of weakness but rather a very empowered and thoughtful act to ensure and or support general well-being. Our mental health is the command center for everything else going on within. Keep that command center in good working order and know that when you are reaching out for support, you are not alone, that your therapist likely sees someone as well, and the need and/or desire to mutually share difficulties is wired within all of us. And, thank you. You have shown up during our most trying times and without you doing so, so many more people would have suffered and struggled during these past two years and counting.

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