With the rapid rollout of safe and effective vaccines against COVID-19 worldwide, the world can breathe easier. Unfortunately, as this global threat is receding, its impact on mental health is becoming increasingly apparent. The problem is such that some experts speak of an “echo pandemic” (Canadian Mental Health Association, 2020). For example, rates of self-reported depression, anxiety and psychological distress have been steadily rising since the beginning of the pandemic (Dozois, 2020). Unfortunately, though vulnerable people and their families will likely need health care and mental health workers, these professionals also show signs of significant strain (Malvardy et al., 2021; Spoorthy et al., 2020). Specifically, rates of anxiety, depression, sleep disorders and posttraumatic stress are soaring among health care workers (Malvardy et al., 2021).
Increased demand for mental health services combined with the diminished capacity of care systems to provide will likely have a significant impact on mental health professionals’ workloads and indirectly also their ability to train the next generation of clinicians. Indeed, at a time when recruits are supposed to be able to count on their mentors, supervisors and educational systems to develop self-efficacy, professional judgment and expertise, they will instead likely experience a baptism by fire (Devys & Beddoe, 2020). Given this confluence of exceptional factors, it is essential to discuss how to best support the next generation of clinicians to ensure the sustainability of mental health care in the long term.
The Necessity to Recognize, Prevent and Treat Vicarious Trauma
Though definitions may vary, vicarious trauma usually refers to changes in cognitive schemas and belief systems resulting from empathic engagement with clients’ traumatic experiences. These changes may result in “significant disruptions in one’s sense of meaning, connection, identity, and world view, as well as in one’s affect tolerance, psychological needs, beliefs about self and others, interpersonal relationships, and sensory memory” (Pearlman & Saakvitne, 1995, p. 151). As interns and new graduates are called upon by care systems to help heal their communities from the traumatic impact of COVID-19, they may be confronted with horrific stories. This includes, for example, doctors grappling with the emotional consequences of practicing “wartime medicine,” nurses holding the hands of dying patients in isolation rooms, children exposed to domestic violence during lockdowns, Asian Americans experiencing racist attacks, and family members conned by ruthless opportunists as they desperately sought to help their dying loved ones (e.g., buying empty “oxygen” tanks in India). Considering what we know, clinical training programs should include mandatory training for interns, graduates and supervisors on interventions to prevent and treat vicarious trauma.
The Necessity for Safe Supervision in Academic and Clinical Circles
When they experience trauma and mental health difficulties, students and recent graduates would like to turn to their academic and clinical supervisors for support (Devys & Beddoe, 2020; Lamothe et al., 2021). Supporting future clinicians means protecting them from re-experiencing trauma and workplace bullying in academic circles and clinical training programs. The relationships graduate students have with their thesis directors and clinical supervisors are uniquely complex and rooted in a profound power dynamic (Yamada et al., 2014). They also evolve in a highly competitive and individualistic academic context that isolates students and discourages bystander intervention (Paull et al., 2020; Yamada et al., 2014; Goodboy et al., 2015).
According to one study, more than 20% of Canadian graduate psychology program students reported having been subjected to bullying by their current supervisor (Yamada et al., 2014). Simons and colleagues (2011) have identified four types of bullying behaviors: belittlement (e.g., intimidating, shouting, teasing, gossiping), punishment (e.g., excessive criticism, threats, accusations), managerial misconduct (e.g., excessive workloads, refusing to work with strengths, micromanaging) and exclusion (e.g., blocking access to different opportunities, isolating students). Bullying behaviors from supervisors against graduate students are increasingly being recognized as a threat to individual well-being and work productivity (Goodboy et al., 2015; McKay et al., 2008; Xu et al., 2018; Yamada et al., 2014).
Bullying behaviors undermine student emotional safety, a key component of effective supervision (Devys & Beddoe, 2020). Indeed, when done right, supervisor support has been identified as a critical ingredient in fostering resilience and professional growth among graduate students who experience trauma (Devys & Beddoe, 2020; Lamothe et al., 2021). With the lingering effect of COVID-19 on society and the increasing pressure being placed on new recruits, universities and the academic community must reflect on ways to prevent and address bullying. Many measures can be put into place immediately to help reduce rates of bullying behaviors. Specifically, universities can raise awareness through university-wide educational programs, enact behavioral contracts with thesis directors and clinical supervisors, monitor and assess behaviors through the completion of surveys by students/interns, reduce isolation with the creation of student support groups, and empower student unions for greater advocacy. Furthermore, university work and safety offices can reach out to students directly to explain their role and encourage denunciation.
The points discussed above are only a starting point to help students and recent graduates adapt to their context. The suggestions made above are unlikely to address all the challenges faced by graduate students, interns, fellows and recent graduates, so institutions need to continue listening to their members. Together, students, supervisors, health care systems and universities can ensure that communities will continue to receive the highest level of mental health care for years and even for decades to come.
About the Authors
Josianne Lamothe, MSW, is a doctoral student in criminology at Université de Montréal. She works as a clinician in mental health. Her research focuses on the experiences of youth protection workers with client violence.
Marine Tessier, PhD.c., MPs, is pursuing her doctorate in clinical psychology at the Université de Montréal. She holds a master’s degree in clinical psychology from France and has significant clinical experience with various populations including victims of crime and detainees. Her doctoral research project deals with posttraumatic stress injuries among paramedics and emergency dispatchers.
References
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