UPDATE – Therapists Can Make Bullies Too

Share this Blog post

Using the respective work of Drs. Twemlow and Anderegg as a backdrop, I suggested (in my October 14th, 2010 post) that bystanders, such as parents, teachers, principals, legislators, and business leaders, make, maintain, and motivate the bully. A colleague emailed me and pointed out that I (a licensed mental health counselor) conveniently left out mental health professionals, such as social workers, counselors, and even psychologists, from the category bystander. My colleague was right. And as it turns out, there’s actually research that supports the idea that mental health professionals also engage in such psychodynamic gymnastics as displacement and projection as much as other bystander groups (maybe even more).

The article I’m thinking of is by Joel Kanter and appeared in a 2007 issue of Clinical Social Work Journal (Volume 35, Number 4, Pages 289-293) and is entitled Compassion Fatigue and Secondary Traumatization: A Second Look. Kanter was responding to the information that was presented in a special issue of the journal (Volume 35, Number 3) on compassion fatigue. Kanter in effect suggests that the source of the fatigue reported in the special issue—patients or clients—is wrong. Kanter tries to convince us that mental health providers of all stripes are increasingly displacing and projecting their fatigue (also known as countertransference) onto the work they are doing with their clients or patients, when in fact this type of countertransference is more about the clinician’s inability to deal with a work environment that has become increasingly hostile. Mental health clinicians are now forced (as I once was) to work longer hours and take less pay in order to keep their jobs. When I was a therapist, I probably spent 30% of my time performing “utilization review,” which is a fancy way of saying “get insurance companies to pay for additional services.” Did this rather hostile work environment make me frustrated and fatigued? It probably did. And did that frustration and fatigue carryover into the work I was doing with my clients? Probably did. But this is the hallmark of displacement and projection: you fight a fight in an area where you have some level of potency because you feel impotent dealing with problems at their source, which, in this case, consists of a large and rather impersonal insurance industry.

Simply put Kanter’s point is this: clinicians are making their clients and patients out to be bullies when in fact the real bully is a hostile work environment. As Kanter points out, this results in a big disservice to patients and clients. Kanter suggests that therapists should do their patients and clients a big favor by owning their projections. And the best way to do this? by reframing compassion fatigue as what it is, namely, hostile work environment fatigue. Kanter’s voice joins Twemlow’s and Anderegg’s as a chorus begins to grow: We have met the bully and the bully is us.