Feature

When Clare Gibson's mother died seven years ago, the then second-year psychology student had just started treating patients for the first time. Although Gibson knew that her mother had been ill with kidney disease, her death was a tremendous shock.

"My mother lived with bipolar disorder; she was my inspiration for going into psychology," Gibson says. Yet her mother would not get to see her graduate and become the psychologist she is today.

Gibson, then 25, took a week off from her studies at the University of North Carolina at Chapel Hill to attend her mother's funeral. Then she went back to school, resuming her classes, her research and her patient appointments.

But she hadn't considered how the death would affect her emotionally. As she tried to continue her student life, "it was very traumatic," she recalls. She had a patient also dealing with grief over a lost parent, but felt so numb herself that she couldn't provide effective therapy; the patient was transferred out of her care. Gibson then learned the quality of her research work was slipping and recognized she needed psychological help. She began therapy for bereavement and gradually recovered.

Gibson, now a licensed clinical psychologist in Maryland, sees the irony of her experience — that someone trained to help others with emotional problems didn't know when to seek help herself. In retrospect, she says, she wishes she had taken a longer break, but a combination of her competitive nature and the demands of her grad program kept her from doing so.

As Gibson discovered, life events can put kinks in even the best-laid academic track. The question becomes how to deal with — and learn from — the situation. So, what should students do when the inevitable crises occur? And how can schools help, especially in a grad school culture that often emphasizes competition, long hours and show-no-weaknesses stamina?

Common crises

Over the five years of psychology graduate school, "it's more than likely that students will face some kind of trauma, challenge, stressor or losses in their life," says Jeffrey Barnett, PsyD, psychology professor and associate dean at Loyola University Maryland and author of the 2014 book "Self-care for Clinicians in Training." "To think that they're not — that you're going to live this charmed existence — is just not realistic."

For example, one study of 1,575 graduate students at the University of Tennessee found that about 25 percent had experienced the loss of a significant person in their lives within the previous 24 months. The research (part of an unpublished dissertation) showed students experienced grief symptoms lasting at least six months.

Other students fall seriously ill or are injured, must deal with family issues such as divorce, or must care for sick or injured family members.

George,* for instance, is a second-year PsyD student at Loyola University Maryland. Last year, his younger brother went through a severe bout of addictive and self-destructive behaviors. George, then 25, was the only person in his family who knew what was happening, and the person his brother turned to for help.

"It was almost a life-and-death addiction," says George. "A lot of responsibility fell on me to get him into rehab."

The situation was made all the more difficult by George's family living a nine-hour drive or two-hour plane ride from school.

Throughout the crisis, George didn't take any leave or reduce his class load. "I tried to juggle all of it," he says. "I didn't take off from school — that's not my personality. I try to do a lot at once."

Flare-ups of chronic illnesses can be another disruptive factor in students' lives.

Ben Greenberg, 35, a PsyD student at Argosy University in San Francisco and former concert musician, has been dealing for many years with severe tinnitus and sensitivity to sound, which he says can be made worse by stress as well as loud noise.

When Greenberg started at Argosy, he worked with the student affairs office, which on his behalf informed his professors in writing about his condition (which he calls an "invisible disability" because his limitations aren't readily apparent). His professors have been understanding and have made accommodations, he says, such as making allowances if he needs to leave class due to noise level and granting extra time if needed for assignments.

However, at a previous school, Greenberg says, his instructor for a course in creative expression was less accommodating. The course included exercises where students would scream and bang on drums, but Greenberg says the instructor wouldn't let him know when these sessions might occur so he could plan to avoid the noise. "She just said, ‘I'll do it whenever I feel like it.'" This put Greenberg in the awkward position of suddenly having to bolt from class.

Greenberg would like to see schools work more cooperatively with students who have challenges by educating the classroom "to help make known the ways in which students need to be accommodated without shaming the student."

What can students do

First and foremost, students need to tell someone in their program that something is wrong.

"[Students shouldn't] wait until things get terrible and then throw yourself on the mercy of the professors," says John C. Norcross, PhD, a psychology professor at the University of Scranton and author of the 2007 book "Leaving It at the Office: A Guide to Psychotherapist Self-Care." "Having a mentor to turn to in a crisis can be especially helpful."

This may not necessarily be the student's assigned academic advisor, says Barnett. "It might be a faculty member [he or she] had a class with and made a connection with, someone who seemed supportive, approachable, warm or nice," he says.

Faculty mentors can advise students and help mediate situations with other faculty during a crisis. Some programs also assign upper-level student mentors to help. But to be most effective, these relationships need to be established before something goes wrong.

With or without a mentor's help, students should be able to work with faculty to make accommodations once they have communicated their emergency.

The steps to follow will vary by academic institution, says Louise Douce, PhD, special assistant to the vice president of student life and former chair of Ohio State University's crisis support team. But there are common options many can offer to students who are facing emergencies, such as:

  • Extending the deadlines for papers or tests.
  • Dropping courses to ease workload.
  • Taking a temporary incomplete from a course, rather than dropping it altogether. Norcross says this can give a student a delay (typically no more than two months) that allows him or her to finish the course, rather than having to drop it and then retake it.

"In many programs, some sections of courses are only offered once a year, so if you miss them, you are a year behind," says Norcross. Another year of schooling can mean $30,000 or more in debt.

"Having some sensitivity to this can save students time and money," says Norcross, admitting that it can be difficult for faculty. "But we should still be offering it when we think it's needed."

  • Contacting the graduate school dean's office. This may be needed, especially if you are getting assistance for revising academic requirements.
  • Taking a leave of absence from school, which could last a semester, a full academic year or longer (though in most settings a leave can't be indefinite, says Erica H. Wise, PhD, clinical professor and director of the psychology training program at the University of North Carolina at Chapel Hill).
  • Suspending or discontinuing practicums, teaching assistantships, research jobs and similar duties. This should be done in close consultation with advisors and supervisors, says Wise, especially if changes may affect clients or patients. Students should not simply disappear or abandon training obligations without notice; if at all possible, they need to communicate with the appropriate faculty members or their advisor about the problem.

"Self-awareness and communication are critical professional competencies for graduate students in professional psychology programs, especially when they are experiencing a decrement in their ability to adequately complete essential tasks," Wise says.

Seeking self-care

Once an immediate crisis has passed, students often continue to deal with its aftermath. During that time, self-care can include seeing a psychologist, talking with a support group or mentor, carving out more time for friends and family, and relieving stress by exercising or by practicing tai chi or meditation, says Barnett.

Cindy Unger, a research psychology graduate student at New Mexico State University, started her PhD program while grieving the abrupt dissolution of a seven-year relationship. Her advisor was sympathetic, and her research and comprehensive exams were delayed so she could focus on classes and her teaching assistantships only.

But, says Unger, 37, she didn't find support among her fellow students, who are almost all younger than she is. Nor did therapy at the student center help. Instead, she has been dealing with her grief, financial pressures (both due to the break-up and to budget cuts in her program) and loneliness by taking up running and by "working all the time" — primarily teaching classes, which she says helps her "feel like an effective human being."

Sometimes focusing on self-care can be difficult for driven, achievement-oriented grad students. Yet pulling all-nighters and ignoring physical and emotional needs can backfire. "If they try to keep it to themselves and just work harder, it's only going to get worse," says Barnett.

Adding to the problem: Some professors model just this sort of suck-it-up mentality, rather than being open about challenges and sharing how they seek support from family, friends and colleagues, says Wise. She notes that the ability to maintain high standards in one's professional domain while also engaging in flexible and compassionate self-care "is a lifelong endeavor for all psychologists."

"Faculty may not be the best role models if what they talk about to impressionable graduate students is being exhausted after staying up too late completing their own tasks, and thereby not communicating a sense of balance and perspective on their own lives," she says.

Some professors, too, view grad school as a necessary trial by fire, with any detour by students seen as a weakness, says Norcross. Seeking psychotherapy can, unfortunately, be viewed negatively by some professors.

"You would like to believe that doesn't occur, particularly in clinical training programs, but it certainly does — we've all had some experience with that," says Norcross.

This, he says, "is the great irony. We try very hard to inculcate the belief that psychotherapy can be important for well-being and growth — and yet if students select to pursue it in training, there are some professors who will hold it against them. Not all, but some."

This is one reason that psychology programs should provide graduate psychology students with access to confidential services should they need them, says Douce. Since many psychology students serve practicums at school-based clinics, they may need to be provided alternate sources for treatment.

At big universities with large student counseling programs, it can be easier to place psychology grad students with someone who has no connection to their academic department. "You can mask someone's records and put them with someone they will never see in a supervisory role to get clinical services from," says Sherry Benton, PhD, associate professor of psychology at the University of Florida at Gainesville and a former director of the university's student counseling center.

In smaller schools, students may need to be treated by therapists or doctors in the community who are not connected to the program and who have agreed to see students at a lower cost. Schools should maintain lists of available practitioners, says Norcross. However, Gibson says her school's list of outside clinicians was difficult to find and out of date; care must be taken by psychology programs to make sure data is both accessible and accurate.

Online databases are another way for students to get this information, Benton says, pointing to the University of Florida at Gainesville's public database, which is updated by the clinicians who participate.

One option for students to receive confidential and easily accessible counseling is for it to take place online. Benton directs TAO (Therapist Assisted Online) Connect Inc., an 18-month-old service that treats student anxiety via teletherapy. Students complete interactive, online homework modules each week teaching them recovery skills (such as meditation and mindfulness) and attend 10- to 15-minute videoconferences with counselors based at the University of Florida at Gainesville's counseling center. Barton says her research shows the online therapy program has a higher effectiveness rate than face-to-face therapy offered by the university's counseling center.

To date, TAO has been adopted by 10 colleges and universities across the country and one in Canada, Benton says.

Regardless of how therapy occurs, it's key for institutions to have plans made in advance of a student crisis, Benton says, particularly with respect to graduate psychology students, who face potential "dual-role situations" (as both patients and clinicians-in-training).

Programs also need to "set the climate and tone that says seeking help is a strength," says Douce, "and that it's an ethical thing to do to recognize when you need help and to seek it."

She also suggests having mentors contact students if something like a death or illness occurs. "They can check in with them and say, ‘How are you doing? What do you need? How can we help?'"

In addition, advises Norcross, psychology programs should regularly audit how they are incorporating self-care and humane values. Institutions need to "dispute the notion that turning to personal therapy constitutes failure," he says.

"We spend a lot of time trying to convince our patients of that, but we don't spend much time convincing our students of that."

Finding a balance

When Michael,* a postdoctoral research fellow in psychology, was in graduate school, he lost both of his parents, two years apart. His father died suddenly in 2011, while his mother endured a protracted battle with cancer, dying in 2013. The trauma led him to experience anxiety and panic disorder.

Michael says his program's response was "absolutely great." While he didn't arrange formal leaves or other accommodations, his supervisors were flexible and allowed him to work remotely when needed. He also received services from the student counseling center, where his confidentiality needs were automatically taken into account (he was assigned a senior psychologist to limit exposure to people from his program).

Today he is still grieving, but has learned coping skills. Among them, he says, are looking for something to be thankful for each day — "If nothing else, today I can notice a beautiful tree."

Also, he advises students in crisis not to isolate themselves, but to seek social support and to "be willing to open up and talk." Michael, for instance, found one source of support to be his mother's friends.

His parents' deaths have, he says, made him more humble, more appreciative of what's truly important in life, and more able to enjoy the present.

George, meanwhile, tried to ease the stress he felt over his brother's addiction by playing hockey and frequently talking to his faculty mentor, who helped him learn to reprioritize his time, giving more emphasis to such goals as getting a good night's sleep over getting a great grade.

"The hardest part was being OK with Bs and B-pluses for that semester," George says. "It took a while to come to the realization that it was OK to not get 100s, especially with what was going on."

While the crisis with George's brother has passed, its effects have altered how he approaches school and life in general, he says. He no longer focuses solely on the perfect score, but rather on a bigger, healthier goal.

"I'm 100 percent changed in terms of what I value," he says. For example, he now is working with clients and isn't reluctant to take extra time away from his coursework to research treatments for them — even if it means a slightly lower grade.

His situation with his brother became, in some ways, part of his education as a therapist, he says. "It was a very emotional experience — but looking back on it, I grew from it and learned from it."

Similarly, Clare Gibson found that her mother's death forced her to think about self-care.

"I think students can really grow from these traumatic experiences," Gibson says. "They can use that significant life event in a professional way."

*A pseudonym.