Rehabilitative psychotherapy usage rates are growing rapidly in Finland.
The Social Insurance Institution, KELA, provides yearly statistics of the rehabilitated. They clearly show that age-old stereotypes of mental health patients are outdated.
Mental health issues have long been associated with the underprivileged members of society. Now, on the contrary, people seeing a private therapist are to a great extent those we are used to think of as the well-off in society: university students, specialists, managers and entrepreneurs.
What is causing this? Are the well-off people somehow more prone to mental illness? Or has psychotherapy become one of the ingredients of the recipe of success, the same way as self-help literature and trendy yoga classes?
Symptoms are severe
– First, you asked whether therapy could be seen as a tool of ‘self-development’. Of course, we could see it that way. But really, at least the people, who I see in sessions, have very real and severe problems. In a certain way, they seek help already too late, says Irena Miettinen a theologist working as a private psychotherapist since 2003.
Somewhat along the same lines argues psychotherapist, PhD, Irma Karila, who has worked in the profession since the 1970s.
– Back when I started, people seeking help from therapy were mainly people with social phobias. Today, there are, in fact, more difficult cases in rehabilitation psychotherapy, with more multifaceted symptoms of depression, Karila says.
The most common reasons for entering treatment are indeed depression and anxiety disorders. This is confirmed by statistics as well as by the experts interviewed by Elm Magazine.
At least partly, personality traits can predict the need for treatment, because behind many depressions there is a burnout, and behind many burnouts there are traits of a demanding personality, or even obsessive-compulsory personality disorder.
For people of this type of personality, work is a big part of identity, and it needs to be done to perfection.
– People who have a demanding career are often also demanding towards themselves. They whip themselves forward and try to hang on for too long, says Irena Miettinen.
The ingredients of a burnout
Then, could the problem be solved if these individuals learned to relax a bit?
Not quite, the experts convince. Societal changes such as increasing competition for work positions have a profound effect on the overall picture. We are barely over a long recession and the euro crisis. The prospects of steady careers are perceived, at the very least, uncertain.
In addition, work culture has changed, Irma Karila says. Most of the unprofitable moments that have offered a moment’s rest during the working day have been cut out: such as being able to sometimes just waffle on or sit a little longer for coffee, which is important also in terms of sociability.
According to Irma Karila, a well-justified fear often lurks behind workaholism: if I do not invest my 110% all the time, my contract may end. And nowadays this might happen, even if one works until exhaustion.
Psychologist and psychotherapist Katja Myllyviita agrees. She sees a clear mechanism between some personality traits and the ongoing trends of working life: when the pace of work at the workplace accelerates, the demanding personalities get into trouble.
– They should be able to independently lower their standards somewhere, so that they could tighten up from somewhere else. The risk is that they always take it on their own backs, stretch their working hours at the expense of their leisure time, Myllyviita summarizes.
– When at the same time a bunch of people get reduced from the workplace, they fear they might soon face the same fate, if they reveal their weakness: that they no longer cope. So, at this point the instructions given in therapy might be on a collision course with reality, she says.
The intense working life creates workhorses
In practice, the path to exhaustion goes as follows: a demanding or perfectionist person feels that none of the tasks that are given can be refused. When the environment is also demanding, it requires assertiveness – a trait that is too often missing from these individuals. As said, practice in therapy sessions doesn’t help if the working life reality is not responsive.
If a person then tends to just listen and react to messages coming from surroundings, they might forget to listen to their inner signals, explains Irena Miettinen.
– Things like, hey, now you are tired, now you should sleep more. Or, now you should take a vacation or eat more regularly. One begins to neglect their own needs. They get exhausted as a result, and then comes the full stop, Miettinen says.
This is perhaps the most mundane explanation for why we find so many experts and managers in the rehabilitation statistics.
– I see this as an obstacle to rehabilitation. I think it is useless to think that we could rehabilitate people to cope with endless demands, says Katja Myllyviita.
– Many patients also themselves manifest the kind of biased thinking that they would have to somehow cope alone with this problem. They find it hard to see the environmental contribution to their burnout, and instead they feel that it is their own fault. Personally, I think that the work place environment plays a big role in creating the “workhorse syndrome”, Myllyviita says.
The goals and ideals should be more realistic
According to Katja Myllyviita, it is worth to note that especially female burnout sufferers are often independent. It might be difficult to them to ask for help, they do not want to bother anyone, or ask their employers to share their workload.
– Asking for help is part of the healing process. But at that point it would be really important that the employer meets them half way, so that the rehabilitee dares to ask for help next time, Myllyviita says.
According to all the interviewed experts, it would also be important that help would be offered quickly, just as the first symptoms appear.
– The fastest way to help is when the situation is fresh. But when the situation becomes chronic, resources need to be put on the end of the chain. It is absurd, says Irma Karila.
According to Karila one cure would also be to cherish a more realistic idea of a human, so that no one needed to play a role.
– I think that if someone appears to be perfect, it cannot be true, she says.
As a tip for a method of treatment in addition to therapy, Irena Miettinen suggests mindfulness-training; a meditative technique, in which one’s attention and awareness is brought to the very present moment, i.e. to the breath, instead of the usually negative thoughts and feelings. Mindfulness has been scientifically proven in various studies to help reduce symptoms of anxiety.
– It has become fashionable but I believe in it myself, as it can help to be more accepting towards oneself, she says.
But if more and more people need rehabilitation psychotherapy in order to cope in their work or study, and at the same time piles of mindfulness guides are sold on bookstores, should we ask if this is just one more demand of society? That everyone has to put up with the pressure alone, and the society does not need to change?
– I’ve been thinking about it myself, that it does tell us something that mindfulness seems to be around every corner. Sure, it can, and probably will, become another form of trap for some people, if they start to perform it slavishly, Irena Miettinen says.
Rehabilitation psychotherapy in Finland
- The purpose of rehabilitation psychotherapy is to support a person’s ability to work and study in situations where the ability is under threat due to a mental disorder.
- The Social Insurance Institution supports the treatment financially in Finland (around 40-70% of the cost).
- Changes in volumes are partly due to increased availability of the trained therapists, as well as a change in the Finnish law dating back to 2011, when the municipalities became obliged to organize rehabilitation therapy to those who had the required doctor’s referral.
In addition to the three therapists presented in the article, two psychotherapist and two other experts were interviewed.
As the working life changes, do you think lifelong learning and personal development have become an exhausting requirement, imposed by the labour market?
We presented the hypothesis of this article also to Tuija Koivunen, a researcher that was interviewed for another article on this theme issue.
“It’s an interesting and necessary perspective.
As such, learning new skills is of course not a bad thing. Training improves work performance, and self-development is a great thing. But the risk is that it goes too far: that there is not enough time to recover, and nothing is ever enough, you’re never good enough. The flip side is suffering a burn-out before long.
I’ve researched people in the executive level, and they often do not have specific working hours, just an overwhelming amount of work. All the time, one should be better and better. Especially women also have some kind of family responsibilities, and often they educate themselves simultaneously in some way: not necessarily to a degree, but they are studying at least some new things in order to keep up in the director’s career. I see these as quite demanding positions.
It would also be extremely interesting to know more about why people read self-help books on working life in their spare time; they are a growing area of literature. Do people use their leisure time studying these guides, working this way to ensure that they would become better workers? And others go to some classes: mindfulness if not something else.”