Amidst COVID-19, mental healthcare clinicians are experiencing what psychologist Grace Gengoux calls a “double effect:” They are experiencing universal personal struggles such as fear and financial struggles, “but then because of the nature of their work, they’re also bearing witness to and bearing the burdens of the mental health sequela of the pandemic,” Gengoux explains. People who were already isolated, anxious, or traumatized are feeling more so now.
As a result, “supporting mental healthcare clinicians is as important as ever before,” says Gengoux, a clinical associate professor at Stanford who earned her Ph.D. from UC Santa Barbara’s Department of Counseling, Clinical, and School Psychology in 2008. However, the well-being of mental health professionals “was already a serious concern,” she says. “There was already tremendous suffering and risk for burnout and serious mental health consequences that needed to be addressed.”
That’s why she and a team of Stanford psychiatrists and psychologists published a book that focuses on the mental health of mental healthcare professionals. Professional Well-Being: Enhancing Wellness Among Psychiatrists, Psychologists, and Mental Health Clinicians (American Psychiatric Association Publications) was released in April.
The first half of the book is a summary of the literature on professional well-being. “An unreasonable amount of self-sacrifice is a deeply embedded part of the culture of medicine,” says Gengoux. Healthcare workers are socialized to put the patient first. Gengoux says mental healthcare clinicians are “uniquely” susceptible to burnout due to moral injury: because they are “doing work [they] really care about that’s supposed to make the world a better place, it’s even more devastating when there are roadblocks in the way that make it harder for [them] to do the good work [they] feel passionate about.”
Research findings do not support the effectiveness of a prevailing culture of sacrifice. “The literature mainly says that healthy doctors have healthier patients,” Gengoux says. “Doctors and mental health clinicians need to practice self-compassion and accept their own human limitations” to manage their own mental health and better help patients.
Unfortunately, many doctors do not do a very good job of taking care of themselves, Gengoux says. The second half of the book is practical, focusing on personal resilience and strategies to improve professional and personal well-being, including a full night’s sleep and effective energy management.
“It’s an ethical imperative that to be a good doctor and mental health clinician, we have to have awareness of our mental, emotional, and physical health and take care of ourselves,” Gengoux says. “That’s the long-term sustainable way to have a positive impact in our work.”
Fortunately, “there is a part of the culture that is starting to change for the better,” she says. The wellbeing of healthcare professionals is now more widely recognized as a legitimate scientific topic and a real problem. Medical institutions are realizing the costs of burnout, which affects the quality of patient care and causes medical professionals to leave the workforce. “This is a really exciting time in our history to be focused on the topic of wellbeing because there’s much more attention from the scientific community, the business community, and medical leadership,” she says.
Gengoux was invited to write this book by Dr. Laura Roberts, the chair of the Stanford Department of Psychiatry and Behavioral Sciences. Gengoux wrote many of the chapters and took a lead on editing the whole book. “I’m excited that it’s finally out in print and that we can share some of these ideas with the rest of the world,” she says.
Helping Families with Children on the Autism Spectrum
Professional wellbeing is only one of Gengoux’s areas of focus. She actually discovered her interest in burnout and resilience while working with families of children with autism, her initial line of work.
At Claremont McKenna College, where she received a bachelor’s in psychology, Gengoux found her calling working in the autism clinic. Working with children with autism and their families, she found “the perfect combination of improving someone’s quality of life through scientific methods.”
She chose to pursue a Ph.D. with an emphasis in Clinical Psychology at UCSB because she wanted to work with Drs. Bob and Lynn Koegel, two developers of Pivotal Response Treatment, a motivation-based type of therapy that aligns with Gengoux’s interests in using evidence-based practices to help children with autism and in developing interventions that require a small investment of time and money but yield a big positive effect.
Under the mentorship of the Koegels, Gengoux learned that there’s “hope even when a child has a severe disability. They approach the treatment of autism with a tremendous amount of optimism,” she says.
“One of the problems we see in autism is learned helplessness,” Gengoux says. Because of their neurobiological makeup, children with autism experience repeated failure to get their needs met and feel joy in interaction with others, which leads them to give up. Working at the Koegel Autism Center and later at Stanford, she noticed similar trends in the parents of children with autism, who are resilient despite feeling hopeless and tempted to give up. Her colleagues, too, were experiencing burnout. She wondered how she could help. And thus her interest in the wellbeing of healthcare professionals was born.
Self-care, Research, and Resilience
Gengoux also had a personal interest in this topic as a psychologist and parent. “I was also on a track to burn out myself,” she says. She asked herself, “How can I have a meaningful career and still be the parent that I want to be?” “The only way to do that,” she says, “is to do a really good job taking care of myself.” So she made time for exercise, adequate sleep, and her personal life to “fuel [her] professional passions and commitment as a mom.”
Gengoux says her practicum work at the Koegel Autism Center, Hosford Counseling Clinic, and Child Abuse Listening Mediation (CALM) gave her the exposure to a range of populations and clinical settings she needed to become a well-rounded psychologist. She brought what she learned about autism treatment at UCSB to the Yale Child Study Center, where as an intern she also learned about autism diagnosis procedures.
In 2010, Gengoux landed at Stanford, where she wears many hats: She serves as the Director of the Autism Intervention Clinic, maintains a clinical practice, teaches about child development and autism treatment, supervises and trains students, and conducts research focused on the development and evaluation of interventions.
“I feel an ethical obligation to make the world a better place for [families of children with autism], and science is the way to do that,” she says. “That’s why I like the combination of being able to provide direct care and but also being able to do science and push the field forward in terms of what we know about effective treatment. It’s also an ethical obligation in my mind that we teach what we know. My expertise can go a lot farther when I’m in a teaching position.”
Right now, her role as the Well-Being Director of the Department of Psychiatry and Behavioral Sciences is a primary focus. She and Well-Being Directors of other departments are strategizing and developing initiatives to address the current COVID-19 crisis and support the Stanford healthcare community, including a listening forum, informational webinars, and group sessions that provide psychological support.
No matter what hat she’s wearing, Gengoux is dedicated to using evidence-based practices to make a difference in people’s lives and foster resilience in the face of hopelessness.