Clinical summary: When Psychology Trainees Conceal Part of Their Identity

Many people have concealable stigmatized identities, which may include a history of mental illness, minoritized sexual orientation, transgender identity, and a chronic physical disease like HIV. For example, 45% of adults have at least one chronic disease, 21% have a mental illness, and 6% identify as LGBTQ. These identities are stigmatized because of negative social attitudes and behaviours, which pressure people with these identities to conceal themselves to avoid negative interactions and outcomes. Concealing aspects of one’s identity reduces authenticity (acting in congruence with one’s true self) and belonging (feeling connected and integral to a system), which are important for self-esteem, mental health, and work and life satisfaction. In this study, Shepherd and Brochu were interested in looking at the impact of identity concealment in psychology trainees on their experience of burnout and therapeutic relationship quality. The authors conducted an anonymous survey of 335 psychology trainees who reported some level of identity concealment in their psychology training experiences. Most were women (82%), non-Hispanic White (71%), and heterosexual (61%) enrolled in clinical psychology doctoral programs (84%). The trainees were at various levels of training from their second to 7^th year in the program. High levels of burnout were reported in 16% of participants, and on average, the trainees reported a high level of therapeutic relationship quality with their clients. The most identified concealable stigmatized identities were mental health issues (38%), LGBTQ identity (20%), socially devalued cultural values (8%), invisible physical health issues (7%), and religious beliefs (7%). The authors found that the effect of identity concealment on burnout in psychology trainees was partially explained by lower levels of authenticity (b = .03, SE = .01, 95% CI [.0061, .0542], β =.05) and lower levels of belonging (b = .13, SE = .02, 95% CI [.0867,.1688], β = .21). The effect of identity concealment on poorer therapeutic relationship quality was also partially explained by lower levels of authenticity (b = −.04, SE = .01, 95% CI [−.0680, −.0148], β = −.08), and lower levels of belonging (b = −.05, SE = .02, 95% CI [−.0892, −.0117], β = −.09). In other words, identity concealment among psychology trainees lead to burnout and lower therapeutic relationship quality, and this effect may be due to trainees not feeling authentic and not feeling like they belonged in the training system they were in.

Practice Implications

Identity concealment can be a barrier to well-being in many ways. It affected psychology trainees’ level of burnout and their capacity to maintain a positive therapeutic relationship with their clients. Authenticity and trainees’ sense of belonging to a training clinic are possible mechanisms by which various forms of stigma affect occupational resilience (burnout) and social and professional relationships. Work and educational environments should create safer environments for psychology trainees with concealable stigmatized identities (mental health issues, religious beliefs, chronic medical problems, LGBTQ identity), especially since the quality of psychotherapeutic care relies on the well-being of the therapist.

Shepherd, B. F., & Brochu, P. M. (2024). Let’s get real: Identity concealment, burnout, and therapeutic relationship quality among psychology trainees with concealable stigmatized identities. Psychotherapy. Advance online publication. https://dx.doi.org/10.1037/pst0000522

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