The Menninger Clinic in Houston runs a Professionals in Crisis Program (PIC) designed to “minimise the dysfunctional impact of the patient’s position, power, prestige, wealth, or knowledge on the treatment process” [1].

Treating high achieving, well-educated individuals described as ‘very important persons’ (VIPs) presents clinicians with unique challenges.

The clinic treats lawyers, physicians and mental health professionals, business executives and entrepreneurs, professional athletes, artists, priests, rabbis and ministers amongst others.

The treatment of these patients challenges clinicians’ skill, sensitivity and integrity, their ability to sustain professional boundaries and to maintain effective communication and cohesiveness within treatment teams and clinical institutions.

The capacity to respond ethically and therapeutically in the face of their own emotional reactions can be hard.

Around half of the patients have been diagnosed as suffering from major depression and over a third experience addictive disorders.

Symptoms experienced include many common mental illnesses creating constellations of characteristically mutually reinforcing problems.

Typically when professionals reluctantly agree to engage in treatment they will “minimise their difficulties, rationalise even the most maladaptive and outrageous behaviour, and seek to control manipulate, intimidate, denigrate, or seduce their treaters”.

Even for experienced and trained professional therapists the challenge is significant.

Many of the patterns of behaviour that impede effective use of treatment in VIPs are deteriorations or exaggerations of behaviours that have contributed to the VIPs is gaining and sustaining their professional position.

Necessary strengths and characteristics such as those listed above become dysfunctional and are used by resistant professionals to inhibit the goals of therapy.

It is noted that, “as in the case of compulsiveness and perfectionism, a heightened sensitivity and increased capacity to read social cues are significant assets to those who become leaders in society, business, and the professions. Secret or overt feelings of shame and narcissistic vulnerability, and a dysfunctional narcissistic solution to such vulnerability, loom large behind compulsive and paranoid personality constellations”.

PIC is unique in that it allows professionals adequate time to immerse themselves in a therapeutic community. Residents receive individual therapy, medication, management, group therapy over a period of around six to eight weeks.

The therapy can be as seen a progression through three stages: re-moralisation, remediating and rehabilitation.

Re-moralisation has the goal of resolving the acute crisis and restoring hope.

Remediation involves the resolution of the symptoms of the presenting psychiatric condition or behaviour and

rehabilitation involves the restoration of psychological capacity (particularly mentalising) underlying adaptive healthy patterns of coping, experiencing and relating.

Thinking back to the illustration of the juggling ball, we can see that the individuals will brought from the

blue ‘rehab’ area through the

yellow area where they are temporarily removed from the pressures and vicissitudes of excessive stress in their professional lives, back to the

green area where hope and creativity are restored in large part. When they then begin to tip into the

red area they can manage the stresses and strains of professional life with greater self-awareness.

Reverse the therapy
Prehabilitation involves mentalising and then putting into practice adaptive and healthy patterns of coping, experiencing, and relating, so that the risk of tipping into unhealthy symptomatology is minimised and life can be led with a sense of hope and morale.

The cycle of therapy is reversed.

It is also about pre-moralisation and pre-mediation.

It is about being proactive as well as reactive.

To do this we need to think about ourselves, others and what happens around us and what we can do about it. 

In other words, think about Me, You and Do … 




[1] Bleiberg, E. (2006). Treating Professionals in Crisis: A Mentalization-Based Specialized Inpatient Program. In Allen, J. G. & Fonagy, P. (eds.), Handbook of Mentalization-Based Treatment (p. 233). Chichester: John Wiley & Sons.


(This is an edited excerpt from my book A Lawyer’s Guide to Wellbeing and Managing Stress published by ARK Group in 2015.)

(Back to index)