Dr. Tyia Grange Isaacson, LCSW, PhD is a clinician in private practice working in Berkeley, CA and globally via telehealth. She has a specialty of working with PhD students.  Tyia is sharing a series of guest blog posts highlighting some common challenges graduate students face, how these challenges can exacerbate mental health concerns and what to do about it.

By Dr. Tyia Grange Isaacson.

    Almost immediately in elementary school you are noticed.  The teacher sees how school comes easily for you and how you understand what is being taught more quickly than the others.  Your parents notice too and tell you they are proud of you. You learn that being good at school is valued and by extension you are valued.

    In my work with graduate students at the top programs of their chosen fields, I find that there are some common afflictions student face.  Growing up, students who are the best in the class are without peers and can feel isolated. The emotional pain of being alone registers in our brains the exact same way as physical pain.  As they say, it can be lonely at the top.

Yet, you continue to work hard at school.  You follow the prescribed course completing everything your teacher tells you to do.  You preform well. You know you preform well because you receive feedback—good grades and affirming comments.  Without you noticing your sense of self has solidified around achieving validation from your academic performance.  

After high school there is no question you will stay in school and go to college.  You are good at school. School is all you know. Naturally then, after college you go on to graduate school.  You started school when you were three. You are now turning twenty-eight and the last quarter of a century has been spent chasing after what it means to be a good student.  This is your identity. But what happens after you finish everything on your very last syllabus? What happens after you have gotten all the A’s? Now you are suddenly and rudely pushed out of the nest with no flight plan to study and ace. On your own you must fly or fall.    How do you maintain your sense of worth when the metric by which you have always been able to measure and confirm your self value has suddenly and irrevocably been taken away?

You are often unsure of what to think or feel.  You have trouble making decisions. You have spent your life being so terribly busy and tired from completing all of your assignments that   you never had time to look up from your school book long enough to truly figure out what you want. You wonder how you can be so utterly lost when you have been told you are doing so well.  You conclude something must be terribly wrong with you.

The patients in my practice experience distress getting in touch with their own thoughts and feelings especially in the face authority figures with strong opinions.  This occurs in part because a student relies upon her professors and advisors for her survival. She can only advance in her program with their approval and support. The relationship mimics a parent child relationship where a young child is wholly dependent upon her parent.  In certain family systems, especially those with high achievers, children are subconsciously or overtly encouraged to please their parents. Often, the separation between a child’s achievements and a parent’s ego is blurry. In other words, a parent’ co-opts the child’s success and the parent’s identity and self-worth is supported by their child’s achievements.  For such children, displeasing a parent feels threatening to a child’s sense of security and a pattern develops.

You don’t feel good when someone you need expresses an idea that is contrary to yours.  At all costs, you want to avoid disappointing this person. Even though you know it doesn’t make sense to disappoint yourself before disappointing this person you can’t stop yourself.  You know that it is ok to disagree with your advisor. You know that it is your life and you deserve to be happy and do what you want to do.  Your nervous system does not know this.  At your meeting with your advisor she tells you her opinion.  Her opinion is not your opinion and you feel a sinking in your stomach.  Quickly, your heart races. You should tell her what you think. Yet maybe your answer is the wrong answer.  Maybe you will not “get an A” if you risk your answer which is different than your advisor. Your advisor is the authority and she must know the right answer.  You can’t risk failing. You loose your voice and blink back your tears. You nod and smile. She sees you smiling and smiles back at you.

PhD students in therapy with me work to identify the early threads of their distress often starting in their families of origin.  They begin to notice when these early patterned responses impact them in their current life. Instead of relying (as they always have) on their minds, patients link their feelings to responses in their nervous systems.  Identifying thoughts and nervous system responses become a compass to help patients indicate when they need to slow down and try to do something different. Change and growth occurs when a patient can break up an intrenched patterned and respond in a different way instead of automatically responding as they have in the past.  

There is often a lot of internal backlash and noise in patient’s heads about the danger of breaking old patterns of responding.   Sometimes there is an entrenched fear that doing something different will be catastrophic. Despite a strong desire to change students frequently feel stuck.  Paradox can be useful when patients feel stuck For example, patients may work towards the goal of trying and get an “A” in working less or pleasing others less.

When one of my patients has trouble believing in herself and her right to her own thoughts and feelings I encourage her to imagine that she is someone else.  Someone she cares about and perhaps feels protective towards. My patient can easily imagine her best friend’s right to think and feel and respond as she wishes.   The work becomes believing that even without someone telling her so, without the external validation, she too has worth. It is the work of forming a self-identity that is reinforced internally.   Patients in graduate school are used to working hard. It is a different kind of hard work then getting all A’s and it is infinitely more rewarding.