// Mental illness in clients: recognising the signs
A recent survey found that despite mental health issues in clients being deemed very important by personal trainers, most lack the understanding or skills to identify the common disorders. Dr Mirabel McConchie, Dr Hieu Pham and Graeme Campbell explain further.
As a personal trainer you will be aware of, and may have studied, sports psychology, which deals with the relationship between psychological variables and sports performance. A large part of your role involves extended periods of intensive one-on-one contact with clients, so you are probably familiar with the principles of motivation, confidence-building, persistence, the use of imagery, goal setting, concentration, aggression, burnout, and the management of arousal, stress and anxiety (Weinberg and Gould, 2007).
In addition to teaching them the positive principles of achieving their goals, you may find your clients confide intimate details of their lives to you, and you may even notice behaviours that indicate the presence of a mental illness. If you find yourself in this latter situation, it is important to be confident in your ability to recognise the signs of someone suffering from any of the more severe mental illnesses and to be able to appropriately refer your client to a mental health professional.
Psychological issues deemed important
In a recent training seminar, we surveyed nine personal trainers to gain an understanding of the perceived relationship between fitness training and mental health. When asked how relevant the psychological wellbeing of clients is to the role of the trainer, two-thirds of respondents said they believed it to be 'very relevant' and one third deemed it 'relevant'. When asked how important it was that personal trainers have an understanding of the psychological issues that clients face, two-thirds of respondents again reported it to be 'very important', and 22 per cent rated it as 'important'.
Lack of understanding identified
Despite these findings, almost 90 per cent of the group reported lacking confidence in their understanding of the various psychiatric disorders. Significantly, all of the respondents indicated that they felt they would benefit from more training in mental health issues that may affect their clients. A series of short seminars was then presented, with topics including mental illness, personality disorders, difficult clients and professional boundaries and dynamics. The usefulness, interest level and perceived relevance for personal trainers was then assessed post-seminar.
Figure 1 (next page) demonstrates how confident the surveyed trainers were in their ability to recognise the signs and symptoms of the more common mental illnesses, including depression, anxiety, psychosis and eating disorders.
Strengths and weaknesses
As might be expected, personal trainers felt the most confident in recognising people presenting with anxiety, poor self esteem or eating disorder issues. These statistics would appear to reflect the prevalence of such issues within the group of people who are more likely to undertake personal training. Nearly half of all personal trainers felt they were not confident in identifying depression, psychosis, suicidal or self harm thinking, substance abuse issues or grief and loss. Of interest, and also of some concern, was the finding that none of the trainers surveyed had any confidence in their ability to recognise the signs of someone having a psychotic episode, thoughts of suicide or of wanting to harm themselves, or suffering from dangerously unrealistic and pathological self perceptions of their body image.
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Most at risk
According to statistics, one in four people will experience symptoms of depression at some stage of their life (Beyond Blue), and one in fifty will experience symptoms of psychosis. Mental illness is most likely to emerge between the ages of 16 to 30 years and research has shown that early intervention is the most likely factor in improving the outcome for an individual.
A large percentage of clients undergoing personal training may fall into this 'most at risk' age group, emphasising the importance of understanding how to recognise the common disorders. Nearly 80 per cent of the surveyed trainers indicated that they found a training session on mental illness presentations useful, and also felt they would benefit from further training on the topic.
Safeguarding your own mental health
While some clients may display signs of a more easily identifiable mental illness, in many cases it is inter-personal factors related to managing complex personality types and perceived personality clashes that can affect the professional relationship. Some clients may make you feel angry, frustrated, perplexed, avoidant and even make you question your ability to be an effective personal trainer. Learning how to manage clients with complex personalities or even personality disorders, including dependence, avoidance, histrionic and often narcissistic presentations, is crucial to managing your own mental health as a trainer!
Understanding professional boundaries and managing your responses to 'difficult clients' is another important dimension for incorporating an appreciation of mental health issues into personal training. Importantly, managing clients' behaviours outside a training session can be just as challenging, particularly in extreme cases where the professional relationship is misinterpreted and the personal trainer may become a focus of jealously or even stalking. Approximately 90 per cent of trainers reported that they would like further training on the management of personality disorders, difficult clients and professional boundaries.
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These findings highlight not only the inherent complexities of the role of personal trainers, but also a perceived need to be better equipped to deal with the varying challenges that exist when with working with clients with mental health concerns. At present, none of the training certificates required to practice as a trainer include a mental health component beyond examining the issues of self esteem and motivation.
Unless they personally undertake study to improve their understanding of this important area, there will continue to be deficits in the perceived holistic approach to the physical and psychological wellbeing of clients promoted by trainers.
Dr Mirabel McConchie, Dr Hieu Pham & Graeme Campbell
Mirabel is a psychologist working in Mildura, Victoria. She has a focus on both early and crisis intervention for severe mental illness. Hieu is a psychiatrist and psychogeriatrician who works in both Melbourne and Mildura. He has an interest in older persons' mental health and transcultural issues. Graeme is a mental health nurse who holds a master's in public health. He currently works in private practice and has an interest in rural and community-based mental health.