Sleepy Psychotherapists: How Clinicians' Biological Factors May Affect the Conduct of Psychotherapy

• Published in: American journal of psychotherapy Vol. 74; no. 1; p. 30
• Main Author: Yager, Joel
• Format: Journal Article
• Language: English
• Published: United States 01.03.2021
• Subjects: Biological Factors; Circadian Rhythm; Humans; Psychotherapists; Psychotherapy; Sleepiness; Therapeutic Alliance; illness in clinicians; circadian rhythms; episodic ultradian rhythms; psychotherapy outcomes; homeostatic factors; psychotherapy process
• ISSN: 0002-9564
• DOI: 10.1176/appi.psychotherapy.20200030

Numerous therapist variables and cognitive biases can affect the quality of the therapeutic alliance and the conduct and outcomes of psychotherapy. This article aims to examine factors that potentially affect clinician performance, including chronobiological variables of clinicians and patients. The author reviewed literature pertaining to biological influences on human cognitive performance and considered how these factors may apply to the practice of psychotherapy. Biological factors potentially affecting the conduct and quality of psychotherapy were identified. These factors include decision fatigue, hunger, sleep deficit, shift work, and several chronobiological issues related to circadian rhythms and episodic ultradian rhythms. In addition, misaligned scheduling of psychotherapy sessions in relation to therapist and patient evening-morning chronotypes may impede the effectiveness of psychotherapy. The practice of psychotherapy is cognitively demanding, requiring that clinicians remain constantly alert and in command of their executive functions. Decreases in clinician alertness resulting from homeostatic depletion, chronobiologically misaligned schedules, and illness-associated factors may reduce the quality and benefit of psychotherapy sessions. Mitigation strategies are available. Investigations of these factors are needed.