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A qualitative study of mental health help-seeking among Catholic priests

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A qualitative study of mental health

help-seeking among Catholic priests
a a a
Anthony Isacco , Ethan Sahker , Deanna Hamilton , Mary Beth
a a a
Mannarino , Wonjin Sim & Meredith St Jean
a
Graduate Psychology Programs, Chatham University, Pittsburgh,
PA, USA
Published online: 06 May 2014.

To cite this article: Anthony Isacco, Ethan Sahker, Deanna Hamilton, Mary Beth Mannarino, Wonjin
Sim & Meredith St Jean (2014): A qualitative study of mental health help-seeking among Catholic
priests, Mental Health, Religion & Culture, DOI: 10.1080/13674676.2014.910759

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 Mental Health, Religion & Culture, 2014
http://dx.doi.org/10.1080/13674676.2014.910759

A qualitative study of mental health help-seeking among Catholic priests

Anthony Isacco*, Ethan Sahker, Deanna Hamilton, Mary Beth Mannarino,
Wonjin Sim and Meredith St Jean

Graduate Psychology Programs, Chatham University, Pittsburgh, PA, USA

Downloaded by [University of Iowa Libraries], [Ethan Sahker] at 07:16 09 May 2014

(Received 30 January 2014; accepted 29 March 2014)

Little is known about Catholic priests’ mental health help-seeking. Using consensual
qualitative research, this study examined 15 Catholic priests’ narratives about help-seeking
attitudes, help-seeking behaviours, and offers advice for mental health professionals
regarding priest health. Analysis revealed that all 15 priests reported positive attitudes about
mental health help-seeking because counselling helped to deal with and heal problems,
provided a different, unbiased perspective and allowed for spiritual growth. The majority of
participants (9/15; 60%) reported that they have sought help through counselling for various
reasons, such as depression and stress. Barriers to help-seeking entailed perceiving no need
to seek help, stigma, and concerns about counsellor competence. Participants suggested that
mental health professionals understand the importance of prayer to priests, the unique
stressors of the priestly role, and the impact of contextual factors (e.g., frequent transfers
and sexual abuse scandal) on their health. Implications for future research and clinical
practice are discussed.
Keywords: Catholic priests; clergy; help-seeking; consensual qualitative research

The Roman Catholic Church in the USA has seen a decline in diocesan priests from 58,632 in
1965 to 38,964 in 2012 (Center for Applied Research in the Apostolate [CARA], 2012).
During that time, the self-identified Catholic population has risen from 48.5 to 78.2 million in
the USA (CARA, 2012). Despite fewer Roman Catholic diocesan priests (shortened to
“priests” for the remainder of this paper) available to serve in parishes, lay Catholics often
seek help from priests for a variety of mental, social, familial, and spiritual issues (Kane,
2003b). National data from the USA has found that clergy are contacted for help from individuals
with a mental disorder at higher proportions than psychiatrists and general medical doctors
(Wang, Berglund, & Kessler, 2003). The priestly role is considered a “calling from God” and
a “24/7” vocation, rather than a time-specific job, with a focus on meaningfulness, theological
exploration, and being available to serve others (Dik & Duffy, 2009; Raj & Dean, 2005). In a
study with a related sample, findings indicated that Methodist clergy lost focus of their own
needs as they focused on helping others (Doolittle, 2007). Given the declining numbers and
nature of the priestly role, it is not surprising that research has found evidence of burnout,
depression, loneliness, and stress among priests, which indicates an increased need for mental
health services for priests (Knox, Virginia, Thull, & Lombardo, 2005; Zickar, Balzer, Aziz, &

*Corresponding author. Email: aisacco@chatham.edu

© 2014 Taylor & Francis

 2 A. Isacco et al.

Wryobeck, 2008). However, research has not kept pace with unearthing priests’ help-seeking atti-
tudes, preferences, or behaviours, particularly for problems beyond the sexual abuse crisis. The
extant literature can benefit from asking priests about their perceptions and experiences related
to seeking mental health help, which may help mental health professionals to identify and elim-
inate barriers to care and contribute to positive treatment outcomes. Therefore, the purpose of this
exploratory study is to better understand mental health help-seeking attitudes and behaviours
among a sample of Roman Catholic diocesan priests.

Mental health help-seeking among priests

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Increased attention has been given to examining men’s help-seeking and developing interventions
that appeal to male populations (Addis & Mahalik, 2003). The extant literature on men’s help-
seeking has argued for investigating specific populations of men with the aim of understanding
the unique contexts that affect diverse samples of men’s help-seeking (Ward & Besson, 2012).
This study’s examination of priests’ help-seeking is grounded within the empirical literature
about men and help-seeking.
The research on priests’ mental health help-seeking is equivocal. Priests have identified and
accessed several sources of support, such as spiritual directors, family, friends, fellow priests, and
parishioners for vocational discernment, role stress, and discussion of sensitive topics, such as
sexuality (Gregoire & Jungers, 2004; Hankle, 2010; Zickar et al., 2008). According to a recent
study by Rossetti (2011), 46.3% (n = 1148) of a national sample of Catholic priests reported
that they voluntarily sought counselling during their priesthood. Rossetti concluded that priests
are not hesitant to seek mental health services when a need arises and possess the “willingness
and humility” to seek help (p. 62). The study did not identify the specific needs that served as
catalysts for priests to seek help. Factors that facilitate positive help-seeking among priests are
largely unknown. Practitioners would benefit from understanding the reasons why priests seek
counselling and the factors that contribute to positive help-seeking. To address that gap in the
research, this study asked participants if they ever have sought help from a mental health pro-
fessional and what were their reasons for seeking help.
Other research indicates that priests may have difficulty in seeking mental health help. Priests
struggle with recognising when they need support and how to discuss issues such as sexuality,
boundaries, and celibacy (Martin, 2007). Most psychological treatment research on priests is
focused on those priests who are perpetrators of child sexual abuse (Haywood, Kravitz, Gross-
man, Wasyliw, & Hardy, 1996; McDevitt, 2011; Plante & Daniels, 2004; Ryan, Baerwald, &
McGlone, 2008). Little is known about the mental health needs of priests in good-standing,
active in ministry, and who did not perpetrate sexual abuse (Lothstein, 2004). Priests may fear
stigmatisation and being mislabelled as a paedophile for seeking counselling, which may be an
obstacle to help-seeking. Church hierarchy and culture may also serve as barriers to help-
seeking. Priests have perceived bishops as contributing to their role stress, implying that
priests may not seek help due to concerns about supervisory oversight (Zickar et al., 2008).
Kane (2008) found that priests not accused or charged with child sexual abuse did not feel sup-
ported by their supervisors following the sexual abuse scandal. Priests may be reluctant to talk
negatively about their superiors due to personal career advancement concerns and making disclos-
ures that would be deemed detrimental to the Church (Kane, 2008). Other scholars have argued
that the hierarchy has fostered such an unhealthy culture of silence that it is reasonable to conclude
that priests may view seeking help outside of the church as counter to cultural norms and anti-
authoritarian (Frawley-O’Dea, 2007). Because of the mixed findings, this study sought to capita-
lise on the strengths of qualitative methodology by asking open-ended questions about mental
health help-seeking.
 Mental Health, Religion & Culture 3

Mental health professional competence with priests

Cultural competence has become a hallmark of applied psychological scholarship and practice,
with religion/spirituality identified as a specific area of competence (Ponterotto, Casas, Suzuki,
& Alexander, 2010). Despite increased attention to religion and spirituality, clinicians have
been found to be less religious than the clients they serve, often resulting in the promotion of
additional training to help clinicians become more competent with religious and spiritual
clients (Delaney, Miller, & Bisono, 2013). Priests are a unique religious population with particular
norms and roles that mental health professionals should be aware of and integrate into their clini-
cal practice (Ciarrocchi & Wicks, 2000; Martin, 2007). Priests may experience similar mental
health concerns, such as stress, burnout, depression, and loneliness, as other populations (Ciarroc-
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chi & Wicks, 2000; Kane, 2008; Raj & Dean, 2005). However, the specific factors, contexts, and
causes of those mental health concerns are likely to differ for priests. For example, priests may cite
loneliness as a concern due to a lack of social support from the declining numbers of priests. Mis-
conceptions and media sensationalism about priests due to the sexual abuse scandal are common,
which may bias clinicians in their therapeutic work with priests (Plante, 2003). For example,
“Catholic priests are highly likely to be paedophiles” is a “common myth” that biases mental
health professionals despite prevailing estimates indicating that only 2–4% of priests are
sexual offenders of minors (John Jay College Research Team, 2011; Plante, 2003, p. 383).
These misconceptions may contribute to poor help-seeking among priests and interfere with clin-
ician effectiveness with priests. To clarify knowledge about priests for clinicians and contribute to
improved clinical competence with this population, this study asked participants to offer insights
and advice about the mental health of priests to mental health professionals.

Current study
Priests have been found to struggle with psychological, social, and behavioural stressors (Kane,
2008; Raj & Dean, 2005). Little is known about their mental health help-seeking and how mental
health professionals can offer interventions that match the unique roles and lifestyles of priests.
This exploratory study addresses those gaps in the literature by using a qualitative methodology
to examine: (i) mental health help-seeking attitudes and behaviours and (ii) advice for mental
health professionals to work more effectively with priests in clinical practice.

Method
Design
This study used consensual qualitative research (CQR) methodology as an overarching research
design (Hill, Thompson, & Nut Williams, 1997). CQR is a recent addition to qualitative research
methodology, but has gained popularity due to its rigorous and structured approach that aims to
produce an objective analysis of the data. CQR is based on an integration of several philosophical
underpinnings to research, such as constructionism and postpositivism, with the practical goal to
present the voice of the participants with little to no interpretation (Hill et al., 1997). CQR com-
ponents used in this study will be discussed in subsequent subsections of Methods.

Participants
Fifteen Roman Catholic priests participated in this study. All were white men, ranging in age from
29 to 76 (m = 47), living and working in a medium-sized, mid-Atlantic city in the USA. Partici-
pants had a wide range of years in the priesthood (<6 months to 50 years; m = 16.2 years). Nine
 4 A. Isacco et al.

participants were pastors, five were parochial vicars, and one participant did not report his role.
Participants worked in parishes, three oversaw two parishes, two worked in a school, and one
reported duties at a hospital, in administration, and at a prison.

Measure
Per CQR methodology, the semi-structured interview was developed through a thorough
review of the extant literature, an initial pilot interview with a priest, and feedback from
three expert reviewers (Hill, 2012; Hill et al., 1997, 2005). The interview protocol went
through four revisions based on feedback from reviewers and the pilot interview participant.
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Feedback focused on the wording and order of questions; some questions were added/
deleted based on the feedback. The final interview was designed to last 60–90 minutes and
focused on: (i) attitudes and behaviours related to mental health help-seeking, stress,
burnout, and self-care; (ii) strengths and supports of priests; (iii) religious/spiritual aspects
of priest health; and (iv) mental health professionals’ competencies for working with
priests. Data about priest help-seeking included in this study came from the following ques-
tions: (i) What is your opinion of a priest who seeks mental health services such as counsel-
ling? (ii) A lot of people seek mental health help and a lot of people do not. Have you in the
past or would you ever in the future seek help from a mental health professional? Why or why
not? (iii) Do you have any thoughts about the health of priests that you think would be impor-
tant to pass onto counsellors and health professionals? (iv) What are unique stressors to being
a priest? and (v) What are your stressors as a priest? Interviewers had multiple training ses-
sions to develop interviewing competences, such as asking open-ended questions and
probing (Hill et al., 1997).

Procedure
Participant recruitment and data collection
Institutional review board approval was obtained for this study through Chatham University.
Collecting data from priests has been described as a difficult task because of hierarchical over-
sight, scepticism with research, and the sexual abuse scandal (Kane, 2008). This study utilised
snowball sampling techniques because of their proven effectiveness with recruiting priests
(Kane, 2008; Kappler, Hancock, & Plante, 2013; Sadler, Lee, Lim, & Fullerton, 2010). By
following a snowball sampling method, we contacted two priests who were suggested by
the priest who completed the pilot interview. The study was briefly discussed over the
phone, after which they agreed to participate. Informed consent was provided in-person,
through a written document signed by the participant and primary investigator. Upon the com-
pletion of the interviews, each participant was asked if they knew other priests that may be
willing to participate in the study. If so, the participants listed two or three priests and pro-
vided the researchers with contact information. This process was repeated with each partici-
pant until 15 interviews were completed (n = 8–15 is the CQR recommendation; Hill & Nut
Williams, 2012). Priests not included in the sample were 1 priest who had retired, 2 who
scheduled an interview but backed out, 2 who declined upon the initial contact, 6 who
received messages but did not call back, and 14 who were recommended but we did not
contact due to reaching a sample threshold of 15.
All 15 interviews were conducted in-person and audio-recorded with the participants’ per-
mission. After the completion of the interviews, participants were asked for their contact infor-
mation in order to provide them with results and contact them again in the event further
 Mental Health, Religion & Culture 5

clarification was needed. After all of the interviews were transcribed, a few recordings had audio
issues obscuring data and an independent researcher identified vague answers in need of clarifica-
tion. Of the 15 participants, 11 had follow-up phone interviews, 2 were deemed complete with no
further action required, 1 did not respond to a request for a follow-up, and 1 had retired in the
interim and could not be located. This gave the study a follow-up response rate of 85%. Partici-
pants were assigned an identification number in order to secure anonymity.

Research team
The research team consisted of eight members with various roles. The primary investigator is a
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33-year-old white Catholic man with a PhD in counselling psychology; he was an interviewer,
data analyst, and co-author. The other researchers are: a 31-year-old white atheist man with an
MA in psychology (interviewer, data analyst, and co-author), a 59-year-old white woman with
a PhD in clinical psychology with a Christian background but currently religiously unaffiliated
(data analyst and co-author); a 38-year-old white Catholic woman with a PhD in clinical psychol-
ogy (data analyst and co-author); a 26-year-old white Christian woman with an MS in counselling
psychology (interviewer, data analyst, and co-author); a 23-year-old white Catholic woman with
an MA in psychology (interviewer); and a 34-year-old white Catholic woman with an MS in
counselling psychology (interviewer and data analyst). The auditor (and co-author) is a 32-
year-old Asian Catholic woman with a PhD in counselling psychology. All had extensive training
in CQR methodology (Hill, 2012).

Data analysis
Prior to the coding of data, the researchers met on many occasions to discuss their biases and
expectations about the study (Hill et al., 1997). The discussions helped the research team to
keep each other’s biases and expectations in-check to enhance the objectivity of the data analysis.
The discussions involved: (i) the impact of the priest sexual abuse scandal; (ii) thoughts and feel-
ings concerning the Catholic Church (i.e., frustration, anger, authoritarianism, scepticism, life-
giving, source of joy, and happiness); (iii) the effects of church hierarchy, power, and control;
(iv) masculinity and gender issues; (v) expectations priests would demonstrate poor help-
seeking attitudes and behaviours; and (vi) the impacts of stigma related to mental health help-
seeking. Discussions of those issues were influenced by team members’ level of involvement
in spiritual and religious practices and communities and beliefs about the importance of religion
and spirituality in the psychological field.

Domains
After initial discussions of biases and expectations, each team member coded the data separately
and met to achieve consensus. We coded the first two transcripts with a set of a priori domains
(strengths, supports, and stressors). A domain is a broad topic area used to code large sections
of the interview (Hill, 2012). For each question, team members took turns initiating the discussion
on the coding, and the remaining members agreed or disagreed. Team members each stated their
case until consensus was achieved. This process continued until we had a unanimous agreement
for every domain. After the team had gone through the first few transcripts, more domains
emerged, and the early transcripts were recoded for all newly emergent domains. The domains
were then sent to an auditor to check for accuracy and were returned with feedback. The team
met to review the auditor’s feedback and informed the auditor of implemented changes from
the feedback.
 6 A. Isacco et al.

Core ideas
After the initial two interviews were completed by all team members, a modified approach to data
analysis was used to “short-cut the process” (Thompson, Vivino, & Hill, 2012, p. 114). Two sub-
groups were formed; each sub-group consisted of three members. Each member took a turn coding
an interview and brought it to group meetings for discussion and consensus. During this phase of
analysis, the designated member would code for domains and core ideas simultaneously (Hill,
2012). A core idea is a concise and comprehensive summary of participants’ words within a
domain (Hill, 2012). The coded transcripts were then sent to the auditor and were returned with feed-
back for both the domains and core ideas. The team then met to review the auditor feedback. A list was
sent to the auditor describing the decisions after a final consensus was achieved for each transcript.
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Cross-analysis. During this phase of analysis, each group member reviewed all coded transcripts
and came back with categories that emerged from the domains and core ideas. The major theme of
help-seeking was found to be present in all transcripts and had been developed across domains
and a set of categories focused on help-seeking emerged. The categories were discussed
among the group until consensus was reached and a set of categories and subcategories were fina-
lised. The final consensus of the cross-analysis was sent to the auditor, who gave feedback that
was implemented by the team. Frequencies of categories and subcategories were labelled as
general (14–15 cases), typical (7–13 cases), variant (3–6 cases), or rare (1–2 cases; Hill, 2012).

Results
Three main themes emerged from the data: (i) attitudes and behaviours about mental health help-
seeking, (ii) barriers to priests seeking mental health services, and (iii) advice from priests to
mental health professionals. The categories, subcategories, and frequencies associated with those
themes are presented in Tables 1 and 2. Representative quotes are provided throughout the
results to highlight the voice of the participants.

Table 1. Mental health help-seeking attitudes, behaviours, and barriers.

Categories (C) and subcategories (SC) Frequency
Attitudes and behaviours about mental health help-seeking
C1. Counselling helps, heals, and supports priests General
SC1. Counselling helps to deal with specific problems (e.g., alcoholism, depression, anxiety, Typical
and stress)
SC2. Counselling helps to get outside, unbiased support Typical
SC3. Counselling enhances strengths and self-knowledge Variant
SC4. Counselling facilitates healing and spiritual growth Variant
SC5. Counselling is confidential Rare
C2. Counselling was recommended to the priest Typical
SC1. Counselling was recommended by friend, spiritual director, or another priest Typical
SC2. Counselling was recommended by the diocese Variant
C3. Previous use of mental health services was helpful Typical
Barriers to priests seeking mental health services
C1. No perceived need for mental health services Variant
SC1. Sufficient supports Rare
SC2. Own pride Rare
C2. Stigma of help-seeking Variant
SC1. Concerns about seeking help as a priest Rare
SC2. Concerns about how diocese would perceive the priest seeking mental health services Rare
C3. Concerns about the counsellor/mental health professional Rare
 Mental Health, Religion & Culture 7

Table 2. Advice for mental health professionals about priests’ health and well-being.
Categories (C) and subcategories (SC) Frequency
C1. Priests have unique stressors General
SC1. Social stressors Typical
SC2. Work stressors Typical
SC3. Sexual abuse scandal stressors Typical
SC4. Spiritual stressors Typical
SC5. High expectations stressors Variant
C2. The importance of prayer for a priest Variant
C3. Encourage priests to be authentic Variant
C4. Offer congruent therapeutic interventions Variant
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SC1. Importance of fostering trust in therapeutic relationship Rare

SC2. Interventions need to be congruent with priest’s personality Rare

Attitudes and behaviours about mental health help-seeking

All 15 participants (general) reported positive attitudes about mental health help-seeking for
priests, even if they did not utilise mental health services (Table 1). Participants provided
several reasons for their positive attitudes.

Counselling helps, heals, and supports priests (Category 1: General)

Participants reported that counselling is helpful, supportive, and healing, which was the
most frequently cited reason for participants’ positive attitudes about mental health help-
seeking. The following five subcategories are more specific components of this larger
category.

Counselling helps to deal with specific problems (Subcategory 1: Typical). Participants discussed
how counselling can help priests to deal with a specific mental health problem, such as alcohol-
ism, depression, anxiety, and stress. One participant stated,

Some priests run into alcohol and issues and need somebody else to help with the burden. It is good
when a priest is able to know that he needs help and has somewhere to seek it. It can give them an
outlet or another support.

Counselling helps to get outside, unbiased support (Subcategory 2: Typical). Participants stated
that mental health services provided additional support beyond typical supports in their lives. A
participant explained,

It’s a nonbiased outside perspective. When I did seek help, I sought a professional who was non-Catholic
because I felt that was important to get a non-biased, non-connected perspective because I didn’t
want somebody who would be more concerned about me leaving the priesthood. I wanted somebody
who would be concerned about me as a person and I think that was important. It was very helpful
for me.

Counselling enhances strengths and self-knowledge (Subcategory 3: Variant). Participants

expressed that counselling can enhance their strengths and increase their self-knowledge. One
 8 A. Isacco et al.

participant said, “[seeking help] is courageous because of the honesty it takes to say, I need help
and I’m going to do the things that I need to. For myself and for others”.

Counselling facilitates healing and spiritual growth (Subcategory 4: Variant). Some participants
discussed that dealing with mental health problems facilitates their healing and spiritual growth.
Participants reported that their healing and growth were necessary to their priestly ministry, which
helped them heal other people. A participant described priests as “wounded healers” and elabo-
rated on this statement,

We’re wounded, no one had perfect childhoods and we bring our baggage to adulthood. When we’re
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honest about that and realize we’re not perfect, it makes life much easier. Then if we need counseling
for something specific we’re trying to overcome it, it strengthens us. There’s an expression for priests,
we’re called “wounded healers”, if you embrace your own woundedness you’re actually able to heal
other people.

Counselling was an opportunity to experience spiritual growth. One participant discussed how
counselling helped him to clarify that he is not “the saviour” and “not expected to be the saviour”
but rather an “instrument of what Christ wants to have happen”. Another participant expressed that
counselling can help a priest to realise and address a problem, which he considered to be “cooperat-
ing with the Holy Spirit”. He elaborated, “The Holy Spirit puts people in our lives who are able to
help us. Whenever we reach out to those people and ask for their help, then we’re cooperating with
the Holy Spirit in our lives”. For participants who discussed spiritual growth in counselling,
there was an acknowledgement that mental and spiritual growth were symbiotic as encompassed
by a participant who stated, “Good spirituality is good psychology; bad spirituality is bad
psychology”.

Counselling is confidential (Subcategory 5: Rare). Two participants reported that counselling was
helpful because it is confidential, as seen in this quote from a participant,

I think one of the things that’s great about people who come to see priests is that it’s confidential and
it’s the same thing with the mental health profession. You can say anything to them and it’s great to be
able to do that.

Counselling was recommended to the priest (Category 2: Typical)

Receiving a recommendation to go to counselling represents the next most frequently cited cat-
egory from the data. Two subcategories emerged that discussed how the recommendations con-
tributed to mental health help-seeking behaviours.

Counselling was recommended by a friend, spiritual director, or another priest (Subcategory 1:

Typical). A recommendation from a friend, spiritual director, or another priest (i.e., someone trust-
worthy) was particularly important because it helped priests to follow-up on the recommendation
by seeking help. A participant described his experience,

Quite honestly, back in the mid-eighties, I was going through personal struggles. I went at the rec-
ommendation of a friend who recommended somebody. I went to see a counselor for a couple of
years. That absolutely made the biggest difference in my life.

Counselling was recommended by the diocese (Subcategory 2: Variant). Some participants

described that the diocese encouraged mental health help-seeking. One participant said,
 Mental Health, Religion & Culture 9

At the time, I said I needed to talk to somebody and they [diocese] said, “Here’s Dr. So-and-so”. And
it’s very confidential. You do your thing and he sends the bill to the diocese. Which I said, “Aw, that’s
very good”. I’m happy that they’re doing something like that. But what we talked about, he doesn’t
report to them. I think the diocese said, “we need to help guys”.

Previous use of mental health services was helpful (Category 3: Typical)

Most participants (9/15; 60%) reported that they had gone to counselling in the past and had a
positive experience (i.e., counselling was helpful), which contributed to their current positive atti-
tudes about mental health help-seeking. One participant stated, “I’ve been there, done that [coun-
seling]. I had some issues with anxiety and someone directed me in there and I said ‘But I’m not
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crazy’ and they said ‘You don’t have to be crazy’. It was a big help”. Participants’ reasons for why
counselling was helpful are represented in Category 1 (counselling is helpful, healing, supportive;
Subcategories 1–5), which are described above.

Barriers to priests seeking mental health services

Most participants (9/15; 60%) reported that priests encounter barriers to mental health help-
seeking. Three barriers emerged from the data and are described in the following categories,
(i) no perceived need for mental health services, (ii) stigma, and (iii) concerns about counsellor
competence.

No perceived need for mental health services (Category 1: Variant)

Of the six priests that have not sought mental health services, most reported that they never felt the
need for services. Those participants stated that they would or they hoped that they would seek
appropriate services if the need arose in their lives.

Sufficient supports (Subcategory 1: Rare). Participants discussed that they did not need mental
health services because of existing supports in their life as one participant mentioned, “I don’t
need it now because of the support and the support group I told you about. That’s tremendous,
very positive and healthy and nurturing”.

Own pride (Subcategory 2: Rare). One participant recognised that he has not sought counselling
services because of his “own pride” although he would hope that he would pursue counselling in
the future if he “really needed it”.

Stigma of help-seeking (Category 2: Variant)

Some participants identified mental health stigma as a barrier to their help-seeking. Participants
considered mental health stigma to be an issue that is relevant to all people, not just priests.

Concerns about seeking help as a priest (Subcategory 1: Rare). For other participants, the stigma
may be heightened for priests given their public, ministerial roles. One participant stated that he
experienced a “double whammy” concerning help-seeking because of being a priest and having
family members in medical professions,

I think people are skeptical of mental health professions as touchy feely gauzy stuff. “Why can’t you
operate on it and get it fixed?” So it took me a long time to feel like I could go talk to somebody.
 10 A. Isacco et al.

Some participants discussed the stigma of seeking mental health help particularly for priests
because of the sexual abuse scandal. One participant stated,

When they [the diocese] say, so and so is going away for a leave of absence, you know the immediate
thing you think of is, he is being accused of sexual molestation. When somebody is having legitimate
difficulties and they’re not turning to those things there’s a stigma of being branded as a problem. I
think that’s the problem. If I’m having troubles and I have to go to the bishop and say I’m really
having trouble with my priesthood, I think my vocation is in a crisis, he’ll send me to the Betty
Ford clinic for priests, where priests are being counseled for pedophilia and so when you’re
lumped into the same mental institution, you automatically get the stigma of that institution.
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Concerns about how diocese would perceive the priest seeking mental health services (Subcategory
2: Rare). The diocese often plays a role in a priest finding mental health services. For some par-
ticipants, the diocese’s role further contributes to the stigma of mental health help-seeking even if
the priest is open to help. As one participant reported, [I would go] “to minister better but, there’s a
fear of it because there is a fear of a diocesan structure that may use that information against you in
some way. There are these fears of us versus them”. The participant continued by stating that if he
sought help for being “a little stressed out” the diocese would want to know why he is stressed out
and that revealing that information is frustrating and a deterrent to help-seeking.

Concerns about the counsellor/mental health professional (Category 3: Rare)

A small group of participants reported hesitancy to seek mental health services because of concerns
about whether the service provider would be competent to treat their concern(s) and whether the
counsellor had some “basis in faith … who would not discredit the very life that I live”.

Advice for mental health professionals about priests’ health and well-being
The most common responses to the question about the advice for mental health professionals were
clustered into four categories: (i) unique stressors of priests, (ii) importance of prayer for a priest,
(iii) the need for encouragement to be authentic, and (iv) importance of congruent interventions
for priests (Table 2).

Priests have unique stressors (Category 1: General)

Participants described five unique stressors of priests, which are discussed through the following
subcategories; (i) social, (ii) work, (iii) sexual abuse scandal, (iv) spiritual, and (v) high expec-
tations stressors.

Social stressors (Subcategory 1: Typical). Participants reported that the priestly lifestyle included
chronic loneliness, managing multiple roles and boundaries, and parish conflicts. Participants
wanted mental health professionals to understand that working with “the people” is both a posi-
tive and stressful part of their vocation. Participants voiced frustration with ministering to “the
people” who do not hear the word of God, complain about parish activities, and create conflict
in the parish. One participant stated,

Most want to be told how bad they are, rather than how good they are. If I give a homily and I talk
about Hell, “you need a reform”, you get “Father, thank God for saying that”. But if I talk about how
 Mental Health, Religion & Culture 11

wonderful they are, and what great examples they are to the community, they’re not at all comfortable
with that.

Social stressors also entailed figuring out how to manage multiple roles, such as the living
situation of priests. One participant reported, “Most of us live and work at the same place.
People know I’m in this building a lot and call at 3:30 am and ask what time confessions are.
You’re not allowed to chew them out for doing that”. Relatedly, participants felt stressed by
feeling like they have to say “yes” and to “please” everyone. One participant stated, “As a
priest I try to please everyone. And if someone doesn’t do something, I do it, because it has to
be done. I mean I feel it has to be done”.
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Work stressors (Subcategory 2: Typical). Participants discussed many demands on their time,
needing to serve multiple parishes, and the fact that their vocation is not a “9–5” job. Complicat-
ing their feelings of being stretched, participants reported that certain activities (administering the
sacraments) can only be performed by priests. Yet, administrative tasks for which they have little
training require a lot of time. One participant noted, “The seminary spends a lot of time preparing
you for the spiritual side of priesthood and teaching you about the scriptures which is good. But if
you don’t have a sense of business you could really struggle”. In other words, participants
reported stress from perceiving a large number of demands that exceeded a lack of training in
some areas of their ministry.

Sexual abuse scandal stressors (Subcategory 3: Typical). Participants reported that the sexual
abuse scandal has been stressful, such as the difficulty in handling negative media attention
and experiencing negative reactions from people, such as distrust and suspicion. Some partici-
pants discussed having to monitor their own behaviour due to fear that their behaviours will be
misinterpreted. One participant described, “Many priests because of negative media and negative
experiences with people for a while or now, don’t wear their Roman collar, priestly attire in
public. Because they’ve have had a tough situation or they feel ashamed”. Participants also
reported feeling stressed because of how hurtful the scandal has been for the victims.

Spiritual stressors of the priestly vocation and role represent the fourth sub-category
(Subcategory 4: Typical). Participants described examples of spiritual stressors of their vocation,
such as frustration about having to stay silent when intense material is discussed in confession.
Some participants considered some aspects of their promises as stressful (please note: diocesan
priests take promises of obedience, celibacy, and simplicity of life). One participant reported,
“Obedience is a huge challenge at times, especially if we take obedience to mean that you’re
just supposed to be you know, ‘Yes sir, do your job’”. Another participant discussed his stress
with obedience, specifically his challenges with transferring parishes, “uprooted from one
place and placed in another. Uprooted from one life and connection and relational system and
placed in another. A systematic disempowerment. I would like to share that with the field of
psychology”.

High expectations stressors (Subcategory 5: Variant). Participants explained that priests tend to
place unreasonably high expectations on themselves and/or high expectations can be placed on
them by others, which can lead to stress. Some participants referred to this phenomenon as
“the Messiah complex” or “The Messiah mentality”. One participant stated,

If a priest is not a good delegator, he can really burn out very quickly because he’s running between
counseling, celebrating a mass, going to hospitals, writing the bulletin, doing all of these things that
 12 A. Isacco et al.

make up the part of the priest’s day. We have to sort of take on the mentality of John the 23rd, who,
when he would go to bed at night he would say, “Lord it’s your church, I’m going to bed, you deal
with it” [laughing]. We as priests can have a Messiah mentality where it’s like this church will com-
pletely fall apart if I’m not on my game and that can really lead to some major stress.

Participants advised mental health professionals to be aware of how priests may develop some
narcissistic tendencies because of the “Messiah Complex”. Relatedly, participants reported that
priests want to serve as best they can and that they see their vocation as “24/7”, and therefore
can feel guilty about setting boundaries (e.g., saying no to a request). As a result, a priest may
“over give” to exhibit their priestly vocation, which leads to additional stress and “negative
emotions”.
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The importance of prayer for a priest (Category 2: Variant)

Participants emphasised the importance of prayer in the lives and well-being of priests as impor-
tant information for mental health professionals. As one priest put it, “You have to pray. When
priests get in trouble, one of the first questions is, when did you stop praying? They’re always
going to say I stopped praying about six months ago, because I got busy or something”. For par-
ticipants, prayer was important for their spiritual well-being and at the core of how well they func-
tioned in relationships, ministry, and mental health.

Encourage priests to be authentic (Category 3: Variant)

Participants shared that priests are “unique individuals”, but that it is common for their identity as
individuals to get lost in their priestly vocation. In terms of what mental health professionals need
to know, simply put – “priests should be encouraged to be themselves”. In reflecting on his own
experience in counselling, a participant shared the importance of being reminded of his indivi-
duality, “The counselor who helped me really helped me to think of the person I was before
God called me and reminded me that God called me because of the person that I was”.

Offer congruent therapeutic interventions (Category 4: Variant)

Participants discussed a preference for mental health professionals who are respectful of their faith
beliefs and can offer interventions that are congruent with their unique roles and lifestyles.

Importance of fostering trust in therapeutic relationship (Subcategory 1: Rare). Encouraging

authenticity for priests is predicated upon trust in the therapeutic relationship due to the need
for priests to talk about their “baggage”. One participant explained,

A counselor needs to know and appreciate who that person is. I think a counselor needs to know the
background from that individual’s growth to where he is today … anyone who chooses to be in the
priesthood comes with gifts and comes with baggage and hopefully that baggage has been given direc-
tion … That the priest can be totally able to trust that professional to talk about the baggage.

Interventions need to be congruent with priest’s personality (Subcategory 2: Rare). One partici-
pant cautioned against developing general interventions for all priests, but to take a more nuanced
approach by matching the intervention with the personality of the priest. This participant dis-
cussed a desire for more strength-based interventions and how some support groups are not as
appealing to him.
 Mental Health, Religion & Culture 13

Discussion
Although the health of priests is receiving more attention (Rossetti, 2011), it is not entirely
clear how priests perceive and access mental health services. This study sought to better under-
stand priests’ mental health help-seeking. As a qualitative study with a small sample size, gen-
eralising findings to other populations is cautioned. Yet, important insights about priests’
mental health help-seeking emerged from the data that contribute to the extant literature
with this population. All participants expressed positive attitudes about help-seeking and
60% of the participants had sought mental health services. Barriers such as stigma and con-
cerns about counsellor competence were voiced. Participants reported that their unique stres-
sors and the importance of prayer are important for mental health professionals to consider
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when working with priests.

Mental health help-seeking attitudes, behaviours, and barriers

More than half of the participants in the study (9/15; 60%) reported that they have sought mental
health treatment and all participants (15/15; 100%) described positive attitudes about priests
seeking mental health help. Scholarship related to priest help-seeking has produced mixed
results (Rossetti, 2011; Zickar et al., 2008). Some research has found that priests seek out ineffec-
tive sources of support for emotional problems and lack necessary interpersonal skills that facili-
tate help-seeking (Ciarrocchi & Wicks, 2000; Hankle, 2010; Kane, 2003a). Our findings indicate
that many priests are open to and have engaged in mental health help-seeking, in part, to enhance
their psychological health and ministerial lives (Rossetti, 2011).
Participants discussed positive aspects to help-seeking, such as counselling being helpful to
deal with mental health problems, to get a different perspective on issues, to receive healing in
order to heal others, for spiritual growth, and the importance of confidential services. Those find-
ings contribute to an increased understanding of why priests seek mental health services. Mental
health professionals may be able to use the data to eliminate barriers to service utilisation by pro-
moting the various ways that priests consider counselling to be beneficial. Mental health pro-
fessionals could also work on decreasing help-seeking barriers. For example, concerns about
mental health stigma and fears of being mislabelled as a paedophile were barriers to help-
seeking that participants discussed. The need to decrease the stigma of mental illness is a wide-
spread phenomenon, but these findings highlight unique factors that appear to impact priests’
mental health help-seeking. We are not aware of any empirical or clinical efforts aimed at decreas-
ing stigma in priests’ help-seeking. The natural next step in research and clinical practice is to
explore methods of decreasing stigma by targeting fears of being mislabelled as a paedophile,
which may help to eliminate a barrier to help-seeking.
Participants identified additional barriers to mental health help-seeking, including not feeling
the need to seek help and concerns about mental health professionals. Not feeling the need to seek
help was attributed to sufficient social support by some participants, which fits with previous
research that has found that individuals with greater social support perceived less need for
mental health services (Thoits, 2011). A lack of psychological distress and symptoms (i.e.,
“need variables”) are robust predictors of help-seeking behaviour; it makes sense that participants
without a mental health need would not seek mental health services (Vogel & Wester, 2003).
Priests have identified fellow priests as sources of support that help in reducing stress (Zickar
et al., 2008). As the number of priests continues to decline in the USA, thus decreasing opportu-
nities for fraternal support, a future area of research could explore pathways for priests that lead to
more effective support and may mitigate the need to seek mental health services.
Participants expressed mixed views about how the Church hierarchy affects their help-
seeking. A rare number of participants identified the Church hierarchy as a barrier while other
 14 A. Isacco et al.

participants reported that “the diocese” (i.e., church hierarchy) encouraged using mental health
services. The conflicting findings are similar to previous research; for example, Rossetti (2011)
found that 9.1% of priests (226/2468) were encouraged by their superiors to seek mental
health assistance. Encouragement from the diocese may reflect hierarchical openness to the
role of psychologists, which has been found in the aftermath of the sexual abuse scandal
(McGlone, Ortiz, & Karney, 2010). A new culture of openness and decreased stigma towards
psychological interventions may now exist for priests. Nonetheless, the mixed findings shed
light on the important influence that superiors have on priests’ utilisation of mental health ser-
vices, especially given the promise of obedience that diocesan priests assume in their vocation.
A promising area of future research would be to examine bishops’ and cardinals’ perceptions
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of priests who seek mental health services to determine if priests’ fears match with reports
from hierarchy members and identify ways to decrease any existing stigma that flows from the
top down.

Clinical implications
In order to circumvent barriers to priests accessing services, mental health professionals may con-
sider some of the suggestions offered by our participants to enhance their clinical competency
with priests (Ciarrocchi & Wicks, 2000; Proeschold-Bell et al., 2012). Participants’ responses
included the importance of prayer in the life of a priest, encouraging priests in counselling to
be authentic, and the fact that priests have unique stressors. These findings may contribute to
more congruent and effective mental health services for priests.
The importance of prayer makes sense for this population given that priests feel called to a
religious and spiritual vocation, which they discover through prayerful discernment and
decision-making (Hankle, 2010). Previous scholarship has identified spiritual benefits in
priests’ lives, such as their “perceived relationship with God” or “desire for prayer” (Cassibba,
Granqvist, Constantini, & Gatto, 2008; Kosek, 2000). Being a priest is a spiritual ministry and
entails a prominent leadership role within a large religious denomination. Spiritual/religious
issues are likely to be intertwined with their mental health concerns. However, some participants
were concerned that a mental health professional would not have a “basis in faith”, which would
be a barrier to their service utilisation. Participants suggested that mental health professionals
remain unbiased and verbalise an acceptance of the priestly lifestyle. It is difficult to determine
if mental health professionals are able to implement that suggestion, as research indicates a
lack of clinical training focused on religion and spirituality as well as disparate religious and spiri-
tual beliefs between many mental health professionals and priests (Delaney, Miller, & Bisono,
2007; Hage, Hopson, Siegel, Payton, & DeFanti, 2006; Shafranske, 2010). Future research
efforts may seek to clarify what clinical training is being provided that facilitates improved clini-
cal competence with priests and how clinicians mitigate potential biases when working with
priests.
Participants suggested that mental health professionals encourage priests to be authentic. This
finding provides some empirical support for previous theoretical scholarship that discussed
priests’ difficulty to discover a more authentic identity in modernity based in a servant-participant
leader model rather than a pedestal-unquestioned authority leader model (Cozzens, 2000). Partici-
pants discussed their struggle to live up to elevated expectations (whether self-imposed or per-
ceived) and reconcile their lay identity with their current priestly identity. Many mental health
professionals are ideally positioned and trained to help priests to achieve a more authentic identity
that will contribute to a more genuine role and ministry (Ponterotto et al., 2010).
Given priests’ struggles with an authentic identity in a current Church context, it makes sense
that participants described an extensive collection of stressors that no other study to our
 Mental Health, Religion & Culture 15

knowledge has previously catalogued. Our findings highlighted three, unique contextual factors
contributing to stress for priests. First, the shortage of priests is having a clear effect on stress, as
participants expressed taking on multiple roles and parishes, which decreases their availability to
perform their preferred sacramental duties. Second, the sexual abuse scandal and related negative
media attention have led to stress in the form of self-monitoring behaviours, personal attacks, and
concern for victims. Third, participants described how priests’ unique religious roles and lifestyle
(e.g., providing the sacrament of confession; promise of obedience) can be stressful due to an
inability to break the sacramental seal to discuss intense disclosures from parishioners and unex-
pected transfers to different parishes without input from the priest. Mental health professionals
can intentionally inquire about such stressors during the treatment process for assessment pur-
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poses and to communicate an understanding of the priest’s phenomenological experience for

rapport-building. It is unclear what psychological effect the collective and cumulative stressors
are having on priests. Are there other mediating variables that are compounding or buffering
the stress? Such uncertainty is an indication that future research in this area is ripe with possibi-
lities. For example, identifying the specific forms of social support that decrease burnout and
depression (Raj & Dean, 2005) would be an important contribution to priest mental health as
would describing how to enhance support from effective sources such as parishioners, parish
staff, superiors, and fellow priests (Zickar et al., 2008).

Limitations
As a qualitative study, with a small sample size and that used snowball sampling, generali-
sability to other populations such as religious order priests and priests from other dioceses
is cautioned. Participants were White, American, middle-aged, living in the USA; more
racially diverse and international groups of priests may have different experiences of help-
seeking that include issues related to multiple identities, oppression, or additional contextual
factors. Hence, this study may not have captured all of the barriers and negative attitudes
about help-seeking that priests may hold. All participants reported positive attitudes about
mental health help-seeking, which may indicate the possibility of social desirability, self-selec-
tion into the study by participants with a positive interest in mental health counselling, and/or
bias towards interviewers that are in the mental health profession. Despite those limitations,
this study provided important data about Catholic priests’ mental health help-seeking
that can guide future research and practices aimed at improving their mental health and
well-being.

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