Actors, dancers, musicians and other performers are vulnerable to a variety of challenges and clinical issues that are unique to those who choose to make their living using their creative talents and skills. Although artists are people just like the rest of our clients, I believe it is important for counselors to have a framework for conceptualizing the idiosyncratic personal, cultural and professional contexts in which many performers live. As Linda H. Hamilton says in her excellent book The Person Behind the Mask: A Guide to Performing Arts Psychology, “Catering to the special needs of performers is important because of the unique psychological, biological and social stressors related to this vocation.”

My knowledge about the performing arts community comes from many years of personal experience. I became a counselor after working as a professional musician and an occasional actor since the late 1970s. I have played, toured and recorded as a jazz and pop musician. I have also performed in theatrical pit orchestras for many national tours and local productions here in Chicago. I am trained in the acting methods of Sanford Meisner and have worked onstage and appeared in independent films and commercials.

As a counselor, I have been fortunate to work with a diverse cross section of artists, combining my counseling training with my intimate knowledge of the music and theater business. Even so, my clients have been my best teachers. In my view, performers are an underserved clinical population worthy of serious consideration by more counselors. There are, after all, many more actors, dancers and musicians who need counseling than there are clinicians who used to be performers.

Life onstage is analogous in many ways to life as an athlete. The performing arts and sports are inherently stressful professions because of the high expectations of both the audience and the people who have the power to hire and fire. Success in both fields depends on a lifetime of training and constant vigilance, both in maintaining awareness of one’s self in relation to the work and in maintaining one’s skills. Although a great deal of research and attention have been focused on sports physiology and psychology, relatively little clinical attention has been paid to performing artists. The few books available on the subject are largely outdated, and the scholarly literature is scant. Hopefully, this situation will improve in the near future.

What are the life factors that distinguish performers from other individuals who make their way to our counseling offices? It is useful to discuss this population using several contexts: developmental, career, performance-related and societal. Each context has both case conceptualization and treatment factors.

Developmental considerations

Many performers began their training as young children. Some can barely remember when they began to exhibit signs of talent. They may have been singled out as “special” among their siblings or classmates if they showed an aptitude for singing, playing an instrument or dancing.

Counselors should pay particular attention to these clients’ attachment issues with both parents and teachers. Were caregivers supportive or resistant to their child’s talent? Did the client feel encouraged, pushed or dismissed in relation to his or her natural abilities? Was the child considered a prodigy? Did the parental emphasis on performing distract from focusing on social and emotional development?

Many artistically gifted children display a poise that is easily mistaken for emotional maturity. As a result, the normal childhood needs often are either ignored or derided as “childish.” The prodigy label often comes with potentially unhealthy complications, given that 3- and 4-year-olds are incapable of making life-altering decisions for themselves.

Early teachers of these children may have been supportive and loving or harsh and critical. For many young performers, competition for coveted positions can be intense. Children are keenly aware of the talent/skill hierarchies. Were they chosen for the best parts or overlooked? Did they land spots as lead actors in plays, prima donnas in the opera, first-chair players in the orchestra or principal dancers in the ballet? If they are relegated to secondary roles, some children feel that they have somehow failed. This can have repercussions when similar situations occur in their adult lives.

All of these factors play major roles in the personality development of performers. Young children who demonstrate a natural affinity for a certain area of performance are vulnerable to overidentifying with their talent. Counselors need to be aware that a client’s degree of healthy narcissism may be directly linked to his or her perceived level of artistic ability. Besides being treated as special and having to compete, young performers can become socially isolated and lead a very unbalanced life that consists almost exclusively of developing their artistic gifts at the expense of emotional and interpersonal growth. This can become problematic later in life, if and when the client realizes that there is more to life than performing. And in relationships, there is a risk that performance can substitute for genuine intimacy.

Career considerations

A performing artist’s career trajectory is often short and always unpredictable. Unlike in many other professions, there is no clear-cut path to professional success or advancement when you act, play, sing or dance for a living. No amount of natural talent or advanced training can predict success with any reliability. Talent or skill may not matter nearly as much as happenstance, luck or physical appearance (principally for actors and dancers).

Although things seem to be changing incrementally, considerable racial and gender bias still exist in casting. With the dearth of acting and dancing parts for women over 35, it is difficult for women performers to sustain a career much past that age. Issues related to stereotyping and appearance aren’t that much easier for men.

In addition, the ability to earn a living is quite limited for most performers. For example, in 2008, The New York Times reported that only 5 percent of Screen Actors Guild-American Federation of Television and Radio Artists members earned at least $75,000 annually. Actors’ Equity Association, the union representing the world of live theatrical performance, reported that during the 2013-2014 theater season, only 9 percent of its members earned more than $50,000. On average, just over 13 percent of unionized actors were working in any given week that year; their median annual income was $7,463. According to HuffPost, in 2012, the Future of Music Coalition estimated that full-time musicians earn an average of about $34,000 per year.

Low income is just one stressor in the life of most performing artists. A 2015 Australian study, “Working in the Entertainment Industry,” reported strong correlative evidence that underemployment, employment uncertainty, unregulated working conditions and the societal devaluation of artistic work often precede the onset of emotional and cognitive impairment. The large majority of actors, dancers and musicians have to secure secondary employment to make ends meet. The number of performers who continue working past age 30 declines precipitously. The researchers interpreted this to mean that as people begin to focus on their non-arts-related life (marriage, family, home ownership, financial stability), they are more likely to give up on their artistic ambitions and “get a real job.”

The authors of the study concluded “that there is ample evidence to support the assertion that the work environment of the creative person is … fraught with difficult and challenging circumstances. These include performance anxiety, work overload … career anxiety, a lack of career mobility, irregular working hours, high rates of injury, low financial rewards, [having to maintain] high standards of performance, financial insecurity and sporadic work.”

It is crucial for counselors to recognize these professional limitations for people in the performing arts and to keep them in mind as we would for any kind of cultural context.

Performance-related considerations

People in show business expose themselves to some of the most physically and psychologically stressful conditions on an everyday basis. Auditioning, rehearsing and performing require intense concentration, focused energy, strong self-confidence and years of preparatory work. Work hours can be extremely demanding. Knowing that a hundred people are waiting in line behind you to take your job if you falter is nerve-wracking. For these reasons, performers are at risk for anxiety, loss of motivation, difficulty concentrating, burnout, physical injuries, low self-esteem, poor emotional regulation, sleep disruption and crises of confidence and identity.

Because most performers work as members of an ensemble, there can be difficulties with group dynamics or conflicts with co-workers with whom they may be living or traveling. In addition, the “instant intimacy” that can develop between members of a cast can sometimes pose challenges to the stability of relationships outside of the ensemble.

Anxiety and depression are common complaints among performers, just as they are for the general population. However, recent research suggests that the prevalence of both mood disorders is much higher among artists. The Australian study found evidence that performers are 10 times more likely to suffer from anxiety and five times more prone to depression. Likewise, they are three times more likely to experience sleep disorders. Performing artists have higher rates of suicidal ideation, planning and attempts; their abuse of alcohol and other substances is also significantly greater when compared with the rest of the population.

One of the most ominous findings of the Australian researchers was pointed out to me in a personal communication from the lead author of the study, Julie van den Eynde. She wrote that the researchers found “a solid link with suicidal behavior … to depression, anxiety and lack of social support. There was no link to alcohol and drug use. There were no differences in gender or age. These findings run counter to the normal population, as suicide behaviour is different for age and gender and is linked to alcohol and drug use. This means that creative artists and performers are a different and separate group.”

In other words, this population is at higher risk for suicidal behaviors regardless of other factors such as age, gender and substance abuse.

Societal considerations

Despite the performing arts contributing so much to the enjoyment and enrichment of people’s lives, performers are often treated as if their work has remarkably little value (with the exception of the tiny subgroup of the most popular and famous individuals). Due to the nature and intensity of the commitment that a life in the arts requires, performers tend to identify very strongly with their work. If an artist’s work is subject to the uncertainty and devaluation described in the study, then that person’s identity is at risk.

As noted earlier, earning a living wage from performing is difficult for the majority of artists. As is the case for any client whose income is below average, artists are more vulnerable to the societal biases against people who aren’t comfortably middle class, don’t have health insurance or lack a high credit score.

Art often serves society by expressing cutting-edge ideas, including criticism of the status quo. This artistic purpose is often undertaken by people who are most impacted by racism, sexism, genderism, ableism, etc., and who make up a substantial portion of the artistic community. Societal marginalization can contribute significantly to myriad therapeutic issues. Although performing can serve as an emotional outlet for minority populations, the extent to which their ability to express themselves publicly improves their mental health will vary from person to person.

Clinical considerations

It almost goes without saying that performance anxiety (aka stage fright) is often the issue that brings people in show business into the counseling office. Many performers experience stage fright before every show. Famous sufferers include Laurence Olivier, Scarlett Johansson, Ella Fitzgerald, Adele, Pablo Casals, Mikhail Baryshnikov, Vladimir Horowitz and Renee Fleming.

But for many artists, auditions provoke the most anxiety. Auditions present a perfect storm of conditions almost guaranteed to induce performance anxiety in even the most seasoned artists. There is a saying among actors: “Auditioning is your vocation; working is your vacation.” Anxiety before and during auditions arises from the belief that a negative judgment of one’s performance equates with humiliation, embarrassment or personal rejection. Actors face this kind of scrutiny each time they read for a role; rejection is a normal facet of life for them.

Perfectionism is another anxiety-related malady that may surface in counseling sessions with performers. It may present in conjunction with excessive procrastination, practice or rehearsal avoidance, guilt, anger, self-criticism or blaming others, eating disorders and suicidal ideation. As pointed out in Robert H. Woody’s 2015 Psychology Today blog post titled “Perfectionism: Benefit or detriment to performers?” some performers exhibit narcissistic traits that may be associated with perfectionism.

Depression is precipitated in this population for many of the same reasons that anyone else might experience depression. However, some performance-related triggers for depression include:

• Being overlooked for an audition
• Despairing over not getting a coveted part
• Sustaining a career-threatening injury
• Being confronted with an inability to start (or finish) a long-dreamed-of creative project
• Being forced to choose between one’s performing career and the demands of one’s romantic or familial life
• Contemplating leaving a profession that has defined one’s identity

Although certain myths persist about the prevalence and glorification of drug use among performers, substance abuse is a real problem for many actors, dancers and musicians. The combination of high stress, employment uncertainty, low income, inaccessible health care and easy availability of alcohol and other mood-altering substances results in a higher-than-average probability that these clients may be affected by substance abuse and addiction. During intake, counselors should assess for drug and alcohol use, particularly with clients who present with anxiety or depression.

Social isolation, chiefly among musicians, is another common issue. Young people with musical talent, especially those singled out as prodigies, must spend many hours a day practicing their craft. In some cases, this single-minded approach, though perhaps necessary for achieving virtuosity, can lead to social anxiety, poorly developed social skills and difficulty forming intimate relationships. Adult performers who present with social anxiety may have long-established patterns of self-isolation resulting from intensive practice regimens begun in childhood. For a deeper understanding of these issues, I highly recommend Andrew Solomon’s chapter on prodigies in Far From the Tree: Parents, Children and the Search for Identity.

Many performers, and artists more generally, are what Elaine Aron calls “highly sensitive people” or HSPs. They tend to be aware of subtleties in their environment and are likely to have rich and complex inner lives. Although such sensitivity can be a real advantage in their chosen profession, our culture, unfortunately, has little tolerance for highly attuned or easily overwhelmed individuals. They are often thought to be overly fearful, inhibited or neurotic. Although some HSPs may exhibit these traits on occasion, they are not inherent characteristics of this personality type.

The majority of the people in the lives of HSPs may find them difficult to understand because of their sensitivity, their inability to relate to other people and so on. High sensitivity may open another pathway to the mood disorders and social isolation often seen in this population. Aron’s research on HSPs is invaluable with regard to performing artists.

Finally, it would be remiss not to mention the controversial relationship between mental illness and artistic talent. There are those who contend that a direct correlation exists between creativity and the prevalence of bipolar and schizoaffective disorders among artists. Kay Redfield Jamison makes a strong case for this link in her book Touched With Fire: Manic-Depressive Illness and the Artistic Temperament. Contemporary neuroscience has produced evidence both supporting and contradicting this point of view.

Performers are often perceived to be more narcissistic than are members of the general public, although no real evidence exists to suggest that narcissistic personality disorder is more common in this population. Counselors should be aware of their own biases in this regard while maintaining an open mind about the possible presence of mental illness and personality disorders in their artistic clients.

Challenges to counselors

Performers will challenge counselors in a variety of ways. Some may treat their therapy hour as a kind of performance. Actors are notably accustomed to impressing and entertaining strangers, so they may initially prefer to hide their vulnerabilities behind a veneer of cheerfulness (despite having perhaps complained of terrible anxiety when calling to make the appointment). Some members of this population may see you as an authority figure, akin to a “stage mom” or a demanding teacher or director. Monitoring these kinds of transference possibilities is essential to creating a strong therapeutic alliance and allowing your work to proceed productively. Likewise, it is crucial to pay attention to your own countertransference. How are the clients’ projections influencing you? Is their charm or likability getting in the way of accurately assessing their therapeutic needs?

Some performing artists have a difficult time expressing themselves verbally. This is where your creativity might come into play. If clients seem unable to put their feelings into words in session, you might suggest that they write something between sessions or perhaps bring in a monologue from a play that conveys what they lack the words for. I had a client who had trouble discussing her feelings directly but would write and perform her poetry as part of our work. Another client played his instrument in a session to express something that he couldn’t verbalize. Even if you are not trained as an art therapist, you can encourage artistic clients to find alternative ways to communicate emotionally.

Actors and dancers might ask you to attend one of their shows. Musicians may want you to come to a recital or a gig at a bar or club. They might bring in CDs or DVDs of their work and ask you for your assessment. These requests bring up thorny issues for counselors. Do you bend your boundaries to attend a performance? Do you accept a recording, and if so, do you agree to listen (or watch) and offer an opinion? I don’t think there are universal answers to these questions. As always, if you’re unclear on what’s best for your client (and your professional boundaries), seek consultation or supervision.

Counselors know that the “why now?” question is always important, but it could be useful to know that performers often seek help at certain predictable points in their lives. Psychiatrist Peter F. Ostwald, in his article “Psychotherapeutic strategies in the treatment of performing artists,” suggested a few such points: at turning points in their careers, when they seem to be faltering or failing professionally, after a career-threatening injury and when they feel overwhelmed by career-related loneliness.

One final set of challenges directly impacts your ability to work with this population. As previously mentioned, many artists don’t earn a lot of money and often lack health insurance. Scheduling also can be difficult because many performers work full- or part-time day jobs and have either rehearsals or performances during the evenings and on weekends. Counselors must be clear in their decision-making process regarding their desire and ability to be flexible with their fees, schedules or both. Adjusting your professional boundaries should be done carefully and deliberately to ensure that you are able to provide excellent care without resentment.

Concluding thoughts

Life in the performing arts has its rewards, but it is also a difficult and often frustrating way to make a living. The people who choose to pursue the arts professionally make many sacrifices to bring to life diverse forms of expression. There is exceptionally little glamour in show business, despite what you might see on an Academy Awards or Grammys broadcast. I am regularly amazed at the reactions I get when I tell people that I have played for Broadway shows, at a certain jazz festival or on a TV show. Invariably, folks will exclaim how much fun that must have been and how envious they are of these experiences. Yes, it can be thrilling to perform under certain rare circumstances, but most of the real work of artists is unseen, and most opportunities to perform occur under far-from-ideal conditions.

I have tried to provide a comprehensive overview of the psychological and cultural milieu of performers, and to suggest some new ways to think about the unique issues that counselors may encounter with this population. If you provide mental health services to people in the arts, know that you are serving a group of people who truly need you. Performers contribute so much of themselves to make our world a richer, more vibrant place. As counselors, we are called on to perform the related task of helping to create a healthier, more emotionally stable environment for all.

 

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Bill Harrison is a licensed professional counselor on staff at the Claret Center in Chicago, where he specializes in the treatment of performing artists. Contact him at counselorbill1@gmail.com.

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