Work is only one domain of life, but is it really all that different from the others?

About how work may reactivate older patterns of relating, why professional environments can feel both emotionally intense and deeply fragile, and how burnout, repetition, and self-awareness become intertwined in the way we navigate professional life.

We often divide our lives into compartments — the professional, the personal, the social, the intimate. We develop different expectations for each of these domains. At times, we may even feel as though we are different people within them, behaving as different versions of ourselves depending on the context.

We come to believe this separation is evidence of maturity, adaptation, or professionalism. At work, for example, we are expected to behave in specific ways, and we are valued and evaluated according to those expectations.

While these separations do exist, there is inevitably some continuity across them — within ourselves, within others, and within the situations we encounter.

Have I been here before?

We speak of demanding bosses, intrusive coworkers, micromanagement, or the pain of being overlooked as though these experiences existed in isolation. Yet often there are invisible threads connecting these encounters to earlier experiences in our lives.

Workplaces may expose us to completely new people and experiences, but to some extent, many (not all) situations — and many people — are repetitions. A new boss may share striking similarities with important figures from our past. Certain workplaces may unconsciously revive older relational dynamics.

When we overlook these continuities, we may suffer intensely while believing that some wounded part of ourselves — and some “enemies” — exist only at work.

If we pause long enough, we may notice something about the magnitude of our own responses. We may become surprised by how deeply affected we are by a supervisor, an institution, or a workplace conflict. And we may wonder whether that present situation carries layers from our past.

When we pursue that line of thought, we may reach a point where we are able to give each component its proper weight: what started in the present, what comes from the past.

What is more, we may be able to remove some of the layers that are not necessarily called for in the current situation — both in ourselves and in others.

My boss at work may resemble the overcritical or neglectful parent whom I was never able to please, whose attention I could only obtain when I was perfect. But they are not the same person.

Why reenactments at work feel so intense — and so fragile

In many families, relationships are sustained by an assumption of permanence. People may show their best and worst selves while the relationship itself remains relatively durable. Of course, there are important exceptions, and many family relationships do fracture, but intimate relationships often contain some possibility of repair.

Parents do not literally fire children, nor children their parents. Spouses do not usually divorce after the first argument. If conflict emerges, there may still be room to restore the relationship.

Some work environments may resemble families more than many actual families do. Dysfunctional workplaces may, for example, have bosses who behave like “authoritarian parents” and who are satisfied only with highly submissive children. Under that kind of leadership, employees may not only feel that they are being treated like children, but they may also use older ways of coping under difficulty. Compliance, rebellion, helplessness, perfectionism, hypervigilance, withdrawal — all may reappear with surprising force.

Still, at work we cannot react the same way we might react within our families. Employment is inherently conditional. It depends on contracts, evaluations, probationary periods, letters of recommendation, references, and the judgment of people who may have enormous control over our future. To react angrily at work, for example, may cost us our job even when we had all the reasons — past and present — to feel angry.

Being caught in workplace dynamics without always having a feasible way out rapidly becomes a source of suffering that affects all domains of our lives. In many cases, it may result in burnout, anxiety, depression, or the opening of older wounds, including PTSD.

Navigating work difficulties with self-awareness

To say that our workplace difficulties will help us develop awareness of who we were and where we come from seems too pale a silver lining when we are in the thick of our suffering. That awareness, however, can help us navigate the actual problems before us.

We are often advised to navigate work difficulties professionally, but we may forget that we should also navigate them with awareness of ourselves.

To step back, pause, and understand how much of the present relates to the past may help us tolerate certain situations with greater clarity and proportion.

Sometimes the people and situations hurting us are not the original injury, but repetitions of something older. And understanding that may allow us to recognize that not every action around us is specifically designed to wound us. Many people are acting from their own fears, ambitions, limitations, or needs. We are caught in their world as much as they are caught in ours.

Likewise, our reactions may not always reflect who those people truly are, but rather what they represent to us and the reactivation of older ways of reacting. We may react with perfectionism, withdrawal, compliance, overachievement, or anger — the only ways we once knew how to survive.

To realize that some of our feelings, perceptions, and reactions may come from the past does not mean that we will reach a place where nothing affects us anymore or where difficult people suddenly become easy to work with.

It may, however, allow some distance from the immediacy of our reactions. It may help us respond with greater discernment rather than simply reenacting older patterns of feeling, thinking, and reacting.

To realize that parts of our past contribute to these situations does not mean that we can erase or reshape our ways of feeling, thinking, and reacting overnight.

Instead, that understanding should be accompanied by some compassion toward ourselves. That understanding can guide us toward an honest assessment of who we are and what actually works for us: what kind of leadership, what kind of environment, what kind of structure allows us to function well.

To know ourselves does not mean that we will stop compromising or that we will reject every environment that does not fully meet our needs. But it may give us a clearer sense of what to look for, what to avoid, and what we can realistically sustain over time.

With that knowledge, we may be better able to decide — with some balance between integrity and realism — what is possible and what is not, when to stay and when to move on.

- Helder Araujo MD PhD 

What Is the Best Treatment for Me?

The search for the best treatment for mental health issues can be exhausting. It may drive you down a path of seeking multiple psychiatric opinions, reading endlessly online, and trying to reconcile conflicting advice. This process alone can become overwhelming.

The truth is that the best mental health treatment for you is what ultimately works best for you in the long run. That answer may feel unsatisfying at first, but it reflects the reality that effective mental health care depends on multiple individual variables, ranging from your biology to the kind of relationship you have with your psychiatrist or provider.

The Technical Aspects of Psychiatric Treatment

From a technical standpoint, good treatment depends on accurate psychiatric diagnosis and an appropriate choice of treatment. It is reasonable to expect that a psychiatrist, as a mental health specialist, is better equipped to diagnose mental illness and choose appropriate treatment than a health professional who is not specialized in mental health.

Choosing a psychiatric specialist is therefore essential, but that does not eliminate all the complexity and variabilityinvolved in treatment.

Not All Psychiatrists Are Alike

Unlike some medical specialties that rely on strict and highly standardized protocols, psychiatry offers a wide range of treatment approaches within what is considered standard of care. Some psychiatrists rely heavily on structured interviews and standardized questionnaires, while others make use of broader techniques that draw from psychoanalysis, relational psychiatry, and other psychological frameworks.

Both approaches can be valid. What matters most is how well a given approach fits your needs, personality, and treatment expectations.

Not All Mental Illnesses Are Alike

While diagnostic standardization is essential, over-standardization may risk losing the richness of individual experience.

The fact that two individuals are diagnosed with the same condition—such as major depressive disorder—does not mean that their illness is alike. Each depression may be uniquely shaped by an individual’s biology, developmental history, existential concerns, and current life stressors.

Depression symptoms can express themselves in many ways: in thoughts and internal experiences, and in behaviors such as sleep, appetite, motivation, and social engagement.

Not All Bodies Are Alike

If our psychology differs, the same is true of our biology. While humans are alike to a certain extent, we also harbor meaningful biological differences. These differences may seem small or subtle, but they can influence a variety of processes, such as how we think, behave, and respond to psychiatric medications. This helps explain why a treatment that works well for one person may be ineffective or poorly tolerated by another.

Not All Families and Cultures Are Alike

Family dynamics and cultural backgrounds shape how we think, feel, behave, and relate with others. Failing to attend to this cultural variability can turn a benign and culturally normative expression into something that is mistakenly labeled as a mental illness.

Understanding a person’s cultural and familial context is therefore essential to accurate diagnosis and meaningful psychiatric treatment.

Not All Treatments Are Alike

It is true that psychiatry and neuroscience still have a long way to go, and much remains unknown. At the same time, it is important to pay attention to evidence-based treatment, supported by scientific research, including higher levels of analysis such as meta-analyses.

However, no single scientific study accounts for 100% of human variability. Evidence-based practice must therefore be balanced with clinical judgment and flexibility, always aiming toward an individualized treatment plan rather than a one-size-fits-all approach.

Not All Relationships With Providers Are Alike

Therapeutic relationships vary widely, and what feels like a good fit differs from person to person. Some individuals prefer providers who are warm, inquisitive, and exploratory. Others feel more comfortable with a structured, symptom-focused approach centered on medication management.

There is no universally correct therapeutic style. What matters is whether the patient-provider relationship feels sufficiently safe, respectful, and effective to allow meaningful work to take place.

How to Make Sure You Are Receiving the Best Treatment

Setting realistic expectations is essential. Life is complex, and the mind’s processing of life can be equally challenging. Expecting “magic” solutions that eliminate all negative thoughts or feelings, or that lead to perfect thinking and behavior, is often unrealistic. Likewise, expecting that a psychiatrist is as attuned to your needs as an AI algorithm is unrealistic, as psychiatrists, like all people, are “imperfect”.

Having said that, trusting that a therapeutic relationship feels right is essential and may require some degree of comparison shopping. At the same time, flexibility is important, as the therapeutic relationship itself can become part of the treatment—even if you were convinced that all you receive from your psychiatrist are prescriptions.

For example, a person who struggles to assert their needs may avoid expressing concerns to their provider. Practicing assertion within treatment can be therapeutic.

Similarly, someone who tends to walk away from relationships at the first sign of frustration may benefit from attempting repair rather than immediate disengagement.

In fact, many providers informed by relational psychiatry and psychological theory are intentional in how they relate to patients and may base a significant portion of treatment on the therapeutic relationship itself.

Along these lines, it can be important to trust that a provider may challenge you thoughtfully and for a reason. While comfort and familiarity have value, treatment that never evolves can become stagnant. Psychological growth often requires tolerating some degree of purposeful and well-contained discomfort.

In Summary

The best psychiatric treatment is not a single diagnosis, medication, technique, or provider. It is an ongoing process informed by multiple variables—biological, psychological, social, and cultural individuality, therapeutic approach, and—most importantly—the relationship between you and your provider. Finding that fit takes time and patience, but it is often the most meaningful part of the work.

Helder Araujo, MD PhD