Promoting mental health of junior-to-senior transition athletes – advice for sport psychology practitioners

Röthlin Philipp¹, Albertin Katharina^2
1 Swiss Federal Institute of Sport Magglingen
² SPEAK Albertin AG, Wädenswil

Abstract

Mental health (MH) does not only mean the mere absence of psychiatric disorders but also the presence of well-being. Competitive athletes are exposed to risk factors for poor MH specific to the competitive sport context. One such risk factor are athletic career transitions, whereby the junior-to-senior-level transition (JST) is considered one of the most difficult of within career transitions. During this time, developmental changes must be mastered on a psychological, athletic, and educational level and conflicts that occur between the different areas of life, such as school, family, and sports can become more acute. JST is thus a particularly vulnerable period for the MH of competitive sport athletes. In this article, we describe a counseling approach that seems well suited to promote the MH of JST athletes within a sport psychology consulting setting. The approach is based on self-determination theory and ego-state theory. We illustrate the application of our counseling approach with an exemplary case. Finally, we provide recommendations for how sport psychology practitioners can promote MH in JST athletes.

Zusammenfassung

Psychische Gesundheit (PG) bedeutet nicht nur die blosse Abwesenheit von psychiatrischen Störungen, sondern auch das Vorhandensein von Wohlbefinden. Leistungssportler*innen sind Risikofaktoren für eine schlechte PG ausgesetzt, die spezifisch sind für den Leistungssportkontext. Ein solcher Risikofaktor sind sportliche Karriereübergänge, wobei der Übergang von der Junioren- zur Seniorenstufe (JSÜ) als einer der schwierigsten Karriereübergänge gilt. In dieser Phase müssen Entwicklungsveränderungen auf psychologischer, sportlicher und schulischer Ebene bewältigt werden, und Konflikte zwischen den verschiedenen Lebensbereichen wie Schule, Familie und Sport können sich verschärfen. Der JSÜ ist somit eine besonders vulnerable Phase für die PG von Leistungssportler*innen. In diesem Artikel wird ein Interventionsansatz beschrieben, der sich gut eignet, die PG von JSÜ-Athleten*innen im Rahmen eines sportpsychologischen Beratungssettings zu fördern. Der Ansatz basiert auf der Selbstbestimmungstheorie und der Ego-State-Theorie. Wir illustrieren die Anwendung unseres Interventionsansatzes anhand eines exemplarischen Falles. Abschliessend geben wir Empfehlungen ab, wie Sportpsycholog*innen die PG bei JSÜ-Athlet*innen fördern können.

Introduction

Mental health (MH) not only means the mere absence of psychiatric disorders and subclinical symptoms but also includes the level of positive functioning of individuals (i.e., well-being [1,2]). Poor MH leads to much suffering and high costs, both globally and in Switzerland [3-5]. Data show that nearly one-fifth of the Swiss population feels impaired by MH problems, with younger people being affected more often than older people [6]. MH is fundamental for human flourishing and it is of particular interest in the context of competitive sports. Why is this the case?
At first glance, one might think that MH is not very important in competitive sports because it is a well-documented fact that exercise is an effective treatment for depression [7] and because athletes are often presented as role models of human resilience. However, this image of the invulnerable athlete is wrong, as findings indicate that athletes are affected by mental disorders to the same degree as the general population [8]. It also makes sense to distinguish between regular exercise as a hobby and competitive sports because some stressors specific to the competitive sports context [9]may endanger MH. Examples of such sport-specific stressors are injuries [10] or athletic transitions [11,12].
In the sport psychology community exists a broad consensus that MH should be a priority goal throughout an athletic career and beyond [13-16]. However, the realization of this goal is not always successful, as reports show that the sport system has compromised athletes’ MH, including in Switzerland [17,18]. These reports underline how important it is to understand how athletes’ MH can be protected and promoted, which can be carried out in a variety of ways. Examples are educational campaigns to increase MH literacy or setting up a system of screening athletes in vulnerable phases [14,15]. In this article, we highlight yet another way in which MH can be promoted. Specifically, we illustrate what sport psychology practitioners can do to promote MH in the consultation context. In doing so, we focus on a population of athletes whose MH is particularly vulnerable, namely those in the transition from junior to senior level.
The junior-to-senior-level transition (JST) is considered the most difficult of within-career athletic transitions [11,12]. Most athletes are in JST at about 17–19 years of age [19], an age when people in general are at risk of MH problems, such as depression, due to the developmental challenges they face [20,21]. In fact, during JST, important developmental tasks have to be mastered simultaneously at psychological, educational, and athletic levels [19], and conflicts that occur among the different areas of life, such as school, family, and sports, can become more acute (i.e., life-sport conflicts [22]). Initial data on athletes indicate that the main onset of MH problems occurs at 19 years, and 50% of onsets occur in the 17–21 age range, thus supporting the claim that during JST, MH is especially vulnerable [23].
In this article, our aim is to describe a counseling approach that seems well suited to promoting JST athletes’ MH. We focus on basic psychological needs on two levels [24,25]: First, guided by self-determination theory (SDT [26]), we ask to what extent is the sport, family, and school environment able to satisfy athletes’ basic psychological needs? Second, guided by ego state theory (EST [27-31]), we ask on the level of the person, which intraindividual parts are activated to satisfy basic psychological needs?

Description of the counseling approach

The first main theory that guides our counseling approach is SDT, a comprehensive theory about human motivation and personality. SDT states that people have three basic psychological needs: autonomy (feeling that one has a choice regarding one’s behavior), competence (feeling that one can control an outcome and experience mastery), and relatedness (feeling accepted by one’s social milieu [32]). This theory assumes that if the social environment, especially involving significant others such as parents and coaches, enables the satisfaction of these needs, this is associated with better MH. In contrast, when basic needs are thwarted, this is associated with poorer MH [33].
The guiding questions for sport psychologists that can be derived against the background of SDT are the following: Which of the three basic needs are currently not satisfied or even threatened? Does the athlete’s environment (especially significant others) allow the satisfaction of basic needs? Which of the basic needs can athletes satisfy effectively? From our point of view, it makes sense to ask these questions separately for each of the most important contexts in which athletes live: the family, sport, and school. Based on the extent of basic needs satisfaction, the next guiding questions serve as the bases for appropriate interventions: What should be changed in the different contexts so that athletes can satisfy their basic needs? How can I support athletes in realizing the potential for basic needs satisfaction that the environment offers?
The second main theory that guides our counseling approach is EST. The concept of ego states is closely related to schemata and refers to behavioral and experiential syndromes that people develop in their lives to satisfy and protect their basic psychological needs [25,30]. We can think of ego states as neural networks, each comprising specific cognitions, emotions, and bodily sensations [31]. The origin of ego states is influenced by various constitutional, developmental, and socialization processes (e.g., differentiation, introjection of significant others, violations of basic needs, or traumas [25,28]). At the same time, strong interests play a role in the development of ego states (e.g., an athlete’s passionate attachment to a sport [28]).
Ego states are functional in their intention to satisfy and protect psychological needs. However, the way ego states manifest themselves may have effects that are unfavorable for athletic performance and well-being (i.e., destructive-acting ego states [31]). For example, an athlete’s fear of making mistakes in training is an ego state that aims to protect the need for competence (“If I make a mistake, I am a failure.”). However, this has an unfavorable effect on athletic development because too few learning experiences take place. Another example is the fear of disappointing significant others — an ego state that aims to protect the need for relatedness to important people (“If I lose, they won’t like me anymore.”). However, this leads to the athlete becoming extremely tense in pressure situations, since not only athletic success but also the relationship to important others is at stake. EST implies that athletes who can satisfy their needs behind such destructive-acting ego states will be better able to cope with the daily challenges of competitive sports and benefit their MH [28].
Besides destructive-acting ego states, there are resourceful ego states. Our practical experience shows that, in athletes, these resourceful ego states usually appear in the form of deep enjoyment of the movements typical of a sport and the intrinsic desire to compete with others. During JST, these resourceful ego states may be pushed into the background. In sport psychological consultations, adolescent competitive athletes sometimes report transition from a “carefree everyday sporting life” to one characterized by various forms of pressure. Such reports are typical for JST, a phase in which, for example, pressure to succeed or the pressure of selection in sport occur, but also time-related pressure at school can intensify. Against the background of EST, it is beneficial for athletes’ MH if their resourceful ego states are strengthened in counseling [28].
Within EST, psychoeducation can be used to help athletes recognize that ego states provide vital information and serve an important psychological function (i.e., protecting and satisfying basic needs). Conversations about the individual development of ego states can help athletes understand them. Psychological skills or techniques, such as mindfulness [34], self-compassion [35], relaxation [36], and imagery [37], can be used to help athletes engage with all states within themselves, especially those that are more difficult and unpleasant (for more techniques, see 28). These and other techniques (e.g., goal-directed self-instructions [28]) can help athletes repeatedly activate and train resourceful ego states in everyday life. Research data show that interventions based on EST decrease competitive athletes’ stress levels [38].
The guiding questions for sport psychologists that can be derived against the background of EST are the following: How can I recognize the different ego states of athletes (e.g., in body posture, voice, and facial expression)? It is important to make athletes aware of the changes in their physical, vocal, and facial expressions. How can I help athletes to understand and accept their destructive-acting ego states so that they do not take up too much space in competition and training and lead to mental blocks? How can I help athletes activate resourceful ego states? As a rule, these can be activated when asking athletes about their history in competitive sports, their greatest successes, and their reasons for choosing a particular sport.

Exemplary case

The following exemplary youth athlete case is based on information from several real cases, whereby this information has been additionally modified to make it impossible to draw conclusions about the real cases. After briefly describing the case, we show how we proceeded based on our counseling approach (i.e., the promotion of basic psychological needs with regard to the athlete’s environment according to SDT and overcoming destructive-acting ego states and activating resourceful ego states according to EST). Note that we have summarized the processes that usually take place over several consultative meetings.
Selma (18 years old) plays ball sports on a team, with a successful career so far in junior categories and national youth selection squads. Selma had ambitious goals for her career, which had been carefree and successful for a long time. Selma tells how she always passionately loved her sport. Right now, Selma is in a long rehabilitation phase after an injury. Until recently, she was considered a great young talent, was a regular player in the youth team, and was about to make the jump to the first team. Now she hardly ever plays. Her mood is becoming increasingly worse, and her parents fear that she is depressed. This results in their hardly giving her any space. Selma is feeling increasingly hopeless and has a distant relationship with the new coach, who hardly communicates with her. Selma is losing faith in regaining her strengths in her sport and has expressed her desire to quit competitive sports. Changing clubs is difficult because of her parents’ strong connections to the current club. In school, Selma keeps up her academic performance effortlessly.
To improve the relationship between the coach and Selma, it would be useful to have a clarifying conversation, which Selma and her parents do not want. Because of her parents’ concerns, Selma withdrew further, which can be understood as an expression of her need for autonomy. The possibilities of gaining autonomy for Selma were explored with the parents. Psychoeducational discussions on pubertal behaviors and depressive symptoms were effective (i.e., giving more space, allowing withdrawal, asking less, and not suggesting their worry). In addition, the parents were encouraged to reflect on their loyalty to the old club. In the course of counseling, Selma dared to talk to her parents about changing clubs and organized trial trainings in other clubs. These went very positively, and Selma was able to change to a club where the needs for relatedness, competence, and autonomy are better satisfied.
The destructive-acting ego state that mainly showed up in Selma was an accusing and whining one. Among other things, it showed itself in a tearful voice. In everyday training, this ego state led to unfavorable statements by Selma. This was detrimental to the athlete–coach relationship and obstructed the actual desire for recognition (i.e., her need for competence). However, the destructive-acting ego state also referred to her parents, who tended to control her too much. Explaining EST in a psychoeducational way, Selma understood that behind this was a legitimate need for autonomy. In Selma’s narrative of the past, the resourceful ego states of her huge passion for her sport and an intrinsic desire to compete with others became apparent. This was evident in her facial expressions and body posture. The introduction of healing imagery and visualizing technique training allowed Selma to feel these sport-specific resourceful ego states during the rehabilitation phase and gave her a sense of control over her actions (i.e., satisfied her need for autonomy). With the help of body awareness, imaginative exercises, and questioning Selma in detail about her feelings of success, she succeeded in activating her resourceful ego states more often (i.e., satisfied her need for competence). Over time, Selma appeared more balanced, and her overall intrinsic motivation increased.

Recommendations for sport psychologist ­practitioners working with JST athletes

A prerequisite for the presented counseling approach is (as in every counseling) a trusting relationship between the athlete and the sport psychologist, as well as a clear explanation about confidentiality and whether and under which conditions the persons from the athlete’s environment may be involved in the counseling. In general, sport psychologist should also be aware of their own competencies and limits, such as when psychotherapeutic or psychiatric support is required if they lack the appropriate qualifications.
Sport psychologists working with JST athletes should be aware of the challenges that this phase involves. In other words, they should know that this is a period in an athlete’s life when MH is vulnerable, as important changes happen in sports and in school, in addition to psychological development steps. Furthermore, it makes sense for sport psychologists to intervene in an age-appropriate way, i.e. by working with images and emotions, especially with young athletes. In this regard, EST provides a wide repertoire of interventions [29].
To best understand the status of the basic psychological needs and key ego states, sport psychologists should obtain as comprehensive a picture of the athlete as possible. This includes inquiring about the athlete’s past and present experiences, main interests (also outside of sports), and relationships with the most important reference persons in and outside of sports. Ideally, sport psychologists learn about difficult life events. This is because these, as well as sedentary interests and thwarted or unmet basic psychological needs, can interfere with everyday sporting life and can be a reason for poor MH or bad performance.
To promote MH of JST athletes, sport psychologists can follow SDT to generate ideas about what the environment should provide in order for athletes to develop positively and be mentally healthy. EST can further serve sport psychologists to support athletes in overcoming inner barriers and strengthening resources. EST helps create an internal environment that enables athletes to negotiate with the different sides within themselves. This leads athletes to better recognize, if destructive-acting ego states are active and become better able to activate resourceful ego states. This could in turn enable them to have a stronger sense of self-control and self-efficacy, leading to better MH.

Practical implications

• Be aware that the transition from junior to senior level is a vulnerable phase for athletes’ mental health, as it involves developmental changes in several dimensions (i.e., psychological, educational, and athletic).
• Help athletes meet their basic needs for autonomy, competence, and relatedness to enhance their mental health. If possible, involve significant others in the athletes’ environment who can effectively change need-satisfying potentials.
• Find the functionality behind destructive-acting ego states and enable athletes to better identify and advocate for their basic needs.
• Help athletes develop rituals for daily life to activate and strengthen their resourceful ego states.

Acknowledgments, conflict of interest, and funding

The authors declare no conflict of interest.

Corresponding author

Philipp Röthlin
Alpenstrasse 18, 2532 Magglingen
Tel: 058 467 64 23
Email: philipp.roethlin@baspo.admin.ch

References

1. WHO. Mental health: A state of well-being. Geneva, Switzerland: World Health Organization; 2014.
2. Uphill M, Sly D, Swain J. From mental health to mental wealth in athletes: Looking back and moving forward. Frontiers in Psychology. 2016;7:935.
3. Maercker A, Perkonigg A, Preisig M, Schaller K, Weller M. The costs of disorders of the brain in Switzerland: an update from the European Brain Council Study for 2010. Swiss medical weekly. 2013;143.
4. Bloom D, Cafiero E, Jané-Llopis E, Abrahams-Gessel S, Bloom L, Fathima S, et al., editors. The Global Economic Burden of Non-Communicable Diseases: Geneva: World. Economic Forum; 2011.
5. Bundesamt für Statistik. Schweizerische Gesundheitsbefragung (SGB) 2012 2012 [Available from: http://www.bfs.admin.ch/bfs/portal/de/index/infothek/erhebungen__quellen/blank/blank/ess/04.html.
6. WHO. Global status report on non-communicable diseases 2010. Geneva, Switzerland: World Health Organization; 2011.
7. Josefsson T, Lindwall M, Archer T. Physical exercise intervention in depressive disorders: Meta-analysis and systematic review. Scandinavian journal of medicine & science in sports. 2014;24(2):259-72.
8. Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine. 2019;53(11):667-99.
9. Arnold R, Fletcher D. A research synthesis and taxonomic classification of the organizational stressors encountered by sport performers. Journal of sport and exercise psychology. 2012;34(3):397-429.
10. Appaneal RN, Levine BR, Perna FM, Roh JL. Measuring postinjury depression among male and female competitive athletes. Journal of Sport and Exercise Psychology. 2009;31(1):60-76.
11. Stambulova NB, Alfermann D, Statler T, Côté J. ISSP position stand: Career development and transitions of athletes. International journal of sport and exercise psychology. 2009;7(4):395-412.
12. Stambulova NB. Talent development in sport: A career transitions perspective. In: Hung ET-M, Lidor R, Hackfort D, editors. Psychology of sport excellence. Morgantown, WV: Fitness Information Technology; 2009. p. 63-74.
13. Moesch K, Kenttä G, Kleinert J, Quignon-Fleuret C, Cecil S, Bertollo M. FEPSAC position statement: mental health disorders in elite athletes and models of service provision. Psychology of Sport and Exercise. 2018;38:61-71.
14. Henriksen K, Schinke R, Moesch K, McCann S, Parham WD, Larsen CH, et al. Consensus statement on improving the mental health of high performance athletes. International Journal of Sport and Exercise Psychology. 2019:1-8.
15. Henriksen K, Schinke R, McCann S, Durand-Bush N, Moesch K, Parham WD, et al. Athlete mental health in the Olympic/Paralympic quadrennium: a multi-societal consensus statement. International Journal of Sport and Exercise Psychology. 2020;18(3):391-408.
16. Schinke RJ, Stambulova NB, Si G, Moore Z. International society of sport psychology position stand: Athletes’ mental health, performance, and development. International Journal of Sport and Exercise Psychology. 2018;16(6):622-39.
17. Birrer D. Rowing Over the Edge – Non-Functional Overreaching and Overtraining Syndrome as Maladjustment: Diagnosis and Treatment under a Psychological Perspective – A Case Study. Case Studies in Sport and Exercise Psychology. 2019;3(1):50-60.
18. Gertsch C, Steffen B. Ariella Kaeslin – Leiden im Licht: Die wahre Geschichte einer Turnerin. Zürich: Verlag Neue Zürcher Zeitung; 2015.
19. Wyllemann P, Alfermann D, Lavallee D. Career transitions in sport: European perspectives. Psychology of Sport and Exercise. 2004;5(1):7-20.
20. Gulliver A, Griffiths KM, Mackinnon A, Batterham PJ, Stanimirovic R. The mental health of Australian elite athletes. Journal of science and medicine in sport. 2015;18(3):255-61.
21. Suvisaari J, Aalto-Setälä T, Tuulio-Henriksson A, Härkänen T, Saarni SI, Perälä J, et al. Mental disorders in young adulthood. Psychological medicine. 2009;39(2):287.
22. Morgan G. Life domain conflicts in elite sport: Prifysgol Bangor University; 2017.
23. Åkesdotter C, Kenttä G, Eloranta S, Franck J. The prevalence of mental health problems in elite athletes. Journal of science and medicine in sport. 2020;23(4):329-35.
24. Borg-Laufs M, editor Die Befriedigung psychischer Grundbedürfnisse als Weg und Ziel der Kinder-und Jugendlichenpsychotherapie. ­Forum für Kinder-und Jugendpsychiatrie, Psychosomatik und Psychotherapie; 2012.
25. Grawe K. Neuropsychotherapy: How the neurosciences inform effective psychotherapy. Mahwah, N.J.: Lawrence Erlbaum; 2007.
26. Deci EL, Ryan RM. The “what” and “why” of goal pursuits: human needs and the self-determination of behavior. Psychologial Inquiry. 2000;11:227-68.
27. Emmerson G. Ego state therapy: Crown House Publishing; 2007.
28. Fritzsche K. Ego-State-Therapie bei Traumafolgestörungen: Handbuch für die Praxis: Carl-Auer Verlag; 2020.
29. Fritzsche K, Hartman W. Einführung in die Ego-State-Therapie: Carl-Auer-Verlag; 2010.
30. Peichl J. Einführung in die hypnosystemische Teiletherapie: Carl-Auer Verlag; 2019.
31. Zanotta S. Wieder ganz werden: Traumaheilung mit Ego-State-Therapie und Körperwissen: Carl-Auer Verlag; 2018.
32. Ryan RM, Deci EL. An overview of self-determination theory: An organismic-dialectical perspective. In: Deci EL, Ryan RM, editors. Handbook of self-determination theory research. Rochester, NY: University of Rochester Press; 2002. p. 3-33.
33. Vansteenkiste M, Ryan RM. On psychological growth and vulnerability: basic psychological need satisfaction and need frustration as a unifying principle. Journal of psychotherapy integration. 2013;23(3):263.
34. Henriksen K, Hansen J, Larsen CH. Mindfulness and acceptance in sport: How to help athletes perform and thrive under pressure: Routledge; 2019.
35. Baltzell A, Röthlin P, Kenttä G. Self-compassion in sport for courage and performance. In: Henriksen K, Hansen J, Larsen CH, editors. Mindfulness and Acceptance in Sport: How to Help Athletes Perform and Thrive under Pressure. New York, NY: Routledge; 2020. p. 178-90.
36. Acharya J, Morris T. Psyching up and psyching down. In: Papaioannou AG, Hackfort D, editors. Routledge companion to sport and exercise psychology: Global perspectives and fundamental concepts. London, Il: Routledge; 2014. p. 386-401.
37. Morris T, Spittle M, Watt AP. Imagery in sport. Champaign, IL: Human Kinetics; 2005.
38. Sin TH, Ifdil I, Amalianita B. The Effectiveness of Ego State Therapy in the Reduction of Athletes’ Stress Levels. Addictive Disorders & Their Treatment. 2021.