Being a Therapist in an Age of Bureaucracy and Marketization: Psychologists’ Responses to Moral Stress

Mental health care professionals have faced increased work pressure and moral stress since the implementation of bureaucratic and NPM policies. We interviewed Dutch psychologists to investigate how they cope, using Hirschman’s Exit , Voice , and Loyalty framework. Reflecting the solitary nature of their work, many psychologists developed individual approaches, creatively alternating between strategies to relieve pressure. Inadvertently, this contributes to a situation where issues are insufficiently problematized to induce change, while professionals themselves grow more cynical. We recommend system changes to protect professionals’ moral engagement and support collective strategies to address problems effectively and achieve necessary improvements.