Signs you or a colleague could use mental health support

Hosted by Courtney Vien

The COVID-19 pandemic led many CPAs and their employers to think deeply about mental health in ways they may not have before. Amber Setter, a former accountant and an International Coaching Federation–accredited professional certified coach, talks about signs someone may need to consider speaking with a professional about their mental health and what you can do if you notice these signs in someone else. She also gives advice on finding a mental health professional and suggests ways employers can foster staff’s well-being.

What you’ll learn in this episode:

  • How the pandemic has affected accountants’ mental health (5:36).
  • Signs of mental health issues to watch for in yourself (11:04) and in colleagues (12:42).
  • How to approach someone else you are concerned about (13:24).
  • Advice for finding the right mental health professional (15:07).
  • The three reasons people are afraid to seek help (16:55).
  • Why getting help can be a boost to your career (18:59).
  • Three ways employers can contribute to staff’s well-being (21:14).

Play the episode below or read the edited transcript:

To comment on this podcast episode or to suggest an idea for another episode, contact Courtney Vien, a
JofA senior editor, at


Courtney Vien: Hello, and welcome to the Journal of Accountancy Podcast. I’m Courtney Vien, a senior editor with the Journal of Accountancy. Today’s episode features Amber Setter, a certified executive coach located in San Diego. She’ll be talking to us about CPAs and mental well-being, and about how seeking help can benefit you in both your personal life and your career.

But first, please listen to this word from our sponsor:

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Amber Setter is uniquely qualified to speak about CPAs and mental well-being because she was once an accountant herself. While working for a major accounting firm, she earned a master’s degree in leadership and discovered an interest in helping others become better leaders.

Amber took a year of coach training and became certified as a coach with the International Coaching Federation. She has worked as a coach for eight years, both independently and as an in-house coach for a major accounting firm. Her practice focuses mainly on accountants.

When I sat down to Amber to talk about CPAs and mental wellness, I started by asking her to explain more about the coaching process and how it works.

Amber Setter: So it's pretty normal that it's misunderstood and that's partly because it's a younger — as a profession it's a lot younger than say the CPA. So I'm in the business of what I've called "point actualization coaching." This is really the process of guiding someone to their next level of consciousness or self-awareness. It uses disruptive moments in life such as COVID or a calling to change, like, "Oh, I want to do something different" or maybe just discomfort with achievement as really opportunities to find more intrinsic meaning.

You'll see a lot of this in accounting, this discomfort with achievement, because people, like, "I'm going to you know get the hardest degree in business school," "I'm going to become a CPA," "I'm going to get a graduate degree," like keep going and going and then they've done all the things that they thought would bring them happiness, but they don't necessarily feel happy.

Vien: How is coaching different from therapy?

Setter: Coaching really helps someone say, "Where am I today? What's going on with me today, and what do I want in the future? If I had a magic wand and I could create anything for my life in the future, what would that be?" Then partnering to create a plan of action from going from where you are today, to where you want to be in the future.

In contrast, modalities like therapy might say, "OK, where am I today?” and “Let me look at the past and what kind of experiences in my life shaped who I am today and maybe why I'm stuck in this pattern of behavior that doesn’t serve me."

But coaching has a lot more infusion on having somebody really clear like, "OK, had this big insight about what I want out of life, and now here's three things I'm going to do to move myself forward towards achieving that and creating that new life."

One of, part of our code of ethics and our training is to know when somebody needs a therapist and not a coach. So I have referred clients out where it's like, "There's something more for you.”

Vien: And you have clients who work with both you and a therapist.

Setter: I think that’s something that first and foremost there's nothing wrong with asking for help. I work with some very, very talented people who are working and serving very visible, important clients, different, high-performance people is what I want you to know. These people are movers and shakers in the world, and they find value in working with a therapist and with a coach.

Sometimes they might use a therapist, like I said, to go back to their history and their childhood. Sometimes they go to therapy if there's been any kind of substance abuse issue, that might be a reason. They might choose to go to therapy with their spouse and so they might do that.

A lot of times of what people realize when they start talking about their feelings is it's very proactive, it's not reactive. That's why I end up working with people for years. They're like, "Oh when I invest an hour of my day to think about who I want to be as a leader and how to have a strategic conversation in one hour I can get really clear on the right…" like, what feels the right way to do that for them. Versus thinking about it, avoiding it, like all the stuff that goes on for like eight hours one might meander around.

It's sort of like thinking about it as an investment of their energy. You know they stop, they pause, they look within, they get present to what they're feeling, they get present to what their real challenges are and then they think about, "OK, now how do I… What's my plan for overcoming these challenges,"

So, yes, I would say about half of my clients right now are working with a therapist and with me.

Vien: Now we've been in the midst of the pandemic for over a year now. Can you talk about what you're seeing in terms of how that's affected your clients and in particular their mental health?

Setter: Yeah, it's a great question, because I would say that the pandemic has impacted all of us, and it's impacted us at different times and in different ways.

I've been dreaming up this sort of imagery in my mind, which is if you imagine you had a glass of water and it's full 75% and that's sort of like normal life. You know your normal life responsibilities, you only have 25% capacity for other stuff.

And what happens with accountants, whether they're in public accounting or industry, is around a filing deadline, which we might call "busy season" or we might call "month-end close" or whatever it is, work fills up that 25%. And when work is really — there's a lot of demand on work, there's not space for the extra stuff in life. Like going to get your hair cut or going on vacation or going out to happy hour with friends. It's more usually like, “My cup is all the way full. All I have capacity for is normal life and the extra additional load because of the compliance deadline.”

And COVID came along and was like this whole additional thing that wanted to pour into the cup and there was no capacity left.

And so I say that really demand on accountants, on their psychological, like their available space, there's just not a lot of availability. And we really saw with, it got flooded with helping people through PPP or changes in legislation. Like all of a sudden there were these new NOL carrybacks I was hearing about in coaching. All of this stuff happened so practitioners got busier than ever when life was already complicated.

Then the things that they normally do to restore their energy, like taking a vacation after a reporting deadline, they didn't do because there was nowhere to take a vacation to.

So that really just created a lot of burnout to a profession that burnout might be a little more common. There's really definitely high peak periods and then periods to recover, and that recovery felt missing last year.

So, your question was how has it shown up in coaching? The people that I've been coaching for years, because I have some clients that I've worked with for years, at an individual level they were OK. They've really been working on their own self, they're very steady in their own self and calm in their insides, so when the external world feels volatile, it doesn't sort of throw them off the horse. But what they needed support with is how do they help other people.

You know, if they notice, they think something's going on with a colleague, or how do we work from home together effectively, or "Man, my clients are showing up really combative with me, right, what's going on there?” That's what I would do with existing clients.

New clients that hired me once the pandemic was already going I would say have come in with a lot more burnout, a lot more deeply questioning like, "What is the life I've been living?" You know, "Do I really want to go back to that way of living, or is there something else for me?"

Vien: You used the term "burnout," and it's something I've been hearing tossed around a lot during the pandemic. What do people mean when they say they're "burned out"?

Setter: Yeah, I think a really easy way to think about it is imagine that your energy was measurable on, just like it is on your phone. I want to say iPhone, not everybody has one. But you know on our phones we can see like, "OK, I'm at 80%" or we get a message, "Oooh, I'm at 20%, like I better plug in" or “10% I'm critically low.” And so to me burnout is when you're getting to that, "I'm at 20%, I'm really low. I'm not operating as optimally," or "I'm at 10%," or "Man, I am just toasted."

And with knowledge workers they tend to be very much in their heads. Thank goodness, right? You need to be in your head, you need to be critically thinking, you need to understand all the regulations. But when you're always in your head you're sort of disassociated from other access points such as your body. Like I'm noticing I'm holding a lot of anxiety in my body.

So [with] burnout, really I think what happens is people don’t know how to see themselves as an instrument. They can't — it's not as easy as picking up your iPhone and seeing a number, there's not as much — the muscle for stopping and checking in and saying, like, "How am I doing?" "What do I need?" "Do I need to take a vacation?" You know, "Do I need some time alone?" "What do I need?" And when you start getting in the habit and practice of this and knowing it and seeing what burns you out and how you recover, you can do something about it.

Vien: So if somebody is feeling stressed out or burned out, how can they know when it's time to seek professional help, as opposed to maybe something that they can handle on their own?

Setter: This is the million-dollar question, Courtney. It's a really, really good question because I can tell you from my personal experience and living my own life and then from helping other people is oftentimes when we're having a challenging time we don't even realize it. Because it's not always like a traumatic thing that happened.

It's more of the parable of the boiling frog, right? You throw a frog into a pot of water and it leaps out, but if you put a frog in cold water on the stove, and you just turn it on, it slowly cooks. So that latter saying, like burnout, is usually an incremental experience that happens over time.

So what does that actually look like?

It can be some of the classic symptoms or really noticing if you've had a change within you. So you're eating more or you're eating less. You're not able to focus or you're hyper-focused. It can show up like “I sit at my computer and I've got nothing done all day” or “I spent 15 hours working because I didn't want to feel my feelings so I went in my head.” It can be just really feelings of anxiousness. Sometimes people don't realize that a lot of it is in the body, so shortness of breath. I've had people that have felt like they were having a heart attack and gone to the ER, but it turns out it was a panic attack.

Vien: What are some of the signs that a co-worker or family member might be struggling?

Setter: And so you know some of the things that I mentioned, like what are the signs in your own self.

Like you're losing focus or you're working a lot or you're not eating, well, how might that show up in the workplace, right? So if you notice fluctuations in patterns of working hours, people sending things at different times or whatever, it might be a cue that their sleep is off. If you're noticing that the quality of work has shifted dramatically, there might be some loss of focus or something going on. And so really like noticing shifts in patterns of behavior.

Vien: If you notice those signs, what are some steps you could take?

Setter: I think this is something that we do as a coach, we call it "reflect." So imagine I'm holding a mirror up and I’m reflecting to you your behavior. It's a way that can you do it in a compassionate way. Like, "You know, I noticed last week that you sent several emails at 2 a.m., and I just wanted to check in, like, how are you, because you normally don't work at that time." And so reflect and curiosity I think is the important piece.

The other nuances, especially for those who don't normally find themselves in these conversations, is how do you create the space for someone to really open up? And so vulnerability begets vulnerability. So you might consider saying, "You know this past year has been really hard on me. Like, I've struggled with X. How has it been for you?" And as a leader when you're being vulnerable, you're modeling a behavior that you want your employees to reciprocate with.

Then like the third part of this is just to lean in into any discomfort.

If you're having these conversations with others about their feelings or their challenges or their struggles it might feel a little uncomfortable as you're leading it and like just to, to stretch, know that you're creating this space for someone and not to shy away from things when they say, "Oh you know what I'm really having a hard time, you know?"

Vien: If someone feels like maybe they do need professional help, where would you recommend that they start?

Setter: This is another really, really good question. I mean, what I have found is sort of word of mouth is one of the best ways. You can absolutely go to the internet and the research. People have told me, "I found you because I Google-searched 'CPA Coach,'" and they find me and there's value in that.

But what I think the most important thing that I want to let people know on this is talk to more than one person. You know if a prospect comes to me and says they're interested in hiring me, I say, "Go talk to another coach. Go talk to a couple, three." Because whether it's a coach or a therapist you want to feel very comfortable sharing whatever's going on with you, and you want to feel like that person understands you and understands your perspective and can really support you. I think that one of the reasons why I flourish in coaching CPAs is because I've done the work, I know busy season. Like, I get it, I speak the language. And there are things that are challenging. Like, if you're in public accounting and you're in matrix reporting and you’ve got 10 bosses, not one direct boss, that's a totally different conversation.

But, you know, when it comes to "How do I find somebody?," a lot of times what might happen is someone says, "Oh, I have a therapist, they're great, you should use them." And the person goes to the therapist and it turns — like they've never done therapy and they don't realize, well, maybe it's not actually the best fit. So their response is, "Well, therapy's not that helpful." And so that's where I think it's important to do a little of "due diligence" and interview a few people upfront that might be helpful so that somebody really feels they can open up and say whatever they need to say in that space.

Vien: What are some reasons that people and maybe CPAs in particular might be reluctant to seek help?

Setter: Yeah, there are, I would say, three reasons. The top three reasons, number one, they don't even know they need help; that's the number one thing. Usually people who become CPAs you give them, like tell them what to do and they do it and they you know. Like this all you have to do, X, Y, Z and it's like, "X, Y, Z, I can do it." And they're not maybe as practiced in struggling or asking for help.

The second reason is it's a sign of weakness. I'm not huge on generational theory, but what I feel like is a little bit of somewhat of a truth is that [for] older generations this wasn't a conversation that was had. If you went to a therapist you would never tell anybody about it. It used to be in coaching coaches were brought in when people were a problem.

So I think it's like, "Well something's wrong with me if I need this extra help."

The third one, which is my favorite objection to hiring me and this totally doesn’t work, which is, "I don't have time." [Laughs] "I don't have time. Like, I can't go get a haircut during busy season, let alone talk to someone about my feelings for an hour." And I get it, but what I also know is when once people start working with me and they continue to do it they're like, "I need to talk to you today, like the week of a deadline. Like that's when I need it the most. That's when I need to calm the storm. I need to stop if I need to go through my list of priorities or have you help me through having a conversation about telling someone they have a huge tax liability."

It's ROI. They invest an hour, but they energetically or literally get back five hours to their workweek.

Vien: And you’ve said that getting help with these issues can actually help professionals in their careers.

Setter: I think if we think of performance for a knowledge worker as like an iceberg. So the top 10% is the visible, that's what we can see.

So when I was in people development roles, where we're looking at the number of hours somebody works, we're looking did they meet a deadline or not, and then I would be — like I would get an order, “people need time management training. They need time management.” It's like, "OK, I'll go find someone for time management training."

But what I've learned as coach is it's like, "Well, why are you missing the deadline? What's really going on for you?" And that's the 90%, the stuff that we can't see. So reasons why people might miss a deadline is they're a perfectionist. And they might be a perfectionist because, yeah, you want to make sure that people can rely on the work that you're doing, but the issue might be something super deeper than that.

Like when I grew up my parents paid me to get straight A's on my report card. And if I brought a B home, they pointed that to the B and they didn't even acknowledge all the A's that I got. So that's where perfectionism was embedded into me. So that's really where coaching can totally … When someone starts to see, "Oh I have these kind of old…my parents’ voice is showing up in the workplace that I need to be perfect" or “it's weak to ask for help” or whatever, once that unconscious belief system becomes conscious, then they can accelerate in their effectiveness as a leader.

Then they learn how to do different things like let go of perfectionism or to delegate more effectively or to — instead of just being really smart and having all the answers all the time, which gets you somewhat far in accounting, you start to go, "Well tell me more. Tell me about your perspective. What am I not seeing? How do we solve this problem that hasn't existed before?" And helping them to really champion new behaviors that support them in being more effective in their work.

Vien: One thing that's come out of the pandemic is that employers, including CPA firms, are paying more attention to their staff’s mental health. Do you have advice for organizations on how they can foster their employees' well-being?

Setter: So step one is education. What does mental health mean? And then like what are the spectrum of mental health, whether it's just day-to-day or it becomes a disorder. And helping people realize all the variations.

I think also is to normalize it. If you go to the internet and you say, "What are the statistics? How many people experience a mental health issue?" Usually the statistics range from 20 to 25%. So that's pretty high. I mean, one in five or one in four of your employees might be having an issue. And I would say in this year it's probably much higher than that.

So if an organizational leader just operates from the mindset of, "At any given moment maybe 25% of my employees are having a mental health issue."

And then the other piece is just to consider that mental health initiatives are much more than altruistic. This is not like, "Oh, I should do it, and it's nice to have an EAP plan" or "It was really inexpensive to toss that in." There's actually a strong correlation to business performance and the health, the mental health of a knowledge worker. Because if they're experiencing high amounts of anxiety or they are overworking themselves, that is when errors happen, and errors have a cost, a business cost. If it happens and somebody's working on something and a client leaves or there's a penalty related to it or employee turnover.

In our whole life experience we're all going to have times of challenge, you know? When the transitions, becoming a parent, taking care of an aging parent, getting sick, someone in your family getting sick, like there's so many things that are going to happen where maybe you're not at your optimal 100% level. But can we allow someone to contribute at 75% for a period?

Like in my life I went to grad school because I wanted to become greater. I had to take a little detour in career, but my firm was OK with that.

And when I came back at 100% I was all in, because they supported me at something that was important to me, and I ended up being there 10 years, right? So I think when you support people when they need you the most they become your most loyal employees.

Vien: That’s valuable advice for employers and leaders to keep in mind. Again, that was Amber Setter of Amber Setter Coaching in San Diego, reminding you that it’s OK to seek help with your mental health and that doing so can actually benefit your career.

For more information on CPAs and mental health, you can read the Journal of Accountancy article “Depression and the CPA.”

This has been the Journal of Accountancy podcast. Thank you for listening.