Degree In Sight
Janine Delardo knows firsthand how stressful graduate school can be. At the beginning of her master's program, school and life pressures nudged her into a depression so severe she had to take a semester off to get help.
"Stress is a big part of grad school," says Delardo, now a fourth-year psychology student at Chestnut Hill College in Philadelphia. "Although we're being trained to help people with their lives, that doesn't make us immune to problems."
Delardo is the American Psychological Association of Graduate Students (APAGS) representative to APA's Advisory Committee on Colleague Assistance (ACCA).
Whether the issue is depression, drinking or something else, impaired students can derail their training, monopolize faculty's time and reflect poorly on their departments. At worst, patient care can be compromised. And although fellow students may recognize problems before faculty do, many don't know how to react to a peer's impairment. Others may be reluctant to intervene in what can be awkward situations.
"It can be troubling and upsetting to see classmates in distress," says Stephen Behnke, JD, PhD, director of APA's Ethics Office. "Psychology has a good deal of work to do in examining how best to address impairment among our colleagues. It's completely understandable that students may feel overwhelmed or not know how best to respond when a classmate is struggling with a potentially serious disorder or addiction."
But, say Behnke and others, psychology graduate students can help their troubled peers.
Student impairment is an issue that psychology departments face frequently, says University of South Dakota psychology and MBA student Matthew N.I. Oliver in a 2004 article in Professional Psychology: Research and Practice (Vol. 35, No. 2, pages 141-147). Oliver's survey of 46 students in clinical training programs found that most were confused about what to do when peers have problems. They also resented faculty who ignore such situations.
Students and faculty alike may be reluctant to intervene, admits ACCA Chair Roberta L. Nutt, PhD, director of the counseling psychology program at Texas Woman's University in Denton.
"Whether they're faculty or students, they're not quite sure how to go about it without giving offense or making the person angry," she says.
Getting involved can also be stressful, adds Nutt. Students may distrust their own judgment, she says, or worry about snitching on a friend and getting that person in trouble.
However, students themselves are often better positioned than faculty to recognize trouble, says ACCA member Jeffrey Pincus, PhD, a private practitioner with Riegler, Shienvold and Associates in Harrisburg, Pa.
"Students are more likely to talk candidly about personal issues with each other than with faculty," he says. "And they spend much more time with each other."
WHAT TO DO
So what should you do if you suspect a peer's in trouble? Here's some advice from ACCA members and others:
Assess the situation. Instead of relying on feelings or suspicions, focus on specific behaviors. If it's just one incident, you might hold off on acting until you determine there's a clear pattern. Also consider how the problem is affecting the student's studies or clinical work.
Get advice. Students often doubt their own ability to recognize impairment. "We haven't had a huge amount of training," says Delardo. "We may question ourselves or be quick to just let things slide."
Don't deal with the problem in isolation, say Delardo and others. Check whether your department has a written policy on student impairment and get a second opinion by consulting a psychologist or professor. Without naming names, describe the situation and ask for guidance.
In fact, Behnke points out, APA's Ethics Code encourages psychologists to consult with colleagues.
A trusted professor or university ombudsman, for example, can help you determine whether you might talk with the peer yourself or if the situation is serious enough-if patient care is being affected, for instance-to turn the matter over to your department.
Be empathetic. If you decide to approach the peer, do so in private and be compassionate rather than confrontational. Express concern about the problem, share your behavioral evidence and say you'd like to follow up in a few weeks to make sure the person has been evaluated or started treatment.
"Say 'We're in such a stressful situation, it's certainly understandable that this is happening,'" suggests Ronda L. Dearing, PhD, a research scientist at the Research Institute on Addiction at the State University of New York in Buffalo. "Then say, 'But because of those demands, it's important to act now rather than letting things get worse.'"
Recognize that you might be wrong. Give the peer the benefit of the doubt, adds Dearing. There may be some other explanation for the behavior you've noticed, such as prescription medication that could make someone groggy and seemingly depressed. Remember, too, that a person may already be getting help if they really do have a problem. And there's always the chance that your diagnosis is just plain wrong.
Respect confidentiality. Like many insular communities, graduate programs can be rumor mills, says Delardo. Be discreet when talking to the impaired student and respect confidentiality when talking with others. Also keep in mind that faculty who become involved in the case can't give you information about the student.
View the situation as part of your professional development. Although intervening with a troubled peer can be stressful, remember that it's great preparation for handling similar situations once you're out in practice. "Graduate school is an excellent time to learn how to handle these situations," says Dearing. "You've got all these resources to help guide you that you may not have later on."
A LONG-TERM PLAN
Of course, it's easier to intervene when a crisis hits if your department already has programs and policies in place to handle impairment. But many don't.
In fact, APAGS chair-elect Kristi Sands Van Sickle, many departments lack programs that ensure psychology graduate students' access to therapy. That's a problem, since many students can't afford care on their own or avoid campus services because their own professors and peers are the ones providing therapy.
Van Sickle helped do something about that in her department at the Florida Institute of Technology.
"I'd done an anonymous survey of our program's students, and it was clear they wanted access to services," says Van Sickle, now a psychology intern at the James A. Haley Veterans Affairs Medical Center in Tampa, Fla. That led to a task force that compiled a list of local providers who agreed to offer reduced student rates. One provider even agreed to waive co-payments for students with mental health coverage.
Departments also need policies, suggests Nancy S. Elman, PhD, an associate professor of applied developmental psychology at the University of Pittsburgh, in a 2004 article in Professional Psychology (Vol. 35, No. 2, pages 123-130). She recommends that departments establish written policies regarding the way psychotherapy can be recommended or required as part of remediation plans for impaired students.
Janine Delardo is happy to see her own department moving in that direction. Because of past incidents, she says, faculty members are developing formal policies about peer impairment.
"As students we're under so much pressure to keep working toward our goal of being psychologists we sometimes forget about our own health," she says. "If someone I had a close bond with had reached out to me, I would have appreciated it."
Rebecca A. Clay is a writer in Washington, D.C.