A psychologist friend of yours is undergoing a divorce so wrenching, you sense she can barely get up in the morning, let alone provide effective therapy.
A colleague in your building stumbles as he walks down the hall, and you smell alcohol on his breath.
You’ve heard that an older colleague has become forgetful, sometimes seems confused and has even fallen asleep during a session.
How do you ethically handle such scenarios?
APA’s Code of Ethics requires psychologists to recognize when their own personal problems might interfere with their effectiveness and take action. But when it’s someone else who has the problem, knowing what to do can be difficult.
“On the one hand, people want to do something; on the other, they don’t want to get someone in trouble where they might lose their license,” says Michael O. Ranney, executive director of the Ohio Psychological Association. “For many people, it’s a difficult ethical dilemma — what to do and how to do it.”
The approach Ranney and other experts recommend? Step in early and take advantage of a colleague assistance program or other forms of help offered by your state, provincial or territorial psychological association (SPTA). Reporting someone to the state licensing board should be a last resort, they emphasize.
Getting other psychologists the help they need is an ethical duty just like getting help for yourself, says Stephen Behnke, JD, PhD, director of APA’s Ethics Office.
“All of our training, all of our experience is to promote health and well-being, and that should begin in our own community of psychologists,” he says. “It absolutely should be an ethical responsibility that we take on as psychologists to be that supportive community to our colleagues in distress.”
Stopping problems before they escalate is key, Behnke and others agree.
One way to do that is to develop and maintain a network of social relations with other psychologists, says Sam Knapp, EdD, director of professional affairs at the Pennsylvania Psychological Association. Work on meeting your colleagues and reach out to them in good times and bad.
“If you find out that a colleague has just had a death in the family or a divorce or some kind of event like that, send them a card or call them up and express condolences,” says Knapp. “Ninety-nine percent of the time they’re not going to slip into impairment, but they’re going to appreciate it and feel that they can confide in you about other things.”
It’s not just personal issues that can cause problems, he adds. A patient’s suicide, for example, could plunge a psychologist into depression.
Once other psychologists become comfortable with you, says Knapp, they might ask for a referral for therapy or substance abuse treatment. They might seek consultation on a case they’re having trouble with. Or they might just want someone to talk to.
APA’s Ethics Code urges psychologists who believe a peer has committed an ethical violation to bring the issue to that person’s attention and attempt to resolve the problem via an informal intervention.
In some rare cases, says Knapp, an informal resolution clearly won’t work. “Every once in a while, a psychologist has a psychotic episode and has to be involuntarily hospitalized for psychosis,” he says. “If someone is in a flagrantly psychotic state, it’s easy to say they can’t practice.” In other cases, it can be trickier to draw the line.
But you’re not on your own when it comes to helping colleagues in distress.
At least 11 SPTAs have colleague assistance programs, and there may be even more, says Susan Lazaroff, JD, staff liaison to APA’s Advisory Committee on Colleague Assistance (ACCA). The committee, which assists SPTAs that want to establish or re-energize programs and provides self-care resources, is in the process of identifying which SPTAs already have colleague assistance programs.
These programs can provide advice, support and referrals to troubled psychologists and promote self-care so that problems don’t get out of hand. If things have already escalated to the point where a complaint has been filed, programs may also provide services to psychologists referred by their state licensing boards.
The help that colleague assistance programs provide is confidential, so psychologists don’t have to worry they’ll be turned in if they turn to them for assistance. “Once a person makes contact with the program, they are in essence in therapy,” explains Ranney, who predicts that the Ohio Psychological Association’s new program will debut some time this summer.
But colleague assistance programs aren’t just for psychologists who are distressed or impaired. They can also help if you’re concerned about someone else.
“These can be delicate conversations,” says private practitioner James R. Oraker, PhD, founder and co-chair of the Colorado Psychological Association’s Peer Assistance Liaison Committee.
Oraker, who is helping the Ohio Psychological Association and others launch colleague assistance programs of their own, sometimes gets calls from psychologists who are concerned about peers but don’t know how to approach them. He’s happy to offer advice on whether a situation warrants intervention, how to respond and the best way to approach the individual and frame the conversation.
Psychologists should already know what to do, adds Ranney. “It’s almost like a therapy session,” he says. “You’re being friendly and professional, sharing your observations and seeing what they’re feeling and noticing.”
A last resort
How do you know when it’s time to act? Knowing the difference between distress and impairment is critical, says Knapp.
“There are some people who are distressed about something, but they are able to do their jobs,” he points out. “Obviously we want to help those people, but it’s a personal issue that doesn’t impact how they deliver their services.”
And just about everyone is impaired some time, he says. You might be halfway through a day of therapy sessions when the flu suddenly strikes, for example, and you find yourself too sick to function effectively. The kind of impairment that warrants attention is “consistent patterns of incompetent performance,” he says.
Some states, including Ohio and Pennsylvania, have laws mandating that psychologists and other health-care professionals report colleagues to the state licensing board if they’re impaired and aren’t doing anything about it. And APA’s Ethics Code requires psychologists to take further action if an ethical violation has harmed or is likely to harm others and an informal resolution either hasn’t worked or isn’t appropriate. The right response then might be to report the individual to a state or national committee on professional ethics, institutional authorities or the state licensing board, the code says.
But reporting someone to the state board or other authorities should always be a last resort, Behnke and others say.
Says Behnke, “I would hope that involving the licensing board is always the last step and — while sometimes appropriate — only follows other supportive and creative ways for us to act as a caring community to our colleagues who are in distress.”
Rebecca A. Clay is a writer in Washington, D.C.