When Jim Oraker, PhD, needed help in 1988 for a problem threatening his counseling practice and possibly his career, there was no organized program he could turn to for assistance.

So the Colorado psychologist started his own personal colleague-assistance program, seeking counseling and remedial training after cold-calling psychologists who might be able to help him.

Years after surviving the professional ordeal-involving a complaint from a client and a probationary period ordered by his state's licensing board-Oraker now co-chairs the Colorado Psychological Association's Colleague Assistance Program (CAP).

As part of that position, he also serves as the CPA liaison to Colorado's state licensing board, assisting the board in its mission of serving the public.

The CAP is held up as a good example by APA's Advisory Committee on Colleague Assistance (ACCA) for other state associations building programs for psychologists seeking to get their lives and practices back on track. A CAP is an organized effort to aid distressed psychologists and promote self-care within the profession.

Three or four times a month, a call from a distressed psychologist comes to Oraker's office, routed to him from the Colorado Psychological Association. Sometimes it's someone who knows a client is filing a complaint against him or her with the state licensing board; other times it's a psychologist facing mounting personal problems or struggling with business and financial problems.

In a typical month, one of the calls may require a senior psychologist's full-scale intervention in a psychologist's personal or professional life. If it's a personal problem, a referral list is available and therapy can be scheduled. If it's more of a business problem, a senior psychologist can be called in to meet with the psychologist about how to get better organized. If a client files a complaint, the assistance program can help the psychologist write an account of the incident to file with the state licensing board. Colorado's program maintains a cadre of about 20 senior psychologists who can help, Oraker says.

Whenever he gets a call, Oraker tries to schedule a meeting with the psychologist within hours or by the next day to start understanding what the problem is and how the program can help.

"Oftentimes, we'll just meet in a coffee shop and just start talking. The first interview is to kind of quell their fears and assure them we have people who will stick with them," he says.

Oraker emphasizes that the program isn't just for psychologists in serious trouble; it's generally meant to support and assist psychologists across all areas of their lives, as personal troubles that become overwhelming can impair a psychologist's professional work. He notes that volunteers from the program give presentations and write articles on self-care as part of an effort to help all psychologists take care of themselves better.

Building interest in CAPs

Besides his involvement with Colorado's CAP the past 10 years, Oraker chairs ACCA. To encourage more state associations to establish colleague-assistance programs like Colorado's, ACCA, working in collaboration with the Association of State and Provincial Psychology Boards (ASPPB), produced a monograph this year examining existing programs.

Three years ago, the report's writers found that about half of the 60 state and provincial associations were maintaining a colleague-assistance program, says Lynn Bufka, PhD, director of professional development demonstration projects in APA's Practice Directorate.

As described by the report, the kind of assistance a psychologist might need, ranging from self-care to treatment, will lie somewhere on a continuum and vary depending upon what the psychologist is experiencing. The continuum starts with the everyday stress of practicing as psychologist, and can escalate to:

  • Distress--an experience of intense stress that is not readily resolved, affecting well-being and functioning, or disruption of thinking, mood and other health problems that intrude on professional functioning.

  • Impairment--a condition that compromises the psychologist's professional functioning to a degree that may harm the client or make services ineffective.

The report emphasizes the need for preventive features in a CAP to help individual psychologists recognize when they're facing problems in their personal lives.

"The goal is to catch professionals at the top of the 'slippery slope' before harm to self or others has occurred and problems are easier to treat or solve," the report states.

The monograph describes what state associations should consider including for an effective colleague-assistance program, such as a liaison between an association and its licensing board, a "go-to" person with the association to take calls from psychologists, and the means to assess, treat and monitor psychologists who seek help.

Colorado's effort is a good example of how an effective CAP is organized, Bufka says.

"There's a good relationship with the licensing board, and they've trained senior psychologists to serve in the program," she says. "It's a well-developed and integrated program."

ACCA hopes the monograph will prompt leaders of state and provincial associations without CAPs to establish their own programs, Bufka says.

In addition to offering a route for distressed psychologists to get help, a CAP helps promote the idea among psychologists that if they're concerned about something that might develop into a larger problem, there are people they can talk to and resources they can draw on, Bufka says.

"If you have a concern about something, it's best to do something about it early," she notes.

The question of how much need for a CAP exists among psychologists is not clear, but work done by John C. Norcross, PhD, a University of Scranton psychology professor who has studied distress among psychologists, offers some clues. Norcross is writing a book with James D. Guy Jr., PhD, about self-care for psychotherapists.

According to their survey of studies on psychologist distress, 2 to 6 percent of psychologists report experiencing burnout at any given time. And about one-third of psychologists report having experienced problems such as burnout, substance abuse, anxiety or depression to a degree serious enough to interfere with, but not necessarily impair, their work at one time during their career, he says.

That level of distress is comparable to what's experienced by the general public, Norcross notes. His review of the research shows that psychologists do not tend to seek out colleague assistance programs for help, preferring instead to rely on their own resources. Indeed, some associations with CAPs report only a handful of psychologists coming forward for help annually. Why might that be? Many cite concerns about confidentiality and worries about how their license to practice could be affected, Bufka notes.

"We tend to not seek out the very services we heartily recommend to our patients," Norcross says.

ASPPB Executive Director Stephen DeMers, EdD, who served for eight years on Kentucky's licensing board, says greater efforts are needed nationwide to reach psychologists and get them assistance-before their problems escalate into a situation that lands them in front of a licensing board.

"A well-run CAP with an emphasis on early identification and prevention can provide a safety-net for practitioners to realize they have a problem," DeMers says.

Some come for help; some sent for help

Back in Colorado, Oraker says psychologists come to the program's attention via two routes: a self-referral, meaning a psychologist decides on his or her own to call for help, or through the state's licensing board acting on a complaint filed by a client.

In self-referral cases, the program often connects the psychologist to a senior psychologist who can perform an in-depth assessment of whatever problem brought the psychologist forward. If the psychologist is having problems with business practices or record-keeping, the senior psychologist can act as a mentor, helping better organize the practice's business affairs, Oraker says.

As part of an agreement worked out with the licensing board, self-referrals by psychologists to the program are confidential unless the psychologist engages in criminal behavior or is continuing a pattern of behavior that might threaten a patient's care.

If a case is referred to the program by the licensing board, the program evaluates the psychologist's professional training and personal problems. Depending upon what the board stipulates through its disciplinary process, the psychologist might have to undergo therapy, have their work with patients supervised by a senior psychologist, complete additional training and education or have their business practices evaluated during a probationary period lasting two to five years.

Len Tamura, PhD, who finished an eight-year stint on the state's Board of Psychologist Examiners in June, explains that psychologists who agree to stipulations involving monitoring must submit the names of three possible monitors to the state psychology board from a list of about two dozen senior psychologists trained as monitors by the Colorado CAP, Tamura says.

The licensing board has final approval on the psychologist's monitor pick, he says, and relies on regular reports from the monitor to determine when to let the psychologist begin practicing independently at the end of the probationary period, Tamura says.

One psychologist's experience

One Colorado psychologist who has been through the board's discipline process, but didn't want to be named, says having someone to talk to during the months-long process helped him get through the "nightmare" of facing a complaint.

The psychologist said the situation started when a divorcing couple brought in their two children as clients. Owing to their young age, he talked with their mother during the course of counseling, updating her on their progress in the therapy following sessions.

At roughly the same time, the psychologist volunteered as a small-group facilitator for a local church's divorce recovery program, which he had gone through following his own divorce. He was one of two leaders for a group of about 10 people.

On her own initiative, the children's mother had signed up for the program, and program organizers assigned her to the psychologist's discussion group. Subsequently, the woman's estranged husband filed a complaint against him with the board. Because the psychologist didn't switch her to another group, the board found that he had committed a boundary violation, he says.

In its stipulation order, the board said the psychologist admitted that there had been other contact with the woman within six months of termination of counseling, such as a time he dropped by to help her move furniture and another when he attended what it described as a party at her home.

The psychologist says most of the contact was related to activities of the divorce recovery group and admits that all his subsequent troubles-including the ordeal of facing the complaint, thousands of dollars in counseling fees and lost income-could have been averted if he had not been in the same counseling group with her.

"Once that initial boundary was crossed, it opened up the door for other things," he says. "I think conclusions were drawn that were exaggerated from what took place. I can look back and see where I could have done things differently," he says.

The CAP mentor he met with after he was notified of the complaint explained what was going to happen next, says the psychologist, who particularly remembers the moment he met with his board-ordered practice monitor following a review of his records.

"When he completed the practice evaluation and sat down with me to give me some feedback, I knew that this was going to be okay," he says. "For the first time in the whole process, I gained some reassurance that this wasn't the end of my career."

In addition to a trained group of senior psychologists available for monitoring, the Colorado CAP offers a confidential route for psychologists to confront personal and professional problems before those problems result in a compliant filed by a client, Tamura says.

If a complaint is filed in Colorado, possible sanctions for a violation range from a confidential "letter of concern" placed in a psychologist's file to revocation of license, Tamura says.

According to the ASPPB, most state licensing boards can decide to issue a psychologist a private warning, impose stipulations allowing a psychologist to continue practice with conditions, or suspend or revoke a license to practice.

Last year, Colorado's board dismissed 37 complaints against psychologists. It also issued 12 letters of concern, five letters of admonition and imposed stipulations on three psychologists.

From his perspective, the CAP helps the board fulfill its mission of protecting the public from impaired psychologists.

"This is an avenue for psychologists, before they become impaired, that they can seek help and get help," Tamura says.