Gather a group of psychology graduate students together and it's likely that they can name a student or intern peer whose behavior made them worry about the well-being of his or her future clients. A student who appeared severely depressed, who drank too much or experimented with drugs, who obsessed over his or her weight or showed signs of a personality disorder--problems so cumbersome that they interfered with not only the student's own training and performance, but perhaps the morale and productivity of the whole program.
"It's a small number of students, but a consistent number that can take up an enormous amount of time and emotional energy," says Nancy Elman, PhD, an associate professor of psychology at the University of Pittsburgh who has researched distressed and troubled psychology trainees.
In a review of the professional literature on troubled graduate students, Elman and her fellow researchers found that nearly every psychology graduate program reports having at least one troubled or distressed student every three-to-five years. Pair that statistic with the fact that graduate students spend more time with each other than faculty do, and are thus more likely to spot students who may have mental health problems.
Unfortunately, many students don't know whether they should intervene, and many do nothing at all.
"Students often don't know what to do with their concerns," says Carol Williams, executive director of the American Psychological Association of Graduate Students. "They are fearful, too, wondering, 'Are my classmates going to faculty with concerns about me when I am just fine?'"
But there are ways students can--and should--intervene depending on the situation, say faculty and supervising psychologists. In fact, they say, learning how to address such circumstances is an important part of students' professional development. Indeed, it's an issue students will encounter throughout their careers since psychologists--being human themselves--are not immune to mental health problems and troublesome behaviors, says Kathi Borden, PhD, president of the National Council of Schools and Programs of Professional Psychology.
"Seeking assistance and learning to deal with troubled students rather than just ignoring them is something that will serve students well throughout their entire careers," Borden advises.
A professional responsibility
Nadine Kaslow, PhD, chair of the Association of Psychology Postdoctoral and Internship Centers, recalls a site visit where several interns were immensely relieved because a problem intern had recently left the program.
"Students with interpersonal difficulties can cause all sorts of problems for other students," she says. "Students are proud of their profession and they really want it to be well-represented by the people in it."
Often enough, however, students do not appropriately address the problems they see. An exploratory study of seven training programs by Phillips Graduate Institute psychologist Joan Rosenberg, PhD, and three graduate students at the University of Southern California revealed that most students who worried about a distressed peer reported that they shared their concern only with other students, they withdrew from the troubled student or they did nothing.
By not acting on their concerns, students are not fulfilling an important professional obligation, say faculty and supervisors who study the issue of trainee impairment.
"As psychologists, we often have to give people feedback, and we need to be assertive and direct and communicate with people about problems," says Borden, who is also associate chair of the department of clinical psychology at Antioch New England Graduate School. "This is a good way to learn how to do that."
What's more, like psychologists, psychology graduate students are expected to follow APA's Ethics Code. The code states that psychologists have a professional responsibility to be concerned about their colleagues' scientific and professional conduct. It is also advisable to consult with knowledgeable colleagues in order to prevent or avoid unethical conduct.
That said, when it comes to peer assistance, often students haven't learned what to do with their concerns, or whom to consult, says Elman, because faculty may not teach them.
"Part of it is, faculty hope it won't happen, or they are so busy with other responsibilities that we hope we can cross that bridge when we come to it," says Elman, who, along with Michigan State University colleague Linda Forrest, PhD, regularly speaks to faculty and training directors across the country about how to handle distressed and problem students. "I also think faculty don't want to raise anxiety among students."
Faculty may discuss colleague assistance in an ethics course, says Elman, but are more apt to focus on the practicing psychologist than the trainee.
She adds, "I don't think many faculty are entirely clear on the role a student should play with other students...but to their credit, I think faculty are beginning to think more about this."
How to help
APA's Executive Director for Education Cynthia Belar, PhD, points out that there's no one way to intervene when a student seems troubled and may need help. But she and other faculty offer the following advice:
Take it to a trusted professor or supervisor. Just as a faculty member or supervising psychologist would most likely seek the advice of a fellow instructor or psychologist if he or she were concerned about a colleague, students can take their concerns about a peer to a trusted faculty member or supervisor who can help them develop a course of action, says Borden.
"I have heard of situations where what a student thought was an ethical violation turned out to be a difference of opinion," Borden recalls. "Consulting with faculty first can help students get a sense of whether or not they should move forward."
Talk to the student. Another option students have is to explain their specific concerns to the peer they are worried about in a direct, caring way, says Elman.
"Listen to them, and give them a chance to open up and a chance to seek help," she says. "If that doesn't solve the problem, let the student know you are going to a faculty member."
Be specific about your concerns. When approaching either a student or a faculty member or supervisor about a troubled peer, says Elman, a student should be very specific about exact behaviors that occurred, settings, who was involved and what happened.
"The worst thing students can do is diagnose their peer--they are not in a position to do that," she says, adding that students may also want to use the meeting as an opportunity to ask for more training on peer assistance.
Follow through. If a student is worried that his or her concerns haven't been addressed, Elman suggests scheduling a second meeting with the faculty member or supervising psychologist, and encourages students to put concerns in writing. "And if necessary, go to an administrator, but exhaust all local efforts first."
Respect the confidential nature of the situation. Students should understand that when they share concerns with a faculty member or supervising psychologist, they may only get feedback on their concerns--not concrete information on the student, Borden points out.
"Faculty have to respect the confidentiality of students," she says. "If a faculty member is aware that a student is about to be asked to leave the program, they can't share that with another student."
Not to say that leaving the program is the only option for troubled students, adds Elman. Many troubled students can be helped through a careful remediation plan, she says, which might include additional supervision, time off or personal psychotherapy, depending on the nature of the problem.
Recognize when you might be wrong. Students may also be told they have misjudged the situation, says APA's Belar.
"Not all concerns may be as concerning as students think they are," she says. "And then, sometimes they are far more concerning than students think they are."
That's why it's important for concerned students to come forward about a distressed peer, Borden points out, even if they aren't sure how serious a problem is.
"There is nothing for students to be embarrassed about," she says. "They are learning what's OK and what's not OK," she says. "It's often a hard initiation into the role of a psychologist."
In fact, faculty and training directors struggle with how to handle troubled and distressed peers as much as students do, Belar explains, because each case is complex, sensitive and time-consuming. "The situation is always different and it doesn't happen frequently enough that anyone gets to be an old pro at handling it."
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