Even the best of students can miss a deadline. But what if a student is perpetually tardy, appears to be just skating by or doesn't quite grasp the specifics of personal-professional boundaries?
Such behaviors among psychology graduate students are uncommon. But for a handful of students, they are a serious problem — and if they persist, they may lead to professional problems that could harm future clients.
Although there is no specific research linking psychology student behavior problems directly to their success as psychology professionals, research in the medical community confirms that physicians who had been disciplined by licensing boards were more likely to have had negative comments regarding professionalism in their medical school files (Academic Medicine, 2004).
"Professionalism is the area of competence where psychology students often have the most difficulty, but it is also the hardest to quantify and the most challenging for faculty to address," says APA President Nadine J. Kaslow, PhD, a professor at the Emory University School of Medicine.
Not respecting the confidentiality of personal information shared in the classroom and not following through on homework assignments are some of the indicators that students might struggle with professionalism upon graduation, she says. Once graduates enter the field, it can get worse: Work stressors, lack of social support, compassion fatigue and the deterioration of knowledge are just a few of the obstacles that influence competence and cloud the ability to self-assess.
A group of psychologists and educators, including Kaslow, have started to address such issues. In a 2012 American Psychologistopens in new window article, the group proposed a new approach to professionalism, emphasizing that both an individual and the psychology community are responsible for competent work and ethical practice.
How to get there, however, is so far unclear.
"How do we all be responsible not just for our competence but also for that of our colleagues, in a way that is ethical but also kind?" asks Kaslow.
Many roots of the problem
Some professional competence problems stem from the graduate training system, in which professors can be tempted to pass marginally competent students to the next level, hoping problems will be addressed during internship or by the licensure board, says W. Brad Johnson, PhD, professor at the U.S. Naval Academy, who has authored books on mentoring and professional ethics in psychology.
"We call it the hot-potato game," he says. "We still have great difficulty in psychology and other mental health disciplines with passing the buck. Graduate programs are slow to document and slow to intervene."
That's in part because mental health professionals tend to be developmental and humanistic in nature, he adds. "There's always the hope of improvement. The downside is that occasionally we let these problems go on to the next level."
Competence problems may also arise simply because students go to graduate school straight from undergraduate programs in their early 20s without first gaining any other work experience.
"A lot of problems of professionalism arise as a result of the development stage or lack of socialization into the profession," says Rebecca Schwartz-Mette, PhD, a psychologist at the University of Wyoming who has explored the roots of graduate students' problems with professional competence. "All of a sudden, they are expected to adopt a professional identity that many of us have had years to hone."
Another possible cause of student problems is psychology's tradition of self-assessment. Historically, psychologists have been responsible for their own competence, says Kaslow. Even APA's Ethics Code remains silent on the role of community assessment of competence. "That comes from a very Western, individualized approach, and unfortunately we are not very accurate in self-assessing our competence," Kaslow says.
Self-assessment bias in the workplace is a phenomenon of human nature confirmed many times by researchers, and psychology professionals are no exception. A 2012 Psychological Reportsopens in new window study found that no participating mental health professional ranked himself or herself as below average compared with peers, and that 25 percent of participants ranked themselves above the 90th percentile.
Solutions
Kaslow and her group followed up on their American Psychologist article with a 2013 article in Professional Psychology: Research and Practiceopens in new window describing a competence constellation model, which calls on the community to support psychologists' growth. This constellation includes fellow psychologists, personal psychotherapists, supervisors, consultation group members, family members, clergy and others who are committed to the psychologists' professional success.
"Our hope is that the model will be infused progressively into the culture of training," says Johnson. "I'm not aware yet of any programs that are beginning to adopt this approach, but that's our hope and we'll keep at it."
In the meantime, APA's accreditation process is also working to improve professionalism through proposed new guidelines that would require educational programs and internship sites to provide students with written feedback about the steps necessary to remediate problem behaviors.
"We are finally beginning to treat this as a system problem," says Nancy S. Elman, PhD, another author of the competence constellation model and former training coordinator for the doctoral program in counseling psychology at the University of Pittsburgh. "If the policies are not in place, you cannot correct the problem after the fact."
Change must also come from the bottom up, starting in the graduate classroom, where students often first learn to look the other way when they see their teachers ignore problematic behavior among their peers, Elman says. By teaching students to monitor their peers and by holding all students accountable to professional standards, educators can help difficult conversations become learning opportunities for their trainees over time.
"If we do this right at the training level, we can make it more possible for psychologists to suffer fewer competence issues across the lifespan of practice," says Elman. "But if we don't do it at the training level, then it is more likely that a psychologist will be in trouble 10, 20 and 40 years out, and that colleagues will be less able to intervene in helpful ways."
Kathleen Smith is a journalist and family systems therapist in Washington, D.C.