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"CE Corner" is a continuing education article offered by the APA Office of CE in Psychology.
To earn CE credit, after you read this article, purchase the online exam at www.apa.org/ed/ce/resources/ce-corner.
Upon successful completion of the test — a score of 75 percent or higher — you can immediately print your CE certificate.
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Overview
CE credits: 1
Learning objectives: After reading this article, CE candidates will be able to:
- Identify the Ethics Code Standards involved in a psychologist’s compromised competence.
- Consider the effects of a power differential when it comes to conflict resolution.
- Discuss the importance of consultation with colleagues around these issues.
Several times a year, “CE Corner” presents a hypothetical ethical situation and asks ethics experts to offer insights on how to address it. Here is this month’s vignette:
Dr. Young is a postdoctoral fellow at a prestigious hospital. She works with other fellows and interns under the direction of the training director, Dr. Jones, a nationally respected senior psychologist and her primary supervisor. Unfortunately, last spring Dr. Jones was involved in a serious automobile accident that left him with some minor motor impairment, concentration/attention difficulties and short-term memory problems. Dr. Young has noticed that on several occasions her supervisor has appeared tired, unprepared and rambling in response to questions.
In addition, he's often irritable and impatient with the other fellows and interns, repeats questions and sometimes discloses his patients' names when discussing his psychotherapy. Dr. Jones also recently missed two research team meetings, and Dr. Young had to abruptly step in to help out with research assistants on an unfamiliar project. Yesterday, she overheard the receptionist mention that he'd missed another patient appointment. Dr. Jones is frustrated by these impediments but responds defensively at the slightest hint of criticism, often verbally attacking the accuser. He recently confided that he is suspicious some other hospital psychologists are envious of his success and intent on undermining his department position, and that he'll take legal action against anyone to protect his reputation. The hospital is aware of his accident and struggles but has decided to let him continue to work to save his job, especially given his national prominence in his field.
Issues of competence
First and foremost, this month's vignette deals with the issue of a compromised senior psychologist, says Matthew Zimmerman, PsyD, director of training at the University of Virginia's Counseling and Psychological Services Center.
"Through no fault of his own, Dr. Jones seems to have suffered an injury that is compromising his ability to perform his daily job duties," Zimmerman says. "There are questions as to whether or not he's taking in information adequately and problems in the way he's expressing information, creating unsafe therapy and supervision environments."
This case requires guidance from APA's Ethics Code Principle A: Beneficence and Nonmaleficence, which instructs psychologists to "strive to benefit those with whom they work and take care to do no harm."
Further, there are several areas of the code that this case also touches on in terms of competence, says APA Ethics Committee member Nan Presser, PhD, a psychology professor at the University of Missouri–Columbia. For example, per Standard 2.06: Personal Problems and Conflicts, when psychologists recognize that they may be experiencing personal problems that could interfere with their work, they should suspend their work or take measures to make sure that no one is harmed, Presser says. This can happen, for example, if a psychologist is going through a divorce and doesn't want to work with couples or if a psychologist realizes that he or she has developed a substance abuse problem and needs to seek treatment.
What makes this case particularly tricky, however, is that Dr. Jones is not aware that he has a personal problem, Presser says.
Also complicating the competency issues are the power dynamics between Dr. Young and Dr. Jones, says University of Maine psychology professor Rebecca Schwartz-Mette, PhD. "Dr. Jones has power over her, but she's the one who is seeing things very clearly, and she doesn't have much power to make a change."
Dr. Jones's actions have also put himself and Dr. Young at risk of violating Section 2.01: Boundaries of Competence when she steps outside her area of expertise to assist the other researchers on an unfamiliar project as a result of Dr. Jones's absence, Presser says. That section also states that psychologists can delegate responsibilities to a supervisee only when he or she can competently perform them, she says.
"Dr. Jones failed to assess whether or not Dr. Young should be taking over the research team, and he failed to provide adequate supervision on whether or not she did a competent job," Presser says. "That affects not just Dr. Young, but the others on the research team that she was supposedly managing."
Other relevant issues
Zimmerman notes that Principle B: Fidelity and Responsibility is also pertinent in this case. This principle states that psychologists should establish relationships of trust with those with whom they work. Dr. Jones is not in a position to do this now, given his irritability and short-term memory issues, Zimmerman says.
Finally, Section 1.03: Conflicts Between Ethics and Organizational Demands is likely going to play out prominently in this case. "The hospital has said that they're going to let Dr. Jones keep his job because he's in a position of prominence, and that could be an ethical issue, but it also has a liability and legal component because his behavior potentially is putting patients, trainees, the hospital as well as the profession at risk," Zimmerman says.
How to proceed
As for how Dr. Young might proceed in this case, the power differential should certainly be kept in mind, says Terry Gock, PhD, director of Pacific Clinics' Asian Pacific Family Center in Los Angeles. Zimmerman agrees, adding that the way an intern or postdoc will handle this situation will differ from the way a licensed peer will because "there's a safety issue for the trainee and the supervisor is clearly compromised in a way that's going to affect her supervision and evaluation."
Standard 1.04: Informal Resolution of Ethical Violations requires psychologists who believe they've witnessed an ethical violation by another psychologist to attempt to informally resolve the issue by bringing it directly to that individual's attention. Given the supervisor-supervisee relationship in this case, informal resolution may be difficult. But Gock suggests that Dr. Young consider asking Dr. Jones, in a nonconfrontational way, whether there might be a better time of day for holding supervision and research team meetings. "Perhaps earlier in the day may be better for supervision because maybe Dr. Jones would be more alert and less tired," Gock says.
If an attempt at informal resolution doesn't feel safe, however, ethical experts advise Dr. Young to consult with licensed psychologist peers of Dr. Jones or the director who oversees him. She could also contact the director of training in her home academic department to get a consultation, Presser says, since he or she would be aware of the ethics of the situation and be concerned about the quality of training for his or her students.
"Basically, she should go to whomever she feels comfortable with, trusts, and who has knowledge of the ethics and the mission involved," Presser says. Zimmerman also suggests that Dr. Young consider getting input from other trainees in her cohort since they are similarly used to negotiating challenges in the context of power differentials and may have helpful advice, he says.
During the consultation, it's important for Dr. Young to express her concerns, as sensitively as possible, about the hospital continuing to have Dr. Jones take on his normal duties and the ethical conflict and safety issues it is creating for her, Zimmerman says. The goal, he adds, is to develop compassionate allies who are Dr. Jones's peers. These allies may be able to encourage the hospital to request that Dr. Jones undergo neuropsychology testing and perhaps shift some of his duties until the nature of his cognitive deficits is better understood.
"Perhaps it's taking him out of direct contact with patients for a while, with the intention being that his long-standing reputation wouldn't be harmed in all of this," Zimmerman says.
Dr. Young could also request a change in supervisor, says Schwartz-Mette. "She would be better served if she were supervised in a healthy environment without the fear of retribution, verbal attack or erratic behavior," she says.
If an informal resolution to this case cannot be reached, however, Standard 1.05: Reporting Ethical Violations is the next step, Zimmerman notes. "I'd suggest consulting with the APA Ethics Office, since with ethics it is often the shared subjectivity that leads to more clarity with such decisions," he says. If reporting the issue seems to be the only step possible, he suggests reaching out to the hospital's ethics board before going to the state board. "Going to the latter first could cause problems for the institution and Dr. Young that might be unnecessary if going to the hospital ethics board might resolve it, thereby negating the need to take it further."
