Impairment

Impairment is the inability to practice in congruence with professionally defined and accepted standards of care. Impairment among trainees and professionals is a problem within psychology and counseling. Surveys have revealed that up to 10% of professional psychologists reported difficulties with depression, alcohol and other substances, relationship problems, and physical illnesses, all of which significantly interfered with their carrying out their responsibilities with their usual level of skill and ability.

Ethical codes of counselors and psychologists mandate that professionals practice with the highest levels of care and obtain supervision or intervention when their own concerns and difficulties interfere with meeting this standard set by the codes. It is important to distinguish between distress and impairment in considering the topic of impairment. Many psychologists and counselors experience difficulties in their own lives that, while distressing, are not of sufficient impact to negatively affect their work. Impairment, however, typically denotes a significant level of distress that interferes with the ability to competently care for clients, complete necessary and appropriate documentation, and so on. Individuals who are impaired may not recognize that their difficulties are causing interference. And finally, impaired therapists may engage in inappropriate or unethical behavior with clients (e.g., dual relationships, sexual relationships) or supervisees.

O’Connor presented data that suggested mental health professionals may have experienced developmental trauma that was unresolved prior to taking on their caring roles. In his review of this issue, he cited research that indicated between 33% and 50% of psychologists reported alcoholism, physical abuse, or sexual abuse in their family of origin. While a traumatic childhood experience, if resolved, would allow a therapist to more fully identify with similarly treated clients, it also raises the possibility of countertransference issues, problems in separating from clients, substance abuse, and underestimation of the impact of one’s own history on work with clients.

Unfortunately, psychology and counseling professions have had difficulty in identifying impairment as a professional issue. Other professions, such as medicine, dentistry, and nursing, have more fully developed impairment programs that encourage self-identification, supervised remediation, and continued practice and treatment. Additionally, psychologists in general are apt to see more egregious ethical violations, such as sexual relationships with clients, as something they would “never do.” Yet, under the right circumstances, any therapist can be vulnerable to personal conditions that promote the likelihood of ethical violations or boundary crossings.

Psychology tends to intervene after the fact, after a client or colleague has filed an ethical charge, and then a disciplinary focus takes over in a licensing board or ethics committee approach to adjudicating the case. This is in contrast to professions mentioned above where diversion, monitoring, and supervision are used as opposed to disciplinary hearings and delicensing outcomes.

Detecting impairment during training is the most effective approach to preventing impaired professionals. Yet, as Lamb notes, identifying and responding to trainees who show evidence of impairment is problematic. In part this difficulty lies in supervisors being insufficiently trained to detect impairment; in part, training programs have not developed policies with which to approach the problem of impaired trainees. It is during training, however, that the three component parts of impairment are most likely to reveal themselves in trainees: an inability or an unwillingness to integrate professional standards into one’s own behaviors, an inability to acquire professional skills to reach an acceptable level of competence, and an inability to manage personal stressors and the resulting emotional and behavioral dysfunctions.

Program faculty and supervisors are in the best position to be proactive regarding impairment issues, but the professional community at large also needs to be involved in developing improved methods for detecting and treating impairment.

References:

  1. Barnett, J. E., & Hillard, D. (2001). Psychologist distress and impairment: The availability, nature, and use of colleague assistance programs for psychologists. Professional Psychology: Research and Practice, 32, 205-210.
  2. Forrest, L., Elman, N., Gizara, S., & Vacha-Haase, T. (1999). Trainee impairment: A review of identification, remediation, dismissal, and legal issues. The Counseling Psychologist, 27, 627-686.
  3. Kilburg, R. R., Nathan, P. E., & Thoreson, R. W. (1986). Professionals in distress: Issues, syndromes, and solutions in psychology. Washington, DC: American Psychological Association.
  4. Lamb, D. (1999) Addressing impairment and its relationship to professional boundary issues. The Counseling Psychologist, 27, 702-711.
  5. Lamb, D., & Swerdlik, M. E. (2003). Identifying and responding to problematic school psychology supervisees: The evaluation process and issues of impairment. The Clinical Supervisor, 22, 87-110.
  6. O’Connor, M. F. (2001). On the etiology and effective management of professional distress and impairment among psychologists. Professional Psychology: Research and Practice, 32, 345-350.

See also: