ETHICAL GUIDELINES CONCERNING IMPAIRED PROFESSIONALS

1. ETHICAL GUIDELINES CONCERNING IMPAIRED PROFESSIONALS Laura I. Hodges, M.A., LPC Sam Houston State University October 15, 2005

2. And the answer is…… Renee’s last remaining and closest grandparent died on Wednesday. On Friday, she drove from Texas to Alabama, buried her grandparent on Saturday, and drove back to Texas on Sunday. In her position as a school counselor, Monday was quite a busy day – the end of course selection. Monday night was filled with the district’s Career Night. Arriving at school Tuesday morning she learned that her co-counselor had been in a car accident and would be out for the remainder of the week, leaving Renee as the only counselor for 1,000 freshmen.

3. By Friday, Renee was understandably exhausted. After lunch, she was called into the Assistant Principal’s office and directed to counsel a student who had been written up for the third time that day. When this student had a particularly rough day, such as this one, it was suspected that the student’s parents were withholding her medication. In front of the Counselor, the Nurse reported to the Assistant Principal that the student had confirmed that her parents had been withholding her medication.

4. Impairment: a definition “The American Medical Association’s description is ‘the inability to deliver competent patient care resulting from alcoholism, chemical dependency or mental illness, including burnout or the sense of emotional depletion which comes from stress ‘ “ (Stadler, Willing, Eberhage, & Ward, 1988, p. 258). “Counselor impairment is a condition that compromises and reduces the quality of counseling received by clients. The causes of impairment may be due to a physical or mental condition or stress associated with situational factors” (Sheffield, 1998, p. 97).

5. Impairment: a definition (continued) According to Tarvydas & O’Rourke (1998, p. 188): “Impairment is a relative term and is distinct from a disability. A disability is an identifiable condition that is more stable and whose functional limitations, when manifested, are recognized and often overcome with appropriate accommodations. In contrast, an impairment is a more covert, often insidious condition that suggests a level of diminished function (obtained by documented evidence) that may be manifested on a continuum by varying degrees of loss of optimal function.”

6. What does it look like??? Burnout Depression Temporary Emotional Imbalance Stress and Anxiety Drug and Alcohol Abuse Exploitation of Clients Over-involvement and Overwork Contagion Chronic physical illness

7. Burnout Lack of desire to discuss work with friends or family Not wanting to check messages or return phone calls Sense of relief or pleasure when clients cancel appointments Physical and emotional exhaustion Pervasive negative self-concept (Emerson & Markos, 1996, p. 109)

8. Depression Difficult to precisely define (DSM description) Many times, the outward signs of depression are not easy to detect Symptoms sometimes include withdrawal from interaction, lack of cheerfulness, an unwillingness to talk, not feeling needed or useful, lack of interest in work, loneliness. Often characterized as, among other feelings, an irrational thought process that says, ‘no one understands, no one cares.’ (Emerson & Markos, 1996)

9. Temporary Emotional Imbalance Devastating personal loss or trauma is one of the easier impairments to recognize For example: death in the family, home fire, serious car accident, rape, theft, divorce, loss of significant other, loss of family pet (Emerson & Markos, 1996)

10. Stress & Anxiety Environmental: side effect of the occupation Personal: side effect of everyday life, i.e., marital problems, financial difficulties, graduate school Anxious and/or depressed mood Somatic complaints Unresponsive to client needs Canceling appointments (Emerson & Markos, 1996)

11. Drug & Alcohol Abuse High rates of smoking Recurrent physical illness Greater change of divorce or relationship problems Non-diet-related eating pattern changes Increased occurrence of depression Increase occurrence of anxiety Abusers usually arrange appointments around the times they are going to abuse Denial is this counselor’s best friend (Emerson & Markos, 1996)

12. Exploitation ofClients Also known as engaging in sexual relationships with clients Code of Ethics explicitly forbids sexual relationships with clients Why does this happen? The counselor has their own issues, i.e., emotional inadequacies and/or fragile self-esteem Reaction from most ethics board is usually angry and condemning. (Emerson & Markos, 1996)

13. Over-involvement& Overwork Never takes a break or a vacation Does not incorporate healthy activities into their normal life style Becomes too enmeshed, obsessed with their clients Overly idealistic or dedicated counselor, sacrificing their own needs in order to ‘take care’ of their clients Incorporates the client into their personal life (dual relationships come into play here) A contributing factor to the exploitation of clients Withdrawing from other clients and/or family and friends (Emerson & Markos, 1996)

14. Contagion Contagion most often occurs when counselors work with severely disturbed clients. After working with them for many years, and realize little improvement, actually ‘catch’ the pathology. They grieve about it in their dreams and abandon ‘normal’ life to focus all of their energy on understanding their client’s experience. From this perspective, (the client’s), the real world seems insane and the client then seems normal. (Emerson & Markos, 1996)

15. Chronic Physical Illness An illness such as this may go untreated of undiagnosed Usually, the counselor can’t seem to find the time to see a doctor, avoiding facing any diagnosis of chronic physical illness Again, denial is this counselor’s best friend

16. What’s Next????

17. Have a plan……. Herlihy (1998, p. 119) states: “Ignoring impairment of a colleague is not a viable option for ethically conscientious counselors who are required to take action when they have ‘reasonable cause that raises doubts as to whether a counselor is acting in an ethical manner’ (American Counseling Association [ACA], 1995, Standard H.2.a).”

18. Practical, SequentialDecision-Making Plan(Herlihy, 1996) 1. Identify the problem and your relationship to it 2. Apply the current ACA Code of Ethics 3. Determine the nature and dimensions of the dilemma 4. Generate potential courses of action 5. Consider potential consequences of all options and determine a course of action 6. Evaluate the selected course of action 7. Implement a course of action

19. Weakest link….. As stated by Stadler et al., (1988): “The decline of public trust in the mental health professions and the potential increase in litigation give strong support for the need to address the problem of impairment squarely and to the importance of not covering up for impaired colleagues.”

20. …..is that You?!? “Any kind of professional loyalty is clearly outweighed by a duty to prevent grievous harm.” “Impaired mental health care professionals do present a threat to the maintenance of professional standards and quality care.” (Stadler, et al., 1988)

21. …The rest of the story….. After listening to the school nurse and the assistant principal express their desire for Renee to see the student, she quietly and respectfully requested that the student support counselor be called in. Now, demands were being made that Renee see this student. “I have NEVER had a counselor say they won’t see a student!” the assistant principal screamed at Renee. Again, Renee quietly and respectfully declined to see the student. Renee requested that the nurse contact CPS concerning the student’s apparent lack of medication, and excused herself from the meeting. Proceeding to the principal’s office, Renee explained her reasons for not seeing this student. The principal called the student support counselor, verified that the nurse had called CPS, and sent Renee home early. He also thanked her for always doing what was ‘in the best interest of the student.”

22. References Emerson, S., & Markos, P. (1996). Signs and symptoms of the impaired counselor. Journal of Humanistic Education & Development, 34(3), 108-117. Retrieved July 7, 2005, from the EBSCO database. Herlihy, B. (1996). When a colleague is impaired: The individual counselor’s response. Journal of Humanistic Education & Development, 34(3), 118-127. Retrieved July 7, 2005, from the EBSCO database. Sheffield, D. (1998). Counselor impairment: Moving toward a concise definition and protocol. Journal of Humanistic Education & Development, 37(2), 96-106. Retrieved July 7, 2005, from the EBSCO database. Stadler, H., Willing, K., Eberhage, M., & Ward, W. (1988). Impairment implications for the counseling profession. Journal of Counseling and Development, 66, 258-260. Retrieved July 7, 2005, from the EBSCO database. Tarvydas, V., & O’Rourke, B. (1998). Ethical climate. In R.R. Cottone & V.M. Tarvydas (Eds.), Ethical and professional issues in counseling (pp.188-189). Upper Saddle River, NJ:Prentice-Hall, Inc.