Managing Problematic Students in Professional Psychology Programs

1. Managing Problematic Students in Professional Psychology Programs Clark D. Campbell, PhD, ABPP Mary Peterson, PhD Graduate Dept. of Clinical PsychologyGeorge Fox University

2. Questions to address • What is problematic behavior in graduate students? • What causes problematic behavior? • How common is problematic behavior? • Is problem behavior seen as important to the profession? • Is problematic behavior in graduate school connected to long-term behavioral problems? • Who has the responsibility of dealing with problematic behavior? • How do we address problematic behavior? • Can we screen for problematic behavior?

3. What is problematic behavior in graduate students? • “Problematic Behavior is….. an interference in professional functioning …. reflected in …. : • 1) an inability and/or unwillingness to acquire and integrate professional standards into one's repertoire of professional behavior; • 2) an inability to acquire professional skills in order to reach an acceptable level of competency; and/or • 3) an inability to control personal stress, strong emotional reactions, and/or psychological dysfunction which interfere with professional functioning.” (Rodolfa, 2000)

4. What is problematic behavior in graduate students? • Different from impairment. • Different from a qualifying disability • In essence, it is incompetence • Although it may be seen in interpersonal or clinical situations, it should be connected to the academic requirements of the program.

5. The Diathesis-Stress Model Problematic behavior is caused by: Biopsychosocial vulnerability Stress Inadequate social support What causes problematic behavior?

6. How common is problematic behavior? • Psychologists have often expressed concern that a portion of those drawn to the profession have serious psychological or emotional problems when they begin training (Fromm-Reichmann, 1949; Thorne, 1945/2000). • In other cases, problems with psychological stability or fitness may only emerge after training has commenced. (Procidano et al., 1995). • 72% of training programs and 10% of internships had current trainees with significant psychological impairment. Only 58% of training programs report formal policies for managing trainee impairment (Huprich & Rudd, 2004).

7. Is problem behavior seen as important to the profession? • “Personal suitability or fitness to the profession should be considered as a new content area of competence…” • “Knowledge is more easily assessed, but more attention should be given by the psychology profession to developing appropriate assessment of attitudes and values as well as skills.” • Recommendations from the 2002 Competencies Conference – Future Directions in Education and Credentialing in Professional

8. Is problem behavior seen as important to the profession? • “’Professional values’” and attitudes need to be better articulated and clarified by the profession in order to assist in the assessment process of competence. Once clarified into tangible language, assessment tools will need to be developed for evaluating competencies at all levels.” • Recommendations from the 2002 Competencies Conference – Future Directions in Education and Credentialing in Professional

9. Is problem behavior seen as important to the profession? • “We argue that it is inappropriate to undertake formal clinical professional training with students who have not acquired these skills.” • Relationship/Interpersonal Skills: “The ability to form and maintain productive relationships with others is a cornerstone of professional psychology. Productive relationships are respectful, supportive, professional, and ethical.” • Interpersonal skills: Ability to listen and be empathic with others; respect for/interest in others’ cultures, experiences, values, etc.; openness to feedback. • Affective skills: Affect tolerance; tolerance/understanding of interpersonal conflict, ambiguity, and uncertainty. • Personality Characteristics Prerequisite to Practicum Training - Recommended by the Association of Directors of Psychology Training Chairs (ADPTC, 2004)

10. Is problem behavior seen as important to the profession? • Personality/Attitudes: Desire to help others; openness to new ideas; honesty, integrity, valuing of ethical behavior; personal courage. • Reflective skills: Ability to examine and consider one’s own motives, attitudes, behaviors, and one’s effect on others. • Personality Characteristics Prerequisite to Practicum Training - Recommended by the Association of Directors of Psychology Training Chairs (ADPTC, 2004)

11. Is problematic behavior in graduate school connected to long-term behavioral problems? • No longitudinal studies on psychology graduate students • “(Medical) students who received comments regarding unprofessional behavior were more than twice as likely to be disciplined by the Medical Board of California when they become practicing physicians than were students without such comments. The more traditional measures of medical school performance , such as grades and passing scores on national standardized tests, did not identify students who later had disciplinary problems as practicing physicians.” • Papadakis, Hodgson, Teherani, & Kohatsu (2004)

12. Who has the responsibility of dealing with problematic behavior? • DCTs are very concerned about character (M = 4.02, SD = .95) and fitness (M = 4.36, SD = .74) issues in their programs. • DCTs believe that graduate programs (M = 4.10, SD = .81) have primary responsibility for ensuring character and fitness issues in students, followed by internship programs (M = 3.75, SD = .89), and licensing boards (M = 3.41, SD = 1.12). • DCTs were likely to report concerns to internship directors (M = 4.22, SD = .81), but less likely to report them to licensing boards (M = 3.58, SD = 1.19). • Johnson & Campbell (2004), Professional Psychology: Research and Practice, 35, 405-411.

13. How do we address problematic behavior? • Due Process Procedures (Mitnick, Kaslow, & Baker, 2002) • Simple and easy to understand • Written and communicated to each intern/trainee/post doc at the time he/she begins the internship or post doc. • Applied uniformly and in a timely fashion to all such problem or substandard interns/trainees/post docs and to any intern/trainees/post docs complaints about the actions of training program staff.

14. How do we address problematic behavior? • Due Process Procedures (Mitnick, Kaslow, & Baker, 2002) • Applied to all serious performance, conduct, and ethical problems of interns/trainees. • Consistent with your institution’s due process procedures, if appropriate; or incorporate such institutional policies. • Developed and implemented in consultation with your institution’s Legal, Human Resources, and EEO staff.

15. Can we screen for problematic behavior? • Student Admissions: Consider Severity, Frequency, and Proximity of problematic behavior • Ongoing Students: Annual student evaluations • Monitoring Students: Student Evaluation and Development Committee

16. Concluding Thoughts • Those who are involved in training and licensing psychologists are the gatekeepers to the profession. • We have a responsibility to evaluate students for problematic behavior that renders them less than competent in order to protect the public and the profession. • When we identify concerns, we have a further responsibility to deal with students fairly and with due process to help them develop appropriately if possible. It is not fair to the student or profession to expect the next supervisor to deal with a student’s problematic behavior.