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PROFESSIONAL VULNERABILITY

PROFESSIONAL VULNERABILITY. Perfectionism. Despite cultural sanctions, perfectionism is not adaptive. Perfectionism is a vulnerability factor for depression, burnout, suicide, and anxiety. The desire to excel must be differentiated from the desire to be perfect.

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PROFESSIONAL VULNERABILITY

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  1. PROFESSIONAL VULNERABILITY

  2. Perfectionism • Despite cultural sanctions, perfectionism is not adaptive. • Perfectionism is a vulnerability factor for depression, burnout, suicide, and anxiety. • The desire to excel must be differentiated from the desire to be perfect.

  3. “The perfect is the enemy of the good.” - Voltaire

  4. Perfectionism(cont.) • Believing that others will value you only if you are perfect is associated with both depression and suicide. • It contains an element of pressure associated with a sense of helplessness and hopelessness. • “The better I do, the better I’m expected to do.” • Intense need for external validation - Flett & Hewitt, 2002

  5. Origin of Perfectionism • Not well understood • Multiple pathways are involved: • Child factors—temperament, attachment style • Parent factors—style of parenting, parental personality • Environmental pressures—peers, culture, teachers Flett & Hewitt, 2002

  6. Origins of Perfectionism(cont.) • Satisfaction with real achievements is limited because of feelings of fraudulence and the expectations that more will be demanded. • The “driven” quality is designed to gain relief from a tormenting conscience rather than a genuine wish for pleasure.

  7. Consequences • Burnout • Depression & suicide • Problems with self-care • Marital problems • Substance abuse • Professional boundary violations

  8. Definitions of Burnout • State of fatigue or emotional depletion brought about by adherence to a professional role that has failed to produce expected rewards • “An erosion of the soul” -Maslach & Leither, 1997

  9. Definitions of Burnout (cont.) • “Joyless striving” - Holmes & Rahe

  10. Symptoms of Burnout • Failure to take vacations • Chronic fatigue • Emotional exhaustion • Cynicism

  11. Symptoms of Burnout (cont.) • Headaches, lack of pleasure in relationships • Increased drinking • Marital deadness • Explosions of anger

  12. Midlife Disillusionment • The pay-off for self-sacrifice never materializes • Feelings of betrayal and disillusionment

  13. Problems with Spouse or Partner • Psychology of postponement • Lives of quiet desperation • Failure to make time for intimate conversation

  14. Profile of Professionals • No simple formula • 20% are female • 20% are same-sex • Vulnerability is universal

  15. Common Themes • Omnipotence – “Only I can save the patient.”

  16. “True love” is idealized, valorized, and mythologized • The presence or absence of “true love” is irrelevant to ethics considerations

  17. PROFILE OF VICTIMS • Incest victims (sitting duck syndrome) • Patients with a history of sexual abuse • Attractive patient with chronically low self-esteem • Patient with a history of previous hospitalization, suicide attempts, and substance abuse • Depressed and suicidal patient with recent romantic break-up

  18. Profiles of Victims (cont) • Borderline Personality Disorder Patients • Intellectually Challenged Patients • Drug-Seeking Patients • First Nation People • Patients in Lower Socioeconomic Groups

  19. Special Situations • Rural Practitioners • Home Care Practitioners • Multi-Cultural Issues

  20. PRINCIPLES OF ASSESSMENT AND REHABILITATION • Disciplinary measures are the purview of a College or licensing board, while psychiatric assessment is the purview of independent mental health professionals. • Treatment recommendations growing out of an assessment, however, must be integrated with the disciplinary stipulations.

  21. PRINCIPLES OF ASSESSMENT AND REHABILITATION (cont.) • Evaluating team must differentiate between impairment and problems in professionalism. • In some situations, both may be present. • Questions from referring College or board are helpful in focusing the assessment.

  22. PRINCIPLES OF ASSESSMENT AND REHABILITATION (cont.) • Collateral information from complainants, family members, colleagues, police reports, and College are always valuable and often essential. • Signed release to College or other agency is necessary before beginning the evaluation.

  23. Substance Abuse • Substance abuse may be a contributing factor that is hidden • Collateral sources may not know about it • Random urine drug screen is useful to rule out substance use • The professional’s response to the prospect of a urine drug screen is highly informative

  24. Principles of Assessment and Rehabilitation (Cont) • Amenability to rehabilitation must be carefully assessed • Narcissistic mortification is not the same as genuine remorse • Risk of repeating boundary violations and the safety of the public must be weighed against practitioner’s wishes

  25. Components of Rehabilitation Plan • Practice limitations • Chaperone requirements • Mentoring • Supervision • Change of practice setting—group, institution only • 12-steps programs

  26. Components of Rehabilitation Plan (cont) • Individual psychotherapy—psychodynamic, cognitive-behavioral • Marital or couples therapy • Pharmacotherapy • Inpatient or residential • Total duration of plan may be 3-5 years

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