ETHICAL GUIDELINES CONCERNING IMPAIRED PROFESSIONALS

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ETHICAL GUIDELINES CONCERNING IMPAIRED
PROFESSIONALS

• Laura I. Hodges, M.A., LPC
• Sam Houston State University
• October 15, 2005

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And the answer is

• Renees 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 districts
  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.

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By Friday, Renee was understandably exhausted.
After lunch, she was called into the Assistant
Principals 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 students 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.

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Impairment a definition

• The American Medical Associations 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).

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Impairment a definition (continued)

• According to Tarvydas ORourke (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.

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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

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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)

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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)

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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)

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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)

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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 counselors best friend
• (Emerson Markos, 1996)

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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)

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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)

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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 clients
  experience. From this perspective, (the
  clients), the real world seems insane and the
  client then seems normal.
• (Emerson Markos, 1996)

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Chronic Physical Illness

• An illness such as this may go untreated of
  undiagnosed
• Usually, the counselor cant seem to find the
  time to see a doctor, avoiding facing any
  diagnosis of chronic physical illness
• Again, denial is this counselors best friend

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• Whats
• Next????

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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).

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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

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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.

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..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)

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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 wont 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 students apparent
  lack of medication, and excused herself from the
  meeting.
• Proceeding to the principals 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.

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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 counselors 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., ORourke, B. (1998). Ethical
  climate. In R.R. Cottone V.M. Tarvydas (Eds.),
  Ethical and professional issues in counseling
  (pp.188-189). Upper Saddle River,
  NJPrentice-Hall, Inc.