The APA Ethical Principles of Psychologists and Code of Conduct requires that confidentiality rights be observed in proceeding with a complaint with or against a psychologist. Confidentiality rights prevent a psychologist from sharing information, gained in a confidential setting, with others — including colleagues, licensing boards and ethics committees, and even the police in many circumstances. So information received in a client psychotherapy session, or in a confidential session with a supervisee, for example, may not be shared without the source's expressed consent. Informed consent rules in this case are also likely to apply, meaning that the source must be apprised of risks associated with disclosure of this information to a third party. A client, for example, should be notified of the likely consequences of proceeding with a complaint against a psychologist. In many instances, the client will be the only one allowed to file such a complaint, if it pertains to actions that they have witnessed or experienced, as complaints from third parties will often not be accepted by governing boards. It should be noted that states vary in their reporting requirements, and that other regulations may supercede the rule of confidentiality, such as child and elder abuse reporting, or Tarasoff requirements, for example. It is important for the psychologist to become familiar with the applicable regulations in the state where they work.
It is obvious that certain circumstances may be too risky to allow. Such conditions as abuse of clients, criminal behavior or suicidality may preclude a stepwise progression of intervention, as outlined above. These circumstances constitute an inappropriate context for informal resolution, and more direct and immediate action should be taken, in some cases by the authorities. As with psychotherapy clients, it may be important in some instances to act to protect safety first, and ask questions later. Individuals who are impaired, in particular by substances or mental illness, are at heightened risk for suicide. It should be also be noted that male psychologists were reported by OSHA to have the highest rate of suicide for any profession (Ukens, 1995). The moment of intervention may be one of the most painful for a professional who is in trouble. It is important to be aware that this individual may therefore be at significant risk for harm to self or others.
The psychologist colleague is at potential risk for intervening, as well. A colleague who is emotionally or behaviorally unstable may present risk of violence, retaliation or other threat. They may act to negatively impact one's reputation or practice. They may also choose to sue. These risks should not be ignored, but they do not preclude a psychologist's ethical responsibilities. Such circumstances should be carefully evaluated. It may be more appropriate to advocate a family intervention, to hold a group intervention or to call for intervention by the authorities, in some cases. Again, consultation may be helpful in determining the best course of action.
It should be clear by now that consultation — with peers, supervisors and/or experts — is invaluable in the process of intervening with an impaired colleague. Consultation refers both to trusted colleagues, and to local or national experts in the circumstances of concern. Ethics consultation can occur at the local level through the local county psychological association, or at the state level through one's state psychological association. Ethics committees and psychology boards will often provide anonymous consultation, meaning that the impaired individual need not be named. These bodies can provide useful information on ethical and legal questions, and in some cases a perspective on the likely trend in a particular situation.
Consultation can provide a sounding board for one's concerns, can offer help with the interpretation of behaviors, and can provide support for strategizing and for the task of intervention. Rehashing an intervention with appropriate others can help discharge any residual tension and reassure that one has acted reasonably. It can also point out mistakes and provide corrective direction. Psychologists may tend toward the independent, but collegial support is good for everyone, not just the impaired. Those who intervene should be careful to manage the information they gather judiciously however, so that the colleague does not become the object of gossip in the professional community.
Power and Politics
As VandenBos and Duthie have noted, power differentials can impact both the likely success and ramifications of an intervention. In highly power-discrepant or complicated situations, these considerations may be very important. It is not reasonable to expect a student to confront a dissertation chair, a new hire to confront a supervisor, or a confused client to confront a venerable therapist. The least powerful in these "onedown" relationships are unlikely to be successful in an intervention, and run significant risk of political, professional or personal harm (VandenBos and Duthie, 1986). Likewise, being in a position of power may engender suspicion and defensiveness on the part of the impaired psychologist. In some cases, it may be preferable to initiate discussion of concerns with an impaired psychologist through a peer-level colleague, or a nonsupervising staff member. The political climate and interpersonal relations among these individuals should be carefully assessed, to the extent possible. Peers who have a history of competitiveness with each other, or those with a simmering conflict, are obviously not good candidates to direct a successful intervention. When Intervention Succeeds If the colleague in question accepts the proposal that they are not functioning adequately, it is important that they be supported in the process of correcting the problem. This may or may not fall to the psychologist who has brought the problem to their attention. In addition to an action plan, this individual will likely need or benefit from additional interventions via supervision, psychotherapy, group work, education and so on. It may be appropriate for the individual to cut back or take a break from work for a time. It makes sense for this plan to be established conjointly with a colleague, supervisor, therapist or other who can help the individual to cover all necessary bases. Isolation and denial can continue to be a problem otherwise. A focus on maintaining or establishing regular, supportive contact with others, a balanced life and a plan for specific problems should be enacted. Established self-care strategies can be very helpful (see below).
The need for psychotherapy is indicated when an individual is unable to evaluate or correct their functioning through self-care. The benefit of support during such efforts is crucial, and a characteristic of most therapies. Evidence suggests that psychologists prefer psychodynamic therapy for personal work, perhaps because techniques are not as valuable personally as is a strong and supportive alliance in the therapy.
When intervention fails
If the impaired psychologist is not moved to appropriate action following an intervention, there is the option to try again with a different strategy. One can also move up the chain of command for advisement or control as necessary. It is important that the issue not be dropped, however. The best time to intervene with the impaired psychologist is before harm is done. As noted previously, if efforts to encourage change in the impaired professional fail, it may be time to move to more formal means, such as contacting the local ethics committee or state board of psychology. One should be aware that ethics committees may be more supportive of the impaired psychologist than a psychology board. The psychology boards' primary role is to protect the public, and they may be less concerned with the welfare of the impaired psychologist. Nonetheless, egregious ethical failures and potentially dangerous conditions should be addressed to the appropriate authorities quickly in such cases, before more harm occurs.
Strategies that prevent the onset of impairment, when effective, are clearly preferable to intervention after the fact. Self-care strategies have been proposed that seek to ensure resilience in the face of the occupational and personal life hazards all psychologists face to a greater or lesser degree. Psychologists should understand that all psychologists may be vulnerable to impairment in the right circumstance. This is not a problem that affects only a limited group of sub-par professionals. There is also evidence that the profession of psychology may inadvertently select for people who are prone to certain kinds of risk (O'Connor, 2001).
The APA Board of Professional Affairs Advisory Committee on Colleague Assistance (ACCA) has established the following recommendations for appropriate self-care:
Take the risks of occupational stress seriously. If you don't know about them, become informed. Honestly assess your emotional, psychological and spiritual health on a regular basis.
Take care of your physical, mental and spiritual health.
Make and maintain professional connections that include the opportunity to discuss the specific nature and stressors of your work.
Seek consultation when professionally or personally challenged, as necessary.
Understand the risks of vicarious traumatization and how to counter them
Pay attention to the need for balance in work, rest and play. Make self-care a priority.
Pursue opportunities for intellectual stimulation in and outside of the profession.
Develop realistic and reasonable expectations about work-load and your capabilities at any given time.
Identify sources of support and use them.
Take regular vacations.
Monitor your use of substances or processes used to relax or for entertainment carefully.
The profession of psychology can be an immensely satisfying one, but it is not without it's hazards. Psychologists in many settings become role-models, and in practice utilize themselves as therapeutic instruments. This very personal role is unlike that of any other profession, in that a person's "self" is so intimately involved in the work. This instrument must be well-tuned and maintained to ensure the best possible services to the public, and a long and prosperous career for the professional.