Erica H. Wise, PhD
Psychologists bring concerns about their colleagues to the attention of Colleague Assistance Committees and State Ethics Committees on a regular basis. In fact, there is a well-established literature and a variety of resources that describe for us, in great detail, how psychologists can (and should) approach a colleague about whom they have concerns (e.g., O’Connor, 2014; VandenBos & Duthie, 1986). There is also an extensive literature about how to approach such difficult conversations (e.g., Jacobs et al., 2011). However, despite the ready availability of specific step-by-step instructions about how we might proceed, our experience suggests that these concerns are difficult to address and rarely acted upon.
Why Are the Conversations So Difficult?
In this article, I will examine some of the subtle contextual factors that many of us believe contribute to this divergence between how psychologists are advised to act and what they actually do. We believe that the reluctance to approach a colleague goes beyond the very human (and understandable) avoidance of initiating a difficult conversation with a potentially defensive, hurt, or angry colleague. Drawing on emerging literature I will then provide a framework for identifying and addressing these contextual issues so that the profession can evolve to more effectively, proactively, and compassionately identify and respond to distressed colleagues. This re-envisioning of our ethical duty also provides a clear link between proactive care for our colleagues and for ourselves (Wise, Hersh and Gibson, 2011; 2012).
To begin this discussion, we provide a fictionalized vignette. As you read the vignette, notice your reactions and begin to consider how you might respond if you were consulted about this colleague. We encourage you to also keep these thoughts in mind as you read the ethical analysis that follows.
Dr. Jones is a well-respected psychologist in his early 70s who has worked for many years in a small independent private practice. Several recent events have caused concern: The staff of his state psychological association (SPA) became concerned when he sent in duplicate checks for his annual dues payment and became bewildered when he was contacted to get the matter straightened out. They also noticed that he had registered twice for the annual state convention and became defensive when contacted about it. When he attended the conference, he had trouble recalling which workshops he had registered for and got lost when he tried to find his way back to the nearby hotel where he was staying. Independently, several association members mentioned to staff that Dr. Jones asked off-topic questions during a workshop. Subsequently, an early-career psychologist who rents space from Dr. Jones called the State Colleague Assistance Committee consultant to express concern that Dr. Jones had accused her of not paying rent for several months, when she had in fact done so. She shared that Dr. Jones seemed generally baffled when they met to get the financial issues straightened out. She became even more concerned when she observed Dr. Jones back his car into another parked car when he was leaving the office parking lot and then just drive off. When she mentioned this to him he denied that this had occurred. She also informed the CAC consultant that Dr. Jones’s wife and long-time colleague had died in the past year and that he seemed to be alone and isolated. The younger colleague does not know whether Dr. Jones is still seeing clients in his office; she believes that he may still be meeting with just a few very long-term ones, and she knows that he still supervises some advanced graduate students and postdoctoral trainees. Both she and the SPA staff notified the state colleague assistance committee consultant in the hope that he would check in on Dr. Jones. Everyone is very fond of Dr. Jones, and they do not want him to do anything that will get him into trouble with the State Psychology Board -- Nor do they want him to harm his clients. They are also unwilling to discuss their concerns directly with Dr. Jones since they don’t want to offend him and expect that he will deny that there is a problem. They are upset and simply do not know what to do. (Vignette adapted from Martin, 2013).
Framing the Issue
While there is no evidence that psychologists are more prone than other professionals to emotional difficulties, cognitive decline, or substance abuse that leads to distress or competence problems, the nature of psychological work, especially when it occurs in an isolated setting, may make it especially difficult to identify early warning signs in ourselves or our colleagues. The risks of psychological practice (such as vicarious trauma and burn out) are well established (e.g., O’Connor, 2001). What are the ethical considerations related to professional functioning and competence problems? A careful reading of the pertinent code provisions provides some insight into the source of the problem of the difficult conversation with impaired colleagues.
Relevant Ethical Provisions
Principle A of the APA Ethics Code (APA, 2010) is aspirational and reminds us that our “physical and mental health” (p. 3) impacts professional competence. It does not, however, provide guidance as to how we are to maintain wellness. Taken together, Ethical Standards 2.06, 1.04, and 1.05 address concerns about our own and our colleagues’ professional functioning. These standards are quoted below in their entirety since their content is directly related to our analysis.
Ethical Standard 2.06 directs psychologists to anticipate when our “personal problems” may prevent competent functioning and how we are to respond when we “become aware” that personal problems may be interfering.
2.06 Personal Problems and Conflicts
(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.
(b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties (APA, 2010, p. 5).
Ethical Standards 1.04 and 1.05 describe how we are expected to intervene informally or report a colleague’s perceived ethical violations.
1.04 Informal Resolution of Ethical Violations
When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved. (See also Standards 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority, and 1.03, Conflicts Between Ethics and Organizational Demands.)
1.05 Reporting Ethical Violations
If an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution under Standard 1.04, Informal Resolution of Ethical Violations, or is not resolved properly in that fashion, psychologists take further action appropriate to the situation. Such action might include referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities. This standard does not apply when an intervention would violate confidentiality rights or when psychologists have been retained to review the work of another psychologist whose professional conduct is in question (APA 2010, p. 4).
When we look at these ethical standards with fresh eyes it becomes apparent why it is that they are so difficult to enact. Even when aware of their own distress, psychologists are often unsure about how to get help. Furthermore, psychologists are commonly in professional settings that would not readily allow them to “limit, suspend, or terminate” their work (e.g., due to financial constraints or their sense of commitment to clients/patients and colleagues).
Pope and colleagues, in what has become a classic article, found that the majority of psychologists admitted to instances of working when too distressed to be effective despite the fact that most acknowledged that doing so is unethical (Pope, Tabachnick, & Keith-Spiegel, 1987). What about responding to a colleague’s distress or unethical behavior? The survey cited above also found that psychologists were quite confused about whether it was inherently unethical to file an ethics complaint about a colleague or to encourage a colleague to do so. Clearly we struggle with issues of distress when it comes to both ourselves and our colleagues.
Focus on Individual Responsibility in the APA Ethics Code
Recently, ethics scholars have presented the notion that the current APA Ethics Code (APA, 2010) places an unreasonable burden on individual psychologists to take sole responsibility for their personal functioning and professional competence. The underlying (and until recently unexamined assumption) is that we can each effectively monitor our own wellness and competence. While outside the scope of this article, there is strong empirical evidence that many professionals (not just psychologists) are in fact not at all adept at this sort of candid self-assessment. Further, as described above, there is the untenable assumption that we can and will take appropriate steps to deal with problems when they are noted. When it comes to concerns about colleagues, our current Ethics Code (APA, 2010) focuses on approaching or reporting after we suspect or observe an ethical violation. Although the Ethics Code does recommend “bringing it to the attention of that individual, if an informal resolution appears appropriate…” (p. 4), this statement is embedded in Standard 1.04, Informal Resolution of Ethical Violations. There presently exists no standard that can be readily applied to working collaboratively with colleagues to more proactively address potential problems with professional competence that don’t involve a clear ethical violation.
As stated in the current ethics code, psychologists are expected to “take further action appropriate to the situation” (p. 4) when an informal resolution is either not possible or not successful. But, no guidance is provided as to what these further actions might be (other than the very stressful step of making a formal disciplinary report) and, as mentioned above, this statement is clearly directed towards ethical violations, not other concerns that may not rise to that level. It is not at all surprising that psychologists experience confusion about how to proceed when they have concerns about a colleague’s competence and professional functioning (per the Pope et al., 1987, article cited earlier).
Interestingly, in another classic study of psychologists’ responses when aware of a colleague’s impaired professional functioning related to substance abuse, only 19% of those surveyed reported speaking to their colleague about their concerns (Good, Thoreson, & Shaughnessy, 1995). When asked the reasons for not speaking to their colleague to share their concerns, 53% stated they “knew of subtle changes but lacked the tangible evidence of negative impact,” 42% “did not see it detrimental to job performance,” 39% “thought it would do no good,” 30% “thought it was none of my business,” 23% stated that “it was too risky for me,” 19% stated that “the problem was temporary,” and 7% reported feeling that it was “too risky for him or her [the impaired colleague]” (Good, Thoreson & Shaughnessy, 1995, p. 713). These concerns may be exacerbated when the concern is about a mentor, supervisor, or someone else in a position of enhanced power or prestige.
Thus, it becomes increasingly clear that we may need to consider a different approach to these issues. We might like to believe that the nature of our training allows us to be especially adept at dealing with such issues, but this does not seem to be the case — either as individuals or as a profession.
Include Community in Self-Care
Let’s now return to the vignette: If Dr. Jones had been embedded in an ongoing community of caring colleagues, is it possible that he might not be struggling in such an apparently isolated manner with loss, depression, and possible cognitive impairment? It is possible, but not certain. We know nothing about his personal life or other lifestyle issues that we believe are central to determining psychologists’ wellness and resilience. Our vignette is intentionally ambiguous - as are these situations when they come up in real life. Dr. Jones may be primarily depressed or experiencing prolonged grief, or he may have other health problems. While we do know that rates of mild cognitive impairment and dementia increase with age (see Plassman, et al., 2007) we certainly can’t effectively diagnose Dr. Jones based on the available information. A caring circle of colleagues might have prevented or at least softened some of the contributing factors related to his loss. Just as importantly, this caring circle might have effectively and compassionately shared their concerns with Dr. Jones early on as they began to note subtle cues of distress or cognitive decline. Without these networks, psychological associations and individual psychologists are left to struggle with their fears about angering, further isolating, or unfairly getting a colleague into trouble (to name just a few of the reasons we may hold back). We are currently most likely to do nothing - even though we are keenly aware of a failed duty to our colleague and (potentially in this case) to the public.
We strongly endorse the “communitarian” focus recently promulgated by Johnson and his colleagues (2012, 2013). These authors emphasize the importance of proactive professional networks designed to promote care-taking in our professional lives and shared responsibility for maintaining professional competence and intervening early when problems occur. In particular, Johnson, Barnett, Elman, et al. (2012) recommend that the profession shift from an excessive focus on individual responsibility and the reporting of colleagues when they engage in unethical behavior to a communitarian approach in which “communities of psychologists accept responsibility for supporting the functioning and professional competence of colleagues…” (p. 557). They discuss in detail a vision for psychologists to develop and maintain an inner core of close professional colleagues or mentors and a broader collegial community that is embedded in a caring professional community (Johnson, Barnett, Elman, et al., 2013).
As we consider our vignette, the limitations of a system that is solely reliant on self-assessment, confrontation, or the reporting of colleagues to a disciplinary system become painfully apparent. We believe that change is needed at multiple levels. Our professional associations (including the National Register) are well positioned to play a key role in a fostering a more supportive environment for psychologists through the many opportunities that they offer for professional engagement, advocacy, continuing education, peer support, and mentoring (to name but a few). For many psychologists, the National Register can serve as a vehicle for staying up to date on professional practice issues, and for connecting with colleagues who share similar practice interests—both locally and across the United States.
Johnson and colleagues have proposed that we might begin to enact this shift in focus by reformulating our Ethics Code standard on the maintenance of competence (Johnson, et al., 2012, p. 565). Their suggested edits are in italics:
Standard 2.03, Maintaining Competence:
Psychologists undertake ongoing efforts to develop and maintain their competence. Psychologists maintain regular engagement with colleagues, consultation groups, and professional organizations and routinely solicit feedback from these sources regarding their competence for work in specific roles and with specific populations.
Standard 2.06, Personal Problems and Conflicts:
(c) When psychologists become aware that a psychologist colleague is experiencing problems that may lead to interference with professional competence, they offer care and support, and collaborate with that colleague in assessing competence and determining the need to limit, suspend, or terminate their work-related duties.
Revising the code in this manner would help initiate a beneficial shift in our culture. It would recognize that psychologists do not work in a vacuum and would explicitly create an expectation for us to maintain professional networks that will be there to offer support or feedback when we experience times of stress or trouble. Furthermore, these changes would codify that it is an obligation of the profession (not just individual psychologists) to actively work to assist distressed colleagues. This may make that initial conversation a lot easier, more likely to occur, and more effective.
We concur that such ethics code revisions would be a vital first step towards changing the current climate that most commonly leaves us struggling between untenable options and most often doing nothing. However, some interesting concerns have been raised in response to these suggestions. Are we creating risk by adding such an expectation to the ethics code? Are we creating an additional and unreasonable burden on the already-busy psychologist? While these are understandable concerns, it is important to briefly explore how this might be conceptualized. To my knowledge, no psychologist has ever been disciplined solely for a failure in self-care in the absence of improper or incompetent behavior. Similarly, the expectation for maintaining supportive professional networks would be envisioned to work in the same way. In other words, if a psychologist is determined to have engaged in improper or incompetent behavior, they may be held accountable to describe their efforts related to both self-care and meaningful professional colleague support. Given what we know about the importance of these behaviors, it does not seem to be an unreasonable expectation. In addition, the ethics code serves as a useful tool for educating graduate students into the culture and expectations of the profession. In this regard, there is clear value in introducing notions of self and communitarian care into early training.
Finally, there are some excellent models from other professions for us to consider: Among other examples, many states offer Lawyer Assistance Programs that provide a supportive resource for distressed lawyers that is explicitly non-disciplinary. As psychologists, we believe that we can do better than we are doing and hope that psychologists will step forward and support this burgeoning communitarian movement.
This article was adapted with permission from The North Carolina Psychologist, Vol. 66, No. 2, Spring 2014.
Dr. Wise is Clinical Professor and Director of the Psychology Training Clinic for the Department of Psychology at UNC-Chapel Hill. She is the former chair of the American Psychology Association's Ethics Committee and the North Carolina Psychology Board. Her professional interests include education and training, and applications of ethics and self-care in academic and professional practice settings.
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Acknowledgement: This article is the result of ongoing collaboration and discussions between the NCPA Professional Affairs Committee (PAEC) and the NCPA Colleague Assistance Committee (CAC). I offer special appreciation to my colleagues Elliot Silverstein, Prudence Cuper, Christian Mauro, Glen Martin, and Steve Mullinix for their professional support, substantive input, and editing expertise.