Impaired Professionals

by

Frederic G. Reamer

Introduction

In recent years, various professions—such as social work, medicine, nursing, law, and psychology—have paid increased attention to the problem of impaired practitioners. Impairment may involve failure to provide competent care or violation of a profession’s ethical standards. It may take such forms as providing flawed or inferior services to a client, sexual involvement with a client, or failure to carry out one’s duties as a result of substance abuse or mental illness. Strategies for dealing with professionals whose work is affected by problems such as substance abuse, mental illness, and emotional stress have become more prevalent and visible. Professional associations and groups of practitioners have convened to examine impairment among colleagues and to organize efforts to address the problem. However, the social work literature contains relatively little discussion of impaired professionals. One can only speculate about why social work generally has paid less attention than have other professions to the problem of impaired practitioners. It is difficult to know whether the magnitude of the problem is smaller in social work than in other professions (and hence attracts less attention), whether there is greater denial of impairment in social work than in other professions, whether social workers have a higher threshold of tolerance for impairment in general (because of its prevalence among clients), or whether social workers simply write and publish less than do members of other professions. One of social work’s admirable hallmarks is its earnest focus on people’s strengths, as opposed to deficits. This, too, may contribute to social workers’ limited research on impaired practitioners. Further, social workers, compared with other groups of professionals, may be less confident about their status as professionals and are reluctant to draw attention to the profession’s limitations and weaknesses. Social workers who are interested in the subject of impairment must consult literature from other human service professions.

Nature and Extent of Professional Impairment

Scholars in a number of helping professions have investigated the nature and extent of impairment among practitioners. Several seminal discussions explore typical manifestations of impairment, common causes, and constructive responses. Deutsch 1985, Guy, et al. 1989, and Kilburg, et al. 1986 are among the earliest in-depth explorations of the various forms of impairment in the helping professions. Katsavdakis, et al. 2004 provides a rich and informative profile of impaired practitioners. Other publications focus on narrower topics related to impaired professionals. For example, Coombs 1997 discusses the nature of substance abuse among practitioners, and Mahoney 1997 explores the impact of personal distress on practitioners’ lives. Unfortunately, no book on the subject has been written by or about social workers.

• Coombs, Robert. 1997. Drug-impaired professionals. Cambridge, MA: Harvard Univ. Press.

  E-mail Citation »

  Provides a comprehensive review of issues related to alcohol and drug addiction among professionals. Coombs presents case histories of doctors, dentists, lawyers, nurses, and airline pilots to illustrate the nature of addiction among those populations. This book reviews symptoms of impairment, causes, and treatment options.

• Deutsch, Connie. 1985. A survey of therapists’ personal problems and treatment. Professional Psychology: Research and Practice 16.2: 305–315.

  DOI: 10.1037/0735-7028.16.2.305E-mail Citation »

  One of the earliest discussions of the range of personal challenges encountered by psychotherapists and their experiences in treatment. This article reports on therapists’ reports of difficulties they have faced in their own lives and the benefits and limitations of their efforts to get help.

• Guy, James, Paul Poelstra, and Miriam Stark. 1989. Personal distress and therapeutic effectiveness: National survey of psychologists practicing psychotherapy. Professional Psychology: Research and Practice 20.1: 48–50.

  DOI: 10.1037/0735-7028.20.1.48E-mail Citation »

  One of the earliest and most comprehensive surveys of psychologists’ personal impairment and their experiences in treatment. The authors summarize data from a large sample on the nature of psychologists’ impairment, their efforts to obtain help, and the benefits and limitations of available treatment options.

• Katsavdakis, Kostas, Glen Gabbard, and George Athey. 2004. Profiles of impaired health professionals. Bulletin of the Menninger Clinic 68.1: 60–72.

  DOI: 10.1521/bumc.68.1.60.27732E-mail Citation »

  Provides a detailed overview of the personal challenges faced by a range of health-care professionals. The authors summarize key correlates and predictors of impairment.

• Kilburg, Richard, Peter Nathan, and Richard Thoreson, eds. 1986. Professionals in distress: Issues, syndromes, and solutions in psychology. Washington, DC: American Psychological Association.

  DOI: 10.1037/10056-000E-mail Citation »

  This anthology is one of the earliest and most influential publications on impaired professionals. The authors explore the nature of impairment, causes, consequences, and treatment options.

• Mahoney, Michael. 1997. Psychotherapists’ personal problems and self-care patterns. Professional Psychology: Research and Practice 28.1: 14–16.

  DOI: 10.1037/0735-7028.28.1.14E-mail Citation »

  Provides an overview of the range of personal challenges faced by psychotherapists and their efforts to address their impairment. Mahoney offers a brief summary of clinicians’ efforts to address personal problems that can affect their professional work.

• Pope, Kenneth, Barbara Tabachnick, and Patricia Keith-Spiegel. 1987. Ethics of practice: The beliefs and behaviors of psychologists as therapists. American Psychologist 42.11: 993–1006.

  DOI: 10.1037/0003-066X.42.11.993E-mail Citation »

  One of the earliest and most influential discussions of what constitutes ethically acceptable and unacceptable behavior among psychologists. The authors present data gathered from a national survey of psychologists.

• Thoreson, Richard, Marinell Miller, and Charles Krauskopf. 1989. The distressed psychologist: Prevalence and treatment considerations. Professional Psychology: Research and Practice 20.3: 153–158.

  DOI: 10.1037/0735-7028.20.3.153E-mail Citation »

  One of the earliest and most influential discussions of the extent and nature of impairment among psychologists. The authors describe patterns of impairment and focus especially on treatment options.