Impaired Professionals

by

Frederic G. Reamer

• LAST REVIEWED: 08 January 2021
• LAST MODIFIED: 26 May 2021
• DOI: 10.1093/obo/9780195389678-0136

Introduction

In recent years, various professions, such as social work, medicine, dentistry, pharmacy, 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 addiction (substance abuse or gambling) or mental illness. Strategies for dealing with professionals whose work is affected by problems such as addiction, 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. Other publications focus on narrower topics related to impaired professionals. For example, Bryson 2012 discusses the nature of substance abuse among practitioners, and Mahoney 1997 explores the impact of personal distress on practitioners’ lives. Rosen, et al. 2009; Smith and Moss 2009; Williams, et al. 2010; and discuss impairment among psychiatrists and psychologists. Reamer 2021 explores the ways in which moral distress and moral injury among social workers may lead to impairment.

• Bryson, Ethan. 2012. Addicted healers: 5 key signs your healthcare professional may be drug impaired. Far Hills, NJ: New Horizons Press.

  Provides an in-depth discussion of the prevalence of drug impairment among health-care professionals, the causes of such addiction, ways that clients and patients can protect themselves, and sources of help for addicted health-care practitioners.

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

  DOI: 10.1037/0735-7028.16.2.305

  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: 10.1037/0735-7028.20.1.48

  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.

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

  DOI: 10.1037/10056-000

  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: 10.1037/0735-7028.28.1.14

  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.

• Reamer, Frederic. 2021. Moral distress and injury in human services: Cases, causes, and strategies for prevention. Washington, DC: NASW Press.

  This book includes an in-depth discussion of the ways in which moral distress and injury experienced by human service professionals may lead to impairment. The author includes case examples and prevention protocols and strategies.

• Rosen, Alan, Andrew Wilson, Patte Randal, et al. 2009. Psychiatrically impaired medical practitioners: Better care to reduce harm and life impact, with special reference to impaired psychiatrists. Australasian Psychiatry 17.1: 11–18.

  DOI: 10.1080/10398560802579526

  Reviews treatment outcomes for impaired practitioners and explores issues related to prevention, early intervention, and access to treatment. The authors offer recommendations to enhance prevention and treatment.

• Smith, Penni, and Shannon Moss. 2009. Psychologist impairment: What is it, how can it be prevented, and what can be done to address it? Clinical Psychology: Science and Practice 16.1: 1–15.

  This review of the psychologist impairment literature includes information about rates of impairment, collegial assistance efforts, barriers to treatment, and prevention strategies. The authors discuss the importance of professional education to prevent impairment.

• 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: 10.1037/0735-7028.20.3.153

  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.

• Williams, Bailey, Andrew Pomerantz, Daniel Segrist, and Jonathan Pettibone. 2010. How impaired is too impaired? Ratings of psychologist impairment by psychologists in independent practice. Ethics and Behavior 20.2: 149–160.

  DOI: 10.1080/10508421003595968

  Summarizes the opinions of psychologists in independent clinical practice concerning the point at which collegial impairment requires action. Respondents reviewed vignettes related to practitioner depression and substance abuse. The authors highlight practical and ethical implications.