My mantra is that self-care is an ethical imperative for helping professionals. Why? Let’s chat about that. Psychologists who fail to take care of themselves are less likely to be competent providers, said Erica H. Wise, PhD, a presenter at an “Ethics and Self-Care” continuing-education workshop at APA’s 2006 Annual Convention. In addition, when psychologists’ mental or physical health affects their work, it can create an ethical problem because their ability to help clients is compromised, said Wise, a psychology professor at the University of North Carolina at Chapel Hill.
Impairment doesn’t always take an obvious form like substance abuse, said Wise during the APA Continuing Education Committee-sponsored session. Snowballing personal stressors-such as health problems, marital problems or even day-to-day stressors-can foster mental distress that can impair a psychologist’s effectiveness or even cause improper behavior, such as inability to set appropriate boundaries, breach of confidentiality, fraud or negligence.
According to this article from the APA. Psychologists bear an ethical responsibility to intervene when a fellow psychologist is thought to be impaired. Impairment, in this context, refers to “…impairment of ability to practice according to acceptable and prevailing standards of care” (Ohio Administrative Code.) Impairment therefore refers to circumstances where professional ability is compromised, and may negatively impact the delivery of professional services by the psychologist.
Impairment, while heightening the risk for ethical violations, does not infer such violations. Nonetheless, psychologists are also responsible to ensure that they are competent to provide the services they offer. Impairment, as defined here, compromises the functioning of the psychologist, and should therefore imply a need for close scrutiny of job-related performance in order to preempt ethical violations. The following sections of the American Psychological Association Ethical Principles of Psychologists and Code of Conduct (APA ethics code draft, October 21, 2001) pertain to this circumstance:
This guides the question what is our ultimate responsibility for ourselves and for our colleagues and ultimately our clients.
From the article referenced above.
Section 2.01 of the code, “Boundaries of Competence” requires psychologists to practice within the limits of their competence.
Section 2.06a of the code, “Personal Problems and Conflicts” states:
- a) “Psychologists refrain from undertaking 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 activities 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.”
This leads to several questions when we consider this for ourselves. Will we know when we are burned out and when personal life issues are interfering to the point that we should limit or stop working? What if we feel this would be best but our families and our lives are dependent upon our working? Not to mention that clients are dependent upon us to play our role in their treatment. When we, due to personal reasons, can’t fulfill the role we should determine who will do that, where and how will our client’s needs be met. What do we, as professionals do for surviving, while taking care of personal needs if we don’t have a plan in place or financial assistance to back us up.
Have you ever seen boundaries crossed or blurred when co-workers are burned out? Have you experienced any of this yourself? Have you been at the point that you can see how violations occur?
What happens when you do witness this?
We have all probably seen co-workers going through rough times, having personal problems and struggling. If we are using this ethical guideline that we should not be practicing when impaired or not fully present, what do we do? What are we obligated to do?
How do we do this when we witness questionable behavior by a colleague? Are we to approach the colleague themselves, address the Board to which they answer. How do we objectively determine when someone other than ourselves cannot ethically continue to serve clients? We certainly do not want to wait until something happens to a colleague or client that makes it obvious that he/she is not able to practice, but how do we know when to intervene for the safety of all involved and when we need to leave it to our colleagues to determine their own competency.
Once again, I am going to propose that the idea of shouldn’t there be a sense of responsibility of the agencies that employ these clinicians? That create the schedules and the “goals” and “productivity” that must be met to maintain employment, do they not have a responsibility to encourage, nurture and even provide self-care opportunities and education?
We have guidelines in every major associations ethical code of conduct but who is ultimately held responsible? This isn’t a new question. This isn’t a new problem, it is a sticky one that no one want to get into. At what cost? The safety of our clinicians and our clients?
I don’t have the answers but I am confident that it begins with self-care of the clinician. Self-care is not pampering and massages. Self-care is the hard stuff like coping with our own grief when we lose loved ones, self-care is staying home when we are sick and not overworking because we need extra money but don’t have the extra energy. Self-care is saying no to things that you want to do in your career or life but you know you can’t without comprising your health and energy for what is already on your plate.
I can’t help but believe if we start here and we each take responsibility for our very own self-care, that slowly we start to eliminate the problem. What do you think? Could just becoming aware of lead to the resolution? After all, isn’t awareness the first step in making change?
I welcome your comments on this. Together we can find the answer to sustained self-care in our lives as helpers. As we gain the awareness, skills and knowledge we share that and we change the world one step at a time. We create a movement of live changing and sustaining self-care.
Aren’t you worth it?