Preventing problems of professional competence in the face of life-threatening illness.

Abstract

When a psychologist is diagnosed with a serious medical condition and faces the prospect of an arduous treatment regimen and perhaps a bleak prognosis, it may be difficult to attend to one's level of professional competence. Like their clients, psychologists are vulnerable to distress and diminished functioning caused by a life-threatening illness. Psychologists have an ethical responsibility to monitor and ensure professional competence, yet the distress and distraction that accompany serious health problems can inhibit and undermine self-assessments of competence in many ways; distressed psychologists may react with denial, shame, fear, and problematic countertransference responses. The limitations associated with evaluating competence in the context of distress are discussed and several recommendations are offered for psychologists who deliver services, support gravely ill colleagues, and serve in credentialing and regulatory capacities.

The competence constellation model: A communitarian approach to support professional competence.

“…In 1949, Fromm-Reichmann reflected that, “we have to bear in mind that no amount of inner security and self-respect protects the psychiatrist from being as much a subject of and vulnerable to the inevitable vicissitudes of life as everyone else” (p. 378). As a consequence of constantly caring for others who are emotionally distressed, psychologists may suffer emotional depletion, disrupted personal relationships, loneliness, anxiety, professional isolation, and depression (Johnson & Barnett, 2011). Compassion fatigue, vicarious traumatization, and even shame regarding feelings toward clients can leave psychologists functioning below thresholds for competent practice (Elman & Forrest, 2007; Kaslow et al, 2007; Smith & Moss, 2009).…”

“…National surveys confirm concerns that when the vocational hazards of professional practice interact with psychologists’ human vulnerabilities, the risk for decrements in professional competence increases (Johnson et al, 2012). Evidence suggests that a significant number of psychologists experience severe anxiety, depression, and even suicidal ideation (Gilroy, Carroll, & Murra, 2002; Johnson & Barnett, 2011; Pope & Tabachnick, 1994) and that many of those continue to provide services despite self-awareness of diminished competence (Guy, Poelstra, & Stark, 1989; Pope, Tabachnick, & Keith-Spiegel, 1987). In addition, psychologists are as vulnerable as the rest of the population to serious, possibly life-threatening, physical illness (Centers for Disease Control & Prevention, 2010).…”

“…In addition, psychologists are as vulnerable as the rest of the population to serious, possibly life-threatening, physical illness (Centers for Disease Control & Prevention, 2010). Johnson and Barnett (2011) noted that the most common reactions to a serious medical diagnosis—emotional distress, denial, fear, and strong countertransferential reactions—might easily lead a psychologist to manifest problems of professional competence.…”

“…In a recent article, Johnson and colleagues (2012) highlighted a fundamental weakness in a system of credentialing and continuing professional development that relies exclusively on self-assessment of competence. Because psychologists, like other human beings, are vulnerable to life’s tribulations including personal distress, illness, and cognitive decline, they sometimes manifest problems of professional competence (Elman & Forrest, 2007; Johnson & Barnett, 2011; Kaslow et al, 2007). Yet, health care professionals often are inefficient and inaccurate when it comes to self-awareness and self-assessment of diminished competence (Davis et al, 2006; Johnson et al, 2012; Kaslow et al, 2009).…”

“I just can’t, I am frightened for my safety, I don’t know how to work with her”: Practitioners’ experiences of client violence and recommendations for future practice.

“…Indeed, Kleepies (2002) asserts that psychologists are currently not giving client violence appropriate consideration or concern. We have professional obligations for self-care and this includes making effective decisions about continuing to see clients while ensuring our own safety (see also Johnson & Barnett, 2011).…”