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Strategies for Preventing Work-Related Stress Involving High-Risk Clients/Patients

Strategies for Preventing Work-Related Stress Involving High-Risk Clients/Patients

Kristen Webb (2011) addressed the ethical dilemma of providing consistent and reliable care to a patient with suicidal urges, self-harming behaviors, and significant abandonment issues with the need to ensure competent provision of services in formal sessions and telephone contact. She scheduled brief (8-minute) regular telephone check-ins between sessions to assure the patient of her availability to assist with life-threatening urges, but she limited these phone calls to skills coaching. She adhered to firm boundaries for beginning and ending sessions. Webb carefully used self-disclosure to provide the patient with examples of how she had weathered storms in her life, consistently monitoring the effect of the disclosures on her patient and the therapeutic (vs. countertransferential) motivation for the disclosures, and sought regular peer consultation. She was alert to feelings of professional discouragement, physical exhaustion, and stress related to fears of a poor outcome for her patient. She monitored her sleep and eating, created transitional activities between work and home, and made time to set aside her worries and counter the self-isolation that therapists can experience through self-nourishing exercise and socializing. Readers may also wish to refer to the Hot Topic in Chapter 3 on the ethics of self-care.

(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. (See also Standard 10.10, Terminating Therapy.)

Standard 2.06b applies to situations in which psychologists who are already providing services, teaching, or conducting research become aware that their personal problems are interfering with their work. The standard calls for psychologists to take appropriate steps to remedy the problem and to determine whether such remedies are sufficient for them to continue work-related activities.

A teaching psychologist who was undergoing outpatient treatment for a life-threatening medical disorder found it increasingly difficult to prepare lectures, grade papers, and mentor students effectively. The psychologist consulted with the chair of the department, who agreed to assign an experienced graduate teaching assistant for the lectures. The psychologist also asked a colleague to serve as a consultant on the two dissertations he was currently mentoring.

Distinguishing between personal and professional impairment is not always easy, nor is there consensus among members of the profession on how to identify work-related impairment (P. L. Smith & Burton Moss, 2009; Williams, Pomerantz, Segrist, & Pettibone, 2010). Fear of losing highly valued abilities in the face of serious, chronic, or life-threatening diseases or being judged by colleagues as incompetent can create denial and professional blind spots (Barnett, 2008). Health problems and personal distress become professional deficits when they make services ineffective or compromise functioning in ways that harm students, research participants, organizational clients, and patients (Munsey, 2006). Signs of impairment may include intense emotional reactions (e.g., anger or uncontrolled sexual attraction), disrespectful comments to clients/patients or students, lack of energy or interest in work, or using work to block out negative personal feelings to the detriment of those with whom one works (Pope & Vasquez, 2007; P. L. Smith & Burton Moss, 2009).

To comply with this standard, psychologists can turn to the increasing number of state licensing boards and state psychological associations that provide colleague assistance programs to help psychologists deal proactively with and remediate impairment (APA Committee on Colleague Assistance, 2006; Barnett & Hillard, 2001). If such steps are not adequate to ensure competence, Standard 2.06a requires that psychologists appropriately limit, suspend, or terminate work-related duties.

A counseling psychologist returned to her position at a college counseling center after sick leave for physical injuries incurred during a car accident. Within a week at the counseling center, the psychologist realized the pain medication she was frequently taking during the day was interfering with her ability to focus on clients’ problems. She contacted a psychologist assistance program in her state that helped her taper off the medications, provided ongoing supervision to help her self-monitor her ability to perform her tasks, and provided support for the psychologist to approach the director of the counseling center to cut back on her hours.

A psychologist working in a correctional facility was violently attacked by a new prisoner during a psychological assessment interview. The psychologist did not seek psychological counseling for his reaction to the assault. A month later, the psychologist was conducting an intake of a prisoner who reminded him of his attacker. Although the psychological assessment did not provide evidence of extreme dangerousness, the psychologist’s report indicated the prisoner was highly dangerous and should be assigned to the most restrictive environment (adapted from Weinberger & Sreenivasan, 2003).

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