Eye on Ethics
Impaired Professionals Defeating Denial
Two weeks ago I received a telephone call from a therapist who lives and works about 150 miles from my office. He was clearly distressed. The conversation began with a sheepish admission by the therapist that he was in “some very hot water.” He asked whether he might arrange to meet with me to discuss his predicament. I offered to set aside a block of time to chat over the telephone, so that he would not have to travel such a long distance. But the therapist strongly preferred to meet in person, given the magnitude of the circumstances he faced; several days later, the therapist and I met for the first time.
The therapist explained that he has practiced as a clinician for nearly 20 years and is highly regarded in his community. He has had a thriving private practice. Approximately three years earlier, the therapist explained, he began counseling a 38-year-old woman who was struggling in a troubled marriage. About seven months into the counseling, the therapist and client became sexually involved. “I knew at the time that this was a big mistake,” he told me through tears. “After all, I’ve been in the business long enough to understand these dynamics. The truth is, however, this all happened at a vulnerable time in my personal life. I had a lot of problems at home in my marriage and with our finances. I had just declared personal bankruptcy and my marriage was falling apart. I was a real mess and hadn’t addressed my own issues. The bottom line is that I sought comfort in the worst possible place—with my client.”
The therapist went on to tell me that his relationship with the client lasted about one year. He explained that eventually he began to have serious doubts about the relationship’s future and, when he shared this with his client (with whom he had by then terminated the professional-client relationship), the client became angry. Eventually the relationship ended; shortly thereafter, the former client and her husband filed a lawsuit against the therapist alleging professional negligence and filed an ethics complaint with the therapist’s state licensing board alleging unethical conduct.
One of the sad facts of professional life is that some practitioners engage in unethical conduct. In some instances, the misconduct is caused by plain greed or exploitation, for example, when practitioners submit fraudulent invoices to insurers or government agencies to increase their income, or when practitioners misrepresent their credentials to attract new clients. However, in a significant percentage of cases, ethical misconduct results from some form of impairment in the practitioner’s life.
Both the seriousness and forms of impairment among social workers vary. Impairment may involve failure to provide competent care and services or a blatant violation of social work’s ethical standards. For example, impairment may occur in the form of sexual involvement with a client or failure to perform one’s professional duties as a result of mental illness or substance abuse.
The social work profession first acknowledged the problem of impaired practitioners formally in 1979, when the National Association of Social Workers (NASW) issued a public policy statement concerning alcoholism and alcohol-related problems. By 1980 a nationwide support group for chemically dependent practitioners, Social Workers Helping Social Workers, had formed. In 1982 NASW formed the Occupational Social Work Task Force to develop a strategy to address impairment among social workers. Two years later, the NASW Delegate Assembly issued a resolution on impairment, and in 1987 NASW published the Impaired Social Worker Program Resource Book to help NASW chapters and other groups develop programs for impaired practitioners. Most recently, the NASW added new standards to its Code of Ethics, for the first time in the profession’s history, explicitly acknowledging social workers’ ethical obligation to address their “own personal problems, psychosocial distress, legal problems, substance abuse, or mental health difficulties” that affect their professional judgment and performance (standards 4.05 [a & b]) and social workers’ obligation to consult with and assist colleagues who are manifesting symptoms of impairment (standards 2.09 [a &b]).
In spite of these various efforts, social workers (as well as all other groups of professionals) often find it difficult to acknowledge problems in their own and in colleagues’ lives. Impairment is a hard fact to face. Sometimes social workers find it difficult to seek help because of their denial about the seriousness of their problems, mythical belief in their ability to help themselves and in their invulnerability, skepticism about colleagues’ ability to help them, and concern about confidentiality and cost. As the NASW Impaired Social Worker Program Resource Book astutely observes: “The problem of impairment is compounded by the fact that the professionals who suffer from the effect of mental illness, stress, or substance abuse are like anyone else; they are often the worst judges of their behavior, the last to recognize their problems and the least motivated to seek help. Not only are they able to hide or avoid confronting their behavior, they are often abetted by colleagues who find it difficult to accept that a professional could let his or her problem get out of hand” (p. 6).
Ideally, social workers and the profession itself should take several steps to address the phenomenon of practitioner impairment. First, social workers need to be educated about the nature, extent, and manifestations of impairment. This should occur in schools and departments of social work, agency settings, and in continuing education venues. Second, social workers must develop constructive ways to acknowledge and address impairment in their own and in colleagues’ lives. An essential element is the development of competent, confidential resources within the professional community to help struggling colleagues, along the lines of an employee assistance program. Finally, the social work profession must implement sound and strong “quality control” mechanisms to ensure that impaired colleagues get the help they need and that clients are protected from practitioners whose judgment and job performance are below par. The latter requires the cooperation and involvement of diligent, conscientious, and fair licensing boards, ethics adjudication committees, professional associations, and employers.
The good news is that relatively few social workers are severely impaired and engage in ethical misconduct; by and large, social workers are remarkably ethical and principled professionals. In addition, in recent years, social workers have become much more willing to acknowledge the possibility of impairment within the ranks. Clearly, social workers have a responsibility to be alert to possible impairment in their own and in colleagues’ lives and to respond to the impairment constructively and assertively. We owe this openness not only to ourselves and those within the profession but also—and most importantly—to the clients we serve.