Codes of Ethics on Therapists' Impairment, Burnout and Self Care
By Ofer Zur, Ph.D.
This paper reviews the sections in the major psychotherapeutic professional organizations’ code of ethics relating to burnout, impairment and self-care.
THE FOLLOWING CODES OF ETHICS ARE CITED: APA, NASW, ApA, ACA, AMHCA, AAMFT, CAMFT
ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT (APA) 2016:
2.06: Personal Problems and Conflicts
(a) Psychologists refrain from initiating 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 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.)
CODE OF ETHICS OF THE NATIONAL ASSOCIATION OF SOCIAL WORKERS (NASW) 2017:
2.08: Impairment of Colleagues
(a) Social workers who have direct knowledge of a social work colleague’s impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties and that interfereswith practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.
(b) Social workers who believe that a social work colleague’s impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.
2.09: Incompetence of Colleagues
(a) Social workers who have direct knowledge of a social work colleague’s incompetence should consult with that colleague when feasible and assist the colleague in taking remedial action.
(b) Social workers who believe that a social work colleague is incompetent and has not taken adequate steps to address the incompetence should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.
THE PRINCIPLES OF MEDICAL ETHICS WITH ANNOTATIONS ESPECIALLY APPLICABLE FOR PSYCHIATRY, 2013 EDITION:
Addendum 2: Questions & Answers About Procedures for Handling Complaints of Unethical Conduct
http://www.psychiatry.org/File Library/Practice/Ethics Documents/principles2013–final.pdf
A physician shall uphold the standards of professionalism, be honest in all professional interactions and strive to report physicians deficient in character or competence, or engaging in fraud or deception to appropriate entities.
4. Special consideration should be given to those psychiatrists who, because of mental illness, jeopardize the welfare of their patients and their own reputations and practices. It is ethical, even encouraged, for another psychiatrist to intercede in such situations.
AMERICAN COUNSELING ASSOCIATION (ACA) CODE OF ETHICS AND STANDARD OF PRACTICE, 2014:
Counselors monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired. They seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until it is determined that they may safely resume their work. Counselors assist colleagues or supervisors in recognizing their own professional impairment and provide consultation and assistance when warranted with colleagues or supervisors showing signs of impairment and intervene as appropriate to prevent imminent harm to clients.
C.2.h. Counselor Incapacitation, Death, Retirement, or Termination of Practice
Counselors prepare a plan for the transfer of clients and the dissemination of records to an identified colleague or records custodian in the case of the counselor’s incapacitation, death, retirement, or termination of practice.
Section F.5.Student and SuperviseeResponsibilities
Students and supervisees monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when such impairment is likely to harm a client or others. They notify their faculty and/or supervisors and seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until it is determined that they may safely resume their work.
AMERICAN MENTAL HEALTH COUNSELORS ASSOCIATION (AMHCA) CODE OF ETHICS, 2020
C. Counselor Responsibility and Integrity
- h. [CMHCs] recognize that their effectiveness is dependent on their own mental and physical health. Should their professional judgment or competency be compromised for any reason, they seek capable professional assistance to determine whether to limit, suspend, or terminate services to their clients.
B. Counseling Process
3. Multiple Clients
When working with multiple clients, CMHCs respect individual client rights and maintain objectivity.
- b. If it becomes apparent that CMHCs are unable to maintain objectivity, resulting in conflicting roles, they must appropriately clarify, adjust, or withdraw from roles.
B. Counseling Process
5. Termination and Referral
CMHCs do not abandon or neglect their counseling clients.
- a. Assistance is given in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacation and following termination.
B. Counseling Process
7. Clients’ Rights
Clients have the right to be treated with dignity, consideration, and respect at all times. Clients have the right to:
- c. Information such as time of sessions, payment plans/fees, absences, access, emergency procedures, third-party reimbursement procedures, termination and referral procedures, and advanced notice of the use of collection agencies.
II. Commitment to Other Professionals
A. Relationship with Colleagues
7. When CMHCs have knowledge of the impairment, incompetence, or unethical conduct of a mental health professional, they are expected to attempt to rectify the situation. Failing an informal resolution, CMHCs should bring such unethical activities to the attention of the appropriate state licensing board and/or the ethics committee of the professional association.
AMERICAN ASSOCIATION FOR MARRIAGE AND FAMILY THERAPISTS (AAMFT) CODE OF ETHICS, 2015
3.3 Seek Assistance. Marriage and family therapists seek appropriate professional assistance for issues that may impair work performance or clinical judgment.
3.12 Professional Misconduct. Marriage and family therapists may be in violation of this Code and subject to termination of membership or other appropriate action if they: (a) are convicted of any felony; (b) are convicted of a misdemeanor related to their qualifications or functions; (c) engage in conduct which could lead to conviction of a felony, or a misdemeanor related to their qualifications or functions; (d) are expelled from or disciplined by other professional organizations; (e) have their licenses or certificates suspended or revoked or are otherwise disciplined by regulatory bodies; (f) continue to practice marriage and family therapy while no longer competent to do so because they are impaired by physical or mental causes or the abuse of alcohol or other substances; or (g) fail to cooperate with the Association at any point from the inception of an ethical complaint through the completion of all proceedings regarding that complaint.
CALIFORNIA ASSOCIATION OF MARRIAGE AND FAMILY THERAPISTS (CAMFT), ETHICAL STANDARDS 2019:
1.3 TREATMENT DISRUPTION:
Marriage and family therapists are aware of their professional and clinical responsibilities to provide consistent care to clients/patients and to maintain practices and procedures that are intended to provide undisrupted care. Such practices and procedures may include, but are not limited to, providing contact information and specified procedures in case of emergency or therapist absence, conducting appropriate terminations, and providing for a professional will.
Marriage and family therapists use sound clinical judgment when terminating therapeutic relationships. Reasons for termination may include, but are not limited to, the client/patient is not benefiting from treatment, continuing treatment is not clinically appropriate, the therapist is unable to provide treatment due to the therapist’s incapacity or extended absence, or due to an otherwise unresolvable ethical conflict or issue. (See also sections 3.8 Client/Patient Benefit and 5.11 Scope of Competence.)
Marriage and family therapists do not abandon or neglect clients/patients in treatment. If a therapist is unable or unwilling to continue to provide professional services, the therapist will assist the client/patient in making clinically appropriate arrangements for continuation of treatment.
3.8 CLIENT/PATIENT BENEFIT:
Marriage and family therapists continually monitor their effectiveness when working with clients/patients and continue therapeutic relationships only so long as it is reasonably clear that clients/patients are benefiting from treatment.
5.1 CONVICTION OF CRIME:
Marriage and family therapists are in violation of this Code and subject to termination of membership, or other appropriate action, if they: are convicted of a crime substantially related to their professional qualifications or functions, are expelled from or disciplined by other professional organizations, or have licenses or certificates that are lapsed, suspended, or revoked or are otherwise disciplined by regulatory bodies.
5.4 PROFESSIONAL ASSISTANCE:
Marriage and family therapists seek appropriate professional assistance for their personal problems or conflicts that impair work performance or clinical judgment.
5.5 PRACTICING WHILE IMPAIRED:
Marriage and family therapists do not practice when their competence is impaired due to physical or psychological causes or to the use of alcohol or other substances.
8.2 IMPAIRED COLLEAGUES:
Marriage and family therapists are encouraged to provide consultation or assistance to colleagues who are impaired due to substance use or mental disorders.
8.3 ETHICAL COMPLAINTS AGAINST COLLEAGUES:
Marriage and family therapists are encouraged to take reasonable actions to resolve disputes with colleagues before filing an ethics complaint against a colleague. Reasonable measures may include, addressing the matter with the colleague, consultation, and/or mediation. Marriage and family therapists do not file or encourage the filing of ethics or other complaints that they know, or reasonably should know, are frivolous.