|KPA-CAP Program Overview|
The members of the Kentucky Colleague Assistance Program (KPA-CAP) committee would like to thank David Shen-Miller, Ph.D. and the entire Advisory Committee on Colleague Assistance (ACCA) of APA for providing the source for these materials. They were obtained from an informational session which Dr. Shen-Miller presented to the Ohio Psychological Association earlier this year. A reference list will be provided at the end of this document.
A Colleague Assistance Program (CAP) is a mechanism set up by a profession to recognize and address the stressors involved in being a practitioner in a given field. Its purpose is to provide mutual support in the form of information about self-care and, in the case of the mental health professions, the provision of psychotherapeutic services by colleagues. Kentucky Colleague Assistance Program (KPA-CAP) is the framework sponsored by the Kentucky Psychological Association to provide these services to psychologists practicing in Kentucky. In many states, the CAPs are integrally connected to the state licensing boards to provide a resource for therapy and supervision to psychologists who have been sanctioned. However, this is NOT the case in Kentucky. KPA-CAP has no association with the state licensing board, nor does it intend to do so in the future.
This is a rewarding profession which can be fraught with perils as recognized by fellow mental health professionals:
1. "No one who, like me, conjures up the most evil of those half-tamed demons that inhabit the human breast, and seeks to wrestle with them, can expect to come through the struggle unscathed.” (Freud, 1905/1933. P. 184).
2. "It is grueling and demanding work and the therapist who denies this is mendacious, deluded, or incompetent.” (Thorne, 1989, p.60).
Psychologists have been reported in the news to have engaged in improper, even criminal behavior:
1. A 73-year old psychologist sentenced to six months of home confinement for bilking a Catholic diocese in New Jersey out of more than $100,000 for services she did not perform. (Denson, 2015)
2. Former Harvard University psychologist fabricated and falsified data and made false statements about experimental methods in six federally funded studies. (Carpenter, 2012)
3. A Kids Company psychologist admitted being high on MDMA while out with young people who used the charity, allowed them to stay in her home, admits using drugs on several occasions, and testing positive for cocaine during a routine drug test. (Crossley, 2016)
4. "Well-known psychologist reprimanded for dragging child.” (Nelson, 2016)
The Advisory Committee on Colleague Assistance has been formed by the American Psychological Association (APA) to address the vulnerabilities of the profession.
1. To prevent and ameliorate professional distress and impairment and their consequences among psychologists.
2. To foster and provide resources via links to state associations.
3. Thereby, to better protect the public.
Enacting ACCA’s Mission:
1. Recognize and investigate the unique occupational vulnerabilities of psychologists and their need for colleague assistance (with emphasis on promoting wellness).
2. Promote the development and continuation of state level colleague assistance programs and peer assistance networks.
3. Developing informed relationships between state ethics committees, board of examiners, and colleague assistance programs for the benefit of the professional and the public.
Physical and mental stressors:
Financial strain Mental health disorders (depression and anxiety)
Relationship stress Family stress
Illness or injury Family pressures to model mental health
Current political events Discrimination
Concerns about client care Inclusivity of colleagues and organization
Concerns about trainees
Multiple roles Productivity pressures
Degree of autonomy Long work hours
Doing more with less Working with managed care
Administrative activities Organizational fairness/politics
Isolation Complex and challenging clients
Fear of client harm to self or others Malpractice concerns
Slow pace of therapy Often not knowing outcome of therapy
Residual Stressors: Graduate Training:
Debt Post graduate hurdles
Lingering effect of constant evaluation Cultural competence of training program
Health of strategies used in training Trainer modeling: stress management, ethical behavior,
Stress → Distress → Impairment → Improper Behavior
How does one maintain competence and flourish in the face of these stressors? The concept of "carrying capacity” from environmental science can help explain why it is so hard. Some definitions first:
Capacity: carrying capacity of the land to accommodate human development
Load: incremental strain of additional human population and activity
Margin: whether population growth and development are sustainable
When capacity > load, the margin is positive and sustainability is achieved–A Positive Margin
When load>capacity, the margin is negative and sustainability cannot be maintained-A Negative Margin
Results of a Negative Margin
Studies over the years have documented distress among psychologists by their self-report:
1. 9.1% reported "sometimes to very often” operating while too distressed to be effective
4.4% reported that it is ethical to do so
5% "did not know” whether it was ethical or not to do so (Schwartz-Metz and Shen-Miller, 2016)
2. 62% self-identified as depressed, 42% with suicidal ideation
14% with suicidal ideation did not reveal concerns to anyone, including their therapist
(APA, 2010: Gilroy & Murra, 2002; Mahoney, 1997)
3. 6-13% report substance abuse, primarily alcohol
6% reported conducting therapy while under the influence
5.3% reported that it was ethical to conduct therapy while under the influence (although no one reported doing so. (Pope et al, 1987; Schwartz-Mette & Shen-Miller, 2016)
4. MN Psychological Association members
47% acknowledged having experienced depression
60% acknowledged having been burnt out/overworked
44% acknowledged experiencing an anxiety disorder (Brodie & Robinson, 1991)
APA Ethics Code points the way
…Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work. (APA, 2010).
2.01 Boundaries of Competence
(a)Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of competence, based on their education, training supervised experience, consultation, study, or professional experience. (APA, 2010)
2.03 Maintaining competence
Psychologists undertake ongoing efforts to develop and maintain their competence. (APA, 2010)
2.06 Personal Problems and Conflicts
(a) Psychologists refrain from initiating an activity when they know or should know that there is substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner. (APA, 2010)
(b)When psychologists become aware of personal problems that may interfere with their performing their work-related duties adequately, they take appropriate measures, such as obtaining consultation or assistance, and determine whether they should limit, suspend, or terminate their duties.
As can easily be seen from the guidelines of our profession, we are ethically bound to get the help we need. KPA is now providing an avenue for obtaining such help through its newly developed Kentucky- Colleague Assistance Program (KPA-CAP). Call now to find a provider. Contact information is located on this website.
Many Psychologists Don’t Call:
1. In a survey of practitioners, 43% reported not telling anyone about their stressors (ACCA, 2011; Barnett et al., 2007)
2. Low utilization of Colleague Assistance Programs – between 5-12 calls per year
3. Low awareness of CAPs – 75% were not sure whether their state had one
4. Low availability – Only 29-32% of state associations reported having a CAP, among those without a CAP, almost 25% had one in the past (ACCA,2011; Barnett & Hilliard, 2001; Martin, 2013; Westbrook & Wind, 2012)
Why Psychologist Don’t Call:(ACCA 2009, 2010)
N=578 (Percentage Reporting, 2010)/N=427 (Somewhat of a barrier, 2009):
Lack of time 61% /40%
Privacy and/or confidentiality concerns 43%/25%
Don't know about available resources 31% /19%
Shame, guilt, or embarrassment 40%/18%
Lack of motivation, energy, or interest 40%/18%
Cannot afford (financial constraints) 33%/18%
Minimization or denial of issues 43%/17%
Fear of loss of professional status 29%/15%
Inadequate social support 27%/14%
It might feel like this:
USE 3 diving slides
APA also wants to lead the way with proposed changes to the Ethics Code:
Proposed edits are in italics
Standard 2.03, Maintaining Competence:
Psychologists undertake ongoing efforts to develop and maintain their competence.
Psychologists maintain regular engagement with colleagues, consultation groups, and
professional organizations and routinely solicit feedback from these sources regarding their
competence for work in specific roles and with specific populations.(Johnson, Barnett, Elman, et al., 2013)
Standard 2.06, Personal Problems and Conflicts:
(c) When psychologists become aware that a psychologist colleague is experiencing problems that may lead to interference with professional competence, they offer care and support, and collaborate with that colleague in assessing competence and determining the need to limit, suspend, or terminate their work related duties. (Johnson, Barnett, Elman, et al., 2013)
One Answer may be the Competence Constellation
A Competence Constellation is "A cluster of relationships with people who take an active interest in and engage in action to advance a professional’s well-being and professional competence.” (Johnson et al., 2013, p. 343-348).
It is a network of colleagues, supervisors, consultation groups, and others which:
- Can provide multiple sources of evaluation
- Can prevent problems resulting from lack of a sense of well-being and possible incompetence
- Can promote optimal functioning
- Can assume mutually binding responsibilities between the community and the individual
(Johnson et al., 2012, 2013)
It is a shift from viewing competence as a sole, individual responsibility to one rooted in community which would provide a resource for renewal, support, and sustainability. The competence constellation provided by KPA-CAP can be the beginning of increased mutual support among psychologists in Kentucky in the spirit of Remen’s Divine Diaspora:
"…in the shadow of these (cultural values of independence, competence, self-sufficiency) lies a profound rejection of our human wholeness. As individuals and as a culture we have developed a sort of contempt for anything in ourselves and in others that has needs, and is suffering……perhaps our only refuge is in the goodness in each other”. (Remen, 2000, p. 10)
Evaluate the information:
* Is it an ethical issue? Is it a competency issue? Or is it just unpleasant behavior?
* Are there enough data to warrant action?
* Would peer consultation be useful? (Be careful to protect confidentiality?)
(Keith-Spiegel, 2005; O’Connor, 2001; Vanden Bos and Duthie, 1986)
Decide who should confront the colleague based on:
* The severity of concern(s) and the relationship with the colleague
* The power differential which may play a role
* The possibility of more than one person being involved
* The motivation to engage (or avoid):
*Previous experience with the colleague
*Emotional reactions to observations or allegations
Avoid covert behaviors:
*May be tempting as nerves rise
*Consist of: *informing other colleagues to warn them
*Sending material about the problem (i.e. Ethics code with relevant underlines)
*Sending anonymous notes related to allegations
*May result in unintended consequences:
*Can lead to potentially harmful gossip
*Result in paranoia and/or defensiveness
(O’Conner, 2001; Keith-Spiegel, 2005; Vanden Bos and Duthie, 1986)
Prepare before the meeting:
*Organize thoughts, anticipate reactions
*Explore, manage feelings toward colleague and their behavior
*Be clear, concise, precise
*Identify 2-3 issues and 2-3 observations for each
*Practice opening comments, getting down to under 2 minutes
*Role play, review notes
Schedule meeting in advance:
*A business/professional setting is preferable
*The sooner the better
* Face to face if possible
*.Email creates trail but may compromise confidentiality (in addition to other challenges of emedia)
Speak, listen, discuss
*It is not therapy, but you can be empathic
*Set tone as alliance: Not loyalty but caring and facing problem together
*Prepare for anger and/or defensiveness
*Focus on understanding behavior from colleague’s perspective
*Acknowledge you may have misunderstood but behavior is concerning
*Allow ample time for response; colleague may be surprised, may need time to
work through and address issue
*If colleague becomes abusive/defensive:
*do not become agitated in return (if possible)
*offer to continue conversation
*note the next steps if conversation does not continue
*Describe ethical obligations
*Discuss next steps, including a plan
*Document initial meeting, date for follow up
*What has been done since the conversation?
*Try to be open to hearing concerns
*Try to work openly and honestly to address the matter
*Try to be grateful for being approached directly