Having the Most Difficult Conversation

Having the Most Difficult Conversation
By Kristin B. Webb, Psy.D. & Alexis T. Franzese, Ph.D.
Colleague Assistance Committee Members
The North Carolina Psychologist Vol 65(3), 2013

You work in a small private practice with two other psychologists, one doctoral and the other master’s level. Over several weeks you overhear a client of the latter referring to him as “Dr. Smith.” You worry that you can’t say something without insulting your friend and business partner.  Is it even a problem? Is it worth a potentially angry response?

A colleague who successfully manages her bipolar disorder has recently begun to share concerns regarding your work. She believes you have acted unethically on several occasions and describes in detail how your actions may be harming patients. She has extensive documentation of these details. She has mentioned that she would like for you to discuss her concerns with her, at length, and for you to ask forgiveness of your patients. You strongly believe that you have not acted unethically or harmed any of your patients in any way. Additionally, you suspect that  her concerns are symptomatic of a manic episode. How can you get her to back off and stop telling you that you’re unethical? Can you ask her if she is taking her medications? Can you suggest to her that she needs to return to treatment for her bipolar disorder?

If It’s About a Colleague

The APA Ethics Code is vague about how to deal with such ethical conundrums as a case of colleague who is exercising poor judgment or is distressed to the point that it interferes with his or her work, or who may be impaired.

As psychologists, we are enjoined to seek informal resolution. Although we are generally well trained about and accustomed to having difficult conversations with clients, we sometimes avoid having such conversations with colleagues. Our reluctance to approach a colleague might reflect a desire to maintain a professional and/or personal relationship, our own feelings about confronting others, or myriad other concerns.

The NCPA Colleague Assistance Committee offered a workshop on this topic in April 2012. Our presentation, from which this article is taken, is based on a review of research on this topic, on CAC members’ experiences, and on comments offered by NCPA members.

If you’re concerned about a colleague who appears to be in distress or is struggling with substance use or other potentially problematic behavior, the following guidelines may be helpful in considering whether and how to approach him or her.

• Consider why you are concerned. What are your motivations? Do you want to express concern, lecture, or punish or criticize?  If you want to do anything other than express concern, stop.

• Pick the time and place—Make sure you have enough time for a roomy conversation, and enough privacy for both of you to feel comfortable. Don’t attempt to engage a person when she or he is in an altered or clearly distressed state unless it’s urgent.

• Don’t feel the pressure of having to “know” if someone has a problem or not.  If you’re worried, that’s worth a conversation. Start with affirming the connection between the two of you, whatever it is (i.e., “We’ve been friends for a long time….”), and talk in terms of “I’m concerned about you, not “I think you have a problem.”  Be prepared with specifics of times that have concerned you.

• Be ready with resources.

• Don’t worry about scripting each word—The conversation is likely to be awkward yet may still be helpful.

If you are rebuffed and your colleague’s behavior is of great concern, first remember that the person you care about has heard you, regardless of denial or defensiveness.  However, if the behavior is dangerous and your colleague is unwilling or unable to address it, take it to the next level, which may mean consulting the CAC, the Ethics Committee, or the North Carolina Psychology Board.  Remember, decisions about these situations need to be informed by the APA Ethics Code and relevant state and federal law.

Or Topsy Turvy

The complexities involved in us approaching a colleague with concerns also apply when we think about how to respond to a colleague who approaches with us with concerns about our behavior.

• Express appreciation for the contact (even if you disagree with the facts or the opinion being expressed).
• Recognize that it’s most likely coming from a place of concern.
• Limit defensiveness and argumentativeness. Respond inquisitively rather than argumentatively (e.g., “What did you notice that caused discomfort?”;  “What caused you to bring this issue to my attention now?”) Use your listening skills to get a good understanding of the facts being presented.

Take time before responding, but do not ignore your colleague’s approach and do respond to it eventually. Seek consultation. It is crucial to remember that this is a colleague’s attempt at managing the issue informally which is ultimately for your benefit and in your best interest.

In Any Case

In conclusion, the APA Ethics Code provides for both autonomy and responsibility. By allowing, and expecting informal resolution, the Ethics Code is respecting the competence and ability of psychology’s professionals. Therein lies the responsibility to protect our discipline and profession and to care for our colleagues and those we serve.

The APA Advisory Committee on Colleague Assistance (ACCA) seeks to promote the health and well-being of psychologists by providing resources to help them prevent burnout and to thrive and flourish in their personal and professional lives. It also seeks to help organizations in which psychologists work to promote their well-being. ACCA has a threefold mission:

1. To prevent and ameliorate professional distress and impairment and their consequences among psychologists.
2. To foster and provide resources via linkages to state associations to this end.
3. Thereby, to better protect the public.

ACCA attempts to attain these goals in three ways: By promoting an understanding and acknowledgment of the unique occupational hazards of psychologists’ work, supporting the development and maintenance of state level assistance programming, and encouraging appropriate linkages between state ethics committees, regulatory boards and assistance programs.

By working in these areas, ACCA hopes to serve the interests of the public and the professional community. Resources to help psychologists and their professional organizations can be found on the ACCA web page: (http://www.apa.org/practice/leadership/colleague-assistance.aspx).