professional vulnerability
DESCRIPTION
PROFESSIONAL VULNERABILITY. Perfectionism. Despite cultural sanctions, perfectionism is not adaptive. Perfectionism is a vulnerability factor for depression, burnout, suicide, and anxiety. The desire to excel must be differentiated from the desire to be perfect. - PowerPoint PPT PresentationTRANSCRIPT
PROFESSIONAL
VULNERABILITY
Perfectionism
• Despite cultural sanctions, perfectionism is not adaptive.
• Perfectionism is a vulnerability factor for depression, burnout, suicide, and anxiety.
• The desire to excel must be differentiated from the desire to be perfect.
“The perfect is the enemy of the good.”
- Voltaire
Perfectionism (cont.)
• Believing that others will value you only if you are perfect is associated with both depression and suicide.
• It contains an element of pressure associated with a sense of helplessness and hopelessness.
• “The better I do, the better I’m expected to do.”
• Intense need for external validation
- Flett & Hewitt, 2002
Origin of Perfectionism
• Not well understood
• Multiple pathways are involved:
1. Child factors—temperament, attachment style
2. Parent factors—style of parenting, parental personality
3. Environmental pressures—peers, culture, teachers
Flett & Hewitt, 2002
Origins of Perfectionism (cont.)
• Satisfaction with real achievements is limited because of feelings of fraudulence and the expectations that more will be demanded.
• The “driven” quality is designed to gain relief from a tormenting conscience rather than a genuine wish for pleasure.
Consequences
• Burnout
• Depression & suicide
• Problems with self-care
• Marital problems
• Substance abuse
• Professional boundary violations
Definitions of Burnout
• State of fatigue or emotional depletion brought about by adherence to a professional role that has failed to produce expected rewards
• “An erosion of the soul” - Maslach & Leither, 1997
Definitions of Burnout (cont.)
• “Joyless striving”
- Holmes & Rahe
Symptoms of Burnout
• Failure to take vacations
• Chronic fatigue
• Emotional exhaustion
• Cynicism
Symptoms of Burnout (cont.)
• Headaches, lack of pleasure in relationships
• Increased drinking
• Marital deadness
• Explosions of anger
Midlife Disillusionment
• The pay-off for self-sacrifice never materializes
• Feelings of betrayal and disillusionment
Problems with Spouse or Partner
• Psychology of postponement
• Lives of quiet desperation
• Failure to make time for intimate conversation
Profile of Professionals
• No simple formula
• 20% are female
• 20% are same-sex
• Vulnerability is universal
Common Themes
• Omnipotence –
“Only I can save the patient.”
• “True love” is idealized,
valorized, and mythologized
• The presence or absence of “true love” is irrelevant to ethics considerations
PROFILE OF VICTIMS
• Incest victims (sitting duck syndrome)• Patients with a history of sexual abuse• Attractive patient with chronically low self-
esteem• Patient with a history of previous
hospitalization, suicide attempts, and substance abuse
• Depressed and suicidal patient with recent romantic break-up
Profiles of Victims (cont)
• Borderline Personality Disorder Patients
• Intellectually Challenged Patients
• Drug-Seeking Patients
• First Nation People
• Patients in Lower Socioeconomic Groups
Special Situations
• Rural Practitioners
• Home Care Practitioners
• Multi-Cultural Issues
PRINCIPLES OF ASSESSMENT AND REHABILITATION
• Disciplinary measures are the purview of a College or licensing board, while psychiatric assessment is the purview of independent mental health professionals.
• Treatment recommendations growing out of an assessment, however, must be integrated with the disciplinary stipulations.
PRINCIPLES OF ASSESSMENT AND REHABILITATION (cont.)
• Evaluating team must differentiate between impairment and problems in professionalism.
• In some situations, both may be present.
• Questions from referring College or board are helpful in focusing the assessment.
PRINCIPLES OF ASSESSMENT AND REHABILITATION (cont.)
• Collateral information from complainants, family members, colleagues, police reports, and College are always valuable and often essential.
• Signed release to College or other agency is necessary before beginning the evaluation.
Substance Abuse
• Substance abuse may be a contributing factor that is hidden
• Collateral sources may not know about it
• Random urine drug screen is useful to rule out substance use
• The professional’s response to the prospect of a urine drug screen is highly informative
Principles of Assessment and Rehabilitation (Cont)
• Amenability to rehabilitation must be carefully assessed
• Narcissistic mortification is not the same as genuine remorse
• Risk of repeating boundary violations and the safety of the public must be weighed against practitioner’s wishes
Components of Rehabilitation Plan
• Practice limitations• Chaperone requirements• Mentoring• Supervision• Change of practice setting—group,
institution only• 12-steps programs
Components of Rehabilitation Plan (cont)
• Individual psychotherapy—psychodynamic, cognitive-behavioral
• Marital or couples therapy
• Pharmacotherapy
• Inpatient or residential
• Total duration of plan may be 3-5 years