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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
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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
•
•
•
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Failure to take vacations
Chronic fatigue
Emotional exhaustion
Cynicism
Symptoms of Burnout
• Headaches, lack of pleasure in
relationships
• Increased drinking
• Marital deadness
• Explosions of anger
(cont.)
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 selfesteem
• 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
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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