Table of Contents
Therapeutic impairment in the counseling profession takes place when the professional functioning of a counselor is significantly affected to a degree that a counselor poses danger and possible harm to the client. Some of the factors that contribute to the condition of impairment are chemical dependency or substance abuse, debilitation or physical illness, and a personal crisis associated with various trauma or traumatic events, life crisis, and burnout (Lawson & Venart, 2007). The American Counseling Association (ACA) has established a task Force in 2003 in order to develop mechanisms that could be used to cater for the special needs of impaired counselors and their clients. Impaired counselors are different from the merely distressed or stressed counselors. Such people are experiencing high levels of stress, but their ability to effectively function is usually not affected to a degree that they cannot perform their duties. This paper critically analyzes the incidence, characteristics, and risk factors that contribute to the condition of counselor impairment.
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Since the early 1970s, there have been a tremendous number of empirical studies and conceptual studies that have tried to examine the complex phenomenon associated with counselor burnout. As research continues to develop, it has become evident that the conditions of burnout or impairment are prevalent cross-culturally and that they tend to affect diverse professions, including teachers, clerks, and managers. According to Gerard (2007), 5% of counseling professionals are affected by burnout and 10% are affected by compassion fatigue. In the professional counseling community, the incidence of therapeutic impairment is a complex topic, and most of the studies that aim to determine the exact numbers of professionals who are affected are not entirely compelling. Nevertheless, across a wide range of studies, there has been evidence that 21% to 67% of professionals in the counseling community tend to experience high levels of impairment (Morse, et al, 2012).
A study was carried out on 151 communities of mental health professionals based in Northern California. The scholars found that 38% of these professionals have reported high rates of depersonalization, while 54% of them had significantly increased levels of emotional exhaustion. Nevertheless, most of these professionals still reported achieving high levels individual accomplishments (Morse, et al, 2012). In the year 2000, a study was conducted on 29 directors who were managing community mental health centers based in Iowa. The study found that more than two-thirds of the subjects had low personal level of accomplishment and reported high levels of emotional exhaustion. Moreover, close to half suffered from high levels of depersonalization.
In 2005, scholars analyzed a state chapter of social professionals. Out of the 751 participants, 36% were found to have increased levels of emotional exhaustion. The researchers also attempted to utilize a single item for measuring the levels of burnout, with 18% of respondents reporting that they are currently suffering from problems of burnout (Morse, et al, 2012). In 2007, a study was conducted on 71 forensic mental health professionals in the United Kingdom. The study found that 54% of the subjects demonstrated high levels of emotional exhaustion, while an earlier study had shown that 21% to 48% of professionals in the field of general mental health suffered from high levels of emotional exhaustion as well (Morse, et al, 2012). Basically, it is evident that the levels of burnout tend to differ among the different fields of mental health profession. This implies that the members of the entire professional counseling community experience diverse levels of burnout and there is a need for studies to compare the impairment rates across disciplines or professions.
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Characteristics/ Signs and Symptoms
Designs and symptoms of counselor impairment may significantly differ depending on the nature of profession and on the amount of work that an individual is subjected to. However, the first sign of risks of impairment is burnout. Many professionals recognize burnout as the initial stage of deterioration. This is usually followed by a depression, temporary emotional disturbance or imbalance, like a person reacting when he/she faces a tragedy (Deters, 2008). Other common symptoms include overwork, over involvement, and contagion. Some studies have also demonstrated that some counselors tend to suffer from eating disorders when they are affected by the issues related to impairment. Basically, three common attributes of burnout are emotional exhaustion, reduced sense of accomplishment, and depersonalization, which manifests in loss of caring, empathy, and compassion.
Another crucial sign of impairment which occurs as the level of burnout worsens is vicarious traumatization, also known as the secondary traumatic stress. When counselors are treating victims of trauma, they may go through a very emotionally intense experience. Thus, these professionals have signs of trauma themselves, which brings about similar debilitating and intrusive symptoms. According to Barnett (2015), the signs of vicarious trauma include avoidant responses, somatic complaints, physiologic arousal, intrusive thoughts, distressing emotions as well as compulsive and addictive behaviors that affect professional competence.
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There are several risk factors that increase the counselors’ vulnerability to the development of counselor impairment. These factors fall into two categories: personal and work-related. Work related factors include the type of a client, work setting, relapses and chronic conditions, suicide attempts, crises and emergencies, aggressive and violent clients, ethics complaints, fearing malpractice claims, complexities in collecting fees, and complaints from licensure boards (Barnett, 2015). Counselors also neglect their personal needs and tend to overconcentrate on the needs of their clients. Principally, working for long hours and being unable to adhere to a proper time schedule increases the risks of counselor impairment. Furthermore, administrative responsibilities, such as managed care and insurance, increased paperwork, utilization review, lower reimbursement, inadequate resources and staff cutbacks may also lead to the development of a counselor impairment condition. Psychotherapists work in an environment where they require feedback in order to determine the efficiency of their treatment methodologies. On certain occasions, such feedback may not be immediate or even absent. Sometimes, counselors may receive a negative feedback, which makes a counselor feel unappreciated. When such issues are combined with tight time demands and other work pressures, they contribute to burnout, particularly when it is impossible to complete all of the duties that are on a counselor’s schedule.
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Personal factors that contribute to impairment are family, financial, health, relationship, substance abuse, and mental health issues. For instance, when a counselor cares for his sick family members, is suffering from a depression or goes through a divorce process he/she is at a higher risk of suffering from an impairment conditoin. Nevertheless, it is important to note that it is very difficult to differentiate personal and professional lives when analyzing the factors that contribute to counselor impairment. Both types of factors tend to influence and impact on each other, for instance, personal issues may curtail the ability of an individual to effectively perform her professional therapy duties.
This paper has critically analyzed the incidences, characteristics and risk factors that contribute to the condition of counselor impairment. Since counselors are supposed to care for the patents with mental health issues, most people assume that counselors themselves are not exposed to mental problems as a result of burnout and impairment. Nevertheless, studies have shown that incidence of counselor impairment range between 21% and 67%. Furthermore, professionals who work in different mental health care fields tend to be affected differently depending on the intensity of the work they are exposed to. Signs of burnout act as the initial symptoms of impairment. This can include depression, emotional disturbance, overwork and avoidant responses. These symptoms are caused by both professional and personal matters such as aggressive clients, tight schedules, lack of or negative feedback as well as depression. On most occasions, the factors that contribute to impairment are closely interrelated and they tend to worsen when the counselor ignores his personal needs. It is therefore imperative to put into consideration the factors that may contribute to impairment in order to prevent their occurrence.