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Mental health practitioners' knowledge of colleagues' problems of professional competency.

There is a lack of empirical research on how mental health practitioners (MHPs) are affected by professional incompetency of their colleagues. To bridge this gap in the literature, a total of 213 MHPs were surveyed to determine their knowledge of coworkers' problems of professional competency (PPC). Descriptive statistics were utilized to analyze the data. Findings suggest the majority of MHPs are aware of colleagues with PPC and believe these colleagues are disrupting the work environment and adversely affecting client care.

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Before approximately 2009, mental-health-related literature was primarily focused on using the term impairment to describe physical, mental, and emotional problems of personal nature found in practice and training (American Counseling Association (ACA), 2014; Falender, Collins, & Shafranske, 2009; Schwartz-Mette, 2009, 2011). However, the discussion has shifted to include professional competency as a way to more accurately describe problematic behavior to distinguish those conditions related to specific disabilities as identified by the Americans with Disabilities Act (Falender et al., 2009). Currently, problems of professional competency include behavior problems, psychological problems, and developmental problems. Problems of professional competency (PPC) with counselors-in-training have been well documented in areas of poor academic performance, interpersonal difficulties, and inappropriate ethical decision-making (Brown-Rice & Furr, 2013; Duba, Paez, & Kindsvatter, 2010; Gaubatz & Vera, 2006; Herlihy & Dufrene, 2011; Kerl, Garcia, McCullough, & Maxwell, 2002; Miller & Koernin, 2001; Zoimek-Daigle & Christensen, 2010). In fact, Brear and Dorrian (2010) noted that 58% of the counseling faculty reported that they "... have passed a student in one of [their] courses whom [they] deemed to be unsuitable for the counseling field" (p. 267).

Empirical research on counselors-in-training has also found students are negatively affected when their peers' problematic behaviors and conduct in mental health training programs disrupt the learning environment (Brown-Rice & Furr, 2013; Oliver, Bernstein, Anderson, Blashfield & Roberts, 2004; Rosenberg, Getzelman, Arcinue, & Oren, 2005), causing emotional consequences to students (Brown-Rice & Furr, 2013; Mearns & Allen, 1991; Rosenberg et al., 2005), and affecting relationships with counselor educators (Brown-Rice & Furr, 2013; Forrest, Elman, & Shen-Miller, 2008; Oliver et al., 2004). For example, Brown-Rice and Furr (2013) used a survey design and found "that the majority of preservice counselors are aware of classmates with PPC and report frustration with faculty for not addressing problematic peers" (p. 224). These issues have resulted in many problems, including students questioning counselor educators' role in addressing issues, educators feeling ill-equipped to intervene, and programs initiating dismissal procedures with attendant fear of litigation (Brown-Rice & Furr, 2013; Foster & McAdams, 2009; Gaubatz & Vera, 2006; McAdams, Foster, & Ward, 2007).

Engaging in gatekeeping procedures can be challenging for educators due to fear of recrimination (e.g., being sued, poor teaching evaluations) (Gaubatz & Vera, 2002; Jacobs et al., 2011), lack of clear evidence of students' PPC (Brear & Dorrian, 2010), and absence of clear program protocols to address students' PPC (Jacobs et al., 2011). Failure to address students' PPC may also relate to counselor educators having their own PPC. Brown-Rice and Furr (2015) surveyed 335 counselor educators and found that 75% had observed colleagues with PPC teaching in their programs. As a result, the majority of these participants believed that problematic faculty behavior interfered with students' learning and the overall learning environment.

The counseling field is not alone in experiencing these effects due to PPC. Related fields such as psychology and marriage and family therapy have reported similar challenges (Elman & Forrest, 2007; Elman, Illfelder-Kaye, & Robiner, 2005; Forrest, Elman, Gizara, & Vacha-Haase, 1999; Oliver et al., 2004; Russell, DuPree, Beggs, Peterson, & Anderson, 2007; Schwartz-Mette, 2009; Vacha-Haase, Davenport, & Kerewshi, 2004). Clemens, Horwitz, and Sharp (2011) noted that "few things cause more consternation and reluctance to act in a professional community than emerging evidence of impairment in a colleague" (p. 53).

It is clear from the literature that PPC exist in mental health training programs. What is not as clear is the extension of these concerns into the field of practice, specifically, how colleagues with PPC affect the work setting for mental health practitioners (MHPs) or how MHPs are personally affected when working alongside a colleague with PPC. To date, no studies extend the investigation of the competency concerns found in training to the practice arena with the effort to explore more tacit related factors contributing to the impact of PPC in the work environment.

Given the limited research investigating these topics and a need to understand how working with a colleague with PPC affects MHPs, the purpose of this study was to investigate how and to what degree practitioners experience PPC impact. Specifically, the study attempted to answer the following research questions: 1) Do MHP believe they have colleagues with PPC at their current place of employment? 2) What types of colleagues' PPC do MHPs perceive have the greatest impact on themselves? 3) What do MHPs believe is the most significant impact on them as a result of working with a colleague with PPC? and 4) What is MHPs' knowledge of their current work settings' protocol for addressing a colleague with PPC?

In order to properly address these questions, we must first define our terms of investigation. In this study, mental health practitioners are those individuals designated by their state licensing board as being a licensed professional counselor (LPC) or licensed mental health provider (LMHP), colleague is any mental health practitioner whom the participant has worked alongside, impact relates to a strong effect on a participant during or after employment in a particular setting, and administration is a supervisor and/or manager at a place of employment. For this study, Problem of professional competency (PPC) follows the definition laid out by Falender et al. (2009). PPC refers to attitudes and/ or behaviors that could interfere with the professional competence of a mental health provider, including (a) a lack of ability to acquire or opposition to acquiring and integrating professional standards into one's professional behavior; (b) a lack of ability to attain professional skills and reach an acceptable level of competency; (c) a lack of ability to manage one's stress, psychological dysfunction, or emotional responses that may negatively affect professional performance; or (d) engagement in unethical behavior (Falender et al., 2009). It is important to note that these attitudes and/or behaviors can be involved in the practice of therapy or interacting with other colleagues or a combination of the two.

METHOD

Participants and Procedures

Prior to initiating the study, we obtained institutional review board approval. This study utilized a non-experimental descriptive design to answer the above research questions. This method was appropriate given that the purpose of this research was to provide a descriptive summary of the actual perceptions and behaviors of mental health professionals (Huck, 2011). To gather the data, a cross-sectional survey design was used. Recruitment of participants was conducted by mailing a recruitment letter, informed consent form, and a paper survey (Problems of Professional Competency Survey--Practitioner Version; PPCS-P) to MHPs in two Midwestern states. The researchers of this study obtained a list of the names and addresses of licensed MHPs from the state licensing hoard for one state which utilized the licensure title of licensed mental health professional and the list of current licensed professional counselors from the second state, published on the licensing board's website. The first author organized a list of mailing addresses provided by state boards to contact the population for this study. Based upon these two lists, a total of 1,200 surveys were mailed to prospective participants. Of the 1,200 mailings that were sent, 10 were returned as undeliverable; leaving a total sample size of 1,190 MHPs. A total of 217 participants completed the survey; however, respondents with missing or invalid data (n = 4, less than 2%) were eliminated via listwise deletion, leaving a total number of 213 participants included in this study. Listwise deletion is the appropriate means for removal of the missing data given the assumption that the missing values were randomly distributed across the data set (Sterner, 2011). This resulted in a response rate of 18%. To check the representativeness of the sample, the demographic characteristics of this current study were compared to prior empirical literature. It was found that the percentages of gender and race were similar; however, the participants in this study were somewhat younger (Sidani, Price, Dake, Jordan, & Price, 2011).

Of the 213 participants (77%, n =164 women, 23%, n = 49 men), 92% (n = 196) identified their cultural/racial background as being Caucasian, 3% (n = 6) identified as African American, 2% (n = 4) identified as Native American, 1% (n = 3) identified as Multiracial, 1% (n = 2) identified as Hispanic/Latino, and 1% (n=2) identified as Asian/Pacific Islander. Three percent (n = 6) defined their age as between 20 to 29 years, 19% (n = 40) indicated that their age was between 30 to 39 years, 21% (n = 46) defined their age as between 40 to 49 years, 29% (n = 62) were between 50 and 59 years, and 28% (n = 59) indicated that their age was 60 years or older. The majority of the respondents identified as heterosexual (94%, n = 200) with 6% (n = 13) identified as bisexual, gay, or lesbian. Regarding the participants' place of employment, 47% (n = 101) indicated they worked in private practice, 21% (n = 44) defined their work setting as a non-profit agency, 14% (n = 29) stated they worked at a for-profit agency, 6% (n = 12) at an elementary/secondary school, 5% (n = 10) at a government agency, and 2% (n = 3) indicated they were not currently employed. The remaining 7% (n = 14) identified another type of setting (i.e., college counseling center, university faculty, in-patient facility).

Regarding the highest degrees obtained, 54% (n = 11 5) respondents indicated that they had a master's in counseling from a Council for Accreditation of Counseling and Related Educational Programs (CACREP)-accredited program, 29% (n = 61) had a master's in counseling from a non-CACREP-accredited program, 3% (n = 6) had a doctorate of philosophy (PhD) in counseling from a CACREP-accredited program, 2% (n = 5) had an education specialist degree in counseling, 2% (n = 5) had a master's degree in pastoral/ divinity counseling, 1.5% (n =4) had a PhD in psychology, 1% (n = 3) had a master's in social work, and 0.5% (n = 1) had a PhD in counseling from a non-CACIIEP-accredited program. The remaining 7% (n = 13) reported having some other type of degree (i.e., educational doctorate in counseling, school psychology master's, clinical psychology master's, PhD in marriage and family therapy). All participants (n = 213) reported being licensed by their state licensing board, 72% (n = 154) stated they were LMHP and 28% (n = 59) reported holding an LPC. Regarding how many years respondents had been practicing, 21% (n = 46) reported two to five years, 12% (n = 25) reported six to 10 years, 23% (n = 48) reported 11 to 15 years, 18% (n = 38) reported 16 to 20 years, and 26% (n = 56) stated that they had practiced for over 20 years.

Instrumentation

To answer the research questions for this study, a self-report survey was designed based upon the PPCS-MS, which was developed by Brown-Rice and Furr (2013). The original purpose was to determine a master's students' knowledge of peers with PPC enrolled in CACREP-accredited programs. The items for the PPCS-MS were determined from the literature regarding PPC in psychology, counseling, and social work. To establish content validity and reliability, the PPCS-MS underwent an expert review process and two pilot studies. Further, a principal component analysis created components representative of what the review of the literature provides on these issues (Brown-Rice & Furr, 2013).

The questions and the format of the PPCS-MS were utilized and adjusted to he specific to MHP to create a self-report instrument entitled the Problems of Professional Competency Survey--Practitioner Version (PPCS-P, See Appendix A). In this survey, the term master's student was changed to colleague and the term program was changed to agency/school for all definitions and survey items and questions were added regarding working with clients. The PPCS-P was divided into three parts: Part I--Demographic Information, Part II Knowledge of Colleagues' PPC, and Part III--Knowledge of Supervisees' PPC (removed from this analysis, as the focus of the study pertained to practicing mental health providers, not the act of supervision). Part II included two sections: Section I, MHPs' Knowledge of Current Colleagues' PPC, which included four questions to determine if participants had observed colleagues with PPC at their current place of employment; and Section II, MHPs' Perceptions of the Impact of Colleagues' PPC, which included 25 questions. The answers to the first 25 questions were based on a 5-point Likert scale (1 = strongly disagree to 5= strongly agree). The 26th item was unstructured, to provide a place for the participants to provide additional information. The Statistical Package for Social Sciences (SPSS, Version 21.0) software was used to screen the data, gather descriptive data, and determine frequencies and percentages for demographic variables. To answer the research questions, we analyzed data by creating tables using SPSS to determine frequencies, averages, and percentages. Cronbach's coefficient alpha was used to determine internal consistency and homogeneity in measuring similar concepts of the survey items in Part III, Section II of the PPCS-P version. Items related to type of classmates' PPC resulted in a Cronbach's alpha coefficient of .88 compared to .90 in the original PPCS-MS version, items related to measuring the impact of working at an agency/school with colleagues having PPC had a Cronbach's alpha coefficient of .88 compared to .85, and items related to responses to PPC had a Cronbach's alpha coefficient of .60 compared to .73 in the PPCS-MS version.

RESULTS

Experience with Colleagues' PPC

Of the 213 participants, the majority (69%, n = 147) reported that they had observed colleagues with PPC at their current place of employment and completed Part I, Section I of the PPCS-P. Additionally, 3% (n = 7) of the respondents indicated they did not know if there were colleagues with PPC at their current agency/school, leaving 28% (n = 59) who had not observed any colleagues with PPC at their current employment site. For those respondents who believed they had observed a colleague with PPC (n = 147), 35% (n = 52) had observed one colleague, 35% (n = 51) had observed two colleagues, 14% (n = 21) had observed three colleagues, 5% (n = 7) had observed four colleagues, and 11% (n = 16) had observed five or more. When the participants (n = 147) were asked if they were impacted by currently working with a colleague with PPC, 82% (n =120) reported in the affirmative, leaving 18% (n = 27) who stated they were not impacted. Of those participants (n = 120) who were impacted, the majority 54% (n = 65) indicated that the most significant concern was the level of competent care clients were receiving. In terms of the nature of the impact, 21% (n = 25) of the participants described their work environment being disrupted, 13% (n = 15) stated that their workload had increased, 8% (n = 9) reported that the colleague with PPC interfered with the participant's ability to focus and work efficiently, and 4% (n = 6) reported other ways they were most impacted (e.g., affected relationship with the colleague away from work, affected relationship with the colleague at work, affected their trust in agency administration, damaged professional reputation of the agency).

Perceptions of the Type and Impact of Colleagues' PPC

All participants (n = 213) completed Part II, Section II of the PPCS-P. Frequencies and percentages for all participants (n = 213) of the specific types of PPC observed are reported in Table 1. The frequencies and percentages of participants' perception of the most significant impact on them due to working with a colleague with PPC are reported in Table 2. When the participants' responses for strongly agree and agree were combined, the most common types of PPC observed by participants were a colleague's inadequate clinical skills 60% (n = 137), a colleague's inability to regulate emotions 52% (n = 110), and a colleague with psychological concerns 47% (n = 101). Regarding the respondents' belief about the specific type of impact of working with a colleague with PPC, 75% (n = 159) were concerned about the quality of the counseling profession when a colleague with PPC is allowed to continue to practice, 74% (n = 158) were concerned that a colleague with PPC is allowed to continue to work with clients, and 62% (n = 131) believed the colleague with PPC disrupted the overall work environment. When looking at the direct impact on a MHP working alongside a colleague with PPC, 59% (n = 125) reported being frustrated with their supervisor for not addressing colleagues with PPC, 57% (n = 122) reported feeling stressed, and 57% (n = 122) provided they were frustrated because the colleague was allowed to continue to practice.

Knowledge of Current Agency/Schools' Protocol for Addressing

When all (n = 213) participants' responses for strongly agree and agree are combined, 88% (n = 187) believed it was the responsibility of their supervisor to be aware of colleagues with PPC, 77% (n = 163) believed that it was the supervisor and respondents' responsibility to be aware of colleagues' PPC, and 70% (n = 150) believed that it was their responsibility to be aware of colleagues with PPC. Additionally, 55% (n = 116) of the participants would like more information regarding how to respond to a colleague with PPC and 48% (n = 102) would like more information regarding how to identify a colleague with PPC. Further, 62% (n = 133) reported that they knew the appropriate intervention to take regarding a colleague who demonstrated PPC, 62% (n = 131) were aware that their agency/school had procedures regarding how to address colleagues' problematic behavior, and 35% (n = 75) reported that their supervisor had discussed their agency/school's procedure regarding addressing PPC with them.

LIMITATIONS

Limitations of the present study should be noted. First, the sample was obtained from licensed MHP in two Midwestern states, which is not likely to be representative of all MHP. Those who chose to participate in the study might be different from other MHP in several ways, including their willingness to participate in research, and their knowledge of colleagues with PPC and perceived impact of working with these colleagues. The second limitation of this study is related to the utilization of a researcher-created survey. While the survey was built upon a previous instrument that was found to be representative of literature concerning PPC, using a measure that has been validated may have resulted in clearer outcomes. Also, while the authors provided a definition of PPC, providing examples of PPC for participants might have yielded clearer results. Another limitation is associated with the survey being a self-report measure. There is a risk that participants provided answers that they considered to be socially desirable. Even though the participants were informed in advance that their answers would be kept anonymous, they may still have responded in a manner that was not representative of their true feelings or knowledge. Lastly, and perhaps more importantly, this study was exploratory in nature with limitations to the ability to glean definitive understanding of PPC in the work place. Majority percentages (e.g., 69%) can only provide a piece of understanding and based on the current study it is difficult to know if respondents could be identified as having PPC of their own, consequently influencing responses.

DISCUSSION

The primary focus of this study was to examine the views of mental health professionals when working alongside a colleague's problems of professional competency. Given the growing focus of professional competence in training settings and the lack of research exploring professional competence in the field, this study attempted to complete a more systematic picture of this issue. It is important to reiterate that these data are preliminary in nature, and as such, caution is needed in drawing conclusions.

Experiences of Colleagues with PPC

In this current study, 69% of the participants believed they had observed a colleague with PPC. This percentage is comparable to previous reports regarding counselor educators having a colleague with PPC (75%) (Brown-Rice & Furr, 2015) and counseling master's students having a peer with PPC (74%) (Brown-Rice & Furr, 2013). Further, participants were more likely to observe one colleague with PPC (35%) than five or more colleagues with PPC (11%). Mowever, a careful investigation of these observations exposed an interesting dynamic. Participants were just as likely to observe a second colleague (35%) with PPC. Therefore, it is possible that when mental health professionals are viewing concerning behaviors they are seeing multiple offenders from their perspective. A level of caution is certainly needed when making interpretations based on one's perception related to concerning behavior. An observation could come from a highly trained participant with a high ability in recognizing PPC (Oliver et al., 2004) or from participants who were unclear or confused about the representation of PPC in a colleague (Brown-Rice & Furr, 2013). In either case, it is clear from training to practice, suspect behaviors are observed in more than isolated incidents.

Of particular interest is the high percentage (82%) of mental health professionals believing they are affected in negative ways (i.e., an increase in concern for client care, work environment disruption, workload increase) by a peer with PPC. In other words, regardless of the exact validity of one's perception related to PPC, the majority reported being stressed as a result of interactions with their problematic peer (57%) and believed the colleague with PPC disrupted the overall work environment (62%).

Types of PPC Observed

For this study types represent attitudes and/or behaviors (e.g. clinical skills, ability to manage stress, emotional instability, psychological functioning) associated with observed PPC. As noted earlier, the most frequent type of PPC observed was the perception of inadequate clinical skill in a colleague. This finding connects with training literature, in that there are portions of graduating mental health professionals entering the field with inadequate skills as judged not only by students, but also by faculty/trainers (Brear & Dorrian, 2010; Brown-Rice & Furr, 2013; Gaubatz & Vera, 2006; Mearns & Allen, 1991; Oliver et al., 2004; Rosenberg et al., 2005). In other words, if some portion of counselors-in-training enter practice with a degree of inadequate clinical skill, colleagues in practice are likely to perceive similar degrees of inadequate clinical skill.

Other types of PPC included colleagues not regulating their emotions well while at work, having psychological dysfunction, and demonstrating signs and symptoms of personality disorders and substance use issues. The experiences noted in this study were similar to previous training-related literature, which noted problems with professional behavior (Shen-Miller et al., 2011), interpersonal issues (Mearns & Allen, 1991), emotional problems (Rosenberg et al., 2005), and personality disorders (Oliver et al., 2004). For example, Shen-Miller et al. (2011) reported that 58.5% of counselors-in-training viewed a peer as having difficulties with professional behavior. The results of this current study suggest there are common types of PPC operating across mental health disciplines and from the training environment to the field of practice.

Perceived Impact of Colleagues with PPC

As noted previously, participants in this study reported viewing colleagues with various types of PPC. The type of PPC led to varying areas of impact. This study found results similar to those found in mental health training literature. Namely, participants reported that PPC disrupted the work environment (Oliver et al., 2004; Shen-Miller et al., 2011), led to their feeling stressed from interactions with problematic colleagues/students (Brown-Rice & Furr, 2013; Mearns & Allen, 1991), and increased workload (Rosenberg et al., 2005). In addition, this study found a similarity between increased frustration with limited action from the profession and supervisor(s) and lack of trust in faculty/ trainer credibility (Forrest et al., 2008). The impact of such limited action in particular has been of great concern for training programs as they are tasked with the responsibility of gatekeeping (Brown-Rice & Furr, 2013; Gaubatz & Vera, 2002; Russell et al., 2007; Schwartz-Mette, 2009; Vacha-Hasse et al., 2004). The findings of this study and previous empirical literature suggest three main patterns. First, PPC are present whether with students, educators, or practitioners. Second, others who are learning/working alongside a peer with PPC are being negatively affected. Third, students/educators/practitioners are frustrated that colleagues' PPC is not being addressed. Specifically, the concerns that are present in training programs are repeating themselves in the professional setting.

Knowledge of Protocols to Address Colleague PPC

The results of this study related to protocol found that the large majority of participants believed it was their responsibility and the responsibility of the supervisor to be aware of colleagues with PPC and that the participants were aware of work-setting protocol. Only approximately half wanted more information regarding identifying and responding to PPC. The reason for seeking or not seeking more information was not addressed in this study. These results suggest that mental health practitioners have some understanding of protocol as it relates to work setting and also to broader professional guidelines related to ethical behavior and decision-making. These results matched the results from training programs. The majority of students and faculty believed they had the responsibility to know how to address PPC in the environment (Shen-Miller et al., 2011). Interestingly, Shen-Miller et al. (2011) noted that students believed little to no improvement would result from their action. Future research to uncover if and how MHP are engaging in addressing colleagues with PPC is needed to gain further understanding.

IMPLICATIONS FOR CLINICIANS AND CLINICAL SUPERVISORS

The results of this study provide specific implications for clinical supervisors. This study found that 82% of clinicians reported being affected in negative ways by peers with PPC. Specifically, 59% of the participants stated they were frustrated with their supervisor for not addressing colleagues with PPC and 57% were frustrated because the colleague was allowed to continue to practice. Similar results have consistently been found in areas of training, such as students believing faculty are not adequately addressing peers with PPC (Brown-Rice & Furr, 2013; Forrest et al., 2008; Oliver et al., 2004; Rosenberg et al., 2005). Educators have found that responding to problematic student behavior results in emotional conflict over their dual relationships (Kerl et al., 2002; Russell et al., 2007; Vacha-Haase et al., 2004), absence of colleague and institutional support (Gizara & Forrest, 2004), and the risk of litigation or recrimination from students (Gaubatz & Vera, 2002). In fact, educators believe interacting with students with PPC to be difficult, demanding, and complicated (Gizara & Forrest, 2004). Therefore, it would seem that these same stressors would have implications for those training and supervising counselors in the field and may be affecting how clinical supervisors are engaging in gatekeeping and remediation practices. Additionally, it may be increasing these supervisors' job stress and burnout. In short, it is possible this same pattern of "gateslipping" (Brear & Dorrian, 2010) that occurs in educational settings is continuing in clinical practice.

If it is true that PPC are operating to some degree at various levels (i.e., training to practice), then clinical supervisors and even clinicians are encouraged to take action. In particular, supervisors should not overlook the issue of clinicians with PPC in their organizations and agencies. Clinical supervisors are essential gatekeepers for the counseling profession and are ethically bound to have specific training in supervisory methods, techniques, and models and charged with ensuring clinicians with PPC are addressed so clients are not harmed (ACA, 2014). We believe clinical supervisors should be provided with proper institutional, collegial, and professional support to be able to engage in these ethical obligations. We believe this support is a necessary first step toward action. We encourage clinical supervisors to support each other in this challenging part of the job, but also hold each other accountable to be ethical supervisors. The failure to act as this final gatekeeper can result in incompetent clinicians causing unnecessary harm to clients. Thus, the organization, regardless of exact setting type, needs to encourage the recognition of and willingness to address PPC matters. In other words, there must be a push to infuse policy into the organization to help and support those working within.

Once an organizational-level policy of support is developed, clinical supervisors or even those in management positions can implement a simple action strategy. We believe a needed second step is to assess the work environment for the extent to which PPC are present. Simply put, administering sections II and III from the Problems of Professional Competency Survey (Appendix A) on an annual or semi-annual basis will provide the clinician or clinical supervisor with a better understanding of PPC existence in the work environment. In some cases, the organization might discover a low presence of PPC operating. However, in others, a prominent picture of increased workload, poor client care, or overall presence of toxicity in the environment may emerge. It will be up to each organization to determine when intervention is needed and to what degree. Interventions could be individual conversations or remediation plans to more significant decisions.

When there are supervisees with PPC, these individuals can receive increased needed attention from supervisors to assist them in obtaining the required competencies. However, what support do their peers receive? A third recommended action step is to support those who are affected by PPC. This current study found that over half of mental health practitioners believed a peer with PPC disrupted the overall work environment and nearly half believed a problematic peer increased their workload. Therefore, supervisors should be mindful to not overschedule the non-problematic clinicians and to provide them with validation of their efforts on behalf of the agency and the clients who are served.

We understand that structure and demands of organizations vary. We also know that PPC operation can represent complex, difficult problems for a clinical supervisor to solve. This is why we strongly encourage system-wide action. Clinicians and clinical supervisors should set up policies and protocols to assess the environment and address concerns as needed. While the protocols and interventions established may differ bv setting, it is imperative that all working in the mental health environment acknowledge a need to address PPC. More specifically, supervisors and clinicians cannot ignore the presence of PPC and must be diligent in assessing if this issue is occurring in their agencies and organizations.

RECOMMENDATIONS FOR FUTURE RESEARCH

This research study has offered contributions and implications for mental health practitioners. As a result of these findings, some important considerations for future research have emerged. First, the participants for this study were licensed professionals from two Midwestern states; therefore, research from a more geographically diverse population would be beneficial. A second research consideration relates to the homogenous sample of this current study, in that the majority of the practitioners were female, Caucasian, and heterosexual. Therefore, future research focused on underrepresented racial and cultural groups would be beneficial to ascertain if minority counselors are affected in similar ways and to a similar degree when observing PPC in colleagues. This current study found that 59% of the participants were frustrated with their supervisors for not addressing a problematic colleague. Therefore, a third research consideration is to determine clinical supervisors' knowledge of supervisees' PPC. A fourth research consideration relates to investigating a direct correlation between job satisfaction, burnout, well-being, self-care, and working with a colleague with PPC. Another consideration for future studies might focus on the outcome of attempted interventions with PPC. Finally, it is important to validate instruments that can be used to assess practicing counselors' observations and knowledge of colleagues' PPC and how these peers affect them. Given that this is the first known study to examine practitioners' knowledge on this topic, there is a need for continued empirical research to further understand how working in a setting with a peer demonstrating PPC affects the overall work environment, job satisfaction, and client care.

CONCLUSION

The results of this research study indicate that mental health practitioners have awareness of colleagues' PPC and report negative experiences in working with these colleagues. Specifically, practitioners believe problematic peers disrupt their work environments. In particular, they are concerned about the impact peers with PPC have on the care that clients are receiving. As no clinician is immune from developing a competency issue (Clemens et al., 2011), it is crucial that we confront this complex matter as a profession. A collaborative effort is needed to ethically challenge, support, and intervene with colleagues with PPC without enabling them. Our failure to have an open dialogue regarding this issue would mean that PPC will continue to adversely affect clinical work settings.

doi: 10.17744/mehc.38.4.03

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APPENDIX A

Problems of Professional Competency Survey--Practitioner Version Section I: Demographic Information Instructions: Please check the appropriate box.

1. Indicate your current age. --

2. Which of the following best identifies your background?

1) African American []

2) Asian/Pacific Islander []

3) Caucasian []

4) Hispanic/Latino []

5) Native American []

6) Multi-Racial []

3. Indicate your gender. --

4. Which of the following best identifies your sexual orientation?

1) Bisexual [] 2) Gay or Lesbian [] 3) Heterosexual []

5. What type(s) of organization are you employed at? --

6. What state do you counsel in? --

7. What degrees have you obtained? --

8. Please check which accrediting body accredited the graduate program you graduated from.

1) Council for Accreditation for Counseling and Related Educational Program []

2) American Psychological Association []

3) American Psychiatric Association []

4) Council of Social Work Education []

5) Other --

9. What licenses/certificates do you hold? --

10. How many years have you been practicing?

1) Less than two years []

2) Two to Five years []

3) Six to Ten years []

4) Eleven to Fifteen years []

5) Sixteen to Twenty years []

6) Over Twenty years []

Section II: Knowledge of Colleagues' Problems of Professional Competency

Problems of professional competency--refers to attitudes and/or behaviors that could interfere with the professional competence of a mental health provider, including (a) a lack of ability or opposition to acquire and integrate professional standards into one's professional counseling behavior; (b) a lack of ability to attain professional skills and reach an acceptable level of competency; (c) a lack of ability to manage one's stress, psychological dysfunction, or emotional responses that may impact professional performance; or (d) engagement in unethical behavior (Falender, Collins, & Shafranske, 2009).

Colleague--Any mental health provider you have worked alongside at your place of employment.

Administration--Supervisor and/or Management at your place of employment. Instructions: Please read each statement below and check the box that best corresponds with your knowledge.

1. Do you believe you have observed colleague(s) with problems of professional competency at your agency/school?

1) No []

2) Yes []

3) I don't know []

2. How many total colleagues with problems of professional competency do you believe you have observed at your place of employment?

1) None [] (Skip to Section III on page 3) 4) Three [] (Go to question 3)

2) One [] (Go to question 3)

3) Two [] (Go to question 3)

5) Four [] (Go to question 3)

6) Five or More [] (Go to question 3)

3. Do you believe you have been impacted by colleague(s) with problems of professional competency at your place of employment?

1) No [] (Skip to Section III on page 3)

2) Yes [] (Go to question 4)

4. In what way do you feel you were the most affected [please check one]?

1) Interfered with my ability to focus and work efficiently []

2) Disrupted my work environment []

3) Increased my workload []

4) Affected the level of competent care clients were receiving []

5) Affected my relationship with this colleague away from work []

6) other [] ease specify --
Section III: Perceptions of the Impact of Colleagues' Problems
of Professional Competency

Instructions: Please read each statement below and circle the
number that best corresponds with your feelings and/or knowledge.

                                             Neither
                        Strongly            Disagree          Strongly
                        Disagree  Disagree  nor Agree  Agree   Agree

1.  I have been            1         2          3        4       5
    Impacted by a
    colleague who had
    inadequate
    clinical skills.

2.  I have been            1         2          3        4       5
    Impacted by a
    colleague who was
    not able to
    regulate his/her
    emotions.

3.  I have been            1         2          3        4       5
    Impacted by a
    colleague who had
    a personality
    disorder.

4.  I have been            1         2          3        4       5
    Impacted by a
    colleague who had
    a substance abuse
    issue.

5.  I have been            1         2          3        4       5
    impacted by a
    colleague who had
    a psychological
    dysfunction.

6.  I have been            1         2          3        4       5
    Impacted by a
    colleague who
    engaged In
    unethical
    behavior.

7.  A colleague with       1         2          3        4       5
    problems of
    professional
    competency has
    interfered with my
    ability to be an
    effective
    professional.

8.  A colleague with       1         2          3        4       5
    problems of
    professional
    competency has
    disrupted the work
    environment.

9.  A colleague with       1         2          3        4       5
    problems of
    professional
    competency has
    increased my
    workload.

10. A colleague with       1         2          3        4       5
    problems of
    professional
    competency has
    resulted in me
    feeling stressed.

11. A colleague with       1         2          3        4       5
    problems of
    professional
    competency has
    resulted in me
    having difficulty
    concentrating and
    completing my own
    work.

12. A colleague with       1         2          3        4       5
    problems of
    professional
    competency has
    resulted in me
    feeling resentful
    of this colleague.

13. I am frustrated        1         2          3        4       5
    when 1 believe
    that supervisor(s)
    is not addressing
    a colleague with
    problems of
    professional
    competency.

14. I am frustrated        1         2          3        4       5
    when a colleague
    with problems of
    professional
    competency is
    allowed to
    continue to
    practice at my
    agency/ school.

15. I am concerned         1         2          3        4       5
    about colleagues
    with problems of
    professional
    competency being
    allowed to
    continue to work
    with clients.

16. I am concerned         1         2          3        4       5
    about the quality
    of the counseling
    profession when a
    colleague with
    problems of
    professional
    competency is
    allowed to
    continue to
    practice.

17. I think it is my       1         2          3        4       5
    responsibility to
    be aware of a
    colleague's
    problems of
    professional
    competency.

18. I think it is the      1         2          3        4       5
    responsibility of
    my supervisor(s)
    to be aware of
    problems of
    professional
    competency with
    colleagues.

19. I think it is the      1         2          3        4       5
    responsibility of
    both my
    supervisor(s) and
    me to be aware of
    colleagues with
    problems of
    professional
    competency.

20. I am aware of my       1         2          3        4       5
    school/agency's
    procedure or
    policy regarding
    how administration
    addresses an
    employee who
    demonstrates
    problems of
    professional
    competency.

21. A supervisor has       1         2          3        4       5
    discussed my
    school/agency's
    policy with me
    regarding how
    employees with
    problems of
    professional
    competency are
    addressed.

22. I have received        1         2          3        4       5
    training at my
    school/agency
    regarding how to
    intervene with a
    colleague who 1
    believe is
    demonstrating
    problems of
    professional
    competency.

23. I know the             1         2          3        4       5
    appropriate
    intervention that
    1 should take
    regarding a
    colleague 1
    believe is having
    problems of
    professional
    competency.

24. I would like to be     1         2          3        4       5
    provided with more
    Information
    regarding how to
    Identify a
    colleague with
    problems of
    professional
    competency.

25. I would like to be     1         2          3        4       5
    provided with
    Information
    regarding how to
    respond when 1
    believe a
    colleague has
    problems of
    professional
    competency.

(26.) If there is any other information that you would like give,
please provide it in the space below:


Seth Olson

Kathleen Brown-Rice

Natasha Keller

University of South Dakota

Seth Olson, Kathleen Brown-Rice, and Natasha Keller, Division of Counseling and Psychology in Education, University of South Dakota.

Natasha Keller is now working at Crossroads Addiction and Mental Health Services, Sioux City, Iowa. Correspondence concerning this article should be addressed to Seth Olson, Division of Counseling and Psychology in Education, University of South Dakota, Vermillion, SD 57069. Email: Seth.Olson@usd.edu
Table 1 Participants' Responses Regarding Degree
of Impact of Specific Type of Colleagues' PPC

                                    Affected by Colleagues' PPC

                             Strongly      Disagree      Neither
                             Disagree                    Disagree
                                                         or Agree

Type of PPC                   n      %      n      %      n      %

Inadequate clinical skills    20    9.4     44    20.7    22    10.3
Inability to regulate his/    25    11.7    44    20.7    34    16.0
  her emotions
Psychological Dysfunction     31    14.6    47    22.1    34    16.0
Personality disorder          40    18.8    60    28.2    36    16.9
Substance use disorder        57    26.8    70    32.9    41    19.2
Unethical behavior            48    22.5    47    22.1    31    14.6

                                    Affected by Colleagues' PPC

                             Agree         Strongly
                                           Agree

Type of PPC                   n      %      n      %      M      SD

Inadequate clinical skills    96    45.1    31    14.6   3.35   1.23
Inability to regulate his/    85    39.9    25    11.7   3.19   1.23
  her emotions
Psychological Dysfunction     82    38.5    19    8.9    3.05   1.25
Personality disorder          61    28.6    16    7.5    2.78   1.26
Substance use disorder        33    15.5    12    5.6    2.40   1.20
Unethical behavior            58    27.2    29    13.6   2.87   1.39

Table 2 Participants' Perception as to the Most Significant
Impact on Them

                                      Impacted by Colleagues' PPC

                               Strongly      Disagree      Neither
                               Disagree                    Disagree
                                                           or Agree

Type of Impact                  n      %      n      %      n      %

Participant's ability to be     52    24.4    71    33.3    45    21.1
an effective professional

Disrupted the overall work      22    10.3    42    19.7    17    8.0
environment

Increased participant's         36    16.9    53    24.9    27    12.7
workload

Resulted in participant         28    13.1    39    18.3    24    11.3
feeling stressed

Participant's ability to        48    22.5    63    29.6    56    26.3
concentrate and complete own
work

Participant feeling             23    10.8    45    21.1    45    21.1
resentful of colleague

Participant frustrated          19    8.9     30    14.1    39    18.3
supervisor is not addressing
colleague

Participant frustrated          17    8.0     30    14.1    44    20.7
colleague Is allowed to
continue to practice

Participant concerned           8     3.8     21    9.9     26    12.2
colleague is allowed to
continue to work with
clients

Participant concerned about     10    4.7     20    9.4     24    11.3
the quality of profession

                                      Impacted by Colleagues' PPC

                               Agree         Strongly
                                             Agree

Type of Impact                  n      %      n      %      M      SD

Participant's ability to be     40    18.8    5     2.3    2.44   1.25
an effective professional

Disrupted the overall work     103    48.4    29    13.6   3.35   1.23
environment

Increased participant's         78    36.6    19    8.9    2.96   1.29
workload

Resulted in participant         87    40.8    35    16.4   3.29   1.30
feeling stressed

Participant's ability to        37    17.4    9     4.2    2.51   1.14
concentrate and complete own
work

Participant feeling             75    35.2    25    11.7   3.16   1.20
resentful of colleague

Participant frustrated          92    43.2    33    15.5   3.42   1.17
supervisor is not addressing
colleague

Participant frustrated          82    38.5    40    18.8   3.46   1.18
colleague Is allowed to
continue to practice

Participant concerned          105    49.3    53    24.9   3.82   1.04
colleague is allowed to
continue to work with
clients

Participant concerned about    105    49.3    54    25.4   3.83   1.05
the quality of profession
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Title Annotation:RESEARCH
Author:Olson, Seth; Brown-Rice, Kathleen; Keller, Natasha
Publication:Journal of Mental Health Counseling
Article Type:Report
Date:Oct 1, 2016
Words:8198
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