Professional distress and impairment exists among all communities of health professionals. The history of professional distress is lengthy, and the chronology and methods for addressing impairment have varied from discipline to discipline. The expansion of the definition of impairment to include mental illness and emotional distress-rather than substance abuse alone-has been a more recent development.
American Medical Association
Reports of impairment date back as early as Sigmund Freud who, in 1884, became addicted to combinations of opiates and cocaine. It was not until 1958, however, that the Federation of State Medical Boards first identified addiction among medical doctors as a disciplinary problem and called for a model probation and rehabilitation program to be adopted by state medical boards (American Psychiatric Association [APA], 2004). In 1973 the AMA formally recognized physician impairment as a serious problem and issued its policy paper "The Sick Physician: Impairment by Psychiatric Disorders, Including Alcoholism and Drug Dependence." As a result of this policy and conferences held by the AMA in both 1975 and 1977, today all medical societies have impaired-physician and psychiatrist programs for each state and the other jurisdictions of the AMA (APA, 2004).
National Association of Social Workers
The National Association of Social Workers (NASW) first acknowledged the problem of impaired practitioners in 1979 (Reamer, 1992). At first, the focus was almost exclusively on alcohol or drug dependency-but it expanded by 1984 to include mental illness and emotional distress as well. Since then, the NASW has developed support groups, professional protocols for intervening with impaired colleagues, and has issued resource materials specific to intervention and programming (Reamer, 1992). In 1987 the NASW published an Impaired Social Worker Program Resource Book to help practitioners and state boards to develop programs to address the problem of impairment in their ranks (NASW, 1987).
American Psychological Association
In the early 1970's Richard Thoreson formed an informal volunteer group within the American Psychological Association (APA) called Psychologists Helping Psychologists to address the issue of alcoholism within the organization (Epstein, 1997). In 1981, the APA held its first open forum at its annual convention on the subject of impairment (Thoreson, Nathan, Skorina, & Kilbug, 1983). This discussion marked the beginning of efforts to shape the definition of impairment within the field of psychology and the term came to be understood to represent a broad range of issues affecting professional functioning (Thoreson et al., 1983). In 1988 the APA's committee on distressed psychologists issues a manual entitled "Assisting Impaired Psychologists" to aid in intervention for psychologists in crisis (Epstein, 1997).
American Counseling Association
In the counseling profession, attention to the issue of impairment has been more recent. An article on the subject of counselor impairment was published in the ACA's Journal of Counseling & Development in 1988 (Stadler, et al.). In 1991, the American Counseling Association created a task force to begin addressing this important issue. The 1991 ACA Task Force on Impaired Counselors conservatively estimated that at least 10% of helping
professionals were impaired at any selected moment in time meaning that (at that time) at least 6,000 ACA members were experiencing some form of impairment that reduced their ability to care properly for their clients (ACA, 1991).
In 1994, the Council for Accreditation of Counseling and Related Educational programs (CACREP) published, and ACA approved, the 1994 Model Legislation that included language designed to encourage remediation of impaired counselors (Glosoff, Benshoff, Hosie, & Maki, 1995). In 1996, a special issue was published by ACA's division, the Association for Humanistic Education and Development (AHEAD), focusing specifically on the issue of
counselor impairment (see Journal of Humanistic Education & Development, 34 ). Download PDF
Current Task Force on Impaired Counselors
The Governing Council of the American Counseling Association established a second Task Force on Impaired Counselors in the Spring of 2003. The creation of this task force reflected ACA's commitment to identifying and developing intervention strategies and resources to help impaired counselors. The new task force surveyed all of the state licensing boards to determine whether and how counselor impairment was defined at the State-level. This process revealed that the vast majority of States do not make distinction between impaired professionals and unethical professionals, and that there are very few intervention programs designed to assist counselors. The States of Minnesota (www.hpsp.state.mn.us), Michigan (www.hprp.org), and Virginia (www.vahpip.org) stood out as having good impairment programs-as they each broadly defined impairment to include mental and physical illness, stress and substance abuse and had impairment programs that included counselors. Future advocacy work is necessary to educate boards on impairment and gain support for the development of impairment programs similar to those created for the American Medical Association through the Federation of State Physician Health Programs. (Read more at www.ama-assn.org/ama/pub/category/5705.html).
Survey of ACA Members
After polling the state licensing boards, it was important to find out what counselors knew about impairment. In a 2004 survey of a random sample of ACA members, the task force found that most counselors have known a counselor they would consider impaired (63.5%). In those cases, supervisors (54.3%) and colleagues (64.2%) were also aware of the impairment. In most cases, the impaired counselor did not receive disciplinary action (77.8%) or therapeutic intervention (73.7%). Counselors believe that impaired counselors present a significant risk to the counseling profession (75.7%). Counselors did not know if there was a program for impaired counselors in their state (82.7%), and that rate did not change significantly (84.6%) when we included only counselors in states that do in fact have an impairment program. (Note: 770 Respondents in the survey-5% confidence interval-3.5% margin of error.)
The results of that survey led to three broad avenues for addressing the needs of impaired counselors. The first is impairment prevention and resiliency education designed for all counselors and initially targeted to the membership of ACA. The second area of need involves resources, intervention, and treatment for counselors who are impaired. Finally, the task force recognizes the importance of advocacy within ACA and on the state and national level to address the needs of impaired counselors - through clarification of ethical guidelines, providing access to services for impaired counselors before ethical concerns arise, and addressing the stigma associated with seeking mental health treatment among counselors. The information on this site will focus primarily on the first of the three areas of need: wellness and resiliency.