Sunday Ethics Pontification

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BuckeyeLove

Forensic Psychologist
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Hypothetical and ethical brain teaser for your consideration:

A practicing and well respected psychologist is in therapy. They endorse to their respective therapist that they have been a functioning abuser of substances for the entirety of their practicing career. How might the clinician handle this from a duty to report perspective? I understand this might vary based on the jurisdiction, but... Is knowledge of a clinician actively abusing substances warrant further action? Per the ethics code in terms of how certain things are worded, I imagine that this might fall under some form of problematic practice. The other kicker, does the fact that in this hypothetical the client is what we would consider "functioning" and successful in their own respective practice, does that change things?

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functioning abuser of substances

This would need to be clarified. I thought part of the criteria for assigning "substance abuse" (formerly) was that it was producing marked impairment in functioning? If this is absent, then should just be an issue of guiding healthful behavior for clinician working with them-there no obligation to report anything.

If it's present, I think you are guided to speak with the person about ceasing to practice until this is resolved before you initiate a board complaint.
 
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Per the ethics code in terms of how certain things are worded, I imagine that this might fall under some form of problematic practice. The other kicker, does the fact that in this hypothetical the client is what we would consider "functioning" and successful in their own respective practice, does that change things?

We aren't under obligation to report illegal behaviors from anyone with the exceptions of harm to self/others/vulnerable persons. You said there's no apparent impairment to functioning so there's nothing to be reported.
 
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The other kicker, does the fact that in this hypothetical the client is what we would consider "functioning" and successful in their own respective practice, does that change things?

Of course it does. This is a very different situation than, say, if the psychologist admitted to sexually harassing a patient while under the influence.

Besides, it sounds like the psychologist in question is in fact taking the appropriate action (per section 2.06) by seeking professional assistance. Possibly that could lead to some insight that the substance use creates more impairment than the person is willing to acknowledge at present. But if there is no evidence to support this, I'm not sure what purpose would be served by a knee-jerk board complaint.
 
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If you are concerned about the substance abuse affecting their ability to practice (and/or they're practicing while impaired), what about suggesting that they self-report to a third party provider, such as their state's professionals resource network (or whatever their specific state calls it). You would not be filing a complaint with the board and PRN would likely recommend an addiction medicine evaluation, with possible monitoring contract.
 
In my mind, if a therapist is my patient, that is much different than if they are a colleague. I would not report them to a board. I do not break confidentiality for my patients except for the standard legal exceptions. I use the term therapist since I have treated them but never a psychologist.
 
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In my mind, if a therapist is my patient, that is much different than if they are a colleague. I would not report them to a board. I do not break confidentiality for my patients except for the standard legal exceptions. I use the term therapist since I have treated them but never a psychologist.

Maybe not in this case, but an argument could be made that your duty to public safety would supercede confidentiality in similar cases.
 
I've treated several psychologists. It's a pretty narrow band of misconduct that activates mandated reporting in my jurisdiction. Fortunately, I've never had to go there.
 
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Maybe not in this case, but an argument could be made that your duty to public safety would supercede confidentiality in similar cases.

I think this would definitely be a question for the state board, ethics organization or even an attorney. Either way you are opening yourself up to potential lawsuits.

Barring evidence of serious misconduct by the individual that was directly negatively impacting patients, I would likely side with smalltown based on my personal beliefs. Practicing drunk and saying inappropriate things to patients gets reported. Being a generally crummy clinician that may or may not be due to active psychopathology probably would not. Simply meeting criteria for a diagnosis without any indication it is impacting their ability to practice definitely would not. It somewhat speaks to the stigma surrounding substance use disorders that the latter is even a question. I find it hard to believe anyone would say a therapist who had say - an MDE following a divorce should be reported to the board in the absence of any obvious impairment in functioning. (Note: This isn't meant to be derisive towards the OP or anyone else. Just observing, intellectualizing, etc. I'm an addiction researcher. These things interest me.).

To me, I'd apply roughly the same standards I would with any other patient. Broadly speaking, confidentiality would trump duty to report in any situation where risk isn't imminent. That said, I'd consult with any and every available resources and ultimately defer to whatever the board, APA ethics folks or whoever else indicates is the best course of action.
 
I would spend like 8 seconds not thinking about it, call my malpractice insurance's free consultation service, document the conversation, and go about my day.
 
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