Challenges and Risks: Therapist Impairment
Typically, the progression of inevitable life events and experiences, challenges and risks associated with therapy (discussed in previous sections) which the therapist may or may not be aware of often lead to therapist impairment.
Sherman and Thelen (1998) defined impairment as '"the interference in the ability to practice therapy, which may be sparked by a variety of factors and results in a decline in therapeutic effectiveness." Macchi, O'Conner and Garrett (2007) also define impairment as "a deficiency of a therapist's competence in at least one of three areas:
- Knowledge, training, experience
- Theoretical orientation
- Therapist personal characteristics"
Some common behavioral patterns that signify impairment for therapists includes:
- Social isolation
- Loss of energy
- Feelings of failure
- Somatic complaints
- Lowered self-esteem
- Decreased exercise
- Neglecting meal breaks
- Putting clients' needs first
(Carroll, 1999; Margison, 1997).
While these behaviors are very helpful indicators that something is going wrong, by their very nature they are easy to miss, at the same time they are impairments which when not dealt with may lead to poor clinical judgment, increased risk of ethical breaches, boundary violations, and inappropriate emotional involvement in clients (Nicely 2008).
Therapist impairment can adversely affect clients well being, impede therapy outcome and endanger your professional role as a home therapist (Macchi, O'Conner & Garret, 2008) It is also possible that sometimes the sense of stigma, embarrassment, loss of status and client loss, may prevent you from getting help for your impairment. For instance sometimes you may feel judged, ostracized by your colleagues who learn of your impairments (Nicely 2008). To avoid the hazards of practicing beyond your area of competence, you should improve your treatment skills; refuse to accept certain clients for whom you are not well prepared to treat; know personal danger schedules and monitor your own mental health.