Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Distress. Show all posts
Showing posts with label Distress. Show all posts

Wednesday, June 12, 2024

The health care workforce crisis is already here

Caitlin Owen
Originally posted 7 June 24

Demoralized doctors and nurses are leaving the field, hospitals are sounding the alarm about workforce shortages and employees are increasingly unionizing and even going on strike in high-profile disputes with their employers.

Why it matters: Dire forecasts of health care worker shortages often look to a decade or more from now, but the pandemic — and its ongoing fallout — has already ushered in a volatile era of dissatisfied workers and understaffed health care facilities.
  • Some workers and experts say understaffing is, in some cases, the result of intentional cost cutting. Regardless, patients' access to care and the quality of that care are at risk.
  • "There are 83 million Americans today who don't have access to primary care," said Jesse Ehrenfeld, president of the American Medical Association. "The problem is here. It's acute in rural parts of the country, it's acute in underserved communities."
The big picture: Complaints about understaffing, administrative burdens and inadequate wages aren't new, but they are getting much louder — and more health workers are leaving their jobs or cutting back their hours.

Here are some thoughts:

The news of the healthcare workforce crisis being "already here" is deeply concerning.  It's not just about future projections; it's about the impact on patient care, provider well-being, and the ethical obligations we all share.

Providers will likely walk an ethical tightrope, that will likely have negative consequences. Imagine a doctor facing a packed waiting room, knowing some patients won't receive the time and attention they deserve.  This is the reality for many providers stretched thin by staffing shortages. It creates an ethical tightrope: how to deliver quality care amidst overwhelming pressure.  Burnout, compassion fatigue, and even medical errors become more likely.  This is likely the starting point for the possibility of moral distress and/or moral injury.

The crisis isn't just a burden on healthcare providers or institutions. It's a societal challenge.  Policymakers, educators, and even patients themself can play a role.

This isn't about pointing fingers; it's about recognizing a shared responsibility.  By working together, we can ensure a healthcare system that is ethical, sustainable, and provides quality care for all.

Monday, January 29, 2024

Two in three UK doctors suffer ‘moral distress’ due to overstretched NHS, study finds

Denis Campbell
The Guardian
Originally posted 28 Dec 23

Two in three UK doctors are suffering “moral distress” caused by the enfeebled state of the NHS and the damage the cost of living crisis is inflicting on patients’ health, research has found.

Large numbers are ending up psychologically damaged by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs or the fact that poverty or bad housing is making them ill.

A new survey found that 65% of doctors overall, including nearly four in five (78%) GPs and more than half (56%) of hospital doctors, have experienced “moral distress” as a direct result of situations they have encountered working in the NHS.

Seeing patients with malnutrition or hypothermia, or stuck on trolleys in A&E corridors asking for help or forced to choose between heating their home or getting a prescription dispensed are among the events triggering their distress, medics said.

“There’s barely a doctor at work in the NHS today who doesn’t see or experience this distress on a daily basis,” said Prof Philip Banfield, the leader of the British Medical Association.

The NHS is “impossibly overstretched”, has thousands of vacancies for doctors and has a quarter fewer doctors a head of population than Germany, he added.

“In practice that means we can almost never give the standard of care we would want, only ever the care we can manage. That takes its toll, as we see here,” Banfield said.

Key points:

The study also found that:
  • Nearly half (47%) of doctors believe the cost of living crisis is contributing to their moral distress.
  • 72% of doctors say being unhappy at work has affected their mental health.
  • 85% of doctors have experienced fatigue as a result of their work.
Causes of moral distress:
  • Doctors are often in situations where they have to make difficult decisions about who to treat first, or whether they can afford to give a patient the treatment they need.
  • They may also feel that they are not able to provide the level of care that they would like to because of the lack of resources in the NHS.
Impact of moral distress:
  • Moral distress can lead to burnout, depression, and anxiety.
  • It can also make it difficult for doctors to continue working in the NHS.

Monday, October 30, 2023

The Mental Health Crisis Among Doctors Is a Problem for Patients

Keren Landman
Originally posted 25 OCT 23

Here is an excerpt:

What’s causing such high levels of mental distress among doctors?

Physicians have high rates of mental distress — and they’re only getting higher. One 2023 survey found six out of 10 doctors often had feelings of burnout, compared to four out of 10 pre-pandemic. In a separate 2023 study, nearly a quarter of doctors said they were depressed.

Physicians die by suicide at rates higher than the general population, with women’s risk twice as high as men’s. In a 2022 survey, one in 10 doctors said they’d thought about or attempted suicide.

Not all doctors are at equal risk: Primary care providers — like emergency medicine, internal medicine, and pediatrics practitioners — are most likely to say they’re burned out, and female physicians experience burnout at higher rates than male physicians.

(It’s worth noting that other health care professionals — perhaps most prominently nurses — also face high levels of mental distress. But because nurses are more frequently unionized than doctors and because their professional culture isn’t the same as doctor culture, the causes and solutions are also somewhat different.)

Here is my summary:

The article discusses the mental health crisis among doctors and its implications for patients. It notes that doctors are at a higher risk of suicide than any other profession, and that they also experience high rates of burnout and depression.

The mental health crisis among doctors is a problem for patients because it can lead to impaired judgment, medical errors, and reduced quality of care. Additionally, the stigma associated with mental illness can prevent doctors from seeking the help they need, which can further exacerbate the problem.

The article concludes by calling for more attention to the mental health of doctors and for more resources to be made available to help them.

I treat a number of physicians in my practice.

Sunday, October 1, 2023

US Surgeons Are Killing Themselves at an Alarming Rate

Christina Frangou
The Guardian
Originally published 26 Sept 23

Here is an excerpt:

Fifty years ago, in a landmark report called The Sick Physician, the American Medical Association declared physician impairment by psychiatric disorders, alcoholism and drug use a widespread problem. Even then, physicians had rates of narcotic addiction 30 to 100 times higher than the general population, and about 100 doctors a year in the US died by suicide.

The report called for better support for physicians who were struggling with mental health or addictions. Too many doctors hid their ailments because they worried about losing their licenses or the respect of their communities, according to the medical association.

Following the publication, state medical societies in the US, the organizations that give physicians license to practice, created confidential programs to help sick and impaired doctors. Physician health programs have a dual purpose: they connect doctors to treatment, and they assess the physician to ensure that patients are safe in their care. If a doctor’s condition is considered a threat to patient safety, the program may recommend that a doctor immediately cease practice, or they may recommend that a physician undergo drug and alcohol monitoring for three to five years in order to maintain their license. The client must sign an agreement not to participate in patient care until their personal health is addressed.

In rare and extreme cases, the physician health program will report the doctor to the state medical board to revoke their license.

Here is my summary:

The article sheds light on a distressing phenomenon in the United States: an alarming increase in suicide rates among surgeons. It underscores the severity of this issue by featuring a courageous surgeon who has taken the initiative to address it openly. The article suggests that the mental health and well-being of surgeons are under significant strain, potentially due to the demanding nature of their profession, and it calls for greater awareness and support to tackle this growing crisis. The featured surgeon's decision to speak out serves as a poignant reminder of the urgent need to address the mental health challenges faced by medical professionals.

The article underscores the critical issue of high suicide rates among U.S. surgeons, with a particular focus on the brave act of a surgeon who has chosen to raise awareness about this problem. It highlights the pressing need for comprehensive mental health support within the medical community to address the unique stressors that surgeons encounter in their line of work.

Saturday, July 1, 2023

Inducing anxiety in large language models increases exploration and bias

Coda-Forno, J., Witte, K., et al. (2023).
arXiv preprint arXiv:2304.11111.


Large language models are transforming research on machine learning while galvanizing public debates. Understanding not only when these models work well and succeed but also why they fail and misbehave is of great societal relevance. We propose to turn the lens of computational psychiatry, a framework used to computationally describe and modify aberrant behavior, to the outputs produced by these models. We focus on the Generative Pre-Trained Transformer 3.5 and subject it to tasks commonly studied in psychiatry. Our results show that GPT-3.5 responds robustly to a common anxiety questionnaire, producing higher anxiety scores than human subjects. Moreover, GPT-3.5's responses can be predictably changed by using emotion-inducing prompts. Emotion-induction not only influences GPT-3.5's behavior in a cognitive task measuring exploratory decision-making but also influences its behavior in a previously-established task measuring biases such as racism and ableism. Crucially, GPT-3.5 shows a strong increase in biases when prompted with anxiety-inducing text. Thus, it is likely that how prompts are communicated to large language models has a strong influence on their behavior in applied settings. These results progress our understanding of prompt engineering and demonstrate the usefulness of methods taken from computational psychiatry for studying the capable algorithms to which we increasingly delegate authority and autonomy.

From the Discussion section

What do we make of these results? It seems like GPT-3.5 generally performs best in the neutral condition, so a clear recommendation for prompt-engineering is to try and describe a problem as factually and neutrally as possible. However, if one does use emotive language, then our results show that anxiety-inducing scenarios lead to worse performance and substantially more biases. Of course, the neutral conditions asked GPT-3.5 to talk about something it knows, thereby possibly already contextualizing the prompts further in tasks that require knowledge and measure performance. However, that anxiety-inducing prompts can lead to more biased outputs could have huge consequences in applied scenarios. Large language models are, for example, already used in clinical settings and other high-stake contexts. If they produce higher biases in situations when a user speaks more anxiously, then their outputs could actually become dangerous. We have shown one method, which is to run psychiatric studies, that could capture and prevent such biases before they occur.

In the current work, we intended to show the utility of using computational psychiatry to understand foundation models. We observed that GPT-3.5 produced on average higher anxiety scores than human participants. One possible explanation for these results could be that GPT-3.5’s training data, which consists of a lot of text taken from the internet, could have inherently shown such a bias, i.e. containing more anxious than happy statements. Of course, large language models have just become good enough to perform psychological tasks, and whether or not they intelligently perform them is still a matter of ongoing debate.

Monday, June 12, 2023

Why some mental health professionals avoid self-care

Dattilio, F. M. (2023).
Journal of Consulting and Clinical Psychology, 
91(5), 251–253.


This article briefly discusses reasons why some mental health professionals are resistant to self-care. These reasons include the savior complex, avoidance, and lack of collegial assiduity. Several proposed solutions are offered.

Here is an excerpt:

Savior Complex

One hypothesis used to explain professionals’ resistance is what some refer to as a “savior complex.” Certain MHPs may be engaging in the cognitive distortion that it is their duty to save as many people from suffering and demise as they can and in turn need to sacrifice their own psychological welfare for those facing distress. MHPs may be skewed in their thinking that they are also invulnerable to psychological and other stressors. Inherent in this distortion is their fear of being viewed as weak or ineffective, and as a result, they overcompensate by attempting to be stronger than others. This type of thinking may also involve a defense mechanism that develops early in their professional lives and emerges during the course of their work in the field. This may stem from preexisting components of their personality dynamics. 

Another reason may be that the extreme rewards that professionals experience from helping others in such a desperate state of need serve as a euphoric experience for them that can be addictive. In essence, the “high” that they obtain from helping others often spurs them on.

Another less complicated explanation for MHPs’ blindness to their own vulnerabilities may be their strong desire to avoid admitting to their own weaknesses and sense of vulnerability. The defense mechanism of rationalization that they are stronger and healthier than everyone else may embolden them to push on even when there are visible signs to others of the stress in their lives that is compromising their functioning. 

Avoidance is also a way of sidestepping the obvious and putting it off until later. This may be coupled with the need that has increased, particularly with the recent pandemic that has intensified the demand for mental health services.


The dismissal of MHPs’ own needs or what some may term as, “denial” is a deeper aspect that goes hand-in-hand with cognitive distortions that develop with MHPs, but involve a more complex level of blindness to the obvious (Bearse et al., 2013). It may also serve as a way for professionals to devalue their own emotional and psychological challenges. 

Denial may also stem from an underlying fear of being determined as incapacitated or not up to the challenge by their colleagues and thus prohibited from returning to their work or having to face limitations or restrictions. It can sometimes emanate from the fear of being reported as having engaged in unethical behavior by not seeking assistance sooner. This is particularly so with cases of MHPs who have become involved with illicit drug or alcohol abuse or addiction. 

Most ethical principles mandate that MHPs strive to remain cognizant of the potential effects that their work has on their own physical and mental health status while they are in the process of treating others and to recognize when their ability to be effective has been compromised. 

Last, in some cases, MHPs’ denial can even be a response to genuine and accurately perceived expectations in a variety of work contexts where they do not have control over their schedules. This may occur more commonly with facilities or institutions that do not support the disclosure of vulnerability and stress. It is for the aforementioned reasons that the American and Canadian Psychological Associations as well as other mental health organizations have mandated special education on this topic in graduate training programs (American Psychiatric Association, 2013; Maranzan et al., 2018).

Lack of Collegial Assiduity

A final reason may involve a lack of collegial assiduity, where fellow MHPs observe their colleagues enduring signs of stress but fail to confront the individual of concern and alert them to the obvious. It is often very awkward and uncomfortable for a colleague to address this issue and risk rebuke or a negative outcome. As a result, they simply avoid it altogether, thus leaving the issue of concern unaddressed.

The article is paywalled here, which is a complete shame.  We need more access to self-care resources.

Sunday, November 27, 2022

Towards a Social Psychology of Cynicism

Neumann, E., & Zaki, j. (2022, September 13).


Cynicism is the attitude that people are primarily motivated by self-interest. It tracks numerous negative outcomes, and yet many people are cynical. To understand this “cynicism paradox,” we review and call for more social psychological work on how cynicism spreads, with implications for how we might slow it down.

The Cynicism Paradox

Out of almost 8,000 respondents from 41 countries, many agree that “powerful people tend to exploit others” or that “kind-hearted people usually suffer losses”. This indicates widespread cynicism, the attitude that people are primarily motivated by self-interest, often accompanied by emotions such as contempt, anger, and distress, and antagonistic interactions with others. What explains such cynicism? Perhaps it reflects a realistic perception of the suffering caused by human self-interest. But workin social psychology regularly demonstrates that attitudes are not always perfect  mirrors of reality.  We will argue  that  people  often  overestimate self-interest,  create  it through their expectations, or overstate their own to not appear naïve. Cynicism rises when people witness self-interest, but social psychology –so far relatively quiet on the topic –can explain why they get trapped in this worldview even when it stops tracking reality.

Cynicism is related, but not reducible to, a lack of trust. Trust is often defined as accepting vulnerability based on positive expectations of others. Generalized trust implies a general tendency to  have  positive  expectations  of  others,  and  shares  with  cynicism  the  tendency  to  judge  the character of a whole group of people. But cynicism is more than reduced positive expectations.It entails a strongly negative view of human nature. The intensity of cynicism’s hostility further differentiates it from mere generalized distrust. Finally, while people can trust and distrust others’ competence,  integrity,  and  predictability,  cynicism  usually  focuses  on  judgments  of  moral character.  This  differentiates  cynicism  from  mere  pessimism,  which  encompasses  any  negative beliefs about the future, moral or non-moral alike. 

Direct applications to psychotherapy.

Tuesday, October 25, 2022

More than a quarter of U.S. adults say they’re so stressed they can’t function

American Psychological Association
Press Release
Originally posted 19 OCT 22

Americans are struggling with multiple external stressors that are out of their personal control, with 27% reporting that most days they are so stressed they cannot function, according to a poll conducted for the American Psychological Association.

A majority of adults cited inflation (83%), violence and crime (75%), the current political climate (66%), and the racial climate (62%) as significant sources of stress.

The nationwide survey, fielded by The Harris Poll on behalf of APA, revealed that 70% of adults reported they do not think people in the government care about them, and 64% said they felt their rights are under attack. Further, nearly half of adults (45%) said they do not feel protected by the laws in the United States. More than a third (38%) said the state of the nation has made them consider moving to a different country.

More than three-quarters of adults (76%) said that the future of our nation is a significant source of stress in their lives, while 68% said this is the lowest point in our nation’s history that they can remember.

Various disparities in stressors emerged among population subgroups. For example, 72% of the members of the LGBTQIA+ community reported feeling as if their rights are under attack, which is a higher proportion than non-LGBTQIA+ adults (64%). Younger adult women (ages 18 to 34) were more likely to report that most days their stress is completely overwhelming, in comparison with older women (62% vs. 48% 35–44; 27% 45–64; 9% 65+) and men ages 35 or older (62% vs. 48% 35–44; 21% 45–64; 8% 65+). Seventy-five percent of Black adults said that the racial climate in the U.S. is a significant source of stress, while 70% of Latino/a adults, 69% of Asian adults and 56% of white adults reported the same.

Furthermore, Latinas were most likely, among racial/ethnic groups, to cite significant sources of stress related to violence, including violence and crime (89% Latinas; 80% Black women; 79% Asian women; 77% Latinos; 75% Black men; 73% white women; 72% white men; 70% Asian men), mass shootings (89% Latinas; 78% Latinos; 77% Black women; 77% Asian women; 73% white women; 71% Black men; 67% Asian men; 66% white men) and gun violence (87% Latinas; 83% Black women; 77% Asian women; 76% Latinos; 75% Black men; 69% white women; 68% white men; 63% Asian men).

“It’s clear that the impacts of uncontrollable stressors are profound for most Americans, but psychological science shows us that there are effective ways to talk about and cope with this type of stress,” said Arthur C. Evans Jr., PhD, APA’s chief executive officer. “Focusing on accomplishing goals that are in our control can help prevent our minds from getting overwhelmed by the many uncertainties in life. From using our breathing to slow racing thoughts, to intentionally limiting our social media consumption, or exercising our right to vote, action can be extremely empowering.”

Adults reported that stress has had an impact on their health; 76% of adults reported they had experienced at least one symptom in the last month as a result of stress—such as headache (38%), fatigue (35%), feeling nervous or anxious (34%) and feeling depressed or sad (33%). Seven in 10 adults (72%) experienced additional symptoms in the last month, including feeling overwhelmed (33%), experiencing changes in sleeping habits (32%), and/or worrying constantly (30%).

Saturday, June 4, 2022

About one-fifth of lawyers and staffers considered suicide at some point in their careers, new survey says.

Debra Cassens Weiss
American Bar Association Journal
Originally posted 10 MAY 22

A new survey of lawyers and staff members hailing mostly from BigLaw has found that anxiety, depression and isolation remain at concerning levels, despite a slight decrease in the percentages since the survey last year.

The Mental Health Survey by Law.com and ALM Intelligence found that 67% of the respondents reported anxiety, 35% reported depression and 44% reported isolation, according to an article by Law.com.

The survey, conducted in March and April, asked respondents from around the world about their mental health and law firm environments in 2021.

The percentage of respondents who contemplated suicide at some point in their professional careers was 19%, the article reports.

In addition, 2.4% of the respondents said they had a drug problem, and 9.4% said they had an issue with alcoholic drinking.

About 74% of the respondents thought that their work environment contributed to their mental health issues. When asked about the factors that had a negative impact on mental health, top concerns were always being on call (72%), billable hour pressure (59%), client demands (57%), lack of sleep (55%) and lean staffing (49.5%).

The survey asked about the impact of remote work for the first time. About 59% said remote work increased their quality of life; about 62% said it increased the quality of home-based relationships; about 54% said it led to an increase in their billable hours; and 50% said it improved personal finances. But 76% said remote work hurt the quality of interpersonal relationships with colleagues.

Saturday, January 2, 2021

Involuntary Commitments: Billing Patients for Forced Psychiatric Care.

Nathaniel P. Morris & Robert A. Kleinman
The American Journal of Psychiatry
Vol 177, 12, 1115-1116.

Surprise medical billing, in which patients face unexpected out-of-pocket medical costs, has attracted widespread attention. As of March 2020, members of the U.S. House of Representatives and Senate were working on legislation to limit these billing practices. Surprise medical bills have various consequences for patients and families, including loss of income or savings, worsened credit scores, use of resources for legal counsel or litigation, and psychological stress. Patients can receive surprise medical bills for care they did not authorize, including treatment for loss of consciousness, cardiac arrest, traumatic injuries, and other emergencies where informed consent cannot be obtained before care. A related set of medical bills has not garnered much attention yet may rank among the most surprising for patients and families—bills for involuntary psychiatric care.

Billing patients for involuntary psychiatric care deserves more attention for several reasons. First, these patients may be held financially liable for care they did not authorize and even actively refused. Compared with most medical care, involuntary psychiatric care is different in that patients can be detained for evaluation and treatment against their expressed wishes. All U.S. states have statutes that authorize emergency and inpatient civil commitment, such as involuntary hospitalization on grounds of dangerousness to self or others due to a mental disorder, and a majority of states have provisions for outpatient civil commitment. These statutes are based on principles that under specific circumstances, individual and/or public benefits of managing someone’s mental health needs supersede that person’s rights to refuse psychiatric care. However, forcing someone to assume financial liability for involuntary psychiatric care may infringe upon additional liberties, including individuals’ abilities to consent to contracts and to allocate money. By shifting the balance of autonomy, justice, beneficence, and nonmaleficence associated with involuntary psychiatric care, these billing practices raise ethical concerns.

Monday, November 18, 2019

Suicide Has Been Deadlier Than Combat for the Military

Carol Giacomo
The New York Times
Originally published November 1, 2019

Here are two excerpts:

The data for veterans is also alarming.

In 2016, veterans were one and a half times more likely to kill themselves than people who hadn’t served in the military, according to the House Committee on Oversight and Reform.

Among those ages 18 to 34, the rate went up nearly 80 percent from 2005 to 2016.

The risk nearly doubles in the first year after a veteran leaves active duty, experts say.

The Pentagon this year also reported on military families, estimating that in 2017 there were 186 suicide deaths among military spouses and dependents.


Experts say suicides are complex, resulting from many factors, notably impulsive decisions with little warning. Pentagon officials say a majority of service members who die by suicide do not have mental illness. While combat is undoubtedly high stress, there are conflicting views on whether deployments increase risk.

Where there seems to be consensus is that high-quality health care and keeping weapons out of the hands of people in distress can make a positive difference.

Studies show that the Department of Veterans Affairs provides high-quality care, and its Veterans Crisis Line “surpasses most crisis lines” operating today, according to Terri Tanielian, a researcher with the RAND Corporation. (The Veterans Crisis Line is staffed 24/7 at 800-273-8255, press 1. Services also are available online or by texting 838255.)

But Veterans Affairs often can’t accommodate all those needing help, resulting in patients being sent to community-based mental health professionals who lack the training to deal with service members.

The info is here.

Sunday, June 30, 2019

Doctors are burning out twice as fast as other workers. The problem's costing the US $4.6 billion each year.

Lydia Ramsey
Originally posted May 31, 2019

Here is an excerpt:

To avoid burnout, some doctors have turned to alternative business models.

That includes new models like direct primary care, which charges a monthly fee and doesn't take insurance. Through direct primary care, doctors manage the healthcare of fewer patients than they might in a traditional model. That frees them up to spend more time with patients and ideally help them get healthier.

It's a model that has been adopted by independent doctors who would otherwise have left medicine, with insurers and even the government starting to take notes on the new approach.

Others have chosen to set their own hours by working for sites that virtually link up patients with doctors.

Even so, it'll take more to cut through the note-taking and other tedious tasks that preoccupy doctors, from primary-care visits to acute surgery. It has prompted some to look into ways to alleviate how much work they do on their computers for note-taking purposes by using new technology like artificial-intelligence voice assistants.

The info is here.

Saturday, December 8, 2018

Psychological health profiles of Canadian psychotherapists: A wake up call on psychotherapists’ mental health

Laverdière, O., Kealy, D., Ogrodniczuk, J. S., & Morin, A. J. S.
(2018) Canadian Psychology/Psychologie canadienne, 59(4), 315-322.


The mental health of psychotherapists represents a key determinant of their ability to deliver optimal psychological services. However, this important topic is seldom the focus of empirical investigations. The objectives of the current study were twofold. First, the study aimed to assess subjective ratings of mental health in a broad sample of Canadian psychotherapists. Second, this study aimed to identify profiles of psychotherapists according to their scores on a series of mental health indicators. A total of 240 psychotherapists participated in the survey. Results indicated that 20% of psychotherapists were emotionally exhausted and 10% were in a state of significant psychological distress. Latent profile analyses revealed 4 profiles of psychotherapists that differed on their level of mental health: highly symptomatic (12%), at risk (35%), well adapted (40%), and high functioning (12%). Characteristics of the profiles are discussed, as well as potential implications of our findings for practice, trainee selection, and future research on psychotherapists’ mental health.

Here is part of the Discussion:

Considering that 12% of the psychotherapists were highly symptomatic and that an additional 35% could be considered at risk for significant mental health problems, the present findings raise troubling questions. Were these psychotherapists adequately prepared to help clients? From the perspective of attachment theory, the psychotherapist functions as an attachment figure for the client (Mallinckrodt, 2010); clients require their psychotherapists to provide a secure attachment base that allows for the exploration of negative thoughts and feelings, as well as for the alleviation of distress (Slade, 2016). A psychotherapist who is preoccupied with his or her own personal distress may find it very difficult to play this role efficiently and may at least implicitly bring some maladaptive features to the clinical encounter, thus depriving the client of the possibility of experiencing a secure attachment in the context of the therapeutic relationship. Moreover, regardless of the potential attachment implications, clients prefer experiencing a secure relationship with an emotionally responsive psychotherapist (Swift & Callahan, 2010). More precisely, Swift and Callahan (2010) found that clients were, to some extent, willing to forego empirically supported interventions in favour of a satisfactory relationship with the therapist, empathy from the therapist, and greater level of therapist experience. The present results cast a reasonable doubt on the ability of extenuated psychotherapists, and more so psychologically ill therapists, to present themselves in a positive light to the client in order to build strong therapeutic relationships with them.

Friday, June 1, 2018

The toxic legacy of Canada's CIA brainwashing experiments

Ashifa Kassam
The Guardian
Originally published May 3, 2018

Here is an excerpt:

Patients were subjected to high-voltage electroshock therapy several times a day, forced into drug-induced sleeps that could last months and injected with megadoses of LSD.

After reducing them to a childlike state – at times stripping them of basic skills such as how to dress themselves or tie their shoes – Cameron would attempt to reprogram them by bombarding them with recorded messages for up to 16 hours at a time. First came negative messages about their inadequacies, followed by positive ones, in some cases repeated up to half a million times.

“He couldn’t get his patients to listen to them enough so he put speakers in football helmets and locked them on their heads,” said Johnson. “They were going crazy banging their heads into walls, so he then figured he could put them in a drug induced coma and play the tapes as long as he needed.”

Along with intensive bouts of electroshock therapy, Johnson’s grandmother was given injections of LSD on 14 occasions. “She said that made her feel like her bones were melting. She would say: ‘I don’t want these,’” said Johnson. “And the doctors and nurses would say to her: ‘You’re a bad wife, you’re a bad mother. If you wanted to get better, you would do this for your family. Think about your daughter.’”

The information is here.

Wednesday, August 27, 2014

Practicing School Psychology While Impaired: Ethical, Professional, and Legal Issues

Emery B. Mahoney, Richard J. Morris
Journal of Applied School Psychology 
Vol. 28, Iss. 4, 2012


Studies on impairment in psychologists and other mental health practitioners began appearing in the literature 30–35 years ago. Since then, research and related scholarly writings have continued to be published to more fully understand this concept and its components. In school psychology, however, little has been written regarding school psychologists’ delivery of psychological services while they are impaired. This is true even though the provision of such services violates numerous ethical principles and standards of professional conduct in the ethics code of the National Association of School Psychologists and the American Psychological Association. In this article, the authors review the prevalence and incidence data regarding impairment, as well as definitional issues regarding what constitutes impairment. Ethical and legal issues associated with practicing while impaired are also discussed, followed by a discussion of assessing risk for impairment in school psychologists and the presentation of a self-administered risk assessment scale on the basis of empirical and other literature in the area of ethics and professional standards in the practice of psychology. Future directions for developing an agreed-upon definition of impairment within the field of school psychology and future directions for research on assessing and predicting impairment in school psychologists are discussed.


It is unfortunate that there is a paucity of research investigating impairment issues as applied specifically to school psychologists. As a result, on the basis of empirical research and risk assessment models developed with psychologists practicing in mental health clinics, private practice, and hospital settings, we have presented in Figure 1 the Instrument for Monitoring Psychologists’ Awareness of Impaired Responding (IMPAIR).

The entire article is here.

Thursday, June 23, 2011

Colleague Assistance

A recent article in the Monitor on Psychology by Rebecca Clay highlights several important points about colleague assistance and your ethical responsibilities as a psychologist.  The article features our own Sam Knapp.

The article, When A Colleague is Impaired, can be found here.  A portion of it is reproduced below.

          *          *          *          *          *          *          *          *          * 

A psychologist friend of yours is undergoing a divorce so wrenching, you sense she can barely get up in the morning, let alone provide effective therapy.

A colleague in your building stumbles as he walks down the hall, and you smell alcohol on his breath.

You’ve heard that an older colleague has become forgetful, sometimes seems confused and has even fallen asleep during a session.

How do you ethically handle such scenarios?

APA’s Code of Ethics requires psychologists to recognize when their own personal problems might interfere with their effectiveness and take action. But when it’s someone else who has the problem, knowing what to do can be difficult.
“On the one hand, people want to do something; on the other, they don’t want to get someone in trouble where they might lose their license,” says Michael O. Ranney, executive director of the Ohio Psychological Association. “For many people, it’s a difficult ethical dilemma — what to do and how to do it.”

The approach Ranney and other experts recommend? Step in early and take advantage of a colleague assistance program or other forms of help offered by your state, provincial or territorial psychological association (SPTA). Reporting someone to the state licensing board should be a last resort, they emphasize.

Preventing problems

Getting other psychologists the help they need is an ethical duty just like getting help for yourself, says Stephen Behnke, JD, PhD, director of APA’s Ethics Office.

“All of our training, all of our experience is to promote health and well-being, and that should begin in our own community of psychologists,” he says. “It absolutely should be an ethical responsibility that we take on as psychologists to be that supportive community to our colleagues in distress.”

Stopping problems before they escalate is key, Behnke and others agree.
One way to do that is to develop and maintain a network of social relations with other psychologists, says Sam Knapp, EdD, director of professional affairs at the Pennsylvania Psychological Association. Work on meeting your colleagues and reach out to them in good times and bad.

“If you find out that a colleague has just had a death in the family or a divorce or some kind of event like that, send them a card or call them up and express condolences,” says Knapp. “Ninety-nine percent of the time they’re not going to slip into impairment, but they’re going to appreciate it and feel that they can confide in you about other things.”

It’s not just personal issues that can cause problems, he adds. A patient’s suicide, for example, could plunge a psychologist into depression.

Once other psychologists become comfortable with you, says Knapp, they might ask for a referral for therapy or substance abuse treatment. They might seek consultation on a case they’re having trouble with. Or they might just want someone to talk to.