that people at her stage in the illness typically lived no more than
two to four years.
Although unprepared and unwilling to quit her job as a
supervising psychologist in a mental health clinic, Myrna found
herself struggling with a rapidly shifting collage of emotions.
Throughout a week, a day or even a single counseling session,
she could find herself struggling with intense grief, anger, fear
and numbing shock. Although vaguely aware that she was less
attentive and present with her clients, the depth of her distress
and ambivalence about losing her professional life led her to feel
immobilized and unable to determine how best to proceed.
Although distress doesn’t necessarily result in psychological
impairment or problems with professional competence
(O’Connor, 2001; Smith & Moss, 2009), there is a positive
correlation between them. Dire medical news and the evolution
of a life-threatening medical condition can create profound
personal distress; psychologists who typically see themselves
as strong, competent and in control may be quite unsettled by
feeling weak and vulnerable (Guy & Souder, 1986).
Psychologists may also find that while medical events
are moving quickly all around them, their own process of
psychological adjustment moves more slowly (DeMarce, 2007;
Rolland, 1984). Emotional distress about a terminal diagnosis
may even interfere with the psychologist’s normally keen
awareness of his or her level of competence. It is understandable
that anyone struggling for safety and survival will have
less motivation for pursuing higher-order needs linked to
professionalism and self-actualization (Maslow, 1987).
Case #2: Denial
When Charles, a clinical psychologist, began to lose weight, a
few colleagues in his group practice congratulated him on his
commitment to diet and fitness. But as months passed, Charles
continued to lose weight and began to look gaunt and fatigued.
When the same colleagues expressed concern, Charles admitted that
he was being treated for cancer but that his prognosis was excellent.
But as the weeks passed, Charles began to cancel sessions with
greater frequency. His colleagues were shocked when they received
word that Charles had died of pancreatic cancer. He had informed
no one of the serious nature of his diagnosis, nor did it seem that he
accepted the terminal nature of his illness himself. Both clients and
colleagues were left entirely unprepared for his death.
Denial, the most primitive defense mechanism, may
be a psychologist’s first response to the diagnosis of a life-threatening condition. Denial may serve to distract and
protect the psychologist while he or she works to marshall
more constructive defenses and support from colleagues and
Immediately following diagnosis, denial may enable adaptive
performance of necessary duties. But denial may prevent a
psychologist from accurately seeing his or her diminished
competence. Due to what Barnett (2008) terms “professional
blind spots,” psychologists may only want to see themselves
as helpers. A seriously ill psychologist may be unable to easily
shift to seeing him- or herself as one who requires, rather than
Case #3: Fear
When Meredith had lunch with her former supervisor, Nora, she
was startled by a dramatic change in Nora’s demeanor. At 60, Nora
was a highly regarded analyst with 30 years in a busy practice. She
was known for her quick wit, verbal repartee and delightful humor.
But her behavior over lunch suggested dramatic changes in Nora’s
cognitive ability. She was slow to respond, obviously forgetful and
had trouble generating the correct word on several occasions. When
Meredith expressed concern, Nora became angry and accused
Meredith of being ageist. She said, “I’m 60 for God’s sake, everyone
has a little trouble at my age.” Meredith remembered that during
their supervision relationship, Nora had revealed that her mother
had died of Alzheimer’s disease. She wondered why Nora couldn’t
see the signs of dementia in her own behavior and wondered what
she should do as a concerned colleague.
At times, a psychologist may downplay the impact of
difficult medical news or the growing symptoms of a life-threatening disorder out of fear about declining health,
professional status, financial well-being and personal and
professional independence. The ill psychologist may fear
that his or her acumen and judgment may begin to ebb,
while simultaneously worrying that colleagues will cease
making referrals to him or her (Counselman & Alonso, 1993;
When she was diagnosed with terminal cancer, Claire E.
Philip, PhD, wrote, “my reluctance to reach out to colleagues
for help on disclosure and practice issues when I was most in
shock regarding my diagnosis resulted in a delayed reaction of
Research indicates that threats to perceived control portend
depression and a more difficult disease course (Williams &
Koocher, 1998). Psychologists who unconsciously equate illness
with weakness may suffer shame and fear that keep them
from seeking consultation and taking corrective action when
problems of professional competence arise. They might even
work to hide symptoms and dysfunction — from themselves
and others — in an effort to maintain the appearance of
strength, vigor and competence.
Case #4: Countertransferential reactions
As a psychology intern in a children’s hospital, Edgar worked with
children who had serious, often life-ending diseases. When he
received the news that a rare form of brain cancer was the cause
of his own failing health, he was adamant that he be allowed to