continue his internship half-time while undergoing chemotherapy
and radiation in the same hospital. He insisted that his clients and
their parents were particularly sensitive to issues of loss and grief
and he did not want to abandon them during their treatment. He
appeared unreasonably rigid about preventing any family from
discovering his illness, and if they did, he sidestepped their efforts
to discuss it with him and express their own genuine concerns.
Edgar’s supervisor reflected that it might be Edgar, not his clients,
who might be unprepared to deal with his diagnosis.
Counselman and Alonso (1993) observed that “patients like
to see their therapists as invincible [and] it is very tempting for
therapists to agree with this flattering view, and to deny their
own vulnerability to illness, aging and inevitable death.” A
diagnosis of a life-threatening condition may trigger defensive
countertransference reactions in psychologists who might
strike a pose as hero, suffering martyr or stoic parent, ostensibly
to protect clients, but actually in an effort to deny their own
mortality and delay their need to assess their competence for
practice (Rosner, 1986). Acknowledging such vulnerabilities
and difficulties “might be seen as inimical to the image of the
competent psychologist, and this may then, unfortunately, lead
to the exactly opposite effect” (Barnett, 2008).
But how we respond to and address our own illness can be
an important opportunity for modeling adaptive behaviors
and a healthy response to our clients. It may also provide
an opportunity for deep and meaningful sharing between
psychotherapist and client. For some clients, the ability to “give
something back” to their psychotherapist may be especially
meaningful and a therapeutically important step toward
their autonomous and effective functioning. Avoiding such
discussions may rob the client of these potentially valuable
Problems with self-monitoring professional
Standard 2.06 of APA’s Ethics Code states that the psychologist
is exclusively responsible for monitoring and addressing
problems of his or her professional competence. But when a
psychologist is overwrought by a terminal medical diagnosis
or experiencing the effects of rapid decline in health, is it
reasonable to assume that he or she will be able to self-monitor?
Early confusion about the diagnosis and extent of likely
incapacitation as well as the psychologist’s own denial may keep
ill psychologists from accurately assessing their competence
(Rosner, 1986). Older psychologists may have similar feelings
when they begin to demonstrate cognitive decline.
The problem with self-evaluation extends beyond
psychologists who are sick or distressed. A review of studies
comparing the accuracy of physicians’ self-assessment reveals
that most physicians rate themselves more competent than
they actually are (Davis et al., 2006). Other social psychology
research leads to similar conclusions in most domains of
human self-assessment: Self-assessments of both professional
skill and personal character tend to be flawed in substantive
and systematic ways (Dunning, Heath, & Suls, 2004). Further,
people in general tend to wrongly predict how they would
respond to emotion-laden situations when they are not
currently emotionally aroused (Van Boven, Lowenstein,
& Dunning, 2005). Ultimately, self-assessment research
suggests that “people tend to be blissfully unaware of their
incompetence” (Dunning, Johnson, Ehrlinger, & Kruger, 2003).
If psychologists with serious medical problems are
reluctant to seek help from their colleagues (Good, Thoreson,
& Shaughnessy, 1995) or for various reasons are ineffective
at monitoring their own competence, then perhaps Nancy S.
Elman, PhD, and Linda Forrest, PhD, were right in observing
that it may “take a village” to address problems of professional
competence (Johnson et al., 2008). When psychologists are
effectively trained to be members of ethical communities of
supportive peers who consult with and watch out for each other,
the risk of professional competence problems related to illness
should be diminished (Johnson et al., 2008; Kaslow, 2004).
To be effective, such peer networks must overcome several
barriers when a colleague is not performing competently. Those
• A reluctance to intrude on a colleague’s independence or to
suggest that he or she may lack current competence;
• Fear that there is insufficient evidence of incompetence to
raise the concern;
• Worry that addressing the concern will undermine the
relationship with the colleague;
• A lack of clarity regarding one’s ethical or professional
obligations to intervene;
• Hope that the colleague’s difficulties are temporary, linked
to recent medical challenges and likely to resolve quickly.
Recommendations for practicing psychologists
So what should psychology practitioners do to reduce the risk
of incompetence related to an illness? Recommendations for
psychologists fall into two general categories: prevention and
In terms of prevention, we encourage psychologists to
pursue several avenues of physical, emotional, spiritual and
social wellness. Psychologists should:
• Strive for excellent physical fitness, good nutrition, healthy
sleep habits and recreation.
• Strike a balance between professional obligations and
personal time. Do not take on excessive client loads that
interfere with reasonable health and fitness. Set clear boundaries
between work and play. Be diligent about scheduling and
adhering to time off.
• Regularly engage with significant others, nurture close
friendships and make time for rewarding leisure pursuits.