Colleagues and Ethical Dilemmas in the Mental Health Profession
In any work environment problems or difficulties with coworkers and colleagues may arise. The mental health profession is not exempt to this. In fact, those who work in the mental health profession may encounter other complexities in dealing with colleagues not seen in other fields, such as working with colleagues who use different theoretical approaches, working with colleagues who have different educational backgrounds and training (e.g., psychology vs. social work vs. counseling), or colleagues who adhere to different codes of ethics (ACA vs. APA) and ethical standards (or no ethical standards at all). In addition to these differences, other issues may arise from different personality styles, colleagues who are experiencing personal problems (such as those who may be in recovery from a mental illness, addiction, or personality disorders), as well as those who blatantly break ethical codes of conduct. In the following paper, I will discuss these issues, as well as how to handle them in an ethical manner (Corey, Corey, & Callanan, 2011).
Those who work in the mental health profession often work alongside others with different educational backgrounds. One’s colleagues may have been educated through medical school, psychology programs, counseling programs, or social work programs. Undoubtedly, the education and training one receives will surely influence how he or she views mental disorders, as well as how they should be treated. Indeed, these differences can create conflict if one’s colleagues are not flexible or accepting of each other’s viewpoints. Ideally, colleagues would respect/embrace one another’s differing educational backgrounds, as well as appreciate how it may contribute to unique viewpoints that may better serve clients. After all, a multidisciplinary approach usually only better serves clients (Koocher & Keith-Spiegel, 2008).
Likewise, colleagues may have different educational levels, such as BA, MA, PhD or MD, which may influence their perspective on treatment. Although those from different educational levels may be just as competent as one another, conflict may easily arise when such professionals view others from lower educational levels as less competent. For example, those with higher level degrees may assume superiority over those with lower level degrees (such as a PhD over a MA or a MA over a BA), even when the person with the higher level degree is not a direct supervisor of the other. In fact, there may be times that a person with a MA is the supervisor of a person with a PhD. Although a high degree of education is important, and does play a role in competence, a person with a lower level degree and many years of experience may be as competent as someone with a PhD (or even more competent) (Reiter & Runyan, 2013).
In an ideal world, colleagues and professionals alike would acknowledge that a degree is but one aspect of competence and does not give one an inherent superiority over other colleagues. Equally, professionals should recognize the value in a high level of education. Colleagues who fail to the either of these will contribute to tension in the work environment (Reiter & Runyan, 2013).
Furthermore, conflicts may arise amongst colleagues who hold different types of licensure or no licensure at all. Depending on what type of licensure one holds will determine what code of ethics one follows. However, those who are not licensed may not follow any particular code of ethics (unless it is a requirement of their employer). Various ethical codes often give different guidance for how to deal with ethical issues. Counselors/psychologists must be sure to adhere to their own ethical codes, while at the same time recognizing that these guidelines may be different from those of their colleagues. Recognizing, acknowledging, and respecting this will help to reduce potential conflict from arising in the work environment (Koocher & Keith-Spiegel, 2008).
Even amongst professionals with similar educational backgrounds, educational levels, and identical licensures, conflict can come about between those who practice different therapeutic approaches. Some professionals may adhere strictly to one therapeutic approach and view all others as less effective, inappropriate, or even inferior. For example, amongst addiction counselors there is considerable debate about whether abstinence-only approaches or harm-reduction approaches (teaching clients to use in moderation) are more effective (Kanzler, 2013).
Indeed, tempers can flare when each respective counselor feels he/she knows what is best for his/her clients, but is unwilling to be flexible. As in the other example, mental health professionals should strive to be open minded and accepting of various theoretical approaches. Regardless of how counselors/psychologists view other therapeutic approaches, attacking one another on a personal level because they disagree with an approach will only foster an environment of negativity and resentment, which may ultimately negatively affect the clients being served (Kanzler, 2013).
Even with all things being equal, working closely with colleagues can still prove challenging. Other things that can lead to conflict include interpersonal style, strong personalities, or colleagues with their own set of problems (personality disorders, psychiatric disorders, addiction, or those who may simply be experiencing an acute life stressor). Working with colleagues from different cultural backgrounds may lead to some misunderstandings, as well.
Personality styles that counselors/psychologists may encounter and prove troublesome include those who are rigid, overly critical, and narcissistic. Mental health professionals who are unable to separate their problems or personal life from their work often contribute to an unpleasant work environment. Counselors/psychologists should strive to take care of their own mental health and control their own personality defects, so that it does not affect their colleagues or more importantly their clients (Koocher & Keith-Spiegel, 2008).
Professional code of ethics offer very little guidelines on how to resolve conflict between professionals. For example, the APA code of ethics states that psychologists should attempt to cooperate with one another in order to best serve their clients. Likewise, it states that psychologists should maintain adequate self-care to ensure that their personal problems do not interfere with the quality of their work (APA Code of Ethics, 2012).
The ACA code of ethics is more detailed in its guidelines, however. For example, in addition to encouraging cooperation and self-care, the ACA code of ethics encourages respect and acceptance of various therapeutic approaches. Furthermore, it gives guidance on how to deal with negative work environments (such as when the environment is so negative that it may affect clients). These guidelines encourage counselors to escalate matters as far as making contact with state licensure boards if colleagues are unable to resolve the problem amongst themselves (ACA Code of Ethics, 2014).
If a counselor or psychologist finds herself in a conflict with colleagues or in a negative work environment, it can have many adverse effects. For example, it can affect the counselor’s or psychologist’s career, mental health, or his or her clients. Below I will describe how mental health professionals should proceed to minimize these adverse effects.
Firstly, the counselor/psychologist should determine if the conflict between the two colleagues is ethical in nature. For example, is the disagreement between a colleague’s approach to treatment escalated to a point that it is affecting his or her clients? To determine this, the counselor/psychologist should consult with his or her code of ethics. Ideally, each place of work would have procedures in place for dealing with conflict amongst employees. Those experiencing conflict should review such procedures. Afterwards, the counselor/psychologist should discuss the situation with those who are not involved and can be objective in providing guidance and feedback. Lastly, the counselor/psychologist should consider trying to resolve the conflict with his or her colleague directly (providing that doing so would not escalate the conflict further). If all else fails, the last option would be to make a report to the appropriate ethical board (Koocher & Keith-Spiegel, 2008).
However, in many cases, such as a disagreement over therapeutic approaches, ethics boards would be unable to help, as no ethical violations per se have taken place. It is, therefore, important to determine beforehand if ethical violations have actually taken place, since making unnecessary ethical complaints is inappropriate. Ultimately, if a counselor is unable to resolve conflict through the appropriate channels, it may be appropriate for the counselor to seek employment elsewhere in order to ensure that the work environment does not begin to affect them in a negative way (such as causing them to neglect clients due to a lack of motivation caused by a poor work environment) (Koocher & Keith-Spiegel, 2008).
As in any work environment, conflict with coworkers is inevitable. Consulting with colleagues, getting supervision, and consulting with one’s code of ethics can help determine if the conflict is a matter of ethics or not. Ultimately, however, each counselor is responsible for himself or herself regarding how to resolve conflict and ensure that conflict does not become an ethical dilemma.
American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA
American Psychological Association. (2012). American Psychological Association ethical
principles of psychologists and code of conduct.
Corey, G., Corey, M.S., & Callanan, P. (2011). Issues and Ethics in the Helping Profession, International Edition, 8th edition, Brooks/Cole. ISBN-13: 9780495904687
Kanzler, K., et al. “From colleague to patient: Ethical challenges in integrated primary care.” Families, Systems, & Health, 2013, 31: 41-48.
Koocher, G.P. & Keith-Spiegel, P.A. (2008). Ethics in Psychology and the Mental Health Professions: Standards and Cases. New York: Oxford.
Reiter, J. & Runyan, C. “The ethics of complex relationships in primary care behavioral health.” Families, Systems, & Health, 2013, 31: 20-27.