PhD/PsyD Ethical question

[EthicalQuandary]

I’m a post-doctoral fellow, and I have an ethical concern regarding another fellow. She’s engaging in daily substance use, and on at least one occasion used substances in her office at work. In short, all of her peers are worried about her, yet none of the supervisors (who are both clinically astute, and excellent supervisors) appear to share these concerns. In fact, they often comment on her efficiency and speak very highly of her clinical abilities. They are not aware of her substance use.

At the end of the day, there’s no clear indication that she engages with patients in a problematic way, and no obvious indication that her substance use is impacting her clinical work. I’ve reviewed the APA ethics code several times about this issue, but I was hoping to tap the collective wisdom of the forum. Earlier on, in line with standard 1.04, I tried to check in with her informally about these concerns. Do I have a responsibility to bring any aspect of this to the attention of supervisors? Or should I trust that they would notice a true competence issue?

[Thank you for your responses. Edited to further deidentify.]

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[futureapppsy2]

1.04 Informal Resolution of Ethical Violations

"When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual."

The OP stated that they already tried to do that, and it didn’t go well.

 

[ClinicalABA]

I’d say you sum it up pretty nicely in the first sentence of your second paragraph. Combined with your statement (and assuming it’s correct) that her supervisors are competent, it’s not clear where the actual ethical violation is. Section 2.06(b) would come into play if she were impaired in her abilities, but you have not encountered or presented evidence of this.

I would be concerned about substance use in the workplace, as well as any substance use with psychoactive effects that carried over into the workplace. You may have an obligation as an employee to report this (I know I would, even if no impairment was obvious). I’d be especially concerned if she knows that you know, as failure to report may be a violation of your rules of employment, and her behavior may suggest that she is unpredictable in regard to not letting others know that you know, especially if she is called to task on it. It’s a good CYA move, even if not an ethical obligation.

Let me be clear here- I’m not an expert on the code, nor do I assume I have all the facts regarding your situation. Please consult with a supervisor- either current or from your school program- for more specific advice. My post should not be seen as a substitute for actually consulting with a person with more info about the specifics of this particular situation. In other words, if things go south for you regarding this, “I was just doing what some anonymous stranger on the internet said to do” is not a good defense!

 

[super.ego]

The OP stated that they already tried to do that, and it didn’t go well.

My bad. Missed that.

 

[PsyDr]

Do you want to ever answer “yes” to an attorney asking, “Dr. X, were you aware that this person was abusing substances in their office?”???????

The answer should be “no”.

This isn’t high school. Being a narc isn’t a bad thing. As a professional you tell on people doing bad things. If not from moral grounds, for self preservation.

 

[deleted343839]

At the end of the day, there’s no clear indication that she engages with patients in a problematic way, and no obvious indication that her substance use is impacting her clinical work.

By "no clear indication" do you mean that you have directly observed her clinical work and found nothing amiss?

Do I have a responsibility to bring any aspect of this to the attention of supervisors? Or should I trust that they would notice a true competence issue?

Yes, you should bring it to your supervisors' attention, preferably alongside your colleagues who are similarly concerned. Why would you assume that your supervisors would notice this when there is an obvious incentive for her to conceal her behavior from them? You are doing your supervisors a service! Their licenses are on the line.

 

[psych.meout]

Just because you don't actively know of any problems this is causing with patients doesn't mean it isn't. Do you or anyone else observe every encounter she has with them?

You're aware of problematic behaviors (both the substance abuse and odd beliefs), so you should inform someone whose responsibility and capability it is to investigate such matters.

 

[Kadhir]

Perhaps this was in the pre-edited version of the original post, but do you have cogent/direct evidence of substance use, or just suspect it?

 

[AbnormalPsych]

If there is clear evidence of use on employers grounds I would start your concern from there. This is factual. I am guessing you don't share clinical work with this person and as such have no direct knowledge of if it truly is impacting services or not - just assuming.

I agree with the above that you need to do something to CYA at the very minimum. If able I'd approach this with your colleagues who are also concerned and speak with supervisors, since their licenses are on the line. Inform them of what you saw, be very direct and matter of fact. You may then also disclosure your groups concern about the other use. As a supervisor I would definitely want to know this information about my supervisee. Approaching as a group may help diffuse any direct ramifications from supervisors on you (if they are the type to engage in such awfulness).

 

[Psych-ops]

I’m super late to this convo and haven’t read the rest of the responses. So I apologize if this suggestion was previously offered.

My state’s board has an in-house attorney available for consultation. It’s possible your state does too. I’d suggest calling them and getting his or her advice about the matter. Then document the details of the call along with the dates/times you’ve observed her using drugs or seemingly under the influence of drugs. Also document the dates and times you’ve spoken with your supervisors about her behavior.

 

[RejectClinical]

I once learned (after the fact) that someone I worked with was abusing substances (not clear if this person was abusing in the office, but definitely became clear that this person was under the influence during treatment with clients). How do I know this? Well patients of this individual reported to their next therapists that something "felt off." I don't think you're necessarily in a position where you can say with 100% certainty that it is not impacting her clinical work. I would DEFINITELY bring this to the attention of your supervisors, and I would do it ASAP.

 

[psychRA]

Since you mentioned her efficiency, I just wanted to clarify - is she taking a prescribed stimulant medication, or is she using a substance (illicit or otherwise) recreationally?

 

[cara susanna]

Does your clinic or organization have a clear policy about substance use during work hours that this is violating?

 

[Action_Potential]

If something were to go terribly (or even mildly) wrong with a patient that this person were working with, and you could have prevented it, how confident would you be in defending your assertion of there being no clinical impact? And when the family member of that patient sued? I wouldn’t want to be on the stand saying “well... I thought about telling my supervisor but they seemed to be doing okay.”