This is a request for your help for referrals from your OPA Prevention and Wellness Program and your OPA Ethics Committee.

As most of you know, the Ohio Board of Psychology has designated the Ohio Professionals Health Program (OPHP) as a safe haven program.  We are working with OPHP to help them fill in some gaps in their referral network.  Below is a list of the types of professional referrals they are seeking, both for individual practitioners, groups, and treatment centers. I am also including a follow up email that describes what they mean by “safety sensitive workers”.   

If you know of anyone who fits these criteria, please email me their contact information and I will forward them on to OPHP.  We greatly appreciate your help!  I want to emphasize that the provider sets their own fees; this is not like signing up to be on an insurance panel; however they do have a procedure to become a provider, which is also described below. Again, thanks for any help you can provide. 

Howard Fradkin, Ph.D., Member, PWP and Ethics Committee

The message is from the CEO of OPHP, Kelley Long: 

Below is the preliminary list created by the clinical leadership regarding desired providers/treatment providers to help support the practitioners involved with OhioPHP. I appreciate any assistance you and/or OPA can provide to help find quality providers in the state of Ohio.

• Addiction psychiatrists who are familiar with the differences between requirements for safety sensitive workers versus community--this includes being abstinence-based and not taking a harm reduction focus; they must also be willing to opine on a participant’s fitness to practice with their healthcare license according to acceptable and prevailing standards of care, from a mental health perspective and substance use disorder perspective
  
• Substances use treatment facilities that take Medicaid and Medicare, and are knowledgeable about the differences in expectations/treatment for safety sensitive workers versus the community--as above, this includes being abstinence-based and not taking a harm reduction focus; they must be willing to work with OhioPHP/communicate regularly with respect to individual treatment progress
  
• Mental health PHP and IOP programs across the state
  
• PHP or IOP programs specialized in treatment of co-occurring substance use disorders and mental health conditions (sexual disorders, PTSD, etc.) who are familiar with the differences between requirements for safety sensitive workers versus community
  
• Psychologists knowledgeable about the differences in expectations/treatment for safety sensitive workers versus the community--as above, this includes being abstinence-based and not taking a harm reduction focus and an understanding of cross-tolerance / cross-addiction; additionally, they should encourage individuals to seek medication management for psychiatric diagnoses in which the primary treatment modality should be medications; they must also be willing to opine on a participant’s fitness to practice with their healthcare license according to acceptable and prevailing standards of care, from a mental health perspective
  
• Traditional/full DBT programming which includes group and individual therapy, with 24/7 therapist availability
  
• Neuropsychologists available to see participants within a reasonable time frame (weeks versus months), who are also willing to opine on a participant’s fitness to practice with their healthcare license according to acceptable and prevailing standards of care, from a cognitive perspective
  
• Providers offering EMDR treatment

 
They are planning to have a few meetings on this matter, and I will forward any additional needs identified your way. Thank you for your help!
 
Below is a summary of the OhioPHP’s Treatment Provider Network and process for approval:

1. The TPN is managed by the OhioPHP TPN Committee. The TPN Committee is comprised of the OhioPHP Medical Director with a minimum of three selected clinical and non-clinical OhioPHP team members. The Committee’s responsibility is to review and approve evaluators and treatment providers that meet the standards set forth by the committee. The committee meets at least quarterly to review applications, discuss site visits recently held, and monitor the ongoing performance of evaluators and treatment providers. Annually, the TPN Committee reviews the utilization of evaluators and treatment providers and discusses the need to remove or add providers to the TPN.
   
2. The OhioPHP approval and renewal process is defined as below
   
   • Facilities and individual providers must submit a completed evaluator and/or treatment provider application along with all supporting documentation:
     • Copy of their professional liability insurance
     • CV for all Medical Directors
     • Sample of work product for evaluation and/or discharge summary
       
   • Once all documentation has been received, the TPN Committee will review the application at the next available TPN Committee meeting. Note:  incomplete applications will not be considered.
     
   • Unless otherwise determined by the TPN Committee, the Medical Director or his/her designee will conduct a site visit for all facilities and either an in-person or virtual meeting with all individual providers. Note: the site visit must be within the last twelve (12) months prior to the application unless otherwise approved by the TPN Committee.
     
   • If approved, the TPN Committee administrative liaison will notify the treatment facility in writing within sixty (60) days of the approval. Certificates will list what types of services and level of care the facility and/or individual provider has been approved to provide.
     
   • Approvals are for two (2) years, unless deemed otherwise by the TPN Committee.
     
   • Approved evaluators and treatment providers will be required to attend a minimum of annual training provided by OhioPHP.
     
3. Criteria considered for evaluation/treatment facility approval are as follows:
   
   • Hold active accreditation with FSPHP ETA, ASAM, CARF, Joint Commission or others as deemed appropriate by the TPN committee;
     
   • Have an appropriately Board-certified Medical Director or a Medical Director with significant experience in the treatment field working with healthcare professionals in safety-sensitive occupational roles, as appropriate;
     
   • Demonstrate experience in treating safety sensitive workers (including healthcare workers);
     
   • Be willing to comply with the OhioPHP communication and documentation requirements;
     
     • Inform OhioPHP immediately at the time of entry into treatment;
       
     • Inform OhioPHP within one (1) business day if the practitioner or applicant leaves against medical advice or clinical advice, if there are problems with treatment compliance, positive drug screens, or if there is a change in
     • the level of care;
       
     • Inform OhioPHP of unplanned discharge or termination of treatment within one (1) business day;
       
     • Provide OhioPHP with a weekly progress report for each practitioner or applicant engaged in treatment;
       
     • Provide OhioPHP with each practitioner’s or applicant’s continuing care requirements;
       
     • Provide a statement of the practitioner’s or applicant’s ability to practice according to acceptable and prevailing standards of care;
       
     • Provide initial discharge plan five (5) business days prior to discharge;
       
     • Provide a final written discharge summary within fourteen (14) days of discharge; and
       
     • Obtain an unrestricted release of information to provide information to OhioPHP before beginning the treatment process.
       
   • Be willing to comply with OhioPHP reporting requirements;
     
   • Develop individualized treatment plans for practitioners or applicants entering treatment;
     
   • Consistently apply evidence-based treatment with additional consideration of treatment plans based on safety sensitive workers;
     
     • Assessment focuses on the total practitioner’s or applicant’s needs such as mental health, medication for addiction treatment, neurocognition, trauma, etc.;
       
     • Use effective methods of treatment such as cognitive behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy, eye movement desensitization and reprocessing therapy, motivational interviewing, etc.; and
       
     • If a substance use disorder treatment provider, provide abstinence-based education.
       
   • Measures outcomes and makes adjustments to treatment plans as appropriate to improve outcomes, etc.
     
   • The treatment provider shall require the practitioner or applicant to immediately suspend practice as requested by OhioPHP
     
   • Be capable of determining whether a practitioner or applicant is capable of practicing according to acceptable and prevailing standards of care. Any Medical Director of a treatment provider approved by the OhioPHP may perform such assessment; and
     
   • Submit a complete OhioPHP TPN treatment provider application along with a copy of their professional liability insurance (certificate of insurance is accepted), CV for any medical directors, and other documentation as requested by OhioPHP.
     

Our applications are only offered once a provider/facility has had preliminary conversations with a representative of the TPN Committee. You can find more information about our trainings on our website here: https://www.ohiophp.org/provider-portal.

The message is from the CEO of OPHP, Kelley Long that describes the phrase "Safety Sensitive Workers:" 

The term “safety-sensitive worker” refers to an employee whose job duties have a direct impact on the health, safety, or well-being of themselves, their coworkers, or the public. Because of this, they are held to stricter standards—especially regarding issues like substance use disorders or medical/mental health conditions that could impair performance. A safety sensitive role is any position where even a brief lapse in attention, judgment, or motor skills could result in serious injury, harm, or significant risk. Confidentiality rules (like 42 CFR Part 2 in healthcare) still apply, but employers and regulators may impose extra oversight due to public safety concerns, including strict “fitness for duty” standards. Examples of this are: pilots, train engineers, healthcare workers, heavy equipment operators, law enforcement, and others.
 
In short, a safety-sensitive worker is anyone whose impairment could put lives at risk. Several federal agencies recognize this as well as national policy frameworks such as the US Department of Transportation (and subagencies), Occupational Safety and Health Administration, Substance Abuse and Mental Health Services Administration, American Society of Addiction Medicine, American Psychiatric Association, The Joint Commission, Federation of State Medical Boards, Federation of State Physician Health Programs (FSPHP), and others. OhioPHP uses a combination of existing policies that establish national standards for the evaluation, treatment, and monitoring of safety sensitive workers, most notably the FSPHP Guidelines.
 
We also expect our evaluators and treatment providers to use guidance defined in the American Society of Addiction Medicine Criteria, which states, to determine level of care recommendations for a safety-sensitive worker, the diagnosis and severity must be considered in the context of recurrence- and impairment-risk to public safety (2023). Subsequently, the appropriate level of care recommendation for a safety-sensitive worker is often more intense than that of the general public with the same SUD severity. Recommendations should be made by evaluators with knowledge and experience regarding the safety-sensitive industry. Lack of incidents at work does not mean lack of potential impairment or need for treatment.

If you have questions or wonder if you’re a good fit, we welcome any inquiries! Thanks in advance for considering our invitation!

To give your input on this initiative, please complete the survey.

Thanks for any input you have. 
Howard Fradkin, PhD, Chair, Prevention and Wellness Program

1. Valuing the person of the psychologist: We know from research that the person of the clinician is the locus of successful psychotherapy. Because of this, it is important to explore how we can increase our self-awareness. This assembly will help us explore various methods of monitoring our self-care behaviors. We will also address the need for developing self-empathy, taking the time and space for ourselves without feeling indulgent, guilty or needy. We’ll invite you to commit to what we like to call “exquisite self-compassion.”
2. Refocusing on the rewards: Research over the past 50 years has found that the percentage of psychologists who expressed satisfaction with their careers was no lower than 88% at any time—yet, in the midst of all of the burdens of our work, especially in the past eight months, we may be struggling with overlooking our rewards. This assembly will focus on helping us acknowledge the satisfaction of helping our clients, students, and supervisees grow; acknowledge the freedom and independence we can enjoy; acknowledge the intellectual and emotional stimulation of our work, and lastly acknowledge how our ability to relate to spouses, significant others, friends and family members are also enhanced by our work. We’ll discuss the concept of counter-resilience, the benefit we can experience working with traumatized people.
3. Recognizing the hazards: Self-care necessarily also involves us being mindful of the inevitable hazards of our work as well. One we’ll discuss is the paradox of being so alone physically in the midst of the most intimate of interpersonal encounters. We’ll also look at the ways in which we experience emotional isolation, due to the ethical and legal requirements of confidentiality which can result in a tendency to split off the emotional impact of our work from the rest of our lives. We’ll also talk about the impact of rarely seeing people “at their best” and how this can impact our perceptions of society and humanity. Lastly, we’ll discuss how we can avoid burnout and how we can manage the inevitable phenomenon of vicarious traumatization and counter-trauma.
4. Minding the body: As we said at the beginning, we are great at reminding our clients to listen to their bodies; however, what are our bodies telling us?  We’ll take time to listen, and see if our bodies are giving us any messages about our need for a more solid commitment for more sleep, for example. Maybe our body is telling us we need to get up and move around in between sessions or at least take a short walk during the day? How open are you to receiving a massage? How are you doing with minding the nutrition you take in, including how much hydration you give yourself in the midst of your busy day?  We’ll also explore our experience with exercise, and explore our blocks and successes to committing to various forms of exercise.
5. Mindfulness: Most of us know mindfulness of one of the oldest methods of self-care. It has been called many things depending on your theoretical orientation, including the observing ego, “listening with a third ear,” or centeredness or groundedness, and mindful meditation to name a few. There has been a lot of research on the important neurobiological results of mindfulness, and although we might advocate this practice for our clients, and even employ such methods within our psychotherapy, when it comes to our own self-care, we may face our own challenges. We invite you to take time out to talk about what blocks may be in your way. We’ll also take time to hear about your successes. 
6. Cultivating spirituality and mission: Although research indicates psychologists as a group are less conventionally religious than the general population in terms of formal organization and attendance at religious services, we are nonetheless quite a spiritual lot. We’d like to address three aspects of spirituality in this assembly:  how you see your career as a calling; your commitment to promoting your own growth and the growth of the people to whom you offer help; and lastly, becoming a citizen-psychologist. In this last part, we’ll look at the role of becoming involved in social activism, and how you view this work in the context of your spirituality and mission. 
7. Healthy escapes: Our chair says it took him getting two degrees (a bachelor’s and a master’s in therapeutic recreation) to learn how to play; we’ll use this assembly to talk about how you play, as we know many of you do, and we also know from research that as many as ¼ of psychologists do not play. We’ll look at what gets in the way, and how we might help empower you to carve out time for you to play, seek adventure, and take needed breaks. We’ll also talk about how vacations can help you, however research has shown they have limited long-term benefits without a more solid commitment to self-care the rest of the year. 
8. Nurturing relationships: Nourishing relationships can protect us from the ravages of what we all know can be a very demanding profession. Social support has been shown to reduce the actual strain, buffer and mitigate the stressors of work, and moderate the stressor-strain association. Yet, despite all the skills we have in building professional relationships with our clients, supervisees and students, we may also suffer from strained relationships with colleagues, family members, intimate partners and friends. In this assembly, we will strive to create a safe enough environment where we can openly discuss these challenges, talk about what gets in our way, and offer support to each other as we seek to overcome these challenges.  

We look forward to meeting with you over the next year as we strive to build on our self-care. We may well schedule some other assemblies on related topics as our committee seeks to utilize the talents of all of our members. Whether you attend one, a few, or all of our assemblies, we will welcome you with open arms. If you have ideas for other topics, let us know as well. Email our Chair, Howard Fradkin, with your ideas.

To all of our front-line psychologists, psychology assistants, graduate students, and staff, thank you for all of your outstanding efforts to help promote the mental health and well-being of our community.  Together, we have past many mile markers in this marathon: found or made PPE’s and hand sanitizers; learned to be comfortable with masks, social distance and frequent hand-washing; learned the ropes of telepsychology; sifted through medical information and disinformation to keep ourselves and our clients/patients/staff/colleagues informed; hopefully stayed both physically healthy and grounded; and managed a lot of fatigue/stress that results from long hours on the front line. And many more challenges—perhaps also helping to support our partners/spouses/significant others, elderly parents, and our at-home children needing lots more reassurance and guidance.  And a special thanks to the supportive and adaptable leadership of OPA and to each of you who has joined us for one of our Self-Care Assemblies and been willing to share your trust, vulnerabilities, and wisdom.

As Ohio begins to open up, we have many more mile markers ahead.  We encourage you to remain open to checking inside to see what additional needs you may have in these next miles, and to be aware what you needed before may be very different than what you need now.  Some of you may have slowed down enough to allow yourself to feel more of what we have all may have experienced—the feelings of achievement along with the doubts and anxieties of wondering if we have done enough; the pride of having set healthy boundaries and at the same time, the awareness of how much significant extra energy it has taken to maintain them; the comfort of finding out telepsychology can be very effective, and yet knowing in-person work could be even more effective, and struggling with the inevitable nagging doubts of when will you feel safe enough to return to the office, and debating inside about what is best for our clients and for us?  

Times of trauma provide us opportunities for reflection. We invite you in the next miles to take some time for you to reflect on the wisdom you have learned in the past couple months.  Have your priorities changed?  What have you discovered about your resilience capacity?  What have you cried about, laughed about, worried about?  How have you increased or decreased reaching out for your own support?  What coping methods have been effective, and which ones have you discovered have led to less than desirable outcomes?  

Whatever you discover, we invite you to affirm for yourself you are worthy of exquisite self-compassion, deepened connections to your inner resilience and passion, and healthy engagement with the people in your life who help you feel loved, appreciated, respected and grateful. From everyone at OPA, we are grateful to each of you!   

PWP plans to continue every two weeks to provide self-care assemblies.  Our next assembly is Thursday, June 4th, 7-8:15 PM.  Watch your email for your chance to participate, receive support and support your colleagues in future assemblies.

*This Photo of marathon by Unknown Author is licensed under CC BY-SA

Session 1: Tuesday, April 7, 2020 | 7:45 - 9 PM ... REGISTER FOR SESSION 1

Session 2: Wednesday, April 15, 2020 | 8 - 9:15 PM ... REGISTER FOR SESSION 2 

PROGRAM DESCRIPTION:

The past several weeks has given each of us pause to reflect on our values, our health, and our commitment to our patients/clients/students/colleagues/families/neighbors/significant others. It has also given us an opportunity to reflect on our own ability to cope with a trauma of ever-changing proportions and dynamics. Many of us had to make significant changes to how we provide support, education and care in a very short time, and likely that created additional stress on top of the worsening pandemic news. 

OPA is here to help you in this time of need. The OPA Prevention and Wellness Program (PWP) has offered to host weekly FREE virtual assemblies to help create a setting where we can safely share our challenges and stresses, as well as share our strategies for nurturing and building our resiliency. We hoped we would be in a sprint, but indeed we are running a marathon, and that will require a whole community response to support our surviving and thriving. We invite you to reach out for your own support, as well as to think about how you can be there for your colleagues who may be struggling in isolation. 

The objectives for the prevention and wellness assemblies will be:

• As a community, commit to create a safe environment where we can share our personal concerns and struggles
• Discuss the unique emotional challenges of the current circumstances.
• Assess your own needs for and efforts towards self care.
• Identify and apply our resilience building strategies.

These assemblies do NOT offer CE.

MEET YOUR SPEAKERS:

Howard Fradkin, PhD, LICDC-CS has counseled over 1500 survivors of sexual victimization over the course of his 40-year career. He has educated over 2,500 professional colleagues on male sexual trauma. He provides expert consultation for the Ohio and Federal Public Defenders Office. In 2018, he retired after serving 15 years as Co-Chairperson of the Weekends of Recovery program and retired after 35 years from his private practice, Affirmations Psychological Services. He authored Joining Forces: Empowering Male Survivors to Thrive, published in 2012. He serves as Chairperson of the OPA Colleague Assistance Program and is a member of the Ethics Committee.

Carl Tishler, PhD obtained his BS from Kent State University and PhD from The University of Maryland. In Boston, Dr. Tishler completed an internship and two postdoctoral fellowships. He took a position as the Adolescent Psychologist at Children's Hospital in Columbus where he was on call (24/7 solo) and evaluated and referred  hundreds of suicidal children and adolescents. Dr. Tishler has published extensively in the field of child and adolescent suicide. Other academic interests include medical ethics and the usage of psychotropic medications in children.  After nearly 40 years of private psychotherapy practice with adults and children, Dr. Tishler currently works part-time as medical consultant for the Social Security Administration.  He is fortunate to be happily married with 4 adult children and to have time to enjoy water skiing, fishing, and kayaking. (Dr. Tishler will be co-presenting at the April 7th session only.)

INSTRUCTIONS TO JOIN THE ASSEMBLY:

Once your registration is processed, you will receive a confirmation email that includes instructions on how to join the online assembly.

1. We are thrilled to announce we have two winners of our recent self-help video contest. Click on our winners' names to view the creative videos, Brittany Carbaugh, a Counseling Psychology Graduate student at Cleveland State, expected to graduate this fall and Brock Partlow, a Clinical Psychology Doctoral student at Xavier University, who plans to graduate in May, 2023.
2. At spring convention, we are offering a special self- care panel: Speaking of you: A multi-generational, multi-cultural & multi-specialty exploration of self-care in psychological practice. It is a 3-hour ethics workshop.  Here’s a brief description:
   
3. As mental health providers, we advocate for the practice of regular healthy self-care. But what about us, and do we practice what we preach?  What gets in our way and how can we welcome those challenges? Are there unique barriers based on our gender, diversity variables or in our unique employment setting? How does gender socialization impact our practice of self-care? How do life’s traumas and past experiences impact us? 
   
4. We are excited to offer a special all-day ethics workshop, Healing the Wounded Healer: From Counter-trauma to Counter-Resilience, on July 31st in Columbus, co-led by Sandi Forti, Ph.D. and Howard Fradkin, Ph.D. You’ll hear more from OPA in the coming months about this experiential workshop and how you can register. 
   
5. Starting in February, we’ll be posting hypothetical challenging vignettes about our work, and we’ll be inviting you to share with your colleagues your thoughts about how to manage these challenges.  
   
6. You may have already noticed in the monthly newsletter, we are including short articles about different aspects of self-care related to our challenging work. Click here to access all of the articles. A few recent columns were: Acknowledging Our Struggles As We Work With Suicidal Clients (November 2019 E-newsletter), Vaccinations Anyone? Another Aspect of Self Care (December 2019 Newsletter), and An Urgent Cry for Self-Care (September e-newsletter).

Lastly, if our mission excites you, we invite you to join our committee; the time commitment is 1 hour per month, on the second Monday from 9:15-10 am. Just email Howard and let him know you are interested.

The reward is a full registration to the 2020 OPA convention (a $500 value!). It can be stills or videos, all we want is your story about how you engage in self-care. For more information, click here to download a contest flyer.

The deadline to submit your entry is November 28, 2019.

Questions? Contact OPA-CAP Committee Chair Dr. Howard Fradkin at 614-578-8887. 

As a psychologist who performs independent psychological examinations, I have noticed that the number of healthcare providers referred for evaluation has been increasing.  The reason for the referrals varies and can include depression and anxiety, substance abuse, or cognitive impairment. Once a healthcare professional self-refers or is identified as having a problem that interferes with their ability to practice, each profession has various methods to assist them in recovering and returning them to work.  

The Nursing Board, for example, works with a nurse with a substance abuse problem and assists him/her in identifying an appropriate treatment program, completing treatment, and then monitoring their sobriety. Physicians have a large problem with substance abuse, perhaps due to their increased access to medication. The Ohio Medical Board requires all licensees to report other colleagues who are impaired for any reason to the Board or risk being sanctioned.  While the Medical Board may require treatment and monitoring for a physician to retain their medical license, physicians also have a separate program to assist them in obtaining treatment or access to resources, which is not part of the medical board. This program is the Ohio Physician’s Health Program (OPHP). 

The Ohio Physician’s Health Program is a program that provides services to physicians, residents, physician assistants, anesthesiology assistants, dentists, dental hygienists, dental assistants, optometrists, veterinarians, chiropractors, and students of all affiliated healthcare fields with issues impacting their health and well-being. The OPHP also provides community referrals for problems such as: stress, burnout, psychosocial therapy, behavioral issues, gambling addiction, sex addiction, family and marriage counseling, ethics training, boundary violations, prescribing guidelines, legal services, skills assessment, cognitive concerns, eating disorders and others.  

The OPHP does not report a license holder to their medical board if they voluntarily seek treatment and then follow a plan set forth by the program. The exception, of course, it when there is an imminent clear danger to the public. License holders who are required by law to report others who are impaired to the medical board, may satisfy their legal reporting requirement by reporting their concerns to the OPHP. 

In addition, the State of Ohio has a “One Bite” rule for substance abuse by physicians, which was signed into law by Governor Kasich this year. If an impaired physician seeks treatment that meets the standards stipulated by the Medical Board, then they are entitled to “one bite of the apple” meaning they can avoid being sanctioned by the Board and potentially losing their medical license. This treatment must include a 28 day stay in a residential treatment program approved by the Medical Board, 104 sessions with an approved treatment provider, and monitoring for 2-5 years post-treatment. If they utilize the Ohio Physicians Health Program, their treatment is confidential, meets criteria for the Board, and is not reported to the Medical Board. OPHP monitors the recovery of healthcare providers and is able to advocate on their behalf regarding employment, insurance, and legal issues. OPHP is also able to advocate for clients to the appropriate regulatory board if necessary.   

The OPHP is a well-organized program which can help physicians address substance abuse and mental health problems such as burnout and stress. I have had some exposure to the OPHP while evaluating physicians for their employer and have found the program to be highly effective.  Even in situations where a physician is not abusing substances, but was having difficulty with other issues such as emotional regulation or inappropriate behavior, the OPHP provided an effective and collegial monitoring program, which provided the necessary support for success. It was in working with the OPHP and other programs like it that I became interested in the Ohio Colleague Assistance Program, which provides a similar confidential referral service for psychologists requesting assistance or even just resources that may be helpful.  If you are interested in learning more about the OPHP their website is at  https://www.ophp.org/. If you are interested in learning more about providing support for your colleagues in psychology, please contact Cathy McDaniels Wilson at mcdanielswilson@yahoo.com.

The Colleague Assistance Program of the Ohio Psychological Association

Like the proverbial cobbler, whose family members may not have shoes despite the fact that they are a necessity, psychologists do not always benefit from the products of their trade. Perhaps this is an age-old problem. It’s been said that in a blacksmith’s home the knives are wooden, and in a potter’s house the water jug is chipped.

Americans are stressed, and psychologists are not immune. We often fulfill many demands, dealing with people in distress and intense emotional crisis, sometimes with limited resources or too many work hours. Professional isolation, inadequate peer consultation, the demands of managed care, lack of autonomy, and vicarious trauma are other variables that can lead to burnout. Stress can have serious consequences for both psychologists and those around them. A failure to get help can be fraught with risk.

Why do psychologists not get the help they need? It can be hard to identify a qualified, available mental health professional with whom you don’t already have a collegial relationship. Even for mental health professionals, shame and the stigma around mental
illness can create reluctance to seek psychological services. Our altruism, independence, and industriousness get the best of us when we overlook our own needs in favor of working to meet the needs of others.

We need to remember that we are merely human. We all experience loss and distress. Sometimes we need professional help for emotional distress, to resolve significant experiences, or to obtain help in making difficult decisions. Personal psychotherapy can
help us to meet our own needs so that we may better maintain healthy relationships with clients. Ultimately, self-care becomes one way to give our clients the best of ourselves, rather than what is leftover when we are depleted or running on empty. Finally,
the APA reminds us that avoidance of ethical violations and malpractice are other reasons to get help. Self-care can be a responsibility and an opportunity.

The Colleague Assistance Program of the Ohio Psychological Association is working to promote health and self-care among psychologists, to provide better access to personal psychotherapy, and to empower psychologists to better care for each other. Unlike the proverbial cobbler, blacksmith, and potter, we can all work together to reap the full benefits of our profession.

————

For confidential information about whether the OPA-CAP program might benefit you, please call (614) 224-0034.

Dr. Stockton is a clinical psychologist in Wooster, Ohio and a volunteer with the OPA Colleague Assistance Program (OPA-CAP).

1. Identifying and reminding ourselves daily about our own personal strengths, the strengths we have used in any time of stress or challenge;
2. Identifying an interpersonal strength guide or mentor, someone who is living or deceased who stood beside you in tough times; 
3. Identifying a transpersonal/spiritual guide- something greater than yourself, a force, an entity, a presence, something outside of yourself that you have turned to in the past when you have needed extra loving, caring, and protection; and lastly
4. Identifying three messages-one from each of these sources- that we would want and need to hear in a time of stress or challenge. These may be the messages these sources offered us in the past, or they may be new messages based on the situation at hand, grounded in our knowing these resources inside of our souls.  
   

I invite you to consider that all of us are worthy of offering ourselves ESC.  Be aware of the self-talk you use when you believe you are worthy of ESC.  And be aware of what self-talk impedes your ability to offer yourself this essential gift.  Once a week, several times a week, even daily you can use this tool. Once you learn the skill, it can take only a few minutes of your time, and you are worth that degree of self care!  And the best part is, offering yourself ESC will help you transform “countertrauma” into “countergrowth” and “counterresilience,” ⁽¹⁾ great tools to use very day of your life. 

Click here for a helpful worksheet. You or your client can do this alone, or after you’ve written your answers, you can use the format of psychodrama or a role-play if you can do this with another person, or with your client in a session. I’ve also used this format in a large group or experiential workshop.

⁽¹⁾ Gartner, R.B. (2017) Trauma and countertrauma, resilience and counterresilience: Insights from psychoanalysts and trauma experts. New York: Routledge. 

About the Author:
Howard Fradkin, PhD retired from private practice at Affirmations in Columbus, in December.  He recently joined the OPA Colleague Assistance Program committee, and offers this column as one more tool the committee would like you to utilize as needed.  

IF IT'S ABOUT A COLLEAGUE
The APA Ethics Code is vague about how to deal with such ethical conundrums as a case of colleague who is exercising poor judgment or is distressed to the point that it interferes with his or her work, or who may be impaired. 

As psychologists, we seek informal resolution. Although we are generally well trained about and accustomed to having difficult conversations with clients, we sometimes avoid having such conversations with colleagues. Our reluctance to approach a colleague might reflect a desire to maintain a professional and/or personal relationship, our own feelings about confronting others, or a myriad other concerns. 

If you’re concerned about a colleague who appears to be in distress or is struggling with substance use or other potentially problematic behavior, the following guidelines may be helpful in considering whether and how to approach him or her.

• Consider why you are concerned and your motivations? Do you want to express concern, lecture, or punish or criticize? If you want to do anything other than express concern, stop.
• Pick the time and place—Make sure you have enough time for a roomy conversation, and enough privacy for both of you to feel comfortable. Don’t attempt to engage a person when she or he is in an altered or clearly distressed state unless it’s urgent.
• Don’t feel the pressure of having to “know” if someone has a problem or not. If you’re worried, that’s worth a conversation. Start with affirming the connection between the two of you, whatever it is (i.e., “We’ve been friends for a long time….”), and talk in terms of “I’m concerned about you,” not “I think you have a problem.”  Be prepared with specifics of times that have concerned you.
• Be ready with resources.
• Don’t worry about scripting each word—The conversation is likely to be awkward yet may still be helpful.
  

If you are rebuffed and your colleague’s behavior is of great concern, first remember that the person you care about has heard you, regardless of denial or defensiveness. However, if the behavior is dangerous and your colleague is unwilling or unable to address it, take it to the next level, which may mean consulting the Ethics Committee, or the State Board of Psychology. Remember, decisions about these situations need to be informed by the APA Ethics Code and relevant state and federal law.

OR TOPSY TURVY
The complexities involved in us approaching a colleague with concerns also apply when we think about how to respond to a colleague who approaches with us with concerns about our behavior.

• Express appreciation for the contact (even if you disagree with the facts or the opinion being expressed). 
• Recognize that it's most likely coming from a place of concern. 
• Limit defensiveness and argumentativeness. Respond inquisitively rather than argumentatively (e.g., “What did you notice that caused discomfort?”;  “What caused you to bring this issue to my attention now?") Use your listening skills to get a good understanding of the facts being presented. 
  

Take time before responding, but do not ignore your colleague’s approach and do respond to it eventually. Seek consultation. It is crucial to remember that this is a colleague's attempt at managing the issue informally which is ultimately for your benefit and in your best interest.

IN ANY CASE
In conclusion, the APA Ethics Code provides for both autonomy and responsibility. By allowing, and expecting informal resolution, the Ethics Code is respecting the competence and ability of psychology’s professionals. Therein lies the responsibility to protect our discipline and profession and to care for our colleagues and those we serve. 

The APA Advisory Committee on Colleague Assistance (ACCA) seeks to promote the health and well-being of psychologists by providing resources to help them prevent burnout and to thrive and flourish in their personal and professional lives. It also seeks to help organizations in which psychologists work to promote their well-being. ACCA has a threefold mission: 

1. To prevent and ameliorate professional distress and    impairment and their consequences among psychologists.
2. To foster and provide resources via linkages to state associations.
3. Thereby, to better protect the public.
   

ACCA attempts to attain these goals in three ways: by promoting an understanding and acknowledgment of the unique occupational hazards of psychologists’ work, by supporting the development and maintenance of state level assistance programming, and by encouraging appropriate linkages between state ethics committees, regulatory boards and assistance programs. 

By working in these areas, ACCA hopes to serve the interests of the public and the professional community. Resources to help psychologists and their professional organizations can be found on the ACCA web page: (http://www.apa.org/practice/leadership/colleague-assistance.aspx).

As psychologists, we are well-practiced at managing stress. We are trained to advise our clients how to relax their bodies, question their negative perceptions, consider alternate views of the situation, and become aware of their habitual distortions in order to free them from believing and behaving according to them. We provide this advice with an attitude of gentle acceptance, helping them to quiet the harsh judge inside in order to effect change without humiliation. Most of us entered the field because we have always been good at advising others in this way, and we pursued our strength. 

But how good are we at managing our own stress? We can’t deny that the work itself is stressful. A psychologist in full time practice walks on the edge of each client’s sanity, each hour switching scenes to don the next client’s world view. This empathic involvement is our modus operandi, and without it we are ineffective; it is as satisfying as it is challenging. Those of us working with children and adolescents, seniors needing assistance, people with drug/alcohol problems or legal offenders also need to juggle and incorporate the views (and often feelings) of other parties involved in the client’s life. On top of the clinical stressors, we have administrative responsibilities, whether we practice independently (billing, managed care, personnel problems, building space issues) or in the context of a large organization (quality assurance, billing quotas, committees). And then we go home to our families!

It is easy for psychologists to convince ourselves that we are so good at managing stress that we do not need help doing it for ourselves. If anyone else tried to say they could, we would doubt it, but it is easy to stand in our own blind spot. In truth, we need to do for ourselves what we advise others to do: have a tool box of stress-relieving activities to use regularly and especially at times of high strain. Every individual is different, but there are some general principles: 

1. Physical exercise helps everything. Just increasing your physical challenge a little beyond what you already do will blow off steam and bathe your heated brain in endorphins. Seem like too much effort? You deserve the kind of effort you give to others!
2. Slow, deep breaths and a focus on physical sensations will bring you back to the moment and away from your worst fears (which are unlikely to become real anyway). The more you practice, the easier and more effective this becomes.
3. Kicking back with friends or family eases the strain.
4. Talking about your concerns, with someone you trust to understand them, helps enormously.

So easy to say; so hard to remember in the thick of a complicated situation! 

We at OPA’s Colleague Assistance Program are here to help. We are psychologists, who have been there too. We know that excess stress can lead us to behave in ways that may temporarily relieve us, but are not in our best interests in the long run. We want to be sure to redirect our energies before risking any harm to ourselves or others. 

To talk with someone confidentially about whether this program will work for you, call 614 224-0034. Or, see our website for ideas on how to handle different stressful situations we typically encounter. Be well, and take care of yourself!