3.5 Counselor Impairment

As we have previously discussed, counselors encounter numerous unique and emotionally demanding stressors working in the field and have an ethical duty to remain self-aware of both the psychological microcosm they bring to their practice, and the impact their occupation, clients, and personal lives have on the work that they do. Sometimes, despite the best, well-intentioned efforts, a counselor becomes impaired in some capacity and can no longer practice with the level of ethical and professional diligence that our field requires. The counselor should ideally reach a conclusion themselves. However, it is also often brought to light by a colleague, supervisor, or significant other, or even by a client in the form of a formal complaint. The ACA and NAADAC codes provide extensive but differing guidance on counselor impairment, which we present below before analyzing and applying their prescriptions in clinical practice.

The ACA (2014) Code of Ethics states:

While the NAADAC (2021) Code of Ethics states:

and

When analyzing these two codes, a few critical trends regarding professional impairment management emerge:

1. Counselors continually monitor themselves for any aspect of their lives that impairs their work as professionals. 
2. If impairment is identified, a counselor seeks assistance to address it.
3. Counselors assist their colleagues and supervisors experiencing impairment in addressing and remediating it.

You likely also noticed that the ACA (2014) code of ethics prohibits counselors from practicing in any capacity when unaddressed impairment is present—an ethical precedent that is even more stringent than those included in some statutory requirements. This prescription likely follows from a belief that impaired practice represents a greater risk to patient safety than any disruption that may result during a transition of care, as the impaired counselor can no longer practice with the objectivity and diligence necessary to ensure patient safety.

Though the NAADAC (2021) code does not explicitly prohibit impaired practice, many state laws and organizational policies do in some capacity. Thus, if a personal or circumstantial difficulty reaches the level of professional impairment, ceasing practice until the impairment can be addressed in some capacity is generally always warranted. While the temporarily impaired counselor can always continue to practice with clients once the impairment has been resolved, causing a grievous ethical violation by continual impaired practice can have drastic consequences for client well-being, professional licensure, and the reputation of the field as a whole.

Furthermore, it is essential to note that while the NAADAC (2021) section on impairment is the only one to advocate the counselor’s duty to abide by legal and statutory requirements, generally speaking, state and federal laws supersede the prominent codes of ethics. Counselors must be familiar with the state and federal laws applicable to their profession and practice.

Self Monitoring and Remediation of Impairment

Self-monitoring of impairment is a challenging task, as a decreased sense of self-awareness is often a prominent symptom of the occurrence of impairment. Furthermore, it is a humbling, sobering, and potentially frightening experience to admit that one can no longer practice effectively. All counselors will likely experience a professionally impairing event, whether emotional, physical, or psychological, at some time in their career. Keeping this in mind, in line with previous recommendations on self-awareness, we advocate a continual process of self-monitoring that includes regular supervision and consultation with trusted colleagues, self-reflection exercises, and mindfulness practice. In addition to this, consider the following suggestions below:

• Create a list of events you could see yourself experiencing that may impair your ability to practice in some capacity. Think about more minor forms of impairment as well. All counselors experience things such as acute bouts of illness or family emergencies that prevent them from actively treating clients for periods. Once finished, keep it easily accessible and refer back to it during stressful periods to check in with yourself.
• Keeping in mind the past sections in this chapter on countertransference, stressors, and burnout. Make a list of some signs and symptoms that could be warning signs of impairment. These can be things you have experienced personally or could see yourself experiencing later in practice. If you have had limited experience in clinical work, what have been some signs and manifestations of personal stress for you during complex projects in school or relational difficulties?
• Apply the “reasonable person” standard whenever you experience a moment in your practice that makes you feel strange or uncomfortable. Would a reasonable person have any objections to how you approached the situation? Would you feel comfortable with your decision and actions being published in the newspaper? Failing to meet this standard every once in a while constitutes a mistake that can be remedied. However, repeated instances of unethical conduct are more likely to constitute impairment.
• Identify a trusted colleague you can regularly meet with to discuss complex cases or professional concerns. Consider making it a weekly or monthly ritual where you both support each other through your work.

Remediation of Personal Impairment

If a counselor learns, either by the process outlined above or in a meeting with a supervisor or colleague, that they have become professionally impaired and unable to perform their duties effectively, it is their ethical responsibility to take immediate action to protect their clients and maintain professional standards (ACA, 2014; NAADAC, 2021). The first step is acknowledging the impairment, whether it stems from personal struggles such as mental health issues, burnout, substance use, or overwhelming life stressors. Recognizing that their ability to function professionally is compromised is crucial for preventing harm to clients.

Once the impairment is identified, the counselor should immediately cease or modify the client’s work. This may involve reducing their caseload, postponing sessions, or, in more severe cases, temporarily stopping all client-related work. The counselor must prioritize the safety and well-being of their clients over personal concerns about reputation or financial stability. It is essential to respectfully inform clients of the situation, ensuring they are referred to another qualified professional when necessary. Additionally, as appropriate, the counselor should notify supervisors, employers, or relevant professional bodies to ensure continuity of care for clients during their absence.

Seeking professional help is vital in addressing the root causes of impairment. This may include counseling or therapy, supervision, or other forms of professional support to address mental health concerns, burnout, or personal issues. Engaging in self-care and receiving appropriate treatment is essential for recovery and a successful return to competent practice. Counselors must also comply with any legal obligations, including reporting requirements that may exist in some states for issues such as substance use or mental illness affecting professional competence.

Finally, the counselor should only return to full client work once they have taken appropriate steps to resolve their impairment and feel confident in their ability to provide ethical, effective care. Seeking supervision or consultation may help assess whether it is appropriate to resume client work. By prioritizing their own well-being and being transparent with clients and colleagues, counselors uphold the integrity of their profession while ensuring client safety.

Monitoring and Remediation of Impairment in Colleagues

As advocated by the ACA (2014) and NAADAC (2021) codes, in addition to addressing personal impairment, counselors also have an ethical obligation to assist impaired colleagues and supervisors in identifying and addressing their impairment. Given the insidious nature of impaired practice, this is often a difficult task and requires a great deal of diligence, empathy, and compassion.

When a counselor notices impairment in a colleague, whether due to substance use, mental health issues, or any other personal challenges affecting their professional functioning, it is an ethical and often legal obligation to address the situation, impairment can compromise the counselor’s ability to provide effective and safe care to clients, making it a serious concern.

As outlined in the ethical codes from both the ACA (2014) and NAADAC (2021), counselors are expected first to attempt to resolve ethical concerns by addressing the colleague directly, if appropriate (ACA, 2014, Standard I.2.a.; NAADAC, 2021, Standard VIII-1). This expectation of addressing the issue with the individual reflects the principle of beneficence—acting in the impaired colleague’s and their client’s best interest—while maintaining professionalism and respect. In practice, this might involve having a private, non-confrontational conversation with the colleague to express concerns and offer support, such as suggesting they seek supervision, counseling, or other appropriate resources to address their impairment. However, if the impaired counselor does not take appropriate action to address the problem or there is immediate concern for client safety, the situation must be escalated.

In such cases, the counselor is ethically obligated to report the impairment to appropriate authorities, such as a supervisor, ethics board, or professional licensing body, depending on the organization’s protocol. State laws may also mandate reporting of impaired professionals, and failing to comply with these laws can have legal consequences for both the impaired counselor and the colleague who fails to report it. The counselor must balance their ethical responsibility to protect clients from harm with the duty to support the impaired colleague in addressing their issues. Following ethical guidelines and state regulations helps the counselor ensure client safety and upholds the profession’s integrity.

Considerations for Counselors in Recovery from Substance Use Disorders and Acute Mental Health Conditions

For counselors in recovery from mental health and substance use disorders, it is essential to balance personal well-being with professional responsibilities to ensure both effective practice and personal stability. Prioritizing personal recovery efforts is the cornerstone of this balance. Counselors should engage in ongoing treatment through individual therapy, counseling, and other self-management practices (Wise & Barnett, 2016). Maintaining a stable recovery is essential for their ability to offer meaningful support to clients. Regular self-assessment is necessary to determine if they are in a healthy place to counsel others, and it is acceptable to take a step back if personal recovery feels threatened. Practicing self-care through activities such as mindfulness, regular exercise, and maintaining a robust social support network is crucial for managing stress and preventing recurrence or exacerbation of symptoms.

Establishing and maintaining clear professional boundaries is another critical component for counselors with personal histories of mental health or substance use disorders. Counselors must carefully navigate the line between personal experiences and professional roles. While their lived experiences can offer valuable insights, avoiding oversharing personal recovery stories is essential. The primary focus should be on the client’s journey and needs rather than the counselor’s past. Maintaining ethical boundaries with clients, particularly those with similar experiences, helps prevent becoming too personally involved in their struggles. It is also essential to be prepared to refer clients to other professionals if their issues overlap significantly with the counselor’s own experiences, ensuring that the therapeutic relationship remains objective and effective.

As such, ethical disclosure plays a significant role in maintaining professionalism. Counselors should use self-disclosure strategically, only sharing personal recovery experiences when it directly benefits the client’s therapeutic process. The timing, context, and purpose of such disclosures must be carefully considered to ensure they serve the client’s interests. Transparency with supervisors and colleagues about any concerns regarding how personal recovery might impact clinical work is also important. Regular supervision or peer consultation can help navigate potential ethical dilemmas and provide guidance on maintaining professional integrity.

Counselors should also stay informed about ethical guidelines and licensing requirements. Adhering to organizations’ ethical standards, such as the ACA or NAADAC, is crucial. These standards emphasize self-awareness and professional conduct, guiding counselors in managing their recovery while practicing effectively. Additionally, counselors must be aware of state laws related to professional impairment, which may require disclosure of recovery status or impose specific mandates for continued practice.

Supervision and peer support are invaluable for counselors in recovery. Engaging in regular supervision allows for processing any challenges related to personal recovery and its impact on clinical work (Dearing et al., 2005). Support from peers who understand the complexities of being a counselor in recovery can offer additional insights and coping strategies. Continuous professional development is also essential. Counselors should pursue ongoing education and training on best practices for managing personal and professional challenges, including strategies for ethically integrating lived experience into practice. Specialized training can help counselors use their experiences to enhance their work rather than hinder it.

Finally, monitoring countertransference is crucial for maintaining professional effectiveness. Counselors must be aware of their emotional reactions, especially when working with clients whose situations may evoke strong personal feelings. When emotions become overwhelming, consulting with supervisors can help manage these responses and ensure they do not negatively affect the therapeutic process. Seeking personal therapy, if necessary, can provide additional support in navigating these complex dynamics (Wise & Barnett, 2016).