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Article Excerpt
This article updates and adds to the literature on graduate trainee impairment provided by L. Forrest, N. Elman, S. Gizara, and T. Vacha-Haase (1999) in their comprehensive literature review. Based on recommendations by Forrest et al., a program model for dealing with impaired trainees is proposed. The 5-step therapeutic process model includes (a) informed consent, (b) intake and assessment, (c) evaluation, (d) treatment planning and follow-up, and (e) termination. Each step is explained within the context of graduate training programs, and key points to consider are discussed.
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A recent review of the literature indicates that trainee impairment in the mental health field has been dramatically understudied (Forrest, Elman, Gizara, & Vacha-Haase, 1999). Citing an overall lack of consistency in the systematic ways that programs deal with trainee impairment, Forrest et al. endorsed the development of program policies that comprehensively address the how-to's of student evaluation, remediation, and dismissal. Thus, the purpose of this article is twofold. First, an overview of the literature on trainee impairment is offered. Second, a framework is suggested to assist counselor educators with integrating program policies and practice. The proposed framework uses five commonly accepted components of the therapeutic process: informed consent, intake and assessment, evaluation, treatment planning and follow-up, and termination. These five components may be considered by educators during the thinking process required to develop comprehensive program policies that address impaired students and their needs. Key points to address within each component of the model are emphasized. Counselor educators are encouraged to develop the components presented in this article in ways that fit the needs of their programs.
Understanding Trainee Impairment
A review of current mental health literature (spanning counselor education, psychology, and social work) indicates that scholars across disciplines are writing and thinking about trainee impairment. However, no single term for this phenomenon has yet been embraced. Some call impaired trainees "problem students" (Cobb, 1994). Others refer to this population as "inadequate" (Bernard, 1975; Olkin & Gaughen, 1991), "unsatisfactory" (Biaggio, Gasparikova-Krasnec, & Bauer, 1983), or "deficient" (Gaubatz & Vera, 2002). Still others refer more globally to the issue of impairment by citing what they call "substandard behavior" (Baldo, Softas-Nall, & Shaw, 1997). These varied terms have resulted in multiple, sometimes disparate definitions. Perhaps the definition offered by Lamb et al. (1987) comes closest to encompassing the full scope of this particular issue. Trainee impairment is an interference in professional functioning that is reflected in one or more of the following ways: (a) an inability and/or unwillingness to acquire and integrate
professional standards into one's repertoire of professional behavior; (b) an inability to acquire professional skills to reach an acceptable level of competency; (c) an inability to control personal stress, psychological dysfunction and/or excessive emotional reactions that interfere with professional functioning. (p. 598) This definition encompasses three crucial categories identified by Forrest et al. (1999) that need to be considered when thinking about student deficiencies: (a) unethical behavior, (b) trainee incompetence, and (c) impairment of any kind. It is also important to note that the definition excludes disability as an indicator of trainee impairment unless such disability results in any of the previously listed manifestations. This distinction is crucial to an understanding of the differences between impairment and disability.
Despite a dearth of empirical research on the subject, it is clear that trainee impairment is confronted by most, if not all, training programs at one point or another (Forrest et al., 1999; Gaubatz & Vera, 2002; Procidano, Busch-Rossnagel, Reznikoff, & Geisinger, 1995). Furthermore, there is evidence to suggest that many programs are ill equipped to respond in comprehensive ways to student needs when problems arise (Gaubatz & Vera, 2002; Procidano et al., 1995). These findings elicit the following questions: (a) How do graduate training programs select students and subsequently evaluate them on a regular basis in order to ensure that only students who are prepared to meet the challenges of the profession are advancing? (b) How can programs identify and respond to those...
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