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PROFESSIONAL VULNERABILITY

Perfectionism, often seen as a virtue, is a vulnerability factor linked to mental health issues such as depression, anxiety, burnout, and even suicide. It stems from various origins, including parenting styles and societal pressures, and manifests as an intense need for external validation. This relentless pursuit of perfection not only hinders genuine achievement but also leads to significant personal and professional consequences. Awareness and differentiation between striving for excellence and an unachievable ideal are crucial for better mental health and life satisfaction.

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PROFESSIONAL VULNERABILITY

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  1. PROFESSIONAL VULNERABILITY

  2. Perfectionism • Despite cultural sanctions, perfectionism is not adaptive. • Perfectionism is a vulnerability factor for depression, burnout, suicide, and anxiety. • The desire to excel must be differentiated from the desire to be perfect.

  3. “The perfect is the enemy of the good.” - Voltaire

  4. Perfectionism(cont.) • Believing that others will value you only if you are perfect is associated with both depression and suicide. • It contains an element of pressure associated with a sense of helplessness and hopelessness. • “The better I do, the better I’m expected to do.” • Intense need for external validation - Flett & Hewitt, 2002

  5. Origin of Perfectionism • Not well understood • Multiple pathways are involved: • Child factors—temperament, attachment style • Parent factors—style of parenting, parental personality • Environmental pressures—peers, culture, teachers Flett & Hewitt, 2002

  6. Origins of Perfectionism(cont.) • Satisfaction with real achievements is limited because of feelings of fraudulence and the expectations that more will be demanded. • The “driven” quality is designed to gain relief from a tormenting conscience rather than a genuine wish for pleasure.

  7. Consequences • Burnout • Depression & suicide • Problems with self-care • Marital problems • Substance abuse • Professional boundary violations

  8. Definitions of Burnout • State of fatigue or emotional depletion brought about by adherence to a professional role that has failed to produce expected rewards • “An erosion of the soul” -Maslach & Leither, 1997

  9. Definitions of Burnout (cont.) • “Joyless striving” - Holmes & Rahe

  10. Symptoms of Burnout • Failure to take vacations • Chronic fatigue • Emotional exhaustion • Cynicism

  11. Symptoms of Burnout (cont.) • Headaches, lack of pleasure in relationships • Increased drinking • Marital deadness • Explosions of anger

  12. Midlife Disillusionment • The pay-off for self-sacrifice never materializes • Feelings of betrayal and disillusionment

  13. Problems with Spouse or Partner • Psychology of postponement • Lives of quiet desperation • Failure to make time for intimate conversation

  14. Profile of Professionals • No simple formula • 20% are female • 20% are same-sex • Vulnerability is universal

  15. Common Themes • Omnipotence – “Only I can save the patient.”

  16. “True love” is idealized, valorized, and mythologized • The presence or absence of “true love” is irrelevant to ethics considerations

  17. PROFILE OF VICTIMS • Incest victims (sitting duck syndrome) • Patients with a history of sexual abuse • Attractive patient with chronically low self-esteem • Patient with a history of previous hospitalization, suicide attempts, and substance abuse • Depressed and suicidal patient with recent romantic break-up

  18. Profiles of Victims (cont) • Borderline Personality Disorder Patients • Intellectually Challenged Patients • Drug-Seeking Patients • First Nation People • Patients in Lower Socioeconomic Groups

  19. Special Situations • Rural Practitioners • Home Care Practitioners • Multi-Cultural Issues

  20. PRINCIPLES OF ASSESSMENT AND REHABILITATION • Disciplinary measures are the purview of a College or licensing board, while psychiatric assessment is the purview of independent mental health professionals. • Treatment recommendations growing out of an assessment, however, must be integrated with the disciplinary stipulations.

  21. PRINCIPLES OF ASSESSMENT AND REHABILITATION (cont.) • Evaluating team must differentiate between impairment and problems in professionalism. • In some situations, both may be present. • Questions from referring College or board are helpful in focusing the assessment.

  22. PRINCIPLES OF ASSESSMENT AND REHABILITATION (cont.) • Collateral information from complainants, family members, colleagues, police reports, and College are always valuable and often essential. • Signed release to College or other agency is necessary before beginning the evaluation.

  23. Substance Abuse • Substance abuse may be a contributing factor that is hidden • Collateral sources may not know about it • Random urine drug screen is useful to rule out substance use • The professional’s response to the prospect of a urine drug screen is highly informative

  24. Principles of Assessment and Rehabilitation (Cont) • Amenability to rehabilitation must be carefully assessed • Narcissistic mortification is not the same as genuine remorse • Risk of repeating boundary violations and the safety of the public must be weighed against practitioner’s wishes

  25. Components of Rehabilitation Plan • Practice limitations • Chaperone requirements • Mentoring • Supervision • Change of practice setting—group, institution only • 12-steps programs

  26. Components of Rehabilitation Plan (cont) • Individual psychotherapy—psychodynamic, cognitive-behavioral • Marital or couples therapy • Pharmacotherapy • Inpatient or residential • Total duration of plan may be 3-5 years

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