# How do clinicians control for their own mental disorders?

Has any research been done on how clinicians' (either internists or psychiatrists) known psychological conditions influence the diagnoses, misdiagnoses, and prognoses they make?

And, related to that, has there been any concerted conscious effort made to control for the above?

(I'm also curious how medical, non-psychological conditions affect the above, but that wouldn't strictly-speaking be on topic so I'm limiting this to psychological problems for now.)

## the kind of studies I mean

What I'm envisaging is a study akin to the following, and am curious about what similar studies have found:

• two pools of practicing clinicians are chosen (with random partitioning between the two),
• everyone in pool A is screened for current psychological disorders by a subset (say, three) of multiple, randomly chosen individuals from pool B,
• the professional (diagnostic) history of every clinician in pool A is reviewed, and
• the experimenter looks for patterns of correlation between mental disorders in the clinicians themselves, and the disorders that those individuals tend to diagnose / misdiagnose (sensitivity v. specificity).

## the kind of (statistically significant) results I'm curious about

So, for example, do clinicians who have (to choose two disorders randomly) NPD tend to diagnose depression more often than those without NPD? And, when they do diagnose depression, do they tend to have more favorable or less favorable prognoses for their patients? What are their recommendations? And how often do their recommendations work out well v. badly? What mental characteristics are adaptive v. maladaptive within this extremely specific context?

More to the point, does it "take one to know one", or does a lack of personal experience with something provide better objectivity?

And are some disorders (maladaptive within larger society) unambiguously good across-the-board in a clinical setting, are they all harmful, or should people with disorder X specialize in disorder Y, and avoid treating patients with disorder Z?

Obviously, pool A doesn't actually need to be psych clinicians. It could be applied to GPs, oncologists, surgeons, etc.

• This is a great question! Try to Google it for fun - zero hits. +1
– AliceD
Sep 7 '16 at 12:01
• Are you asking about clinicians that have mental disorders themselves, or about how the mental disorders that clinicians know about influence their diagnoses? Sep 8 '16 at 9:50
• Are you asking about clinicians that have mental disorders themselves This. I'm assuming no one, with the DSM applied to them, would come away without something sticking. Sep 9 '16 at 23:19
• Obviously, you'd want to control for as many variables as possible (the type of practice and what patients people see, age, gender, level of education, etc.) Sep 9 '16 at 23:35
• I suppose a side-effect of this would be some interesting findings on whether there are any disorders overwhelmingly more common in clinicians than the general population. Of course, if that were the case, it might go completely unobserved due to a shared blind spot among people predisposed toward entering a psych-related field. Sep 9 '16 at 23:46

Clinical Supervision (see these articles on effectiveness) is standard practice and required in codes of practice for registered counsellors, psychotherapists, psychologists, psychiatrists, etc. and those in training.

Note: This is separate and completely different to line-management but necessary for effective line-management

There is no one way to do clinical supervision, but there are a few principles…

• clinical supervision allows a person to focus on particular aspects of their clinical practice in a way that they would not normally do
• it is characterised by reflection on previous action and its implications for future action
• a clinical supervisor will often challenge the supervisee to think outside of their current ways of working
• the clinical supervisor will offer support and advice
• the supervisee tends to learn alternative ways of working and specific skills
• the clinical supervisor will be interested in the quality of the supervisees performance and wellbeing; and will offer constructive feedback

Assuming that all therapists follow the code of practice, all clinicians will be monitored for mental health conditions and other problems which would affect their ability to perform their work effectively.

Clinical supervisors have a duty of care, not only to the supervisee (the therapist), but also the supervisee's clients, and if the supervisor feels that abuse of power is occurring they must refer it to the governing bodies to remove their licence to practice.

If they feel there are any mental health issues preventing the supervisee from acting effectively, then the supervisor will refer the supervisee for therapy. If necessary, they may also take further action to prevent the therapist from causing harm to their clients whilst undergoing therapy.

• That link is pretty much the equivalent of a 'let me google that for you' link, which are banned on Stack Exchange. If you have a specific article you want to reference, please do so in the recommended APA format, or just remove the link altogether. Sep 8 '16 at 9:39
• it's actually not a LMGTFY link and therefore is not disrespectful, and it is also actually helpful because it provides search terms that the question asker might not have thought to use.
– honi
Sep 11 '16 at 1:26

# 1

In Germany and some other countries, only licensed experts may practice psychotherapy. The institutes that offer the postgraduate education screen applicants and do their best to admit only psychologically healthy individuals. The view is that a psychotherapist must be fully "functional".

# 2

Psychotherapists are members of a professional organization which requires frequent supervision of its members. Thus, the professional behavior is controlled by colleagues.

# 3

Of course, an intelligent psychopath or borderliner will be able to fake psychological functionality and steal into the education and the profession. Since psychologists know how psychological tests work, they will give the answers to appear healthy, when screened.

Your "study" will never manage to identify any psychotherapists or psychologists with mental disorders, as these people will only manage to achieve that position if they are able to hide their affliction and appear healthy to highly trained experts.

# 4

In countries where the titles "psychologist" and "psychotherapist" are not protected by law and anyone can offer such services irrespective of qualification, the state of psychotherapy is so bad that your study makes no sense, as there will be no difference between a mentally healthy charlatan and a mentally disordered charlatan.

• There are a few ways to account for these confounds. One would be to do a longitudinal study, whereby people are tested before they've gotten through a significant percentage of the curriculum, specifically for disorders which tend to be stable over time (so, personality disorders). Another is to choose to focus on disorders which can be diagnosed physiologically. A third is to employ misdirection / trickery in obtaining the diagnosis. A fourth is to assure anonymity and / or lack of consequences for a diagnosis. Mar 1 '17 at 4:52
• You could also just look at big five correlations within sub-clinical ranges and try to generalize from those findings. Mar 1 '17 at 4:54
• And finally, you could simply focus on countries where there are qualifications, but those qualifications do not include a psych evaluation. I'm guessing such countries exist, since frankly a psych evaluation is a pretty rare qualification in other professional disciplines. For example, I'm a qualified engineer. I'm not a "charlatan". Because I passed all the tests, I got the grades, I have the degrees to prove it, and I work professionally as an engineer as a consequence. At no point in that process was I evaluated psychologically. Mar 1 '17 at 4:58
• Not sure- someone else would know more- but I'm pretty sure to be a psychiatrist in the U.S. you legally must be a licensed medical doctor... But you don't need to be sane. In part because, strictly speaking, past a certain minimal threshold, you don't really need to be at all sane to be good at your job. And some jobs almost certainly benefit from various neuro-atypical or otherwise disadvantageous traits. Mar 1 '17 at 4:59