Student impairment and remediation in accredited marriage and family therapy programs

Journal of Marital and Family Therapy, Jul 2003 by Russell, Candyce S, Peterson, Colleen M

Frequency of Impairment in Last 5 Years

Using Burgess's (1994) definition of impairment as "an objective and negative change in a student's functioning that is pervasive and affects more than one area of the student's functioning, goes beyond problems typically expected in professional training, is emotional, physical or academic and is impervious to feedback" (p. 10), program directors were asked how many impaired students their program had dealt with in the last 5 years. A total of 108 impaired students were identified by our respondents. The range was 0-8 per program. The mean was 2.5, and the modal response was 2 impaired students in the last five years.

Indicators of Impairment

Using the survey of clinical programs by Olkin and Gaughin (1991) as a guide, we listed 16 indicators of student impairment and asked respondents to rank their top five concerns. The five concerns checked most often were, in order of perceived importance: ethical violation, unprofessional conduct, suicide attempts, substance use/abuse, and possible signs of a personality disorder. Table 1 lists the 16 concerns, together with the number of respondents who ranked each item among their top five concerns. One respondent failed to answer the question. Thus, the total number of respondents for this item was 43. Two of these 43 respondents "checked" rather than ranked their top five concerns. In these two cases, the checked responses were each given a rank of three for coding purposes.

Remediation Methods

The most popular remediation methods (those being used by one-half or more of the programs) included referral to therapy, increased supervision, leave of absence, increased contact with faculty advisor, and repeating academic coursework. Other choices included on the questionnaire but checked less often included tutoring, special seminars or extra coursework, peer support groups, special assignments, and referral to an ombudsperson. Our respondents generated several more strategies, including: (a) faculty meeting with student to discuss problems and concerns; (b) slowing or postponing practicum work; (c) letter of remediation cosigned by faculty and student; (d) "shadowing" a peer mentor; (e) cotherapy; and (f) a "counseling out" process that includes a written recommendation plan that could include extra coursework, independent testing, therapy, and more live or video supervision.

Outcome for Students Identified as Impaired in Last 5 Years

Directors were asked to report how many of the students identified as impaired took a leave of absence, dropped out, were dismissed from the program, or transferred to another program. Four participants (who reported eight cases of impairment) failed to provide information on outcome. Thus, outcome is reported for 100 of the original 108 cases. Two outcomes were reported for one of the 100 cases, making the total number of outcomes reported 101. The majority of the 100 students either dropped out (n = 39) or took a leave of absence (n = 35). Seventeen were reported to have been dismissed from the program. Ten students reportedly transferred to another program.