Unbreakable Kimmy Schmidt and Gypsy are a couple of the latest TV series, both streaming on Netflix, to feature impaired therapists. Kimmy Schmidt‘s Tina Fey has a minor role as Andrea, an alcoholic therapist who somehow still manages to offer the lead character (Ellie Kemper) tidbits of useful advice. Her impairment, however, has ultimately led to losing her license, one possible outcome in the real world as well.

Gypsy‘s Naomi Watts portrays a therapist who’s been described as unethical and a sociopath.

In real life a relatively small percentage of clinicians in any of the mental health disciplines—which include such areas as social work, psychology, and psychiatry—are likely to be impaired therapists. However, in order to protect the clients who may potentially be affected, rules have to be in place.

Therefore, the various professional organizations whose members are providers of mental health services have pertinent codes of ethics. According to a leading ethical expert in my own field, Fredric Reamer, impairment can not only involve failure to comply with those ethical standards but also incompetence (Social Work Today).

The social work code of ethics specifically states the following regarding steps to take when a colleague is deemed impaired:

(a) Social workers who have direct knowledge of a social work colleague’s impairment that is due to personal problems, psychosocial distress, substance abuse, or mental health difficulties and that interferes with practice effectiveness should consult with that colleague when feasible and assist the colleague in taking remedial action.

(b) Social workers who believe that a social work colleague’s impairment interferes with practice effectiveness and that the colleague has not taken adequate steps to address the impairment should take action through appropriate channels established by employers, agencies, NASW, licensing and regulatory bodies, and other professional organizations.

All of the above takes into account the unfortunate fact that sometimes the nature of certain personal issues—such as addictions, burnout, health issues, and mental illness—can mean they will go undetected by the practitioners themselves.

Pertinent to this is a quote from the NASW Impaired Social Worker Program Resource Book that Reamer cites:

The problem of impairment is compounded by the fact that the professionals who suffer from the effect of mental illness, stress, or substance abuse are like anyone else; they are often the worst judges of their behavior, the last to recognize their problems and the least motivated to seek help. Not only are they able to hide or avoid confronting their behavior, they are often abetted by colleagues who find it difficult to accept that a professional could let his or her problem get out of hand (p. 6).

It’s not only colleagues who have recourse; clients do as well and need to trust their own instincts in this regard. If you notice something is wrong and talking it out with the therapist either doesn’t seem like an option or fails, you can report the impaired therapist to his/her employer and/or professional association and/or licensing board, and/or, if involved in payment for services you’re receiving, your health insurance company.