Psychology in extremis: Preventing problems of professional competence in dangerous practice settings.

Abstract

When a psychologist provides services in a dangerous context—a work setting defined by persistent threat to the psychologist's own personal safety and well-being—the psychologist is said to practice in extremis. Psychologists who routinely function in extremis, such as those in correctional, disaster response, military, and police psychology—among other specialties—may be at increased risk for troubling experiences such as direct or vicarious traumatization, compassion fatigue, and empathy failure. Over time, in extremis experiences may contribute to decrements in professional competence. When psychologists become aware of personal problems that interfere with their work, they must take steps to ameliorate the problem while protecting consumers. In this Focus on Ethics, we discuss the difficulty inherent in self-identifying and correcting problems of professional competence when working in a high-threat environment. Three expert commentaries further elucidate in extremis competency concerns from the perspective of disaster response, police, and military psychology. The authors provide numerous recommendations for helping psychologists to ensure ongoing competence in in extremis jobs.

Reflections on the Opportunities and Challenges of Disaster Response

“…In addition to ensuring that interactions with disaster survivors follow ethical practices and guidelines (Spokane et al, 2011), counseling psychologists in disaster settings need to consider ethics as they pertain to their own competence and readiness to practice. In a recent Focus on Ethics article (Johnson et al, 2011a, 2011b), Sullivan and Bongar commented on the considerations for psychologists practicing in disaster situations. They noted that disaster mental health can be considered practicing in extremis , or in a situation that poses a persistent threat to the psychologist’s well-being and safety.…”

In Extremis Leadership: A Study of the Effects in Different Contexts

“…Interest in critical incident leadership, particularly military combat operations, has escalated for more than a decade (Campbell, Hannah, & Matthews, 2010;Laurence & Matthews, 2012;Wong, Kolditz, Millen, & Potter, 2003). Critical incident research also extends beyond military operations to fire fighters (Baran & Scott, 2010;Hytten & Hasle, 1989;Ramthun & Matkin, 2014;Weick, 1993), law enforcement personnel (Bechky & Okhuysen, 2011;Johnson et al, 2011;Murphy, 1965) and other first responders (Graen & Graen, 2013;Kolditz, 2006Kolditz, , 2007Sweeney, Matthews, & Lester, 2011). Previous research adds tremendous value and insight toward improving the effectiveness and efficiencies of many important organizations, yet many significant issues remain unresolved.…”

Atenção Psicológica em Situações Extremas: Compreendendo a Experiência de Psicólogos

“…Em estudo sobre psicólogos militares (Johnson, Sullivan, Bongar, Miller, & Sammons, 2011), para tanto, cunharam a expressão psychology in extremis ao se referirem à atenção psicológica que se efetiva em contextos nos quais há grande risco aos próprios profissionais, com persistente ameaça em termos de segurança e bem-estar destes. Assim, nesta pesquisa achamos pertinente utilizar o termo situações extremas, a fim de preservar a multiplicidade de situações vivenciadas pelos psicólogos.…”

“…É o campo da atenção psicológica que se efetiva sob elevado risco pessoal aos próprios profissionais, em função da desestruturação do contexto em vários níveis, acompanhada de persistente ameaça em termos de segurança e bem-estar a todos, vítimas e equipes de ajuda (Johnson, et al, 2011).…”