The Impaired Colleague Who Is Also Your Friend
You are an LMFT in a group practice in San Diego. A colleague, Renee, is a licensed LMFT who shares your suite. Over six weeks you have noticed slurred speech in the afternoon, missed sessions, and a client's parent telling you that Renee "smelled like alcohol" during a family session. Renee is a friend; you socialize and she referred several of your current clients. Yesterday you saw her pour from a flask in the break room before a session with a 9-year-old. You have not confronted her. Your practice has no written impairment policy, and the owner is on vacation for two weeks.
1. What are your ethical obligations regarding Renee, and what is the appropriate sequence of action?
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You have an ethical duty to address impaired practice that poses a risk to clients. The CAMFT Code of Ethics addresses confronting and reporting unethical or impaired conduct, and the licensing law gives the Board authority over unprofessional conduct, including practicing while impaired. Your duty is not to diagnose Renee but to protect clients.
Sequence: (1) Immediate client safety-if she is about to see a client while impaired, intervene now, e.g., tell her you are concerned and that she should not see the client, and notify a supervisor or the practice owner. (2) Direct, documented confrontation in private: state specific observations, not conclusions; express concern; ask about her wellbeing. (3) Encourage self-referral to a diversion or monitoring program and to her own treatment. (4) If she denies, minimizes, or continues, escalate to the practice owner and, if clients remain at risk, report to the Board. (5) Document dates, observations, and actions.
The tested judgment is that collegial loyalty does not override client protection, and that you act on observable facts rather than rumor.
2. Renee says she will "handle it" and asks you not to tell anyone because it would destroy her career. How do you weigh confidentiality and loyalty against client welfare?
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You should tell Renee clearly that you cannot promise silence where clients are at risk. Confidentiality among colleagues is not absolute; it yields to the safety of clients and to legal reporting duties. You can be transparent about what you will do and when: for example, that you will give her a short window to self-report and seek help, but that you will escalate if impaired practice continues.
Weigh the harms: the harm to Renee's career is real and should be handled with discretion-limit disclosure to those who need to know (owner, supervisor, Board if required). The harm to a 9-year-old client of an impaired therapist is immediate and serious. Loyalty and friendship are values, not duties that override the welfare of clients.
Document what you told her, what she agreed to, and any deadline you set. The tested judgment is that you can act compassionately and confidentially in scope while still escalating.
3. What should you do about the practice's lack of an impairment policy, and what would a sound policy include?
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You should raise the gap with the owner and propose a written policy. A sound policy includes: a clear statement that impaired practice is prohibited; definitions and examples; a duty for any clinician to report concerns to a designated person; a confidential pathway for self-referral and treatment; a monitoring or return-to-work plan; protections against retaliation for good-faith reports; procedures for immediate client protection (covering sessions, transferring care, notifying clients if needed); documentation requirements; and a reminder of legal reporting obligations to the Board.
You should not wait for the owner to return if a client is at immediate risk; use the chain of command or contact the owner by phone. Document your recommendation and the response.
The tested judgment is that individual action is necessary but insufficient-systemic prevention through policy, training, and a clear reporting channel is part of ethical practice.