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Counselor Impairment and Wellness: A Comprehensive and Reflective View
Taylor Davis
School of Behavioral Sciences Liberty University
Abstract
Counselor impairment can happen to any licensed practicing counselor. There are multiple
different ways this can be seen, including burnout, compassion fatigue, and secondary trauma.
Self-examination can aid in impairment prevention. Additionally, it is important for counselors
to set S.M.A.R.T. goals. Prevention is the first step in avoiding ethical dilemmas stemming from
impairment, such as potential client harm. After self-reflection and completion of multiple
wellness assessments, the author offers a personal wellness plan.
Keywords: impairment, wellness, ethical dilemma, impairment prevention
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Counselor Impairment and Wellness: A Comprehensive and Reflective View
Counselor impairment is an issue that can change the course of a whole career. This
paper will aim to define impairment and offer prevention methods. Ethical implications of
impairment will also be addressed, per the ACA Code of ethics (2014) and the state board.
Additionally, a self-reflection and explanation of well-being assessments will be explained.
Professional Counseling and Impairment
The American Counseling Association (ACA, 2014) defines impairment as “a significantly
diminished capacity to perform professional functions” (p. 20). This is not specific to solely the
counseling profession, but there is an incredible potential for harm when impairment is seen in
counselors. It can have severely detrimental effects on both the counselor and the individuals
being counseled.
Counselors can become impaired for several reasons. It can be difficult for counselors,
who consistently care for others, to take care of themselves. This could be due to counselors
overworking, leaving little time to focus on self-care (Simmons et al., 2024). Without this time,
counselors are unable to recognize their own emotions and thoughts. They may not be able to
identify negative thoughts (Simmons et al., 2024). Counselors can also become impaired when
they fail to seek professional or personal support (Simmons et al., 2024).
One of the earliest signs of impairment is seen in the form of burnout. This begins when
working individuals experience dissatisfaction in their occupational environment (Simmons et
al., 2024). It is often a gradual transition from joy to burnout. Emotional, physical, and spiritual
exhaustion are all signs of this form of impairment. In the counseling profession, triggers for
burnout can be seen both outside and inside the profession. Some things that may lead to
counselor burnout are major life stress, medical concerns, heavy client case load, and office
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politics (Simmons et al., 2024). Counselors experiencing burnout can feel frustrated or like they
are a failure with low feelings of personal accomplishment (Simmons et al., 2024).
Another form of impairment is compassion fatigue. This is an expansion of burnout,
encompassing many of the same feelings (Simmons et al., 2024). However, compassion fatigue
is rapidly onset and often accompanied by anxiety and depression (Simmons et al., 2024).
Counselors are often faced with the task of deeply caring for their clients. Empathy and
compassion, after all, are critical components of counseling. It is when the counselors no longer
feel satisfaction with helping others that compassion fatigue has set in (Simmons et al., 2024).
This could be due to lack of self-care, isolation, or vicarious trauma (Simmons et al., 2024).
Secondary trauma and vicarious trauma encompass the third form of impairment.
Counselors experience secondary trauma when they obtain emotional duress from listening to
their clients express their traumatic experience (Simmons et al., 2024). When counselors listen
and retain stress from client trauma for so long, the secondary trauma can segway to vicarious
trauma. This is defined as ongoing exposure to accounts of client trauma (Simmons et al., 2024).
Vicarious trauma is a combination of the feelings of burnout and compassion fatigue (Simmons
et al., 2024). Additionally, counselors may be triggered by their own trauma history when a
client comes in expressing trauma. This can lead to traumatic countertransference (Simmons et
al., 2024).
As with all the aforementioned impairments, the end result of counselors practicing with
impairment is a potential for client harm. Counselors that are impaired put their whole line of
work at risk. This is true across all forms of impairment. It is not abnormal to see impaired
counselors disengaged, distant, and disinterested in the counseling profession and individual
sessions (Simmons et al., 2024). Counselors practicing in this manner shed a negative light on
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the growing profession, as clients can catch on to the feelings of impairment from the
counselor. Additionally, the level of care that counselors offer when at an impaired status opens
the door for ethical practice issues. It is crucial for counselors to guard against impairment and
provide best practice for their clients.
Ethical Implications of Impairment
When impairment is left untreated and unacknowledged, it can lead to ethical
misconduct. Potential client harm is one of the most notable side effects of counselor
impairment. The ACA Code of Ethics (2014) addresses this as fundamental principle of ethical
behavior, naming it nonmaleficence- avoiding actions that cause harm (p. 3). For example, it
could cause harm to the client for the counselor to have traumatic countertransference. If the
counselor is struggling with their own trauma, they are unable to accurately aid a client in
processing theirs. The counselor may also impose their own feelings and beliefs about their own
trauma on the client, even when situations are not relevant.
Unfortunately, the frequency of ethical violations in the field of counseling is rather high.
This is particularly true in my state. A 20-year cumulative ethical violation study by Cowan, Cole,
and Gilette (2019) found that of the ethical violations, the slight majority were committed by
males. Additionally, 92.1 percent of all offenders were Licensed Professional Counselors (Cowan
et al., 2019). Of the 105 cases studied, 147 ethical violations were found, most of which
involved having sexual and romantic relationships with clients (Cowan et al., 2019). The second
most common ethical violation was found to be failure to complete continuing education
among female counselors (Cowan et al., 2019). The third ranking for most common violations
was tied for legal arrest and dual relationships (Cowan et al., 2019).
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This study aligns with the findings in my state currently. Most of the cases of ethical
violations are due to having sexual and romantic relationships with clients (Virginia Department
of Health Professions, 2023). The state of Virginia also still sees a surplus of cases involving
failure to complete continuing education, making it the second most documented ethical
violation (VDHP, 2023). The recommended hours for the state of Virginia is 20 hours. Numerous
cases reported having those hours, but further audits showed differently (VDHP,
2023).
Impairment Prevention
While professional impairment is an issue that can affect any professional, there are
ways to protect against impairment. The ACA Code of Ethics (2014) requires that counselors
“monitor themselves for signs of impairment […] and refrain from offering or providing
professional services when impaired” (p. 9, section C.2.g.). This means that when a counselor
realizes, whether by self or by other’s recognition, that they are struggling with impairment,
they should take time away from counseling to refocus on wellness. The counselor should seek
assistance when the impairment is at a professional level (ACA, 2014, p. 9). This should all be
done with the goal of preventing harm to the clients that are being served.
The main goal of well-being is to attain and then maintain wellness throughout all areas
of life. Wellness is a multifaceted status, and it is critical for counselors to make all factors of
wellness a priority. These include intellectual, emotional, physical, occupational, social, and
spiritual aspects of one’s life (Simmons et al., 2024). When one wellness practice falls out of
balance, the rest are at risk of doing the same. For example, if the spiritual wellness is lacking,
the emotional and social aspects may also get weaker.
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The most important thing a counselor can do to promote wellness and prevent
impairment is to establish a plan of self-care, including goals (Simmons et al., 2024). These goals
can be organized using the acronym, S.M.A.R.T., which stands for specific, measurable,
achievable, relevant, and time bound (Simmons et al., 2024). Setting specific goals allows for
clear direction. When a goal is measurable, it means the individual knows what it will take to
achieve it. That falls right in line with achievable; it must be practical and doable. Relevance is
important in goal setting because if the goal isn’t relevant then the importance of it can get lost.
And finally, individuals should know how much time it will take to accomplish the goal
(Simmons et al., 2024).
Wellness Assessment
The wellness assessments were very informative for me. These assessments consisted of
the stress test, self-care assessment, life balance assessment, and scale of perceived social
support. These are all areas of importance when considering professional impairment and
wellness. All the assessments help me pinpoint areas that I could improve.
The first assessment is the Life Change Index Scale, or the stress test. My end score was
266, which was higher than I thought it would be. This qualified me to be 50 percent likely to
have an illness in the near future. The two categories that I scored the highest on were the
change in the health of a family member and having a pregnancy in the last year. My father-in-
law was just recently diagnosed with congestive heart failure, which we have tried to remain
optimistic about. However, it is a hard truth given the family history of heart problems. Also, my
third child was born 10 months ago. She is my third child in three years, which I know has
caused stress not only on my body, but also my family. I am so blessed to have my children.
They decisions that have accompanied their existence, though, have created stress mentally,
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financially, emotionally, and maritally. Almost all the rest of the events that I marked scores for
in the assessment are due to the children. For example, having a mortgage. When everything is
put together, I can see how the stress score is so high.
The second assessment is the Self-Care Assessment Worksheet. This was a little bit more
difficult for me to complete. There is not an overall or final score, but rather the assessment
requires that one item from each category is chosen to be worked on. In the case of physical
selfcare, I can definitely do better. Having all my children so young makes it hard to take care of
myself physically. This has been a particularly difficult adjustment as I was a year-round athlete
through high school and college. Therefore, the area I decided I need to work on is getting
general exercise. Under psychological self-care, I need to work on saying no to extra
responsibilities. I am a self-acknowledged people pleaser. When people ask me to oversee or
participate in something, I often say yes without even thinking about it. I find myself
overcommitted quite often. Emotional self-care is a category that I have been working on
recently. I struggled with postpartum depression and anxiety after my first child was born. It
wasn’t until I received counseling a year later that I realized what I was battling. Ever since then,
I don’t laugh like I used to. It is an area of my life that I want to be very proactive in changing.
This falls right in line with spiritual self-care. The more I can cherish optimism and hope, the
more likely my life is to be full of joy. The final section, workplace or professional self-care, was
difficult to apply to my current life. I have been a stay-at-home mom for four years now so
things like taking a break during the workday or taking time to chat with co-workers are not
applicable.
The Multidimensional Scale of Perceived Social Support did not offer surprising results.
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Ultimately, my support from my husband rated the highest. He is always there to support me,
encourage me, and comfort me. Next rated was my family. While my in-laws do not show the
level of support that my personal family does, they are both more than willing to try to help and
support me. Understandably, the social support with my friends was rated third. Getting
married, having kids, and moving to a new town in the middle of nowhere has caused a
distance in my closest friendships. We still check in with each other every couple of weeks or
months, but the relationship is not as close as it once was. A large part of that is due to the
difference in life stages.
The fourth and final test was Assessing Your Life Balance. This assessment was by far the
most difficult of them all. The scale of zero to one hundred made it difficult to pinpoint an
accurate number. Even still, I found that the side of the wheel that encompassed physical and
financial had the lowest scores. That does not surprise me. As previously mentioned, my
physical well-being is not where I would like for it to be. Additionally, my husband I own a small
business with two brick and mortar stores. Initially, he was responsible for all finances- personal
and business. I have recently taken over the finances, though, as it was too much on my
husband to run the store fronts and employees, order all products, and manage the finances. I
am only about a month into the endeavor, so I have a long way to go and a lot to learn, but I am
confident and optimistic about turning our financial status around. The highest scored sections
were social and spiritual. I have a great relationship with people in my community that support
and encourage me on a weekly basis. Also, being the children’s pastor at my church has forced
me to have a deeper relationship with my Lord. I spend time every week to write a lesson and
plan games. That time has allowed me to grow in my knowledge of who He is.
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Personal Wellness Plan
I feel like there are areas of my life that I am doing well in, but there are areas that could
use improvements. Most notably, my physical well-being could be better. I understand that
physical well-being affects so much more than just personal appearance. Physical well-being is
more than just eating healthy and working out. It also encompasses things like taking breaks
from work, getting massages or going to the chiropractor, and getting enough sleep. In
accordance with my personal wellness plan, I will strive to take more time to enhance my
physical well-being. One way I can do this is to transfer my infant to her own crib instead of my
bed, which will ensure more restful sleep. Also, I will schedule time into my day to partake in an
exercise regimen. I recognize that I need to start slow to prevent injury. I also need to find a
workout that I can do with my children present. Finally, I need to reinstate regular visits with my
chiropractor.
The other area of my well-being that could be improved upon is my financial well-being.
My husband and I have learned a lot with owning our own businesses. There have been
moments of success and moments of failure. Ultimately, he is overwhelmed and cannot keep up
with what bills are due when. We have decided as a team that I will gain control of the finances,
including paying all bills, employees, and monitoring spending habits. I have hired a financial
expert to develop a program for me and teach me how to use it. Once my family’s finances are
organized and under control, I feel like everything else will feel more manageable. Of course,
this will take time. As soon as the program is completed and I am trained in operating it, I will
begin improving our financial well-being.
I could afford to give less attention to the social aspect of my well-being. While it is
important to have social engagements, sometimes I get stressed with the volume that I am
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involved in. Moving forward, I need to learn that it is okay to say no to people. It is okay not to
be at every community event, to be involved in all the groups, or to take the kids to fun things
every weekend. Moderation of social engagements would allow more time for the areas of my
life that need more attention.
Conclusion
Counselor impairment and wellness are the cornerstone of a healthy professional career.
A counselor must first take care of themselves in order to be able to take care of others.
Impairment can come in many forms including burnout, compassion fatigue, and secondary
trauma. Practicing while impaired can lead to ethical dilemmas and, in turn, action by the state
board. In order to prevent impairment, it is important to practice a wholistic wellbeing lifestyle,
monitor yourself regularly, and make a self-care plan.
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References
2014 ACA Code of ethics. American Counseling Association. (2014).
https://www.counseling.org/docs/default-source/default-document-library/ethics/
2014 aca-code-of-ethics.pdf?sfvrsn=55ab73d0_1/
Cowan, R., Cole, R., & Gilette, C. (2021). Trends in ethical violations and resulting disciplinary
actions by the Virginia Board of Counseling, 1999-2019.
Simmons, R., Lilley, S., & Kuhnley, A. K. (2024). Introduction to counseling: Integration of faith,
professional identity, and clinical practice (2nd ed.). Kendall Hunt.
Virginia Department of Health Professions. (2023, May 1).
https://www.dhp.virginia.gov/enforcement/cdecision/boardresults.asp?board=7
