This article was originally published in CBT Today magazine, February 2026 issue.
In this series we consider ethical dilemmas and concerns that come up in CBT and think about how we might respond to them. These articles are intended to stimulate reflection and discussion, without necessarily providing a definitive answer.
Thank you to members who have contacted us to ask questions and share dilemmas they face. We will include some of these as anonymised examples in future editions.
As CBT psychotherapists, wellbeing practitioners, researchers, teachers and supervisors and related practitioners, we are expected to hold ourselves to high standards of conduct. This means to protect the public, act in the best interests of our clients and uphold the reputation of the profession.
In many situations, it can be very clear how to act in accordance with ethical principles. In this column, we look at issues that have come up for our members – perhaps where it seems that ethical principles may conflict with each other, or where it may not be obvious how to apply them in the circumstances. We also consider themes from complaints that have been brought about members – or where decisions made by our members have been questioned on professional or ethical grounds. There are some questions to reflection at the end of the article.
Part 2: What do I do if I am worried about a colleague’s fitness to practice? What concerns might come up, and what should I do?
The situation
A senior Psychological Wellbeing Practitioner (PWP) working in a large primary care team has noticed that their CBT therapist colleague seems to be working more and more hours. There is a high level of demand, pressure on the service, and there is a reorganisation in progress. The CBT therapist seems to be overwhelmed, tired, ‘distant’ and not their usual self.
The PWP hasn’t noticed any mistakes, it’s more that the colleague seems to have stopped showing their usual ‘warmth’, compassion and enthusiasm for their work, while at the same time seeming to be increasingly busy, distracted and intolerant of being interrupted. Sometimes their clinical sessions overrun. They have made one or two comments in the staff kitchen that are more cynical than usual, and have been implying that their job satisfaction is really low without stating it openly.
The PWP has had a conversation in confidence with their case management supervisor, as they have started to wonder if the CBT therapist is okay. They wondered if they have the psychological resources to carry on like this, as it doesn’t seem healthy. They are concerned for their colleague’s wellbeing.
The case management supervisor has asked whether they should be concerned about the wellbeing of clients, too. The PWP does not want to make anything worse, ‘tell tales’ or cause trouble for a valued colleague who may just be going through a bad patch – but they aren’t completely sure. They do think that the therapist is showing reduced empathy and compassion – although not enough to cause harm. Their concentration doesn’t seem to be the same – perhaps they are working longer hours because they are not as efficient as usual.
In Part One, published in CBT Today, November 2025, we explored how to ensure and support our own fitness to practice, and the same principles apply to concerns about colleagues, too. While our first responsibility is focused on ‘do no harm’, we can refer to codes of practice, employer policies or similar guidance to help inform decisions about whether we need to raise a concern. If the matter is likely to lead to harm, it should always be reported.
Our Standards of Conduct Performance and Ethics state: ‘When we say someone is ‘fit to practise’, we mean that they have the skills, knowledge, character and health to practise safely and effectively within your scope of practice.’
If the therapist’s ability to deliver patient care or make appropriate clinical judgements may be impaired, or their decision-making may fall below our standards then there is a fitness to practice concern.
In the previous article, signs of ‘burnout’, over-using alcohol or other substances, making mistakes or over-stepping boundaries were all mentioned as potential areas where fitness to practice is compromised. Prolonged over-working can make it more likely that feelings of being ineffective, or loss of confidence can develop. Anxiety or depression could also occur, in addition to being exhausted and being more vulnerable to physical health problems.
Specifically in our field, there may be increased vulnerability to vicarious trauma or intrusive imagery if the therapist’s resources are depleted and they are not able to process the material they encounter in sessions effectively.
How can we know if a colleague’s fitness to practice may be impaired and what actions should we take?
Using our Standards of Conduct, Performance and Ethics to reflect, put them into context and guide next steps, considering how to put those standards into
practice in this situation. Taking the step of seeking advice as soon as possible – as in this example – is appropriate.
- In this scenario, it is not clear that harm is occurring. There are clear concerns about the therapist’s wellbeing, which should prompt actions to check if they are okay. It is uncertain whether harm could occur to a client. If it is possible to have a conversation with the therapist about how they are, sharing those concerns, it could be a useful prompt for the therapist to take this to supervision and seek other sources of support – and at least to reflect on how they are doing and decide whether actions are needed.
- It may be difficult to do this if the person we’re concerned about is someone in a leadership position, such as a supervisor or manager themselves. Finding a different trusted colleague who may be better placed to approach them about it could be a helpful step if needed. Ultimately if there is a concern, it is better to raise it than avoid it, to ensure that the person does receive support if they need it – and primarily to protect clients from possible harm if we do not act. The workplace as a whole may decide to review how they support practitioners and prevent burnout, ensuring that therapists delivering care really are enabled to do good work and are not expected to compromise their wellbeing to keep up with demands.
- In other contexts, the options may be different. If the therapist showing signs of burnout is a sole practitioner in independent practice, policies will be different from a large NHS service, for example. It would be just as possible to approach them directly and express concern for their wellbeing and check that they are taking actions to care for themselves – and that they are being open in supervision too. Conversations of this kind may lead to considering options for self-practice/self-reflection, as well as exploring opportunities for peer support with other similar practitioners, or special interest groups to belong to, which ensure a lone practitioner isn’t isolated from professional support and contact.
- Doing no harm is still the key principle. If there has been a potential effect on patient safety, or other concern about meeting professional and care standards, a report should be made. This can be to the agency/employer if there is one, and to BABCP (and other regulatory bodies if applicable).
As mentioned in part one of these two articles exploring fitness to practice, BABCP has a commitment to protect the public, and individual members have a responsibility to act in the best interests of patients. This is based on ethical principles of beneficence and non-maleficence. Addressing fitness to practice concerns is not intended to be about punishing people, but rather about making sure that we do meet standards well enough to practice safely. This means taking into account the therapist’s competence, knowledge, character and health.
- If you were in this situation, what steps would you take next?
- As a peer or trusted colleague, how would you respond if this was brought to you for your advice?
- Are there actions we can take as clinical supervisors to pay attention to areas where we tend to be less focused, or to ensure that therapists feel safe to bring difficult concerns or dilemmas openly to supervision?
- Evaluating – is there anything else to learn from this situation?
- Does anyone in this scenario need more training or other professional development to help in the future?
- Ensuring that our workplaces have systems in place to support practitioners doing their work can help to support fitness to practice, reduce burnout, and enhance the service we provide to our clients. Our forthcoming guidance for services providing CBT will give an opportunity for self-audit and reflection for further reading.
To share your thoughts and reflections about this, or to ask an ethical question for a future issue – contact communications@babcp.com with ‘CBT Today – Ethics’ in the subject line
Further reading and reference:
Kingdon D, Maguire N, Stalmeisters D, & Townend M (2017). CBT Values and Ethics. Sage Publishing
Ethical decision-making in practice (Kingdon et al 2015)
- When we are putting values and ethics into practice, there are some considerations that help with making an informed decision
- Identifying the issue, and reflecting on whose problem it is- considering who we owe an obligation or alliance to in the situation concerned
- Putting it into context-
- are there laws, organisational policies or ethical codes which apply in this situation?
- If this situation involves a client, what do I understand about their values?
- Reasoning – what ethical theories and principles can be used to help with this decision?
- Who can I consult with? – Clinical supervisor, or senior member of my team, my professional body- other?
- Processing and reflecting the information gathered so far – using discretion and judgement to consider the most appropriate options
- Deciding – making a decision which has a rationale, and is sensible and justifiable
- Evaluating – is there anything to learn from this situation? Can I or my colleagues do more to ensure that situations like this are resolved helpfully? Does anyone including me need more training or other professional development to help in the future?
