This information guide is
intended for consultant psychiatrists and trainees in psychiatry
who are experiencing difficulties with their colleagues. The
information should be used as a guide only and is not a substitute
for professional advice. This leaflet does not cover dealing with
disciplinary matters or criminal behaviour (for that, please see
guide no. 7, On
Reviews, Investigations and Inquiries). Bullying is the
topic of a separate guide no. 6, On Bullying and
Relationships with colleagues
Trust is an essential component of
good interpersonal relationships. Individuals vary in their
capabilities in forming and sustaining relationships. Furthermore,
early personal experiences shape later relationships. For example,
elements of ‘sibling rivalry’ may occur in the interactions between
colleagues of similar seniority. Similarly, the relationships
between senior and junior colleagues may resemble ‘parent and
child’ relationships (Garelick & Fagin, 2004).
Individuals vary in their personal
characteristics and in their capacity for emotional
self-regulation. At work, emotions can surface such as anger,
frustration, disappointment, anxiety, fear, envy and jealousy. They
may appear as behaviours such as rudeness, impatience, obstruction,
hostility to patients or staff, or as difficulties with colleagues.
Emotions may be projected onto others, who in turn experience the
emotion through transference, ‘projective identification’ and
‘splitting’ into good and bad ‘objects’. Effective leadership and
clarity of boundaries can enhance the stability of staff
relationships within organisations (Garelick & Fagin,
During interpersonal difficulties,
colleagues may employ various defence mechanisms to cope with or
relieve stress. It is important to recognise that this may delay or
even prevent the resolution of underlying problems. The following
examples are adapted from Steinert (2008):
- Denial: makes excuses for the
person, thus fails to accept that the problem exists
- Displacement: undertakes more
clinical work, so avoids or delays investigating and tackling the
- Reaction formation: becomes angry
and frustrated, blames the other person, loses objectivity and does
not tackle the cause of the problem
- Sublimation: wants to rescue or
protect the individual, may take on more work to avoid exposing the
other person to challenges, rather than addressing the underlying
Relationships between peers
At work, many factors can lead to
difficulties between those of the same or similar grade (Garelick
& Fagin, 2004). Colleagues tend to compare their workload (e.g.
case-load, on-call duties, complexity of work), their working
environment (e.g. office, furnishings, clinics), resources (e.g.
number of skilled team members, dates of annual leave,
opportunities for training and personal development, financial
remuneration for similar work and monies for services), and support
(e.g. from local managers, tutors, trust management)
Relationships between seniors and
The ‘problem’ senior can affect
trainees in any of their senior roles as a teacher, team leader,
mentor, clinical supervisor and manager. Underlying causes can be
similar to those above and additional factors include:
- situation: working in a
dysfunctional team or organisation, the senior and/or trainee react
to the dynamics and behave badly
- personal problems: overwork,
stress at work or at home
- attitude: trainee makes an error
or fails their exams, leading to them being viewed as incompetent
- behaviour: senior is critical,
undermining and intimidating
- boundaries: senior makes sexual
advances, hurtful jokes, bullies or ridicules trainee (alone, in
presence of peers or team members)
- selfishness: senior loads trainee
with work, takes all school holidays for self, absent from the
service, so trainee lacks supervision and training (adapted from
The ‘problem’ trainee may have
problems in one or more areas of their life, which can be
long-standing or recent. They may present with ‘difficult’
behaviours or poor standards of work. It is essential to find the
underlying causes and contributing factors (National Association of
Clinical Tutors, 2008).
Trainees may have problems
- knowledge: lacks sufficient basic
medical or psychiatric knowledge
- attitude: lacks understanding of
others’ and own behaviour, lacks motivation, feels challenged, is
anxious or fearful, does not seem to enjoy psychiatry
- skills: has poor clinical
judgement, poor organisational skills, problems with time
management, poor interpersonal or technical skills
- personal life: loneliness,
relationship problems, financial difficulties, substance misuse,
emotional difficulties, and problems with mental or physical health
(adapted from Steinbert, 2008).
Health of organisations
Sometimes difficulties between
colleagues are generated by problems within organisations. The
health of organisations fundamentally affects the working
relationships within and between professional groups (Obholzer
& Roberts, 1994). Common system problems affecting staff
include having unclear standards and responsibilities, excessive
workloads, complex patients, lack of feedback or appraisal, as well
as lack of support for a particular role, for example as a teacher
How to deal with difficult
Chances of success in changing behaviours: three
First decide whether you are likely
to succeed in getting this ‘difficult colleague’ to change their
behaviour towards you by asking these questions (Houghton,
- Has this person taken an active
part in causing the problem?
- Does this person
consistently cause problems?
- Is there a
consensus that this person generally causes
If the answers are ‘yes’, Houghton
advises asking yourself what the chances are that this person will
modify their behaviour for you. The following tips may help you to
decide how to proceed.
(adapted from Garelick & Fagin, 2004)
- What is the difficulty?
- What are the issues (specific or
- Why has the problem arisen?
- Is it affecting other people?
- Is it a personal or an
organisational issue presenting as a personal one?
- Has anyone else had similar
- What was the situation before the
- What is the nature of the
relationship between the parties having difficulty (peers, senior
and junior, other)?
- What has already been tried to
resolve the situation?
- Who could you approach for advice
- What should you do if you are
being bullied or are ‘whistle-blowing’? (see the Psychiatrists
Support Service information guide no. 6, On Bullying and
Harassment and guide no. 3, On Whistle-Blowing and Passing
between colleagues (adapted from Garelick & Fagin,
- Do not avoid the issue hoping it
will go away
- Try to see the difficulty from the
other person’s viewpoint
- Have an informal chat over a cup
of coffee with a friend or with colleagues
- Share the problem with an
independent and trusted colleague
- Find time to deal with the
- Find a local supporter/mentor
- Be prepared to learn from your
A framework for the management of
trainees in difficulty is available from the National Association
of Clinical Tutors (2008). The process includes:
- assessing trigger or event (Does
this really matter and need attention? Do you need advice about
this? Who is the best person to give advice?)
- defining the problem (investigate
and collect information from several sources; keep records and
avoid reaching hasty conclusions)
- deciding whether the cause is an
individual or organisational issue, or both.
For more serious concerns
- Seek advice from the clinical and
- Consider contacting the human
- Keep records of events, contacts
and actions taken
- Obtain advice from your defence
- For advice and support on
resolving performance concerns about doctors, dentists and
pharmacists, contact the National Clinical
Further help and support
Royal College of Psychiatrists
21 Prescot Street,
London E1 8BB
Tel: 020 7245 0412
- GARELICK, G. & FAGIN, L.
(2004) Doctor to doctor: getting on with colleagues. Advances
in Psychiatric Treatment, 10, 225–232.
- GRAY, C. (1997) Dealing with
difficult bosses. BMJ Careers, 314,
- HOUGHTON, A. (2005) Personal
support 4: Helping each other deal with tricky relationships.
BMJ Careers, 331, s17.
- NATIONAL ASSOCIATION OF CLINICAL
TUTORS (2008) Managing Trainees in Difficulty. Practical Advice
for Educational and Clinical Supervisors. NACT UK
- OBHOLZER, A. & ROBERTS, V. Z.
(1994) The Unconscious at Work: Individual and Organizational
Stress in the Human Services. Routledge.
- STEINERT, Y. (2008) The ‘problem’
junior: whose problem is it? BMJ, 336,
© Royal College of Psychiatrists 2010
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