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The Royal College of Psychiatrists Improving the lives of people with mental illness

Dealing with Difficult Colleagues

To contact the Psychiatrists' Support Service please telephone: 020 7245 0412  or



This information guide is intended for consultant psychiatrists and trainees in psychiatry who are experiencing difficulties with their colleagues. This information should be used as a guide only and it is not a substitute for professional advice. This leaflet does not cover dealing with disciplinary matters or with criminal behaviour.


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, 2004).


Defence mechanisms

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 issues · 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 problems.


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) (ibid.).


Relationships between seniors and juniors

A ‘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 listed 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 and/or at home, isolation and ill health
  • attitude: trainee makes an error or fails their exams, leading to trainee being viewed as incompetent or useless
  • 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 Gray, 1997).

A ‘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, 2013).

Trainees may have problems with:

  • 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: relationship problems, financial difficulties, substance misuse, loneliness, emotional difficulties, problems with travel, fatigue, mental or physical ill 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 resources and lack of support for a particular role, for example as a teacher (Steinert, 2008). Organisation can have a culture of fault-finding, criticism and bullying.


How to deal with difficult colleagues

Chances of success in changing behaviours: three Cs

First decide whether you are likely to succeed in getting this ‘difficult colleague’ to change their behaviour towards you by asking these questions (Houghton, 2005):

  • 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 problems?

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.

Assessment (adapted from Garelick & Fagin, 2004)

  • What is the difficulty?
  • What are the issues (specific or general, type)?
  • Why has the problem arisen?
  • Is it affecting other people?
  • Is it a professional or performance issue?
  • Is it a personal or an organisational issue presenting as a personal one?
  • Has anyone else had similar difficulties?
  • What was the situation before the current difficulty?
  • 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 and support?
  • Are you being bullied or are you whistle-blowing? (see the Psychiatrist Support Service guide 6 On Bullying and Harassment, and guide 3 On Whistle-Blowing and Passing on Concerns)

The GMC has guidance on Raising and acting on concerns about patient safety (2012). Recommended reading: Understanding doctors’ performance by Cox et al (2006).

Managing difficulties between colleagues (Adapted from Garelick & Fagin, 2004)

  • Don’t 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 issues
  • Find a local supporter/mentor
  • Be prepared to learn from your mistakes.

Managing difficulties in trainees

A framework for the management of trainees in difficulty is available from the National Association of Clinical Tutors (2013). The process includes:

  • assessing trigger or event (Is patient safety affected? 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.

A framework for managing trainees in difficulty in Scotland includes 10 guiding principles, a classification system and examples of resources for remediation (Anderson et al, 2011).


For serious concerns

  • Seek advice from the clinical and medical directors
  • Consider contacting the human resources department
  • Keep records of events, contacts and actions taken
  • Obtain advice from your defence organisation
  • For advice and support on resolving performance concerns about doctors, dentists and pharmacists, contact the National Clinical Assessment Service.


The Psychiatrists Support Service

The Psychiatrists' Support Service is a free, confidential support and advice service for psychiatrists at all stages of their career who find themselves in difficulty or in need of support. The service is available during office hours Monday to Friday. To contact the service, telephone: 020 7245 0412 or email:



  • ANDERSON, F., CACHIA, P.G., MONIE, R., & CONNACHER, A.A. (2011) Supporting trainees in difficulty: a new approach for Scotland. Scottish Medical Journal, 56:72-75.
  • COX, J., KING, J., HUTCHINSON, A., MCAVOY, P., Understanding Doctors’ Performance, Radcliffe Publishing. Oxford, 2006.
  • GARELICK, G. & FAGIN, L. (2004) Doctor to doctor: getting on with colleagues. Advances in Psychiatric Treatment, 10, 225–232.
  • GMC 920120 Raising and acting on concerns about patient safety. Last accessed: 15.04.17
  • GRAY, C. (1997) Dealing with difficult bosses. BMJ Careers, 314, 2.
  • HOUGHTON, A. (2005) Personal support 4: Helping each other deal with tricky relationships. BMJ Careers, 331, s17.
  • NATIONAL ASSOCIATION OF CLINICAL TUTORS (2013) Managing Trainees in Difficulty (version 3). 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, 150–153.


Copyright: The Royal College of Psychiatrists 2017

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If you require advice and support about a particular issue then please contact the Psychiatrists' Support Service at the Royal College of Psychiatrists on 0207 245 0412 or email

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