Clinical Competency and Ethics in Psychology

By Danielle M. Dean
2010, Vol. 2 No. 10 | pg. 1/3 |

Abstract

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The American Psychological Association (APA) Ethical Principles and Code of Conduct (2002) have multiple standards on competence. These standards are particularly relevant to clinical psychologists in Illinois given the fact that under The Clinical Psychologist Licensing Act, those licensed in this state are not required to continue their after licensure. Licensed clinical psychologists will encounter many ethical dilemmas regarding competency during their careers. It is important to understand the meaning of competence and its importance in all fields of psychology. This paper discusses the APA code of as it pertains to competence, current dilemmas regarding competency in psychology, and recommendations to improve competency in clinical practice.

American Psychological Association’s Ethical Principles and Code of Conduct

Psychologists have values and these values are infused throughout their professional work (Bergin, 1991; Meara, Schimdt, & Day, 1996; Prilleltensky, 1997; Remley & Herlihy, 2007; as cited in Shiles, 2009). The purpose of an ethics code is “to reflect an explicit value system as well as clearly articulated decisional and behavioral rules” (Fisher, 2009) in which all members of the group following the code agree to adhere to. Psychologists are allowed to have personal values that may not be addressed within their code of ethics but are assumed to uphold the values that are stated within their code. The American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (APA, 2002) is the standard to which all members and student affiliates agree to comply with. The 2002 Ethics Code consists of the Introduction and Applicability Section, Preamble, General Principles, and Enforceable Standards. Many of these enforceable standards address the area of competence. These standards are as follows:

2.01 Boundaries of Competence

(a) Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.

(b) Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, , national origin, , sexual orientation, disability, , or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals, except as provided in Standard 2.02, Providing Services in Emergencies.

(c) Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.

(d) When psychologists are asked to provide services to individuals for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order to ensure that services are not denied if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation, or study.

(e) In those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect clients/patients, students, supervisees, research participants, organizational clients, and others from harm.

(f) When assuming forensic roles, psychologists are or become reasonably familiar with the judicial or administrative rules governing their roles.

2.02 Providing Services in Emergencies
In emergencies, when psychologists provide services to individuals for whom other mental health services are not available and for which psychologists have not obtained the necessary training, psychologists may provide such services in order to ensure that services are not denied. The services are discontinued as soon as the emergency has ended or appropriate services are available.

2.03 Maintaining Competence
Psychologists undertake ongoing efforts to develop and maintain their competence.

2.04 Bases for Scientific and Professional Judgments
Psychologists' work is based upon established scientific and professional knowledge of the discipline. (See also Standards 2.01e, Boundaries of Competence, and 10.01b, Informed Consent to Therapy.)

2.05 Delegation of Work to Others
Psychologists who delegate work to employees, supervisees, or research or teaching assistants or who use the services of others, such as interpreters, take reasonable steps to (1) avoid delegating such work to persons who have a multiple relationship with those being served that would likely lead to exploitation or loss of objectivity; (2) authorize only those responsibilities that such persons can be expected to perform competently on the basis of their education, training, or experience, either independently or with the level of supervision being provided; and (3) see that such persons perform these services competently. (See also Standards 2.02, Providing Services in Emergencies; 3.05, Multiple Relationships; 4.01, Maintaining Confidentiality; 9.01, Bases for Assessments; 9.02, Use of Assessments; 9.03, Informed Consent in Assessments; and 9.07, Assessment by Unqualified Persons.)

2.06 Personal Problems and Conflicts
(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.

(b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties. (See also Standard 10.10, Terminating Therapy) (APA Ethics Code, 2002).

Competence

Competence within the field of psychology is as important as any other standard and possibly more important inasmuch as the knowledge available to practicing psychologists is constantly growing and changing, making competency a lifelong goal that is never quite satisfied. There is always more to learn and the thought of knowing all there is to know is overwhelming. To aid in this attempt at competency, researchers have developed guidelines for psychologists to remain competent in their field.

Shiles (2009) states that professional competency is not a fixed construct, meaning that psychologists are either incompetent or competent. Instead she argues that competency lies on a continuum and there are many facets to competency which can be expanded through a variety of ways. There are three obligations under the 2002 APA Ethics Code in relation to Standard 2.01 (b) (Boundaries of Competence) (Fisher as cited in Shiles, 2009). The first obligation is becoming familiar with professional and scientific knowledge. Second is acquiring professional skills. Third, psychologists must know when to refer and when not to, thus recognizing when they do or do not have access to obtain the knowledge or appropriate experience required. If a psychologist does not follow these obligations, according to Fisher, they are in violation of the 2002 APA Ethics Code.

The Cube Model (Rodolfa, Bent, Eisman, Nelson, Rehm, & Richie as cited in Kerns et al., 2009) also provides three specific domains, in which any psychotherapist should retain competency during their career. The first domain is composed of foundational competencies. These are the knowledge, skills, attitudes, and values which underlie the function of psychologists. Examples of foundational competencies include graduate coursework, practicum/intern experiences, and the aspirational goals in the APA 2002 Ethics Code. Practicing psychologists should have a firm background in these competencies which is built up in the early years of their career, during graduate school, when one first learns of all the necessary foundational competencies.

The second domain of the Cube Model is functional competencies which encompasses the professional activities of psychologists. This means what does any given psychologist do on any given day? Whether it is clinical, research, educational, or administrative in nature, psychologists are required to remain competent in the specific field in which they practice.

The third domain of the Cube Model is a developmental perspective of competency. This perspective stresses the importance of continued professional growth through a process of ongoing self-reflection and reexamination of one’s competencies and efforts consistent with a commitment to continuing education. Once a psychologist finishes graduate school, receives their license, and is employed, their training does not stop. As in any scientific field, new discoveries are being made constantly and it is a psychologist’s ethical, personal, and professional responsibility to keep up with these new discoveries and utilize them whenever possible to advance the field of psychology.

Another area of competency not outlined by the Cube Model but relevant to all psychotherapists is that of ethical competency (Sporrong et al., 2007). According to Sporrong and colleagues, ethical competence at work requires the ability to integrate perception, reflection, and action, and to understand oneself as being responsible for one’s own actions. Key competencies in ethics include knowing and understanding codes of ethics, being able recognize and analyze ethical situations, and trying to resolve them. It is not enough to understand the field of psychology and its ethics code. One needs to be able to identify unethical situations and have the abilities necessary to correct them.

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