Addressing professional competence problems in trainees: Some ethical considerations.

Psychologists working as graduate student educators and clinical supervisors often encounter trainees who manifest problems of professional competence. At times, faculty members and supervisors may experience role conflict, ambiguity, and anxiety about how to respond to trainee competence problems. Psychologists engaged in the education, training, and credentialing of trainees are ethically and professionally obligated to balance their developmental and gatekeeping roles with respect to trainees. A discussion of several systemic concerns related to psychology's approach to competence problems is presented along with 3 expert commentaries that further elucidate the core issues from the vantage point of education, training, and licensure. Several recommendations for enhancing cooperation and excellent practice among psychologists who train and credential are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology in extremis: Preventing problems of professional competence in dangerous practice settings.

[Correction Notice: An erratum for this article was reported in Vol 42(2) of Professional Psychology: Research and Practice (see record 2011-08009-001). The title and authors for the first section of the article, beginning of the first column on page 95, were inadvertently omitted. The section should have begun with the following: “In Extremis Practice: Ensuring Competence During and After Deployment to a Combat Zone,” by W. Brad Johnson and Shannon J. Johnson.] When a psychologist provides services in a dangerous context—a work setting defined by persistent threat to the psychologist's own personal safety and well-being—the psychologist is said to practice in extremis. Psychologists who routinely function in extremis, such as those in correctional, disaster response, military, and police psychology—among other specialties—may be at increased risk for troubling experiences such as direct or vicarious traumatization, compassion fatigue, and empathy failure. Over time, in extremis experiences may contribute to decrements in professional competence. When psychologists become aware of personal problems that interfere with their work, they must take steps to ameliorate the problem while protecting consumers. In this Focus on Ethics, we discuss the difficulty inherent in self-identifying and correcting problems of professional competence when working in a high-threat environment. Three expert commentaries further elucidate in extremis competency concerns from the perspective of disaster response, police, and military psychology. The authors provide numerous recommendations for helping psychologists to ensure ongoing competence in in extremis jobs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychologists' competence to treat lesbian, gay and bisexual clients: State of the field and strategies for improvement.

Recognizing research which suggests that many practicing psychologists enter the field without training or with inadequate training in the knowledge, skills, and awareness needed to treat lesbian, gay, and bisexual (LGB) clients, the authors in this Focus on Ethics provide suggestions for psychologists seeking competence with this population. In the lead article, Lyons fleshes out the contours of competent practice, presents the current state of psychologist competence, and calls for greater levels of competence. Next, Bieschke and Dendy respond by applying the Ethical Acculturation Model to describe the question of competence for those who may come from cultures not condoning of an LGB affirmative stance. Worthington provides hypotheses for the current rates of competence in the field and encourages the use of evidenced-based training and practice to increase competence. Finally, Georgemiller confirms the role of practicing psychologists who are heterosexual allies and identifies resources for gaining competence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life-long learning for psychologists: Current status and a vision for the future.

As a profession we are committed to maintaining and enhancing our competence as psychologists in order to most effectively serve the public throughout our careers. While this is a widely shared commitment among psychologists, there is considerably less consensus regarding how best to accomplish this goal. This dilemma is examined from the ethical, educational and legal perspectives. The American Psychological Association (APA) Ethics Code clearly articulates that competence is an ethical duty, although there is little guidance provided in the code as to how to meet this standard. As a profession we have tended to focus on the construct of life-long learning and we have incorporated this principle into our education and training standards. In fact, APA accreditation requires that doctoral programs inculcate this value into our foundational training. The majority of Psychology Licensing Boards have addressed this issue through the endorsement of mandatory continuing education requirements that primarily focus on hours and the content or structure of approved programs. Potential limitations to our ability to effectively self-assess our professional training needs are discussed and several innovative models are presented for integrating effective self-assessment and continuing education. Three invited experts provide commentaries that further explore the challenges and dilemmas posed by the ethical, legal and professional duty to maintain and enhance competence throughout our professional careers. These commentaries broaden the considerations, provide practical suggestions from other professions and provide a vision for the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology in extremis: Preventing problems of professional competence in dangerous practice settings: Correction to Johnson et al. (2011).

Reports an error in Psychology in extremis: Preventing problems of professional competence in dangerous practice settings by W. Brad Johnson, Shannon J. Johnson, Glenn R. Sullivan, Bruce Bongar, Laurence Miller and Morgan T. Sammons (Professional Psychology: Research and Practice, 2011[Feb], Vol 42[1], 94-104). The title and authors for the first section of the article, beginning of the first column on page 95, were inadvertently omitted. The section should have begun with the following: “In Extremis Practice: Ensuring Competence During and After Deployment to a Combat Zone,” by W. Brad Johnson and Shannon J. Johnson. (The following abstract of the original article appeared in record 2011-04544-013.) When a psychologist provides services in a dangerous context—a work setting defined by persistent threat to the psychologist's own personal safety and well-being—the psychologist is said to practice in extremis. Psychologists who routinely function in extremis, such as those in correctional, disaster response, military, and police psychology—among other specialties—may be at increased risk for troubling experiences such as direct or vicarious traumatization, compassion fatigue, and empathy failure. Over time, in extremis experiences may contribute to decrements in professional competence. When psychologists become aware of personal problems that interfere with their work, they must take steps to ameliorate the problem while protecting consumers. In this Focus on Ethics, we discuss the difficulty inherent in self-identifying and correcting problems of professional competence when working in a high-threat environment. Three expert commentaries further elucidate in extremis competency concerns from the perspective of disaster response, police, and military psychology. The authors provide numerous recommendations for helping psychologists to ensure ongoing competence in in extremis jobs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Preventing problems of professional competence in the face of life-threatening illness.

When a psychologist is diagnosed with a serious medical condition and faces the prospect of an arduous treatment regimen and perhaps a bleak prognosis, it may be difficult to attend to one's level of professional competence. Like their clients, psychologists are vulnerable to distress and diminished functioning caused by a life-threatening illness. Psychologists have an ethical responsibility to monitor and ensure professional competence, yet the distress and distraction that accompany serious health problems can inhibit and undermine self-assessments of competence in many ways; distressed psychologists may react with denial, shame, fear, and problematic countertransference responses. The limitations associated with evaluating competence in the context of distress are discussed and several recommendations are offered for psychologists who deliver services, support gravely ill colleagues, and serve in credentialing and regulatory capacities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Striving for competence in the assessment of competence: Psychology's professional education and credentialing journey of public accountability.

The history of psychology's development as a licensed profession is traced over the past 60 years through the evolution of the profession's quality control practices in education and credentialing. These two essential features of a profession began at about the same time, but evolved quite independent of one another for the first 30 years. Shaped by events of the 1970s and 1980s, however, there has been a gradual convergence of focus by those responsible for professional education and credentialing on how best to assess the quality of professional education programs and their graduates who apply for licensure. Although at first this focus was predominantly on the content of curriculum taught and the knowledge examined, increasingly over the past decade there has been a shift of emphasis to the broader, more complex construct of competence to practice for which examination of knowledge is a necessary but insufficient assessment. The article describes the events and structures that led to this outcome and concludes with comments about the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confidentiality, ethics, and informed consent.

Comments on the article Protecting confidentiality rights: The need for an ethical practice model by Mary Alice Fisher (see record 2007-19520-001). In Fisher's excellent and much-needed article, she rightly implied that when discussing ethical dilemmas, psychologists may find themselves saying "consult an attorney" almost as often as they find themselves saying, "consult a fellow psychologist." Fisher's article was meant to turn the ship so to speak, by providing psychologists with a foundation for thinking clearly about confidentiality issues--a foundation that does not use legal arguments as primary building blocks. The above being said, we offer comments about four issues that we hope will add to the fine ideas expressed by Fisher. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promoting emotional competence in children and adolescents: Implications for school psychologists.

This article articulates the central role school psychologists can play in enhancing the emotional competence of students. An overview of the theoretical basis of emotional competence is provided, as well as an exploration of the relevance of emotional competence for positive youth development. Emerging applications for the assessment of emotional competence are presented. In addition, school-based methods of enhancing emotional competence are offered. The article concludes with suggestions for future research on the development of child and adolescent emotional competence in the context of school-related behavior. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Observations on the retirement of professional psychologists.

If you are interested in eventual retirement, this article discusses some issues that you may wish to consider. For example, a variety of ethical, legal, professional, business, clinical, and personal considerations are critical when a psychologist decides to retire and close a practice. When these diverse considerations are approached sensitively and are well resolved, the best interests of clients are emphasized, and optimally, they will cope more adequately with their psychologist's retirement. Managing these considerations effectively will also enhance the psychologist's move into retirement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Juvenile competence to stand trial evaluations: A survey of current practices and test usage among psychologists.

What is the current standard of practice for evaluations of juvenile competence to stand trial (JCST)? The present study surveyed psychologists regarding the practices used when conducting JCST evaluations. Respondents rated the importance of 17 elements that might be included in a JCST evaluation report. Of these elements, 7 were considered essential by 70% or more of respondents, with 9 additional elements rated as either essential or recommended. A majority of respondents felt that the use of psychological and forensic instruments was important. A list of tests used is provided, and the implications for the development of standards and policy are discussed to provide practitioners with additional knowledge that will help to further the state of the discipline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical competence for practicing psychologists: Clearly a work in progress.

Competence is an issue of vital importance for all practicing psychologists, and each spends his or her career seeking to develop it, achieve it, maintain it, and enhance it. But just what is competence, how is it best achieved, what are the factors that may adversely impact it, and what are each psychologist's ethical obligations with regard to clinical competence? These and other relevant questions are addressed for psychologists individually, for those who train them, and for those in the profession who establish professional standards. The article and 3 invited expert commentaries address these issues and make practical recommendations for action that will assist psychologists, trainers, and the profession to better achieve the ideal of competence so that they may best be able to meet the needs of those they serve. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology trainees with competence problems: From individual to ecological conceptualizations.

[Correction Notice: An erratum for this article was reported in Vol 3(1) of Training and Education in Professional Psychology (see record 2009-01388-008). The order of authorship was printed incorrectly, both in the issue Table of Contents and in the article. The correct order of authorship for this article is: Linda Forrest, Nancy S. Elman, and David S. Shen Miller.] Problems with professional competence or impairment in psychology have been viewed almost exclusively as residing within the individual trainee or psychologist, with limited attention to the contexts in which such difficulties are embedded. The authors propose an ecological perspective (Bronfenbrenner, 1979, 1989, 1995) to capture the influence of multiple factors that affect trainee development and provide a stronger base from which to conceptualize and address problems of professional competence. The authors describe Bronfenbrenner's ecological model and use it as a framework to understand professional competence problems, recommend best practices for prevention and intervention, and suggest future research directions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Challenges to the assessment of competence and competencies.

Challenges to the assessment of competence and competencies in professional psychology are discussed in this article. These include difficulties in defining competencies in precise and measurable terms; reaching agreement within the profession about the key elements of each competence domain; establishing an armamentarium of tools for assessing all components of competence, including the knowledge base, skills, and attitudes (and their integration); determining appropriate agreed-upon minimal levels of competence for individuals at different levels of professional development and when "competence problems" exist for individuals; assuring the fidelity of competency assessments; and establishing mechanisms for providing effective evaluative feedback and remediation. But even if these challenges can be met, perhaps the single biggest obstacle would be convincing those who are skeptical of the value of the culture shift toward the implementation of comprehensive competence assessments across the professional life span. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical competence in psychotherapy termination.

The termination of an active psychotherapy relationship can be a very complex process. It calls for a blending of clinical, practical, and ethical factors that become the foundation for the required level of reasonable professional conduct in this area. Competence in termination requires that the psychotherapist first have a strong foundation in ethics and second understand how to apply the ethical principles and standards in unique and varied clinical settings. In this article, we highlight the necessary foundational competence in ethical knowledge and link this knowledge to practical steps as a general guide for functional competence in psychotherapy termination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trainees' experiences with peers having competence problems: A national survey.

Trainees with problems of professional competence (TPPC) are a significant phenomenon in psychology education and training. Although most faculty and students are able to identify at least one TPPC over a 5-year period (Forrest, Elman, Gizara, & Vacha-Haase, 1999), investigations have typically focused on trainers; trainees' perspectives are relatively unexplored. We used survey research to assess perspectives on TPPC from 321 trainees in counseling, clinical, school, and combined psychology programs from masters' through predoctoral internship training levels. Questions targeted (a) training on TPPC and awareness of program policies, (b) general beliefs about faculty/supervisor/peer awareness and action related to TPPC, (c) specific experience with TPPC, (d) characteristics of the experience with a TPPC, (e) impact of program dynamics, (f) faculty/supervisor/peer actions with specific TPPC instances, (g) making a decision to take action, (h) personal and systemic impact of taking action, and (i) not taking action. Results revealed that 44% of students were aware of a TPPC. Participants were confident that trainers were aware of TPPC, yet less certain that trainers would address TPPC. Similarly, participants held more confidence that their peers were aware of TPPC than they were that peers would take action. Although more than half of participants reported taking action, a majority did not draw on their training when doing so. Common action strategies included consulting with faculty/supervisors and peers, venting with peers, or approaching the TPPC. Implications for training are discussed, including attention to training related to TPPC and understanding faculty and student roles. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The legal exosystem: Risk management in addressing student competence problems in professional psychology training.

This article provides a lawyer's perspective on the issues raised when a training program decides that a trainee is not doing competent work and action must be taken. It serves as a companion piece to Forrest, Elman, Miller (2008) and Wester, Fowell, Fouad, Santiago-Rivera (2008). Potential legal claims of disappointed trainees and best practices to reduce legal risk are reviewed. Risk management advice is generally congruent with other exosystems affecting training programs, such as the accreditation and ethics standards applicable to training in professional psychology, as well as model policies adopted by the Council of Chairs of Training Councils. These recommended practices serve to minimize legal risk, but also promote fairness and program integrity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarifying confidentiality with the ethical practice model.

Replies to comments (see record 2008-14338-012) on the author's original article Protecting confidentiality rights: The need for an ethical practice model (see record 2007-19520-001). The important issues raised by Pipes, Blevens, and Kluck illustrate the complications that can arise in discussing confidentiality and making decisions about it: First, they noted that the term client consent is used by psychologists to mean two quite different things about confidentiality: (a) acknowledgement of its limits and (b) consent to disclose specific information. Second, Pipes et al made several comments about laws, one of which referred to Behnke's (2004) "doors" model. Third, Pipes et al elicited my personal thoughts about the current APA Ethics Code (APA, 2002). Finally, Pipes et al expect the ethical practice model to be used in psychology training programs. The current author hopes it will provide the next generation of psychologists with a clear ethical framework for considering confidentiality issues. Meanwhile, as in this exchange, it can facilitate conversation among colleagues not only about ethical and legal questions but also about cultural issues, personal values, and professional standards that affect our approach to confidentiality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fostering a Culture Shift: Assessment of Competence in the Education and Careers of Professional Psychologists.

What is professional competence and how should it be assessed? Professionalism in psychology requires the habitual and judicious use of knowledge and skills as well as ongoing assessment. The authors synthesize discussions of the Assessment of Competence Workgroup that met during the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology. The workgroup discussed how to establish a culture of competence and elaborated principles and considerations necessary for the development of methods to assess competence. Principles identified include maintaining a developmental perspective, practicing multicultural sensitivity, and conducting formative and summative, career-long assessment. Recommendations are offered that support a "culture shift" from the current levels of competence assessment to an embracing of continual assessment of professional knowledge and skills over the life span. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Basic and advanced competence in collaborating with clergy.

Some of the stories of psychologists and clergy working together have happy endings, and some do not. Twenty psychologists and clergy who work together well were interviewed, and 94 clergy (53% response rate) and 145 psychologists (76% response rate) were surveyed. A 2-tiered schema for working well with clergy is proposed. Basic collaborative qualifications, such as respect for clergy and communication with clergy as needed, should be considered minimal competence for all professional psychologists. Additional qualifications, such as awareness of religious spirituality and shared values, are necessary for more advanced forms of collaboration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)