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    14 Ansichten13 Seiten

    Koocher Cap 4

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    Koralys Bonilla
    Koocher Cap 4

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    4 Knowing Thyself Understanding Competence and Credentials ‘There is nothing more dangerous than ignorance Contents (CONCEPTUAL ISSUES St rds of Practice tecting Incompetence ‘TRAINING ISSUES Campetence by Degrees? “The Doctoral Vers Mi PypD. Vesus PRD. Johann Wolfgang von Goethe Ingredients of the Poychology Human Services Graduate Program Postgraduate Transformations ‘The Student in Transition Student Evaluations ‘The Incompetent Institution Primary Credentials Secondary Credential ING ISSUES stands asa warning to they have mastered ‘MAINTAINING PERSONAL COMPETENCE, Continuing Profesional Education [NEW PRACTICE DOMAINS Beyond Competence lege: Paychology Versus Payehiaty ‘THE SICK DOCTOR Bumout ‘The Troubled Mental Health Profesional ‘THE CLIENT WHO DOES NOT IMPROVE. MENTAL HEALTH PROFESSIONALS AS "TEACHERS AND RESEARCHERS SUMMARY GUIDELINES References ‘one’s motives and relationships insight not easily taught and never perfected, et count among the most critical to func: ming as an ethical mental health profesional Tt will become evident that competence related issues perade many chepter. in this book. Competence issues nostic assessment and testing ae speci dressed in Chapter 9. Sin sof Chapters and 6 The focus of his matters of general competence and and relates chiefly to the personal de- velopment and profesional behavior of the of incompe- tentor troubled mental health professionals, itis Jmpottant to understand basic ethical problems associated with training, credentialing, and ‘competence at the postgraduate i as recognizing problem ips when they develop portance ofrecogni competence and th es (Clark & Abel CONCEPTUAL ISSUES High-quality profesional practice demands two very different types of competencies: intellectual ‘appropriate treatment for a part problem, Most important, possessing intellectual competence means recognizing what one does not know. For example, vast experience in treating middle-class American Causeasian li ents does not necessarily ta sion of race, ethnicity, and psychotherapy in Knowing Thysel Chapter 5). This does not mean that € strive to recognize all fences and seek to acqu my knowledge needed to teat such clien tively or make appropriate referrals, Emotional competence refers to th ifficult work that is psychotherapy Sonne, & Greene, range of sehal ‘therapists can compete ‘of client or with all kinds of probl 2006; Haldeman, 2006; N. D. Hanser 2006; Koocher, 2003; Maxie, phenson, 2006; Sue, 1998). Recogaiz acknowledging this fact does not cons sign of weakness. Quite the contrary. E fortunately, many mental be have long struggled with the p 3g profesional competence an ‘many forms. They include the developt ‘ethics codes, standards of practice or 1 sidelines -payer quality 2s: rogram, state licensing or certification (Packard, Simon, & Vaughn, 2006), an \competent professional tnely enforce sanctions tence, those that lead to fling forma plaints, are often the only ones that com attention of licensing boards and ethie mttees. Partof the diulty relates toa presumption of competence, much ai dictum that one is “innocent un guilty.” Obtaining a eos wna det 72 _tthies in Psychology and the Mental Health Professions hhas been clusive both health and mental health petence when investigators must func constraints of due process and the need to ac- ‘cumulate substantial evidence. Standards of Practice From the perspective of professional compe: tene, we recoguze that prfecton isso be standard. Rather, we expect each practitioner to function as a“good enough therapist, by peers who understand the standards of care ‘expected in the contest ofeach case. The Ameri- cean Psychological Asociation (APA) and many other profesional groups have promulgated documents that represent significant and com: prehensive attempt to codify both general stan dards of practice and guidance in special ‘These range fiom conducting psychotherapy or th special popula (eg, record keeping or oblaining cons general, such documents help to define mini forcement weight unless some type of form complaint or lawsuit ensues. Nevertheles, ‘we recommend actively seeking out whatever {guidelines or standards apply to your work and becoming familiar with them as a best prac- tice for ensuring professional com perspective of profesional cussed in Chapter 17.) One illustration of confus proficiency, or particular the practice of psychology cal, counseling, industrial school psychology have traditionally bee ognized as specialties, but there are certainly ‘many special areas of expertise within each of these h selection. A cli psychologi in psychotherapy and assessment -may lack the forensic knowledge to evahute a defendant's competence to stand Wal. And, a counseling paychologist with many years of experience asa psychotherapist to adults may be untain work wth children. What constitutes the 4ualifcation needed to practice personnel sullaton, forensic evaluations, ot child payeho- therapy? Are these specialties orsubspecialies or simply special types of competence, profien- rental health professions her attorney asked whether he would tesiy in support of her having custody of her 7-yearold child. Despite having na forensic t rience, Dr. Klutzkind agreed an stand offered many opinions about (of the woman and her € filed an ethical comp! first edition of the Wechsler Adult Intelligence Scale (WAIS), House-Tree-Person drawings, and the Bender Motor Gestalt Test. She has never and has no knowledge of designed for use in neu- 1d perceptual se- ‘She accepted the referral and tested the /and-tre” techniques she learned decades earlier, In these three cases, the practitioners have failed to recognize the boundaries of theit re- spective formal taining, While we acknowledge that no uniform professional standards now exist to define expertise in family therapy or forensic practice across professions and jutisdictions, Dr. Klutakind and Ms. Hasty lacked even the mit ‘mum levels of competence one should reason- ably possess. Dr. Klutzkind’s lack of knowledge about forensic practice and failure to recognize the deficiency led hie ethically astray, Pethaps his concern fo 1 paties in the case APA's ethics code ind other extant profesional he seems unaware. In Hasty’s we can not say for certain whether she ac- anyone. No one would k of training under lesa formal om Dr. Bellu, who trained in an era that pre- dated most of no longer current or adequate. We ean no whether De. Bellum even has a elue reg the evolution in the Feld snce completing her doctoral training some 40 vears ava. Both Drs. 1 vaguely defined construct Knowing Thysel Bellum and Klutzkind also appear ign constraints on functioning nesses, (See Chapter 17 fo a full diseut If no formal standards exist for many types of practice or techniques, therapi ‘exercise prudence and take a conserva res widely regs ‘experts on the particular matters at han« colleagues can offer wise guidance regat acy of training or of current practi rs. An important trend in profesiona training and secre tencies. The Ass doctoral and nt the field in these (htipiwew.appicong/) provides many reports that have broad. generalizable ‘many different professional development much of the training of mental heal fessionals. Attendees at the conferer ‘cussed professional development as to professional fun« posed 2 definition of at focused on two elements: interp functioning and thinking like a psych mentors and pe ‘This approach generalizes across the health professions and caries implicat both trainingand lifelong practices ofthe wal educators wory that d termal degree programs 1 74 Ethics in Psychology and the Mental Health Professions Detecting Incompetence Ethics codes enjoin us to avoid practicing be- yond our areas of competence; however, such rately, complaints by someone. As we saw in Chapter 3, expulsion from a professional orga- nization will not necessarily intereupt the prac- offender. They may simply practice ining a professional association. If a licensing board revokes the practitioner’ license, Can incompetence be detected car? A par ticularly intereing study by Peterson and Diy 980) examined competence by reviewing ap. als of 126 doctor of prychology students by “high Je the mast common charac Tack of 2 tating scale composed ofthe 28 most commonly wsed tess to cvalate students the subsequent year, fou factors emerged as central tothe concept alization of competence: oriented supe qj Avariety ofcontrover ‘The data also suggested that behaviorlly ave somewhat les weight to warmth in evaluating competence than did «eclectic or psychodynamically oriented super Another problem to keep in mind when con- ing the conceptalization and detection of competence involves understanding the range 3 variability of skill among mental health pro- fessionals, whether they work oF consultants Hogan made the point well vwotk onthe regulation of psychotherapist, he noted the substantial discrepancy between ade quate and superior competence. Within each sensed mental health profesio there will be some who just barely pasied the aa ‘Lake Woebegone (Altman, wot everyone can be “above average.” cceptional competence is certainly de- ical to practice in an area competence is simply “ade- quate," assuming we know what adequate ‘means (APA: 2.01-2.06) and have correctly es tablished that threshold ‘TRAINING ISSUES ound the taining of mental health prac ‘or acquire new skills should they wish to become human service providers. A variety of confer: ‘ences addressing such issues for psychology as a ‘prove most appropriate for modern practitioners, Rather, we are concerned about ethical issues in the conduct of traning. Are practitioners ade- «quately tained for the jobs Hey intend to per foo? Are the techniques used to train thems tically defensible? Are students evalvated in an cthiclly appropriate manner Is the institution providing the taining competent to do. so? “These comprise the substantive ethical problems linked to the taining of all mental health pro fesionals Competence by Degrees? In the feds oflaw and medicine, the ent practice degrees in the United States are «,as the JD. and MD, respectvl Using psychology as our example, we find historical diversi. In addition to the PhD, EAD, Poy.D, MA, and MS. degrees, py. chologists have historically listed a number of other eamed degrees in reporting their quai cations for recagition ling uate EdS. (Edu- DMH._ (Doctor of Mental ctor of Theology}, D-Min, (Doctor of Ministy); M.Ed. (Master of Educa tion); and MSSS. sought recogni. Inet, 1978): American, ‘ment, general studies, guidance counseling, health and physical education, home and these departments in which degrees were granted are even more diverse. In Part, this variety sprang from the fat that many state laws at one time recognized degrees in ted field” asa qual- for psychology licensing. Since the 1990s. highly successful efforts an a , more than 75% ofall prese Knowing Thysel approved on the time legislation w. are often termed grandparenting provis Aefinition, these professional ccan retain thy they could not q citera, Medicine also has some interesting tions in degrees and training subtleties t] ld Doctor of Osteopathy the United Kingdom, medical 5 yearsand a Bachelor of Medicine and Surgery, abbreviated as MBChB. or someti BM. for Bachelor of Medicine, No r degree, however, involves significant trai by general. A forme the American Psychiatric Associa that general physicians, not psychiatrist: , 2006). In addition, typical medi dents have had only six to eight weeks of fewer psychi ‘employment or fll their p ing traditional psychotherapy. cut on # more remunerative psychop 76 Ethics in Psychology and the Mental Health Professions are avarded each year in psychology, leading to Tongyrecognized potential identity crises for those who do not continue study to the doctoral level (Moses, 1990). Unlike doctoral programs, the ‘Association of State and Provincial P= chology Boa the Examination forthe Professional Practice of Psychology, EPP?) doctoralevel vensing candidates consistently 994), is mean that holders of doctoral ways more compet professional tasks than holders of entry to advanced practi also license 1 The PsyD. degree frst began. couraged a move Doctor of Physi and advance practice fof Science in Nussing or From an ethical perspective, three key issues independent of degree or taining program apply: + accurately representing one’s training and + adhering to the et applicable to degre and experience do not qualify for wse ofthat ttle) Psy.D. Versus Ph.D. 1976). Some psychologists that a PhD. degree was credential for determi too generic a schol nation of who ought to be recognized as health service provider in psychology (Shapivo & Wig- gins, 1994). They suggested that a Doctor yD. degree) should identify service provider in psy far as to recommend that Poy.D. degrees be awarded retroactively, in much the same manner as the J.D. degree was awarded to attorneys who had earned LLB. ‘Many professions that once considered the ‘master’s degree as the top clinical practice credential in their field have begun to imitate the Psy.D. degree, Physical therapy has en- In psychology large numberof profesional schools have evolved, some offering both Psy.D. and Ph.D. options. While some profesional schools of psychology exist within university systems, other are freestanding entities, and etary (eg, owned by investo 35 apposed to standing as nonprofit educational Taformation on schools ofeing the Pyy:D. degree can be found at the Web ste forthe National Council of Schools and Pro grams of Profesional Psychol ‘esp info/). The key to id of respect i bodies for exch profession that have ‘eared recognition by the U.S, Department of Education through its Council on Higher Edu- cation Accreditation _(htp://www.chea.org), For psychology, this would be the APA's Office yee progam in any of the mental health fields should readily advise applicants of important dats relevant to ac- creditation, graduation rates, internship and job placement rates, licensing exam pass rates for firsttime attempters, and similar data, Whi no single datum ance of competence, the types of information noted here do offer an indication of the degree to which any given prog iuces gradu ates who succeed in the tages of their Ingredients of the Psychology Human Services Graduate Program Prychology provides a useful example regarding hhow a training program is configured at the doctoral level. Recognizing that psychologists who act as human service prac Knowing Thyseh chological practitioners, Ci dress the following: gical, cognitive-afective, ans of behavior story and systems of psychology psychological measurement and of data analysis tific foundations of practice child, working with 2 geriatric client, 0 ing to administer projective personal following experience in seve placements ai ‘ments behind them, Other program believe that students who may have see iay qualify for some jobs and + an MSW. plus years of exp ‘may stand as the prezequisite for an indep ization, oF child protect work and not as psychothera ‘may focus heavily on psychotherapeutie - fe in treating pal is not necessarily bad as long as gradu: ‘main aware of their competence and tions. ‘The recent graduate of a doctor gram who recognizes a training. inad: for a part 78 Ethics in Psychology and the Mental Health Professions developmental psychology to become a health se shifts are occasional vices provider. permitted by g¢ discussed in the fll Postgraduate Transformations ‘The APA poli lopted by its Council of Re- presentatves holds that simply completing in- ip or appli cient for the professional preferable that ‘programmatic, sequential, and ea {ored program, as opposed to a loose: training such inc times choose 2 “backdoor” route, seeking in- ternships George Grownup, Ph.D, completed 2 {degree in clinical psychology ftom a program fully accredited by the APA, He took all ks about developmental psychology and child ‘weatment. cian whose attempt to pr with children is glaringly superficial. His ap- broach certainly exceeds his trained compe tencies, although he does not seem to realize i Although 2 regulatory board may never catch him unle conduct rem: Case 4-5: Dee Vella Pmental, Ph.D., completed her degree in human development within a psy= psychotherapy, withthe types of patients she has been studying. Dr. Prental volunteers moe than a dozen hours per week for 3 years at a local teaching hospital with an APA-approved intern- ship program. She sees patients under close su- pervision while also attending didactic seminars and taking courses in personality assessment at a local university. Dr. Pmental has better traning to wotk with children than does Dr. Grownup, but techni- cally she has not sought form cautious than Dr. Grownup in attempting to censure her competence in the activities she tice. Although her behavi clinician from another profession, Case 4-6: Metz Morphosis, MSW, completed her field placements asa medical sccal worker ata hospital. She became experienced in 238 par of the training program. Ms. Morphosis recognized that her educa tion and training had not prepared her for anew area of practice she hoped to enter. She sought appropriate training opportunity that ww her to develop the skills she seeks in a pathway recognized by her profession ‘The Student in Transition ‘Students in psychology are obligated to abide by ethical prin are other psychologists individuals seeking shift in profesional ident find themselves caught in a perplexing bind 2s they attempt a professional transition. Consider the following case example aren Quandary, MS.W., has 4 years of experience ional Psy- chology. Ms. Quandary acknowledges that she ddoesnothotd a psychology license, although shes a “psychology graduate student” fied with the profession by becoming a stud _member of APA. At he same time, she trained in psychotherapy through her social work degree program. She holdsa license to practice as a social worker. While she does not qualiy for licensing as ® psychologist, and thus cannot practice as aps cholo indertake psychodiagnostic A person with two valid professional identities hhas no obligation to surrender one while devel- ‘oping the second. As long at Ms, Quandary does not lead the public or her cients to belive that she isa psychologist, and as long as she practices within her areas of soci has not behaved unethi Ms. Quandaty can not consider herself to be a psy hol announce herself as one to the te professional he meets appro and statutory standards forth Knowing Thyse sional titles and professional functions f ‘one has appropriate taining. To the ex social work ethies and psychology ethics specificity, Ms. Quandaty should alw: herself to the more stringent standard, tion, she would be wise to check with he about any special rules imposed on het dent in her particular degree progran programs places practice ions + students more stringent than the require the ethics code. 2000) points out the special respons faculty toasses the progres ofeach std to keep the students advised of these ng-term who do not function effect texpersonal spheres she im, Each program cific procedures to routinely and competence of students, ‘outcome, and delineate appropriate seq of action and alternative outcomes. The edu ld be explicit, writen, ane Case 48: Michael Mello left his urbay Coast home to attend graduate school Midwestern university. At the end of ester, he received a boeing terminated as “person: tinue in the school’s counseling program. filed ethics complaints against the dire: ining and department chair. He complain he had never previously been advised of pro Furthermore, his grades were excellent, « had heen donied die arncess 180 Ethics in Psychology and the Mental Health Professions Case 4-9: Liz Militant also traveled across the country to attend graduate schoo! in psychology: Afr 3. years in the program wi and failed. tna hurry totake anintemsh she had been accepted, Ms. Militant again tempted the exams and filed. As a result of failing ‘ice, she was terminated as a degree candidate in accordance with department regulations. Ms. ‘miltant fled an ethics cormpaint agaist several faculty members, noting thatthe grading of the ‘exams she failed was highly subjective, and other psychologists to whom she had shown her answers some faculty for her 3 years atthe school. She at uted her fllures to contamination by these factors in the subjective grading of her exams ‘These two cases had several elements in common when they came before an ethics committee at approximately the same time ‘They involved students with cultural values different from the majority of the faculty and community within which they were taining, (On inquiry by the ethics committee, it became clear that both schools lacked formal proce- ures for student grievances, and that both sto- dents were “surprised” by the efforts to dismiss them. Mello claimed to have had no warning that the program deemed him to have serious with some faculty membets but had received good evalvations foom her field placement supervisors and sais: factory or better grades in al hd known about the rule that two candidacy, she had expected to pass any case, entitled to an appeal. sand students involved criticizing the other's ly were the mare and had been, at the very st, subjected to poor communi ation by the ethics committee led to Mi being awarded a master’s degree for wark dently and to take guidance fom ment. In the end, her university re status, and she success sree, Much ofthe acts episodes iverities involved developed more specific procedures for monitoring the progress of st- dents and given them timely feedback about their perceived competence problems We address the problem of the impaired psychologist or “sick doctor" at the end of this chapter. Many of the issues discussed under that heading can also apply to sents, and it seems appropriate to highlight the iny student at this point. The students mentioned in Cases 4-8 and 4-9 did not have clear signs of any medical or psychological impairment. Con- sider the following cases from paychology and medical graduate schools: (Case 4-10: 191975, Jane Doe entered New York University’s Medical School. Prior to her admis: sion, she had a long history of emotional prab lems, including numerous involuntary hospital: zations, which she never revealed to the school. During her first year, the emotional problems and she began behaving in a atleast one alleged suicide atemptin a laboratory ‘on campus. The school encouraged her to take a leave of absence; she sought voluntary hospital zation and was released with nosis. The medical schot mission after an examining psychiatrist deemed 1e Jane Doe case is ‘A federal court inary injunction Knowing Thyse rowledge. He often provoke ish in the The faculty worried that become a risky but also would reflee fon the department and institution, smer was enrolled as a gra work at Middle State Uni case because his annoying pe ther than his academic and sentenced toa term in prison, Follow ings parole, he reapplied to complete bis degree. ight A grades and nearly com- pleted a master’s degree prior to his ares leagues (see Chapter 1 to engage in and maintain good ¢ tionships can form the basis of valid ‘mance criterion and reason for dismissin son from the workplace, described by a $ “the no asshole rule” (Sutton snd professional | i dis Emma Petuous had envolled as a graduate student at the Manhattan Sc ional Psychology, where she earned Student handbooks © ete expectations tential penalties provide good appro dealing with such inserted ther in student and faculty mailboxes. ‘Mr, Flamer and Ms. Petuous represent dis- guised cases of variable pathology. They pre- sented focal symptoms tha _ Trtemination fom the progam, as opp some lee dtc aed oe td tnaly who det roach. The rest diel ais inset, gatons can be bl dents who seem penonly unsuited tothe field sted nthe f Inhich they ar seeking sdogie overt fal but whose probleme ate mere die and tes eal dovamented ing programs. The consequences fo Case 4-13: Aroganto Obnoxia performed wel in class but earned the disdain ofis educators and department about fellow students alike. He seemed to enjoy showing by faculty members and about oth ‘off with what he sel-asuredly assumed to be his misconduct. In ane of man exams new 82 Ethics in Psychology and the Mental Health Professions Knowing Thyse the cour, Stepakof alleged that during one class, and the “educational institution” isa post office unless the licensing board in hi other organizations, inclu when students watched a group thera box in a foreign country clause that allows interven hhome (M, Hanse_ through a one-way ‘The names ofthese diploma mills—and they lient was reasonably led to believe that offer “sheepskins for sale and out of business regulaly ~can sound ‘vidual wasa genuine mental quite impressive (eg, Lawford State University, the Royal Academy of Seience and Ac, Sussex College of ‘Technology, Atlantic. Southern 199). When in doubt, cons. should look to the for guidance and require no solid decurs via the Intemet. Thus, many of clinical competence. ‘2pportunites for deception exist and consum- Only eamed degrees om regional £15 can be misled at best and harmed at worst dited universities and colleges may be that he found the thought of ing one large woman naked “really disgusting (Shen, 1996). Stepakof also complained professors were having sex with students. Depart- led to respond to her tequests for action. Instead, some faculty made 2 variety of allegations about Ms. Stepakoff and No uniform national standards exist for ac. APA members when discusing ther succeeded in having her expelled after she had (eg, Stamford University, creditation of degrees tials (APA 02: 5.01c), and that may hol been admitted to doctoral candidacy. These were Dartmuth College) are used as wel legations to convince aN is regional ac and awarded her $600,000 in com. The following commonly used terms do not Pensatory and punitive damages (Susan A. Ste- has remained alive and can come up with price equal accreditation: licensed, xecognized, au- ing or posting the degre in ‘pakoff v. University of Maryland at College Park, of the prod ber of these enterprises thorized, approved, or chartered. These terms client or member ofthe pl Robert Brown, Robert Dies, Raymond Lorion, and Barry Smith, 1996). In November 1996, the sate settled with Stepakof for $550,000 rather than ‘nay difer in legal meaning fiom state to state taken influenced by it and may have no relevant meaning a all. Many ls or bogus degree programs tion, but often by a spurious CREDENTIALING ISSUES iy. We and socalled verification loyer wants to make sure ‘Credentials presumably exist as a tang dicatorof accomplishment in a given fie for gauging the competene: sychology, there are at $100. Today, the charge can be well over $1,000 depending on how many extras are purchased its Council on Higher Edueation Accr Case 415: The outgoing and superficially (CHEA) are the bodies that recogni charming. Shammy Fake opened ig associations; for colleges of universities, i regional accrediting associa. st The Incompetent Institution owed secondary, and 1979). As one move the primary toward the tertiary level, one further and further away from the dat: relevant for predicting potential compe ‘The need to develop valid measures of evel and continued professional compete

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