Understanding Limits

As the field of psychology and other disciplines has continued to expand, opportunities to engage in multiple professional activities have also increased. At the same time, this abundance of opportunities also presents ongoing challenges requiring an understanding of personal limits. To rise above these challenges, we as professionals need to understand their limits and apply this understanding to professional situations that we encounter.

Discuss the situations in which you believe you may now be or could be less competent, situations that could require you to make a professional referral. Discuss how you would make a referral and what you would say to your client. You can create a scenario of your choice with a client in which you need to make this referral. When discussing this scenario, address (1) the background and presentation of the client, (2) your working relationship with the client to date, and (3) why the referral is essential and ethically significant in this scenario. Using the Internet, research your professional code of ethics for examples related to conflicts and the need to refer your client or case out. Your initial post should be at least 300 words in length.

HELPFUL READING:
How does professional competence impact the provision of human services?
McNamara (1975) defines professional competence as the delivery of quality services by use of professional knowledge, skills, and abilities. In the social services, basic levels of competence were created as a means to ensure no harm would come to clients by human service providers. In addition to harming clients, incompetence also harms the helping professions in general, as the public can lose trust in the field.
Overholser and Fine (1990) describe five types of professional incompetence:
* Incompetence Due to Lack of Knowledge
* Incompetence Due to Inadequate Clinical Skills
* Incompetence Due to Deficient Technical Skills (inability to use specialized assessment instruments, etc.)
* Incompetence Due to Poor Judgment
* Incompetence Due to Disturbing Interpersonal Attributes (personality characteristics, social skills, and emotional problems)
Significant legal and ethical consequences can- and have- occurred as a result of human service professionals’ incompetency. Even well-meaning professionals can cause harm to clients as a result of practicing beyond their expertise.
While practicing within the scope of one’s expertise may seem easy at first glance, there are questions to consider. For example:
* How does a professional know he/she is not competent if there exist no standard assessments for competence beyond the requirements of licensure?
* Does the professional possess the self-awareness necessary to acknowledge lack of expertise in a given area?
* How does a new professional with no experience become competent unless he/she works in areas not known to him/her?
* Is competency less of an issue for seasoned professionals when compared to professionals new to the field?
For a thought-provoking read on this topic, consider the issues presented by Frederic Reamer in his article:
The Limits of Professional Competence https://www.socialworktoday.com/news/eoe_041410.shtml
Most ethical codes describe options a practitioner can take when confronted with a case outside of the scope of his/her expertise. One possibility is to refer the client to a more appropriate provider. This occurs often in private practice because other options are limited. Another approach is to consult closely with an expert in the problem area while continuing to provide effective services to the client. In community-based settings, clinical supervisors often prefer to use the experience as an opportunity for professional growth. In these cases, the professional continues working with the client while the supervisor closely monitors the case and provides skilled advice.
Continuing education can also assist in preventing competency-related ethical breaches. Many organizations have guidelines for the education and training of its employees. Most state licensing boards also require continuing education for license renewal. Of note, professional development is meant to be a life-long activity. Competence at the beginning of one’s career does not equate to a lifetime of competence. As Corey, Schneider-Corey and Callanan (2007) state:
We also see the development of competence as an ongoing process, not a goal that counselors can ever finally attain. The process involves a willingness to continually question whether you are doing your work as well as you might and to search for ways of becoming a more effective person and therapist. (p. 360)
Finally, don’t forget what was stated in the first guidance of the course: while ethical codes of conduct vary depending on the specific profession, it is important to note that one concept exists among them all: first and foremost, do no harm to the client. Remembering this concept will help guide you as you consider issues in your own practice that relate to professional competence.
This week, I’d also like to highlight the issue of competence.Competence, like a lot of terms, means something different as used in the vernacular than in professional circles For many people, describing someone as “competent” is, to paraphrase Alexander Pope, to “damn with faint praise”; it’s meant to express minimal adequacy. Thus, I often have students asserting they aren’t/won’t settle for being “competent” when competence has to do with having mastered essential knowledge and skills. This is also the dictionary definition – competence is the ability to do something thoroughly and well.
Of course, we see the same type of issue in regards to other terms. No doubt you remember studying Erikson’s young adult stage, which highlights the challenge of intimacy vs. isolation. You may also have had one or more classmates who were under the unfortunate misimpression that intimacy = sexual relationships. This is not what intimacy means in psychology, just as being “barely adequate” is not what competent means!
Competencies are those essential skill sets and knowledge bases that are part of a job or profession. This week, you are challenged to reflect on how your personal experiences impact various aspects of professional competence, or will impact them. Note: everyone has a personal history and that history helps form each of us. If you practice psychotherapy, who you are is part of your tool kit. Thus, we cannot pretend that our experiences have no impact whatsoever on who we are as professionals; instead, we must cultivate mindful awareness, wise insight and ongoing formation so that the “who we are” is helpful to the clients who seek our assistance.
For example, speaking for myself, my life experiences include: being the oldest child (a female) in a large family; being a parent; being in a long marriage; being of a particular ethnicity and religious background; having particular health challenges; being strongly introverted; childhood experiences of being bullied. These are not unique, and they are not requirements for being a therapist…but they are part of the “who” that I bring into the therapy room. I must be aware of my particular insights, sensitivities, etc., in regard to these as they come up against not just different but also very similar factors in my clients.
Freud developed the term “countertransference” to describe the situation in which the therapist’s issues were triggered by the client. Countertransference is a problem if we are blind to its influence on our actions and reactions; it is a helpful tool if, for example, my sense of frustration is triggered by a client who cannot see how unfair it might be to constantly put her 8-year-old daughter into the position of “assistant parent” over children ages 7, 5 and 4, and I realize that my empathy for the child must be framed with empathy for the overworked, stressed parent whose beloved spouse is deployed in a dangerous situation. Of course – I am a military mom whose beloved child was in very dangerous situations, and in that case my empathy for the parent must be acknowledged and worked within the framework of the whole family. You can see, I hope, how reacting without insight to my personal history and its effect could be harmful, but tapping into it can be a real gift in bridging understanding. On the other hand- there is often a tendency in new therapists to jump to “I understand because I had the same situation,” when in fact each situation is unique. Thus we can tentatively offer reflections on the meaning of the situation without turning it into an “all about me, too” episode.
Challenge for the week: what one aspect of your history seems to create reflexive “me, too!” responses in you among friends, acquaintances, coworkers, etc.? How well do you moderate your “me, too!” to stop, listen, and ask respectful questions to enhance your understanding of the other before launching into something about you?

References
Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Thomson.
McNamara, J. R. (1975). An assessment proposal for determining the competence of professional psychologists. Professional Psychology, 6, 135– 139.
Overholser, J. C., & Fine, M. A. (1990). Defining the boundaries of professional competence: Managing subtle cases of clinical incompetence. Professional Psychology: Research and Practice, 21(6), 462-469.

REQUIRED REFERENCES (PICK OF CHOICE TO USE IN DISCUSSION) ONLY PICK 2:
Anderson, A., Barenberg, L., & Tremblay, P. R. (2006). Professional ethics in interdisciplinary collaboratives: Zeal, paternalism and mandated reporting. Clinical Law Review, 13. 659-718.

Ashley, G. C., & Reiter-Palmon, R. (2012, September). Self-awareness and the evolution of leaders: The need for a better measure of self-awareness. Journal of Behavioral and Applied Management, 14(1), 2-17.

Caldwell, C. (2009). Identity, self-awareness, and self-deception: Ethical implications for leaders and organizations. Journal of Business Ethics, 90, 393-406

Hunter, S. T. (2012, April). (Un)ethical leadership and identity: What did we learn and where do we go from here? Journal of Business Ethics, 107(1), 79-87.

Johnson, W. B., Barnett, J. E., Elman, N. S., Forrest, L., & Kaslow, N. J. (2012, October). The competent community: Toward a vital reformulation of professional ethics. American Psychologist, 67(7), 557-566.