Discuss the difference between professional impairment and incompetence? In what ways do these concepts overlap? 
In response to your peers, discuss the ways the concepts are different.


 Supervisor Beware, Ethical Dangers in Supervision 

c h a p t e r
8 Professional Competence and Training
In this chapter we focus on the ethical and legal aspects of professional compe- tence and the ongoing education and training required for mental health profes- sionals. We discuss issues related to professional licensing and certification as well as approaches to continuing education.
Ability is not easy to assess, but competence is a major concern for mental health professionals. Striving for competence is a lifelong endeavor. We are called upon to devote the entire span of our careers to developing, achieving, maintain- ing, and enhancing our competence. Competence at one point in our career does not assure competence at a later time. To remain current, we must take active steps to maintain our knowledge and skills. Continuing education is particularly impor- tant in learning about emerging areas of practice.
Barnett and Johnson (2015) remind us to consider the scope of our compe- tence. Being competent in one area of counseling does not mean we are compe- tent or feel comfortable handling client concerns in other areas. It is important to accurately assess each area of our practice to ensure competence. In one study examining school counselors’ comfort and perceived competence in addressing student issues pertaining to spirituality, 80% of participants felt they needed to improve their competence level even though they said they were comfortable with these issues (Smith-Augustine, 2011). Practitioners and students can develop com- petence both as generalists and as specialists. A generalist is a practitioner who is able to work with a broad range of problems and client populations. A specialist is a worker who has developed competence in a particular area of practice such as career development, addiction counseling, eating disorders, or family therapy.
Definitions of competence center around a practitioner’s ability to perform cer- tain tasks and roles appropriately and effectively (Johnson et al., 2008). Competent practitioners have the necessary self-awareness, knowledge, skills, and abilities to provide effective services. To apply our knowledge and skills competently, we must consistently attend to our physical, emotional, mental, and spiritual well-being. As we saw in Chapter 2, self-care and wellness are basic to being able to function com- petently in our professional work and are considered ethical issues.
We give the education and training of mental health professionals special attention because of the unique ethical issues involved. Indeed, ethical issues must be considered from the very beginning, starting with admission and screening procedures for graduate programs. One key issue is the role of training programs in safeguarding the public when it becomes clear that a trainee has problems that are likely to interfere with professional functioning.
Therapist Competence: Ethical and Legal Aspects
In this section we examine therapist competence, or the skills and training required to effectively and appropriately treat clients in a specific area of practice. We discuss what competence is, how we can assess it, and what some of its ethical and legal dimensions are. We explore these questions: What ethical standards offer guidance in determining competence? What ethical issues are involved in training therapists? To what degree is professional licensing an accurate and valid measure of competence? What are the ethical responsibilities of mental health professionals to continue to upgrade their knowledge and skills?
Competence can best be considered on a continuum from incompetent to highly competent. Competence is both an ethical and a legal concept. From an ethical perspective, competence is based on the principles of beneficence and non- maleficence (Knapp, Gottlieb, & Handelsman, 2015). Ethical practitioners protect and serve their clients. Even though mental health professionals may not intend to harm clients, incompetence is often a major contributing factor in causing harm. From a legal standpoint, incompetent practitioners are vulnerable to malpractice suits.
Perspectives on Competence
We continue this discussion of competence with an overview of specific guidelines from various professional associations. They are summarized in the Ethics Codes box titled “Professional Competence.”
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Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
ETHICS CODES: Professional Competence
American Mental Health Counselors Association (2015)
Mental health counselors recognize the boundaries of their particular competencies and the limitations of their expertise. (C.1.a.)
American Association for Marriage and Family Therapy (2015)
Marriage and family therapists do not diagnose, treat, or advise on problems outside the recognized boundaries of their competencies. (3.10.)
American Psychological Association (2010)
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. (2.01.a.)
American Counseling Association (2014)
Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Whereas multicultural counseling competency is required across all counseling specialties, counselors gain knowledge, personal awareness, sensitivity, disposi- tions, and skills pertinent to being a culturally competent counselor in working with a diverse client population. (C.2.a.)
American Psychiatric Association (2013b)
A psychiatrist who regularly practices outside his or her area of professional competence should be considered unethical. Determination of professional competence should be made by peer review boards or other appropriate bodies. (2.3.)
American School Counselor Association (2016)
School counselors monitor their emotional and physical health and practice wellness to ensure optimal professional effectiveness. School counselors seek physical or mental health support when needed to ensure professional competence. (B.3.f.)
These guidelines leave several questions unanswered. What are the bound- aries of competence, and how do professionals know when they have crossed them? How can practitioners determine whether they should accept a client when their experience and training are questionable? What should be the minimal degree required for entry-level professional counseling? Counselors may need to be both generalists and specialists to be competent to practice with some client populations. Many substance abuse counselors argue that if you are licensed as a generalist, you are not qualified to work in the area of treatment of addictions. To qualify as a substance abuse counselor, the CACREP (2016) standards identify specific knowledge, skills, and practices in the following areas: foundations; con- textual dimensions, counseling, prevention, and intervention; diversity and advo- cacy; assessment; research and evaluation; and diagnosis.
Mental health professionals bear the responsibility of ensuring that we meet minimal standards of competence. Ongoing self-assessment and self-reflection are necessary throughout our careers. When unsure of our competence to provide services in a particular area of counseling practice, we consult with colleagues (Barnett & Johnson, 2015). Gathering anonymous feedback from current and for- mer clients can be beneficial in assessing the degree to which clients experienced us as competent. It is a good practice to routinely ask clients for feedback about what is working in the sessions and how they view us as their therapist. By reflecting on some positive and unhelpful interventions, counselors can make it safe for clients to share their own critiques. Routine self-assessment and an honest appraisal of our skills provide the foundation for continued growth and positive changes that will increase our competency and benefit future clients.
Assessment of Competence LO2
Assessing competence is an extremely difficult task. Some who complete a doc- toral program lack the skills or knowledge needed to carry out certain thera- peutic tasks. It is especially important for counselor trainees seeing clients as part of a practicum or internship to learn to assess their own competence. As future professionals, you need to monitor your competence and take steps to acquire the knowledge and skills required for effective practice. Kaslow and col- leagues (2007) suggest that assessment approaches are most effective when they integrate both formative and summative evaluations. Formative assessment is a developmentally informed process that provides useful feedback during one’s training and throughout one’s professional career. Summative assessment is an end point evaluation typically completed at the end of a professional program or when applying for licensure status. Together these assessments address an indi- vidual practitioner’s strengths and provide useful information for developing remedial education plans, if needed, for the person whose competence is being evaluated. Johnson and colleagues (2012) acknowledge that formative and sum- mative assessments of trainees provide rigor and efficacy, but they note some problems associated with self-assessment. Clinicians often fail to recognize their own problems with competence, and some may be reluctant to address problems of competence in colleagues even when there is evidence that these problems exist.
Johnson and colleagues (2008) contend that those who are responsible for educating and training mental health professionals are ethically and profession- ally obligated to balance their roles as advocate and mentor of trainees with their gatekeeping role. One way to manage these sometimes conflicting roles is to thor- oughly and accurately provide routine formative and summative assessment for trainees, carefully document these evaluations, and ensure that multiple profes- sionals give independent evaluations of each trainee. Training faculty are ethi- cally obligated to provide accurate, relevant, and timely feedback for all trainees throughout the program. Jacobs and colleagues (2011) address the importance of initiating difficult conversations with trainees when formative and summative feedback given to trainees has not been effective.
How do beginning counselors assess their readiness to practice indepen- dently? Is the number of supervised hours a sufficient criterion, or are other mea- sures needed? If you are unsure of your ability to provide services in a particular area of counseling practice, you should consult with colleagues. When it becomes clear that a client’s counseling needs exceed your competence, you must either develop the competence necessary to effectively treat the client or refer this client to another competent professional. The decision to refer must be made for the benefit of the client rather than for the comfort of the counselor. Self-reflection and colleague consultation are important steps in making this decision.
As a beginning counselor, if you were to refer all the clients whose problems seemed too difficult for you, it is likely that you would have few clients. You must be able to make an objective and honest assessment of how far you can safely go with clients and recognize when to refer clients to other therapists or when to seek consultations with other professionals. It is not at all unusual for even highly expe- rienced therapists to question whether they have the personal and professional abilities needed to work with some clients. Thériault and Gazzola (2005) suggest that “many therapists continue to worry about their competence despite years of experience” (p. 11) and that “questioning one’s competence is a significant aspect of being a therapist” (p. 16). It is more troubling to think of therapists who rarely question their competence. Difficulty working with some clients does not by itself imply incompetence, nor does lack of difficulty imply competence.
One way to develop or upgrade your skills is to work with colleagues or professionals who have more experience, especially when you go into new areas of practice. Seek consultation before you practice in areas where you have not received education and training, and continue to seek supervision throughout the process of developing competence in those areas. Doll (as cited in Barnett, Doll, Younggren, & Rubin, 2007) contends that practitioners must constantly build com- petence in new knowledge, skills, and practices, long after they leave their training programs. Doll notes that when therapists extend the boundaries of their prac- tice, or when they branch out into an area requiring specialty competence, they should seek collegial consultation or professional supervision with acknowledged experts. Ongoing training and continuing education should be sought throughout the duration of one’s career.
New skills can be learned by attending conferences and conventions, by read- ing books and professional journal articles, by taking additional courses in areas you do not know well and in theories that you are not necessarily drawn to, and by
participating in workshops that combine didactic work with supervised practice. The feedback you receive can give you an additional resource for evaluating your readiness to undertake certain therapeutic tasks.
Making Referrals LO3
Although you may be competent in a certain area, you still may need to refer a client if the resources are limited in the setting in which you work or if the bound- aries of your professional role restrict you from effectively delivering the services your client needs. For example, a school counselor may make a referral to a mental health professional outside of the school for a student needing individual psycho- therapy. The school counselor is practicing ethically by referring the student for more intensive services because these services cannot be provided within a school context. If your work setting limits the number of counseling sessions for clients, develop a list of appropriate, qualified referral resources in your area.
The counseling process can be unpredictable at times, and you could encoun- ter situations in which the ethical path is to refer your client. For example, a school counselor was working with Quan, whose presenting problem was anxiety per- taining to academic success in college, which was within the scope of the school counselor’s training. However, after meeting with Quan a few times, the counselor sensed that this student was very depressed and learned that he had engaged in self-mutilation and other forms of self-destructive behavior. Quan’s counselor recognized that these symptoms and behaviors reflected a problem area that was outside the scope of his practice. Ethical practice required that he make a referral to another professional who was competent to treat Quan’s problems.
Possessing the expertise to effectively work with a client’s problem is one benchmark, but other circumstances can also make you wonder if a referral is in order. However, as you will recall from Chapter 3, referring a client because of a conflict with your value system is not an ethically acceptable reason for a refer- ral. Wise and her colleagues (2015) have eloquently delivered the message that attaining competence to work with a diverse public is not optional: “students do not have the option to avoid working with particular client populations or refuse to develop professional competencies because of conflicts with their attitudes, beliefs, or values” (p. 268). Linde (2016) states that if counselors lack knowledge about clients with whom they are working, they have the obligation to seek addi- tional training, consultation, or supervision to acquire the knowledge and skills to work with these clients. Linde acknowledges that it is ethical to make a referral in some situations: “If the client needs a higher level of care than the counselor can provide, then the counselor may refer the client” (p. 20).
You need to develop a framework for evaluating when to refer a client. It is imperative that you make skillful referrals when the limits of your competence are reached. Your clients deserve to understand the reason for the referral, and you will need to learn how to make this referral in such a manner that your client will be open to accepting your suggestion rather than feeling rejected or abandoned.
We hope you would not see referring a client with whom you have difficulty as a cure-all. If you are inclined to make frequent referrals, explore your reasons for being unwilling or unable to counsel these individuals. You may need to refer
yourself for further help! Most codes of ethics have a guideline pertaining to con- ditions for making a referral, such as this one from the code of ethics for social workers:
Social workers should refer clients to other professionals when the other profession- als’ specialized knowledge or expertise is needed to serve clients fully or when social workers believe that they are not being effective or making reasonable progress with clients and that additional service is required. (NASW, 2008, 2.06.a.)
The Case of Binh
binh is 45 years old and has seen a counselor at a community mental health center for six ses- sions. she suffers from periods of depression and frequently talks about how hard it is to wake up to a new day. it is very difficult for binh to express what she feels, and most of the time she sits silently during the session. the counselor decides that binh’s problems warrant long-term therapy, which he doesn’t feel competent to provide. in addition, the center has a policy of referring clients who need long-term treatment to therapists in private practice. the counselor therefore approaches binh with the suggestion of a referral:
Binh: Counselor:
Binh: Counselor:
binh, during your intake session i let you know that we are generally expected to limit the number of our sessions to six visits. today is our sixth session, and i’d like to discuss the matter of referring you to another therapist.
Well, you did say that the agency generally limits the number of visits to six, but what about exceptions? i mean, i feel as if i’ve just started with you, and i really don’t want to begin all over again with someone i don’t know or trust.
i can understand that, but you may not have to begin all over again. i could meet with the new therapist to talk about what we’ve done these past weeks.
i still don’t like the idea at all. i don’t know whether i’ll see another person if you won’t continue with me. Why can’t i stay with you?
i think you need more intensive therapy than i’m trained to offer you. as i’ve explained, i’m expected to do only short-term counseling.
intensive therapy! Do you think that my problems are that serious?
it’s not just a question of you having serious problems. i am concerned about your prolonged depressions, and we’ve talked about my concerns over your suicidal fantasies. i think it is in your best interest to see someone who is trained to work with depression.
i think you’ve worked well with me. if you won’t let me come back, then i’ll forget about counseling.
consider the ethical issues involved in binh’s case by addressing these questions:
• What do you think of the way binh’s counselor approached her? Would you have done anything differently?
• Was the counselor working beyond the scope of his practice, or was binh not very sophisti- cated about the process of therapy?
• is it possible that the counselor was not clear enough regarding the limitation of six visits? at what point would you have discussed the six session limitation with binh?
• if you were binh’s counselor and you did not think you were competent to treat her, would you agree to continue seeing her if she refused to be referred to someone else? Why or why not?
Commentary. this exchange reflects a common problem; counselors and clients often have different perspectives on termination and referral issues. it is unethical for this therapist to continue counseling binh, even though she opposes ending therapy with him. continued treatment of a client’s problem that is beyond the scope of the therapist’s competence is a serious violation of the standard of care (younggren & gottlieb, 2008). When a therapist deems termination and referral to be the appropriate course of action, to do otherwise violates the fiduciary obligation to the client and the ethics code that prohibits rendering unnecessary treatment sessions. the counselor may have a duty to terminate regardless of the perception and wishes of the client. in extreme cases termination may occur over the objections of the client, yet such objections do not make termination inappropriate (younggren et al., 2011).
how the counselor suggests the referral is critical. this counselor would have been wise to suggest a referral before the last session. With rare exceptions, a therapist should be able to determine whether he or she is competent to treat a given client by the end of the initial inter- view. the counselor should have stressed the short-term nature of the help he was qualified to provide during the informed consent process at the first session. Ultimately, it is the client’s choice whether to accept or decline a referral. if this counselor can demonstrate that a referral is in binh’s best interest, there is a greater chance that she will accept the referral. in this case, the counselor would have been wise to consider not accepting a client like binh whose prob- lems would clearly be better served on a long-term basis. •
Ethical Issues in Training Therapists
Training is a basic component of practitioner competence. You will be able to assume an active role in your training program if you have some basic knowl- edge about policy matters that affect the quality of your education and training. Although providing adequate training is primarily the responsibility of the faculty in your program, you too have a role and a responsibility to ascertain that your training will provide you with the experiences necessary to become a competent practitioner. In this section, our discussion of the central ethical and professional issues in training is organized around questions pertaining to selection of trainees and the content of training programs.
Selection of Trainees LO5
A core ethical and professional issue involves formulating policies and procedures for selecting appropriate candidates for a training program. Here are some issues that training program faculty need to consider:
• What criteria should be used for admission to training programs? • Should the selection of trainees be based solely on traditional academic stan- dards, or should it take into account factors such as personal characteristics,
character, and psychological fitness?
• Is there a good fit between the candidate and the training program? • To what degree is a candidate for training open to learning and to considering
new perspectives? • Does the candidate have problems that are likely to interfere with training and
with the practice of psychotherapy? • What are some ways to increase applications to programs by diverse groups
of candidates?
Your training program has an ethical responsibility to establish clear selection criteria, and you, as a candidate, have a right to know the nature of these criteria when you apply. Although grade-point averages, scores on the Graduate Record Examination (GRE), and letters of recommendation are often considered in the selection process, relying on these measures alone does not provide a comprehen- sive picture of you as a candidate.
As part of the screening process, ethical practice requires that candidates be given information about what will be expected of them if they enroll in the pro- gram. Just as potential therapy clients have a right to informed consent, students applying for a program have a right to know the material they will be expected to learn and the manner in which education and training will take place. In most training programs, students are expected to engage in appropriate self-disclosure and to participate in various self-growth activities. Programs should make sure that applicants understand these requirements. The language in the informed con- sent document must be unambiguous, and the criteria for successful completion of the program easily understood by all concerned.
Screening can be viewed as a two-way process. Faculty screen candidates and make decisions on whom to admit, and at the same time candidates are screening the program and faculty to decide whether this is the right program for them. As students progress in a program, some may come to the realization that the counseling profession is not for them. If you have doubts about contin- uing in a program, discuss the matter with a faculty person whom you trust. It is easy to feel overwhelmed and come to a hasty self-assessment about being unsuitable for the profession when in fact you are simply feeling discouraged at the moment.
The Case of Leo
julius is on a review committee in a graduate counseling program. Leo has taken several intro- ductory courses in the program, and he has just completed an ethics course taught by julius. it is clear to this professor that Leo has a rigid approach to human problems, particularly in areas such as interracial marriage, same-sex relationships, and abortion. Over the course of the semester, Leo appeared to be either unwilling or unable to challenge his beliefs. When challenged by other students in the class about his views, Leo responded by saying that he felt he was in a double bind. his faith gave him very clear guidelines on what is acceptable church teaching. at the same time, in this supervision class he is being asked to violate those values, so he feels conflicted no matter which decision he makes. nobody offers him a solution. if he refers a future client with whom he has value conflicts, he is behaving unethically; if he were to accept such a client, he would be violating his church’s teachings. in meeting with the committee charged with determining whether candidates should be advanced in the program,
julius expresses his strong concern about retaining Leo in the program. his colleagues share this concern.
• What reactions do you have to this case? how would you respond to Leo’s dilemma?
• Do you see any benefit to Leo expressing his values openly in his training program?
• are any other avenues open in working with Leo short of disqualifying him from the program?
• if Leo’s values reflected his cultural background, would that make a difference? Would the committee be culturally insensitive for rejecting him from the program?
• What if Leo said that when he eventually obtained his license he intended to work exclu- sively with people from his cultural and religious background? should he be denied the opportunity to pursue a degree in counseling if his career goal is to work with a specific population that shares his views and values?
• if you were on the committee, how would you handle candidates who seemed to exhibit racism, homophobia, and rigid thinking?
• are there any informed consent issues pertaining to graduate students that should be addressed in a case such as this? if so, what are they?
Commentary. Leo’s case illustrates the dilemma counselor educators sometimes face when they have serious concerns about trainees who are likely to impose their values on their future clients. ethically, the client’s problems need to be explored and resolved in a way that matches the client’s values, not the therapist’s values. Leo will be expected to help clients understand and address the concerns they bring to therapy. although Leo is not seeing clients now, he has the potential to do harm to clients if the rigidity of his value system is not challenged. Leo’s openness about his beliefs gives the faculty and his supervisors a place to begin to work with him. the greater concern is that Leo seems unwilling to examine how his beliefs might hinder his ability to work with clients who do not share his values.
educators and supervisors have several ethical obligations to students and trainees who may be impaired or incompetent. at least one faculty representative should meet with Leo to explore with him how his religious values might affect his work with clients. Leo has a right to his own values, but it would be unethical for him to impose them on clients. Leo must learn to bracket his values in sessions, and he should be given the opportunity to receive supervised practice in bracketing his values with mock clients. the faculty should document consistent and clear formative feedback to Leo as well as efforts to encourage remediation or personal development before deciding to dismiss him from the program.
educators who fail to adequately orient prospective and current students regarding expec- tations and evaluation procedures heighten the risk of conflicts with ill-informed students (barnett & johnson, 2015). Leo should have been clearly oriented to the graduate program’s expectations for students, including minimum competencies such as working with culturally different clients and avoiding the imposition or the intrusion of one’s own values. •
Content of a Program
It is important to ask questions about the content of your own training program and to seek ways to become as actively involved as possible in your own learn- ing. From an ethical perspective, counselor educators and trainers are expected to present varied theoretical positions. Training programs would do well to offer students a variety of therapeutic techniques and strategies that can be applied to a wide range of problems with a diverse clientele.
Look at your program and ask how it measures up against these questions:
• Is the curriculum inclusive of many cultures, or is it culturally biased? • What does your program tell you about imposing your values on clients? Or
about referring clients with whom you have a conflict of values? • Does the curriculum give central attention to the ethics of professional practice? • What core knowledge is being taught in your training program?
In training programs for various mental health professions, general content areas are part of the core curriculum, which are generally outlined by CACREP (2016) standards. Content areas typically required for all students in counseling programs include professional counseling orientation and ethical practice, social and cultural diversity, human growth and development, career development, counseling and helping relationships, group counseling and group work, assess- ment and testing, and research and program evaluation.
Effective training programs are designed to help you acquire a more complete understanding of yourself as well as gain theoretical knowledge and develop clin- ical skills. Ideally, you will be introduced to various content areas, will acquire a range of skills you can utilize in working with diverse clients, will learn how to apply theory to practice through supervised fieldwork experiences, will learn a great deal about yourself personally, and will develop a commitment to acquir- ing or enhancing personal wellness. A good program does more than impart knowledge and skills essential to the helping process. In a supportive and chal- lenging environment, the program will challenge you to examine your attitudes and beliefs, will encourage you to build on your life experiences and personal strengths, and will provide opportunities for expanding your awareness of self and others. An effective program also addresses the importance of self-care and emphasizes wellness throughout the program.
Although ethics is supposedly incorporated in a number of required courses, seminars, supervision, and practicum and internship experiences, we contend that the lack of systematic coverage of ethical issues will hinder students, both as train- ees and later as professionals. The topics addressed in books like this deserve a separate course as well as infusion throughout all courses and supervised field- work experiences.
Effective programs combine academic and personal learning, weave together didactic and experiential approaches, and integrate study and practice. A program structured exclusively around teaching academics does not provide important feedback to students on how they function with clients. In experiential learning and in fieldwork, problem behaviors of trainees will eventually surface and can be ameliorated. Evaluation is an important component of this process, and we turn to this topic shortly.
Training Practitioners to Work in a Digital Culture
Technology is evolving at breakneck speed and is expanding the ways counsel- ing services can be conceptualized and delivered. With the popularity of social media as a platform for communication in society, online counseling has garnered the attention of numerous researchers (e.g., Bradford & Rickwood, 2014; Glasheen
et al., 2016; Richards, 2013; Steele, Jacokes, & Stone, 2014/2015). Online counseling services are increasingly common, and counselor preparation programs need to rise to the challenge of training their students to work in a digital culture. Anthony (2015) states that the need for training in transferring face-to-face skills to the online environment has been acknowledged for a number of years by leading pro- fessional organizations as not simply desirable but also essential. Because training in this area “is a relatively young part of the profession, certainly younger than online therapy itself . . . literature on it is scarce” (p. 37). We anticipate that research in this area will continue to increase as the use of online interventions expands.
Counselors in training must become knowledgeable about the complicated ethical and legal considerations that may apply when working with clients online. Describing the complications of working online with clients who reside in other countries, Anthony (2015) points out the need for a central database that spells out what is allowed in each country; services may be unregulated in some countries and subjected to strict regulations in others. “Where once we were able to trust our knowledge of laws and ethics within our own geographical barriers as part of our core training, we are now required to know those of all the countries in the world when approached by an international client” (p. 39). Globalization is creating new challenges that future generations of counselors will have to meet, and memoriz- ing the intricacies of every country’s code of ethics and laws is a daunting task. Instead, trainees and experienced counselors alike should learn about the process of finding the relevant facts they may need to work with international clients.
Evaluating Knowledge, Skills, and Personal Functioning
As a student in a counselor education program, you have a right to know how you will be evaluated, both academically and personally. If you are aware of the evaluation criteria and procedures, you are in a better position to ask key ques- tions that can influence your degree of satisfaction and your involvement in your educational program.
Evaluation Criteria and Procedures
Every training institution has an ethical responsibility to screen candidates so the public will be protected from incompetent practitioners. Programs clearly have a dual responsibility: to honor their commitment to the students they admit and to protect future consumers who will be served by those who graduate. The crite- ria for selecting applicants to a program should be clear, and the criteria for suc- cessful completion and the specifics of the evaluation process need to be spelled out just as clearly and objectively. The criteria for dismissing a student should be equally clear and objective. Academic programs should have written policies that are available to students as part of the orientation to the program.
As a student you need to know that your knowledge and skills, clinical per- formance, and interpersonal behaviors will be evaluated at different times during
the program. Ongoing evaluation of you as a trainee is crucial to determine whether you are making satisfactory progress in the various areas of the training program (Wilkerson, 2006). In addition to assessing knowledge and skills competencies, it is of vital importance to assess personal and interpersonal competencies, such as the capacity for self-awareness and self-reflection (Orlinsky, Geller, & Norcross, 2005). Consistent with the existing research on psychotherapy outcomes, Orlinsky and colleagues state that interpersonal relatedness is a core aspect of the therapeutic process. They emphasize the personal qualities of the therapist, including the thera- pist’s emotional resonance and responsiveness, social perceptiveness, compassion, desire to help, self-understanding, and self-discipline. In our view, possessing per- sonal characteristics such as these are the foundation for professional competence.
As a student, you need feedback on your progress so you can build on your strengths or remediate problem areas. It is important that you also engage in self-evaluation to determine whether you are “right” for the program and whether the program is suitable for you. The first goal of an evaluation of candidates is to assess progress and correct problems. If shortcomings are sensitively pointed out to trainees in a timely way, they can often correct them and continue in the program.
Ideally, we would like to see each professional organization develop specific guidelines pertaining to students’ successful completion of a program: NASW for social worker students, AAMFT for students in marital and family therapy programs, APA for students in clinical and counseling psychology, and ACA for students in counselor education programs and clinical mental health counseling programs. Fac- ulty in these respective professional training programs would then have the backing of their professional association in determining the evaluation procedures to be used when decisions regarding retaining or dismissing students are made.
We strongly support the standards for performance evaluation of the ACA, NASW, and APA (see the Ethics Codes box titled “Evaluating Student Perfor- mance”). In addition to evaluating candidates when they apply to a program, we favor periodic reviews to determine whether trainees should be retained.
314 / chaPter 8 Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
ETHICS CODES: Evaluating Student Performance
American Counseling Association (2014)
Counselor educators clearly state to students, prior to and throughout the training program, the levels of competency expected, appraisal methods, and timing of evaluations for both didactic and clinical competencies. Counselor educators provide students with ongoing feed- back regarding their performance throughout the training program. (F.9.a.)
National Association of Social Workers (2008)
Social workers who have responsibility for evaluating the performance of others should fulfill such responsibility in a fair and considerate manner and on the basis of clearly stated criteria. (3.03.)
American Psychological Association (2010)
In academic and supervisory relationships, psychologists establish a timely and specific pro- cess for providing feedback to students and supervisees. Information regarding the process is provided to the student at the beginning of supervision. (7.06.a.)
Psychologists evaluate students and supervisees on the basis of their actual performance on relevant and established program requirements. (7.06.b.)
Evaluation of Interpersonal Behavior and Personal Characteristics
Your success in a counseling program and as a future counseling professional involves a great deal more that performing well academically. Who you are as a person and your ability to develop and maintain effective interpersonal relation- ships during your training program are of major importance. When you begin seeing clients in a practicum, your knowledge and helping skills as well as your ability to make connections with clients will be directly related to positive out- comes. Your interpersonal style, your ability to relate to clients, and your willing- ness to reflect on the characteristics that either help or hinder you in working with clients are key variables.
It is of the utmost importance that your faculty evaluate your professional behavior, clinical performance, and identify interpersonal behaviors and person- ality characteristics that are likely to influence your ability to effectively deliver mental health services. Evaluating trainees on the basis of personal characteristics is often a challenging task. Interpersonal behaviors of trainees have a direct bear- ing on their clinical effectiveness, so these factors must be taken into consideration in the evaluation process. According to Sofronoff, Helmes, and Pachana (2011), assessment of fitness to practice (FTP) within training programs requires balancing the rights of students to pursue their career interests with the rights of their future clients.
The faculty of each training program has a responsibility to develop clear defi- nitions and evaluation criteria for assessing the character and psychological fitness of trainees. Later in this chapter, we address some ways of evaluating students whose performance or behavior does not meet professional and ethical standards.
Scholars across disciplines are engaged in discussions about psychological fit- ness of trainees (Wilkerson, 2006), referring to this notion variously as problem stu- dents; inadequate, unsatisfactory, deficient, substandard behavior; and problematic student behaviors. Elman and Forrest (2007) recommend better terminology and clearer definitions and caution that the term impairment overlaps with a specific legal meaning in the Americans With Disabilities Act (ADA), which could create legal risks for programs. They recommend that faculty avoid using the term impair- ment to refer to trainees who are not meeting minimum standards of professional competence and instead refer to such trainees as having problems with professional competence or professional competence problems. Kress and Protivnak (2009) prefer the term problematic counseling student behaviors. They state that “problematic” focuses on student behaviors without labeling the student as incompetent or impaired. Possible problematic behaviors include poor clinical skills; poor interaction with fac- ulty, supervisors, and colleagues; inappropriate self-disclosure with clients; and fail- ure to communicate with clinical supervisors or faculty about needs and concerns.
Sometimes students have personal characteristics or problems that interfere with their ability to function effectively, yet when this is pointed out to them, they may deny the feedback they receive. The helping professions often use DSM-5 cri- teria to classify mental dysfunctions of clients yet show no such clarity in defining the mental, emotional, and personal characteristics required of students entering a training program. A program has an ethical responsibility to take action rather than simply pass on a student with serious academic or personal problems. However,
university administrators are often in favor of high graduation and completion rates and are fearful of lawsuits and may put pressure on faculty to pass students (Maureen Kenny, personal communication, September 25, 2016). Students who are manifesting emotional, behavioral, or interpersonal problems could be encour- aged to avail themselves of services at the campus counseling center. Elman and Forrest (2004) believe training programs should have written policies describing how and when personal psychotherapy might be recommended or required with respect to the remediation of a student’s problems.
Training programs need to reduce their ambivalence about involvement in personal psychotherapy when it is used for remediation. The challenge is to provide develop- mentally appropriate educational experiences for trainees in a safe learning environ- ment while protecting the public by graduating competent professionals (p. 129).
Information about remediation of a student’s interpersonal problems could be put in the student handbook and given to students at the orientation session prior to admission to the program. However, addressing these policies and pro- cedures only at the time of orientation is not sufficient. Faculty should make clear to incoming students that becoming a competent counselor involves more than acquiring knowledge and skills; a critical variable of effective counseling is the ability of trainees to establish a working alliance with their clients, which depends largely on their own personality characteristics and behavioral attributes. Ongoing discussion of these issues throughout the training program is necessary to prepare trainees for potentially difficult conversations pertaining to their own professional competence (Jacobs et al., 2011).
Letourneau (2016) describes a collaborative decision-making model for addressing problematic behaviors in counseling students. Designed to address diversity and cultural influences, students are involved in the decision-making process, which can help establish students’ trust in the process. Letourneau notes that inclusion of a student during any point of the decision-making process may foster the student’s commitment to the course of action taken and may contribute to the student’s sense of empowerment.
Systematic Procedures in Evaluation of Student Performance
As a student you have a right to be clearly informed of the procedures that will be used to evaluate your performance. A key part of the informed consent pro- cess involves learning about the policies pertaining to the roles that personal and professional development play in the program. Informed consent requires clear statements about what constitutes ground for concerns, including when and why students may be terminated from a program (Wilkerson, 2006). Brown-Rice and Furr (2013) point out that the types of problems that result in student dismissals fall into three categories: inadequate academic or clinical skill levels, psychological or personality unsuitability, and inappropriate moral character. Your faculty has an ethical responsibility to ensure that you are qualified to enter the profession of counseling after you graduate; their ultimate ethical obligation is to protect the clients with whom you will be working by effectively executing their role as gate- keepers of the profession.
Kress and Protivnak (2009) describe a systematic plan for assisting students in remediating problematic areas. Their professional development plans (PDPs) are detailed contracts that can be used to address problematic student behaviors. PDPs systematically document and address faculty expectations of students; spe- cific behaviors required of students; tasks students need to attend to; and con- sequences to students if they do not successfully address the specific tasks and engage in the required behaviors. Such concrete, simple, and explicit plans can be integrated into a program’s remediation, review, dismissal, and retention policies.
Seattle University’s Department of Counseling and School Psychology has developed an excellent form designed to assess students’ personal and professional competencies at several junctures in their program. With the permission of the fac- ulty and dean of this program, we are reproducing their assessment form, which is a good model for informing students about expectations of the program and for providing students with regular feedback on both their personal and professional development (see the box titled “Personal and Professional Competencies”).
Personal and Professional Competencies
Professional Competence and Training / 317 Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
The counseling faculty, Department of Counseling and School Psychology, College of Education, Seattle University, believes that counseling students must be able to demonstrate basic counseling skills and be knowledgeable of a variety of counseling theories. Additionally, they must be able to integrate the learned skills with their own developed philosophical and theoretical constructs. The faculty knows the role of the school counselor, mental health counselor, and post-secondary counselor to be, and, therefore, expects students to meet the Personal and Professional Competencies. Each student is assessed at candidacy, prior to internship, and at the end of each quarter of the three-quarter internship. Students are aware of the Personal and Professional Competencies when they enter the program and know that they will be evaluated as to whether or not they meet these competencies. At the end of internship, the student must have met each competency Clinical training faculty also have a responsibility to protect other graduate students in their program from those trainees who are dealing with problems of professional competency. Brown-Rice and Furr’s (2013) study involving 389 mas- ter’s students attending CACREP-accredited programs revealed that the majority (74%) of trainees were aware of classmates who were experiencing problems of professional competency and felt frustration toward faculty for failing to address these problematic peers. More than 50% of the respondents who observing class- mates with competence issues stated that “they were affected by a problematic peer or peers” (p. 227). One challenge we have found as faculty is that students may express frustration with what appears to be inaction on the part of the faculty, yet due to confidentiality issues faculty often are not permitted to share what is being done to remediate any problem behaviors with a particular student. Some- times faculty are unaware of the scope of the student’s problematic behavior or dispositions, and peers can play a role in helping to identify students who may be in need of remediation or dismissal. In some cases, the institution impedes rather than supports faculty attempts at remediation or dismissal, giving the problematic student too much power due to fear of litigation.
Historically there has been very little examination of problematic student behavior or of the evaluation and dismissal of students in professional programs, but this is now changing. With increased awareness of the damage that can be caused by mental health professionals who do not possess the personal qualities necessary for effective practice, there is an ethical imperative for training faculty to serve as gatekeepers for the profession (Johnson et al., 2008). With revisions to the ACA Code of Ethics in 2014 and recent litigation initiated by students dismissed for attitudes and behaviors in violation of ethical standards, gatekeeping has gained significant attention (Francis & Dugger, 2014), and the role of counselor educators as gatekeepers is expanding. Counselor educators have the responsibility for being culturally and developmentally sensitive in interpreting, applying, and enforcing ethics codes with counseling students (Letourneau, 2016).
Faculty cannot rely on screening procedures during the admissions process alone to identify students who do not have the necessary personality characteris- tics to become competent clinicians (Kerl, Garcia, McCullough, & Maxwell, 2002). Programs have an obligation to operationally define the personality characteris- tics that are likely to impede a student’s ability to practice effectively. In fairness to students, counseling faculty need to develop objective evaluation procedures and processes to communicate to students both their strengths and areas need- ing improvement with respect to interpersonal behavior and clinical performance. This should begin as early as possible in the program so that a timely intervention might solve the problem and help the student. If a student initiates a legal chal- lenge regarding his or her professional performance, faculty and program admin- istrators must show documentation of the student’s lack of competency (Kerl et al., 2002).
Gaubatz and Vera (2002) investigated whether formalized gatekeeping proce- dures and program-level training standards influence the rates at which problem- atic trainees are graduated from counseling programs. Their findings indicated that programs with formalized standards and procedures reduce the num- ber of deficient students it graduates. In a later study, Gaubatz and Vera (2006)
iscovered that “well-designed gatekeeping procedures appear to improve the effectiveness with which [deficient students] are identified and prevented from progressing unremediated into the counseling field” (p. 41). Although Gaubatz and Vera endorse the efforts of individual training programs to address the issue of deficient trainees, they also add that these efforts “should be integrated into the professional standards that guide the field of counselor training as a whole” (p. 41).
The Case of a Discouraged Professor
Karmella was a student at a university with a 48-unit master’s degree program in counseling. this core degree and a few additional classes qualified a graduate to apply for the licensed pro- fessional counselor examination once the required supervised internship hours were completed. Karmella was identified by the faculty as having a level of affect that indicated a complete lack of empathy. in counseling dyads, group process experiences, and classroom exercises, it became clear that Karmella was unable to make empathic connection. academically, Karmella received good grades; she completed the reading, wrote satisfactory papers, and did well on the examinations. it was in the behavioral dimension—such as reflective listening, being able to establish client rapport, and demonstrating empathic understanding—that her lack of skill was noted.
Karmella progressed through most of the graduate program and entered an intensive group process course, which was a requirement of the program. the professor in this didactic training environment noted Karmella’s barriers to building effective counseling relationships and made two or three interventions. these interventions included direct discussion with Karmella as well as referral and recommendation for personal counseling. at the end of the semester, Karmella’s behaviors and skills had not improved, and by some measures they had actually deteriorated. the grade for the group process class was the only grade Karmella needed to complete her degree program. after many hours of soul searching, the professor decided that this student should not be allowed to advance because her lack of empathic understanding and her typi- cally bizarre responses in counseling dyads made her, as a potential counseling professional, a risk to others. he gave Karmella a failing grade, which meant that Karmella would not receive her degree without successfully repeating the group process class.
Karmella responded by suing both the professor and the university. an investigation was completed at the university by the academic senate. in addition to the professor and the stu- dent, several members of the faculty and many individuals from the group process class were called as witnesses. the senate overruled the professor’s grade and awarded a master’s degree in counseling to Karmella. today she is a licensed professional counselor.
Discouraged by the lack of support from the university, the professor reduced his teaching to part time and retired at the first available opportunity. in reflecting on this case, what impli- cations can you draw?
• Was the professor justified in blocking her from a master’s degree based on her perfor- mance in this one group process course?
• Might Karmella’s lack of empathy and connection to others cause potential harm to clients?
• Does Karmella’s lack of empathy and connection necessarily imply that she is incompetent? What else might explain her behaviors?
• What criteria were used to determine her fitness?
• What are your thoughts about the actions taken by the administration?
• is it the responsibility of professional accrediting agencies to intervene in a situation such as this?
• Did other professors who had noticed Karmella’s lack of empathy have an ethical responsi- bility to address this issue with her earlier in her graduate coursework?
Commentary. the gatekeeping function continues to present many challenges to faculty in counseling programs. in addition to possible legal issues, administrative support may be lacking for a program’s decision to dismiss a student for nonacademic reasons. the welfare of future clients is paramount when evaluating students who are deemed to lack competence due to personality issues. furthermore, students need to know that they will not be endorsed by faculty before a licensing board or for employment if they demonstrate problematic behaviors. students should be advised as early as possible if their behavior is problematic, and they should be given direction and opportunities to ameliorate problem areas. When students are not made aware of concerns on the part of the faculty until later in the program, they have a legitimate complaint.
students in counselor training programs are often asked to work on their personal problems as a part of their professional development. this can expose parts of the student’s personal life that may make the student more vulnerable to negative evaluations. faculty must provide space for students’ growth, both personally and professionally, but students must be chal- lenged when their personal characteristics may cause harm to future clients. this requires effort on the part of all involved, and intervention and remediation must be tailored to the individual to be beneficial.
students should not be allowed to complete a graduate program if they do not successfully remediate personal or interpersonal problems that negatively affect their clinical performance. Karmella was unable to offer the emotional connection that many clients require to profit from therapy. in our view, the professor did the right thing in adhering to both a clear process of feedback and remediation and his obligation to serve as gatekeeper for the profession in protecting the public. When there are conflicts between ethical obligations and institutional policies (e.g., graduating incompetent students), we should make the conflict known to the institution and then stick to our ethical duties. •
Dismissing Students for Nonacademic Reasons
From our perspective, faculty who are in the business of training counselors should be credited with the ability to have accurate perceptions and observations pertaining to personality characteristics that are counterproductive to effective counseling. When a student has good grades but demonstrates substandard inter- personal behavior, action must be taken immediately. Some students may not pos- sess the emotional maturity or interpersonal skills necessary for clinical work, but they may have other skills that may be useful in our profession. We sometimes counsel students to focus on a different area of the profession, such as research or writing, if those are their strengths. Supporting students in following a path that accentuates their areas of strength can be beneficial. Dismissal from a program is a measure of last resort and should be employed only after all other attempts at remediation have failed.
Legal Deterrents to Dismissing Students
Some of the barriers to taking the action of dismissing students from a program include difficulties in giving clear evidence to support the decision to dismiss a student; the lack of adequate procedures in place to support a dismissal decision;
concern about the psychological distress for faculty and students; concern about the heightened resistance and defensiveness in the trainee; the potential for receiv- ing criticism from other faculty or supervisors who were not involved in the train- ee’s remediation; and lack of administrative support (Forrest, Elman, Gizara, & Vacha-Haase, 1999). Perhaps the major deterrent to dismissing a student is the fear of legal reprisal by that student. Bernard and Goodyear (2014) have noted that faculty in training programs traditionally have been concerned about their legal standing if they decide to dismiss a student from a program for “nonacademic” reasons. At times, both counselor educators and administrators are reluctant to dismiss students who have interpersonal or clinical skills deficits. This may be especially true if the concerns are about personal characteristics or problematic behavior, even when the faculty is in agreement regarding the lack of suitability of a given student.
If it can be demonstrated that a program failed to adequately train an indi- vidual, the university may be held responsible for the harm the graduate inflicts on clients (Custer, 1994; Kerl et al., 2002). Custer (1994) describes a lawsuit involv- ing a master’s level counselor who graduated from Louisiana Tech’s College of Education. A female therapy client filed suit against Louisiana Tech, claiming that the program allowed an incompetent practitioner to graduate from the program. The client claimed that her life had been destroyed by incompetent therapy. The claim was that the program itself was inadequate in that it simply did not ade- quately prepare her counselor. The counselor was named in the malpractice action along with her supervisor and the university. The initial lawsuit was settled in 1994 for $1.7 million. A case such as this makes it clear that specific competency standards for retaining and graduating counseling students are not only useful, but necessary.
Court Cases on Dismissing Students From a Program
Mary Hermann summarized a court case pertaining to dismissing a student for nonacademic reasons (as cited in Remley et al., 2002). In Board of Curators of the University of Missouri v. Horowitz (1978), the United States Supreme Court consid- ered a case brought by a student who had been dismissed from medical school, in spite of the fact that she had excellent grades. The decision to dismiss the student was based on the faculty’s determination that she was deficient in clinical per- formance and interpersonal relationship skills. Prior to the dismissal, on several occasions the faculty expressed dissatisfaction with the student’s clinical work and informed her that she faced dismissal if she did not exhibit clear improvement. The student continued to receive unsatisfactory evaluations on her clinical work. Prior to the student’s dismissal from medical school, she was evaluated by seven independent physicians in the community, all of whom agreed with the medical school professors that her clinical skills were unsatisfactory.
After being dropped from the program, the student filed a lawsuit claiming that her dismissal from medical school violated her constitutional rights. In review- ing the case, the Supreme Court considered that the student had been informed of the faculty’s dissatisfaction with her clinical performance, and the student knew that unless she made significant improvement in this area, she would be dismissed
from the program. The Court held that the decision to dismiss the student from medical school was based on a careful and deliberate evaluation by the faculty, and thus the student’s dismissal was not a violation of her constitutional rights.
The model described for medical students would be an excellent model for counselor education programs to adopt in dealing with a student identified as lacking the necessary qualifications to be an effective helper. Using this model, the problematic student would be evaluated both at the university and in the commu- nity, where a number of experienced practitioners would review the findings of the faculty and administration.
Kerl and colleagues (2002) describe the importance of designing systematic procedures for training programs to evaluate students’ professional performance. When dismissal from a program is based on interpersonal or clinical incompe- tence, Kerl and colleagues underscore the importance of sound systematic aca- demic evaluation and adherence to procedural and substantive due process. These authors argue that in counselor education programs the evaluation of students’ interpersonal and clinical skills is part of the overall assessment of their academic performance. They conclude that courts have consistently viewed personal char- acteristics or behaviors as basic to academic performance, which makes this an academic issue. Kerl and colleagues describe an evaluation instrument, Profes- sional Counseling Performance Evaluation (PCPE), designed by the counseling faculty at Southwest Texas State University to provide feedback to students on their progress in meeting professional standards and to document deficiencies that are serious enough to result in dismissal from the program.
The PCPE is provided to all students at admission and is discussed during program orientation. The PCPE is completed for each student in every experi- ential course. Students receive a copy of the evaluation and have an opportunity to discuss their ratings with the faculty member at the end of each course. Kerl and colleagues state that using the PCPE throughout the program has resulted in significantly fewer students finding out about their problematic behavior as they reach the end of their program and significantly fewer dismissals from the program.
Kerl and colleagues describe a legal challenge by a student who was dismissed from the counseling program at Southwest Texas State University. The student exhibited poor impulse and anger control, unethical behavior, and inadequate counseling skills. This student had received three completed PCPEs that identified significant reservations by faculty members regarding the student’s professional performance competency. Suggestions for improvement were given to the student at the time each PCPE was shared and discussed with the student. The student failed to follow through with remediation plans and filed suit against the university and the counseling program. Kerl and colleagues describe the outcome of this case:
The court ruled that the student was provided adequate due process, that the univer- sity had the obligation to uphold professional standards, that the university’s policies and procedures were enunciated in the graduate catalog and other departmental docu- ments, and that the faculty had followed these procedures. (pp. 330–331)
This court decision identified professional performance competence as an aca- demic concern. The use of the PCPE (along with the clear standards, policies, and
procedures developed by the faculty) played a key role in the court’s judgment, which ruled in favor of the university on all counts (Kerl et al., 2002).
McAdams, Foster, and Ward (2007) and McAdams and Foster (2007) describe their experience and lessons learned from a challenge in federal court when their program dismissed a counseling student on the grounds of defi- cient professional performance. The student had engaged in unethical behavior during a clinical practicum and then failed to cooperate with a remedial pro- gram implemented by the program faculty. Many systematic procedures were implemented prior to making the decision to dismiss the student, who later filed a lawsuit against the counseling program faculty and the university. One of the charges was that the program and the university violated the student’s constitutional right to due process. To the credit of this program, the faculty had designed a document detailing specific criteria for systematically evaluat- ing students in their program in their Professional Performance Review Policy Standards (PPRP).
A key strength of the program’s legal position rested in the steps the faculty took in formally documenting all the remedial actions taken in dealing with the student. In a federal jury trial, the court ruled in favor of the counseling program and the university by upholding the dismissal decision. This court case demon- strates that when counselor trainees are found to be deficient in their professional performance, training programs have a legal obligation to develop a just and fair remedial plan of action (McAdams & Foster, 2007). Although the faculty won the case, there was no sense of victory in the aftermath of a painful and long litiga- tion process that had a huge impact on both the students and the faculty in the program.
Professional Licensing and Certification
Most states have established specific requirements of supervised practice beyond the receipt of a master’s or doctoral degree for licensing and certification in areas such as clinical social work, clinical or counseling psychology, rehabilitation coun- seling, clinical mental health counseling, and couples and family therapy. In some countries, licensure and regulation do not exist and any individual can call him- or herself a counselor and establish a counseling practice. For example, Ireland has no mechanism in place to license counselors (O’Morain, McAuliffe, Conroy, Johnson, & Michel, 2012). All 50 U.S. states require licensure, but some do not have a professional scope of practice that requires an individual to be licensed prior to establishing a private practice. Prior to going into private practice, review your state’s laws regarding professional scope of practice.
Purposes of Legislative Regulation of Practice
Sweeney (1995) describes credentialing as an approach to identifying individuals by occupational group, involving at least three methods: registry, certification, and licensure. In its simplest form, registry is generally a voluntary listing of individu- als who use a title or provide a service. Registration represents the least degree of
regulation of practice. Both certification and licensure involve increased measures designed to regulate professional practices.
Although licensing and certification differ in their purposes, they have some features in common. Both require applicants to meet specific requirements in terms of education and training and acceptance from practicing professionals. Both also generally rely on tests to determine which applicants have met the standards and deserve to be granted a credential.
Certification is a voluntary attempt by a group to promote a professional iden- tity. Certification confirms that the practitioner has met a set of minimum standards established by the certification agency. Some types of certification are required for practicing in a certain setting. For example, in most states school counselors must obtain a certificate in order to practice.
Unlike certification, licensure statutes determine and govern professional practice. Licensure acts, sometimes called practice acts, specify what the holder of the license can do and what others cannot do (Remley, 1995). “Licensure is a governmentally sanctioned credential that regulates which professionals can be reimbursed legally by third-party and private payers for general counseling ser- vices” (Tarvydas, Hartley, & Gerald, 2016, p. 17).
Licensure and certification assure the public that practitioners have completed minimum educational programs, have had a certain number of hours of super- vised training, and have gone through some type of evaluation and screening. Licenses and certifications do not, and probably cannot, ensure that practition- ers will competently do what their credentials permit them to do. A degree or a license alone does not guarantee competence for rendering all psychological ser- vices to all populations. For example, clinicians need to acquire specialized knowl- edge and skills for the ethical practice of family therapy. The main advantages of licensure and certification are the protection of the public from grossly unquali- fied and untrained practitioners and the formal representation to the public that practitioners are part of an established profession. Credentialing protects coun- seling consumers by establishing the minimum standards of professional skills and knowledge (Tarvydas et al., 2016). However, there are limitations to ensur- ing competence by means of licensure, and some question whether licensure does ensure general competence, protect consumers, or promote higher standards of professional practice (Remley & Herlihy, 2016).
Licensure restricts both the use of the title and the practice of an occupa- tion. Most licenses are generic in nature; the holder of the license is assumed to have minimal competence in the general practice of counseling or clinical work. Licenses usually do not specify the clients or problems practitioners are compe- tent to work with, nor do they specify the techniques they are competent to use. For example, a licensed professional counselor may possess the expertise needed to work with adults yet lack the training necessary to work with children. The same person may be qualified to do individual psychotherapy yet have neither the experience nor the skills required for family counseling or group therapy. Most licensing regulations do specify that licensees are to engage only in those therapeutic tasks for which they have adequate training, but it is up to the licensee to put this rule into practice. Such a broad definition of practice also applies to many other professions.
Continuing Professional Education and Demonstration of Competence
Professionals are required to engage in ongoing study, education, training, and consultation in their areas of practice. A practitioner’s level of competence may diminish over time, and changes in laws pertaining to mental health, evolving ethical standards, and new trends in professional and evidence-based practices continue to be made. Most professional organizations support efforts to make continuing professional education a mandatory condition of relicensing (see the Ethics Codes box titled “Continuing Professional Education Requirements”).
Most mental health professionals are required to demonstrate, as a basis for relicensure or recertification, that they have completed a minimal number of continuing education activities. As a condition for relicensure as a social worker, psychologist, clinical mental health counselor, or a marriage and family therapist, most states require specific courses and a minimum number of hours
ETHICS CODES: Continuing Professional Education Requirements
American Counseling Association (2014)
Counselors recognize the need for continuing education to acquire and maintain a reasonable level of awareness of current scientific and professional information in their fields of activity. Counselors maintain their competence in the skills they use, are open to new procedures, and remain informed regarding best practices for working with diverse populations. (C.2.f.)
American School Counselor Association (2016)
School counselors engage in professional development and personal growth throughout their careers. Professional development includes attendance at state and national conferences and reading journal articles. School counselors regularly attend training on school counselors’ current legal and ethical responsibilities. (B.3.e.)
National Association of Social Workers (2008)
Social work administrators and supervisors should take reasonable steps to provide or arrange for continuing education and staff development for all staff for whom they are responsible. Continuing education and staff development should address current knowledge and emerging developments related to social work practice and ethics. (3.08.)
American Association for Marriage and Family Therapy (2015)
Marriage and family therapists pursue knowledge of new developments and maintain their competence in marriage and family therapy through education, training, and/or supervised experience. (3.1.)
American Mental Health Counselors Association (2015)
Mental health counselors recognize the importance of continuing education and remain open to new counseling approaches and procedures documented by peer-reviewed scientific and professional literature. (C.1.f)
American Psychiatric Association (2013b)
Psychiatrists are responsible for their own continuing education and should be mindful of the fact that theirs must be a lifetime of learning. (5.1.

of continuing professional education. The most common area of mandated continuing education is professional ethics, and 32 states currently require an ethics course as a component of continuing professional development (Taylor & Neimeyer, 2016). Licensing boards often conduct random continuing education audits of their licensees. In California, if licensees fail a continuing education audit, such as not completing the total required hours of continu- ing education within a renewal period, or not completing the law and ethics course, they are subject to a citation and a fine (California Board of Behavioral Sciences, 2017).
A Lifelong Commitment to Maintaining Competence
A commitment to lifelong learning is a common theme in the ethics codes of most mental health professions as a way to maintain and enhance competence. John- son and colleagues (2012) doubt whether a beginning mental health professional will have either the capacity or the determination to accurately assess his or her own competence across a lifetime of ever-changing job demands, life stressors, personal problems, and declining abilities due to aging. They recommend ongoing peer consultation and state that “periodic recertification of competence should become a requirement of licensure renewal” (p. 566). The focus of continuing edu- cation should be on maintaining competence, rather than simply on accumulating the required hours to maintain licensure.
To assume that our skills never deteriorate or that we know everything we need to know upon graduation is naive. Unless mental health practitioners engage in lifelong learning, their professional knowledge may decline drastically, even if they are in the early phase of their career (Neimeyer, Taylor, & Cox, 2012; Taylor & Neimeyer, 2016). A useful way to combat knowledge obsolescence and maintain competence is to be willing to consult with other professionals throughout your career, participate in peer consultation groups, engage in self-directed learning, and attend professional conferences. Learning never ceases, and new clients pres- ent new challenges. Even recent graduates may have significant gaps in their edu- cation that will require them to take workshops or courses in the future. Research in the allied health fields supports the notion that lifelong learning is a key com- ponent of professional competence, and Taylor and Neimeyer (2015) recommend that training faculty “instill a love for lifelong learning in graduate school, rein- forcing the notion that lifelong learning is an ongoing endeavor that must be con- tinued to be pursued, even after graduation” (p. 388). New areas of knowledge and practice demand ongoing education. Online classes are becoming increasingly popular because this form of continuing education delivery is convenient and eco- nomical; it is likely that online offerings will increase in years to come (Taylor & Neimeyer, 2016).
You may also need to seek supervision and consultation in working with var- ious client populations or to acquire skills in certain therapeutic modalities. For example, your job may require you to conduct groups, yet your program may not have included even one group course in the curriculum. When continuing edu- cation is tailored to your personal and professional needs, it can keep you on the cutting edge of your profession.
Clarifying Your Stance It is important to find ways to maintain and enhance your competence over the course of your career. Use the following questions to clarify your thinking on the issues we have raised. What is your own strategy for remain- ing professionally competent?
• What effects on individual practitioners do you think the trend toward increased accountability is likely to have? How might this trend affect you?
• Do you think it is ethical to continue practicing if you do not continue your education? Why or why not?
• What is the rationale for stating that maintaining competence as a lifelong endeavor?
• What are some advantages and disadvantages to using continuing education pro- grams solely as the basis for renewing a license? Is continuing education enough? • What are your reactions to competence examinations (oral and written) for entry-level applicants and as a basis for license renewal? What kinds of exami-
nations might be useful? • What are your thoughts about enhancing your knowledge via online contin-
uing education? Would you be inclined to participate in online delivery for
some continuing education? • Should evidence of continuing education be required (or simply strongly rec-
ommended) as a basis for recertification or relicensure? • If you support mandatory continuing education, who should determine the nature
of this education? What standards could be used in making this determination? • What kinds of continuing education would you want for yourself? Through what means do you think you can best acquire new knowledge and skills and
keep abreast of advances in your field?
Review, Consultation, and Supervision by Peers
Peer review is an organized system by which practitioners within a profession assess one another’s services. Peer review provides some assurance to consumers that they will receive competent services. In addition to providing peer review, colleagues can challenge each other to adopt a fresh perspective on problems they encounter in their practice. Regarded as a means rather than an end in itself, peer review has as its ultimate goal not only to determine whether a practitioner’s pro- fessional activity is adequate, but also to ensure that future services will be up to standard. Peer review continues a tradition of self-regulation.
Peer supervision provides a path to continue the transition from trainee to independent practitioner. It entails elements of support and is another useful route to enhancing professional competencies. The goal of peer supervision is to assist professionals in obtaining feedback on their professional work and functioning and to help them monitor their personal reactions to their cases (Shah & Rodolfa, 2016). Peer supervision groups are useful for counselors at all levels of experi- ence. For trainees, peer supervision groups offer a supportive atmosphere and help them learn that they are not alone with their concerns. For counselors in prac- tice, they provide an opportunity for continued professional growth. According to Shah and Rodolfa (2016), peer supervision groups provide for vicarious learning
o occur. “As peers consult with each other, provide feedback, and share experi- ences, they can take the learning with them and apply it to future professional situations when they arise” (p. 204). Counselman and Weber (2004) contend that peer supervision groups are valuable for therapists for many reasons, some of which include ongoing consultation and support for difficult cases, networking, and combating professional isolation and potential burnout. Clinicians often rec- ognize a renewed need for supervision at a later point in their careers because they want additional training, because of the emotional intensity of practicing therapy, or because of the stress associated with their professional work.